Instruction: Generate impression based on medical findings.

Input: 77-year-old female status post minimally invasive esophagectomy complicated by leak and empyema. Status post induction therapy. LUNGS AND PLEURA: Left upper lobe micro-nodule seen on series 5 image 24 is not significantly changed. Right upper lobe consolidation or scarring with associated bronchiectasis is improved and may be secondary to radiation. Increased left pleural effusion. Small right pleural effusion has resolved.MEDIASTINUM AND HILA: Non-opacification of the SVC, with multiple chest wall and mediastinal collaterals, suggests SVC occlusion. No discrete tumor or mass is seen at the level of suspected SVC occlusion.CHEST WALL: Extensive venous collaterals are seen throughout the subcutaneous tissues of the left anterior and posterior chest wall.ABDOMEN:LIVER, BILIARY TRACT: Status-post cholecystectomy. Heterogeneous enhancement seen throughout the left lobe of the liver is likely due to the previously mentioned SVC obstruction and collateralization.SPLEEN: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts. ADRENAL GLANDS: Bilateral diffuse thickening of the adrenal glands not significantly changed from prior. PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multifocal eccentric mural thrombus seen in the proximal and distal abdominal aorta are new findings when compared to previous exam. Intimal calcifications at these levels are not displaced making intramural hematoma unlikely. No aortic aneurysm identified.BOWEL, MESENTERY: Tip of the J-tube is in the jejunum. BONES, SOFT TISSUES: Compression fracture of T6 unchanged from prior. The bones are diffusely demineralized.OTHER: No significant abnormality noted

Output: 1.New SVC occlusion with extensive collateralization as described above.2.New multifocal eccentric mural thrombi in the abdominal aorta as described above.3.Increased left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: MaleReason for Study: Reason: eval acute process History: HTN The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: upper abdominal pain, history of vomiting; rule out widened mediastinum History: abdominal pain Cardiomediastinal silhouette is unchanged. Left chest port tip in SVC. Postop change involving the neck. No new lung opacity.

Output: Cardiomediastinal silhouette is unchanged. No new lung opacity.


Instruction: Generate impression based on medical findings.

Input: 21 years old Female. Reason: is there an infiltrate History: cough, fever. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: Infiltration History: fever Unchanged pulmonary metastases.Small right pleural effusion unchanged versus diaphragmatic elevation from known hepatic metastases.No obvious pneumonia.Right jugular catheter, tip in SVC.

Output: Right hemidiaphragm elevation and/or right pleural effusion, and known metastases, but no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 82-year-old female with RA/DOE mucus production, cough. Diffuse bilateral bronchial wall thickening and bronchiectasis similar to prior. Chronic blunting of the costophrenic angles likely related to pleural thickening/scarring without definite pleural effusions. No new focal airspace opacity. No pneumothorax. Normal cardiomediastinal silhouette.

Output: Chronic bronchial wall thickening and bronchiectasis consistent with pulmonary manifestation related to know rheumatoid arthritis without superimposed acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 4-year-old male with increased secretions and fever.VIEWS: Chest AP/lateral (two views) 10/25/2016, 1352 hours. Tracheostomy tube tip is below the thoracic inlet. Cardiothymic silhouette is normal. There is increase in patchy and streaky retrocardiac opacities, suspicious for pneumonia.

Output: Increasing patchy and streaky retrocardial opacities, suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Tracheostomy check. No significant interval change in the previously described support devices. Interval placement of a right jugular catheter with the tip terminating at the cavoatrial junction. Persistent bilateral interstitial and airspace opacities, appearing similar to the prior study. No large pleural effusion or pneumothorax. Mild cardiomegaly, unchanged.

Output: Persistent bilateral interstitial and airspace opacities.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: IABP check The IABP has been repositioned and retracted, currently the tip marker projects 6 cm from the aortic arch. ICD, Swan-Ganz and underlying cardiopulmonary appearance are otherwise similar

Output: IABP repositioning


Instruction: Generate impression based on medical findings.

Input: Age: 33 yearsGender: FemaleReason for Study: Reason: Rule out infection in setting of possible MS flare History: Pls see above, no cough or URI symptoms The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: evaluate pulm edema and pulm opacifications History: please evaluate pulm edema and pulm opacifications Unchanged chest tubes and pleural effusions with mild basilar edema.Foci of atelectasis unchanged.ECMO cannulae stable in position.A Dobbhoff tube extends below the lower margin of the image.

Output: Unchanged pleural effusions and mild basilar edema. Stable support devices. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Positive Quantiferon gold. Normal cardiomediastinal silhouette. No focal pulmonary opacities or pleural fluid.

Output: Normal chest. No evidence of active intrathoracic tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p afib ablation Catheter tip in the SVC.Left chest tube in place with no significant pneumothorax.Small pleural effusions and basilar atelectasis, unchanged.Left atrial clamp in place.

Output: Small pleural effusions and mild basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: R/O INFECTION History: cough x 1 month, pna exposure 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: 51-year-old female with abdominal pain and weight loss. CHEST:LUNGS AND PLEURA: Mild bronchial wall thickening. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: Ill-defined soft tissue density is also noted in the anterior mediastinum (series 3, image 26).No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Mildly enlarged axillary lymph nodes (series 3, images 17 and 31). Enlarged lymph node is also noted anterior to the right pectoralis muscle laterally.Heterogeneous thyroid.ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: The spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly enlarged inguinal lymph nodes are seen bilaterally. For reference, a right inguinal lymph node (series 3, image 180) measures 1.3 x 1.3 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the lower lumbar spine.

Output: Scattered, mildly enlarged axillary and inguinal lymph nodes. Given patient's symptoms, findings are suspicious for a low-grade lymphoma. Continued follow-up is suggested.


Instruction: Generate impression based on medical findings.

Input: Reason: ET tube, check position History: see above ET tube tip approximately 4 cm above the carina.Mild subsegmental atelectasis in the left lower lung, improved compared to previous.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: esophagectomy; bilateral chest tubes History: above Right chest tube directed towards apex, left chest tube towards left hilum. No evidence of pneumothorax.Enteric tube tip near diaphragmatic hiatus. Post change in upper chest and PA

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Right subclavian dialysis line. Right sided central venous catheter in the projection of the right atrium, this appears to be positioned in the projection of the jugular, rather than the subclavian vein. No pneumothorax. Left subclavian pacemaker with leads in the right atrium and projection of the right ventricular apex.Low lung volumes with basal compressive atelectasis. Small volume of pleural fluid on the left. Surgical clips project over the right thoracic inlet.

Output: Right-sided venous access catheter terminates somewhat low within the right atrium. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female status post laryngeal cancer status post laryngectomy; evaluate for lung metastases CHEST:LUNGS AND PLEURA: Mild to moderate centrilobular emphysema, unchanged. Biapical scarring also stable.Previously noted pulmonary micronodules remain unchanged (series 5, images 27, 31, 39, 65, and 68) with no evidence of new nodules.Stable bibasilar scarring and/or atelectasis.MEDIASTINUM AND HILA: Postsurgical changes in the neck with tracheostomy tube in its expected location. Vocal prosthesis is also noted. Small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Left adrenal nodule measures 2.3 x 1.5 cm (series 3, image 95), relatively unchanged accounting for differences in technique. Low-density nodule seen in the pancreatic body, measuring approximately 9 x 6 mm (series 3, image 96); it appears larger than on prior studies but is of indeterminate etiology.

Output: 1. No evidence of pulmonary metastases2. Stable left adrenal nodule.3. Indeterminate pancreatic nodule versus cyst; indolent malignancy cannot be entirely excluded given apparent interval growth.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: trach collar present, concern for vol overload History: trach collar present Tracheostomy tube remains in stable position.Interval decreased lung volumes with persistent patchy consolidation in the lower zones on a background of an edema-like pattern. Small pleural effusions. No pneumothorax.

Output: Patchy mid to lower zone opacities, greatest on the right on a background of an edema-like pattern.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for effusions, SOB History: as above Mild cardiomegaly with pacemaker leads in place, unchanged from previous.No evidence of pulmonary edema or pleural effusions.

Output: Cardiomegaly with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: s/p rt subclavian cl History: line placement No significant cardiopulmonary abnormality.ET tube tip approximately 2 cm above the carina.Right subclavian catheter tip low in the right atrium.

Output: Right subclavian catheter tip low in the right atrium.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female history of urothelial cancer status post resection and ileal conduit. CHEST:LUNGS AND PLEURA: Scattered subcentimeter micronodules are stable.MEDIASTINUM AND HILA: There has been slight interval increase in the size of a right hilar lymph node, now measuring 1.2 x 1.0 cm (series 3, image 45) and previously measuring 0.8 x 0.9 cm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: There is a wedge-shaped low attenuating focus in the right lobe of the liver that was likely present on the prior study, with an associated area of peripheral hyperemia on today's exam. The appearance of this lesion is not typical for metastasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are wedge-shaped low attenuating lesions in bilateral kidneys, which is new since the prior study. This finding is consistent with infarctions or pyelonephritis. In addition, there is stable mild bilateral dilatation of the renal collecting systems, greater on the left. RETROPERITONEUM, LYMPH NODES: There has been interval increase in periaortic and retrocaval lymphadenopathy. Reference lymph node measures 1.3 x 1.0 cm in axial dimension (series 3, image 108).BOWEL, MESENTERY: Ostomy with ileal conduit is seen in the right lower quadrant. There has been resolution of previously noted right lower quadrant fluid collection.BONES, SOFT TISSUES: Postsurgical changes of the thoracolumbar spine. Deformity of the L1 vertebral body appears similar to the prior studies.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Absent or atrophic.BLADDER: Status post cystectomy.LYMPH NODES: Bilateral inguinal lymphadenopathy appears grossly similar to the prior study. Reference left inguinal lymph node measures 1.4 x 1.2 cm (series 3, image 24).BOWEL, MESENTERY: Ostomy in the right lower quadrant with ileal conduit formation as noted above.BONES, SOFT TISSUES: Postsurgical changes at the thoracolumber spine are noted. Deformity of the L1 vertebral body appears similar to the prior studies.OTHER: No significant abnormality noted.

Output: 1.Increase in right hilar, periaortic, and retrocaval lymphadenopathy as noted above. These findings are concerning for metastatic disease.2.Wedge-shaped low attenuating lesions in bilateral kidneys is new since the prior study. This finding is concerning for infarction versus pyelonephritis.3.Status post cystectomy with ileal conduit formation. There has been interval resolution of the right lower quadrant fluid collection.4.L1 vertebral body deformity appears stable.


Instruction: Generate impression based on medical findings.

Input: History: congestion Cardiomediastinal silhouette is within normal limits. Large lung volumes compatible with COPD. No pulmonary opacity. Persistent blunting of the right costophrenic angle compatible with atelectasis.

Output: No acute cardiopulmonary abnormalities, without interval change.


Instruction: Generate impression based on medical findings.

Input: 77-year-old female with history of metastatic renal cell carcinoma status post 16 cycles of chemotherapy. Please evaluate disease status. CHEST:LUNGS AND PLEURA: Scattered lung nodules previously identified bilaterally unchanged in appearance. The 5 x 7 mm nodule in the left lung base on series 5, image 65/95 remains stable in size.MEDIASTINUM AND HILA: Previously visualized superior mediastinal mass to the right of the trachea anteriorly measures 2.1 cm x 1.9 cm on series 80220, image 14/24 remains stable in appearance. Also on comparison to prior study, smaller, hypoattenuating mass superiorly just below the left thyroid lobe is seen on series 80220, image 3/184 and remains stable in size and appearance.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Mild intrahepatic ductal prominence unchanged from previous exam.SPLEEN: No significant abnormality noted.PANCREAS: There is redemonstration of diffuse pancreatic atrophy. Stable mass in the body the pancreas on series 80220, image 85/184 measures 1.5 cm x 1.2 cm. Complex cystic mass in head of the pancreas measuring 5.5 cm x 2.7 cm on series 80220, image 101/184 remains unchanged.ADRENAL GLANDS: Left adrenal nodule remain stable in size. Surgical clips are present in the region the right adrenal gland.KIDNEYS, URETERS: Surgically absent right kidney. Multiple small cysts are again visualized in the left kidney.RETROPERITONEUM, LYMPH NODES: Rim enhancing retrocaval mass on series 80220, image 105/184 is stable in size and appearance on comparison to prior study.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: Degenerative changes in the lumbar spine are observed.OTHER: No significant abnormality noted.

Output: All lesions are stable on comparison to prior study. No new lesions are identified.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o acute process History: abd pain Small lung volumes with interstitial basilar opacities compatible with known chronic interstitial disease and atelectasis.Moderately tortuous and ectatic aorta.No sign of free air in the abdomen.

Output: Basilar chronic interstitial disease with superimposed mild atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: r/o pneumonia, widened mediastinum History: SOB, chest pain Unremarkable mediastinal contours and cardiac silhouette.Right apical paraseptal emphysema.The lungs are otherwise unremarkable.

Output: Right apical paraseptal emphysema which would predispose the patient to a pneumomediastinum. No other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: ETT check Moderate interval improvement with decreasing patchy opacities in all 4 quadrants greater in the upper lungs without specific additional interval change. See subsequent report

Output: Suspected partially resolved edema superimposed upon additional nonspecific changes


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Advancement of ETT. Low position of endotracheal tube with tip less than 2 cm above the level of the carina. Other tubes and lines unchanged. Low lung volumes with coarse interstitial abnormality about the same.

Output: ETT less than 2 cm above carina, suggest repositioning.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: MaleReason for Study: Reason: s/p lvad and pneumonia, assess for improvement History: sob, o2 requirement Left-sided ICD in LVAD unchanged.Left IJ venous catheter has been removed.Decreased lung volumes stable cardiac enlargement.Right pleural effusion and right basilar consolidation/atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: No interval change in the right pleural effusion and right basilar consolidation/atelectasis. No new abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Clamshell sternotomy for bilateral lung transplant.Nonspecific left basilar consolidation. No pneumothorax.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: post op, intubation History: intubation Heart size normal.Status post mitral valve repair, right chest tube with no significant pneumothorax.ET tube tip 8 cm above the carina.Two right jugular catheters noted.

Output: No pneumothorax following recent surgery. Mild basilar subsegmental atelectasis noted.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: S/P cardoac surgery History: S/p cardiac surgery Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly with extensive bilateral airspace opacity which are nonspecific but compatible with edema/ARDS, hemorrhage or infection.No pneumothorax or other acute change.

Output: Cardiomegaly and extensive nonspecific pulmonary opacity without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: preop mvr History: preop mvr Right-sided central venous catheter tip projects over the distal SVC.Low lung volumes. There is minimal bibasilar subsegmental atelectasis. No pleural effusions. No specific radiographic evidence of edema or infection. Cardiomediastinal silhouette is within normal limits.Bilateral shoulder hardware is imaged.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: interval change History: interval change Moderate to severe cardiomegaly with unchanged basilar opacities including edema, left lower lobe consolidation and pleural effusions. Two jugular catheters terminate in the SVC.

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


Instruction: Generate impression based on medical findings.

Input: Age: 32 yearsGender: FemaleReason for Study: Reason: hemothorax? History: bleeding from CT Support devices unchanged.Stable marked cardiac enlargement.Blunting of the right costophrenic angle compatible with a small pleural effusion.No evidence of pneumothorax.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with goiter. Evaluate substernal component. LUNGS AND PLEURA: Right middle lobe opacity measures 10 x 12 mm on axial image 53/103 with irregular borders which probably represents a benign scar, but an approximate 6 month follow-up is recommended. No focal consolidation, edema or pleural effusion.MEDIASTINUM AND HILA: Bilateral enlargement of the thyroid gland, worse on the right. Maximum dimensions on the right are 6.2 x 4.2 by 8.0 cm (axial image 30/103 and coronal image 49/90). The right sided goiter extends approximately 3.5 cm inferior to the top of the manubrium. Minimal compression of the trachea is noted. Internal calcification evident within the right sided goiter.Cardiac size is normal with no pericardial effusion. The main pulmonary artery is dilated compatible with pulmonary artery hypertension. Coronary calcifications noted. No significant hilar or mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Subcentimeter left adrenal nodule is most likely benign (axial image 96/103).

Output: 1.Bilateral goiter extending approximately 3.5 cm below the top of the manubrium on the right.2.Irregular right middle lobe opacity, most likely benign, but 6 month follow-up is recommended.3.Evidence of pulmonary artery hypertension.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old. Reason: PNA History: SOB Dobbhoff tube, central lines are unchanged in position. ET tube tip is approximately 4 cm above the carina.Cardiomediastinal silhouette is unchanged.Interstitial opacities compatible with mild to moderate edema, similar to prior. Persistent retrocardiac opacity and small pleural effusions.

Output: Unchanged pulmonary edema and retrocardiac opacity.


Instruction: Generate impression based on medical findings.

Input: 60-year-old female patient with fluid collection in right inferior chest. Evaluate fluid collection seen on CT in inferior right chest. Targeted ultrasound performed along the right lateral chest and abdominal wall demonstrates fluid tracking from the right inferior rib to the right iliac crest measuring approximately 4 mm in thickness. There is no significant surrounding vascularity on color Doppler imaging.

Output: Fluid tracking along the right lateral chest/abdominal wall.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: assess IABP placement History: cardiogenic shock Mild cardiomegaly status post sternotomy.No specific evidence of infection or edema.IABP catheter proximal marker 3 cm below the top of the aortic arch. Left PICC, tip in left subclavian.

Output: IABP catheter proximal marker 3 cm below the top of the aortic arch. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: eval ETT, lung fields History: s/p CABG Bilateral chest tubes noted. Right IJ line terminates in the SVC. Bibasilar atelectasis. Focal opacity in the upper aspect of the right lung. Mild to moderate cardiomegaly. No large pneumothorax.

Output: Focal opacity in the upper aspect of the right lung, which may represent aspiration, hemorrhage, or contusion.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: bradycardia History: bradycardia Nonspecific basilar opacities possibly subsegmental atelectasis right inflation artifact. Mild cardiomegaly and a tortuous aorta.

Output: Increased basilar lung markings either underinflation artifact or subsegmental atelectasis, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: Patient with exam findings concerning for pleural effusion History: SOB New pleural effusions and basilar opacities suggestive of CHF or infection.

Output: New pleural effusions and basilar opacities suggestive of CHF or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: eval for recurrence History: h/o NSGCT, s/p chemotherapy Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases.

Output: No significant abnormality. Reference should be made to a separately reported CT.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old. Reason: ETT placement s/p intubation The endotracheal tube tip is approximately 3 cm above the carina. Left subclavian ICD unchanged. Right lower lobe airspace opacity compatible with pneumonia is again seen. Moderate cardiomegaly and tortuosity of the thoracic aorta unchanged.

Output: Endotracheal tube in adequate position.


Instruction: Generate impression based on medical findings.

Input: Age: 33 yearsGender: MaleReason for Study: Reason: pna History: fever, sob, prod cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: FemaleReason for Study: Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: baseline eval pre kidney transplant Stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: FemaleReason for Study: Reason: s/p thora. Assess for pneumothorax. History: s/p thoracentesis Interval decrease in right-sided pleural effusion postthoracentesis.No significant pneumothorax identified.Stable cardiac mediastinal silhouette.No new pulmonary opacities identified.

Output: Interval decrease in right-sided pleural effusion. No evidence of a pneumothorax post thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: S/p pericardial window POD 2 eval lung fields History: as above Stable cardiomegaly and pleural effusions with mild edema. No change in basilar atelectasis.

Output: Stable cardiac megaly and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: s/p left thoracentesis, eval for pneumothorax History: S/p left thoracentesis Improvement in left lower lobe consolidation and left effusion.Small residual right pleural effusion.Heart mildly enlarged.Right subclavianSingle chamber pacemaker lead unchanged. Left subclavian and left jugular catheters terminate at the cavoatrial junction level.

Output: Improving left lower lobe consolidation and left pleural effusion. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain and polycystic kidney disease. CHEST:LUNGS AND PLEURA: Since 11/2009 there is been clearing of the prior small left pleural effusion. However, marked increase in right pleural effusion is seen with right basilar atelectasis. Calcification the pleural spaces again seen in the right which may represent posttraumatic changes from prior chest tube is at appears to line up along the tubular tract. Where it may represent changes from prior treatment. Right basilar atelectasis and compressive changes. Left lung is clear.MEDIASTINUM AND HILA: Benign calcified lymph node seen. No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN: Lack of IV contrast limits evaluation of solid organs. Within these limitations the following observations can be made:LIVER, BILIARY TRACT: Numerous cysts are seen again throughout the liver parenchyma. They are too numerous to count. The largest dominant cyst in the right lobe of the liver has slightly increased in size and now measures 16.2 x 16.6 cm compared with 15.0 x 15.2 cm. The liver itself is increased in size and extends more into the pelvis than on previous examination. No other changes are seen in the liver. No intrahepatic or extrahepatic biliary duct dilatation is seen. Gallbladder appears normal.SPLEEN: No significant abnormality noted.PANCREAS: Mild dilatation pancreatic duct seen diffusely unchanged since November/10/2009 no other abnormalities seen..ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nephrectomies..RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderately large amount of diffuse ascites. The ascites is decreased since prior examination. No loculations are seen to suggest abscess..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS: Scans through the upper pelvis to the level of the acetabulum reveal the followingUTERUS, ADNEXA: Not visualized -- either atrophic or surgically removed..BLADDER: Not included in the imaged area..LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse ascites without loculation. No significant abnormality noted in visualized bowel..BONES, SOFT TISSUES: Subcutaneous edema seen without focal abnormality..OTHER: No significant abnormality noted.

Output: 1. Slight increase in overall size of liver and enlarged dominant cyst in right lobe of liver in patient with polycystic liver disease. 2. Cleared left pleural effusion but moderately large right pleural effusion. 3. Diffuse ascites without focal loculation seen. 4. No other cause for patients pain identified.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.History of bladder cancer, evaluate for metastatic disease. Multiple healed posterior right rib fractures.Normal heart size.Low lung volumes with mild basilar atelectasis/scarring without consolidation or suspicious pulmonary nodules.

Output: No acute cardiopulmonary abnormality or specific evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Dyspnea Persistent mild basilar changes suggesting CHF with cardiomegaly, small effusions greater on the right and patchy edema-like opacities also greater on the right.Mildly tortuous aorta unchanged

Output: Suspected mild CHF


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with history of mesothelioma. Status post two cycles of chemo. CHEST:LUNGS AND PLEURA: Previously noted numerous pleural-based lesions of peripheral and heterogeneous central enhancement are reidentified throughout the right hemithorax. They have increased in number and size on comparison to prior study.Reference measurements:At the level of the aortic arch (series 3, image 32), at 3 o'clock measures 3.3 cm (previously 2.1 cm).At the level of the pulmonary trunk (series 3, image 45), at 5 and 10 o'clock measure 1.8cm and 2.3 cm respectively (previously 1.6cm and 1.6 cm).At the level of the atrium (series 3, image 67), at one o'clock and 10 o'clock measure 2.1 cm and 3.6 cm respectively (previously 2 cm and 3.1 cm).Extensive subpulmonic disease is again noted extending deep into the costophrenic angle laterally and posteriorly.Pleural-based calcifications are noted in the left hemithorax without evidence of associated mass.MEDIASTINUM AND HILA: Tumor extends into the mediastinum with probable SVC invasion as noted previously.Central venous catheter tip in SVC.CHEST WALL: Previously noted questionable region of tumor invasion laterally deep within the right pleural sulcus is again visualized (series 3, image 108). Adjacent ribs remain intact. Stable degenerative changes of the spine.ABDOMEN:LIVER, BILIARY TRACT: Reidentification of hepatic cysts, the largest measuring 1.6 x 1.3 cm (series 3, image 88).SPLEEN: Splenules.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable degenerative changes of the spine.

Output: Interval progression of disease in the right hemithorax. No specific evidence of extrathoracic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: s/p TECAB History: asx Increasing basilar opacities and effusion. No other change.

Output: Increasing basilar opacities and effusion.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with endometrial cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Left lobe of the thyroid is significantly enlarged and extends into the mediastinum. Lack of IV contrast limits optimal evaluation.CHEST WALL: No significant abnormality noted.ABDOMEN:Evaluation of the visceral organs for focal lesions is limited due to lack of IV contrast. Patient's body habitus further limits the quality of the study.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral significant hydronephrosis, larger on the right compared to the left.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm measures 4.6 cm on image number 143, series number 8. Right common iliac artery aneurysm measures 2.9 cm on image number 162, series number 8.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is enlarged and extends to the superior aspect of the pelvis.BLADDER: No significant abnormality noted.LYMPH NODES: Right obturator lymph node is unchanged and measures 2.4 by 0.9 cm in image number 179, series number 8.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Generalized anasarca. Postsurgical changes involving the anterior abdominal wall in the pelvis.OTHER: No significant abnormality noted.

Output: Severely limited study due to lack of IV contrast and body habitus of the patient.Bilateral severe hydronephrosis, more prominent on the right compared to the left.Enlarged left lobe of the thyroid gland extending into the mediastinum.Large infrarenal abdominal aortic aneurysm. Left common iliac artery aneurysm.Postsurgical changes involving the anterior wall of the pelvis.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: s/p IVC filter removal; History: dyspnea Small lung volumes.Minimal subsegmental atelectasis.No specific evidence of infection or edema.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: r/o infection History: r/o infection Minimal subsegmental atelectasis at left base. No pleural effusion.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: r/o cardiopulm abnormality History: cough, shortness of breath No significant cardiopulmonary abnormality.Healing right rib fracture.Upper abdominal surgical clips.

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


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Pleural effusions question change. Left subclavian dual-chamber pacemaker leads are similar in position. Bioprosthetic aortic valve. Mitral ring.Moderate to large right pleural fluid collection increased in volume since the prior study. Stable small left pleural effusion. Basilar atelectasis is improving on the left. Compressive atelectasis on the right.Unchanged cardiomegaly and prominence of the central pulmonary vasculature.

Output: Enlarging right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: pneumo-mediastinum? ptx? History: AMS, endoscopy yesterday, tachy, hypertensive, hiccups No evidence of pneumomediastinum as clinically queried. No acute cardiopulmonary abnormality.

Output: No evidence of pneumomediastinum.


Instruction: Generate impression based on medical findings.

Input: Pneumothorax check Persistent and stable appearing left apical small and suspected loculated hydropneumothorax.Underlying cardiopulmonary appearance otherwise unchanged with a well-positioned tracheostomy tube. G-tube projects over the upper abdomen

Output: Left Pneumothorax unchanged


Instruction: Generate impression based on medical findings.

Input: 60-year-old female status post right IJ placement. Status post median sternotomy.Interval placement of right jugular catheter with its tip at the cavoatrial junction. No pneumothorax. Unchanged cardiomegaly with severe dilatation and peripheral calcification of the central pulmonary vasculature.Left upper lobe opacities without significant change, consistent with pneumonia.

Output: Interval placement of right jugular catheter with its tip at the cavoatrial junction. No pneumothorax. Left upper lobe opacities unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.SOB. Trace pleural fluid on the left. Cardiothoracic ratio is enlarged for the patient's age. The lungs are clear.

Output: Cardiomegaly for age and a small left pleural effusion. Cardiomyopathy cannot be excluded. Further evaluation recommended.


Instruction: Generate impression based on medical findings.

Input: Female 5 years old Reason: reassess pneumothorax and lung expansion, pleural effusions History: empyema s/p chest tube, pneumothorax seen 12/10VIEW: Chest AP (one view) 12/11/2015 at 0324 hours. Right-sided chest tube is unchanged. Cardiac silhouette size is normal. Persistent right apical pneumothorax and remaining lung opacity. Round lucency just below the edge of the chest tube may represent an anterior pneumothorax as well.

Output: Persistent right-sided pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old. ] PICC line with its tip at the SVC/RA junction.Decreased lung volumes with borderline cardiac enlargement and prominence of the pulmonary arteries.Scattered areas of scarring/discoid atelectasis without focal areas of consolidation.No pleural effusions.

Output: Right PICC line with its tip at the SVC/RA junction. No acute cardiopulmonary abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: evaluate lung History: pneumonia Right PICC tip in SVC.Extensive airspace opacity in the left lower lung consistent with pneumonia. A smaller opacity is noted at the right base. There are bilateral small pleural effusions. There may be superimposed edema.

Output: Extensive airspace opacity in the left lower lung consistent with pneumonia. A smaller opacity is noted at the right base. There are bilateral small pleural effusions. There may be superimposed edema.


Instruction: Generate impression based on medical findings.

Input: Male 4 days old Reason: elevated O2 requirementsVIEW: Chest and abdomen AP (2 views) 7/18/2015 at 1149 hours. ET tube tip is below thoracic inlet. NG tube terminates at the stomach. Esophageal temperature probe tip is at the lower thoracic esophagus. UVC terminates at the right atrium. UAC is crossing over from the right to the left iliac artery. Persistent soft tissue edema.Cardiac silhouette size is top normal. No focal opacities, or pneumothorax. Small right-sided pleural effusion.Almost complete paucity of abdominal gas.

Output: No focal lung opacities. Small right-sided pleural effusion.Almost complete paucity of abdominal gas


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: pre-op clearance for urgent orthopedic surgery History: acute femoral neck fracture requiring urgent orthopedic surgery Limited examination due to patient rotation. Cardiomediastinal silhouette is within normal limits. Right internal jugular catheter terminates at the cavoatrial junction. Chronic-appearing interstitial changes without superimposed acute abnormality. No reliable evidence of infection.

Output: Chronic-appearing interstitial changes without superimposed acute abnormality. No reliable evidence of infection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: s/p right pleurx catheter on 11/8 History: s/p right pleurx catheter on 11/8 Right subclavian central venous catheter tip terminates at the confluence of the brachiocephalic veins. Right chest tube position unchanged. Unchanged right upper lobe pulmonary mass and nodules. Right pleural effusion with associated basilar atelectasis may be slightly improved compared to the prior examination, although apparent differences may be accentuated reflected by differences in technique. The cardiac and mediastinal contours are within normal limits for size.

Output: 1.Unchanged spiculated right upper lobe mass, with perhaps slight interval improvement of the basilar atelectasis and effusion. 2.Right basilar chest tube position unchanged. 3.No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Evaluate for pulmonary hemorrhage or pneumonia, new hemoptysis, quarter sized, started last night. Cardiomediastinal silhouette is unchanged. Left greater than right streaky basilar opacities are unchanged. No pleural effusions or pneumothorax. Mild bronchial wall thickening. Chronic rib deformities.

Output: Unchanged bilateral basilar streaky opacities without evidence of new consolidation. Mild bronchial wall thickening.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: high fever to > 105F History: dry cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: eval for infection History: hypotension, leukocytosis No change in right lower lung zone consolidation and mild basilar edema.The left pleural effusion has enlarged despite a Pleurx catheter.ET tube tip approximately 4 cm above the carina.An NG tube extends below the lower margin of the image.

Output: Enlarging left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: Line Placement, Initial Check History: POST-OP Transplant Small lung volumes with perihilar and basilar atelectasis possibly from aspirated secretions or mucous plugging.Azygos pseudolobe normal variant.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach, the side port above the GE junction.Right jugular Swan-Ganz catheter tip in proximal right pulmonary artery.

Output: Postop perihilar predominant opacities suggestive of aspirated secretions or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: 3 year old male with shortness of breath, hypoxia and decreased breath sounds right lower lobe. Evaluate for infiltrate.VIEWS: Chest AP/lateral (two views) 2/28/2015 Cardiothymic silhouette is normal. Peribronchial thickening is noted with no focal airspace opacities. No pleural effusion or pneumothorax.

Output: Reactive airway disease/bronchiolitis pattern.


Instruction: Generate impression based on medical findings.

Input: Female, 93 years old.Reason: CHF exacerbation History: SOB Developing basilar edema pattern.Heart size upper normal.Small pleural effusions.

Output: CHF with edema and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: FemaleReason for Study: Reason: pulm edema, pneumonia History: hx of chf, presenting with dehydration, concern for gi bleed. Left-sided ICD with lead wires in the right atrial appendage and right ventricle.Mildly decreased lung volumes with cardiac enlargement.Airspace and interstitial opacities identified within the right mid lung compatible with infection or aspiration.Hyperlucency left upper lobe compatible with emphysema.Prominent pulmonary arteries suggesting pulmonary arterial hypertension.Median sternotomy is intact.

Output: Airspace and interstitial opacities in the right mid lung suggestive of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: lung cancer History: s/p RLL lobectomy Right hemithorax postsurgical volume loss with improved lung inflation, stable right pleural effusion and no new abnormalities.No evidence of tumor recurrence.

Output: Postoperative findings with no evidence of tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: 24 years old Female. Reason: chf, pulmonary edema History: shortness of breath. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse bilateral interstitial edema. There is also bilateral patchy air-space edema. Small amount of bilateral pleural effusions are noted. The double-lumen catheter is stable in position. No evidence of pneumothorax.

Output: The above findings are consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with metastatic renal cell cancer Evaluation of the solid organs is limited by lack of IV contrast.CHEST:LUNGS AND PLEURA: Reference right lower lobe nodule measures 8 x 8 mm (series 6; image 69), previously 10 x 6 mm. The other pulmonary nodules are unchanged. MEDIASTINUM AND HILA: Reference paratracheal lymph node measures 3.0 x 2.3 cm (series 4; image 33), previously 3.2 x 2.2 cm. The reference of right hilar conglomerate adenopathy measures 3.3 x 2.6 cm (series 4; image 43), previously 3.8 x 2.8 cm.Coronary artery calcifications. Status post CABG.CHEST WALL: Nonunited left clavicular fracture with mild callus formation, not significantly changed. This fracture may be pathologic in nature. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Soft tissue lesion posterior to the pancreatic body measures 2.5 x 2.2 cm, previously 2.4 x 2.4 cm.ADRENAL GLANDS: Right adrenal mass measures 3.9 x 3.4 cm, previously 4.0 x 3.8 cm when remeasured (series 4; image 92).The left adrenal mass measures 8.8 x 5.0 cm (series 4; image 97), previously 9.2 x 4.6 cm.KIDNEYS, URETERS: Right nephrectomy. Tumor involvement of the left kidney has not grossly changed. Suspected left renal vein involvement is also unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right paracolic gutter mass measures 8.1 x 3.5 cm (series 4; image 133), previously 8.8 x 4.3 cm.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: Left gluteal mass measures 3.9 x 2.9 cm (series 4; image 162), previously 4.4 x 2.8 cm.OTHER: No significant abnormality noted

Output: Mildly decrease in the size of a few of the reference lesions.Nonunited comminuted fracture of the proximal left clavicle, possibly pathologic, not significantly changed.Metastatic peripancreatic lesion, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.History of chronic systolic congestive heart failure who is dobutamine dependent, evaluate PICC line placement. Right-sided central catheter with tip in SVC.Moderate cardiomegaly, unchanged. Mild interstitial opacities suggestive of edema, slightly increased. No large pleural effusions.

Output: Right-sided central line tip in SVC. Worsening CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Epicardial lead placement and drain removal. Left subclavian ICD with epicardial lead unchanged in position. No pneumothorax. Previously seen small caliber drain or lead projecting over the lower chest has been removed the interim. Unchanged cardiomegaly and basal atelectasis.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old, with history of lung cancer status post left pneumonectomy. CHEST:LUNGS AND PLEURA: Volume loss and postoperative change on the left compatible with pneumonectomy. A small amount of fluid occupies the pneumonectomy space, similar to the prior exam.Paramediastinal fibrosis on the right may represent prior radiation. Right lower lobe groundglass opacity, atelectasis or scarring.Few pulmonary micronodules, unchanged.MEDIASTINUM AND HILA: Mediastinal shift to the left. The cardiac size is normal. Small amount of loculated pericardial fluid on the left is unchanged. Coronary and aortic atherosclerotic calcifications are present.No evidence of pathologically enlarged hilar or mediastinal lymph nodes.The proximal esophagus remains dilated.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Aortic atherosclerotic calcifications.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild spinal degenerative changes.OTHER: No significant abnormality noted

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old. Cardiogenic shock. Evaluate swan advancement. Advancement of the right IJ Swan-Ganz catheter, tip in the right main pulmonary artery. Right subclavian catheter tip at the cavoatrial junction, unchanged.Stable cardiomegaly. Perihilar/basilar interstitial opacities suggestive of edema and pleural effusions, unchanged.

Output: Advancement of the right IJ Swan-Ganz catheter, tip in the right main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Right hemithorax volume loss with improving right basilar opacity.Left lung unremarkable.No significant pneumothorax.

Output: Improving right base opacity with no pneumothorax. Right hemithorax postsurgical volume loss is present.


Instruction: Generate impression based on medical findings.

Input: Reason: MM, chills and malaise History: chills,malaise Port catheter tip in the SVC and filter device in the IVC.No significant cardiopulmonary abnormalities.

Output: No sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: IABP History: IABP Iatrogenic devices are unchanged. No new focal pleural parenchymal opacity. Stable focal nodular opacity at the right lung base. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: interval eval for HF History: as above Left IJ line terminates in the SVC. Diffuse pulmonary edema with left basilar opacity and small pleural effusions again noted. Unchanged cardiomegaly.

Output: Unchanged pulmonary edema, left basilar opacity and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for pneumothorax s/p thoracentesis History: s/p thoracentesis; prior accumulating R pleural effusion Decreased right effusion following thoracocentesis with no sign of pneumothorax.Residual right basilar opacity compatible with pleural effusion and atelectasis.

Output: Decrease pleural effusion and no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Cough with venous sputum. Evaluate for pneumonia. Minimal left basilar atelectasis. Chronic appearing mild diffuse interstitial opacities. No focal pulmonary opacities to suggest infection. No pleural effusions or pneumothorax.Cardiac mediastinal silhouette is within normal limits.

Output: Minimal left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: check pulmonary status History: check pulmonary status Left basilar opacities with a left effusion consistent with infection or aspiration, unchanged.ET tube tip approximately 6 cm above the carina.Right jugular catheter tip in right atrium, unchanged.An NG tube extends below the lower margin of the image.

Output: Unchanged left basilar opacities. No new findings. Stable support devices.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pna, cough/fever History: cough/fever Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 35-year-old female with Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: Previously described patchy, peripherally based opacity seen in the right lung have significantly improved but small amount of the changes persist. MEDIASTINUM AND HILA: Index node in the anterior mediastinum is smaller measuring 2.3 by 0.7 cm on image number 34, series number 8.CHEST WALL: Right axillary spiculated soft tissue density measures 1.6 by 1.2 cm on image number 21, series number 8, slightly smaller compared to previous study.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in the size of the index lesions.Previously described patchy, peripheral opacities in the right lung have improved.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: pneumonia History: generalized weakness, productive cough Large lung volumes consistent with severe COPD.Basilar interstitial opacities are nonspecific, but could be the result of mucous plugging or aspirated secretions particularly in the right lung base.Mild cardiomegaly is present with prominent central pulmonary arteries.

Output: Nonspecific basilar interstitial opacities likely subsegmental atelectasis in the right base, but no other reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Shortness of breath, chest pain Emphysema without focal pulmonary opacity, pleural effusion, or pneumothorax.Heart size is normal.

Output: Emphysema without acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: respiratory failure History: respiratory failure Lines and tubes are unchanged. Nasogastric tube side port at the gastroesophageal junction. Endotracheal tube tip just below the clavicular heads. Bibasilar opacities again noted, improved on the right. Small pleural effusions, as before. Unchanged cardiomegaly. No pneumothorax.

Output: Mild improvement in right basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate pleural effusion History: recurrent pleural effusion Severe globular cardiomegaly with a moderate right pleural effusion, slightly increased, and underlying opacity compatible with atelectasis.No other significant change.

Output: Severe cardiomegaly, compatible with cardiomegaly and pericardial effusion, with increased right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: PNA? Signs of aspiration? History: cough No acute abnormality.Vascular occluder device projects over the medial aspect of the right clavicle.Tracheostomy tube, the tip at the level of the thoracic inlet.Left jugular catheter, tip in SVC.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with prostate cancer CHEST:LUNGS AND PLEURA: Bilateral micronodules, some calcified, unchanged.MEDIASTINUM AND HILA: Enlarged mediastinal lymph nodes have not significantly changed. However, the reference subcarinal lymph node has increased in size, measuring 3.5 x 1.4 cm (series 3; image 46), previously 2.6 x 1.0 cm .Status post CABG.CHEST WALL: Gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodensity in segment V the liver is unchanged, likely benign.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cysts remainRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Metastatic spinal lesions with compression fractures remainPELVIS:PROSTATE, SEMINAL VESICLES: ProstatectomyBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: DiverticulosisBONES, SOFT TISSUES: Blastic metastases within the pelvic bones and spine are more prominent.OTHER: No significant abnormality noted

Output: Osseous metastases, more prominent than on the prior study. Correlation with bone scan is recommended for accurate comparison.Increase in size of the reference mediastinal lymph node. However, other mediastinal lymph nodes have not significantly increased in size.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with history of head and neck cancer status post CRT. History of lung cancer status post resection. CHEST:LUNGS AND PLEURA: Surgical suture lines in the right lung parenchyma and hilum compatible with right upper lobe resection. The previously seen nodule is no longer evident.Apical scarring and ground glass opacity are unchanged and may represent prior radiation therapy.1-2 mm left upper lobe (axial image 43/109) and left lower lobe (axial image 59/109) micro-nodules, unchanged. MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged. No pathologically enlarged hilar or mediastinal lymph nodes. The cardiac size is normal. A small pericardial effusion is unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy clips in the gallbladder fossa.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal hypoattenuating lesions are unchanged and probably represent benign cysts.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild aortic atherosclerotic calcification.BOWEL, MESENTERY: Prominence of the terminal ileum is incompletely evaluated, of unclear significance. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Postoperative change status post right upper lobe resection. No evidence of recurrent or metastatic disease in the chest or upper abdomen.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: FemaleReason for Study: Reason: pt with hx of blebs w/ pneumo w/ chest tube in place History: SOB, hypoxia Right-sided apical chest tube unchanged.No significant pneumothorax identified.Stable cardiomediastinal silhouette.Diffuse interstitial opacities and small right pleural effusion similar in appearance to the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance. No significant pneumothorax identified.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old. Reason: eval for worsening effusions History: hypoxic Tracheostomy tube tip 8 cm above the carina. Gastrostomy tube in place.Unchanged pulmonary opacities and pleural effusions consistent with pulmonary edema.No pneumothorax

Output: Unchanged pulmonary opacities and pleural effusions consistent with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: infection? History: Leukocytosis, chills/sweats Status post right thoracoplasty with resulting deformity of the right hemithorax.Mild basilar scarring but no sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: picc line placement History: picc line placement No significant cardiopulmonary abnormality.Right PICC, tip in the SVC.

Output: PICC placement, without complication.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: r/o infection. Hx: stem cell transplant admitted w appendicitis History: febrile, tachycardia No significant cardiopulmonary abnormality.Right jugular catheter, tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: Malfunctioning atrial lead. Check positioning A 2-lead left subclavian ICD demonstrates 2 leads one projected into the aortic arch near the takeoff of the right brachiocephalic and the second lead projects near the SA node. Of particular note is made of lead wires circling the generator overlying the left chest wall. Possible twiddling must be considered. Comparison with prior imaging is also neededThe cardiac and mediastinal contours are otherwise within limits. Lungs are clear

Output: Left subclavian ICD with questionable lead placement. Ms Moyer was reached with this result


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with severe emphysema. CT 6 months ago at outside hospital showed 6 nodules. Assess nodules and emphysematous changes. LUNGS AND PLEURA: Moderate to severe centrilobular emphysema is identified. Bilateral scarring is identified. Multiple micronodules are identified within both lungs. Some of these are calcified. However, the largest noncalcified nodule measures 7 mm in the right middle lobe (image 212/373). These are nonspecific at this size.MEDIASTINUM AND HILA: Coronary artery calcifications are present.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Multiple well-circumscribed hypodense lesions within the visualized portion of the liver likely represent cysts. Calcified gallstones. Small hiatal hernia.

Output: Multiple micronodules on a background of moderate emphysema. Largest nodule measures 7 mm in the right middle lobe. If the patient's previous CT is available, this may be submitted for comparison. Otherwise, a 6 month follow up exam is recommended.


Instruction: Generate impression based on medical findings.

Input: Altered mental status question pneumonia. Moderate cardiomegaly, with marked enlargement of the left atrium. Central pulmonary vasculature appears enlarged, suspicious for pulmonary hypertension.Extensive subsegmental atelectasis or scarring, left greater than right involving the lower lobes, caudal left upper lobe and lingula.Minimal septal thickening at the bases suggests a component of edema. No large pleural effusions. Hazy subpleural opacity at the lung bases indeterminate and could reflect atelectatic lung or possibly interstitial lung disease.Leftward tracheal deviation may indicate enlarged right thyroid lobe.

Output: No conclusive signs of pneumonia however basal opacities may be monitored with follow-up PA and lateral chest radiographs if symptoms persist. Cardiomegaly with signs of pulmonary hypertension in a configuration which could indicate mitral valve disease.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: 57M w/ AML, fatigue, failure to thrive History: fatigue and neutropenia, eval for pna New right cardiophrenic consolidation since previous study. Small right pleural effusion with faint opacities in the right lower and middle lobes. Findings are suggestive of pneumonia. PA and lateral radiograph recommended for further evaluation.

Output: Right cardiophrenic consolidation suspicious for infection with associated pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Productive cough and wheezing question pneumonia. Normal heart size. No focal airspace opacities suggest pneumonia. No pleural fluid.

Output: No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Pancreatic cancer CHEST:LUNGS AND PLEURA: Index left lower lobe nodule is unchanged measuring 5 mm in image number 75, series number 5. Left upper lobe ground glass opacity on image number 25, series number 5 is also unchanged measuring 1.4-cm in diameter.MEDIASTINUM AND HILA: Bilateral thyroid nodules, unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific subcentimeter hypodense lesions in the liver and fatty infiltration of the liver are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes in the pancreas. Residual pancreas is unremarkable.ADRENAL GLANDS: Nodular adrenal glands are stable.KIDNEYS, URETERS: Renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat containing umbilical hernia is stable.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: Previously described right adductor muscle mass is smaller and demonstrates calcification. It cannot be well measured. Fracture of right pubic bone is again noted.OTHER: No significant abnormality noted.

Output: Interval significant decrease in the size of the pelvic mass. Fractures involving the sacrum and right pubic bone are unchanged. No other significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: PICC line placement History: PICC line placement Right PICC, tip at RA level.

Output: Low right PICC, subsequently repositioned.


Instruction: Generate impression based on medical findings.

Input: Hemorrhagic pancreatitis status post multiple surgeries. Status post drain removal of a pancreatic pseudocyst. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Residual thymus tissue in the anterior mediastinum. Multiple nonenlarged mediastinal lymph nodes. Right hilar adenopathy measuring 10 x 12 mm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Linear hypodensity and peripheral wedge-shaped hypodensities in the spleen are unchanged and may be secondary to old trauma. Splenic vein is patent but remains attenuated.PANCREAS: Small amount of peripancreatic fluid collection on the tailADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large ventral hernia containing nonobstructing bowel loops is unchanged.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: Central cystic area within the prostate is unchanged and may represent a utricle.

Output: Minimal peripancreatic inflammatory changes which have significantly improved from previous CT.Ventral hernia containing nonobstructing bowel loops.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: r/o pneumothorax History: tachypnea New moderate right pneumothorax. Other findings stable in short interval.

Output: New moderate right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Heart failure Dobbhoff projects beyond inferior edge of the image. Right jugular catheter extends into the mid SVC unchangedMild-to-moderate nonspecific cardia megaly with layered moderate right and small left effusions. Underlying suspected pulmonary edema greater in both bases

Output: Suspected CHF with pleural effusions


Instruction: Generate impression based on medical findings.

Input: Metastatic colorectal cancer. CHEST:LUNGS AND PLEURA: Index left upper lobe spiculated lesion measures 3 x 1.9 cm on image number 26/92, series number 5. Posterior segment right upper lobe lesion measures 19 x 15 mm on image number 36. Other multiple smaller metastases are unchanged. No new nodules are seen.MEDIASTINUM AND HILA: Mild cardiomegaly, unchanged. Calcified lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Liver metastases are again very ill-defined and poorly delineated as before. Within this limitation, the index lesion measures 3.4 x 2.0 cm on image number 106/219. No new metastatic lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 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: Stable postsurgical presacral changes.

Output: Stable liver metastases. Lung metastases have also not significantly changed except for slight decrease in the size of the left upper lobe nodule.


Instruction: Generate impression based on medical findings.

Input: 83-year-old female with colon cancer status post hemicolectomy. Evaluation of the visceral organs is limited by lack of IV contrast.CHEST:LUNGS AND PLEURA: Severe emphysematous changes with biapical scarring. Postsurgical changes are seen in the left upper lobe adjacent to the oblique fissure. The previously reported nodular focus has not significantly change in size, measuring 12 x 6 mm. At least one micronodule is seen in the left lung base (series 4, image 73). Two punctate calcified granulomas in the left upper lobe.MEDIASTINUM AND HILA: Calcifications affect the aorta and coronary arteries. A 17 x 9 mm right hilar soft tissue density is grossly unchanged (series 3, image 52).CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The gallbladder is difficult to delineate from adjacent small bowel.SPLEEN: Calcification in the splenic hilum is unchanged, likely representing a calcified splenic artery aneurysmPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney is inferiorly positioned with respect to the left. A left renal artery aneurysm measuring 1.1 cm is unchanged from 12/12/08. Linear calcification in the left kidney is likely vascular.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: The aorta and its major branches are heavily calcified. The infrarenal abdominal aorta varies in caliber but has not significantly changed.PELVIS:UTERUS, ADNEXA: Hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis.BONES, SOFT TISSUES: Osteopenia.OTHER: No significant abnormality noted.

Output: Limited evaluation of the visceral organs due to lack of IV contrastNo significant change in the nodular opacity in the left upper lobe.Diffuse atherosclerotic disease with left renal and splenic artery aneurysms.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old. New right IJ Swan-Ganz with its tip in the right ventricular outflow tract.Right subclavian catheter with its tip in the SVC/RA junction.Stable cardiac enlargement with perihilar/basilar interstitial opacities and pleural effusions that have increased since the prior exam.

Output: New right IJ Swan-Ganz with its tip in the right ventricular outflow tract. CHF with interval progression.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate Lines/Drains/Devices History: Evaluate Lines/Drains/Devices Cardiopulmonary monitoring and support devices, unchanged.Basilar opacity compatible with atelectasis and small effusions.No new findings.

Output: Basilar atelectasis and small effusions with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: s/p arrest, eval lines and tubes History: s/p cardiac arrest Patchy pulmonary opacities suggestive of aspiration or acute edema unchanged.Mild cardiomegaly.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.Esophageal probe placed.

Output: ET tube tip approximately 4 cm above the carina. Unchanged perihilar opacities.


Instruction: Generate impression based on medical findings.

Input: 79-year-old female with central line placement. Interval placement of left IJ venous catheter with tip in distal SVC. Endotracheal tube tip not well visualized however appears to be 4 cm above the carina. Enteric tube with sidehole at the GE junction.No interval change in bilateral pulmonary opacities. Normal cardiac mediastinal silhouette.

Output: Left IJ venous catheter with tip in distal SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 14-year-old female status post gunshot wound, please for pneumothorax.VIEW: Chest AP (one view) 12/27/2016 2234 Surgical clips noted in the left axilla. There is left axillary soft tissue edema. Metallic fragments overlie the left upper hemithorax. Endotracheal tube terminates above the carina. Left chest tube is unchanged. Enteric tube sidehole is at the distal esophagus.There remains a residual apical left pneumothorax. No pleural effusion.

Output: Small residual left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Evaluate for bowel obstruction, nausea/vomiting, distention Left approach drainage catheter seen with tip in right mid abdomen. Possible trace pneumoperitoneum, compatible with patient's history of recent laparoscopic intervention. Overall relative paucity of small bowel gas. Mild gaseous small bowel distention and colonic dilatation most likely related to postoperative ileus. Residual contrast in large bowel and bladder. Presumed skin fold overlying left symphysis pubis. Mild bibasilar atelectasis.

Output: Overall relative paucity of small bowel gas. Mild gaseous small bowel distention and colonic dilatation most likely related to postoperative ileus. Possible trace pneumoperitoneum, compatible with patient's history of recent laparoscopic intervention. Additional findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: Pt with head/neck CA; please eval for aspiration or pna History: Pt with low grade temp and chills. Increasing interstitial opacities suggestive of edema, with enlarging pleural effusions left larger than right.Chronic postsurgical left hemithorax volume loss.Right jugular catheter, tip in SVC.

Output: Developing edema with pleural effusions consistent with CHF/hypervolemia. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: pna? History: inc confusion Cardiothymic silhouette is normal in size and configuration. Left hilar calcified granuloma.Lungs are clear with no focal consolidation, sizable pleural effusion or pneumothorax.No acute osseous abnormalities. Mild degenerative spurring of the thoracic spine.

Output: No radiographic evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: history of penile cancer s/p partial penectomy, and bilateral pelvic lymphadenectomy, with enlarged inguinal nodes History: history of penile cancer s/p partial penectomy, and bilateral pelvic lymphadenectomy, with enlarged inguinal nodes Sternotomy for aortic valve replacement.No specific evidence of infection or edema.No evidence of metastases.

Output: No significant abnormality. No sign of metastases.


Instruction: Generate impression based on medical findings.

Input: 43-year-old male with CHF. Missing one needle during intraoperative count. No radiopaque foreign object. Surgical sponges seen overlying the upper chest and left lower chest.Interval intubation. Interval advancement of Swan-Ganz catheter overlying the proximal right pulmonary artery. ICD unchanged in position.Low lung volumes. Unchanged small right pleural effusion. Mildly improved right basilar opacity.

Output: No radiopaque foreign object.Spoke with attending surgeon Dr. Onsager by telephone at 2:47 PM.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: spiking fevers, ALL Right internal jugular port catheter tip in the SVC.The heart size is normal. Subsegmental right middle lobe atelectasis. No pleural effusion or pneumothorax. Increased bibasilar opacities are nonspecific but may represent aspiration or edema.

Output: Increased bibasilar opacities nonspecific but may represent aspiration or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old. Crohn's disease with right-sided abdominal pain, evaluate for bowel distention Visualized chest unremarkable without evidence of focal consolidation. Moderate to large stool burden, no bowel obstruction. Relatively collapsed appearance of descending and rectosigmoid colon may reflect sequela of chronic inflammation, better seen on prior CT imaging. Hip degenerative disease. Pelvic phlebolith formation. Left hip enthesophyte formation or heterotopic ossification seen.

Output: Nonobstructive bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old. A right central venous catheter has been placed with its tip in the SVC.Spinal stimulator unchanged.Extensive postsurgical changes involving the right apex and right upper chest wall.Marked volume loss in the right lung with fibrotic changes.No new pulmonary opacities identified.

Output: Interval placement of right central venous catheter with its tip in the SVC. Stable cardiopulmonary appearance with extensive right chest postsurgical changes and right lung volume loss/fibrotic changes


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Shortness of breath. Stable cardiomegaly. There is blunting of the costophrenic angles, consistent with small bilateral pleural effusions. No focal airspace opacity or pneumothorax. Median sternotomy wires with fracturing of the inferior wires is unchanged. Cardiac stent is noted.

Output: Small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: hx lung ca, worsening cp History: cp, lung ca, left lower lobe cavitary mass, adenocarcinoma Stable left basilar scarring/atelectasis. The cavitary left lower lobe lung mass seen on recent CT is indistinct but probably unchanged. The heart size is normal. No pleural effusions or pneumothorax. Port catheter tip projects over the SVC.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with history of right lower lobe lung nodule. Compared with previous LUNGS AND PLEURA: 5 mm x 5 mm right lower lobe nodule is stable (image 67, series 5). Scattered small stable micronodules are identified. No new nodules are identified. No evidence of pleural effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Degenerative changes are redemonstrated within the dorsal spineUPPER ABDOMEN: No significant abnormality noted.

Output: Stable 5 mm x 5 mm well marginated right lower lobe nodule. Follow up exam in one year is advised to ensure stability.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: monitor lead position History: monitor lead position ICD device with leads in the expected locations, unchanged from previous. No pneumothorax or other complications.Moderate cardiomegaly and diffuse interstitial opacity compatible with edema with small pleural effusions.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: ETT checked ETT currently is 3 cm above the carina. NG and underlying cardiopulmonary appearance is otherwise similar. See subsequent report

Output: ETT repositioned


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.History of lymphoma presenting with shortness of breath and chest pain. Please evaluate for pneumonia or mass. No pleural effusion or pneumothorax. Right Port-A-Cath with tip in the atriocaval junction is unchanged. No focal pulmonary opacity to suggest infection or mass. Right costophrenic angle blunting is unchanged from 2013.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Empyema. TPA.VIEWS: Chest AP/lateral (two views) 05/10/15, 1400 and 1402 Right chest tube remains in place. Subcutaneous emphysema continues.Opacity in the right lower two thirds of the hemithorax continues. Right heart border and portions of the right hemidiaphragm are visible. Some vascularity is identified within the opacity. Left lung is normal in appearance. Cardiothymic silhouette is normal.Left thoracic curve continues. Mildly to moderately dilated bowel loops are present in the upper abdomen.

Output: Unchanged right hemithorax opacities.


Instruction: Generate impression based on medical findings.

Input: Lung transplant No acute cardiopulmonary abnormality. Unchanged right subclavian single port and post transplant changes

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Patient on ECMO evaluate lungVIEW: Chest AP 4/9/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. ECMO cannulas and umbilical lines unchanged. Bilateral chest tubes again noted. Bilateral pneumothoraces left greater than right. The opacities at the left lung base likely to represent a moderate size pleural effusion. The right lung is nearly completely opacified.

Output: Bilateral pneumothoraces left greater than right not significantly change with near complete opacification of the right lung.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of Hodgkin's lymphoma. Completed chemotherapy on 8/2008. CHEST:LUNGS AND PLEURA: No significant change in basilar fibrosis with traction bronchiectasis and volume loss. Focal scarring unchanged.MEDIASTINUM AND HILA: Previously measured hilar lymph node adjacent to the main pulmonary artery unchanged, now with 13 x 6 mm (image 46 series 3), previously 13 x 5 mm. Coronary artery calcifications are present. Port-A-Cath tip in SVC. Surgical clips in the superior mediastinum.CHEST WALL: Sternotomy wires. Right chest port with distal tip in right atrium.ABDOMEN:LIVER, BILIARY TRACT: Mild hepatomegaly is unchanged. Nonspecific punctate hypodense liver lesions are unchanged.SPLEEN: Mild splenomegaly is unchanged. No focal splenic lesions.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodense lesions in both kidneys are stable and likely represent cysts.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node again measures 10 x 7 mm (image 128, series number 3), unchanged.BOWEL, MESENTERY: No significant abnormality noted.PELVIS: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 examination.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with history of lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Thyroid nodules, bilateral, grossly stable.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Previously described, ill-defined, heterogeneous mass in the spleen is unchanged measuring 2.4-cm in diameter image number 82, series number 4.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Ill-defined infiltrative soft tissue density surrounding the aorta and IVC, stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Heterogeneous appearance of the uterus. This may be secondary to a fibroid, however, further evaluation with pelvic ultrasound may be helpful.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: Pelvic ultrasound is recommended for further evaluation of the uterus. No significant change in the splenic lesion or ill-defined retroperitoneal soft tissue density.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: FemaleReason for Study: Reason: r/o PTX History: chest pain Right Port-A-Cath with its tip in the SVC.Stable cardiomediastinal silhouette.Right basilar opacity and increasing right pleural effusion.Stabilization hardware identified within the cervical as well as thoracic lumbar spine.

Output: New small right pleural effusion and interval increase in right basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Brain disorder and PICC line placement New left PICC line projects into the mid subclavian. No additional distinct cardiopulmonary abnormality other than the persistent small effusions previously observed. Borderline cardiomegaly exaggerated by scoliosis

Output: Left PICC line placed


Instruction: Generate impression based on medical findings.

Input: Shortness of breath ETT remains 6 cm above the carina. NG tube projects at inferior edge of the image.Basilar interstitial changes with suspected superimposed scarring and/or atelectasis. No distinct new superimposed focal airspace process

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.ETT in place. Endotracheal tube has been retracted with tip now 8.5 cm above the level of the carina.Enteric tube incompletely visualized but the sidehole is at the level of the gastric body.Right Pleurx catheter unchanged in position.Loculated pleural fluid in the left hemithorax probably similar in volume. Left pleural effusion unchanged.Pulmonary nodules and masses and coarse interstitial abnormality unchanged. Retrocardiac atelectasis/consolidation about the same, nonspecific, correlate for signs of infection.

Output: High endotracheal tube. No acute change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: aspiration History: aspiration Low lung volumes. Increased opacities in the right lung demonstrating, many demonstrating incomplete border sign suggestive of loculated pleural fluid within fissures. Trend toward increasing right basilar opacity. Left hemithorax remains clear. Normal heart size. No pneumothorax. Enteric tube extends inferiorly off the field-of-view.

Output: Trend toward increasing right basilar opacity which may represent aspiration or pneumonia. Increased conspicuity of probable loculated pleural fluid within fissures.


Instruction: Generate impression based on medical findings.

Input: Check IABP The IABP marker remains 3 cm from the aortic archRight jugular catheter and remaining underlying cardiopulmonary appearance including cardia megaly with minimal edema in a perihilar distribution appears unchanged. Small effusions

Output: IABP marker unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: CF exacerbation requiring bipap History: CF exacerbation requiring bipap Upper lobe volume loss with bronchiectasis consistent with known cystic fibrosis.Mild hilar adenopathy may be reactive.No new findings.

Output: Cystic fibrosis without new findings such as infection.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: Evaluate for pulmonary edema History: CHF, syncopal episode at home today Severe cardiomegaly. ICD directed towards RV apex. Left basilar streaky opacity likely due to atelectasis. No significant pleural effusions or pulmonary edema.

Output: Left basilar streaky opacity likely due to atelectasis. No significant pleural effusions or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: s/p lvad, shortness of breath, assess for edema or effusions History: sob Cardiomegaly is unchanged. LVAD, unchanged in position. Left subclavian ICD is unchanged.Low lung volumes. Scattered linear opacities suggesting scarring/atelectasis are unchanged. Blunting of the costophrenic angle may represent trace pleural effusion/thickening.

Output: Scattered atelectasis and low lung volumes without specific evidence of edema or interval change.


Instruction: Generate impression based on medical findings.

Input: Left upper lobectomy Interval removal of two left chest tubes with redevelopment of a moderate to large left pleural effusion with underlying atelectasis. Right lung otherwise remains grossly clear. No gross cardiac or mediastinal contour change or new abnormality within this limitation

Output: Left chest tubes removed and new left pleural effusion


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: Please re-evaluate for progression of effusion, opacities/edema. History: As above Right basilar pigtail chest tube and left subclavian port catheter remain unchanged. Cardiac silhouette is significant posterior but remains unchanged.Low lung volumes with extensive bilateral pulmonary opacities, stable to slightly improved allowing for differences in technique and position. Right apical pleuroparenchymal scarring remains unchanged.

Output: Stable to slight improvement in bilateral extensive pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: eval lung fields History: s/p BiVADs Unchanged support devices. Cardiomegaly with bilateral left greater than right pleural effusions and pulmonary edema. Bibasilar atelectasis. Diffuse hazy opacities are nonspecific unchanged.

Output: No significant change in cardiomegaly, pulmonary edema, pleural effusions, bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 81-year-old female with pain in the right hip status post fall. Evaluate for infection, edema, effusion, or fracture. Post op change on left. No acute cardiopulmonary abnormality. Large lung volumes with possible small left effusion and faint nonspecific right sided opacity unchanged.

Output: Post op change on left. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: opacity? History: Infectious w/u Small lung volumes with the suggestion of bronchial wall thickening.No specific evidence of infection or edema.

Output: Small lung volumes with possible bronchial wall thickening, but no reliable evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: Eval swan placement History: None Cardiomegaly with pleural effusions unchanged.Mild basilar edema improved.Left jugular Swan-Ganz catheter, tip in left descending pulmonary artery, previously in the right.Left subclavian ICD, leads unchanged in position.

Output: Swan-Ganz catheter tip now in the left descending pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: infiltrate History: cough Cardiomediastinal silhouette is within normal limits. No focal pulmonary opacity. No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: RIJ HD catheter placement History: RIJ HD cath The endotracheal tube terminates 5 cm above the carina. Interval placement of a right IJ central catheter that terminates at the superior caval atrial junction. The previous right IJ temporary pacer has been removed. The remaining support devices, including circulatory support devices, remain in stable position.When accounting for change in patient position, there is no significant change in the dense pulmonary opacities throughout both lungs. Layering pleural effusions are present. Retrocardiac atelectasis persists. No pneumothorax.

Output: No pneumothorax following right IJ pacer removal and placement with right IJ central catheter.


Instruction: Generate impression based on medical findings.

Input: 24 years old Male. Reason: interval change History: trach. Interval improved ventilation in left hemithorax. stable markedly reduced lung volume on the right with basilar opacity compatible with atelectasis and possibly effusion. Tracheostomy tube and venous catheter unchanged.

Output: Interval improved ventilation in left hemithorax. Otherwise significant interval change.


Instruction: Generate impression based on medical findings.

Input: Weight loss, positive voltage gated potassium channel antibodies CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: 2-cm left ovarian cyst likely physiologicBLADDER: 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: Unremarkable study.