Instruction: Generate impression based on medical findings.

Input: Male, 59 years old, admitted with hypoxia and worsening dyspnea. On chronic steroids for pulmonary fibrosis secondary to amiodarone. Evaluate for worsening fibrosis and infection. LUNGS AND PLEURA: Diffuse bilateral interstitial and groundglass opacities persist, now involving the left upper lobe as well, with some slight interval improvement in basilar opacities. The background of paraseptal and centrilobular emphysema is more prominent, and given the short interval time course, this likely reflects progressive fibrosis and retraction. No airtrapping is seen on the expiration views, and these abnormalities persist on prone positioning. The differential diagnosis continues to include viral and atypical infection, drug or hypersensitivity reaction.MEDIASTINUM AND HILA: Cardiac size is mildly enlarged. No significant pericardial fluid. Aortic and coronary artery calcifications. Calcified subcarinal lymph node probably represents prior granulomatous disease.CHEST WALL: Deformity of T10 on the right compatible with old healed fracture.UPPER ABDOMEN: Splenic calcifications compatible with prior granulomas disease.

Output: Diffuse interstitial and ground glass opacities, slightly improved at the bases. The differential diagnosis continues to include viral and atypical infection as well as drug and hypersensitivity reaction. Progressive retraction and fibrosis is suggested.


Instruction: Generate impression based on medical findings.

Input: 53 years, Male. Reason: Abdominal pain History: above Normal bowel gas pattern no evidence of obstruction. Less than average stool burden. Suture lines left mid abdomen. Ostomy right lower quadrant.Lungs clear. Heart size normal.

Output: No obstruction. Lungs clear.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: ro pna History: admission 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: 51 year old female with lung cancer status post two cycles of chemotherapy. LUNGS AND PLEURA: A large right upper lobe lung mass shows heterogeneous attenuation indicative of necrosis. This measures 10.1 x 6.7 cm (image 47/115). This involves the pleura but there is no pleural effusion. This abuts and deviates the airways on the right. Multiple satellite nodules are identified in the right lung, some of which are confluent with this mass. No nodules or pleural effusions identified on the left.MEDIASTINUM AND HILA: Mediastinal and right hilar lymphadenopathy is present. For reference, a precarinal lymph node measures 3.2 x 1.6 cm (image 47/115). Heart size normal with no pericardial effusion.CHEST WALL: The lung mass appears to involve the pleura with no osseous invasion. There is no axillary lymphadenopathy.UPPER ABDOMEN: While this is an incomplete evaluation of the abdomen, a hypoattenuating lesion in the right lobe of the liver may represent an site of metastatic disease (image 95/115).

Output: Large right upper lobe lung mass representing a site of primary malignancy with possible metastases to the liver.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: eval for signs of volume overload History: eval for signs of volume overload Endotracheal tube terminates approximately 6 cm from the carina. Enteric tube terminates in over the mid mediastinum to the left of midline. Right IJ line, unchanged. Vascular stent in the upper abdomen, again incompletely visualized. Improvement in right basilar atelectasis. Perihilar opacities likely represent mild edema. Left basilar pleuroparenchymal opacity, not substantially changed. Small left pleural effusion. No pneumothorax. Unchanged cardiomegaly.

Output: Improvement in right basilar opacity, likely atelectasis. Perihilar opacities suggestive of mild pulmonary edema. Small left pleural effusion. No pneumothorax. Enteric tube terminates in over the mid mediastinum to the left of midline.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Shortness of breath. Normal heart size. Mild bronchial wall thickening centrally, but no specific signs of pneumonia. No pneumothorax or visible pleural fluid.

Output: Nonspecific mild bronchial wall thickening, but no signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Check pulmonary status. History of right mastectomy and radiation. Asymmetric opacity projecting over the lower right thorax consistent with chest wall soft tissue swelling. Tracheostomy tube and Dobbhoff tube unchanged in position, the Dobbhoff tube may be advanced. No focal airspace opacities. Surgical clips project over the left chest wall and neck.

Output: No acute pulmonary abnormality. The Dobbhoff tube may be advanced.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: MaleReason for Study: Reason: r/o pna History: altered mental status There are decreased lung volumes. Borderline cardiac enlargement.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: 41 year old male with wheezing, history of asthma on continuous neb. Evaluate for pneumonia. No focal airspace opacities. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old. Tip of Swan-Ganz catheter in the main pulmonary artery.Lines are stable. No significant pneumothorax.Stable basilar opacities.

Output: Lines are stable . Unchanging basilar opacities


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: heart block History: heart block Bilateral pleural effusions and left lower lobe opacity consistent with atelectasis, unchanged. No pneumothorax.

Output: Residual small effusions with atelectasis are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old. Shortness of breath. Interval intubation with ETT tip at the left mainstem bronchus orifice.NGT courses through stomach, tip distal to caudal margin of film.Right jugular catheter tip at the cavoatrial junction.Small lung volumes with basilar atelectasis, similar to prior.

Output: Low ETT.Findings communicated over the phone to clinical service, Dr. Gibson, at time of dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old. Febrile, s/p impella and intubation. Monitor hardware, febrile overnight. Evaluate for new infiltrates, recently extubated. Impella device projected in area of left ventricle.Stable cardiomegaly with an ICD.Swan-Ganz catheter tip is not well visualized due to motion but is in the region of the right main pulmonary artery.Bibasilar opacities, greater on the left, suggestive of atelectasis, unchanged. No new focal pulmonary opacity.

Output: Impella device projected in area of left ventricle. Basilar atelectasis. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: r/o infectious etiology History: weakness Unchanged cardiomediastinal silhouette.No focal consolidation, significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Upper back pain Note that the upper thoracic spine is not well seen secondary to overlying anatomy. Radiographs of the thoracic spine are otherwise unremarkable with no findings to account for the patient's back pain.

Output: No specific findings to account for the patient's back pain.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB, elevated WBC count to 16.7 History: SOB Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 46-year-old male with dysphagia. Evaluate for signs of aspiration. No pleural effusions or pneumothorax. Normal cardiac mediastinal silhouette.

Output: No focal pulmonary opacity.


Instruction: Generate impression based on medical findings.

Input: 59 year old female with pancreatic cancer staging 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: A new, subcentimeter hypodense lesion in the right lobe liver image number 81, series number 3 measures 6 mm and suspicious for metastatic disease.SPLEEN: No significant abnormality noted.PANCREAS: Patient's pancreatic body mass, but is seen on coronal images now measures 2.9 x 3.3 cm on image number 46, not significantly changed from previous study. The mass again in a retroperitoneal vessels, causes thrombosis of the splenic vein and obstruction of the duodenum. A metallic stent is noted extending from distal duodenum to proximal jejunum. SMV is also invaded.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Peripancreatic and gastrohepatic nodes are again identified.BOWEL, MESENTERY: Moderate amount of ascites, new. Index node anterior to the jejunum measures 1.3 by 0.9 cm on image number 100, series number 3, not significantly changed. Other mesentery lymph nodes are also grossly unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Previously mentioned septated complex cystic mass arising from ovaries measures 12.6 x 12 cm and is displaced superiorly by the new ascites in the pelvis.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: Moderate amount of the ascites.

Output: Interval development of a new ascites and subcentimeter hepatic lesions suspicious for metastatic disease. Other findings are stable.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with abdominal pain, nausea, vomiting. 38-pound weight loss. CHEST:LUNGS AND PLEURA: Scattered micronodules bilaterally. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: Multiple unenlarged mediastinal lymph nodes. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Well-defined hypoattenuating focus adjacent to the fissure for the falciform ligament likely represents a perfusion defect. Hepatic and portal vasculature are patent. No intra- or extrahepatic biliary ductal dilatation.Cholecystectomy clips.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic right kidney containing subcentimeter renal stones.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the descending aorta.BOWEL, MESENTERY: Approximately 15 cm distal to the expected location of the ligament of Treitz, there is focal, concentric wall thickening of the small bowel with upstream dilatation of the proximal jejunum, which measures approximately 4.4 cm in caliber. No evidence of free air or adjacent free fluid.Several prominent adjacent mesenteric nodes are noted, with the largest measuring approximately 2.4 x 0.9 cm (series 3, image 96).BONES, SOFT TISSUES: No significant abnormality noted.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: No significant abnormality noted.

Output: Approximately 15 cm distal to the expected location of the ligament of Treitz, there is focal, concentric wall thickening of the small bowel with upstream dilatation of the proximal jejunum. Given that no other lesions are identified, this finding is suspicious for primary adenocarcinoma of the small bowel.Findings were communicated to Dr. Konda (pager: 2866) via telephone at the time of dictation, who states that the patient will be scheduled for enteroscopy.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: vaso-occlussive crisis, assess for signs of acute chest History: as above Unchanged mild cardiomegaly. No large pleural effusion or pneumothorax. No focal pulmonary opacity. No specific evidence of infection, edema, or acute chest. Osseous changes of sickle cell disease.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old. Reason: signs of aspiration History: difficulty swallowing Unchanged cardiomegaly and tortuous aorta.Degenerative disease of the spine.No focal consolidation, significant pleural effusion or pneumothorax.Stable bibasilar streaky opacities, suggestive of scarring/atelectasis.

Output: No acute cardiopulmonary abnormality, without significant interval change. No specific evidence of aspiration.


Instruction: Generate impression based on medical findings.

Input: 37 year-old female with carcinoid syndrome. Please compare to previous. 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: Again noted are innumerable hypodense lesions throughout the liver consistent with metastatic disease. Reference lesion in segment 4 is stable, measuring 1.6 x 1.5 cm (image 60/12 5 on series number 3). This previously measured 1.6 x 1.5 cm. The lesion in segment 6 measures 1.1 X 1.0 cm (image number 96/205, series number 3).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: Lobulated mesenteric mass is unchanged in size measuring 2.5 x 2.0 cm (image 107/205 series 3).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Exophytic masses extending from the uterine wall which likely represent leiomyomas are unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace amount of ascites is unchanged and may be physiologic.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant interval change in the size of the mesenteric mass or reference hepatic lesions.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Chest pain. No pneumothorax or pleural fluid. No focal airspace opacities. Normal heart size. Mediastinum unchanged in appearance allowing for lordotic positioning.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: FemaleReason for Study: Reason: s/p left lobectomy, eval chest tubes History: chest tube Left-sided chest tubes unchanged.Small left apical and left lateral pneumothorax.Stable cardiac enlargement with prominence of the pulmonary arteries.Pulmonary edema and pleural effusions increased from prior exam.

Output: Minimal left-sided pneumothorax. Increasing pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: Pre-kidney transplant evaluation. R/o effusions, r/o cardiomegaly History: Pre-surgical evaluation No significant cardiopulmonary abnormality.Moderate scoliosis.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Cough and fever Mild nonspecific basilar patchy opacities mildly greater on the left with decreased lung volumes. Overall appearance is similar to prior exam and may represent residual scarring with questionable superimposed atelectasis. Again close serial imaging should be considered if symptoms and suspicion persist

Output: Nonspecific basilar scarring and suspected subsegmental atelectasis


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with history of non-Hodgkin lymphoma. CHEST:LUNGS AND PLEURA: Ill-defined left apical nodule, unchanged (series 4, image 13). No new suspicious nodules, masses, or pleural effusions.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.Small SVC thrombus is seen adjacent to the catheter (series 3, image 30), a new finding.CHEST WALL: Right chest wall Port-A-Cath with catheter tip in the right atrium. ABDOMEN:LIVER, BILIARY TRACT: Stable hepatic dome lesion (series 3, image 64).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. Small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.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: No significant abnormality noted.

Output: Stable exam with no evidence of disease recurrence.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: symptomatic bradycardia History: above No focal lung consolidation. No large pleural effusion or pneumothorax. Mild cardiomegaly.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: cough, r/o Pna History: cough, r/o PNA Left jugular dialysis catheter tip in upper SVC.Left lower lobe consolidation with associated pleural effusion may be due to aspiration or pneumonia. Given the patient's age this should be followed to resolution to exclude an underlying neoplasm.

Output: Left lower lobe consolidation with associated pleural effusion may be due to aspiration or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: abd pain, hx of perforated viscous History: abd pain, hx of perf viscous No change in the left retrocardiac opacities.Heart size unchanged.No pneumothorax.Interval extubation.No radiographic evidence of free intraperitoneal air.

Output: 1. No radiographic evidence of free intraperitoneal air2. No change in left retrocardiac opacities


Instruction: Generate impression based on medical findings.

Input: Female with anal squamous of carcinoma, needs baseline imaging CHEST:LUNGS AND PLEURA: 10-mm nodule in the lingula image number 40, series number 8. Left lower lobe air peripheral scarring.MEDIASTINUM AND HILA: Subcentimeter mediastinal lymph nodes, nonspecific. A reference pretracheal lymph node measures 9 mm number 24, series number 8.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: 16mm enhancing round, exophytic lesion in the anterior aspect of the midpole of the right kidney consistent with renal cell carcinoma. Multiple other subcentimeter lesions in both kidneys are too small to characterize. No obvious enhancement is noted in the small lesions.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Perianal stranding, more prominent anterolaterally on the right side.

Output: Subcentimeter mediastinal lymph nodes. Lingular 1 cm nodule suspicious for metastatic disease.Small enhancing lesion in the right kidney highly suspicious for renal cell carcinoma. Other subcentimeter lesions in both kidneys are too small to adequately characterize.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: Intubated, ?pneumonia, assess tube position and LLL infiltrate History: see above Patchy left base opacity suggestive of infection or aspiration, unchanged.Heart size normal. ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.

Output: No change in support devices or left basilar opacity suggestive of aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: sob History: above Right lower hemithorax anterior pleural mass seen on prior CT, but no evidence of acute edema or pneumonia.Heart size normal.

Output: Right pleural mass projects over the right lower lung zone, without acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Intubation. Endotracheal tube tip 6 cm above the carina. Right subclavian central venous catheter at mid SVC. Enteric tube has been advanced.Multifocal airspace opacities are not significantly changed. Probable trace effusions.

Output: Multifocal airspace opacities are not significantly changed.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: r/o infiltrate History: hx of cough, shortness of breath Large lung volumes consistent with COPD.No specific evidence of infection or edema.Heart size normal.

Output: COPD, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.History of shortness of breath with right lung opacity. There is persistent, near complete opacification of the right hemithorax. Mild left lower lobe airspace opacities appear stable.

Output: 1.Complete opacification of the right hemithorax compatible with patient's known, large tumor.2.Stable, mild left basilar opacities probably related to aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Intubated, evaluate for effusion. Endotracheal tube tip 5-cm above the level of the carina. Small left pleural effusion. Improvement in the coarse interstitial abnormality seen previously, though it has not resolved. Left superior mediastinal contour abnormality nonspecific and may reflect lymphadenopathy or vascular ectasia.ETT cuff measuring 28-mm in transverse dimension, correlate with desired degree of inflation.A small caliber right jugular catheter terminates at the level of the right clavicular head.

Output: Slight improvement in reticulonodular pulmonary opacities nonspecific but suggestive of diffuse aspiration bronchiolitis. Superior mediastinal widening on the left poorly assessed and may be secondary to lymphadenopathy or vascular ectasia, recommend correlation with erect PA and lateral chest radiographs when feasible, KAK, MANISHA (2488) notified via text page at a: 15 a.m. on 4//2015..


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: CF with exacerbation History: increased cough/mucus Right IJ Mediport remains unchanged.Partially obscured cardiac silhouette is stable.Grossly unchanged extensive chronic changes of cystic fibrosis with mid and upper lung predominant bronchiectatic changes and mucous plugging. Persistent blunting of the costophrenic angles. No pneumothorax.

Output: No significant change in chronic lung disease compatible with cystic fibrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: infectious work-up History: leukocytosis Moderate cardiomegaly with a tortuous aorta.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: is there an infiltrate History: cough and chills Large lung volumes consistent with COPD, with mild to moderate cardiomegaly.No evidence of edema or pneumonia.Internal fixation hardware lower cervical spine with degenerative abnormalities.

Output: COPD, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 30-day-old former 25-26 week gestational age patient with pneumothorax. Respiratory failure and desaturations.VIEW: Chest AP (one view) 11/17/15, 1852 Endotracheal tube tip is below thoracic inlet. Feeding tube tip is in stomach with side ports in lower esophagus. Two right chest tubes remain in place. Right upper extremity PICC has its tip in right atrium.Soft tissue edema is increasing.Right pneumothorax is slightly smaller with anteromedial and subpulmonic components.Opacities are present in the lungs right greater than left. Cardiac silhouette size is upper limits of normal.

Output: Decrease in size of right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: ett History: ett NG tube tip in stomach. ET tube tip 6 cm above carina.Persistent basilar consolidation with pleural effusions.

Output: ET tube tip 6 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: r/o new pna History: leukocytosis, cough Feeding tube extends inferiorly off the field-of-view. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: assess ETT advanced 3cm, please assess History: as above ET tube tip approximately 4 cm above the carina, repositioned.Other devices, pulmonary opacities and cardiomegaly are unchanged.

Output: ET tube repositioned, the tip now 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: SOB, vent and transitioning to trach ET tube tip approximately 2 cm above the carina.Feeding tube tip in the gastric antrum.Mild perihilar and lower zone opacities compatible with aspirated secretions.No pneumothorax or other acute change.

Output: Mild perihilar and lower zone nonspecific opacity compatible with aspiration and infection, not significant changed.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Left subclavian ICD, leads unchanged in position.No pneumothorax.No acute abnormality.Right jugular catheter, tip in SVC.A Dobbhoff tube terminates in the stomach.

Output: Left subclavian single chamber ICD, without placement complication.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: swan, check placement History: see above Right jugular Swan-Ganz catheter, tip very far peripherally in the right lower lung zone, which can lead to infarction or damage to the pulmonary artery.The lungs are unremarkable otherwise.Mild/moderate cardiomegaly noted.

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


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: S/P MVR History: Chest tubes and Pacer wires now removed Chest tubes removed with no pneumothorax.Unchanged multifocal atelectasis and small pleural effusions.Median sternotomy with persistent cardiomegaly.

Output: No pneumothorax following chest tube removal. Unchanged multifocal atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: abnormality History: cough Small lung volumes.Nonspecific pulmonary opacities consistent correspond to patchy groundglass seen on a follow-up CT.No significant sized pleural effusions.Heart size normal.

Output: Patchy pulmonary opacities suggestive of aspiration or atypical edema.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.History of heart failure with preserved ejection fraction here with shortness of breath. There is been interval removal of the Swan-Ganz catheter and stable appearance a mitral valvular clip and Amplatz occluder device. Cardiomegaly stable. No pneumothorax. Interval increase in bilateral pleural effusions and interstitial edema.

Output: Interval increase in bilateral pleural effusions and interstitial edema with stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: TLC placement History: TLC placement Right IJ catheter terminates in the SVC. Left sided PICC is unchanged.Stable cardiac silhouette status post median sternotomy and aortic valve replacement.Mild interstitial edema again seen. Low lung volumes with bibasilar opacities, likely representing atelectasis. Trace bilateral pleural effusions unchanged. No pneumothorax.

Output: Right IJ catheter terminates in the SVC.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: pna History: respiratory distress Right basilar opacity suggestive of infection with a right pleural effusion.

Output: Right lower lobe pneumonia with a right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: s/p DHT placement - evaluate position History: Dysphagia Cardiomegaly, unchanged.Diffuse interstitial and airspace opacities appear similar to prior. Right greater than left pleural effusions are unchanged. No pneumothorax.Interval placement of Dobbhoff with tip at the level of the GE junction. Median sternotomy wires are intact. Residual contrast material is present within the partially imaged colon.

Output: 1. Interval placement of Dobbhoff tube with tip at the level of the GE junction. Recommend advancing by 5 cm prior to use.2. CHF not significantly changed from prior.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: eval for ETT placement History: cardiac arrest Interval placement of endotracheal tube which overlies the mid trachea, localized approximately 3.2 cm above the carina. Enteric tube coursing below the diaphragm, with sidehole overlying the GE junction. Advancement is recommended.Gaseous distention of the proximal intrathoracic and cervical esophagus is noted.Global cardiomegaly, signs of pulmonary venous and arterial hypertension.Asymmetric heterogeneous opacities suggestive of alveolar pulmonary edema.Trace bilateral pleural effusion is also noted. No pneumothorax.

Output: Adequate position of ET tube.Recommend advancement of enteric tube to ensure sidehole position below the GE junction.Signs of asymmetric alveolar pulmonary edema and trace bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Fluid overload. Check for failure Underlying predominant interstitial abnormality seen in both bases with superimposed atelectasis and/or scarring. Mildly decreased volumes. Overall appearance is likely represents chronic interstitial change however minimal edema cannot entirely be excludedPersistent borderline cardiomegaly and tortuosity of the aorta is exaggerated by mild scoliosis and rotationQuestionable chest tube and/or drainage catheter projects over the left upper quadrant, and/or less likely the lung base.

Output: Questionable mild edema, please see details and the limitations described


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: PNA? History: white count Focal opacity right lung base atypical in appearance for infection. Bone suppression images suggest another opacity lateral to the right hilum.No significant pleural effusion identified.Heart size normal.

Output: Right basilar opacity atypical in appearance for infection although this is most likely cause. A thoracic CT is recommended for follow-up, however. This was communicated through stat consult.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: ETT placement ETT 2.5 cm above the carina.Dobbhoff tube tip projects over the distal gastric body.Right internal jugular catheter tip at the cavoatrial junction.Unchanged diffuse bilateral airspace opacities and elevation of the right hemidiaphragm.Stable obscuration of the cardiomediastinal silhouette.No pneumothorax.

Output: ETT 2.5 cm above the carina. Extensive bilateral airspace opacities again compatible with pulmonary edema, infection, or hemorrhage, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old. Status post left CT removal. Evaluate for effusion and pneumothorax. History: s/p MVR, TVR, CABG Interval removal of left chest tube without significant pneumothorax. Right chest tube is unchanged.Basilar opacities consistent with small pleural effusions and underlying atelectasis/edema, unchanged.Left PICC tip in the left subclavian vein, unchanged.

Output: Interval removal of left chest tube without significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old. Reason: sp extubation History: none Interval removal of ET tube and NG tube. Right IJ central venous catheter, tip near the cavoatrial junction. Drain overlying the right lung base, unchanged in position. Surgical clips overlying the left chest and upper abdomen.Cardiomegaly. Low lung volumes. Persistent basilar predominant pulmonary opacities, compatible with effusions and atelectasis. Increasing peripheral left upper lobe opacity.

Output: Increasing left-sided airspace opacities may reflect aspiration. Additional basilar opacities, compatible with effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old. CHF and SWAN in place. Assess volume status and positioning. Cardiomegaly with mild pulmonary edema, not significantly changed though less nodular in appearance in the right upper lung zone.Right jugular Swan-Ganz catheter tip in the main pulmonary artery, unchanged.Left ICD, unchanged.

Output: CHF, unchanged.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female status post chemotherapy for uroepithelial cancer CHEST:LUNGS AND PLEURA: Stable micronodules.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: Left renal calcification which represents AtheroCath a chores stone. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Borderline enlarged lymph nodes are unremarkable. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Status post cystectomy. Ileal conduit is unremarkable.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: Fever Persistent left basilar atelectasis and/or scarring without additional new cardiopulmonary abnormality

Output: Atelectasis without specific findings to suggest pneumonia


Instruction: Generate impression based on medical findings.

Input: Reason: dyspnea History: see above Heart size about upper normal.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Rule out pneumothorax. Shortness of breath. History of lung transplant. There may be a small loculated air collection at the apex versus shift of layering fluid with patient now in the correct position. Short-term follow-up suggested. Asymmetric lung volumes with diffuse opacities in the transplanted lung similar to prior, likely the result of chronic rejection. In the native emphysematous left lung, reticular opacities in the base appear worse and there is new perihilar groundglass opacity.

Output: Indeterminate finding which could reflect a loculated pneumothorax or pneumatocele at the lung apex, probably visible due to shift in pleural fluid in the erect position. Short-term follow-up suggested, preferably with inspiration and expiration films if feasible. Worsening opacity in the left lung may be infectious or inflammatory.


Instruction: Generate impression based on medical findings.

Input: Clinical information PULMONARY VASCULATURE: Bilateral lower lobe segmental pulmonary emboli that extend into subsegmental arteries (series 8, images 110 and 131). LUNGS AND PLEURA: Focal scarring located medially in the right posterior lower lobe adjacent to degenerative vertebral osteophyte.MEDIASTINUM AND HILA: Upper normal heart size. There may be a small amount of calcification in the left anterior descending coronary artery.CHEST WALL: Degenerative changes of the spine.UPPER ABDOMEN: No significant abnormality noted in partially visualized liver, spleen, and right kidney. Small hypoattenuating left renal cortical lesion incompletely evaluated (series 8, image 226), too small to characterize.

Output: Bilateral lower lobe segmental pulmonary emboli that extend into subsegmental arteries.Findings discussed with Dr. Cifu at 15:10.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: IABP placement, to be done 12/8/15 History: none Status post median sternotomy.Small lung volumes with questionable edema.No specific evidence of infection.Impella device removed.Left jugular Swan-Ganz catheter, tip in interlobar pulmonary artery. Right PICC placed, tip just entering the subclavian region.Left subclavian ICD, leads unchanged in position.IABP not clearly identifiable although it placed the proximal marker may be 3 cm below the top of the aortic arch.

Output: Impella device removed, no other change.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Cough and fever. The lungs are slightly better inflated currently. Cardiomegaly with mild diffuse interstitial pattern suggesting edema is stable. Previously questioned small right pleural effusion not visualized currently.

Output: Cardiomegaly with mild edema pattern, stable. No focal consolidation or significant effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: extubation, rule out pneumothorax History: as above Nonspecific basilar opacities could be edema or aspirated secretions.No pneumothorax.Status post extubation and NG tube removal.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: shortness of breath History: see above Right jugular catheter tip in SVC.Cardiomegaly with pulmonary edema and pleural effusions.

Output: Cardiomegaly with pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Respiratory failure evaluate for interval change. Left upper lobe nodular airspace opacity unchanged. Left lower lobe airspace opacity appears more linear and scarlike on the current examination. Pleural fluid and atelectasis on the right slightly worse.Retrocardiac consolidation on the right persists.

Output: Multifocal airspace opacities suspicious for pneumonia. Right pleural fluid collection slightly larger.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Chest tube. Tracheostomy tube tip above the carina. Enteric tube extends below the diaphragm out of field of view. Right central venous catheter tip in the right atrium. Left upper extremity PICC tip in the SVC. Patient is status post sternotomy. Pigtail drain projects over the right upper quadrant. Multilevel vertebroplasty and IVC filter is unchanged.Cardiomediastinal silhouette is unremarkable. Bilateral patchy pulmonary and interstitial opacities without significant interval change. Left pleural effusion.

Output: Bilateral patchy pulmonary interstitial opacities without significant change. Left pleural effusion unchanged.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: eval lung fields History: cp Moderate cardiomegaly. No specific evidence of infection or edema.

Output: Moderate cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: new opacity in R L History: new opacity in R L LUNGS AND PLEURA: Spiculated nodular right upper lobe pleural-based opacity measuring 15 mm x 18 mm (image 27 series 5).No additional suspicious pulmonary nodules or masses.No pleural effusion.Moderate upper lobe predominant centrilobular emphysema.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of pericardial effusion.Moderate aortic calcification.CORONARY ARTERY CALCIFICATION: None. CHEST WALL: Degenerative changes in the thoracic spine.Status post median sternotomyUPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.

Output: Pleural based right upper lobe spiculated nodule suspicious for primary neoplasm.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: retching, nausea (baseline), with new L sided CP and SOB this morning History: CP, nausea, SOB Mildly decreased lung volumes.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: cp History: cp Mild cardiomegaly.Small pleural effusions, and chronic appearing elevation right hemidiaphragm.Possible basilar edema.Right jugular catheter tip at cavoatrial junction.

Output: Cardiac megaly with small pleural effusions suggestive of CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: preop aortic valve surgery History: SOB Cardiomediastinal silhouette is normal. Mild bibasilar scarring/atelectasis. No specific evidence of infection or edema. Increased lung volumes compatible with COPD

Output: No acute cardiopulmonary abnormality. Mild bibasilar scarring/atelectasis. Increased lung volumes compatible with COPD.


Instruction: Generate impression based on medical findings.

Input: Reason: pt intubated w/ aspiration pna, eval placement of tube History: ams ET tube tip approximately 3 cm above the carina.Catheter tip in the SVC. Mild left basilar opacity compatible with aspirated secretions, unchanged.

Output: Findings compatible with mild left basilar aspiration with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: LLung opacity , unclear History: sob The left hemithorax remains nearly opacified with primarily left effusion.Worsening patchy right lower lung zone opacities suggestive of infection or aspiration.An NG tube extends below the lower margin of the image.

Output: Partial opacification left hemithorax and increasing airspace opacity right lung base suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 21 yearsGender: FemaleReason for Study: Reason: is there an infiltrate History: cough. earaches, sore throat The cardiomediastinal silhouette is unremarkable.Left basilar consolidation compatible with pneumonia.The right lung is clear.No pleural effusions.

Output: Left lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: r/o PNA, pleural effusion History: SOB, fever, hypoxia Heart size upper normal.Mild interstitial opacities with pleural effusions consistent with edema more likely than pneumonia.

Output: CHF with pulmonary edema and pleural effusions. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o acute process including infection History: r/o acute process including infection Moderate cardiomegaly with evidence of previous median sternotomy. Catheter in the left anterior chest wall with its proximal tip in the subcutaneous tissues and its distal tip in the SVC. This has apparently fractured at its proximal end and has been unchanged since at least a CT scan of 4/1/2015.Left lower lobe nonspecific airspace opacity with a component of atelectasis, not significantly changed since earlier exams dating back to 10/30/2014, and better shown on the CT scan of the previous day.

Output: Focal left lower lobe atelectasis and consolidation, unchanged from earlier exams. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: Rule out pneumonia History: cough Dilated loops of small bowel are again noted.There are multiple healed right rib fractures.The cardiomediastinal silhouette is stable and normal.Chronic elevation of the right hemidiaphragm is again seen.Reticular perihilar interstitial opacities are improving from the prior examination without definite septal lines or large pleural effusions.

Output: 1.Improving reticular perihilar interstitial opacities suggestive of resolving edema or bronchial wall thickening.2.Partially visualized dilated loops of small bowel suggestive of obstruction.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with history of metastatic renal cell cancer CHEST:LUNGS AND PLEURA: Index right lower lobe lesion measures 8-mm in diameter image number 78 on series number 5, stable. Index left lower lobe mass measures 2.9 by 2 cm image number 69, series number 5, not significantly changed. Other pulmonary nodules are also stable.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Again noted multiple hypodense lesions in the liver. Index left lobe lesion measures 3.2 by 2.7 cm in image number 92, series number 4, not significantly changed from previous study.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Prominent gastrohepatic node is unchanged on image number 97, series number 4. Index left aortic node measures 1.4 x 1 cm on image number 119, series number 4. Other retroperitoneal lymph nodes are alsoBOWEL, MESENTERY: Multiple prominent mesentery lymph nodes appear 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: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Hemoptysis and fever assessment for pneumonia. Moderate pleural effusions with associated atelectasis, about the same. Retrocardiac opacity on the left nonspecific and could represent infection, but has been unchanged over multiple prior films and is more likely to represent atelectasis based on the appearance. Faint bronchial wall thickening at the right lung base unchanged from the most recent prior film. Surgical staples project over the upper abdomen.

Output: Moderate pleural effusions with associated atelectasis, but no new findings to account for the patient's hemoptysis. Note is made of bronchial wall thickening which is new from remote earlier films; although this is a nonspecific finding it could indicate bronchitis or be the result of aspirated blood products in the right lower lobe.


Instruction: Generate impression based on medical findings.

Input: 49 year-old female with metastatic breast cancer CHEST:LUNGS AND PLEURA: Bilateral metastatic lung nodules. Index nodule in the left upper lobe measures 13 x 12 mm image number 34 series Number 4.MEDIASTINUM AND HILA: Mediastinal component of the chest wall mass measures 7.1 by 5.7 cm, image number 38, series number 3. This mass is in the right anterior/superior mediastinum.Additional mediastinal adenopathy is present. Precarinal enlarged lymph node measures 15 x 13 mm image number 33, series number 3.CHEST WALL: Left supraclavicular neck chronic metastatic adenopathy measuring 17 x 18 mm image number one, series number 3. Other supraclavicular and subcutaneous metastatic lesions are also present in the superior anterior chest wall.Large necrotic mass in the right chest wall extending to the midline invading the sternum, right sided superior ribs and mediastinum measures 10.9 x 5.5 cm in image number 23, series number 3. Multiple other subcutaneous metastatic nodules are also present.ABDOMEN:LIVER, BILIARY TRACT: Extensive metastatic hepatic lesions. A large lesion replacing most of the right lobe of the liver measures 15.7 x 12.6 cm on image number 76, series number 3. Another very large, exophytic lesion is present in the left lobe. Numerous other metastatic lesions are also present. Large exophytic left lobe metastases compresses the proximal stomach and causes dilatation of the esophagus. This mass also displaces the pancreas inferiorly and posteriorly.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: Compression of the proximal stomach by the hepatic metastases and dilatation of the esophagus. Ill-defined enhancing soft tissue masses within the small bowel, mesentery, measuring 3.9 x 4 cm, image number 123, series number 3. These cannot be differentiated from the surrounding small bowel loops and are consistent with metastatic mesenteric and small bowel deposits.Multiple additional metastatic mesentery nodules are present. Small amount of ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Partial thrombus in the left common iliac vein. Left internal iliac vein is completely thrombosed. Small amount of ascites. Generalized anasarca.

Output: Extensive metastatic disease in bilateral lungs, mediastinum, and the liver.Bilateral supraclavicular and multiple subcutaneous metastatic lesions.Chest wall mass invades into the mediastinum, and pleura.Compression of the stomach by the large hepatic metastatic lesion causing is esophageal dilatation.Multiple mesenteric and small bowel metastases. A small amount of ascites.Partial thrombus of the left common iliac vein and complete thrombosis of the internal iliac vein.Oncology intern on call, Dr. Verma was notified at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Chest pain question pneumonia. Normal heart size. No pneumothorax or pleural fluid. No focal airspace opacities.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Abdominal pain right upper quadrant and fever. History of melanoma. Sternal wires and postsurgical signs of coronary revascularization.The low lung volumes. No focal air space opacities or pleural fluid. No pneumothorax. Healed rib fracture deformities on the right.Multiple loops of air-filled bowel in the upper abdomen, please refer to separately reported same date abdominal CT.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with history of gist tumor. CHEST:LUNGS AND PLEURA: Biapical scarring. Multiple stable micronodules are seen in lungs, particularly along the right major fissure, not significantly changed.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Several stable hypodense subcentimeter lesions in the liver.SPLEEN: No significant abnormality noted.PANCREAS: Stable subcentimeter cystic patient in the pancreatic tailADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable parapelvic renal cysts.RETROPERITONEUM, LYMPH NODES: Soft tissue adjacent the celiac trunk is unchanged.BOWEL, MESENTERY: Soft tissue the density to the left off the midline is stable in size and measures 1.8 x 0.9 cm number one at 22, series number 3. Partially calcified soft tissue density in the left lower quadrant measures 2.9 x 2.7 cm and coronal images, image number 36/74. This lesion was more medial on the previous study on image number 141, series number 3 has not significantly changed in size.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right adnexal cystic lesion is stable measuring 3.9 x 2.5 cm image number 117, series number 3. Calcification anterior to this lesion is also stable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change in the above-described lesions.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: sob History: sob No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Diffuse pulmonary opacities. Probable right pleural effusion within the major fissure. Normal heart size. No pneumothorax.

Output: Diffuse prominent opacities most consistent with pulmonary edema. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 89 years old. ET tube tip approximately 3 cm above the carina. Right jugular catheter tip in the upper right atrium and left jugular catheter tip in the SVC.Pacemaker leads and feeding tube unchanged.Bilateral nonspecific airspace opacity and pleural effusions without significant interval change.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: on ECMO, eval lung fields History: as above Support devices unchanged with Swan-Ganz catheter tip in the pulmonary artery.No evidence of a pneumothorax.Stable cardiac enlargement.Perihilar/basilar opacities are compatible with edema.Left retrocardiac consolidation/atelectasis small pleural effusion similar to the prior exam.

Output: Support devices unchanged. Stable cardiopulmonary appearance with cardiomegaly, edema/atelectasis, and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: eval mediastinum History: dizzy with palpitations No significant cardiopulmonary abnormality.Healed granulomatous disease.Coronary stents or calcifications.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with pneumonia. Evaluate ET tube placement. ET tube tip is approximately 3 cm above the carina. Enteric tube projects inferiorly beyond the visualized field-of-view. Central venous catheter tip at the SVC/RA junction. Cardiomegaly, bilateral pleural effusions and bilateral lower lung airspace opacities, unchanged.

Output: ET tube in acceptable position. Stable cardiopulmonary appearance with pleural effusions and diffuse edema.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: FemaleReason for Study: Reason: s/p cardiac surgery History: SOB Chest/mediastinal tubes and been removed.Right Swan-Ganz catheter with its tip in the pulmonary artery.Persistent right apical pneumothorax unchanged.Stable cardiomediastinal silhouette.No new pulmonary opacities identified.

Output: Chest/mediastinal tubes removed. Persistent moderate-sized right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: chest tube placement History: same Left apical pneumothorax, slightly increased now measuring 3.1 cm compared to 1.9 cm previous study. Left-sided subcutaneous emphysema again noted. Left basilar pleural drain/chest tube again noted.

Output: Small left apical pneumothorax, slightly increased.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: eval swan History: Status post Swan-Ganz placement. No acute abnormality.Left jugular Swan-Ganz catheter, tip in right main pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: No acute abnormality. Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: Please rule out asthma exacerbation. Low lung volumes. Mediastinal silhouette is stable. No focal pulmonary opacity. No pleural effusion or pneumothorax.Borderline cardiomegaly, however partially exaggerated due to technique

Output: Low lung volumes without superimposed acute cardiopulmonary abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Check IABP Mild cardiomegaly with otherwise clear lungs. IABP marker projects into the aortic arch unchanged. ICD also unchanged.

Output: IABP marker projects into the aortic arch


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: Rule out infiltrate History: mild chest pain, ketoacidosis The heart size is within normal limits. No pneumothorax or pleural effusion.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: 71 year-old female with unresectable cholangiocarcinoma CHEST:LUNGS AND PLEURA: Interval developed on the for pleural-based nodule in the left lower lobe measuring 8 x 7 mm on image number 80, series number 5. Small right pleural-based nodule in the right lower lobe is unchanged.MEDIASTINUM AND HILA: Portacatheter with its tip in the SVC.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Pneumobilia is unchanged. Previously described hypodense lesion in the right lobe of the liver is unchanged measuring 1.3 x 0.9 cm on image number 107, series number 3. Metallic stent in the common bile duct is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic pancreas is unchanged.ADRENAL GLANDS: Bilateral adrenal nodules are stable.KIDNEYS, URETERS: Presumed renal cysts are stable.RETROPERITONEUM, LYMPH NODES: Peripancreatic adenopathy is stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Large calcified uterine fibroid is stable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post vertebroplasty changes involving L3 vertebral body, stable.OTHER: No significant abnormality noted.

Output: Interval development of a subcentimeter pleural-based left-sided nodule, otherwise no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old. Reason: Evaluate swan position History: hemodynamic monitoring Swan-Ganz catheter has been advanced, with tip in the right pulmonary artery vasculature.Stable cardiomegaly. No focal airspace opacities. No large pleural effusions. No pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Reason: 50M s/p EGD/EUS with drainage of a necrotic pancreatic fluid collection, check NGT placement History: n/a NG tube doubled back in the stomach.Small lung volumes with basilar nonspecific opacity compatible with atelectasis and effusion, greater on the left.

Output: NG tube looped in the stomach.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: Severe sepsis, rule out pneumonia History: see above Improved aeration at the lung bases with resolved pleural effusions versus 7/2015. No new opacity to suggest pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: desaturation following OLT History: desaturation following OLT The Swan-Ganz catheter has been removed. The NG tube has been removed. Left IJ tip terminates in the left brachiocephalic vein.Slightly increased small right pleural effusion with associated atelectasis. There is persistent elevation of the right hemidiaphragm. The left lung remains well aerated. The cardiac and mediastinal contours are unchanged. No pneumothorax. The right upper quadrant surgical drains and clips in place.

Output: Slightly increased small right pleural effusion with associated atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Assess for infection patient with V. tach. Left subclavian ICD with coils in projection of the left brachiocephalic vein and straddling the right atrium/right ventricle near the midline. No pneumothorax. No focal airspace opacities to suggest pneumonia. Eventration of the right hemidiaphragm.

Output: No visible signs of pneumonia or other acute


Instruction: Generate impression based on medical findings.

Input: 78-year-old male, evaluate lines/tubes/devices Interval removal of right Swan-Ganz catheter. Tracheostomy tip unchanged. Left internal jugular central venous catheter tip overlies the distal left brachycephalic vein. Other support devices unchanged. Unchanged bilateral interstitial edema, atelectasis and layering pleural effusions. Stable cardiomediastinal silhouette.

Output: Bilateral interstitial edema, atelectasis and layering effusions unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old. Reason: eval for PNA. History: above Interval removal of ET tube.Enteric tube with side-port just below the GE junction.Mild cardiomegaly, unchanged.Mild basilar subsegmental atelectasis, unchanged. No large pleural effusion or pneumothorax.Status post median sternotomy.

Output: Unchanged basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: 69M with h/o lung ca, DVT, DM p/w SOB, abd pain History: SOB, abd pain Port catheter terminates at the cavoatrial junction. Mild right-sided pleural thickening again noted. No pneumothorax. Right hilar opacity again noted. No new focal lung consolidation. Unchanged heart size. No acute bony abnormality.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: FemaleReason for Study: Reason: cardiopulmonary process History: 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.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: evaluate for pneumonia vs pulmonary edema History: worsening hypoxemia, right sided heart failure, GI bleed Cardiomegaly with large central pulmonary arteries consistent with PA hypertension.Lower lung zone predominant moderate interstitial opacities with small pleural effusions are suggestive of edema.Right jugular catheter tip at SVC/artery junction level.

Output: CHF with cardiomegaly and moderate pulmonary edema, without specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female 66 years old Reason: 66 yo f w/ h/o latent tb s/p treatment, OSA, ?IPF?, GERD who presents w/ hypoglycemia, fevers, chills History: fevers, chills, rigors - eval for e/o TB, infection Examination slightly limited by grid artifact.Streaky basilar opacities suggest mild atelectasis.Left hilar granuloma.No pleural effusion or pneumothorax.Cardiomediastinal silhouette is normal.

Output: Left hilar granuloma may reflect prior tuberculosis infection as suggested clinically, but no evidence of acute infection or fibrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out chest metastasis History: hx of renal cell carcinoma, sp partial nephrectomy Unremarkable cardiac and mediastinal silhouette.Bilateral breast prostheses.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: is there an infiltrate History: left pleuritic chest pain No significant cardiopulmonary abnormality.No specific evidence of infection.No significant pneumothorax.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for opacity, fevers History: as above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: rule out chest metastasis History: hx of renal cell carcinoma Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No sign of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 52 years old Male. Reason: chf, eval for interval change History: see above. Severe emphysematous changes are seen, predominantly in the upper lungs with probable large bullae. Linear densities are seen in the lung bases, which are consistent with the scars or atelectasis. There is no evidence of acute infiltrate or pleural effusion or pneumothorax.

Output: Stable severe upper lobe predominant emphysema with probable large bullae.


Instruction: Generate impression based on medical findings.

Input: Reason: assess RLL for infection; pt with a week of increasing RUQ pain History: upper abd pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Intubation ETT remains 4 cm above the carina, mildly retracted. NG tube well-positioned.Underlying cardiopulmonary appearance remains suspicious for patchy streaky densities greater in the left lung base, possibly aspiration

Output: ETT well-positioned


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: Eval for pulmonary edema. History: SOB w/ hx of CHF. No significant edema. No focal opacities to suggest pneumonia. Borderline heart size.

Output: Borderline heart size but no significant pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: eval for edema History: SOB, hx of CHF Is borderline cardiac enlargement increased from the prior exam.Prominence of pulmonary arteries are compatible pulmonary material hypertension.No focal airspace opacities.Subtle increased interstitial opacity suggesting mild interstitial edema.No pleural effusions.

Output: Mild interval increase in cardiac size with prominence of the pulmonary arteries. Questionable very mild interstitial edema.


Instruction: Generate impression based on medical findings.

Input: Fever Interval right jugular triple Hickman placed, tip at least in the mid SVC. No additional postprocedural complicationNo underlying cardiopulmonary abnormality

Output: Right jugular triple-lumen Hickman placed


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: FemaleReason for Study: Reason: pulmonary edema History: hypoxia, sob Interval increasing cardiac size with mild/moderate cardiac enlargement.The lungs are clear.No pleural effusions.

Output: Increasing cardiac size without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: s/p congenital heart surgery; History: SOB Sternal wires remain well aligned.Trace residual right hydropneumothorax. Mid to lower zone opacities of subsegmental atelectasis with small left pleural effusion. Heart size remains enlarged.

Output: Trace residual right pneumothorax. Mid to lower zone opacities of subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: eval progression of R sided infiltrate History: SOB, intubated ET tube tip approximately 3 cm above the carina.NG tube tip in the stomach.Moderate elevation of the left hemidiaphragm with overlying subsegmental atelectasis.Interval clearing of diffuse right lung opacity and volume loss consistent with atelectasis.

Output: Interval clearing of right lung atelectasis.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female, evaluate chest nodule seen on clinical exam by outside study and evaluated returns and/or metastatic disease CHEST:LUNGS AND PLEURA: Biapical scarring. No lung nodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Multiple sub-centimeters lesions in the liver likely representing benign hamartomas are unchanged.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: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: s/p esophagectomy History: NA Right chest tube with a small pneumoperitoneum, unchanged.Mild basilar atelectasis.An NG tube traverses a gastric pull-up.

Output: Postop pneumoperitoneum. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: eval lung fields History: s/p MVR Iatrogenic devices are unchanged. New small left pneumothorax. Small left-sided pleural effusion. Resolution of small right pneumothorax. No focal lung consolidation. Unchanged heart size.

Output: New small left hydropneumothorax. Resolution of small right apical pneumothorax. Repeat imaging is suggested today to exclude growth. This unexpected finding was discussed with Dr. Elizabeth Martin at 9:15 AM on day of study.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: evaluate LVAD cannula positioning, please ensure the entire LVAD is visible, tube feed view History: s/p LVAD implant Severe cardiomegaly status post sternotomy for LVAD placement.Bilateral pleural effusions and basilar subsegmental atelectasis noted.LVAD and ICD are unchanged in position.Right PICC removed.

Output: Unchanged LVAD and ICD.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: trached, positive blood cultures History: same Left lower lobe consolidation and left pleural effusion consistent with pneumonia.Heart mildly enlarged.Healed granulomatous disease noted.Tracheostomy tube, the tip at the level of the thoracic inlet.Right PICC, tip in axillary region.

Output: Left lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old. Palpable areas of concern in the abdomen and chest. Chest: Single echogenic focus in the subcutaneous tissues of the left chest measures 1.5 x 1.4 x 0.5 cm with minimal internal vascularity.Abdomen: Echogenic focus in the subcutaneous tissues in the right abdomen below the costal margin measures 0.8 x 0.8 x 0.3 cm. No significant internal vascularity.Echogenic focus in the subcutaneous tissues in the left abdomen below the costal margin measures 1.1 x 0.5 x 0.6 cm. No significant internal vascularity.

Output: Three palpable sites in the subcutaneous tissues in the chest and abdomen have sonographic appearances which are favored to represent lipomas.


Instruction: Generate impression based on medical findings.

Input: Ventilator dependent patient Overall improved aeration with otherwise decreased lung volumes greater on the right. Underlying diffuse edema-like changes in both bases with cardiomegaly and layered pleural effusions greater on the right again observed. Tracheostomy tube terminates 8 cm above the carina

Output: Decreasing suspected pulmonary edema with an appearance similar to earlier on 5/27/15


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with history of metastatic breast cancer. CHEST:LUNGS AND PLEURA: Stable biapical radiation fibrosis. MEDIASTINUM AND HILA: Reference AP window node (series 3, image 26) measures 1.8 x 1 cm; right hilar lymph node measures 1.7 x 1.1 cm (series 3, image 32). Both reference nodes are relatively unchanged to mildly decreased in size accounting for differences in technique.CHEST WALL: Right chest Port-A-Cath with catheter tip in right atrium. Patient is status post mastectomy and multiple surgical clips are seen in the left axilla.ABDOMEN:LIVER, BILIARY TRACT: Interval increase in metastatic lesions. While the reference lesion (series 3, image 79) measures 3.1 x 1.5 cm and is relatively decreased in size on comparison to prior study, multiple new lesions are identified within the liver. For reference, one new lesion in the right hepatic lobe measures 2.3 x 1.9 cm (series 3, image 77).The portal and hepatic vasculature remain patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable scarring and parenchymal calcification of the right kidney.RETROPERITONEUM, LYMPH NODES: Multiple enlarged retroperitoneal lymph nodes are identified (series 3, image 113).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse osseous metastases, many of which are new. T12 compression fracture appear stable.PELVIS:UTERUS, ADNEXAE: Status post hysterectomyBLADDER: No significant abnormality noted.LYMPH NODES: Small pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right hip prosthesis. Diffuse osseous metastases.

Output: Interval progression of disease with increasing hepatic and osseous metastases as well as new retroperitoneal lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: post thoracentesis History: sob, hypoxemia No substantial change in bibasilar pleural-parenchymal opacities. Improvement in left pleural effusion. Unchanged cardiomegaly. No pneumothorax. Unchanged left PICC in the left axilla.

Output: No substantial change in bibasilar pleural-parenchymal opacities. Improvement in left pleural effusion. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: HF EF 10% History: SOB Severe cardiomegaly. No evidence of pulmonary edema or large effusions.

Output: Severe cardiomegaly with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old.Reason: PNA v URI History: SOB The cardiomediastinal silhouette is normal. No pulmonary opacity, no pleural effusion, no pneumothorax.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Chest pressure, chest pain. Normal cardiomediastinal silhouette. No focal airspace opacities, pleural fluid or pneumothorax.

Output: Normal chest.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: r/o increasing pleural effusions History: previous thora Unchanged pleural effusions and basilar atelectasis left worse than right.No significant pneumothorax.Right jugular catheter, tip in SVC.

Output: Unchanged pleural effusions and left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 50 yearsGender: MaleReason for Study: Reason: IABP placement History: IABP placement Right-sided ICD BP marker unchanged.Decreased lung findings stable cardiac mediastinal silhouette.The lungs are clear.

Output: Support devices unchanged with IABP marker in the aortic arch.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with apical lung abnormality seen on cervical spine MRI. Follow-up suggested by radiology. CHEST:LUNGS AND PLEURA: 5-mm left lower lobe nodule (series 4, image 81). Linear left lower lobe scarring. No suspicious mass or pleural effusions identified. Specifically, no abnormality is seen at the right lung apex as suggested by recent cervical spine MRI.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Severe calcifications of the left coronary and LAD arteries.Heterogeneously enhancing thyroid gland likely represent nodules in both lobes.CHEST WALL: Degenerative changes of the spine. UPPER ABDOMEN: Atherosclerotic disease of the aorta.

Output: 5-mm left lower lobe nodule. Given that no prior exam is available for comparison, follow-up CT should be considered at 12 months to confirm stability in a low risk patient. If the patient has a smoking history, however, a follow-up CT may be considered in 6-12 months.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.CVA The cardiomediastinal silhouette is within normal limits. No focal consolidation, pneumothorax, or effusion.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: 47-year-old female with chest pain. History of PE. Rule out PE. CHEST:PULMONARY VASCULATURE: No acute pulmonary embolus. Pulmonary webs are seen in left lower and right upper segmental pulmonary arteries, consistent with resolving emboli on prior study. Current study is diagnostic to the level of the segmental arterial branches.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: No significant abnormality noted. UPPER ABDOMEN: Low-density lesion is again seen in the right hepatic lobe and remains too small to characterize.

Output: No acute pulmonary embolus. Residua from prior emboli are identified as above. Current study is diagnostic to the level of the segmental arterial branches.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung volumes History: vent status ET tube tip approximately 4 cm above the carina.Catheter tip in the SVC.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.Interval clearing of right upper lobe opacity.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 76 years old Female. Reason: patient with history of hypersensitivity pneumonitis and restrictive lung disease presenting with recurrent pneumonia History: SOB, cough and hypoxemia. Review of the patient's old pathology reports indicated the history of neurofibromatosis. Significant respiratory motion artifact limits evaluation of the study.LUNGS AND PLEURA: Left lower lobe consolidation is suggestive of pneumonia, aspiration or compressive atelectasis. Hypoinflation of the left lung with elevation of the left hemidiaphragm is noted. Mosaic attenuation and scattered groundglass opacities throughout the lung are poorly evaluated due to significant respiratory motion artifact but are compatible with reported history of hypersensitivity pneumonitis. Left upper lobe non-solid pulmonary nodule is seen on image 22 of series 5 and raises the question of lung malignancy and was not seen on previous scans. Recommend follow-up CT in 6 months to confirm stability.Pleural-based mass in the right lower lobe most likely represents a neurofibroma given the patient's history of neurofibromatosis.Stable right upper lobe micronodule. Additional pulmonary nodules there has been followed on prior scans are not delineated on the current scan due to respiratory motion artifactMEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Kyphoscoliosis with severe compression fractures of T5, T8, and T12 and moderate compression fractures of T7 and L1. Numerous skin nodules are consistent with neurofibromatosis.UPPER ABDOMEN: Cholelithiasis with no evidence of cholecystitis.

Output: 1.Left lower lobe consolidation and atelectasis compatible with aspiration and infection.2.Left upper lobe non-solid pulmonary nodule new since previous scans. Recommend follow-up CT in 6 months to confirm stability.3.Kyphosis with severe compression fractures.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o acute chest History: CP, SOB Heart size about upper normal.Mild basilar interstitial opacity, likely chronic with a focal horizontal opacity at the right costophrenic angle which may be due to scarring, atelectasis or impacted bronchi. The chronicity of this finding is uncertain.No specific evidence of pneumonia.

Output: Small focal opacity at the right costophrenic angle of uncertain chronicity. No specific evidence of acute airspace disease.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: FemaleReason for Study: Reason: assess for PTX History: assess for PTX Less than ICD and right IJ venous catheter unchanged.Stable cardiomediastinal silhouette.Basilar atelectasis and small effusions similar to the prior exam.No pulmonary opacities identified.No pneumothorax identified.

Output: Stable cardiopulmonary appearance with mild basilar atelectasis and small effusions. No evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Prekidney transplant end-stage renal disease rule out cardiomegaly rule out infiltrates. Moderate multichamber cardiomegaly. Pulmonary vascular redistribution but no convincing evidence of pulmonary edema. No pleural fluid. No focal airspace opacities.

Output: Moderate cardiomegaly with signs of hypervolemia but no convincing evidence of pulmonary edema or other acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p adjusting central line History: see above Interval adjustment of right jugular catheter with its tip in the SVC.Bilateral lower zone nonspecific airspace and interstitial opacities with small pleural effusions, not significantly changed.Large lung volumes consistent with COPD.

Output: Interval adjustment of right jugular catheter.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: r/o infection prior to starting TNF History: r/o infection Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural abnormality.

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


Instruction: Generate impression based on medical findings.

Input: Elbow pain. Motor vehicle collision. Elbow: No radiographic abnormality. Specifically no evidence of fracture dislocation. No effusion.Chest: No cardiopulmonary abnormality

Output: Normal exam


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: Confirm ETT History: as above The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.ET tube in place with its tip 5 cm above the carina.

Output: ET tube with the tip 5 cm above the carina. No acute cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Reason: neutropenic fever. evaluating for source History: fever Small lung volumes with no sign of pneumonia.Multiple expansile rib lesions consistent with known multiple myeloma.Catheter tip in the SVC.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: hypoxia History: above Small lung volumes with diffuse fine reticular opacities compatible with fibrosis, unchanged.Stimulator device in the spinal canal.

Output: Chronic interstitial disease with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Injury, chest pain Cardiomediastinal silhouette is normal. No large pleural effusion or pneumothorax. No specific evidence of infection or edema.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung s/p right pneumectomy History: eval lung Extensive opacification of the right hemithorax with an irregular air collection superiorly, compatible with loculated air and fluid not significantly changed from previous.Tracheostomy tube and venous catheters unchanged.Opacity in the left lower lung suggestive of edema and, atelectasis and effusion.

Output: Extensive bilateral abnormalities as described with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: fever. postop from neck flap. r/o pna History: fever. postop from neck flap. r/o pna Small lung volumes with increased focal opacity suggestive of atelectasis.Tracheostomy tube tip approximately 5 cm above the carina.

Output: Increased focal opacities more suggestive of atelectasis than pneumonia, but could be aspiration or mucous plugging related.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p LVAD History: LVAD Moderate cardiomegaly with interstitial edema and small pleural effusions, unchanged.Cardiopulmonary monitoring and support devices, unchanged.

Output: CHF with no significant change.


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: FemaleReason for Study: Reason: post op, eval lung fields History: s/p AVR Support devices unchanged with ET tube tip 2 cm above the carina.No evidence of pneumothorax.Stable cardiac enlargement with evidence of aortic and mitral valve prostheses.Bilateral pulmonary opacities and probable small pleural effusions similar in appearance to the prior exam.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: ro pneumothorax History: tachypnea, hx of pneumothorax Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Left upper lobe sutures.No significant pneumothorax.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: cough History: cough Marked cardiomegaly.Catheter tip in the SVC.Elevated left hemidiaphragm with overlying nonspecific opacity compatible with atelectasis and scarring, unchanged over the past 3 days.Diffuse emphysema.

Output: COPD and increased opacity at the left base consistent with atelectasis as shown on a recent abdominal CT scan. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: eval mediastinum, effusion/PTX, hx of PE History: vomiting, severe chest pain rad to back No significant cardiopulmonary abnormality.Contrast material in the renal collecting systems as from a recent CT.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: 64 M s/p minimally invasive esophagectomy now w chest pain History: chest pain, SOB Gastric pull-up.Increasing basilar opacities suggestive of edema and atelectasis with pleural effusions.Right jugular catheter, tip in SVC.

Output: Increasing basilar opacities suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: neutropenic fever with progressive hypoxia, please eval for interval progression; concern for ARDS History: as above Mild perihilar interstitial opacities suggestive of aspiration or atypical infection.Heart size upper normal.

Output: Perihilar interstitial opacities suggestive of atypical infection including viral etiologies and pneumocystis, or aspiration.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 77 yearsGender: MaleReason for Study: Reason: left MPE s/p pleurX History: MPE Left-sided chest tube unchanged.Volume loss in the left lung with pleural thickening/effusion and basilar atelectasis similar in appearance to the prior exams.Nodular opacity identified on the lateral view most likely in the superior segment left lower lobe unchanged.The right lung is clear.

Output: No interval change in the left pleural thickening/effusion and basilar atelectasis. No acute cardiopulmonary abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Reason: Leukocytosis, SOB History: as above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 80 yearsGender: MaleReason for Study: Reason: left pleural effusion History: dyspnea Left pleural effusion slightly decreased from the prior exam.Small right pleural effusion noted.Stable cardiomediastinal silhouette.The lungs are clear..

Output: Bilateral pleural effusions left greater than right with slight interval decrease on the left. No evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: H/o PTX s/p subclavian line placement now s/p basilar and apical chest tubes. Evaluate PTX History: pneumothorax, tachycardia Lines and tubes are unchanged. Left-sided pneumothorax is difficult to evaluate due to overlying structures but appears smaller and certainly is not bigger. No substantial change in bibasilar pleural-parenchymal opacities.

Output: Lines and tubes are unchanged. Left-sided pneumothorax is difficult to evaluate due to overlying structures but appears smaller and certainly is not bigger.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Abdominal pain and bloating No acute intrathoracic process. Gaseous distention of proximal colon. No small bowel obstruction. No free air

Output: No acute intrathoracic process. Gaseous distention of proximal colon; a distal obstructing lesion cannot be completely excluded. No small bowel obstruction. No free air.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: eval picc line placement History: as above Mild left base subsegmental atelectasis and small left pleural effusion are unchanged.Heart size normal.Left PICC, tip at cavoatrial junction.Right jugular catheter, tip in SVC.

Output: Left basilar atelectasis and left pleural effusion unchanged.New left PICC.


Instruction: Generate impression based on medical findings.

Input: Female 26 years old Reason: assess pneumothorax History: pneumothorax with clamped chest tube The right pleural catheter tip remains directed towards the right lung apex.There has been significant interval increase in size of a right apical pneumothorax, now measuring up to approximately 2.6 cm.There is no focal consolidation or pleural effusion evident.The cardiac and mediastinal contours are within normal limits for size.

Output: Significant interval increase in size of the right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: r/o PTX or evidence of pulmonary contusion History: chest pain s/p Ped vs. Auto Moderate cardiomegaly unchanged.Mild interstitial opacities suggestive of edema are stable.Right jugular catheter, tip in SVC.

Output: Cardiomegaly and mild interstitial opacities suggestive of edema although there are no pleural effusions. Underlying chronic interstitial disease may be present which could be evaluated by interstitial lung disease CT. No evidence of traumatic injury or pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: Evaluate for fluid collection History: Chest pain, shortness of breath Large right pleural effusion or hemothorax, based on provided history. The aerated right upper lobe demonstrates subsegmental atelectasis. The left lung is clear. No pneumothorax present.

Output: Large right pleural effusion or hemothorax, extending to the mid one half of the right hemithorax.


Instruction: Generate impression based on medical findings.

Input: Patient with new onset confusion. Check for infection Moderate streaky densities observed in both lung bases suggesting subsegmental atelectasis with a questionable small right effusion versus scarring. Upper lungs otherwise remain clear.Improved cardiac silhouette with decreased contour size however borderline cardiomegaly remains suggested. Midline sternotomy.

Output: Basilar atelectasis without definite associated discrete airspace opacity suggesting pneumonia. Serial imaging however is needed to confirm given patient history


Instruction: Generate impression based on medical findings.

Input: Reason: ET tube moved back by 1cm History: ET tube manipulated ET tube about 2.5 cm above the carina.Catheter tip in the SVC.Cardiomegaly, pleural effusions and underlying airspace opacity, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: eval infection, edema, effusion History: sob, DOE Cardiomegaly. Nonspecific basilar opacities likely edema and atelectasis. Small bilateral pleural effusions

Output: Cardiomegaly. Nonspecific basilar opacities likely edema and atelectasis. Small bilateral pleural effusions


Instruction: Generate impression based on medical findings.

Input: Desaturation. Hypoxemia. Question pneumonia. Elevation of the right hemidiaphragm; the lung parenchyma in the right costophrenic angle is obscured and cannot be accurately assessed. Basal atelectasis on the left. The remainder of the lungs are clear. Surgical clips project over the chest wall in the axillary regions bilaterally. Normal heart size.

Output: No visible signs of pneumonia however the right costophrenic angle region is obscured due to diaphragmatic elevation and if there is a high level of clinical suspicion for pneumonia, erect PA and lateral chest radiographs would be suggested.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: Evaluate for infiltrate, pulm edema History: pulmonary edema Interval improvement in pulmonary edema. Other findings stable.

Output: Interval improvement in pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 37 year-old female with carcinoid syndrome. 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: Again noted innumerable hypodense lesions throughout the liver consistent with metastatic disease. Reference lesion in segment 4 measures 1.5 x 1.6 cm image number 68, series number 4. The lesion in segment 6 measures 10 x 10 mm image number 97, series number 4.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: Lobulated mesenteric mass measures 2.5 x 1.9 cm on image number 107, series number 4.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 significant change in the size of the mesenteric mass. Minimal interval decrease in the size of the hepatic metastases.