Instruction: Generate impression based on medical findings.

Input: 66-year-old female with pleuritic right-sided chest pain. 2 day history of shortness of breath, fevers and cough. Cardiomediastinal silhouette is within normal limits.Low lung volumes. No focal pulmonary consolidation or pleural effusion.No evidence of pneumothorax or obvious rib fractures.

Output: No acute cardiopulmonary abnormality without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: iabp History: iabp Aortic balloon catheter and venous catheter unchanged.No significant cardiopulmonary abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old. AM CXR. Bilateral lung transplant. Interval removal of NGT. Post-surgical findings of bilateral lung transplant.Basilar opacities consistent with edema/atelectasis and pleural effusions, unchanged.Displaced fractures of the right and left third ribs, unchanged.

Output: Interval removal of NGT. No significant change in edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: weight loss, anemia, former smoker, eval for mass or infiltrate History: weight loss, eval for mass/infiltrate The cardiomediastinal silhouette is unremarkable.Lungs are clear.No pleural effusions.Surgical clips overlying right upper thorax redemonstrated.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: chest pain; eval for PTX, infiltrate History: chest pain Blunting of costophrenic angle consistent with persistent small pleural effusions as seen on prior CT. No new opacity to suggest pneumonia. No evidence of pneumothorax.

Output: Blunting of costophrenic angle consistent with persistent small pleural effusions as seen on prior CT. No new opacity to suggest pneumonia. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: CT s/p VATs History: sob Right chest tubes in place with nonspecific opacity in the right hemithorax consistent with consolidation, atelectasis and pleural effusion.Focal atelectasis at the left base.Focal air collection medially at the right base that may be located in the pleural space or in the lung, such as a pneumatocele.

Output: Persistent atelectasis, consolidation and pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Respiratory distress. Interval removal of right jugular Swan-Ganz catheter without visible pneumothorax. Other cardiopulmonary hardware and support devices appear similar in position. Cardiomegaly. Right basal atelectasis/consolidation, about the same. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.

Output: Persistent right basal opacity suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Dyspnea and shortness of breath Right bronchial valves again observed without interval significant change in the underlying cardiopulmonary appearance. Lungs remain decreased in overall volume demonstrating largely diffuse interstitial mixed with minimal airspace opacities. Layered pleural effusions greater on the right.Right chest tube again projects into the apex with minimal retraction and a new enlarging now small to moderate apical pneumothorax. Apical measurements approximately 1 cm. Pager 1062 contacted

Output: Mild recurring right pneumothoraxPager 1062 contacted


Instruction: Generate impression based on medical findings.

Input: Stage III colorectal cancer patient. Please evaluate for metastases. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: leukocytosis r/o pneumonic process History: leukocytosis Amputated left ICD electrodes with removal of the pulse generator. Skin staples are noted at the upper abdomen with sternotomy wires well aligned.Blunting of the bilateral costophrenic angles may represent small effusions or scarring. No evidence of pneumonia or edema. Heart size is normal.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: fracture/migration of AICD lead History: fired 4 times No significant cardiopulmonary abnormality.Left subclavian single chamber ICD, tip in the RV region, appearing intact but new since the prior study.

Output: No significant abnormality. Intact appearing left subclavian ICD.


Instruction: Generate impression based on medical findings.

Input: Tuberculosis screening No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.History: Recent bilateral pneumothoraces. Right chest tube unchanged in position with minimal right chest wall subcutaneous emphysema.Interval increase in moderate right pneumothorax. No significant interval change in large left loculated pneumothorax. Stable appearance of underlying cystic lung disease.Persistent small pleural effusions.Stable cardiomediastinal silhouette.

Output: Interval increase in moderate right pneumothorax. No significant interval change in large left loculated pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? History: SOB Normal heart size with large central pulmonary arteries consistent with pulmonary hypertension.Pacemaker leads and venous catheter unchanged.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: eval for sudden onset SOB History: SOB, chest pain Pigtail drain in left upper quadrant. Lungs hypoinflated with no acute abnormality.

Output: No acute cardiopulmonary mouth.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.History of MRSA pneumonia, evaluate ETT. Endotracheal tube tip unchanged, approximately 2 cm above the carina. Portacatheter tip in the RA/SVC junction. Enteric tube tip beyond the field of view.Cardiomediastinal silhouette stable.Bilateral pleural effusions, basilar opacities, and dense left retrocardiac opacity unchanged.

Output: No significant interval change with acceptable position of endotracheal tube tip.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and dyspnea Improved aeration, however mixed interstitial and patchy airspace opacities observed in all 4 quadrants with relative sparing of the left upper lobe otherwise appears more similar. No definite effusions, however correlation with pending CT is recommended due to greater sensitivity.Cardiomediastinal contours are grossly unchanged

Output: Mild improved aeration with resolving patchy are nonspecific opacities, however chest CT is pending, please correlate


Instruction: Generate impression based on medical findings.

Input: Reason: eval for focal infiltrate History: tachycardia, chest pain, sob Normal heart size with ICD leads in place, unchanged from previous.Catheter tip in the SVC.No significant pulmonary abnormalities.

Output: No acute abnormalities. Chest


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent mild multi chamber cardiomegaly with diffuse mixed interstitial and airspace opacities in all 4 quadrants. Appearance again suggest edema, however in the absence of effusions, the appearance is nonspecificRight jugular dialysis catheter unchanged.

Output: Suspected mild edema, however serial imaging may be needed to confirm


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Shortness of breath status post chest tube removal, empyema Right-sided chest tube unchanged in position, terminating near the cardiophrenic angle. Trace right pneumothorax near the base not measurable as it is probably anteriorly located. Increased fluid in the fissure. Patchy atelectasis on the left slightly worse. Low position of right jugular catheter with tip in the right atrium. Nasogastric tube unchanged in position.

Output: Increased fluid in the fissures on the right.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Pleurx insertion evaluation Interval placement of left Pleurx catheter. Left subcutaneous emphysema noted. There is improvement in the left pleural effusion. Moderate apical left pneumothorax. Right lung appears clear. Stable appearing right subclavian port tip in the cavoatrial junction.

Output: Interval placement of Pleurx catheter with improvement in left pleural effusion. Persistent moderate left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Pneumothorax after thoracentesis on the left? Minimal lucency in the left lateral costophrenic angle consistent with a very small pneumothorax. Tubes and lines unchanged. Decreased volume of pleural fluid on the left, otherwise no acute change in cardiopulmonary

Output: Very small left pneumothorax postthoracentesis with decrease in left pleural fluid volume.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.History of liver transplant, now with shortness of breath. Right internal jugular catheter tip unchanged in position.There is stable mild cardiomegaly.No focal pulmonary opacities or large pleural effusions.Prominent gas-filled loops of bowel.

Output: Mild cardiomegaly without acute cardiopulmonary abnormality.Prominent gas-filled loops of bowel. Correlation with physical exam suggested.


Instruction: Generate impression based on medical findings.

Input: 80 years old Female. Reason: fever History: fever. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There are diffuse mild bilateral interstitial changes.. Nodular densities seen in the right upper lobe. There is deviation of the trachea to the left which is most likely due to thyromegaly.

Output: The cardiomegaly and mild interstitial changes are suspicious for CHF. Suggest clinical correlation. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Tunica vaginalis mesothelioma status post orchiectomy. Evaluate extent of disease and compare to previous.. CHEST:LUNGS AND PLEURA: New 7 x 6 mm left lingular pulmonary nodule (image 50; series 5). Given history, this should be regarded as a metastasis until proven otherwise. A small primary lung carcinoma is a second consideration although the nodule has relatively smooth margins rather than being spiculated. Biapical pleural scarring, unchanged. Right pleural thickening (image 63; series 5) stable.MEDIASTINUM AND HILA: Complex right lobe thyroid nodule is unchanged measuring 2.5 x 1.8 cm (image 16; series 3). Subcentimeter mediastinal lymph nodes unchanged.CHEST WALL: Metallic screws in right humeral head. Bilateral gynecomastia. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral small cysts are stable. RETROPERITONEUM, LYMPH NODES: Nonspecific retroperitoneal lymph nodes are unchanged. No lymphadenopathy. No nodes larger than 1 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged heterogeneous prostate gland. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Postsurgical changes in the right groin.

Output: New 7-mm left upper lobe pulmonary nodule concerning for metastatic lesion. No substantial change in right thyroid complex nodule.Findings discussed with Dr. Kindler at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Thoracoscopic wedge excision of right upper lobe nodule, thoracoscopic right upper lobectomy, mediastinal lymph node dissection follow-up. Postoperative volume loss compatible with right upper lobe wedge resection. Retro-manubrial opacity on the lateral radiograph not present previously and is without a correlating abnormality on the frontal radiograph, of unclear clinical significance. The remainder of the lungs are clear.No pleural fluid or pneumothorax.

Output: Nonspecific opacity posterior to the manubrium on the lateral radiograph only, of unclear etiology. This is most likely due to summation from overlying soft tissue however short-term follow-up PA and lateral chest radiographs are suggested for confirmation. If abnormality persists on subsequent examination, then additional recommendations may be made at that time.


Instruction: Generate impression based on medical findings.

Input: Metastatic prostate cancer and colon cancer CHEST:LUNGS AND PLEURA: Interval development of numerous bilateral lung metastases. Index left lower lobe nodule has also increased in size and now measures 15-mm in diameter image number 77, series number 5.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Interval development of new hypodense lesions in the liver. An index lesion measures 27 by 24-mm on image number 87, series number 3 consistent with metastatic disease. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Interval development of extensive bilateral para-aortic adenopathy. An index conglomeration of adenopathy in the right para-aortic space measures 29 by 26 mm on image number 128, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Ill-defined enhancing mass in the pelvis invading the prostate and rectum. There are two areas of peripherally enhancing collections on both sides of the rectum and the mass. Right-sided collection measures 5.5 x 2.5 cm. Left-sided collection measures 2.2 by 2.4-cm. These are consistent with abscesses.BLADDER: No significant abnormality notedLYMPH NODES: Interval development of extensive bilateral alterative adenopathy. Index left obturator adenopathy measures 7.1 by 2.5-cm image number 172, series number 3.BOWEL, MESENTERY: Ill-defined large mass invading the rectum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Left common femoral vein DVT,

Output: Interval development of bilateral numerous lung, liver metastases and retroperitoneal adenopathy.Interval enlargement of the previously detected mass in the pelvis with bilateral pelvic abscesses.Left common femoral vein thrombosis.Dr. o`Donnell was notified and acknowledged about these findings at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: new evidence of infxn; interval change in edema History: 1x T of >38 Lower lung zone opacities suggestive of edema and retrocardiac atelectasis are unchanged.Superimposed basilar infection is also in the differential diagnosis.No new findings.

Output: Unchanged basilar predominant opacities with atelectasis behind the heart, suggestive of edema although infection is in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Generalized weakness. Concern for cardiomegaly, pneumonia. Stable cardiomediastinal silhouette. Focal density at the left apex, may be artifact however not seen on prior.Cholecystectomy clips unchanged.

Output: Left apical focal density, suggest CT for further evaluation. Findings discussed with ER resident at 2:00 PM.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: chest pain History: above Cardiac mediastinal silhouette is unremarkable. Low lung volumes. No focal pulmonary opacities or pleural effusions.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Pain The persistent basilar right chest tube again projects towards the midline without interval change or new complication. A small underlying pneumothorax again is observed apically, and possibly loculated.Right hilar mass and underlying pulmonary changes are similar with essentially clear left lungThe cardiac and mediastinal contours are otherwise similar. Left PICC line remains well positioned, tip extends into the proximal SVC

Output: Right chest tube unchanged


Instruction: Generate impression based on medical findings.

Input: Right middle lobe nodule, wedge resection Interval removal of the right chest tube with otherwise previously described postsurgical changes, largely volume loss. No associated superimposed acute cardiopulmonary abnormality.

Output: Chest tube removed


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for evidence of obstructive lung disease History: chest pain, dyspnea after using heroin Unremarkable cardiac and mediastinal silhouette. Perihilar bronchial thickening suggestive of bronchitis or asthma.No specific evidence of emphysema although a chest radiograph is not sensitive in this respect.

Output: Findings compatible with bronchitis or asthma.


Instruction: Generate impression based on medical findings.

Input: 80 year-old male with history of lung cancer. Surveillance scan. CHEST:LUNGS AND PLEURA: Stable 5-mm right middle lobe nodule (series 4, image 52); this nodule has been stable since at least 2005 as mentioned on report for CT chest/abdomen from 1/23/2009. No new suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy with surgical clips in the pelvis.BLADDER: No significant abnormality noted.LYMPH NODES: Referenced right obturator lymph node (series 3, image 183) measures 0.8 x 0.8 cm; previously measuring 1 x 0.9 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Penile reservoir is seen in the right anterior lower abdomen (series 3, image 167).

Output: 1. Status post radical prostatectomy.2. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: Check Pulmonary Status History: Check Pulmonary Status Tracheostomy tube in place. Right upper extremity PICC tip in the superior SVC. Left central venous catheter tip in the superior SVC.Near complete opacification of the right lung with large pleural effusion and underlying atelectasis/consolidation, unchanged. Stable small to moderate left pleural effusion with retrocardiac atelectasis/consolidation.

Output: Large right and small-to-moderate left pleural effusions with underlying atelectasis/consolidation, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Chest pain question pneumomediastinum. No visible pneumomediastinum on the frontal radiograph however on the lateral film I cannot exclude pneumomediastinum. No pneumothorax. No focal pulmonary opacities or pleural fluid.

Output: Possible pneumomediastinum on the lateral radiograph. Case discussed with ED attending at 8:58 AM on 8/20/2016 and they will contact the patient to assess for change in symptoms.


Instruction: Generate impression based on medical findings.

Input: Male 17 years old Reason: eval VP shunt s/p revision History: previous disconnectVIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 8/14/2015 Unchanged positioning of intracranial portion of the VP shunt system. Extracranial VP shunt catheter follows a non interrupted pathway towards the right soft tissues of the neck, anterior soft tissues of the chest and abdomen and terminates in the right lower abdominal quadrant. No evidence of kinking. A small piece of orphan catheter is visualized in at the base of the right neck.Cardiac silhouette size is normal. No focal opacities, effusions or pneumothorax. Normal abdominal gas pattern with minimal fecal accumulation.

Output: No evidence of VP shunt kinking or discontinuities.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: eval for infiltrate History: sob/respiratory distress Unchanged interstitial pulmonary edema pattern. Unchanged cardiomegaly. No large pleural effusion or pneumothorax. Moderate spinal curvature again noted.

Output: Interstitial pulmonary edema. Unchanged cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB, CAT P History: SOB, hypoxia New diffuse interstitial opacity in the right lower and midlung with bronchial thickening, in a pattern suggestive of bronchiolitis. This can be seen in acute infection but more commonly in a more chronic infection which may be related to recurrent aspiration.Unremarkable cardiac and mediastinal silhouette.

Output: Diffuse interstitial opacity in the right lung compatible with infection, possibly related to recurrent aspiration. If clinically indicated this could be better defined by CT scan. The findings were discussed with Dr. Howes at the time of reporting.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for acute chest History: sickle cell Mild cardiomegaly with increased upper zone blood flow compatible with anemia.Port catheter with its tip in the SVC.No acute pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: interval change History: hypoxemia Small lung volumes with basilar atelectasis, which could be the result of aspirated secretions or mucous plugging.No reliable evidence of pneumonia.

Output: Nonspecific basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p colonic interposition with hematemesis and ulceration History: 1 mo f/u Large hiatal hernia extending to the left of the mediastinum above the left hemidiaphragm.Adjacent opacity compatible with atelectasis.Mild interstitial opacity and atelectasis at the right base, unchanged from previous.

Output: Large hiatal hernia and basilar atelectasis without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: h/o chf, evaluate for edema History: chf Left subclavian ICD. Sternotomy fixation.Streaky basilar opacities; favor atelectasis.Small bilateral pleural effusionsNo pneumothorax.Severe globular cardiomegaly.

Output: Cardiomegaly with small bilateral pleural effusions.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: 56 year old female with newly diagnosed cervical cancer CHEST:LUNGS AND PLEURA: Two nodular densities in the left upper lobe (series 4, image 34) ribs and pulmonary nodules versus mucous plugs.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.A small hiatal hernia may be present.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal sinus cysts are noted on the right. Cystic densities in the left renal hila may be due to renal sinus cysts rather than hydronephrosis given the absence of hydroureter.RETROPERITONEUM, LYMPH NODES: Multiple mildly enlarged retroperitoneal lymph nodes are identified, the largest measuring 23 x 13 mm at the aortic bifurcation (series 3, image 143).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: A heterogeneous, septated lesion with multiple low density foci measuring approximately 17.6 x 9.1 x 18.0 cm is identified in the midline of the pelvis. It displaces the adjacent colon and the urinary bladder. Contact with both pelvic sidewalls is present. The margins of the uterus are obscured by the mass.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple enlarged lymph nodes are noted along the right common iliac and right external iliac chains. The largest pelvic lymph node measured 4.4 x 2.5 cm in the right obturator region.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: The right common iliac vein is greatly narrowed by adjacent adenopathy.

Output: Large pelvic mass that is inseparable from the uterus which contacts the pelvic sidewalls. Abdominal and pelvic metastatic adenopathy..Mild left hydronephrosis versus parapelvic cysts. Left ureter is normal in size


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate ETT History: see above ET tube tip approximately 3 cm above the carina. Venous catheters unchanged.Diffuse pulmonary opacity compatible with edema with pleural effusions, greater on the right, improved compared to previous.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 45 years, Female. Reason: pouch distention vs ileus vs obstruction History: Distention, nausea. Postoperative day 3 status post lap RYGB. Exam is limited by patient's body habitus. Dilated loops of small bowel measuring up to 5 cm in diameter with several air-fluid levels. There is gaseous distention of the large bowel with relative paucity of gas of the distal large bowel. Right upper quadrant surgical clips are noted. Additional clips are noted in the left hemiabdomen. Suture material is noted in the left upper quadrant. Please refer to the chest radiograph performed on the same day for chest findings.

Output: Dilated loops of small and large bowel, findings favor postoperative ileus given the clinical history versus colonic obstruction at the level of the pelvis.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Cough and hypoxia question pneumonia. Low lung volumes due to semierect patient positioning. Associated basal atelectasis and bronchovascular crowding at the lung bases limits evaluation in these areas. Pulmonary nodules elsewhere present previously. Scarring in the upper lobes. No pleural fluid or signs of CHF.

Output: Exam limited due to extensive underinflation with bronchovascular crowding in the lung bases. If the patient remains symptomatic, follow-up erect PA and lateral chest radiographs at full inspiratory effort would be recommended to better evaluate. No signs of pneumonia in the upper lung zones.


Instruction: Generate impression based on medical findings.

Input: Age: 77 yearsGender: MaleReason for Study: Reason: ETT History: as above ET tube with its tip 4 cm above the carina.NG tube with its tip in the stomach.Decreased lung volumes a stable cardiac mediastinal silhouette.No new pulmonary opacities noted.

Output: ET tube in satisfactory position. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Shortness of breath. Chronic congestion rule out pneumonia. Hazy opacity in the right middle lobe suspicious for infection. No pleural fluid or pneumothorax. Mild elevation of the left hemidiaphragm.

Output: Hazy right middle lobe opacity suspicious for infection.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: PNA History: fever and vomiting Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Cervical spinal fusion hardware, incompletely visualized. Status post cholecystectomy.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: daily CCU CXR History: s/p OHT with antibody mediated rejection and acute heart failure, s/p IABP Median sternotomy for heart transplant.No specific evidence of infection or edema.Minimal right pleural effusion.Tubes and catheters are unchanged.IABP catheter marker obscured by motion artifact.

Output: Minimal pleural effusion but no edema.


Instruction: Generate impression based on medical findings.

Input: Reason: Consolidation, atelectasis History: Trach patient no mechanical ventilation Cardiopulmonary monitoring and support devices, unchanged.Mild nonspecific bilateral interstitial opacity with focal airspace opacity and subsegmental atelectasis in the lower lobes, likely secondary to aspirated secretions.

Output: Basilar opacities compatible with aspirated secretions, slightly increased.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: daily CCU CXR, assess for interval change History: decompensated CHF Mild cardiomegaly.Small lung volumes without edema or pneumoniaRight jugular Swan-Ganz catheter tip has been advanced far into the right interlobar pulmonary artery.

Output: Right jugular Swan-Ganz catheter advanced far into the right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: 64M with new onset chest pain, dyspnea History: chest pain, dyspnea Small lung volumes with basilar atelectasis which may be from aspiration.Heart size normal.Free intraperitoneal air is presumably from recent surgery.

Output: Basilar opacities suggestive of aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Interval decrease in a right upper lobe cavity or pleural air-fluid level with residual opacity volume loss in the right apex.Blunting of the right costophrenic angle compatible with scarring.Port catheter with its tip in the SVC. No new findings.

Output: Marked decrease in right upper lobe cavity or loculated hydropneumothorax with only a small residual air collection surrounded by pleural thickening and pulmonary opacity compatible with fibrosis and possibly residual tumor. No new findings.


Instruction: Generate impression based on medical findings.

Input: Reason: ET Tube placement History: SOB ET tube tip approximately 3 cm above the carina.Left lower lobe focal airspace opacity compatible with aspiration and infection, not significantly changed.Feeding tube looped in the hypopharynx.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with history of non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Stable subcentimeter right middle lobe. Micronodular.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Age: 50 yearsGender: MaleReason for Study: Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Stable cardiac enlargement.Right central venous dialysis catheter with its tip in the right atrium.Left pleural effusion improved from the prior exam.Right lung is clear.

Output: Cardiac enlargement with left pleural effusion mildly improved from the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old. Status post thoracentesis. Metastatic bladder cancer. Moderate to large pleural effusions with overlying atelectasis and consolidation, mildly increased. No significant pneumothorax.Right chest port tip at the cavoatrial junction.Stable cardiomediastinal silhouette.

Output: Moderate to large pleural effusions with overlying atelectasis/consolidation, mildly increased.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: central line History: IJ Right jugular catheter tip in the area of the SVC. Right paramediastinal opacity consistent with an azygos pseudolobe, and basilar opacities compatible with atelectasis, unchanged.Gastric band visible in the area of the stomach.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female C. demonstrated. Right upper lobe pulmonary nodule. Evaluate for change LUNGS AND PLEURA: There is redemonstration of a 8mm by 10-mm right apical pulmonary nodule. This is unchanged in size or appearance since the previous examination. Identified is a 5-mm pulmonary density adjacent to the right major fissure. These most likely are benign. There's also is a small, calcified granuloma at the left lung base There has been however, mild progressive pleural thickening in the right hemithorax posteriorly in comparison to the exam dated 1/19/09. This may be secondary to an interval inflammatory processMEDIASTINUM AND HILA: There are calcified mediastinal lymph nodes, as well as coronary artery calcificationCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: There is redemonstration of calcified gallstones as well as pancreatic calcifications and splenomegaly

Output: 1. Stable appearance of the pulmonary nodules in the right lung.2. Progressive pleural thickening posteriorly in the right hemithorax compared to the previous examination.3. Redemonstration splenic enlargement, pancreatic calcifications, cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: FemaleReason for Study: Reason: pna History: cough, increased hallucinations Right Port-A-Cath with its tip in the SVC.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: cough, crackles, eval PNA History: cough, crackles, eval PNA Linear atelectasis or scarring.No specific evidence of infection or edema.Heart size normal.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 89 yearsGender: FemaleReason for Study: Reason: r/o infiltrate, rib fx History: syncope, fall? Stable cardiac enlargement.Mild perihilar interstitial opacities suggestive of edema.No focal airspace opacities.No pleural effusions.No evidence for pneumothorax.No obvious rib fracture identified.

Output: Cardiac enlargement without acute cardiopulmonary abnormalities. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 52 year old female with history of head and neck (right base of tongue squamous cell) cancer. Evaluate for any evidence of disease recurrence. CHEST:LUNGS AND PLEURA: Interval resolution of previously seen left lower lobe consolidation, with small residual atelectasis versus scarring (for example, series 6, image 64). Previously noted (CT chest from 7/24/2008), punctate micronodule within left upper lobe apex; nonspecific and unchanged.MEDIASTINUM AND HILA: No evidence of mediastinal lymphadenopathy. Tracheostomy tube.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastrostomy tube, unchanged.BONES, SOFT TISSUES: No significant abnormality noted

Output: No evidence of disease recurrence. Interval resolution of left lower lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: Mr. Ashton is a 76 yo male with a 40 pack-year smoking history who presented to the ED with a tension pneumothorax. History: chest pain and dyspnea Despite a left pleural drain the left pneumothorax has enlarged, subsequent radiograph showing a chest tube placed.Basilar atelectasis is present, unchanged.

Output: Enlarging left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: assess lung fields History: as above Pulmonary nodules and airspace opacities with a large left pleural effusion are unchanged.No new findings.

Output: Unchanged pulmonary opacities and metastatic nodules, with a left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male. Reevaluate disease status following adjuvant therapy. Compare the previous scan. Stage III melanoma. CHEST:LUNGS AND PLEURA: Micronodules identified. Index nodule in the left lower lobe series 4 image 91 measures 0.6 x 0.5 cm. Previously 0.5 x 0.5 cm. Micronodules in the right middle lobe are unchanged. Postinflammatory changes posterior aspect of the right lung and fibrotic apices unchanged. No new nodules. No effusions.MEDIASTINUM AND HILA: Calcified and noncalcified mediastinal nodes are identified. Index right hilar node series 2 image 47 measures 1.4 x 0.8 cm. Previously 1.4 x 0.9 cm. Other nodes are also stable. Coronary artery calcifications.CHEST WALL: Stable gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: Stable hepatic cyst in the left lobe. No evidence of metastases.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left lower pole cyst. Other lesions too small to characterize, unchanged. Probable cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease. No evidence of aneurysm. Some ulcerated plaques are noted.BOWEL, MESENTERY: No significant abnormality noted. Scattered small mesenteric nodes are stable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable lung micronodules mediastinal adenopathy. No evidence of recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: Shortness of Breath History: Shortness of Breath No change in basilar opacities suggestive of atelectasis, with a moderate size right subpulmonic pneumothorax.Small lung volumes.Heart size normal.Left jugular catheter, tip in SVC.

Output: Unchanged basilar atelectasis and right subpulmonic effusion.


Instruction: Generate impression based on medical findings.

Input: Hypoxemia Persistent mildly decreased lung volumes with perihilar and basilar opacities again suggesting atelectasis greater on the left. Additional small to moderate effusions also greater on the left.Right jugular catheter unchanged, tip extends up to the atrium

Output: Pleural effusions and lower zone nonspecific opacities again suggesting mild CHF


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: s/p trialysis line placement Right IJ line terminates in the SVC. Endotracheal tube terminates 4 cm from the carina. Enteric tube terminates within the distal aspect of esophagus and could be advanced if clinically indicated. Mild pulmonary edema pattern slightly improved.. Small pleural effusions. No pneumothorax. Decrease in heart size.

Output: Enteric tube terminates within the distal aspect of esophagus and could be advanced if clinically indicated. Mild pulmonary edema pattern slightly improved.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: s/p left thoracoscopy and talc pleurodesis History: talc pleurodesis Lobulated left pleural thickening or loculated fluid unchanged following left chest tube removal.No significant pneumothorax.Right pleural effusion.Unchanged basilar opacities.Right jugular catheter, tip in SVC.

Output: No pneumothorax following chest tube removal. Lobulated left pleural thickening and pleural effusions unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: desat History: o2 desat Left hemithorax volume loss with left basilar atelectasis and a very small left pleural effusion.Mild right base subsegmental atelectasis.Heart size normal.Cervical thoracic spine stabilization hardware present.

Output: Small left pleural effusion and basilar atelectasis left greater than right.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: swan placement History: swan placement Iatrogenic devices are unchanged. Diffuse pulmonary opacities, unchanged. Small left pleural effusion, as before. Unchanged cardiomegaly. No pneumothorax.

Output: Probable congestive heart failure, not substantially different.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: Worsening SOB, hypoxia in patient with mucus plugging History: hypoxia Near complete white out of the right hemithorax again noted likely combination of right lung atelectasis, consolidated lung, and right loculated pleural effusion. Increase in left basilar opacity with increased left pleural effusion. Heart is likely unchanged. Presumed pericardial drain overlies the left aspect of the mediastinum.

Output: Clear increase in left basilar opacity and left pleural effusion worrisome for volume overload or development of aspiration pneumonia. Near complete white out of the right hemithorax again noted.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: fever History: fever Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: central line placement History: none Support devices are unchanged in position. One of the dual-lumen port is accessed. A percutaneous gastrostomy balloon appears smaller in caliber when compared to prior.The lungs and pleural spaces are clear. The heart size is normal. No interval pneumothorax or edema.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: TB screening History: as above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Chronic blunting right costophrenic angle.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Intra-aortic balloon pump and Swan-Ganz catheter. Right IJ Swan-Gantz catheter terminates in the right pulmonary artery in stable position. A right IJ central venous catheter is stable position terminating in the cavoatrial junction. An IABP appears in stable position approximately 3 cm below the arch of the aorta. The left subclavian ICD is in stable position with the wire tip projecting over the right ventricle. Stable cardiomegaly without increasing airspace or interstitial opacities. No pneumothorax.

Output: Swan-cans catheter and IABP appear in stable position. No significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? aspiration? History: difficulty breathing Volume loss in the left hemithorax with left perihilar opacity compatible with radiation reaction. Port catheter with its tip in the SVC an NG tube tip in the stomach. No sign of pneumonia or other significant change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: Fall with pain to left ribs. evaluate for fx and ptx. History: Fall with pain to left ribs. evaluate for fx and ptx. Unremarkable cardiac and mediastinal silhouette. Mild subsegmental atelectasis at the left base which may be secondary to splinting.No visible displaced rib fractures, although the lower ribs are incompletely visualized and nondisplaced fractures are unlikely to be detected.

Output: No pneumothorax or visible displaced fractures, although the lower ribs are incompletely visualized.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: 57M with Swan placed in cath lab, admitted to CCU for ADHF, ?placement, ?e/o volume overload History: 57M with Swan placed in cath lab, admitted to CCU for ADHF, ?placement, ?e/o volume overload Mild/moderate cardiomegaly.No specific evidence of infection or edema.Right jugular Swan-Ganz catheter tip in main pulmonary artery.Left subclavian ICD, leads unchanged in position.

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


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old.Reason: ett History: ett New retrocardiac atelectasis probably from mucous plugging.Elsewhere, the lungs are unremarkable.ET tube tip approximately 5 cm above the carina.Right subclavian catheter, tip in SVC.

Output: New retrocardiac atelectasis probably from aspirated secretions or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Congestive heart failure. IABP The IVP marker remains within the aortic arch. Associated mild cardiomegaly and nonspecific remains. Tortuosity of the aorta and atherosclerotic changes are also stable in appearance.Lungs appear grossly clear yet mildly decreased in overall volume with an elevated right hemidiaphragm

Output: IABP unchanged


Instruction: Generate impression based on medical findings.

Input: Left sided chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Intubation Essentially unchanged mixed interstitial and patchy opacities in all 4 quadrants with relative sparing of the left upper lung. Appearance remains concerning for ARDS without evidence of new superimposed focal process. Specifically mild improved aeration left lower lobe suggest resolution of superimposed atelectasisETT remains 4 cm above the carina. Dobbhoff projects beyond the inferior edge of the image

Output: Essentially unchanged pulmonary opacities given differences in technique, see detail provided


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pneumonia History: fever Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: s/p bilateral lung trp 2014 History: s/p bilateral lung trp 2014 Chronic left hemithorax volume loss.New decreased lung volumes, with increasing opacities suggestive of edema or infection.

Output: New pulmonary opacities suggestive of edema, aspiration or infection, particularly in the left transplanted lung.


Instruction: Generate impression based on medical findings.

Input: 77-year-old female with Eaton-Lambert syndrome, previous aspiration, pneumonia, assess for malignancy LUNGS AND PLEURA: Stable calcified and noncalcified micronodules are in reference. Right lower lobe reference nodule (image 68, series 5) measures 4 mm in size, previously measuring 6 mm.. No new pulmonary nodules. Predominant upper lobe reticulation, septal thickening, and subpleural cystic changes are compatible with fibrosis. Mild underlying central lobular emphysema.MEDIASTINUM AND HILA: Stable mediastinal lymphadenopathy. Reference mediastinal lymph node (image 33, series 4) measures 12 mm, previously, measuring 13 mm., Reference right hilar lymph node (image 38, series 4) now measures 11 mm x 15 mm, previously, measuring 11 mm x 17 mm.Cardiac size is normal. Coronary calcifications are noted.CHEST WALL: L1 vertebroplasty and evidence of compression abnormalities of the T3 and T10 vertebrae.UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of malignancy. Stable upper lobe fibrosis.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: MaleReason for Study: Reason: daily cxr History: n/a Tracheostomy tube and right PICC line unchanged.Stable cardiomediastinal silhouette.Bilateral pulmonary opacities with multifocal areas of consolidation and pleural effusions similar in appearance to the prior exam.No new pulmonary opacities identified.Apical post radiation fibrosis and upper thoracic osseous post radiation changes.

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


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: intubated, assess ARDS History: intubated, assess ARDS Support devices unchanged with ET tube tip 2 cm above the carina.Stable cardiac mediastinal silhouette.Interstitial and patchy airspace opacities in both lungs similar in appearance to the prior exam.Left retrocardiac consolidation/atelectasis and associated small effusion redemonstrated.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: assess pneumothorax and pneumoperitoneum History: routine xray for eval Small left pneumothorax and no significant right pneumothorax.Nonspecific basilar consolidation and atelectasis.Decreased pneumoperitoneum.Other findings unchanged.

Output: Small residual left pneumothorax and pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: where is IABP History: IABP-dependent HF : Balloon catheter marker in the proximal descending aorta and ICD lead unchanged.PICC line tip in the right axilla.Moderate cardiomegaly with no evidence of pulmonary edema.

Output: No interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: eval for acute cardiopulm abnormality History: cp after smoking crack No significant cardiopulmonary abnormality.

Output: No significant abnormality. No evidence of edema or hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? History: Cough, fever Extensive bilateral mainly upper zone bronchiectasis and bronchial mucous plugging consistent with cystic fibrosis. No focal areas of upper lobe opacity bilaterally may represent superimposed infection or new areas of mucoid impaction.

Output: Extensive upper zone bronchiectasis with new areas of upper lobe opacity compatible with superimposed infection or mucoid impaction.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: r/o pleural edema, pleural effusion History: hypoxic to 83% on HF NC FiO2 100% Previously seen fibrotic appearing opacities now made of superimposed edema with small pleural effusions.No specific evidence of infection.Mild cardiomegaly noted.

Output: Pulmonary fibrosis, now with superimposed edema and small pleural effusions likely from CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: intubated History: intubated Unchanged cardiomegaly, pulmonary opacities and left pleural effusion.ET tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.Left PICC, tip in the SVC.

Output: Unchanged pulmonary opacities and left pleural effusion, and support devices. ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Non-small cell lung cancer status post two cycles of treatment. CHEST:LUNGS AND PLEURA: Right hilar mass smaller measuring 4.3 x 2.5 cm (image 48; series 4). Scattered pulmonary nodules, many of which are calcified. A noncalcified, subpleural nodule previously described is less prominent on today's exam but still present (image 45; series 5). Predominantly upper lobe centrilobular emphysema again noted. Patchy ground glass opacities less prominent on this exam.MEDIASTINUM AND HILA: Mediastinal and hilar lymphadenopathy is identified. Reference precarinal lymph node is smaller and currently measures 14 x 10 mm (image 39; series 4). Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: No mass lesions identified. Portal vasculature is patent. No intra-or extrahepatic biliary ductal dilatation. Cholelithiasis without evidence of acute inflammation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Bilateral adrenal lesions, consistent with metastatic disease. The reference right adrenal lesion measures 4.3 x 2.8 cm (image 99; series 4), decreased in size compared to previous. The left adrenal lesion invades the left renal vein at its confluence as noted previously.KIDNEYS, URETERS: No significant abnormality noted in the kidneys. Invasion of the left renal vein left adrenal mass as noted previously.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the aorta.BOWEL, MESENTERY: The reference metastatic deposit within the mesentery of the left hemiabdomen adjacent to the spleen is smaller measuring 2.5 x 2.4 cm (image 97; series 4).BONES, SOFT TISSUES: Nonspecific, scattered subcentimeter subcutaneous nodules. Degenerative disease of the spine.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Nonspecific, scattered subcentimeter subcutaneous nodules. Degenerative disease of the spine.OTHER: Occlusion of the right common iliac artery. Correlate with symptoms of claudication. This would be amenable to endovascular treatment if desired clinically.

Output: Interval regression of disease with measurements given above.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male history of CA, status post cystectomy and neobladder. Assess for recurrence. CHEST:LUNGS AND PLEURA: Macronodule left lower lobe series 5 image 65 4.7 mm unchanged from prior exam series 4 image 78. No new nodules. Granuloma right lower lobe. No effusions.MEDIASTINUM AND HILA: Atherosclerotic calcifications coronary arteries and aortic arch. No pathologic size lymph nodes. Granulomata right hilum.CHEST WALL: No significant abnormality notedABDOMEN: Exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Stable nodule left adrenal consistent with an adenoma.KIDNEYS, URETERS: Scarring and some atrophy left kidney. Right kidney normal.RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal nodes are unchanged. An index node which previously measured, series 4 image 111 measuring 5.2 mm. atherosclerotic changes aorta and branch vessels no evidence of aneurysm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Surgically absent.BLADDER: Surgically absent. Neobladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable exam. No evidence of recurrence. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old. Reason: pna?EFFUSION? History: sob Severe cardiomegaly with slightly improved aeration of the lungs.Unchanged basilar opacities and pleural effusions.No significant pneumothorax.ECMO cannulae are stable in position.IABP has been removed.Right jugular Swan-Ganz catheter tip in right ventricular outflow tract.Left IJ introducer is unchanged. Interval removal of right subclavian introducer.

Output: Severe cardiomegaly with unchanged basilar opacities and pleural effusions.Removal of right subclavian introducer without significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Cough Minimal streaky densities in both bases greater on the right likely old scarring versus atelectasis. No superimposed acute airspace abnormality upon mild COPD findings.

Output: Mild chronic COPD and suspected scarring


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: r/o acute process History: shortness of breath, hx of copd Mild to moderate cardiomegaly.No specific evidence of infection or edema.No significant change.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: chest tube to water sealVIEW: Chest AP ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Right internal jugular central line again noted. The right chest tube is unchanged. Again noted multiple hepatic artery embolization coils. Cardiothymic silhouette normal. Bilateral lung opacities again noted not significantly changed. There are bilateral small pleural effusions without pneumothorax.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: cough with sputum. History: cough with sputum Streaky bilateral lower zone opacities compatible with atelectasis and bronchiectasis with scarring at the left costophrenic angle.Right lower lobe mass, better shown on a CT scan of the same day.No specific evidence of pneumonia.

Output: Atelectasis and bronchiectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: Intubated, please evaluate lines History: sepsis, likely source pneumonia Diffuse pulmonary opacities in the right lung again noted. Patchy left basilar opacity, as before. Underlying emphysema again noted. Lines and tubes are unchanged. Unchanged heart size. No pneumothorax. Question of small pleural effusions.

Output: No substantial change in pulmonary opacities within the right lung consistent with aspiration or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: ETT eval History: intubated in MICU Endotracheal tube terminates 4 cm above the carina. Support devices are unchanged in position.Diffuse airspace opacities have not significantly changed compared to 24 hours earlier. Small bilateral pleural effusions remain. Mild cardiomegaly is stable. No pneumothorax.

Output: Stable pulmonary edema pattern with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: Lung cancer, hemoptysis History: hemoptysis New 5 x 5.3 cm right midlung mass possibly in the middle lobe consistent with metastasis from the patient's known left upper lobe treated lung cancer.Right jugular or right subclavian catheter, tip in SVC.

Output: New right lung mass, possibly metastasis from a known treated left upper lobe lung cancer. A thoracic CT is recommended for further follow-up.


Instruction: Generate impression based on medical findings.

Input: 21-year-old female with ovarian cancer metastatic to brain CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Fluid attenuation lesion in the left adnexa measuring 2.8 x 2.2 cm likely represents a lymphocele. Further follow-up imaging is recommended.

Output: Possible lymphocele in the left adnexa. No evidence of metastatic disease in the chest abdomen or pelvis.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: cough The heart size is normal.The lungs are clear. No focal pulmonary consolidation.No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: widened mediastinum History: cp/back pain Decreased lung volumes a stable cardiomediastinal silhouette.Mild basilar scarring/atelectasis similar to the prior exam.No new pulmonary opacities.No pleural effusions.Median sternotomy intact with evidence of prior CABG.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: 59 y/o s/p thoracentesis, eval for pneumo History: SOB Moderate size right pleural effusion and underlying atelectasis slightly decreased from the prior exam.No evidence of pneumothorax postthoracentesis.Stable cardiac enlargement.Left lung is clear.

Output: Right pleural effusion without evidence of a pneumothorax post thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Age: 19 yearsGender: MaleReason for Study: Reason: assess for infection - immunosuppressed with cough History: assess for infection - immunosuppressed with cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: s/p chest tube placement by IR History: see above Interval extubation and enteric tube removal. New right midlung pigtail chest tube now in place. Mediastinal chest tube and left-sided PICC remain unchanged. Spiration endobronchial valves again project over the right upper lobe segmental bronchi.Status post median sternotomy and CABG surgery.Emphysematous changes again seen with right upper lung predominance. Patchy left upper lung airspace disease is slightly improved since prior study. Bibasilar small pleural effusions suspected.Interval improvement in right-sided pneumothorax with predominantly residual apical component.

Output: Interval placement of right-sided pigtail chest tube with improvement in right-sided pneumothorax.Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: FemaleReason for Study: Reason: mass or infiltrate? History: L chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Shortness of breath. Stable cardia megaly. ICD/pacemaker in place, with leads terminating in the right atrium, apex of the right ventricle and coronary sinus, stable in position.There are persistent and slightly worsened signs of pulmonary venous hypertension and interstitial pulmonary edema.Right middle lobe and lingular discoid atelectasis.Interval appearance of small bilateral pleural effusions.Mild degenerative changes of the thoracic spine.

Output: Cardiomegaly, signs of pulmonary venous hypertension and interstitial pulmonary edema, worsened from prior. New small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: s/p L lung resection, eval for pneumo / CT position History: as above Two left chest tubes with no significant pneumothorax.Status post partial resection left lung with mild left basilar atelectasis.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with history of Renal cell carcinoma status post resection presents for follow up imaging Evaluation of solid and hollow viscera is limited due lack of IV contrast.CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Interval resolution of hazy soft tissue density in the left nephrectomy bed. Posterior to the tail of the pancreas there is soft tissue thickening most likely representing left adrenal gland, although returned/residual disease cannot be excluded.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis with no evidence of diverticulitis. No significant abnormality noted.BONES, SOFT TISSUES: Interval resolution of the left lower quadrant soft tissue collection. Thoracolumbar scoliosis with Degenerative disk disease and degenerative endplate disease.PELVIS:PROSTATE, SEMINAL VESICLES: Status post radical prostatectomy with surgical clips in the prostatectomy bed.BLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Scattered colonic diverticula.OTHER: Reservoirs for penile prosthesis bilaterally.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: intubated History: as above ET tube tip approximately 2 cm from the carina. Right IJ catheter tip in the mid SVC. Enteric tube is coiled in the stomach.Low lung volumes.Increasing right upper lobe opacity and persistent retrocardiac opacity may reflect atelectasis and/or consolidation.Stable moderate cardiomegaly.

Output: Increasing right upper lobe opacity and persistent retrocardiac opacity may reflect infection.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: 77F s/p TECAB History: - Interval removal of chest tubes and venous catheter. Persistent small pleural effusions and basilar atelectasis but no evidence of pneumothorax. Heart size stable.

Output: No evidence of pneumothorax status post chest tube removal. Persistent small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Rule out acute chest syndrome. Sickle cell pain. Right jugular chest port unchanged in position. Metallic bullet fragments overlying the right chest wall.Heart size is at least upper normal, unchanged. Prominent central pulmonary vasculature, suspicious for pulmonary hypertension.Chronic parenchymal lung scarring. Mild basal atelectasis on the right. No focal airspace opacities are appreciated.Osseous stigmata of sickle cell disease.

Output: Mild basal atelectasis on the right, but no airspace opacities to suggest acute chest syndrome by plain film technique.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: intubated, assess ET tube, interval change History: see above ET tube tip at orifice of right mainstem bronchus. NG tube tip in stomach. Venous catheter unchanged.Lungs hypoinflated with pulmonary edema and pleural effusions.

Output: ET tube tip at orifice of right mainstem bronchus.


Instruction: Generate impression based on medical findings.

Input: Reason: Stem cell transplant patient with new O2 requirement History: none Small lung volumes with streaky horizontal opacities suggestive of subsegmental atelectasis and nonspecific consolidation, which could be related to aspiration and/or infection.Bilateral venous catheters extending to the SVC.

Output: Nonspecific basilar opacities compatible with atelectasis and consolidation which may be related to infection and/or aspiration.


Instruction: Generate impression based on medical findings.

Input: 71 year old female with endometrial cancer status post 3 cycles of Taxol/carbo/Temsirolumus, evaluate disease process. CHEST:LUNGS AND PLEURA: Bilateral apical scar. Minimal basilar atelectasis. Multiple bilateral micronodules (image 67, 76)MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Bilateral breast implants. Tip of the chemo port at the junction of right atrium and SVC.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cortical hypodensities are probably simple cysts. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: Status post retroperitoneal lymph node dissection procedure with multiple surgical clips. Aortocaval adenopathy measures 0.7 x 0.7 cm, previously measured 1.5 x 1.5 cm at axial image 121 of series 3. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Ascites notedBLADDER: No significant abnormality noted.LYMPH NODES: Multiple surgical clips identified in the lateral walls of the pelvisBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid, unchanged.

Output: Bilateral lung micronodulesInterval reduction in size of aortocaval lymphadenopathy.Pelvic free fluid, unchanged.No other measurable lesions.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Evaluate for central line Right central line tip in the right atrium. Enteric tube tip in the stomach. Dobbhoff tube tip also in the stomach. Cardiomediastinal silhouette is within normal limits. Stable appearing diffuse pulmonary opacities. Probable small pleural effusions.

Output: Stable appearing diffuse pulmonary opacities and effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: syncope and collapse Cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax. Severe apical bullous emphysema. Linear opacity in the left midlung zone and bilateral lung bases compatible with scarring. No specific evidence of edema or pneumonia.

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


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: IABP placement The tip of the IABP is localized approximately 3.1 cm below the top of the aortic arch, stable in position.Status post median sternotomy and valvular replacement. Multichamber pacemaker in place.The sternal wires are intact.No signs of pulmonary edema.Persistent small right pleural effusion. No pneumothorax.The right IJ central venous catheter overlies the SVC.

Output: Stable position of IABP, localized approximately 3.1 cm below the top of the aortic arch.No signs of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Chest pain. No focal pulmonary opacities, pleural effusions, or pneumothorax.Cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: 61 yo M with recurrent left lung mucus plugging, ? Left lung aeration History: recurrent mucus plugging Left pleural effusion.Worsening left hemithorax opacification from further atelectasis possibly from mucous plugging.Mild edema pattern right lower lung zone.Tracheostomy tube tip about 4 cm above the carina.Right subclavian catheter, tip in SVC.

Output: Further opacification of left hemithorax probably from increased mucous plugging.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with aortic stenosis presents with shortness of breath. Evaluate for pulmonary edema. Changes of a prior median sternotomy are noted. Surgical clips project over the right scapula.The cardiomediastinal silhouette is apparently magnified and probably enlarged. Well-defined right basilar nodular opacity measures approximately 1.5 x 1.3 cm has a calcified rim, and is indeterminate in etiology although most likely artifactual, by superimposition of the costochondral junction and hilar vessels. Bibasilar atelectasis. No large pleural effusion. No pneumothorax.

Output: 1.Right basilar nodular opacity may be artifactual but indeterminate etiology. Further evaluation with dedicated nonemergent CT is recommended, given unavailability of prior images for comparison, and smoking history.2.No acute cardiopulmonary disease. No pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent moderate mixed interstitial and airspace changes with marked effusions and cardiomegaly all correlating with probable CHFLeft subclavian ICD and left jugular catheter unchanged. Right external jugular PICC line removed

Output: CHF essentially unchanged and right PICC line, possibly once in the external jugular, removed


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old.Reason: evaluating for pna, bronchitis History: pt with cough x 6 wks, worsening over past 2. reported exposure to pna Possible central bronchiectasis with bronchial wall thickening.No reliable evidence of pneumonia.Heart size normal.

Output: Possible central bronchiectasis with bronchial wall thickening in the right suprahilar region, otherwise unremarkable examination.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male history of metastatic NSCLC and also history fungal pneumonia. Recent cecal mass seen on CT concern for fecal matter versus fungal infection versus tumor. Please reevaluate. Productive cough. CHEST:LUNGS AND PLEURA: Dense right lung consolidation with surrounding nodules. Some areas of increased consolidation and nodularity in the right upper lobe. Large area of dense consolidation in the left upper lobe and multifocal nodules are reidentified. There is been minimal change in the distribution of the various infiltrates and most of the nodules are stable in size.MEDIASTINUM AND HILA: Granulomata redemonstrated.CHEST WALL: Calcification intercostal ligaments and deformity of ribs along the posterior left upper thorax.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small pole hypoattenuating foci likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered colonic diverticula. No evidence of bowel wall thickening. No free or loculated intraperitoneal fluid.BONES, SOFT TISSUES: Midline scar. Broad-based incisional hernia nonobstructive.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis right and left colon. Pericolonic fat normal. No evidence of ascites or adenopathy. Particularly given the history I note that no obvious large mass is seen in the right colon by CT, but there is diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Minimal increase in some areas of nodularity and consolidation in the right upper lobe most areas of nodules and consolidation bilaterally are stable consistent with patient's known lung cancer. Concomitant fungal infiltrate cannot be excluded. All of the findings is stable.Colonic diverticulosis.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: R/o pneumonia s/p 4L hydration History: Cough/Fever Perihilar interstitial opacities are new, with bronchial wall thickening.No significant pleural effusions.Heart size normal.

Output: Perihilar interstitial opacities suggestive of edema or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old. Stable line position of support devices.Low lung volumes with basilar opacities are unchanged. Mid and upper lung zones are clear.No pneumothorax.Stable cardiac silhouette

Output: No change in basilar opacities. Line position stable.


Instruction: Generate impression based on medical findings.

Input: Reason: Infiltrates History: Fever Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 65 years old Female. Reason: r/o acute process History: chest pain. Stable nonspecific bibasilar linear interstitial opacities, compatible with atelectasis/scarring, unchanged. No new focal airspace abnormality. The cardiac silhouette is normal.

Output: Stable bibasilar atelectasis,/scarring, unchanged, without definite acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.AVR evaluate lung fields. Interval removal of Swan-Ganz catheter. Mediastinal drains unchanged in position. Small pleural effusions with atelectasis unchanged. Lung volumes remain low. No pneumothorax.

Output: Lung volumes remain low with mild basal atelectasis and small pleural effusions, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: evaluate PTX b/l History: hypoxic resp failure Left apical pleural drain again noted. Mild improvement in left-sided pneumothorax. Persistent left-sided subcutaneous emphysema. Diffuse pulmonary opacities, likely edema. Unchanged cardiomegaly.

Output: Left apical pleural drain remains in place. Improvement in left-sided pneumothorax. Diffuse pulmonary opacities, likely pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: cough, not feeling well in ESRD patient History: cough There is moderate cardiac enlargement with atherosclerotic changes of the aorta.Lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: line placement History: as above Severe cardiomegaly.Very small pleural effusions, improved.No specific evidence of infection or edema.Right jugular catheter, tip in SVC.Left jugular catheter now terminates in the left side of the neck above the clavicle.Left subclavian ICD, leads unchanged in position.

Output: Left jugular catheter, tip in left jugular in the lower neck region. Improvement in basilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Novartis relapsing remitting multiple sclerosis clinical trial (IRB #14914B) Rule out active infection. End of study. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Superior endplate compression of T3 vertebral body, stable.UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with cough, shortness of breath and history of COPD ,question of occupational exposure LUNGS AND PLEURA: The lungs are hyperexpanded. There is bronchial wall thickening, primarily involving the lower lobes. There is some air trapping within the lower lobes. Scattered calcified and noncalcified micronodules are identified. There is no evidence of interstitial fibrosis. There is no pleural effusion.MEDIASTINUM AND HILA: There is mild cardiac enlargement without evidence of a pericardial effusion. No hilar or mediastinal lymphadenopathy can be identified.CHEST WALL: Marked generative changes are noted within the thoracic spine.UPPER ABDOMEN: No significant abnormality noted.

Output: Findings consistent with bronchitis and chronic obstructive lung disease.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Cough. The cardiomediastinal silhouette is within normal limits. The hila and pulmonary vasculature are within normal limits as well. Prominent bibasilar linear atelectasis. Additional subsegmental atelectasis versus scarring noted at the left base. No pleural effusion or pneumothorax.

Output: Bilateral atelectatic changes.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Hypertension complaining of chest pain after cocaine. Low lung volumes.Bilateral mild infrahilar distribution groundglass opacities and atelectasis suspicious for cocaine- related drug reaction.No visible pleural fluid or pneumothorax.Metallic density projecting over the inferior aspect of the right clavicular head.

Output: Mild edema-like opacities in the lower lung zones are suspicious for cocaine-related drug reaction.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: MaleReason for Study: Reason: URI, hx of lung nodule History: hemoptysis Cardiac size is normal.Prominence of central pulmonary vasculature with some pulmonary vascular redistribution.No focal areas of consolidation.No large pleural effusions.Redemonstration of lingular nodule unchanged.

Output: Prominence of central pulmonary vasculature with some pulmonary vascular redistribution similar in appearance to the prior exam. No acute abnormalities. No suspicious pulmonary nodules or masses.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with unknown primary tumor with squamous cell cancer of the inguinal and axillary lymph nodes. Status post 6 cycles of chemotherapy. Currently postchemotherapy break Within the limitations of an unenhanced study, the following observations are made.CHEST:LUNGS AND PLEURA: Multiple bilateral scattered nodules and micronodules describe previously have all regressed or resolved suggesting an infectious etiology. The reference nodule is no longer measurable. Groundglass opacity described previously has also regressed and nearly completely resolved. MEDIASTINUM AND HILA: Calcified right hilar lymphadenopathy, unchanged.CHEST WALL: A right axillary lymph node has is roughly stable measuring 1.6 x 1.5 cm (image 30; series 2). Gynecomastia is evident.ABDOMEN:LIVER, BILIARY TRACT: A lobulated hypoattenuating lesion in the right lobe of the liver is grossly unchanged probably representing a benign cyst. Scattered additional small hypoattenuating lesions are also unchanged. No new mass lesion is evident within the limits of this noncontrast CT.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. The left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is not clearly visualized.BLADDER: Bladder wall thickening is stable and nonspecific but can be seen following radiation therapy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive subcutaneous edema is evident as well as edema involving the scrotum and penis.OTHER: No significant abnormality noted

Output: 1.Regression resolution of previously described lung findings.2.Roughly stable right axillary lymph node.3.No other significant interval change.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and chest pain Moderate COPD changes with superimposed interstitial abnormality greater both bases, somewhat of a nodular appearance. Although possibly old chronic scarring, the reticulonodular appearance warrants comparison with prior outside imaging if available and/or follow-up imaging to better characterize. No effusions.Borderline cardiomegaly. Mild tortuosity of the aorta

Output: Nonspecific reticular nodular abnormality greater both bases, possibly old scarring however serial imaging and/or comparison with prior outside imaging if available is needed to confirm. See recommendation above


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with history of right upper lobe wedge resection for metastatic rectal cancer. Right chest port with tip in the SVC. Interval removal of right-sided chest tube.Stable cardiomediastinal silhouette. Postoperative changes from right upper lobe wedge resection and left lower lobectomy. No focal airspace opacities, pleural effusions, or pneumothorax.

Output: Stable post operative appearance without acute abnormality.


Instruction: Generate impression based on medical findings.

Input: TECAB No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: S/P AVR MVR History: Pulmonary Edema Bilateral pleural effusions and basilar opacities suggestive of edema as well as left lower lobe consolidation, unchanged.Status post aortic valve replacement and mitral valve repair.No new findings.

Output: Persistent pulmonary opacities and pleural effusions, unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: eval PICC line placement, also eval for PNA (tachycardic, hypotensive) History: eval PICC line placement, also eval for PNA (tachycardic, hypotensive) PICC tip in the midline of the mediastinum at the level of the aortic arch, medial to the expected location of the SVC, possibly in the left brachiocephalic vein but its location is uncertain.Left lobe patchy airspace opacities and atelectasis. Marked interval decrease or resolution of the large left pleural effusion present on the previous radiograph.Rib fracture callus projected over the right lower lung.

Output: PICC tip in a slightly abnormal position as described which raises the question of arterial placement.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: s/p thoracentesis .eva fluid status History: sob No change in right mid to lower lung zone consolidation with right pleural effusion.Stable left lower lung zone edema.Mild cardiomegaly status post sternotomy.

Output: Unchanged left mid and lower lung zone consolidation with a left pleural effusion. No pneumothorax following thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: SOB History: r/o Pneumo + Hx Bronchial wall thickening, otherwise unremarkable.No significant pneumothorax.

Output: Bronchial wall thickening consistent with asthma or chronic bronchitis. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.75M s/p DDRT with history of respiratory failure Interval improvement in now small to medium-sized bilateral pleural effusions.No new focal pulmonary opacity. Heart size upper limits of normal.Right IJ catheter tip at superior cavoatrial junction.

Output: Significant improvement in bilateral effusions.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and lightheadedness Persistent decreased lung volumes without associated distinct acute pulmonary abnormality. Mild streaky densities in both bases suggest scarring with questionable minimal atelectasisBorderline cardiomegaly with unchanged tortuous aorta. Calcified hilar lymph nodes largely on the right with scattered calcified granulomata are consistent with old granulomatous disease exposure

Output: Old granulomatous disease exposure with minimal atelectasis and basilar scarring. No new acute pulmonary abnormalities


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Evaluate for edema. COPD, CHF, bronchomalacia. Multiple fractured sternotomy wires. Cardiomegaly. Mild to moderate pulmonary vascular congestion. Elevated right hemidiaphragm. Underlying right basilar airspace disease cannot be excluded.

Output: CHF. Underlying right basilar airspace disease is suspected.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female status post laparoscopic peritoneal biopsy. Evaluate for pneumothorax. Streaky bibasilar opacities likely atelectasis. No focal airspace opacity, significant pleural effusions or pneumothorax. Normal cardiomediastinal silhouette.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 24-year-old male with history of sickle cell disease and previous DVT and CVA presenting with chest pain. Please evaluate for PE/DVT. CHEST:PULMONARY VASCULATURE: No pulmonary embolus is identified. Study is diagnostic to the level of the segmental pulmonary arteries.LUNGS AND PLEURA: Patchy air space and reticular interstitial opacities are noted predominantly at the bases , compatible with acute chest syndrome. There are additional areas of scarring likely secondary to prior infections or prior acute chest crises. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Stable cardiomegaly without pericardial effusion.CHEST WALL: Bony changes of sickle cell disease are reidentified within the axial skeleton. LOWER EXTREMITY DVT STUDY: No evidence of DVT. The left femoral head is partially visualized, however increased sclerosis at this location may represent AVN.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. No PE or DVT.2. Patchy airspace and reticular interstitial opacities predominantly at the bases. Findings may be secondary to acute chest syndrome. No pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Postop robotic CABG evaluate for pneumothorax. Endotracheal tube tip 1 cm above the level of the carina. Right jugular introducer projects over the right brachiocephalic vein at the level of the clavicular head. Left chest tube tip at the apex.Small left apical pneumothorax.Small volume of pleural fluid bilaterally.Patchy opacities in the left lung and at the right base consistent with atelectasis/postoperative contusion.Subcutaneous emphysema left chest wall.

Output: Small left hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: r/o pneumonia History: cough No acute abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with history of follicular non-Hodgkin's lymphoma. Restaging exam. CHEST:LUNGS AND PLEURA: Scattered micronodules unchanged. No new nodules or masses. No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: Pretracheal, right hilar and AP window lymphadenopathy is unchanged to slightly smaller. A reference pretracheal node measures 1.4 by 1.0 centimeters on axial image 31/215 and is slightly smaller when compared to the prior exam where it measured 1.6 x 1.0 cm. Cardiac size is normal. No pericardial fluid. Cystic lesion within the thyroid is unchanged as well.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule is unchanged measuring 1.6 x 2.1 cm on axial image 96/215.KIDNEYS, URETERS: Stable right renal hypoattenuating lesion probably represents a benign cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Soft tissue nodule adjacent to the gastric wall on axial image 94/215 measures 3.2 x 2.2 cm and is grossly unchanged. Colonic diverticula with no evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes affect the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Reference left external iliac lymph node measures 1.8 x 0.9 cm on axial image 179/215 and is slightly smaller when compared to the prior exam where it measured 2.1 x 1.1 cm.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: As above.OTHER: Surgical clips in the inguinal region bilaterally.

Output: 1.Overall improvement in several reference measurements as described above.2.Other findings are stable.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? History: cough, sputum production, chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: post op, eval lung fields History: s/p CABG Multiple chest tubes no pneumothorax.Basilar atelectasis stable.Status post extubation.Right jugular Swan-Ganz catheter removed leaving the introducer.

Output: No change in basilar atelectasis following extubation. No new findings.


Instruction: Generate impression based on medical findings.

Input: Esophagectomy Mild chronic changes with interstitial findings in the focal nodular density in the mid left lung appear similar. No definite new superimposed acute cardiopulmonary findings. Mild COPD.Scoliosis and critical midline structures are otherwise intact and within limits. Postsurgical esophagectomy changes

Output: COPD without superimposed acute abnormalities


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: daily ccu xray, assess interval changes History: HF s/p IABP Cardiomegaly without edema.IABP catheter proximal marker 2 cm below the top of the aortic arch.Left subclavian ICD, leads unchanged in position.Right PICC tip in axillary region.

Output: Stable cardiomegaly without edema. Unchanged tubes and devices.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason for study: Shortness of breath. Evaluate for pneumonia/atelectasis. Interval removal of an endotracheal tube and enteric tube. Improved aeration of the right upper lobe and left retrocardiac space. Left basilar subsegmental atelectasis unchanged. Cardiomediastinal silhouette is normal in appearance.

Output: Interval extubation and removal of enteric tube. Resolving airspace opacities, with residual left lower lobe subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: 70 year old male with sob after coughing. Evaluate for aspiration or pneumonia. Low lung volumes with possible increased left basilar opacity. No pleural effusion or pneumothorax. Cardiomediastinal silhouette unchanged.

Output: Low lung volumes, cannot exclude possible increased left basilar opacity which could be due to aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: FemaleReason for Study: Reason: Leukocytosis, CP History: aboveq Left central venous catheter with its tip at the SVC/RA junction.Cardiac mediastinal silhouette is unremarkable.Lungs are clear.Pleural thickening identified in the right upper hemithorax.

Output: No acute cardiopulmonary abnormalities are identified. No specific evidence of infection. Pleural thickening and nodularity is noted in the right upper hemithorax.