Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: eval for change, line position History: R upper neck pain, lines not flushing Left IJ line is unchanged terminating over the expected location of the SVC but horizontally oriented. This could be abutting the lateral margin of the vein and could be pulled back slightly with repeat flush attempted. Increase in diffuse pulmonary opacities. Pleural effusions, as before. Bibasilar opacities, unchanged. Unchanged cardiomegaly. No pneumothorax.

Output: Left IJ line is unchanged terminating over the expected location of the SVC but horizontally oriented. This could be abutting the lateral margin of the vein and could be pulled back slightly with repeat flush attempted. Increase in pulmonary edema. Small pleural effusions with bibasilar opacities, likely atelectasis, again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Medical clearance. Pain in left thigh. Mild cardiomegaly. No focal airspace opacities or pleural fluid. No pneumothorax. Cervical spine hardware incompletely visualized.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for lesions History: s/p OLT for HCC in December 2104 Unremarkable cardiac and mediastinal silhouette. Catheter tip in the right atrium.Mild chronic blunting of the right posterior costophrenic angle, unchanged.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: uveitis, r/o lung pathology History: none No acute cardiopulmonary abnormality. No change versus previous study.

Output: No acute cardiopulmonary abnormality, and no evidence of sarcoidosis.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Shock. Status post BiVAD. ECMO cannulae similar in position. Left jugular Swan-Ganz catheter tip projects over the right main pulmonary artery. Left chest tube unchanged in position.Dense left paramediastinal collection extending over the lung apex increased in volume.Pleural fluid on the right and edema and atelectasis bilaterally about the same.

Output: Enlarging left paratracheal opacity suspicious for mediastinal and extrapleural hematoma. SCHURLE, ALAN (1145) verbally notified at 9:58 AM on 5/18/2016.


Instruction: Generate impression based on medical findings.

Input: Fatigue and weakness No acute cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: f/u pleural effusion s/p TPC History: effusion Interval marked decrease in the right pleural effusion. Interval placement of right chest tube. No pneumothoraxRight IJ central venous line unchanged.Mediastinal and left upper zone masses are unchanged and consistent with patient's malignancy.Cardiomediastinal silhouette is unchanged.Mild pulmonary edema.

Output: Marked interval decrease in the right pleural effusion. Interval placement of right chest tube. No pneumothorax. Mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Surgery and removal of lap pads.VIEW: Abdomen AP (one view) 12/21/16, 1224 and 1226 The laparotomy pads have been removed. Four drains are identified, three on the right and one on the left. An enteric tube has its tip in the stomach. A small amount of bowel gas is seen. Cooling/heating pad obscures detail.

Output: No unexpected retained foreign object.These findings were discussed by telephone with Dr. Choksi, the attending surgeon, on 12/21/16 at 1235.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: eval for SOB History: sarcoid, SOB No new focal lung consolidation. No substantial change in pulmonary fibrosis, upper lung preponderant consistent with given history of sarcoidosis. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: r/o pna History: chest pain , cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: Swan in place History: Fluid overload HF Small lung volumes with nonspecific basilar subsegmental atelectasis.Right jugular Swan-Ganz catheter tip directed towards the right upper lobe. Left subclavian ICD, leads unchanged in position.

Output: Swan-Ganz catheter unchanged. Low lung volumes.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: worsening pneumonia History: SOB, recent pneumonia dx The cardiomediastinal silhouette is normal. Previously noted right basilar opacity is markedly improved. No pleural effusion, no pneumothorax.

Output: No acute cardiopulmonary disease. Interval near complete resolution of previously noted right basilar opacity.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, 65 years old.Reason: eval for infiltrate or pneumonia History: heart failure Right-sided PICC terminates near the cavoatrial junction. No focal lung consolidation. No large pleural effusion or pneumothorax. Moderate cardiomegaly.

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


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: ? fevers History: SOB Unchanged position of left upper extremity PICC tip in the SVC. Stable cardiomediastinal silhouette.Interval development of bilateral pleural effusions left greater than right and basilar atelectasis.Status post cholecystectomy.

Output: Bilateral pleural effusions and basilar opacities likely postsurgical in etiology.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: sob History: sob Cardiomegaly with basilar opacity suggestive of edema and left lower lobe consolidation.Small pleural effusions are seen.

Output: CHF with cardiomegaly and pulmonary edema. Retrocardiac consolidation most likely is compressive atelectasis rather than infection.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for fluid around lungs History: s/p chest tube Moderate residual left pleural effusion, probably partially loculated.Underlying opacity compatible with atelectasis.Small right effusion unchanged.Catheter tip in the SVC.No pneumothorax.

Output: Residual pleural effusions but no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: IABP check Unchanged IVP marker without change in the right PICC line terminating in the mid SVC. A new right jugular sheath terminates in the upper SVC without apparent postprocedural complicationIncreasing mild to moderate CHF, see subsequent report

Output: Increasing CHF


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: concern for PNA History: cold symptoms for 3 weeks, productive cough, crackles throughout lungs Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Heart size again at the upper limit of normal. Rightward mediastinal shift of the trachea at the level of the thoracic inlet consistent with thyroid mass.

Output: No acute cardiopulmonary process on radiography. Large thyroid mass again noted. Appropriate workup is suggested given the patient's young age which makes benign incidental thyroid lesions less likely.


Instruction: Generate impression based on medical findings.

Input: Reason: Fever, SOB; evaluate for PNA History: as above Moderate cardiomegaly with a tortuous and ectatic aorta, not significantly changedallowing for differences in projection. No evidence of CHF or pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 48 years old Male. Reason: eval for resolution of PTX s/p initiation of BIPAP History: as above. Stable bilateral pleural effusions and bibasilar consolidation as well as the bilateral interstitial changes. Tracheostomy tube, left Port-A-Cath are stable in position. There is no evidence of new pneumothorax.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: sp MV repair. Status post mitral valvuloplasty. Endotracheal tube 6 cm above the level of the carina. Two right internal jugular central venous catheter. Two right chest tubes, one of the chest tube side ports is outside the pleural space. Bilateral lower lobe and perihilar focal opacities suggestive of aspiration or pulmonary contusion. No significant pneumothorax.

Output: Right chest tube side port outside the pleural space. Unchanged bilateral opacities suggestive of pulmonary contusion or aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: FemaleReason for Study: Reason: 75 year old female with fluid overload, hypoxia, please evaluate lung fields History: hypoxia Stable mild cardiac enlargement.Diffuse interstitial opacities right pleural effusion and basilar atelectasis similar in appearance the prior exam.No new pulmonary opacities identified.

Output: CHF without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: Pneumonia, edema History: chest pain and shortness of breath The heart size is normal. Unremarkable cardiomediastinal silhouette. No focal pulmonary opacities, pleural effusion, or pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: 63 y/o M with dermatomyositis, aspiration pna, interval change History: sob Residual atelectasis in the right lower lung zone, or resolution of prior pulmonary opacities.No specific evidence of infection or edema.Heart size normal.

Output: Resolution of prior pulmonary opacities with only residual subsegmental atelectasis in the right lower lung zone.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with respiratory failure and abdominal distention. CHEST:LUNGS AND PLEURA: Small bilateral pleural effusions are seen, greatly improved on the left. Bilateral lower lobe consolidations are identified, and mildly increased on the right. Underlying ground-glass opacities with septal thickening are compatible with underlying edema. Patchy consolidation in the posterior aspect of the right upper lobe has developed, suggestive of aspiration. The left chest tube has been removed and exchanged for one which terminates in the medial aspect of the left apex. Patchy lingular consolidation is identified along the course of the prior chest tube.Endotracheal tube is identified.MEDIASTINUM AND HILA: The heart size is enlarged. A small pericardial effusion is noted. Mitral valve prosthesis. Left ventricular assist device are noted. A small amount of hypodense material is identified within the proximal aspect of the outflow graft, which can be related to a combination of streak artifact, blood/contrast mixing and/or thrombus.Shotty mediastinal nodes are noted.CHEST WALL: ICD and sternotomy changes are noted.ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy clips.SPLEEN: No significant abnormality.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Incidental note of a circumaortic left renal vein.RETROPERITONEUM, LYMPH NODES: Surgical clips are identified in the para-aortic region.BOWEL, MESENTERY: No evidence of obstruction is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Ascites is noted, mild. A 11.4 x 3.6 cm fluid collection is noted where the power catheter attaches to the LVAD pump. This collection is located within the peritoneumPELVIS: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: Small bilateral pleural effusions, greatly improved on the left. Patchy right upper lobe consolidations, likely related to aspiration. Persistent bilateral lower lobe air space disease.Fluid collection within the anterior peritoneum surrounding the site of the attachment of the power catheter to the LVAD pump, likely seroma.A small amount of hypodense material is identified within the proximal aspect of the outflow graft, which can be related to a combination of streak artifact, blood/contrast mixing and/or thrombus.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: fever History: fever Cardiomegaly with redistribution of the pulmonary blood flow.No specific evidence of infection or edema.Median sternotomy.Right jugular catheter, tip in SVC.

Output: Cardiomegaly, without acute edema which has resolved since the prior study.


Instruction: Generate impression based on medical findings.

Input: Rule out lymphoproliferative disorder. Autoimmune hemolytic anemia. CHEST:LUNGS AND PLEURA: Mild emphysema involving the right upper lobe. Linear atelectasis at lung bases.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without biliary dilatation.SPLEEN: Not visualized.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral extrarenal pelvis and mild caliectasis of the right kidney which may be secondary to mild UPJ obstruction.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild right UPJ obstruction causing mild right caliectasis. No evidence of enlarged lymph nodes in the chest abdomen and pelvis.Splenectomy.


Instruction: Generate impression based on medical findings.

Input: Postextubation. Wheezing Motion degrades sensitivity.Right jugular catheter placed with minimal kinking and questionable tip placement. Tip is obscured by overlying lower cervical spine fixation. Please see subsequent report

Output: Right jugular catheter placed with questionable positioning and lead tip placement


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and chest pain left-sided No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Chest pain No cardiopulmonary abnormality

Output: NormalI 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, 74 years old.Intubation assess ETT Endotracheal tube terminates about 4 cm above the level of the carina. Low position of right jugular catheter, overlying the right atrium.No pneumothorax.Basal atelectasis.

Output: ETT tip 4 cm above carina. Basal atelectasis consistent with aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: 68 years old Male with history of urothelial CA, status post left nephrectomy, evaluate for recurrence of disease. Lack of intravenous contrast limits evaluation of solid organs, lymph nodes, and vessels.CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Heterogeneous left thyroid gland with calcific foci.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver without mass or ductal dilatation. Of note fatty liver significantly decreases the sensitivity of none enhanced CT for the evaluation of metastatic disease.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nonspecific right adrenal mass, unchanged.KIDNEYS, URETERS: Status post left nephrectomy. The left nephrectomy site remains clear with continued decreased conspicuity of postoperative soft tissue infiltration. Stable right renal cyst.RETROPERITONEUM, LYMPH NODES: Stable reactive portacaval lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 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 noted

Output: 1- No evidence for metastatic process given the limitations of this exam (lack of IV contrast and fatty liver). 2- Fatty infiltration of liver without mass or ductal dilatation, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: evaluate for asthma changes other pathology History: chronic cough x 3 months Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: chest tube History: chest tube Left subclavian AICD and right chest tube unchanged.Subcutaneous emphysema near the entry site of the right chest tube in the right lateral chest wall.Nonspecific right upper lobe opacity.Right-sided volume loss is redemonstrated.No pneumothorax.Stable cardiomediastinal silhouette.

Output: Stable support devices and right upper lobe nonspecific opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old. Right jugular catheter tip in the SVC with no pneumothorax or other complications.ET tube tip approximately 4 cm above the carina.Chronic interstitial fibrosis in the right native lung and mild hazy opacity at the left base suggestive of effusion and underlying atelectasis.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: eval for edema History: SOB, post arrest Severe cardiomegaly and pulmonary arterial hypertension.No specific evidence of infection or edema.

Output: Severe cardiomegaly and pulmonary arterial hypertension, but no sign of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: MaleReason for Study: Reason: infection History: syncope There are decreased lung volumes.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: s/p TECAB History: s/p TECAB Cardiac silhouette is again mildly enlarged.No focal consolidation, sizable effusion or pneumothorax.

Output: Cardiomegaly with no radiographic evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: swan ganz in place History: swan ganz in place Moderate to severe cardiomegaly.No specific evidence of infection or edema.Right jugular Swan-Ganz catheter tip in right interlobar pulmonary artery.Left subclavian ICD, leads unchanged in position.Left PICC, tip in axillary region.

Output: Cardiomegaly without acute edema. No change in support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old. Left-sided PICC line has been placed with its tip in the right atrium.The cardiomediastinal silhouette is unremarkable.Lungs are clear.

Output: Nipple placement of a left PICC line with its tip in the right atrium.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: post-thoracentesis on L, rule out pneumothorax History: shortness of breath Small left pleural effusion, and streaky opacities in the left retrocardiac region either scarring or bronchial wall thickening.Heart size normal.No significant pneumothorax.Bilateral chest wall resections.

Output: No significant pneumothorax. Small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o PNA History: SOB, wheezing Unremarkable cardiac and mediastinal silhouette. Moderate perihilar bronchial thickening, compatible with asthma and bronchitis.No sign of pneumonia.

Output: Bronchial thickening with no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: 165days s/p sct w/ persist ant cough with hx of RSV and pneumonitis History: productive cough Port catheter terminates just above the cavoatrial junction. Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography. If symptoms continue, chest CT is suggested.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: IABP History: IABP IABP marker in the proximal descending aorta, unchanged in position. Support devices are unchanged. Unchanged cardiomegaly. Vascular redistribution without evidence of frank pulmonary edema. Persistent left retrocardiac atelectasis.

Output: IABP marker in stable position. Cardiomegaly and vascular redistribution without evidence of frank pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: CHF, assess swan placement History: CHF, assess swan placement Severe cardiomegaly.No specific evidence of infection or edema.Right jugular Swan-Ganz catheter tip in right main pulmonary artery.Right PICC, tip still in the subclavian.Left subclavian ICD, leads unchanged in position.

Output: Swan-Ganz catheter placement and removal of left jugular line. Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 23 years, Female with a history of Crohn's disease with stricture and vomiting for days. Evaluate for signs of obstruction. Chest: The cardiomediastinal silhouette is unremarkable. There is no abnormal pulmonary opacity, pleural effusion or pneumothorax.Abdomen: Nonobstructive bowel gas pattern with greater than average stool burden in the right colon. Suture material and a T-shaped contraceptive device projected over the mid pelvis.

Output: Nonobstructive bowel gas pattern with greater than average stool burden in the right colon.


Instruction: Generate impression based on medical findings.

Input: Reason: aspiration? History: post op with increased WOB Normal heart size with superior mediastinal widening on the left, compatible with a goiter as previously confirmed by CT, and a surgical clip projected over the left superior mediastinum. Small lung volumes with streaky bilateral basilar opacities compatible with subsegmental atelectasis, secondary to aspiration.No specific evidence of pneumonia.

Output: Streaky basilar opacities compatible with subsegmental atelectasis secondary to aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: chest tube positioning, R-side pneumothorax status History: SOB, CP Right chest tube unchanged, with tip located medially.Right hydro or hemopneumothorax is grossly unchanged.Left lung is clear.Calcified hilar lymph nodes.Stable cardiac mediastinal silhouette.Unremarkable cardiomediastinal silhouette.

Output: No significant interval change in large right hemo or hydropneumothorax. Consider chest tube repositioning.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: evaluate for pulmonary edema History: shortness of breath, missed dialysis Moderate cardiomegaly with pulmonary vascular redistribution.Mild interstitial edema and very small pleural effusions are noted.

Output: CHF/hypervolemia with edema and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with history of gastrointestinal stromal tumor CHEST:LUNGS AND PLEURA: Right middle lobe micronodular stable measuring 3 mm on image number 63, series number 9. No new nodules.MEDIASTINUM AND HILA: Enlarged right lobe of the thyroid with heterogeneous solid appearing nodule is stable. This nodule is amenable for percutaneous biopsy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Subcentimeter cystic lesion in the pancreas best seen on coronal image 59 stable.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Gastrohepatic lymph node is stable measuring 9 x 10 mm on image number 97, series number 7.BOWEL, MESENTERY: Omental nodules are again identified. Index omental nodularity to the transverse colon measures 1.4 by 1.1-cm image number 96, series number 3. Other omental nodules are also stable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable study.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain History: chest pain Heart size about upper normal with pacemaker leads unchanged from previous.No sign of CHF or infection.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old. ] PICC line with its tip in the SVC.Stable or lytic enlargement.Minimal basilar scarring/discoid atelectasis.No focal airspace opacities.No pleural effusions.

Output: ] PICC line placed with its tip in the SVC. Stable cardiopulmonary appearance


Instruction: Generate impression based on medical findings.

Input: 81-year-old female with history of cough and shortness of breath. Requesting second opinion regarding ILD diagnosed by outside M.D. CHEST:LUNGS AND PLEURA: Small amount of interstitial thickening and ground glass opacities at the right lung base is compatible with chronic aspiration or other inflammatory process. No areas of honeycombing identified. No significant air trapping identified.4-mm nodule seen along the minor fissure (series 5, image 42) statistically most likely represents an intrapulmonary lymph node.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Coronary and aortic calcifications. Enlargement of the main pulmonary artery is compatible with pulmonary hypertension.Large left thyroid nodule at the inferior pole (series 3, image 12; series 80220, coronal image 82).CHEST WALL: Degenerative changes of the spine. Surgical clips in the left axilla. Wedge deformity compatible with compression fracture of the L1 vertebral body best seen on sagittal views, of indeterminate age.UPPER ABDOMEN: Moderate hiatal hernia.

Output: Mild interstitial abnormalities in the right lower lobe is compatible with chronic aspiration or other inflammatory process. Findings are not specific for diffuse interstitial lung disease.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: assess volume status History: IABP Cardiomegaly status post sternotomy and valve replacement.Right basilar airspace opacity suggestive of infection or aspiration, with left basilar subsegmental atelectasis and pleural effusions.Right subclavian ICD unchanged.Right subclavian IABP catheter proximal marker 4 cm below the top of the aortic arch.Right jugular introducer.

Output: Lines stable. No change in small effusions and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: 67yr old male with history of MM; pre-auto sct evaluation History: evaluate Calcified granulomas at the lung bases. No focal lung consolidation. Heart is at the upper limit of normal. No pleural effusion or pneumothorax. Aortic atherosclerosis.

Output: Stigmata of previous granulomatous disease.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: intubated ET tube tip approximately 2 cm above the carina. Other devices unchanged.Left subclavian ICD, leads unchanged in position. Diffuse opacity compatible with edema with pleural effusions and basilar atelectasis, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: hx pleural effusion s/p thora at OSH; eval for effusion, infiltrates History: as above Left hemidiaphragm elevation with overlying atelectasis.No reliable evidence of infection or edema.No obvious pleural effusion.

Output: Left hemidiaphragm elevation with overlying atelectasis.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with history bladder and prostate cancer. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Multiple calcified mediastinal lymph nodes. No enlarged mediastinal or hilar lymphadenopathy. Mediastinal postsurgical changes are noted.Unchanged aortic dissection extending into the origin of the left subclavian artery.CHEST WALL: Sternotomy changes.ABDOMEN:LIVER, BILIARY TRACT: There is a small nonspecific hypoattenuating foci in the dome of the right lobe liver, which is unchanged. No other focal lesions. The gallbladder is normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Thoracoabdominal aortic section and terminating just below the level of the right renal artery and above the level of the left renal artery, with extension into the origin of the superior mesenteric artery. This finding is unchanged compared to MRI on 9/16/11.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Surgically absent. Neobladder is in place. Penile prosthesis with reservoir in the left anterior abdominal wall. LYMPH NODES: There is a 1.3-cm soft tissue density in the right pelvis (series 3, image 168) which may represent a cystic lymph node or a lymphocele.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. No evidence of metastatic or recurrent tumor.2. New right pelvic nodule, which may represent a lymphocele or a cystic lymph node. 3. Unchanged thoracoabdominal aortic dissection originating at the level of the left subclavian artery, extending down to the level of the renal arteries.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: r/o pna History: chest pain, wheezing, sob Interval resolution of small effusions. Mild basilar interstitial opacities likely representing edema.Stable cardiomegaly with ICD leads, unchanged.

Output: Mild interstitial opacities likely representing mild edema.


Instruction: Generate impression based on medical findings.

Input: Age: 43 yearsGender: FemaleReason for Study: Reason: Etiology of pleuritic chest pain History: Tachycardia, tachypnea Left apical opacity significantly reduced in size from the prior exam.Stable cardiomediastinal silhouette.Elevation of the left hemidiaphragm again noted.The right lung is clear.Right central venous catheter with its tip in the SVC.No pleural effusion.No pneumothorax.

Output: No acute cardiopulmonary abnormalities identified. Significant interval reduction in the left apical opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: Hypercapnea History: Hypercapnea Mild cardiomegaly with small lung volumes.Mild left lower lobe opacity compatible with aspirated secretions and atelectasis.No specific evidence of pneumonia or CHF.

Output: Mild nonspecific left lower lobe opacity, accentuated by under inflation.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: Eval for pneumothorax, s/p chest tube removal History: s/p CABG Iatrogenic devices have been removed except for the cardiac pacer leads. No significant pneumothorax. Slight increase in right basilar opacity, likely atelectasis. Left basilar pleuroparenchymal opacity, not substantially changed. Unchanged heart size.

Output: No significant pneumothorax. Slight increase in right basilar opacity, likely atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.SOB, known end-stage lung cancer. Question pneumonia. Right chest port and sternotomy hardware unchanged.No signs of pneumonia. Scarring in the upper lobes bilaterally.The right anterior sixth rib tip appears somewhat dense, this can be assessed on the patient's next scheduled CT

Output: No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT placement? previously in R-mainstem History: see above Interval reexpansion of the left lung with partial residual atelectasis.ET tube tip at the level of the carina. Catheter tip in the SVC.Moderate pleural effusions.An NG tube terminates in the stomach.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: intubated History: as above Basilar opacities suggestive of infection or aspiration are unchanged.Small lung volumes.ET tube tip approximately 2 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.

Output: Stable basilar opacities and support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: lung infiltrate History: fever; CLL s/p chemo Findings the mediastinal and hilar adenopathy seen on the CT study of 1/14/15 are not easily appreciated on plain radiographs.Bilateral basilar opacities likely represent atelectasis from hypoinflation.The mid and upper lung zones are clear of airspace and interstitial opacities. Cardiac silhouette within normal limits.No pneumothorax.

Output: The mediastinal and hilar adenopathy seen on CT study of 1/14/15 are not easily appreciated on plain radiograph.Bibasilar opacities likely representing atelectasis


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: 27M history of testicular Ca, assess for pulmonary mets History: as above 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: Male, 31 years old.Reason: Infiltrates History: fever No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: evaluate for infectious process History: cough x 4 weeks, weight loss, dyspnea No acute cardiopulmonary abnormality.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Headache. Evaluate shunt placement. SHUNT DEVICE: The notch of the pressure valve is questionably adjusted with the notch at the 4:00 position, previously at the 3-3:30 position. A VP shunt exits the skull via left frontal burr hole and courses down the left scalp, neck and anterior chest wall concerning the abdomen and terminating in the pelvis. There is no kinking or discontinuity of the radiopaque portions of the shunt tubing. Also again seen is a spinoperitoneal shunt with its proximal tip is not clearly visualized but is seen descending caudally and again exits the spinal canal at L1-L2. It courses along the right flank before entering the abdomen though its position is slightly changed in the abdomen with its tip now terminating in the right lower quadrant. There is no kinking or discontinuity of the radiopaque portions of the shunt tubing. The notch of the pressure valve point is similar to the prior study. An orphaned shunt tube is again noted intracranially.SKULL: No additional abnormalities.CERVICAL SPINE: No significant abnormality noted.CHEST: No significant abnormalities.ABDOMEN: Nonobstructive bowel gas pattern is present. Surgical clips in the right upper quadrant again seen likely reflecting prior cholecystectomy. Orthopedic screws affix the left sacroiliac joint is near anatomic alignment.

Output: VP and LP shunts as described above without evidence of shunt complication in the radiopaque portions of the shunt tubing.


Instruction: Generate impression based on medical findings.

Input: Reason: cardiopulm eval History: as above Marked cardiomegaly with a tortuous ectatic aorta.Perihilar and basilar opacities compatible with edema, atelectasis and small pleural effusions.

Output: CHF with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated for hypoxic respiratory failures History: hypoxia ET tube tip about 7.5 cm above the carina and NG tube tip in the gastric fundus.Large lung volumes suggest COPD with left lower lobe consolidation and atelectasis, slightly increased. Right lower lobe airspace opacity, unchanged, compatible with aspirated secretions.

Output: COPD with basilar consolidation and atelectasis suggestive of aspiration and possibly infection.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.AML, fever question infiltrates Right jugular chest port with tip at the SVC level.Patchy atelectasis in the region of the lingula. No focal airspace opacities or convincing evidence of pneumonia.

Output: No specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Shortness of breath. Evaluate position of Swan-Ganz catheter. Swan-Ganz catheter tip terminates in the right main pulmonary artery, slightly retracted compared to the prior exam. Right extremity PICC terminates in the SVC.Persistent basilar predominant interstitial and airspace opacities with small pleural effusions. Cardiomegaly is unchanged.

Output: Swan-Ganz catheter tip in the right main pulmonary artery with pulmonary findings compatible with edema.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female metastatic melanoma. Please measurable lesions in two dimensions particularly right axillary lymph node right subcutaneous chest wall nodule, left dorsal subcutaneous chest wall nodule left anterior chest wall nodule possible. Compared to prior scans 1/4/2008. CHEST:LUNGS AND PLEURA: Punctate nodules in the right upper lobe is stable in size and number.There are new small bilateral pleural effusions.MEDIASTINUM AND HILA: Clusters of nodes in the prevascular space are stable. No evidence of hilar nodes.CHEST WALL: High right axillary node image 24/250 and measures 1.3 x 0.8 cm.Caudal to it is another measured axillary node on image 32/250 and measures 1.3 x 1 cm.The left axilla is normal.Clusters of right cardiophrenic nodes are slightly increased. Previously measured node seen on image 72/215 and measures 1.1 x 0.9-cm.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: There is new massive ascites and extensive solid carcinomatosis in the distribution of the omentum. This pattern is unusual for melanoma correlate clinically as to the possibility of an ovarian neoplasm.The small bowel is intrinsically normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: There is some soft tissue prominence in the distribution of the left adnexa. It is questionable whether this could represent some implants inseparable from the left ovary.BLADDER: No significant abnormality noted.LYMPH NODES: Previously measured index node in the right common iliac artery distribution as seen in image 150/215 and measures 1.5 x 1.3 cm. No new nodes are seen.BOWEL, MESENTERY: Massive generalized ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Progression of disease based on findings of massive generalized ascites and carcinomatosis. Pattern would be somewhat unusual for metastatic melanoma.The lymph nodes are generally stable with measurements as above.


Instruction: Generate impression based on medical findings.

Input: 41-year-old male, moved back 2 cm. Evaluate location of ETT Tracheostomy tube tip in the right mainstem bronchus with near complete opacification of the left lung. No focal airspace opacities in the right lung although the right costophrenic angle is not within the field-of-view.Feeding tube side port above the GE junction.

Output: 1. Tracheostomy tube tip in the right mainstem bronchus with complete opacification of the left hemithorax.2. Feeding tube side port above the GE junction.Findings were discussed by on call radiology resident Dr. Mikin Patel with Dr. Benes by phone on 5/30/2015 at 14:35.


Instruction: Generate impression based on medical findings.

Input: History of resolving bronchiolitis with questionable mass. Please compare to 12/08 and 11/08. LUNGS AND PLEURA: Interval improvement in the bronchiolitis type pattern in the right upper lobe as well as the right hilar opacity. Scattered one to 2-mm micronodules are stable. No new abnormalities are identified.MEDIASTINUM AND HILA: Calcified coronary arteries unchanged.CHEST WALL: Hypodense lesions left lobe of the thyroid are unchanged.UPPER ABDOMEN: Granulomas in the spleen without any other abnormality.

Output: Interval resolution of the previously described bronchiolitis pattern. This abnormality was most likely infectious in etiology.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: CF annual visit History: cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. Little evidence of cystic fibrosis is seen on this chest radiograph.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: please evaluate central placement of PICC line for TPN History: PICC placed Small lung volumes with unchanged interstitial opacities.Left PICC, tip in left brachiocephalic vein at the midline, with a tortuous course

Output: Unchanged interstitial opacities and new PICC placement.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Concern for pneumonia Very low lung volumes. Bilateral basilar bandlike opacities likely represent worsening subsegmental atelectasis.No signs of pleural effusion or pneumothorax in this single AP projection.Surgical clips overlie the right upper quadrant of the abdomen.

Output: No radiographic findings to suggest pneumonia.Worsening bilateral basilar subsegmental atelectasis are noted.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: evaluate for etiology of hypoxemia - metastatic pancreatic cancer, elevated ammonia and obtunded w recent emesis History: hypoxemia, obtunded Right subpulmonic effusion with overlying consolidation unchanged.Minimal subsegmental atelectasis left lower lobe.New Dobbhoff tube, tip in distal stomach, which is gas distended.Status post TIPS.Right jugular catheter, tip in SVC.

Output: Unchanged right subpulmonic effusion with adjacent consolidation.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for acute infiltrate History: cough, recent po diet re-start. Lower esophageal stent in place, unchanged.Left basilar opacity compatible with scarring, atelectasis and consolidation, better demonstrated on a recent CT scan.No new findings.

Output: Left basilar consolidation, with cavitation, confirmed on a recent CT scan, suspicious for persistent esophageal leak and infection.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: eval for opacities or effusions History: congestive heart failure Slight improvement in basilar opacities which may been aspiration or edema.Left PICC, tip in the SVC.Right jugular Swan-Ganz catheter, tip in right main pulmonary artery.IABP catheter proximal marker 3 cm below the top of the aortic arch.

Output: Improving basilar opacities. No new findings except for Swan-Ganz catheter placement.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: S/P TECAB History: s/p TECAB Improving pleural effusions without specific evidence of edema.Mild compression atelectasis both lung bases, improved.Heart size near upper normal.

Output: Persistent but improving pleural effusions with no new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: eval for infiltrate History: cough Heart size normal.Lungs clear.No pleural effusion. No pneumothorax.

Output: No evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: r/o acute process History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: FemaleReason for Study: Reason: 67 yo F with recent strep pneumonia. Still with dyspnea on exertion. Evaluate for interval change. History: dyspnea, abnormal prior x-ray The cardiomediastinal silhouette is unremarkable.Significant interval improvement in the patchy airspace and nodular opacities previously identified.Persistent increased thickened and nodular interstitial opacities, more pronounced on the left, compatible with underlying fibrosis.No focal areas of consolidation.No pleural effusions.

Output: Marked interval improvement in the airspace opacities noted on the prior exam. Persistent underlying reticulonodular interstitial opacities compatible with underlying fibrosis. No evidence of acute infection or edema.


Instruction: Generate impression based on medical findings.

Input: Bladder neoplasm Moderate scoliosis with scattered calcified granuloma and COPD changes. No discrete superimposed acute cardiopulmonary abnormalities. Specifically no findings to support new metastatic diseaseCardiac and mediastinal contours are grossly within limits other than moderate atherosclerotic changes most pronounced in the aortic archRight PICC line removed

Output: Right PICC line removed


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 86-year-old female with breast cancer metastatic with pleural effusions and weight loss. CHEST:LUNGS AND PLEURA: Right apical scarring. Left lower lobe pleural-based nodules are evident, the largest of which measures 1.0 x 0.6 cm on axial image 64/97. Scattered additional micronodules. Small bilateral pleural effusions and/or pleural thickening, right side larger than left.MEDIASTINUM AND HILA: No pathologically enlarged hilar or mediastinal lymph nodes. The cardiac size is normal. No pericardial effusion. Extensive coronary artery and mitral annulus calcifications. A small amount of air is evident within the right atrium.CHEST WALL: Surgical clips in the left axilla and postsurgical changes of the left chest wall. No pathologically enlarged axillary lymph nodes.ABDOMEN:LIVER, BILIARY TRACT: Punctate segment 8 hypodensity is too small to characterize but probably represents a benign cyst. Cholelithiasis without evidence of cholecystitis.SPLEEN: Scattered punctate hypodensities are too small to characterize but probably represent benign cysts.PANCREAS: 3.1 x 3.8 cm cystic lesion within the head of the pancreas on axial image 112/198, possibly in continuity with the main pancreatic duct, may represent an IPMN or pseudocyst. Two additional smaller cystic lesions are seen within the body of the pancreas. The pancreatic duct is not dilated.ADRENAL GLANDS: Left adrenal nodule measuring 0.9 x 0.7 cm on axial image 95/198 statistically most likely represents a benign adenoma.KIDNEYS, URETERS: Multiple bilateral low attenuation lesions probably represent benign cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease affects the aorta and its branches. No evidence of aneurysm. Small mesenteric and retroperitoneal lymph nodes are seen.BOWEL, MESENTERY: Diffuse colonic diverticula without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine. A subtle pattern of permeative lucency is evident throughout the vertebral bodies which could represent metastatic disease. Please refer to the nuclear medicine examination performed today for a more thorough evaluation.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: A focus of fat is evident within the fundus of the uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: See above.OTHER: No significant abnormality noted.

Output: 1.Bilateral pleural effusions and subpleural nodules compatible with metastatic disease.2.Pancreatic cystic lesions may represent IPMNs or pancreatic pseudocysts.3.Questionable bony metastatic involvement.4.Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.CVA with respiratory weakness, atelectasis and mucous plugging status post central line pulled back, S.O.B. Interval retraction of right jugular catheter with tip at the superior cavoatrial junction. Metallic fragments project over the upper abdomen.Moderate pleural effusions, left greater than right, about the same.Patchy interstitial and air space opacities and left retrocardiac consolidation without significant change.

Output: Repositioning of right jugular catheter with tip at superior cavoatrial junction. No acute change in pulmonary findings or pleural fluid.


Instruction: Generate impression based on medical findings.

Input: 71 years old Male. Reason: Aspiration PNA History: cough. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: line History: line Right IJ line terminates at the cavoatrial junction. Moderate cardiomegaly, new from previous study. Prominent azygos vein. No new focal lung consolidation. Mild peribronchial cuffing. Mild left basilar subsegmental scarring. No pneumothorax.

Output: New right IJ line without pneumothorax. Increased heart size with prominent azygos vein. Consider correlation with echocardiography if not recently performed.Mild peribronchial cuffing which may represent asthma or bronchitis or fluid overload.No focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Male 14 months old Reason: evaluate for increased pneumothorax History: desaturationsVIEW: Chest AP (one view) 4/14/2016 at 1148 hours. Right IJ venous access tip is at the SVC. ET tube tip is at the distal duodenum. NG tube terminates at the antropyloric region. Left lower extremity central line tip is at the right atrium. ET tube terminates below thoracic inlet. 2 right-sided and one left-sided pigtail chest tubes are again noted.Cardiac silhouette size is normal. Persistent multifocal streaky opacities. Interval improvement in left-sided pneumothorax. No change in right-sided pneumothorax.

Output: Persistent bilateral pneumothoraces with interval improvement in the size of it on the left.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with NHL extranodal status post chemotherapy. Evaluate for relapse; non-infused. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Postsurgical changes consistent with coronary bypass surgery. Some prominent mediastinal fat. No pathologic size lymph nodes.CHEST WALL: Chemo port right chest wall. Sternotomy.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of IV contrast. Given that limitation, the following observations are made.LIVER, BILIARY TRACT: No focal liver lesions. Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: Asymmetric fatty replacement and portions of the head.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic changes aorta. No evidence of aneurysm. No pathologic size lymph nodes.BOWEL, MESENTERY: No bowel wall thickening or dilatation. Scattered colonic diverticulosis.BONES, SOFT TISSUES: Degenerative changes. No lytic or blastic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Postsurgical changes prostatic bed.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A colonic diverticulosis. Surgical clips scattered throughout the pelvis.BONES, SOFT TISSUES: Corkscrew staples anterior pelvic wall.

Output: No measurable disease. Postsurgical changes chest and pelvis. Colonic diverticulosis. Atherosclerotic disease. Cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Reason: effusion? History: cancer, sob Complete opacification of the right hemithorax consistent with effusion and underlying atelectasis.Moderately large left effusion and left upper lobe nodule, not significantly changed.No new findings.

Output: Opacification of the right hemithorax, moderate left effusion and left upper lobe nodule with no acute change.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with metastatic disease.Additional history: Prostate cancer. CHEST:LUNGS AND PLEURA: 8 x 8 mm in right middle lobe pulmonary nodule (series 5; image 56), unchanged. Extensive pleural plaques, some calcified, with mild sub-pleural fibrotic changes remainMEDIASTINUM AND HILA: The ascending aorta measures up to 4.8 cm, not significantly change. Small mediastinal lymph nodes are again visualized. Coronary artery calcifications are seen.Small thyroid hypodensities remain.CHEST WALL: Diffuse blastic metastasesABDOMEN:LIVER, BILIARY TRACT: Stable lesion in segment two of the liver with peripheral discontinuous nodular enhancement is compatible with a hemangioma. The previous described lesion in the right lobe of the liver is not well visualized.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructive right lower pole calculus. Stable renal hypodensities, compatible with cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large duodenal diverticulum.BONES, SOFT TISSUES: Diffuse blastic metastasesOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate gland is asymmetrically enlarged and indents the base of the urinary bladder, unchanged.BLADDER: Mild bladder wall thickening remains.LYMPH NODES: Surgical clips along the iliac chainsBOWEL, MESENTERY: Diverticulosis.BONES, SOFT TISSUES: Diffuse blastic metastases, unchangedOTHER: Atherosclerotic disease.

Output: No significant change in the diffuse osseous metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: assess for acute lung changes History: post op respiratory failure Stable life support devices.Partially obscured cardiac silhouette is unchanged.No significant change in loculated left-sided effusion and opacification of the left upper lung region in the setting of aortic aneurysm repair.No change in right basilar aeration with residual small pleural effusion and adjacent atelectasis. No pneumothorax.

Output: Stable support devices. Pulmonary findings are unchanged.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Chest pain, new PE and fevers rule out infection. No pneumothorax. Normal heart size. Unchanged small right pleural fluid collection. Basilar opacities which may reflect atelectasis and/or small peripheral infarcts appear unchanged.

Output: No specific signs of pneumonia. Basal opacities are unchanged and may reflect atelectasis and/or possibly small peripheral foci of subsegmental parenchymal infarction.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: MaleReason for Study: Reason: pna History: cough fever NG tube has been placed with its tip beyond the margin of the image.Left PICC line with its tip in the left subclavian.Decreased lung volumes with stable cardiomediastinal silhouette.Nonspecific perihilar and basilar opacities compatible with atelectasis.

Output: Interval placement NG tube. Increasing basilar opacities suggestive of atelectasis possibly secondary to aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: chest pain History: chest pain Mild cardiomegaly.Basilar subsegmental atelectasis identified and possible edema.Left subclavian ICD, leads unchanged in position.Right jugular catheter tip at cavoatrial junction.

Output: New basilar opacities, including the differential diagnosis or pulmonary embolism and aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p AVR Interval removal of a Swan-Ganz catheter.Mediastinal drains in place with bilateral small pleural effusions and atelectasis.No pneumothorax or other acute change.

Output: Pleural effusions and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: Post-thoracentsis History: Post-thoracentesis Pleural effusions, improved on the left with no pneumothorax following thoracentesis.Basilar atelectasis.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: Evaluate for pulmonary edema History: Increasing SOB x1 month, crackles over bilateral lung bases Stable cardiomegaly. Very mild pulmonary edema with small bilateral pleural effusions.

Output: Stable cardiomegaly. Very mild pulmonary edema with small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old. Catheter tip in the SVC.No pneumothorax or other complications.No other significant cardiopulmonary abnormalities.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: 29-year-old male with history of testicular carcinoma status post orchiectomy. Evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: The two previously noted pleural-based nodules, possibly representing intrapulmonary lymph nodes along the interlobular fissure, remain stable. 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: Retroaortic left renal vein. Simple right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: 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 other significant abnormality noted.

Output: Stable exam.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: eval for cause of COPD exac History: wheezing, SOB Large lung volumes suggestive of emphysemaCardiac silhouette is normal.Right lower lung zone masslike opacity which may represent loculated effusion and atelectasis or neoplasm. Interstitial septal lines are present.No pleural effusion or pneumothorax.

Output: Right lower lung zone nodular opacities may represent loculated fluid collection and atelectasis. Follow up is recommended with a PA and Lateral radiograph to ensure resolution and exclude an underlying mass. Mild CHF pattern. Findings discussed with Dr. Lemelman (3922) at 1618 on 3/12/15.


Instruction: Generate impression based on medical findings.

Input: 24-year-old male with VA ECMO, bilateral lung transplant. Right IJ ECMO catheter and other support devices unchanged.Bilateral pulmonary opacities and apical pneumothoraces not appreciably changed.Stable cardiomediastinal silhouette.

Output: No appreciable interval change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 56 year old female with acute hemoglobin dropped after EP procedure.Additional history: Right IJ and bilateral groin punctures. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Trace pericardial effusion.CHEST WALL: Bilateral central lines terminate in the SVC.ABDOMEN:LIVER, BILIARY TRACT: Mild intrahepatic biliary duct dilatation is seen. Status post cholecystectomy.SPLEEN: Small amount of perisplenic fluid is identified, including hyperdense material which represents acute hemorrhage.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructive right nephrolithiasis is seen. Punctate calcifications in the left kidney could be vascular in origin or represent nephrolithiasis. A simple left renal cyst is seen.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: Large intraperitoneal fluid collection with hyperdense components, compatible with a hematoma with acute hemorrhage is identified, measuring up to 12.8 x 10.3 cm in the pelvis (series 3; image 166). There is mild extension superiorly adjacent to the spleen. A small amount of right sided retroperitoneal hemorrhage is identified, which extends along the ascending colon.

Output: Large intraperitoneal hematoma with acute components, with mild extension adjacent to the spleen, likely left-sided in origin. Small right-sided retroperitoneal hematoma.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old. Reason: Neutropenic fever, eval for infiltrate History: see above Right-sided PICC terminates in the superior aspect of the right atrium, as before. No new focal lung consolidation. No large pleural effusion or pneumothorax. Heart size is at the upper limit of normal.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: s/p PICC History: s/p PICC Cardiomegaly with very small effusions but no sign of edema or pneumonia.Right PICC, tip in the SVC.Surgical clips overlie the left side of the chest.

Output: Small pleural effusions. Right PICC, tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: r/o pneumonia History: SOB Left subclavian AICD unchanged.No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.Emphysema.

Output: No evidence of acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: Swan positioning History: Swan positioning The right IJ Swan-Ganz catheter has been advanced and the tip overlies the proximal right interlobar pulmonary artery.Global cardiomegaly, stable.No signs of pulmonary edema. Chronic pulmonary venous hypertension again noted.Blunting of the left costophrenic angle due to pleural thickening, stable from priors. No pneumothorax. Stable cardiomegaly

Output: No change in cardiomegaly and line position.


Instruction: Generate impression based on medical findings.

Input: Age: 92 yearsGender: FemaleReason for Study: Reason: eval PTX/rib fx History: L ant rib pain s/p fall There are increased lung volumes compatible with COPD.Stable mild cardiac enlargement.Apical fibrotic changes similar to the prior exam.No new pulmonary opacities identified.No evidence of a pneumothorax.No obvious rib fracture identified.

Output: No acute cardiopulmonary abnormality identified without interval change. No evidence of an obvious rib fracture or pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: PNA? History: cough, fever Heart size remains upper limits normal. There is vascular congestion but no evidence of infection or edema.Improvement in basilar opacities.No pneumothorax.Removal of central venous catheter. No evidence of pneumothorax.

Output: Vascular congestion without evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: FemaleReason for Study: Reason: pulmonary edema, pneumonia History: CHF on dobutamine and milrinone, sepsis Left IJ Swan-Ganz right IJ venous catheter, and left-sided ICD unchanged.Stable cardiac enlargement.Perihilar/basilar opacities are compatible with edema and atelectasis.Pleural effusions and left retrocardiac consolidation/atelectasis similar to the prior exam.

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


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: eval for infiltrate History: shortness of breath Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: h/o ARDS, assess for interval change History: see above Cardiomegaly with small lung volumes. Diffuse bilateral nodular air space and interstitial opacity which may be secondary to ARDS or organizing pneumonia, not significantly changed.No new findings.

Output: Diffuse nonspecific pulmonary opacity without significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: ett position History: ards ET tube tip approximately 5 cm above the carina.Nonspecific airspace opacity compatible with clinical diagnosis of ARDS.Venous catheters and NG tube unchanged.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain, h/o prior mi History: above Unremarkable cardiac and mediastinal silhouette. A focal opacity projected over the left upper lobe is consistent with calcified costal cartilage, confirmed on a recent CT scan of 3/31/2016.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: infection History: neutropenic fever, productive cough Lungs hypoinflated. Minimal basilar atelectasis. No new opacity to suggest pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: eval change History: intubated Support hardware unchanged with ET tube tip 5 cm above carina. Stable cardiomegaly with pulmonary edema and pleural effusions.

Output: Stable cardiomegaly with pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: check pulmonary status History: check pulmonary status No change in pulmonary opacities and pleural effusions.Stable tubes and devices.

Output: No change in pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Cough, chest congestion, decreased temperatures. Evaluate for infiltrate. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax. Degenerative changes of the spine with osteophyte formation in a pattern consistent with DISH.

Output: No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Emphysema. 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: Female, 62 years old.Reason: interval change History: aspiration PNA Persistent left mid and lower lung zone opacities but decreased volume loss.Right upper lobe reexpansion.ET tube tip 2 cm above the carina.

Output: Improvement in atelectasis, but persistent left mid and lower lung zone opacity is suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: increasing oxygen requirements History: increasing oxygen requirements Line position stable.No significant change in low lung volumes with basilar atelectasis.Cardiomediastinal silhouette is unchanged.No pleural effusion. No pneumothorax.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Chest pain question abnormality. Coronary stents in right upper quadrant cholecystectomy clips noted.Tortuous thoracic aorta.Mild bronchial wall thickening and nodularity in the lower zones suggestive of bronchiolitis, most likely the result of aspiration but nonspecific. No focal airspace opacities or pneumothorax. No visible pleural fluid.

Output: Possible mild bronchiolitis, most likely the result of aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: r/o PNA History: cough, crackles on exam Left base is slightly better aerated. Stable cardiomegaly. Small bilateral pleural effusions grossly stable.

Output: Small bilateral pleural effusions grossly stable though the left base is now better aerated.


Instruction: Generate impression based on medical findings.

Input: Productive cough and low-grade temperature No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Postoperative evaluation. Status post CABG. Retrocardiac, and right basilar opacity, unchanged. Trace left pleural effusion. Swan-Ganz catheter, mediastinal clips, left chest tube, mediastinal drain, sternotomy wires and plates, and AVR in place, unchanged. Interval removal of ET tube.

Output: Interval removal of ET tube with persistent bibasilar opacities suggestive of atelectasis.


Instruction: Generate impression based on medical findings.

Input: 14 day old female with hypoxia, poor ventilation. ET tube placementVIEW: Chest AP (one view) 2/21/2015 2:25 ET tube tip in right mainstem bronchus. Feeding tube tip in the stomach.Cardiothymic silhouette is normal. No focal pulmonary opacities. No pleural effusion or pneumothorax.

Output: ET tube tip in the right mainstem bronchus.


Instruction: Generate impression based on medical findings.

Input: 60-year-old female line placement confirmation. Right IJ venous catheter tip at the cavoatrial junction. No focal airspace opacity, pleural effusions or pneumothorax. Normal cardiomediastinal silhouette.

Output: Right IJ venous catheter tip at the cavoatrial junction.


Instruction: Generate impression based on medical findings.

Input: Reason: Fever History: Fever, cough Interstitial opacity in the right lung, with decreased volume and pleural thickening.Focal nodular opacity laterally at the right base appears to have increased although some of the change may be related to projection and inflation. If this is confirmed on subsequent radiographs a CT scan may be indicated for further evaluation.Stent in the area of the bronchus intermedius and port catheter, unchanged.

Output: Nonspecific opacity with pleural thickening and volume loss in the right lung and increased nodular opacity inferolaterally. The differential diagnosis includes infection and neoplasm, and further follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: 60 year old female with questionable tracheoesophageal fistula and distal esophageal stenosis/lesion. Evaluation of lymphadenopathy and solid organ pathology is limited secondary to lack of intravenous contrast.LUNGS AND PLEURA: Bilateral confluent irregular nodularity at apices, right greater than left. Though the configuration favors apical scarring, repeat CT could be obtained to confirm stability and exclude underlying nodule.Small bilateral pleural effusions. Bilateral basilar bronchiectasis, centrilobular nodules, and multiple foci of tree-in-bud opacities compatible with bronchiolitis, most likely aspiration. While these findings are seen in the upper lobes as well, they are present to a lesser degree.MEDIASTINUM AND HILA: Tracheostomy tube in appropriate position. Right mainstem foreign body appears to be a laryngeal prosthesis device. No definitive evidence of tracheoesophageal fistula.Coronary artery calcifications and minimal pleural effusion. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Multiple degenerative changes including ossification of the anterior longitudinal ligament consistent with DISH.UPPER ABDOMEN: Small hiatal hernia. Multiple surgical clips obscure portions of the upper abdomen. Anterior abdominal sutures. Bilateral small well-defined hypodense adrenal nodules consistent with adenomas.

Output: 1. Right mainstem bronchus foreign body. No definitive evidence of tracheoesophageal fistula.2. Probable aspiration pneumonitis.3. Nodular scarring right apex as described above.Dr. Durkin of the clinical service was informed of the above findings. The patient is scheduled for foreign body removal today.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: evaluate Dobhoff tube placement History: s/p Dobhoff tube placement Dobbhoff tube tip in stomach. Other findings stable.

Output: Dobbhoff tube tip in stomach.


Instruction: Generate impression based on medical findings.

Input: Chronic cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female 76 years old Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Left subclavian ICD is in place, lead position is unchanged.The cardiomediastinal silhouette is unremarkable and unchanged.Persistent small left pleural effusion and retrocardiac atelectasis.No new pulmonary opacity or pneumothorax.

Output: Stable cardiopulmonary appearance. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: MaleReason for Study: Reason: 62 yo M with L sided chest pain, dyspnea, and tenderness to palpation on left chest wall and axilla. No obvious masses on exam. Please eval for etiology of pain History: as above The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.Focal metallic densities are identified posteriorly in left chest wall subcutaneous tissue.No evidence of pneumothorax.

Output: No acute cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: r/o mets History: none The lungs and pleural spaces are clear. Cardiomediastinal silhouette is unremarkable.

Output: No visible pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Age: 88 yearsGender: FemaleReason for Study: Reason: eval for PNA vs effusion History: cough, dyspnea Right pleural chest wall mass has increased in size compared to prior exam.There is an associated airspace opacity adjacent to the pleural mass and concomitant infection should be considered.The cardiac mediastinal silhouette is unremarkable.The left lung is clear.

Output: Right pleural/chest wall mass with interval increase in size. Adjacent right upper lobe airspace opacity suggestive of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for pna History: sob Multiple bilateral cavitary pulmonary nodules, not significantly changed.Feeding tube traversing the esophagus. No new findings.

Output: Multiple cavitary nodules compatible with infection with no significant change.


Instruction: Generate impression based on medical findings.

Input: 55 year old female with pulmonary fibrosis. LUNGS AND PLEURA: Diffuse groundglass opacity bilaterally with paraseptal emphysema. No definite honeycombing. No air trapping. These findings are compatible with interstitial lung disease but are not characteristic of any specific interstitial pneumonitis. Multiple cystic structures bilaterally raises the question of LAM. No suspicious nodules or masses. No pleural fluid.MEDIASTINUM AND HILA: Borderline enlarged AP window lymph node on axial image 27/92 and prominent left hilar lymphoid tissue are compatible with interstitial lung disease. Additional calcified left hilar lymph node likely represents prior granulomatous disease. Cardiac size is normal. No pericardial fluid.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Splenic calcifications compatible with prior granulomatous disease. Prominent pancreatic duct.

Output: 1.Lung findings as above compatible with interstitial lung disease but not characteristic of any specific etiology.2.Multiple bilateral pulmonary cysts raises the question of LAM.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: sob, pulm edema vs pna History: acute sob Moderate to severe cardiomegaly.Small lung volumes with minimal edema but no sign of infection.Left subclavian ICD, leads unchanged in position.Right jugular catheter, tip still at the right atrial level.

Output: Cardiomegaly with minimal edema but no sign of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: ETT History: see above Patchy lower lung zone opacities suggestive of edema or aspiration, unchanged.ET tube tip approximately 6 cm above the carina.An NG tube terminates in the stomach.

Output: ET tube tip approximately 6 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.SOB and chest pain. Metallic bullet fragments project over the right shoulder.Normal heart size.Low normal lung volumes.No focal airspace opacities, pleural fluid or pneumothorax.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: abd pain, rule out free air History: abd pain Basilar interstitial lung disease already characterized by CT.No specific evidence of infection or edema.Heart size normal.No free air.

Output: Chronic basilar lung disease, otherwise unremarkable. No free intraperitoneal air.


Instruction: Generate impression based on medical findings.

Input: 79-year-old male status post lobectomy for adenocarcinoma. Please evaluate for interval changes. LUNGS AND PLEURA: Scarlike opacity just above the minor fissure unchanged since 8/20/2008. Small pleural fluid collection loculated medially at the left base, unchanged. Mild paraseptal emphysema.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes consistent with prior granulomatous infection. Atherosclerotic calcifications of the aorta and its branches. Coronary artery calcification.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple microcalcifications consistent with previous healed granulomatous disease.SPLEEN: Multiple microcalcifications consistent with previous healed granulomatous disease.ADRENAL GLANDS: No significant abnormality notedKIDNEYS: A large round homogeneous hypodensity in the right kidney, consistent with benign cyst unchanged.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Aortobifemoral bypass graft is noted.BOWEL, MESENTERY: Rectus diastases with ventral hernia patch. Small bilateral parastomal hernias containing nonobstructed bowel.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Significant atherosclerotic disease with SMA calcification and possible thrombus near the origin.

Output: No measurable metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: evaluate trialysis catheter position History: trialysis catheter in place Cardiomegaly with pulmonary edema unchanged.Right jugular catheter, tip in right supraclavicular region.

Output: Right jugular catheter high, the tip in the supraclavicular region and not central in location.


Instruction: Generate impression based on medical findings.

Input: Reason: pre-op MVR History: SOB Moderate cardiomegaly.Prominent central pulmonary arteries which may indicate pulmonary hypertension.Lower zone interstitial opacity with multiple septal lines and thickening of the pleural fissures consistent with interstitial edema.

Output: Cardiomegaly and interstitial pulmonary edema with possible pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: Coughing and back pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 29-year-old female with worsening headache SHUNT DEVICE: Again seen is an intrathecal shunt device with tip at the level of C6. The catheter courses cranially within the spinal canal and exits at the level of C1-C2. The tube coils posterior to the occiput then courses down the soft tissues of the left neck, posterior chest, and terminates in the pelvis. There is an increased radiolucent distance from the shunt valve to the distal radio-opaque portion of the tubing suggestive of discontinuity, new from the prior exam. The pressure valve points to the 3 o'clock position, previously 12 o'clock . Portions of the shunt tubing are radiolucent and difficult to evaluate, particularly near the pressure valves. SKULL: No significant abnormality noted.CERVICAL SPINE: No significant abnormality noted.CHEST: No significant abnormality noted.ABDOMEN: Nonobstructive bowel gas pattern.

Output: Discontinuity of the shunt tube catheter over the soft tissues of the neck just distal to the valve setting.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with metastatic leiomyosarcoma CHEST:LUNGS AND PLEURA: Again noted innumerable pulmonary bilateral metastases to both lungs. There are stable to minimally increased in size. Index nodule in the right lower lobe measures 16 x 13 mm image number 49, series number 5, minimally enlarged compared to previous study.Reference right upper lobe pulmonary nodule measures 9 x 9 mm, on image number 23, series number 5, again minimally enlarged compared to previous study.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Right T2 lamina. Cystic lesion is unchanged.ABDOMEN:LIVER, BILIARY TRACT: Extensive metastatic lesions throughout the liver is again noted. Index conglomerate mass in the left lobe measures 8.9 by 8-cm on image number 83, series number 3., slightly increased compared to previous study. This lesion is difficult to measure due to its ill-defined borders and also lack of IV contrast.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Status post left adrenalectomy. Soft tissue density in the left adrenalectomy bed is unchanged and is not clear whether it represents part of the pancreas or soft tissue mass. Right adrenal gland is unremarkable.KIDNEYS, URETERS: Status post left nephrectomy. Hypodense lesion in the upper pole of the right kidney measuring 12 mm number 100, series number 3 is stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mildly dilated small bowel loops with diffuse wall thickening is again noted. The dilatation of the small bowel loops is slightly more prominent, especially in the left lower quadrant. Amount of ascites is increased. Distal small bowel loops are smaller in caliber. These findings may represent partial small bowel obstruction. Lack of IV contrast limits optimal evaluation.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: Ascites is increased.

Output: Extensive bilateral pulmonary metastases have minimally increased in size compared to previous study.Liver metastases have slightly increased in size.Interval increase in the amount of wall thickening and dilatation of the small bowel loops and ascites. These findings represent a partial small bowel obstruction. The etiology of the small bowel wall thickening is indeterminate.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: s/p RPLND for testicular cancer; assess for metastatic disease History: s/p RPLND for embryonal testicular CA No focal consolidation, pleural effusion or pneumothorax. The heart and mediastinal contours are within normal limits for size. The bones and upper abdomen are unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: Fever , dementia , R/o aspiration History: fever Unchanged eventration of the left hemidiaphragm. Low lung volumes. No pleural effusion or pneumothorax. No focal pulmonary abnormality.

Output: Low lung volumes without superimposed acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: F/u ETT History: Resp Failure No change in the position of support devices. The distal tip of the Dobbhoff tube remains cranially directed.No significant change in the right lower zone nodularity and diffuse airspace disease throughout the left lung. Elevation of left hemidiaphragm with small left pleural effusion.

Output: No significant change in diffuse left-sided airspace disease with pleural effusion and right lower zone nodular opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old. Reason: IABP History: as above Swan-Ganz catheter tip in the right descending pulmonary artery, unchanged.Left subclavian ICD leads are unchanged in position. Balloon pump marker now approximately 5 cm below the aortic arch. Marked cardiomegaly, unchanged.Mild pulmonary edema, unchanged.No large pleural effusion or pneumothorax.

Output: Balloon pump marker in the descending aorta. No interval cardiopulmonary changes.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Evaluate for pneumothorax status post lung biopsy. Right hilar mass consistent with postbiopsy hemorrhage surrounding the known lung nodule.No pneumothorax. Persistent mild atelectasis in the anterior lower lobes.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: Pre-op TECAB History: Pre-op Status post CABG. Large AP diameter but no acute cardiopulmonary abnormality. Osteopenia involving spine with loss of height at multiple levels.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 78-year-old female, assess for ovarian cancer CHEST:LUNGS AND PLEURA: Nonspecific subcentimeter, nodular opacities in the right upper lobe. An index lesion measures 4-mm image number 36, series numberMEDIASTINUM AND HILA: Trace pericardial fluid. Subcentimeter right thyroid lobe nodule.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Left lobe and caudate lobe of the liver are hypertrophic suggestive of chronic liver disease. There are numerous hypodense lesions throughout the liver consistent with metastatic disease replacing most of the liver parenchyma. The index lesion measures 5 by 5.2-cm in image number 114, series number 4. Intrahepatic portion of the main portal vein and left portal vein are completely thrombosed. Right portal vein is also nearly completely thrombosed. Cholelithiasis without biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing renal cysts.RETROPERITONEUM, LYMPH NODES: Peripancreatic adenopathy measuring 22 x 23 millimeter image number 114, series number 4.BOWEL, MESENTERY: Moderate amount of ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and oophorectomy.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 ascites. Multiple peritoneal deposits in the pelvis. An index lesion measures 4 x 2.3 cm image number 180, series number 4. This may represent an enlarged right ovary due to right marry lesion or metastatic deposit. These findings are suspicious for peritoneal carcinomatosis.

Output: Extensive hepatic lesions with complete thrombosis of the main portal vein. Given the cirrhotic appearance of the liver and thrombosis of the portal vein these lesions may represent primary tumor such as HCC or metastatic disease.Moderate ascites with CT findings consistent with peritoneal carcinomatosis.Nonspecific punctate nodules in the right upper lobe These findings were discussed and acknowledged by Dr. Yamada at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Coronary atherosclerotic disease, abdominal aneurysm and now with shock Superimposed new mild changes suggesting interval minimal edema greater both bases with redistribution. Small to moderate right pneumothorax is again observed, minimally enlarged although this may be partially due to differences in technique and patient positioning.Otherwise support of hardware including an IABP and Swan-Ganz are all otherwise unchanged

Output: Questionably mildly enlarging right pneumothorax with increasing mild CHFPager 6666 contacted


Instruction: Generate impression based on medical findings.

Input: Male 94 years old Reason: Hx of prostate cancer with ascites, evaluate for pleural effusion Mild streaky left basilar opacity suggests atelectasis/scarring. Multiple pulmonary granuloma. There is no focal consolidation, pleural effusion or pneumothorax. The heart and mediastinal contours are within normal limits for size.

Output: Mild basilar atelectasis/scarring, but no evidence of pleural effusion or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 32 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 evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: post-OHT History: OHT Median sternotomy, heart size normal.No significant pulmonary or pleural abnormality.

Output: No significant abnormality following heart transplant.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: cardiopulmonary process History: palpitations Large lung volumes consistent with COPDTortuous proximal aorta.Heart size normal.

Output: COPD, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Reason: iabp placed, eval position History: see above Cardiomegaly with bilateral somewhat patchy pulmonary opacity compatible with edema or infection. Swan-Ganz catheter tip in the distal right descending pulmonary artery.ICD leads unchanged.The balloon catheter marker is not clearly visible and if the catheter is still present it may be obscured by pulsation artifact.A linear opacity in the proximal descending aorta that looks like calcification, but was not visible previously, may represent a blurred balloon catheter marker.

Output: Balloon catheter not clearly identified with a possible blurred radiopaque marker in the proximal descending aorta.


Instruction: Generate impression based on medical findings.

Input: 31-year-old male with history of chest pain evaluate for infiltrate. Right port tip within the right atrium.Slight dextroscoliosis may be related to patient positioning.Cardiomegaly unchanged from prior exam.Severe pulmonary artery enlargement.Stable mild interstitial opacities. No focal consolidation.No evidence of pneumothorax or pleural effusions.

Output: Stable mild interstitial opacities suggestive of pulmonary edema. Severe pulmonary enlargement. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: Infiltrates History: Fever Stable cardiomediastinal silhouette is normal in size.Chronic of asymmetric lung volumes, right greater than left, with hyperinflation and upper lung emphysema. Right apical linear scarring again seen. Left retrocardiac streaky opacities likely an element of aspiration. Nipple shadows project over the lung bases.Right second bone island again seen. A second calcific density projecting over the right apex may represent a granuloma or a second bone island.

Output: 1.Chronic asymmetry of the lung volumes with hyperinflation and upper lung bullous emphysema. 2.Left retrocardiac streaky opacities likely an element of aspiration. No discrete consolidation or specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old. Reason: s/p TECAB. Heart size is upper limits of normal.Improvement of bilateral patchy opacities with residual left basilar atelectasis.Small residual left pleural effusion.Left axillary vascular stent is present and unchanged in position.

Output: Improvement of bilateral patchy opacities with residual left basilar atelectasis and left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: Daily CXR History: S/p MVR Moderate cardiomegaly status post TAVR.Increasing basilar opacities especially in the right middle lobe suggestive of edema and/or aspiration.Right jugular Swan-Ganz catheter removed.Left chest tube still in place with no pneumothorax. IABP distal marker projects 5 cm below the top of the aortic arch.Left subclavian ICD, leads unchanged in position.

Output: Increasing basilar opacities but no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 53 years, Male. Reason: eval for large gastric bubble History: burping, ngt fell out Interval decrease in distention of stomach. Gas distended loops of transverse colon. Interval removal of NG tube.Bilateral chest tubes. Mediastinal wires, plates, clips are unchanged. Retrocardiac opacity is unchanged.

Output: Interval decrease in distention of stomach.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with cough and generalized weakness. Cardiomediastinal silhouette is unremarkable.No consolidation, pleural effusion, or pneumothorax.Interval removal of right central venous catheter.

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