Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: s/p lung resection History: surgery Two right chest tubes with no pneumothorax.Postsurgical changes right apex.Mild left lower lobe subsegmental atelectasis.

Output: Two right chest tubes with no pneumothorax following recent surgery.


Instruction: Generate impression based on medical findings.

Input: Reason: ET tube eval History: intubated ET tube tip approximately 3 cm above the carina.NG tube tip in the stomach with the sidehole in the esophagus.Bilateral pleural effusions, larger on the left with underlying opacity compatible with edema and atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: PNA History: cough prod of green sputum 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: Female, 67 years old.Shortness of breath. Evaluate for pneumonia. Streaky bibasilar opacities, consistent with atelectasis, possibly the result of aspirated secretions. No specific evidence of pneumonia.

Output: Bibasilar atelectasis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 44 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.No specific evidence of infection or edema.Healed left rib fractures.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.TB screening. Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: Pneumothorax History: intra op Moderate size left pneumothorax extending deep into the left costophrenic sulcus, but the lung reexpanded compared to the prior study. Right hemithorax unremarkable.ET tube tip approximately 1 cm above the carina.An NG tube terminates in the stomach. Right jugular catheter, tip at right atrial level.Esophageal probe upper third of the esophagus.

Output: Moderate left pneumothorax, discussed with the attending surgeon who said that a chest tube was subsequently placed.


Instruction: Generate impression based on medical findings.

Input: Age: 20 yearsGender: FemaleReason for Study: Reason: eval for rib fracture History: eval for rib fracture The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.No obvious rib fracture.No evidence of a pneumothorax.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Chest pain Motion degrades sensitivity. Decreased lung volumes limits sensitivity, however patchy nonspecific opacities are observed in both lung bases without definite evidence of associated effusions. Questionable cardiomegaly.

Output: Nonspecific bilateral basilar opacities consistent with atelectasis and/or possible aspiration and/or infection. See subsequent report


Instruction: Generate impression based on medical findings.

Input: Fever Stable cardiopulmonary appearance with moderate tortuosity aorta. Overall diminished lung volumes without superimposed acute abnormality. Minimal changes in left lung base suggest atelectasis.

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Reason: mucous, cough History: as above Severe cardiomegaly with pleural effusions and basilar atelectasis consistent with CHF.Apical scarring, unchanged.No evidence of pneumonia or other significant interval change.

Output: CHF without significant change.


Instruction: Generate impression based on medical findings.

Input: CHEST:LUNGS AND PLEURA: Scattered micronodules, low risk for malignancy.MEDIASTINUM AND HILA: No significant abnormality noted in the extracardiovascular portions of the mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Scattered micronodules, low risk for malignancy.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: stridor History: as above Enteric feeding tube tip terminates out of the field of view inferiorly. There is worsening retrocardiac atelectasis. Increased basilar interstitial opacities and small bilateral pleural effusions consistent with worsening pulmonary edema. Mild cardiomegaly unchanged.

Output: Increased pulmonary edema and small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 92 years old.Shortness of breath. Wheezing. Stable cardiomediastinal silhouette.Large hiatal hernia, similar to prior.Mild bibasilar scarring/atelectasis, unchanged. No specific evidence of infection or edema.

Output: No acute cardiopulmonary abnormality evident.


Instruction: Generate impression based on medical findings.

Input: Reason: evidence of infection, cardiomegaly History: SOB, DOE, cough Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old. Pacemaker. Evaluate for pneumothorax. ICD, unchanged. No significant pneumothorax.Decreased retrocardiac atelectasis. No new focal pulmonary opacity.

Output: Decreased retrocardiac atelectasis. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: eval for mediastinal air, swelling/edema History: esoph ca, s/p radiation finished 5/14, vomiting and coughing No acute abnormality.No specific evidence of infection or edema.Right jugular catheter, tip in SVC.Gastrostomy tube.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: FemaleReason for Study: Reason: cardiac History: LVAD malfunction Left-sided ICD and LVAD unchanged.Stable cardiac enlargement.Lungs are clear.No large pleural effusions.

Output: Support devices unchanged. No acute cardiopulmonary findings.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Increased cough with hyperglycemia. Assess for pneumonia. Streaky opacities in the left lung base, likely mild atelectasis or scarring. No focal pulmonary opacities to suggest pneumonia. No pleural effusions or pneumothorax.Cardiac mediastinal silhouette is within normal limits.

Output: Mild left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: eval for hernia History: epigastric pain The cardiomediastinal silhouette and vasculature are within normal limits. No radiographic evidence of hiatal hernia. The lungs are clear airspace and interstitial opacities. No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.History of CHF now status post Whipple surgery. Enteric tube with tip in gastric fundus and sidehole proximal to the gastroesophageal junction. Upper abdominal surgical drain and skin staples. Right breast surgical clips.Mild blunting of the costophrenic angles consistent with small pleural effusions, similar to prior.Mild basilar predominant interstitial opacities, slightly increased.

Output: Postsurgical changes. Mild CHF, slightly increased. Recommend advancing enteric tube.Findings communicated to WARNECKE, JAMES (4428) via text page at 9:56 a.m. on 6/26/2015.


Instruction: Generate impression based on medical findings.

Input: Solitary pulmonary nodule No associated significant pneumothorax. Minimal gas is observed in left apex, likely due to increased upright positioning without significant interval change. Focal nodular density observed again overlying left lower lung laterally

Output: Small suspected stable minimal postprocedural pneumothorax on the left. Please see description provided


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: assess ETT, IABP, lines History: as above Unchanged pulmonary opacities sparing the left upper lobe where there may be underlying bullous disease.ET tube tip 8 cm above the carina, high.Left jugular catheter tip in left brachiocephalic just short of the SVC.IVC Swan-Ganz catheter looped in the right atrium before extending towards the right main pulmonary artery, unchanged.An NG tube has its tip still above the hemidiaphragm level.Stable circulatory assist catheter and ICD. IABP catheter proximal marker 5 cm below the top of the aortic arch.

Output: Unchanged pulmonary opacities, tubes and devices. NG and ET tube are high, and the Swan-Ganz catheter is looped in the right atrium.


Instruction: Generate impression based on medical findings.

Input: 35-year-old man with history metastatic colon cancer status post 3 cycles chemo. CHEST:LUNGS AND PLEURA: Possibly granulomata right lung base. Persistent elevation right hemidiaphragm with associated atelectasis right lower lobe. No nodules or effusions suspicious for metastatic disease.MEDIASTINUM AND HILA: The calcific granulomata right hilum and subcarinal area.CHEST WALL: Port-A-Cath left chest wall.ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty liver re demonstrated with some poorly demarcated lesions in the right lobe and a well demarcated lesion left lobe all of which appear stable to decreased in size with no new lesion seen.Reference lesion in lateral segment left lobe is a measured on image 72 as 4.8 x 3.7-cm.Lesion in segment 6 is measured on image 85 is 2.9 x 2.8 cm. and the paragraph there's probably a second lesion in the right lobe in segment 6 on image 78 which is also unchanged in the prior exam.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal nodes. Stable thrombus in the right common iliac vein.BOWEL, MESENTERY: Postsurgical changes with ostomy right lower quadrant and nonobstructive parastomal hernia.BONES, SOFT TISSUES: Subcutaneous gas consistent with injection sites the left abdominal wall.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable liver lesions and fatty liver. Stable small thrombus in the right common iliac vein. Stable elevation right hemidiaphragm with associated atelectasis and granulomata. Nonobstructive parastomal hernia.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: eval PTX History: eval PTX Small lung volumes with nonspecific interstitial opacities and cardiomegaly.Right pleural drain with no pneumothorax but persistent extensive right chest wall soft tissue emphysema.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: check for ptx on the left History: known lung cancer Very small <1 cm pneumothorax on the left. Large left perihilar mass consistent with known lung cancer. Right port tip in SVC.

Output: Very small <1 cm pneumothorax on the left.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: p/w VOC new onset somnolence w/ decrease on O2 sats requiring NC History: O2 desaturation Stable cardiomediastinal silhouette.Decreased lung volumes with basilar interstitial opacities suggestive of atelectasis and/or scarring.Subtle increased interstitial markings may represent some degree of edema.No focal areas of consolidation.No large pleural effusions.

Output: Increase pulmonary interstitium may represent development of pulmonary edema. Follow-up recommended. No other change is seen.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: eval for pneumonia History: see above Perihilar predominant opacities suggestive of edema or aspiration.Atypical infection is also in the differential diagnosis.Heart size normal. Without sizable pleural effusions.

Output: Perihilar opacities suggestive of edema or aspiration, or atypical infection.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with aspiration pneumonia. Enteric tube tip extends below the lower margin of the submitted radiograph.Heart size is at the upper limits of normal.Low lung volumes. No focal pulmonary consolidation or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: PE History: sob Subtle opacity in the right upper lobe best seen on lateral view in the retrosternal space. No pleural effusion or pneumothorax. Heart size at upper limits of normal. No acute bony abnormality.

Output: Subtle opacity in the retrosternal space which may represent early pneumonia. Consider repeat imaging in 8 weeks for reassessment.


Instruction: Generate impression based on medical findings.

Input: Check IABP Motion degrades sensitivity. No apparent interval change in the IABP marker terminating 4 cm from the aortic arch. If this is not intentional, repeat imaging may be needed.Underlying cardiopulmonary appearance otherwise similar with persistent mixed interstitial and airspace opacities, decreased lung volumes and moderate nonspecific cardiomegaly suggesting CHF. Small effusions

Output: IABP appears grossly unchanged, see limitations described


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: Confirm position of ETT History: ETT appeared to have moved ET tube tip approximately 6 cm above the carina, slightly lower than before.Basilar opacities and pleural effusions are unchanged.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: ET tube advanced, the tip now 6 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: History of lymphoproliferative disorder CHEST:LUNGS AND PLEURA: Linear subsegmental atelectasis in the lung bases. No significant change.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Small amount of fluid in the gallbladder fossa. No evidence of intra-or extrahepatic biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Previously described subcentimeter lesion in the uncinate process of the pancreas is unchanged, best seen on image number 106, series number 3.ADRENAL GLANDS: Nodular left adrenal gland is unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Index left para-aortic lymph node is unchanged measuring 7 mm on image number 108, series number 3.Index para iliac lymph node is unchanged measuring 6 mm on image number 149, series number 3.Reference left adnexal soft tissue is not significantly changed now measuring 1.3 by 1.1-cm image number 181, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study other than cholecystectomy.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: ET tube placement History: Intubated While the right lung has improved compared to yesterday afternoon, the left lung is more opaque centrally, consistent with acute edema or hemorrhage.IABP catheter distal tip 2 cm below the top of the aortic arch.ET tube tip approximately 3 cm above the carina.Right jugular catheter, tip in SVC.An NG tube extends below the lower margin of the image.An IVC Swan-Ganz catheter has been inserted, the tip directed towards the pulmonary outflow tract.

Output: Increasing left perihilar opacity consistent with aspiration or hemorrhage, or atypical edema.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: assess volume status History: SOB Cardiac size is enlarged. Moderate bilateral pleural effusions, left greater than the right, with slight progression as compared to the prior exam. Interstitial opacities suggestive of edema. No pneumothorax.

Output: Cardiomegaly, bilateral effusions, and pulmonary edema, suggestive of CHF, slightly progressed as compared to prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: eval for PNA History: SOB, CP Port catheter, unchanged. Diffuse reticular abnormality within the lungs again noted consistent with pulmonary fibrosis. Increase in left-sided pleural effusion. Persistent left lower lobe opacification. Unchanged cardiomegaly. No pneumothorax.

Output: Left lower lobe opacification consistent with atelectasis and/or consolidated lung. Diffuse reticular abnormality consistent with pulmonary fibrosis. Increase in size of left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: r/o infection History: cough and subjective fever x 4 days Unremarkable cardiac and mediastinal silhouettes.No significant pulmonary or pleural abnormality.

Output: No acute cardiopulmonary abnormality or significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.IABP marker IABP marker is 3 cm from the top of the aortic arch. Left upper extremity PICC tip is at the superior cavoatrial junction.Cardiomegaly is unchanged.No pleural effusion or pneumothorax. Mild subsegmental left basilar atelectasis.

Output: IABP marker is 3 cm from the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Mycobacteria Moderate COPD changes with persistent retrocardiac opacity and volume loss again suggesting left lower lobe atelectasis. Remaining lungs are otherwise clear other than scattered minimal scarring greater in apices and on the right. Cardiac and mediastinal contours are within limits of the atherosclerotic changes unchanged

Output: COPD and suspected left lower lobe atelectasis


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: intubated History: intubated, ett placement Median sternotomy with multiple chest tubes but no pneumothorax.Stable lower lung zone edema and cardiomegaly.ET tube tip approximately 3 cm above the carina.Right jugular Swan-Ganz catheter, tip in right main pulmonary artery.IABP catheter proximal marker projects over the aortic arch.Right PICC, tip in the SVC.

Output: No change in pulmonary edema, tubes or devices.


Instruction: Generate impression based on medical findings.

Input: 55 years old Female. Reason: eval for pulmonary edema History: bilateral crackles; s/p fluid resuscitation. The left hilar mass is again noted. The Port-A-Cath is stable in position. Bibasilar interstitial changes are again noted.

Output: Stable left hilar mass.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: known right pleural effusion, s/p draining History: see above Right pleural effusion and/or thickening compressing the right lung unchanged.No pneumothorax.Mild subsegmental atelectasis left lower lobe.

Output: Large right pleural effusion compressing the right lung with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: chest pain History: SCD -> ? acute chest No new focal lung consolidation. Moderate cardiomegaly again noted. No large pleural effusion or pneumothorax. Bony changes consistent with sickle cell disease again noted. Surgical clips again noted in the upper abdomen.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male 49 years old Reason: r/o edema History: missed HD for 5 days w/ cp. Median sternotomy and spinal hardware is noted. Right internal jugular central venous catheter in the SVC.Cardiac size is enlarged.No large pleural effusions.Bibasilar opacities likely reflect subsegmental atelectasis.Left lower lobe airspace opacity may represent infection/atelectasis.

Output: Left basilar opacity which may represent aspiration or pneumonia or atelectasis. No evidence of overt left-sided heart failure.


Instruction: Generate impression based on medical findings.

Input: Check right jugular sheath Interval Swan-Ganz removal with a persistent right jugular sheath extending into the SVC at the confluence of the right subclavian.Mediastinal and bilateral basilar chest tubes with underlying cardiopulmonary appearance including cardiomegaly, effusions and nonspecific opacities are all otherwise unchanged

Output: Swan-Ganz removed


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: Infiltrates History: fever Heart size normal.Lungs clear.No pneumothorax. No pleural effusion.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: pneumothorax History: right anterior lower rib pain post fall Left chest port tip likely in the left brachiocephalic vein.Normal cardiomediastinal silhouette.No focal consolidation, pleural effusion, or significant pneumothorax is identified.No displaced rib fracture.

Output: Left chest port tip in the left brachiocephalic vein. No acute cardiopulmonary abnormality, specifically no pneumothorax or displaced rib fracture.


Instruction: Generate impression based on medical findings.

Input: Female 60 years old with history of worsening cough and shortness of breath, possible chemotoxicity vs progression of cancer Bilateral upper lobe airspace and groundglass opacities, which are new from prior radiograph and better demonstrated on recent CT dated 1/11/16.Right lower lobe mass with underlying effusion and atelectasis. Left upper lobe mass now partially obscured by overlying airspace opacities.Stable cardiomediastinal silhouette.

Output: Bilateral upper lobe airspace opacities, which are questionably improved from recent CT dated 1/11/16. The differential includes drug reaction, atypical infection, organizing pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: tachypnea, SOB, wheezing History: tachypnea, SOB, wheezing Cardiomegaly with bilateral mainly interstitial opacity consistent with edema and atelectasis.Bilateral pleural thickeningCatheter tip in the SVC.

Output: CHF, without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: malignancy v infection History: worsening sob and hemoptysis and lung pain Unchanged pulmonary opacities, suggestive of known tumor and fibrosis.Small right pleural effusion.Heart size upper normal.

Output: Unchanged pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with breast cancer CHEST:LUNGS AND PLEURA: Stable fibrotic changes in the paramediastinal region of the right apex. No pulmonary nodules are seen.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: 13 x 12-mm left breast nodule (series 3, image 65), previously measuring 16 x 13 mmABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small splenic hypodensities are stable.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Variant venous drainage is again 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: Stable exam. Grossly stable left breast nodule.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old, with recurrent tonsil cancer. Evaluate for disease progression. LUNGS AND PLEURA: Tree-in-bud and nodular opacities in the right upper and right lower lobes are grossly unchanged and may reflect aspiration bronchiolitis or infection.Reference right lower lobe micro-nodule measures 4 mm on image 47, series 8, unchanged. Scattered additional subpleural nodules are unchanged.No pleural effusion. Left basilar atelectasis or scarring.MEDIASTINUM AND HILA: New tracheostomy tube in place.Reference left paratracheal lymph node measures 1.1 x 1.4 cm on image 33, series 6, and is unchanged.Calcified hilar and mediastinal nodes are again seen and likely reflect prior granulomatous disease. No new pathologically enlarged lymph nodes.The cardiac size is normal. No pericardial effusion.CHEST WALL: The left pectoralis major muscle has been excised.UPPER ABDOMEN: Numerous subcentimeter splenic hypodense lesions are unchanged.

Output: No evidence of disease progression.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Acute worsening hypoxemia. Aspiration versus worsening known cancer/COPD. No acute change in bilateral pulmonary opacities, predominantly interstitial, though with some airspace components.Right lower lobe superior segment consolidation is improving.Pleural effusions are also smaller.Peripheral catheter on the right terminates in the projection of the midright subclavian vein.IVC filter.

Output: Improving pleural fluid collections and consolidation in the right lower lobe. Diffuse bilateral predominantly interstitial process is without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: eval for infiltrates History: infectious workup in setting of probable stroke Cardiomegaly.No specific evidence of infection or edema.Azygos pseudo-lobe, incidental finding.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: Hx of kidney transplant on immunosuppression, cough History: Cough Cardiac silhouette is normal in size.Lungs are clear with no focal consolidation, sizable effusion or pneumothorax.

Output: No evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o cardiopulm abnormality History: chest discomfort, palpitations Moderately severe cardiomegaly, vascular redistribution, and interstitial edema with septal lines at the lung bases.No sign of pneumonia.

Output: CHF with interstitial edema.


Instruction: Generate impression based on medical findings.

Input: Reason: sob History: sob Heart size about upper normal.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Large hiatal hernia with distortion and mediastinal contour changes related to severe scoliosis. No discrete distinct superimposed focal airspace abnormality or effusions superimposed upon moderate emphysematous changes.Moderate tortuosity aorta.

Output: Large hiatal hernia and distortion without a distinct superimposed acute pulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: s/p CABG, eval airspaces History: asx Tracheostomy tube in place. Dobbhoff tube extends beyond the inferior margin of the image. Right jugular catheter with tip at the cavoatrial junction. Sternotomy wires.Diffuse interstitial and airspace opacities and left pleural effusion, increased on the left compared to prior.Dextroscoliosis with multilevel kyphoplasty. Biliary drain. IVC filter.

Output: Diffuse pulmonary opacities, slightly increased on the left, and unchanged small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 22 yearsGender: FemaleReason for Study: Reason: pna? History: leukocytosis Stable cardiomediastinal silhouette.2. Small left pleural effusion and patchy left basilar opacities compatible with infection.The right lung is clear.

Output: Small left pleural effusion and ill-defined left lower lobe opacity suggestive of infection. Pulmonary infarction cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Acute desaturation, evaluate for aspiration. Left subclavian ICD unchanged. Cardiomegaly. Low lung volumes with chronic pleural and parenchymal abnormalities bilaterally, right greater than left, about the same compared to recent priors and suggestive of fibrosis. No specific signs of aspiration.

Output: No acute change in extensive pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Chest tube placementVIEW: Chest AP Right upper extremity PICC with tip in the SVC. Right-sided chest tube in place. There is a small right apical pneumothorax minimally increasing the interval. Cardiac silhouette is normal. There is mediastinal mass not significantly changed.

Output: Right apical pneumothorax minimally increased from prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: eval ETT, lung fields History: s/p MVR Right chest tube following valve repair with no pneumothorax. Mild postoperative atelectasis is present.ET tube tip approximately 3 cm above the carina.Right jugular introducers.

Output: No significant pneumothorax. Mild postop basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 81 year old female with weakness. Evaluate for pneumonia. Left sided pacemaker with leads unchanged. Median sternotomy. Cardiomegaly with bioprosthetic aortic valve and severe calcification in the mitral annulus. Bilateral perihilar and basilar opacities compatible with CHF and probable pleural effusions. No pneumothorax.

Output: Cardiomegaly with bilateral opacities compatible with edema and probable pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.PICC placement. Left upper extremity PICC projects over the region of the left axillary/subclavian venous junction.Low lung volumes. Nonspecific retrocardiac opacity, most likely atelectasis.

Output: Left PICC projects over the region of the left axillary/subclavian venous junction.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: hx of testicular cancer, evaluate for metastatic disease History: see above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Rule out abnormality, pleural effusions, infection or edema. Shortness of breath. Motion artifact grades image quality. Moderate bilateral pleural fluid collections, right greater than left. Basal atelectasis. Low lung volumes, similar to previous.

Output: Moderate pleural effusions and atelectasis. Exam limited by motion.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: Evaluate for evidence of PNA - 77 yo F presenting with sepsis, h/o empyema History: sepsis, ams, febrile, left basilar crackles Mild cardiomegaly with a tortuous aorta having undergone endograft placement.Increased opacity in the right upper lung zone most likely is artifact as there is no other evidence of infection.No pleural effusions.

Output: Vague right upper lobe opacity most likely artifact in this patient having gone thoracic aortic endograft placement. However, infection is in the differential diagnosis this could be confirmed with a PA and lateral radiograph or CT.


Instruction: Generate impression based on medical findings.

Input: History of PE, worsening shortness of breath. Evaluate for pulmonary embolus or lung disease. PULMONARY ARTERIES: No acute pulmonary embolus is identified. There is a web in the right pulmonary artery just distal to the takeoff of the right upper lobe pulmonary artery. This is most likely from a prior pulmonary embolus.LUNGS AND PLEURA: Minimal scarlike opacities are identified at the lung bases.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Osteophytes identified within the thoracic spine.UPPER ABDOMEN: No significant abnormality noted.

Output: No acute pulmonary embolus. Pulmonary web in the right pulmonary artery likely a sequelae of prior PE.


Instruction: Generate impression based on medical findings.

Input: Wedge resection Interval retraction minimally of the right chest tube, tip again and now projects into the apex without redundancy. Underlying cardiopulmonary appearance is otherwise unchanged.

Output: Right chest tube repositioned


Instruction: Generate impression based on medical findings.

Input: Female, 98 years old.Altered mental status evaluate for pneumonia. Note from technologist "patient was very agitated best image taken". Exam limited by patient rotation and technique.No obvious acute abnormalities are appreciated. Unable to exclude cardiomegaly.Bilateral old rib fracture deformities noted.

Output: Limited examination due to patient's condition. No gross pulmonary abnormalities are appreciated.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: Pneumothorax; Post device placement in EP Lab Right ventricular ICD electrode is unchanged in position.No interval pneumothorax. Heart size is mildly enlarged, stable.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Evaluate enteric tube Pelvis excluded. Suboptimal study secondary to patient motion artifact. Enteric tube seen overlying gastric antrum/pylorus, gaseous distention of stomach suggested. Bowel gas noted in portions of transverse colon. Vascular line overlying right lumbosacral region. Central venous catheter suggested in distal SVC. Status post sternotomy and skin staples noted. Left-sided pleural effusion and underlying airspace disease partially imaged. Presumed eventration of right hemidiaphragm.

Output: Enteric tube as above.


Instruction: Generate impression based on medical findings.

Input: Reason: change in pneumothorax? History: PTX after adrenelectomy and hypoxic Persistent small right apical pneumothorax, unchanged.Basilar atelectasis, greater on the right with a small right effusion.A more recent radiograph has been interpreted.

Output: Persistent small right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: sepsis History: sepsis Borderline interstitial disease, but no obvious evidence of infection.Heart size normal.Minimal effusions are present versus extrapleural fat deposition.

Output: Borderline interstitial opacities, but no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain s/p mvc History: chest pain s/p mvc Unremarkable cardiac and mediastinal silhouette. Chronic blunting of the right costophrenic angle consistent with scarring.No acute abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 25 year-old female with history of PE, who presents with chest pain. Patient is postpartum day one. PULMONARY ARTERIES: Adequate study. No evidence of pulmonary emboli. LUNGS AND PLEURA: Mild bronchial wall thickening is noted suggesting the possibility of asthma.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Bilateral thyroid cysts.UPPER ABDOMEN: No significant findings.

Output: 1. No evidence of pulmonary emboli.2. Asthma.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Recurrent moderate CHF changes with cardiomegaly and bilateral left over right effusions. Suspected loculation on the left is also again appreciated

Output: Bilateral pleural effusions with underlying moderate edema and cardiomegaly


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Hematemesis. Evaluate for free air. No focal airspace opacity, pleural effusions or pneumothorax. The cardiomediastinal silhouette is normal. No subdiaphragmatic air.

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


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: fever, vented patient. Evidence of PNA? History: fever, on vent No specific evidence of infection or edema.ET tube tip approximately 2 cm above the carina.An NG tube extends below the lower margin of the image.

Output: Low ET tube. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female postoperative day two status post TAH/BSO. Evaluate for hematoma. Fever/tachycardia. The examination is limited by lack of IV contrast.CHEST:LUNGS AND PLEURA: Streaky opacities in the lung bases most likely due to atelectasis.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: The right-sided central line crosses the midline and terminates in the left brachiocephalic veinABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are again identified.BOWEL, MESENTERY: Mildly dilated small bowel loops without evidence of obstruction, compatible with ileus.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral oophorectomy. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Drains are seen in the anterior subcutaneous tissue.OTHER: Small amount of fluid/fat stranding extends along the pelvic sidewalls. A 4.1 x 2.4 cm fluid collection is identified in the right lower quadrant (series 20422; image 161). This is likely not a well formed collection given adjacent fluid.A smaller, ill-defined air-containing focus is seen in the lower pelvic midline in the postsurgical bed (series 20422; image 167), possibly postsurgical.

Output: Postsurgical changes in the pelvis. 4 x 2 cm fluid collection in the right lower quadrant, unlikely to be well formed.Small air-containing focus in the lower pelvis midline may represent small amount of residual air from surgery.Right-sided central line crosses the midline and terminates in the left brachiocephalic vein.


Instruction: Generate impression based on medical findings.

Input: Screening for tuberculosis No acute cardiopulmonary abdomen. Minimal scarring is observed in left upper lung

Output: Minimal scarring without acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Right lower lobe crackles and hypoxia. Altered mental status. Unchanged multichamber cardiomegaly. Calcified right hilar region lymph nodes and atherosclerotic calcifications of the thoracic aorta. No focal air space opacities or pleural fluid. No specific signs of pulmonary edema.

Output: Cardiomegaly, but no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: TB Screening History: none, for rehab placement Cardiomediastinal silhouette is within normal limits. The basilar atelectasis/scarring, most prominent at the right base. No pneumonia. No evidence of active TB. Blunting of the left costophrenic angle suggests moderate pleural effusion. No pneumothorax.Surgical staples overlie the right abdomen. VP shunt tubing courses through the thorax and is partially imaged projecting over the right abdomen.

Output: Bibasilar atelectasis/scarring and left pleural effusion. No evidence of active TB.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with lung cancer (neuroendocrine) status post chemoradiation, and surgery as of 12/13/10. Reevaluate post operatively. CHEST:LUNGS AND PLEURA: Postsurgical changes of left upper lobe resection. Moderate-sized loculated left pleural effusion, similar to prior. Interval resolution of left pneumothorax. Right upper lobe nodular opacity, similar to prior. Few bilateral lower lobe nodular opacities, new from prior, nonspecific.Small peripheral patchy opacity left base, similar to prior, likely scarring/post inflammatory. Interval resolution of atelectasis suggesting aspiration as seen on prior.MEDIASTINUM AND HILA: Surgical clips in the anterior mediastinum, unchanged. No significant pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: Right-sided chest port with tip in SVC.ABDOMEN:LIVER, BILIARY TRACT: Two new hepatic hypodense lesions, highly suspicious for metastatic disease; segment 4 left hepatic lobe lesion (series 4 image 106) measures 2.4 x 2.1 cm; segment 5 right hepatic lobe lesion (series 4 image 112) measures 2.0 x1.9 cm.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Nodular thickening and enhancement of the right adrenal gland, similar to prior. KIDNEYS, URETERS: Subcentimeter hypoattenuating lesions, too small to characterize, but unchanged from prior, likely represent simple cysts.PANCREAS: 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: Moderate vascular plaque of the abdominal aorta and its branches.

Output: 1) New hepatic lesions, highly suspicious for metastatic disease.2) Postoperative findings in the chest with loculated left pneumothorax, similar to prior. No measurable thoracic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Evaluate for pneumonia/pneumonitis due to inhalation of food and vomiting. Low lung volumes. Stable left lower lobe/retrocardiac atelectasis and left pleural effusion. Pleural fluid and basal atelectasis on the right also similar to prior. No pneumothorax. The heart size is stable although difficult to evaluate due to low lung volumes.An enteric tube courses below the diaphragm and inferiorly out of the field-of-view. A left-sided PICC terminates near the cavoatrial junction is unchanged.

Output: No significant change in bilateral pleural effusions and basal atelectasis. The left lower lobe appears collapsed and may obscure infection.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with history of headache. SHUNT DEVICE: There is a left frontal shunt device coursing down the left scalp and neck entering the left internal jugular vein with tip projecting over the right atrium. The radiopaque portions of the shunt tubing are unremarkable without evidence of kinking or discontinuity.SKULL: There is a prosthetic right globe.CERVICAL SPINE: Mild degenerative disease of the cervical spine.CHEST: No significant abnormality noted.ABDOMEN: The chest is clear. Stable upper thoracic Impression fracture.

Output: Stable appearing shunt device without evidence of complication.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: Is there pneumonia? History: Fever Mild increase in interstitial opacity in the right lung base which can represent aspiration or atelectasis. Remaining lungs are clear. Heart size within normal limits.No pleural effusion. No pneumothorax.

Output: Mild increase in interstitial right basilar opacity which can represent aspiration and/or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Acute onset abdominal pain and history of ulcer, BNP elevated unexpectedly question free air or volume overload. Moderate to severe cardiomegaly appears increased compared to the prior examination.Pulmonary vascular redistribution, but no specific signs of interstitial edema. Mild thickening of the fissures is consistent with hypervolemia.

Output: Interval increase in cardiothoracic ratio since the prior examination. No signs of pulmonary edema and no visible evidence of free intraperitoneal air.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.With balloon pump, evaluate placement. Unchanged cardiomediastinal silhouette.No focal pulmonary opacity, pleural effusion or pneumothorax.IABP catheter tip is 3 cm above the carina, unchanged in position. Left central venous catheter tip projects over the right atrium.

Output: IABP catheter distal tip is 3 cm above the carina, unchanged in position.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: intubated History: intubated Lines and tubes are unchanged. Diffuse pulmonary opacities again noted. Small pleural effusions, as before. Unchanged heart size. No pneumothorax.

Output: No substantial difference compared to previous study. Diffuse pulmonary opacities again noted consistent with diffuse alveolar damage.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: malignant pleural mesothelioma History: none Marked elevation left hemidiaphragm with moderate pleural effusion and/or pleural thickening and left-sided volume loss. Possibility of a left lower lobe nodule or mass cannot be excluded; this can be better characterized with cross-sectional imaging. No significant pleural effusion on the right. No pneumothorax.

Output: Left-sided volume loss with elevation left hemidiaphragm and pleural thickening and/or effusion in the setting of known mesothelioma. Pulmonary nodule or mass left lower lobe may be obscured and can be better characterized with cross-sectional imaging.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: SOB History: SOB post thoracentesis No change in right pleural effusion following thoracentesis, no pneumothorax.Smaller left pleural effusion with left basilar atelectasis noted.Right PICC, tip in the left subclavian periphery.

Output: Pleural effusions unchanged with no pneumothorax following thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: pneumonia History: fevers,tachycardia Cardiomediastinal silhouette is within normal limits.No new focal air space abnormality. No significant pleural effusions.

Output: No acute cardiopulmonary abnormality. Specifically, no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: et placement History: re-intubated Endotracheal tube terminates approximately 5 cm from the carina. Enteric tube terminates within the body the stomach. Interstitial pulmonary edema pattern, unchanged. No substantial change in bibasilar pleural-parenchymal opacities. Unchanged heart size. Right-sided pleural effusion/thickening again noted.

Output: Lines and tubes, as above.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: eval lung fields History: s/p MVR, MAZE Median sternotomy with chest tubes but no pneumothorax.Cardiomegaly and basilar opacities are stable.Right jugular Swan-Ganz catheter tip in right main pulmonary artery.Left subclavian catheter tip at right atrial level.Status post mitral valve replacement.

Output: No change in basilar opacities. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-transplant evaluation Mild cardiomegaly.No specific evidence of infection or failure.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Exam limited with motion. Underlying emphysematous changes with questionable patchy mixed interstitial and airspace opacities in both lungs with basilar left lower lobe atelectasis. Please correlate with pending CT giving greater sensitivity.Midline sternotomy with numerous broken wires.

Output: Nonspecific multifocal patchy opacities and probable small left effusion, CT pending


Instruction: Generate impression based on medical findings.

Input: Aortic aneurysm repair Mediastinal chest tubes remain well positioned. Interval removal of the Swan-Ganz catheter and sheath.Interval enlarging left pneumothorax, apical measurement currently measures 5 cm, previously 3 cm. Pager 6537 contacted. Underlying cardiopulmonary appearance is otherwise essentially unchanged with minimal basilar atelectasis.

Output: Enlarging and now large left pneumothorax


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with malignant neoplasm. Evaluation for progression of metastatic disease CHEST:LUNGS AND PLEURA: 3-mm nodule in the right upper lobe on image number 30, series number 5 adjacent to the fissure.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple metastatic lesions in both lobes of the liver. An index lesion in near the gallbladder measures 24 by 22-mm image number 109, series number 3.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal adenopathy. Peripancreatic index lymph node measures 39 x 32 mm image number 104, series number 3.BOWEL, MESENTERY: Peritoneal carcinomatosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Perirectal likely metastatic adenopathy.BOWEL, MESENTERY: Asymmetric wall thickening in the rectum suspicious for rectal cancer.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites.

Output: Hepatic retroperitoneal and peritoneal extensive metastatic disease. Asymmetric wall thickening involving the rectum suspicious for rectal carcinoma.Nonspecific subcentimeter nodule in the right upper lobe.


Instruction: Generate impression based on medical findings.

Input: Female 72 years old Reason: Tracheostomy LVAD, tracheostomy, ICD are unchanged. Cardiomegaly, similar to prior exam. Patchy bilateral opacities likely representing edema, with small effusions and left lower lobe consolidation not significantly changed.

Output: Edema, effusions and left lower lobe consolidation, similar to prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Recent syncope, shortness of breath Cardiomediastinal silhouette is normal.No pleural effusion or pneumothorax.No focal airspace opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: eval lung fields, increased O2 requirement History: as above Moderate bilateral pleural effusions with basilar consolidation are unchanged.Left subclavian pacemaker, leads unchanged in position.Right subclavian and right jugular catheters terminate in the right atrium.A Dobbhoff tube extends below the lower margin of the image.

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


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: Tachycardia History: Tachycardia Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: Eval lung fields History: Intubated Lines and tubes are unchanged. Leftward patient rotation again noted. Bibasilar opacities, unchanged. Unchanged heart size. No pneumothorax.

Output: Lines and tubes are unchanged. Leftward patient rotation again noted. Bibasilar opacities, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: assess for fluid in lungs History: hypoxia Cardiomegaly with vascular congestion and pulmonary edema compatible with failure.ICD leads stable.

Output: No change in appearance of pulmonary edema


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: fluid balance History: sob Low lung volumes makes detailed cardiopulmonary assessment difficult. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Marked cardiomegaly again noted. Mild peribronchial cuffing, as before.

Output: No focal lung consolidation or evidence of overt left-sided heart failure. Mild peribronchial cuffing may represent asthma or bronchitis.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infection History: weakness Normal heart size with a mild scoliosis.Port catheter with its tip in the SVC.Small lung volumes with mild basilar opacity compatible with atelectasis. No specific evidence of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Cardiac arrest. Assess ETT. Patient is rotated, limiting evaluation.Endotracheal tube tip 5.5 cm above the level of the carina.Right jugular catheter tip at the level of the SVC.Temperature probe projects over the distal esophagus above the GE junction.Enteric tube looped in the stomach.Left lower lobe is collapsed; the distal left main bronchus appears to contain an internal fluid level, likely the result of aspiration.Right lung reexpanded with moderate edema and airspace opacities.Diffuse lytic and sclerotic skeletal lesions in the spine and ribs highly suspicious for metastases or less likely myeloma, better seen on today's study as some of the lumbar spine is now included on the image and dense pedicles of L1 and L2 on the right are now visible.

Output: Reexpansion of right lung, now with edema. Interval collapse of the left lower lobe with endobronchial internal air-fluid level suggesting significant aspiration with occlusion of the airway. Signs of skeletal metastatic disease. Maureen Canellas (4222) notified via text page at 9:23 AM on 8/23/2016.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: r/o pulm edema History: tachypnea, SOB Enlarging bilateral effusions and basilar atelectasis.Heart size at least upper normal.Right jugular catheter, tip in SVC.

Output: Enlarging effusions. Findings suggest CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: chest tube placement History: s/p apical mass resection, previously reported history of neurofibromatosis 1 A right apically directed chest tube is in place.When correlating to previous cross-sectional imaging, there has been resection of the biapical masses. There is residual left apical opacification with convex interface with the left upper lobe with associated thinning of the left posterior rib. Low lung volumes. Right lower lobe opacity is nonspecific and may represent subsegmental atelectasis. No significant pneumothorax. Small amount of right lateral chest wall subcutaneous emphysema.

Output: Interval resection of biapical masses with residual left apical opacification. Nonspecific opacity right lower lobe which may represent subsegmental atelectasis. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.IABP placement. Stable positioning of lines/tubes/hardware. Cardiomediastinal silhouette is unchanged. Elevation of right hemidiaphragm. No new air space opacity.

Output: No significant interval change


Instruction: Generate impression based on medical findings.

Input: Fever and leukocytosis Moderate nonspecific cardiomegaly with similar moderate tortuosity of the aorta and atherosclerotic disease. Left subclavian 2-lead ICDLungs are small in volume with patchy opacities in both bases mildly streaky and probable atelectasis. Aspiration or uterine infection however cannot entirely be excluded in the absence of prior studies and history. Serial imaging is needed to confirm

Output: Nonspecific pulmonary changes although likely atelectasis, infection cannot be excluded given history. Serial imaging is needed


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: H/o pna; please eval for worsening pna or effusion History: O2 desat to 88%, now on 3L O2 Apparent increase in diffuse pulmonary opacities reflecting progression of metastatic disease to the lungs. The right hemidiaphragm and the inferior aspect of the cardiomediastinal silhouette are now obscured. Small bilateral pleural effusions. No pneumothorax.

Output: Progression of metastatic disease to the lungs now associated with bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male; 68 years old. Reason: ventilated, trach History: as above Stable tracheostomy tube and left PICC. Stable cardiopulmonary appearance with extensive bullous disease in the right lower lobe. No new focal pulmonary opacities.

Output: Stable tracheostomy tube and left PICC.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: Eval for cardiopulmonary disease. History: Chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Check ETT Endotracheal tube remains 3 cm from the carina. NG, ICD and left jugular catheters are also unchangedCard megaly with patchy mixed interstitial and airspace changes throughout the lungs largely perihilar distribution again similar in distribution but mildly more discrete suggesting minimal decrease superimposed edema. Persistent concern for retrocardiac consolidation.

Output: Mildly improving pulmonary edema with nonspecific superimposed right upper lobe and left lower lobe consolidation


Instruction: Generate impression based on medical findings.

Input: 75 year old female history of thyroid cancer status post chemotherapy. CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules are stable in size. Largest nodule in the left base compared series 5 image 80) measuring 16 x 13 mm, unchanged. No new lesions.Slight dependent atelectasis/scarring bilaterally.MEDIASTINUM AND HILA: Status post thyroidectomy. Multiple subcentimeter mediastinal lymph nodes, similar to prior, few of which are calcified suggesting prior granulomatous infection. Enhancing soft tissue nodule in the right tracheoesophageal groove (series 4 image 10) measures 10 x 9 mm, similar to multiple priors. Bilateral subhilar lymphadenopathy, unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Calcified granulomata.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postoperative changes of right nephrectomy.PANCREAS: Multiple cystic lesions within the pancreatic body and tail, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis..BONES, SOFT TISSUES: Degenerative changes of lumbar spine, similar to prior.OTHER: No significant abnormality noted.

Output: Stable exam. Pulmonary metastases, subhilar lymphadenopathy, and enhancing lesion in the region of the right thyroid bed, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old.Reason: suspected bacteremia, assess for pulmonary involvement History: see above Right PICC has been removed. No evidence of pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Chest pain with fever, chills and shortness of breath. Cardiomediastinal silhouette is within normal limits. Mildly low lung volumes. There is linear streaky opacity within both lung bases, however greater on the left with relatively increased mild left volume loss. No pneumothorax.

Output: Bilateral basilar atelectasis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for pneumonia History: fever, cough Unremarkable cardiac and mediastinal silhouette. Small scarlike opacity at the left apex. No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: 49yo M with intra-aortic balloon pump. History: iabp IABP radiopaque marker at the level of the proximal descending aorta, unchanged. Right PICC and left single lead ICD, unchanged.Stable cardiac and mediastinal silhouettes. Mild diffuse bilateral interstitial edema, unchanged. No large pleural effusions.

Output: Unchanged IABP.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: S/P LVAD. Repeat CXR to eval for pulmonary effusion History: Repeat CXR to eval for pulmonary effusion Severe cardiomegaly status post sternotomy, without acute edema or sizable pleural effusions.LVAD and ICD unchanged.Right subclavian catheter tip at cavoatrial junction level.

Output: Severe cardiomegaly. No evidence of edema, infection or sizable pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.CHF, mitral stenosis preop valve. Normal heart size. Small lung volumes with diffuse pulmonary opacity. Some of the patchy ground glass opacities seen on the prior study are improving but have not resolved..

Output: Slight improvement in pulmonary air space opacities. Differential considerations include chronic alveolar edema related to the patient's known mitral disease, infection or drug reaction. Sarcoidosis is considered less likely given the apparent improvement but cannot be excluded until resolution..


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: FemaleReason for Study: Reason: pna History: fever,sob Increased lung volumes compatible with COPD.The cardiomediastinal silhouette is unremarkable.No focal airspace opacities.Previous noted nodular opacity in the left upper lobe not identified on this exam.No pleural effusions.

Output: COPD without acute abnormalities. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: crackles, hx of CHF History: crackles cardiac surgery Stable cardiomegaly. Diffuse pulmonary opacities, increasing in the upper zones. The bones are diffusely dense, compatible with patient's history of sickle cell disease.

Output: Increasing upper zone opacities superimposed on chronic changes suspicious for edema.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PTX, pathology History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with chest pain. Evaluate for pericardial effusion. Cardiomediastinal silhouette is unremarkable. No focal airspace opacity, pleural effusion, or pneumothorax. No significant interval change.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Cystectomy, recent emesis now with WBC of 20. Small volume of free intraperitoneal air.Left ureteral stent partially visualized.Enteric tube tip projects over the gastric air bubble.A peripheral catheter from left terminates at the confluence of the brachiocephalic veins with the SVC.Normal heart size.Basilar atelectasis, lung volumes slightly decreased from prior. No pneumothorax.

Output: Free intraperitoneal air, presumably postoperative. Basal atelectasis but no specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p lvad, assess for edema or effusions History: sob Cardiopulmonary monitoring and support devices, unchanged.Left pleural effusion that may be loculated or organized, with adjacent atelectasis.Focal scarring at the right base.No specific evidence of pulmonary edema or other acute change.

Output: Left pleural effusion and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Hypoglycemia, rule out ACS Moderate cardiomegaly without additional cardiopulmonary abnormality

Output: Cardiomegaly without pulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: s/p VAD History: post op Interval removal of right internal jugular catheter.Interval placement of appears to be chest tube overlying right hemithorax. No pneumothorax. Remaining support devices are unchanged.No change in degree of cardiomegaly.

Output: Postoperative appearance with stable appearance of support devices.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: sob, assess for hypervolemia History: as above ET tube has been removed.Enteric tube with its tip beyond the margin of the image.Right PICC line with its tip in the SVC.Left IJ venous catheter with its tip in the innominate.Stable cardiomediastinal silhouette.Moderate-sized pleural effusions, left greater than right, and basilar atelectasis similar in appearance to the prior exam.No new pulmonary opacities noted.

Output: Interval extubation. Stable cardiopulmonary appearance with moderate-sized pleural effusions and underlying atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: Metastatic disease on the clavicle History: Metastatic disease on the clavicle Heart size normal, the lungs unremarkable.Large hiatal hernia noted.Sclerotic bone metastases are noted throughout the spine and ribs, as well as the clavicle better delineated on a dedicated clavicular study.

Output: No active cardiopulmonary disease, but widespread skeletal metastases.


Instruction: Generate impression based on medical findings.

Input: Age: 74 yearsGender: MaleReason for Study: Reason: 74M with mesothelioma and malignant pleural effusion, evaluate effusion History: SOB, malignant effusion Large right related pleural effusion with underlying atelectasis.Only minimal amount of aerated right lung.Cardiac size probably normal.The left lung is clear.

Output: Large loculated right pleural effusion and underlying atelectasis consistent with history of mesothelioma.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Fever cough and trach rule out pneumonia. Tracheostomy tube unchanged in position. Right jugular catheter tip at the SVC/RA junction, no pneumothorax. No focal air space opacities, pleural fluid or pneumothorax.

Output: No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old. Right central venous line has been withdrawn with tip at the superior vena caval/right atrial junction.Mild cardiomegaly, possibly with pericardial effusion.Diffuse basilar predominant interstitial opacity with a fine reticulonodular pattern.Mild blunting of the costophrenic angles suggest small pleural effusions.No specific evidence of pneumonia.

Output: Repositioning of right central line as above. No other change.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: evaluate LVAD positioning History: post op eval Left-sided ICD and LVAD unchanged.Stable mild cardiac enlargement.Small pleural effusions and left retrocardiac consolidation/atelectasis similar to the prior exam.No new pulmonary opacities identified.Median sternotomy intact with evidence of a mitral valve replacement.

Output: Support devices unchanged. Stable cardiopulmonary appearance with small pleural effusions and left retrocardiac atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: chest tightness, asthma History: chest tightness, asthma, cough, increased thick sputum No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: LVAD check LVAD and underlying cardiopulmonary appearance appears unchanged given mild differences in technique and semiupright positioning. Suspected residual scarring without superimposed acute abnormalities, however please note the right lung base is not well visualized.

Output: LVAD unchanged


Instruction: Generate impression based on medical findings.

Input: Reason: brusing to chest wall History: as above Unremarkable cardiac and mediastinal silhouette.Port catheter with its tip in the SVCNo significant pulmonary or pleural disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: SOB, hx lung ca, previous effusion on L History: SOB, adenoid cystic carcinoma with metastasis New large left pleural effusion with underlying atelectasis. Right chest port tip projects over the SVC. Mild right basilar atelectasis. Multiple pulmonary nodules are better defined on CT scan. No pneumothorax.

Output: Large left pleural pleural effusion


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: evaluate for metastasis. History: ewing sarcoma Prior wedge resection, but no evidence of recurrent tumor.Unremarkable mediastinal contours and cardiac silhouette.

Output: No evidence of metastases or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: ETT placement History: intubated Unchanged pulmonary opacities and pleural effusions.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.

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


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Possible air space opacity left lower lung zone versus underinflation artifact.No pneumothorax following ICD placement, leads and generator stable in position.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: Poorly differentiated adenocarcinoma with multifocal intracellular mucin, RLL History: none Postsurgical volume loss and blunting of the right costophrenic angle consistent with pleural scarring and possibly a small residual effusion.No sign of recurrent tumor.

Output: Postsurgical abnormalities with decreased right pleural effusion and no sign of recurrent tumor.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: s/p OHT History: routine xray s/p OHT Stable appearance of cardiomediastinal silhouette. Sternotomy wires intact.No specific evidence of infection or edema. No pneumothorax. No pleural effusion.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: s/p thoracentesis History: see above Marked decrease in right-sided pleural effusion. No definite pneumothorax. Mild patchy right basilar opacity. Left basilar opacity and left pleural effusion again noted. Lines and tubes are unchanged.

Output: Marked decrease in right pleural effusion status post thoracentesis without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female 46 years old Reason: chest pain Low lung volumes. No focal consolidation, pleural effusion or pneumothorax. The heart and mediastinal contours are within normal limits for size. Right upper quadrant cholecystectomy clips.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.History respiratory decompensation, evaluate for pneumonia and aspiration. Interval removal of endotracheal and enteric tubes.Cardiomegaly unchanged.Basilar opacities comprised of small effusions and atelectasis/consolidation slightly increased on the right and decreased on the left, overall similar to prior.

Output: Interval extubation. Basilar opacities increased on the right and decreased on the left.


Instruction: Generate impression based on medical findings.

Input: Reason: 70y/o woman with cough x 1 month that did not improved with Z-pak History: persistent cough Normal heart size and mediastinum with moderate dextroscoliosis.Multiple embolization coils and septal occluder device in place with some of the embolization coils located in coronary artery fistula's, previously characterized by CT scan.No sign of pneumonia or other acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: MaleReason for Study: Reason: infection? edema? History: chest pain The cardiomediastinal silhouette is unremarkable. Mildly increased lung volumes may represent COPD.No focal areas of consolidation.No suspicious pulmonary nodules or massesmoderate/marked degenerative changes throughout the thoracic spine.

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


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old. Right jugular catheter tip in the SVC with no pneumothorax or other complications.Small lung volumes with no gross abnormalities.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? History: septic unknown source Normal heart size and mediastinal contours.Focal scar at the left costophrenic angle, unchanged.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: s/p L thoracotomy History: interval change 2 left chest tubes are unchanged in position. Right chest port terminates in the SVC. Minimal residual left apical pneumothorax, not significantly changed. Left pleural effusion and postsurgical volume loss from left lower lobectomy. Right basilar subsegmental atelectasis, not significantly changed. Minimal left chest wall subcutaneous emphysema.

Output: No significant change from prior examination and minimal left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Cough Minimal basilar scarring without additional superimposed acute cardiopulmonary abnormality.

Output: Minimal scarring without acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Rule out infection. History of syncope with Alzheimer's. Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with esophageal cancer, status post chemotherapy CHEST:LUNGS AND PLEURA: New air space opacities and interstitial changes in the right apex.. These can be secondary to radiation. Given the recent development and fast increase in size. Pneumonia is another diagnostic consideration. Possibility of neoplastic process is low, but cannot be excluded. Left lower lobe fibrotic changes medially, likely secondary to radiation. Bilateral minimal pleural thickening.MEDIASTINUM AND HILA: Calcified subcarinal adenopathy measures 28 x 14 mm image number 46, series number 4. Other mediastinal enlarged lymph nodes are also present. A more inferior enlarged lymph nodes, which is not calcified and measures 18 x 11 mm image number 49, series number 4.The wall of the esophagus is diffuse is thickened. Small very cardial effusion. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 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: No significant abnormality noted

Output: New right apical air space opacities. Differential diagnosis includes radiation changes, pneumonia and much less likely, a neoplastic process. Follow-up CT imaging is recommended for further evaluation. No other significant change from the previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: pneumothorax resolution History: none Right apical pneumothorax improved if changed at all.Moderate right pleural effusion with right base consolidation.

Output: Right pneumothorax possibly improved.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p stent placement Venous catheter, pigtail catheter and stent device unchanged.Bilateral dense airspace opacity, suggestive of aspiration and possibly infection.No new findings.

Output: Bilateral pulmonary opacities suggestive of aspiration and infection with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: h/o OHT, screening CXR History: s/p OHT Status post sternotomy for heart transplant.Heart size normal.No significant pulmonary or pleural abnormality.Remnants of a left subclavian pacer ICD leads remain unchanged.

Output: No significant abnormality. Status post heart transplant.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: initial film to assess lung processes s/p nupulse insertion History: respiratory failure post cardiac surgery NuPulse iVAS device noted. Swan-Ganz catheter has been pulled back and terminates in the RPA. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged cardiomegaly.

Output: NuPulse iVAS device noted.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: eval lung fields History: s/p lung transplant Bilateral chest tubes with a small persistent left pneumothorax.Basilar opacities are unchanged allowing for differences in inflation.Status post extubation and NG tube removal.A Dobbhoff tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: Small left apical pneumothorax unchanged following extubation.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female, potential stem cell transplant donor. Evaluate. Cardiomediastinal silhouette is within normal limits.No focal pulmonary consolidation or pleural effusion.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: SOB History: SOB Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Per requisition: Dysphagia/removal of large esophageal polyp recent egd.Additional history provided per patient: Patient has had 2 episodes of throat swelling, one was 15 years ago, and the last one recently. Last episode associated with syncope. Resolved spontaneously. Currently reports no dysphagia. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions. Retained contrast in the colon.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave. Prominent cricopharyngeus is noted (series 13); does not correlate with patient's symptoms.TOTAL FLUOROSCOPY TIME: 2:02 minutes.

Output: No significant abnormalities to account for patient's episodic throat swelling.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: Pt has T2N2b right tonsillar cancer, presents with fever, evaluate for infection. The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.Streaky opacity at the lung bases may represent scarring and/or atelectasis.

Output: Streaky basilar atelectasis without specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: eval cough History: cough No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Removal of chest tube. Respiratory failure.VIEW: Chest AP (one view) 02/14/16, 0928 Left chest tube has been removed. Left subpulmonic pneumothorax persists. Focal opacities are noted in right upper, right lower, and left lower lobes. Cardiac silhouette size is normal.Endotracheal tube tip is between thoracic inlet and carina. Right internal jugular line has its tip in superior vena cava. Lower extremity PICC tip is in the right atrium. Feeding tube tip is in second portion of duodenum.

Output: Unchanged pneumothorax after chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: is there an infiltrate History: cough, fever, on chemo, history of prebiopsy, stem cell transplant, ALL Right internal jugular catheter tip in the SVC.Heart size is normal.Healed rib fractures.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: ARDS, progression? History: fever, hypoxia Tracheostomy tube and venous catheter unchanged.Small lung volumes with diffuse interstitial and airspace opacity, slightly improved compared to previous, compatible with the clinical diagnosis of ARDS.Gaseous distention of the stomach.

Output: Slightly improved pulmonary opacity compatible with ARDS.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and CHF history Moderate COPD changes without superimposed acute cardiopulmonary abnormality. Persistent similar appearing atherosclerotic changes and mild tortuosity of the aorta. Midline sternotomy.Interval placement of a left subclavian single port, tip extends into the SVC just be on the confluence

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: CT INFUSED PELVIC[LOW ABDOMEN], CT INFUSED UPPER ABDOMEN, CT INFUSED CHEST, 1/5/2008 10:30 AM CHEST:LUNGS AND PLEURA: Single punctate nodule in the right middle lobe on image 69/116, in retrospect probably unchanged from the prior exam. No pleural effusions. No new lung nodules.MEDIASTINUM AND HILA: Small nonpathologic sized axillary nodes bilaterally, unchanged from prior exam. No mediastinal hilar or diaphragmatic retrocrural nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal nodes unchanged nonpathologic by size criteria.BOWEL, MESENTERY: Bowel normal. Postsurgical changes noted.Scattered peritoneal carcinomatosis is unchanged in extent and size of lesions. Largest individual lesion is seen just underneath the left right this muscle above the pelvic inlet on image 164/214. No evidence of ascites.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: Soft tissue densities in the adnexa likely represent carcinomatosis in the dependent portion of the pelvis. Lesion in the right adnexa somewhat changed in shape making comparison difficult. Overall I believe is unchanged. Best measure men is on image 175/214 measures 4.5 x 4.0 cm. No new sites of disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable disease.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: Immunocompromised patient with fever \T\ cough x 1 day History: fever, cough Large mediastinal mass unchanged consistent with known Hodgkin lymphoma.Small lung volumes.No specific evidence of infection or edema.

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


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: productive cough, hx of lung cancer s/p chemo, evaluate for pna History: productive cough, hx of lung cancer s/p chemo, evaluate for pna Port catheter terminates near the cavoatrial junction. Cervical spinal fusion hardware visualized in the cervical spine. Clear lungs. Small pleural effusions versus pleural thickening. No pneumothorax. No acute bony abnormality. Healed left-sided rib fractures. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: Swan, IABP History: Swan, IABP Moderate cardiomegaly.No specific evidence of infection or edema.IABP catheter proximal marker within 2 cm of the top of the aortic arch.Left jugular Swan-Ganz catheter, tip in right main pulmonary artery.Right jugular catheter, tip in SVC.

Output: Unchanged support devices. Cardiomegaly without edema.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with anal cancer with known pulmonary metastases. CHEST:LUNGS AND PLEURA: No suspicious nodules. No pleural effusions. Right apical nodule wedge section postsurgical changes.MEDIASTINUM AND HILA: No mediastinal or hilar enlarged lymphadenopathy. The reference subcarinal lymph node best seen on series 3, image 46 measures 0.6 x 0.4 cm, previously measuring 1.2 x 0.7 cm.Aortic and coronary artery atherosclerotic calcifications.A right chest wall port is in place with its tip in the SVC/RA junction.CHEST WALL: Right chest wall port.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal hypodensities compatible with renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.SOB and left-sided chest pain rule out pneumonia versus effusion. HIV. Normal heart size. Highly tortuous thoracic aorta. No focal airspace opacities, pleural fluid or pneumothorax. Degenerative changes of the mid thoracic spine.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: assess line placement History: pulled back picc line 5-6 cm Interval adjustment of PICC line with the tip now at the SVC/RA junction.Right jugular catheter unchanged. No significant cardiopulmonary abnormalities.

Output: Interval adjustment of catheter and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: sp BIVAD History: - Moderate cardiomegaly with mild edema and persistent left lower lobe consolidation.Stable small pleural effusions.Support devices unchanged in position.Left chest tube with no pneumothorax.

Output: No change in pulmonary opacities or in support devices.


Instruction: Generate impression based on medical findings.

Input: Age: 31 yearsGender: FemaleReason for Study: Reason: 31F with productive cough x several months, eval for PNA History: productive cough Cardiac size is normal.Mild widening the mediastinum possibly representing lymphadenopathy.Patchy airspace opacities in the right lower lobe and left upper lobe are suggestive of infection.No pleural effusions.

Output: Patchy nodular pulmonary opacities suggestive of infection and possible mediastinal lymphadenopathy. CT of the the chest with IV contrast is recommended for further evaluation. The ED was notified by phone at 9:00 AM on 6/9/2016


Instruction: Generate impression based on medical findings.

Input: 20-year-old female presents with productive cough x2 weeks and subjective fevers. Evaluate for airspace disease. No pulmonary opacity, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is unremarkable. The bones and upper abdomen appear normal.

Output: Normal chest radiograph.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Motion degrades sensitivity.Interval increasing mixed interstitial and patchy airspace opacities with relative sparing of left upper lung. Concern for increasing diffuse edema, however multifocal infection cannot entirely be excluded. Persistent decreased lung volumes. Suspected mild cardiomegaly

Output: Diffuse increasing suspected edema and probable CHF


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: MaleReason for Study: Reason: chest pain History: cough There are decreased lung volumes.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with history of bladder cancer status post chemotherapy CHEST:LUNGS AND PLEURA: Stable apical bulla. Emphysema. Right lower calcified granuloma, stable.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without CT evidence of cholecystitis or biliary dilatation, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomyBLADDER: Status post cystectomy. Neobladder is unremarkable.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: interval change History: interval change Right chest tube in place with a small air collection of the right costophrenic angle consistent with pneumothorax andModerate pleural effusion. Underlying consolidation and atelectasis without significant change.Nodular callus at the left seventh rib posteriorly.

Output: Right hydropneumothorax and lower zone consolidation without significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: free air History: free air Cardiomegaly with equivocal but significantly improved improved basilar edema.No specific evidence of infection.No free intraperitoneal air.

Output: Improvement in prior basilar opacities and pleural effusions with no new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: copd exacerbation History: dyspnea Large lung volumes with flattening of the hemidiaphragms compatible with COPD. Biapical scarring and upper lobe cavities, unchanged. No new focal opacities.Unremarkable cardiac and mediastinal silhouettes.

Output: COPD and cavitary lesions with no new findings to suggest active infection, thoug the lesions should be followed.


Instruction: Generate impression based on medical findings.

Input: Intubation Unchanged diffuse interstitial and airspace opacities are consistent with edema, again with small pleural effusions.Right jugular catheter, tip in SVC. ET tube remains and terminates approximately 4 cm above the carina. The NG tube extends below the lower margin of the image.

Output: Persistent edema.


Instruction: Generate impression based on medical findings.

Input: 80 year-old man with history of BPH deteriorating mental status a 50-pound weight loss over past two months. No IV contrast per clinical service 2/2 renal. CHEST:LUNGS AND PLEURA: There is collapse of the anterior segment of the left lower lobe and extensive patchy air space disease among both lung bases consistent with bilateral aspiration pneumonias. Debris and fluid level seen in the trachea and right and left main bronchi, suggesting poor pulmonary toilet. I do not see any endobronchial lesions or discrete masses to suggest pulmonary metastatic disease.Emphysematous changes and fibrotic changes are seen in both upper lobes. Azygous fissure noted. No effusions.MEDIASTINUM AND HILA: Atherosclerotic changes. Prominent caliber of the ascending aorta. Small pericardial effusion. Small nodes.CHEST WALL: Densely sclerotic sclerotic upper thoracic vertebral body consistent with blastic metastasis. Scoliosis. Muscular atrophy.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to the lack of IV contrast. Given that limitation, the following observations are made.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Atrophic.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Large left renal cyst. Small vessel calcifications left renal hilus. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes aorta. No evidence of aneurysm. No pathologic size nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered sclerotic foci in lumbovertebral bodies.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted although prostate is not enlarged there is asymmetry of the soft tissues and possible thickening along the left posterior bladder wall.BLADDER: The bladder wall is diffusely but somewhat asymmetrically thickened.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Abundant stool in rectum consistent with constipation.BONES, SOFT TISSUES: Sclerotic foci in the two lytic foci consistent with metastatic disease. Postsurgical changes or old posttraumatic changes right femoral head and neck. Muscle wasting. Fat stranding along the back and possible decubitus ulcers correlate.

Output: The blastic lesions suggestive of metastatic disease from prostate carcinoma or other primary. Complete collapse left lower lobe anterior segment and multifocal air space disease in the bases consistent with aspiration pneumonias. Emphysematous and fibrotic changes upper lobes. Small pericardial effusion. Diffuse muscle wasting. Possible decubitus ulcers. Asymmetric bladder wall thickening. Stool filled rectum.Dr. Julie Bradley informed at the time of this dictation.


Instruction: Generate impression based on medical findings.

Input: 1-day-old with prenatally diagnosed congenital pulmonary airway malformation.VIEW: Chest crosstable lateral (one view) 6/13/2016, 0818 A cystic lesion with an air-fluid level is noted just below the level of the hilum corresponding to the hazy opacity seen on the frontal radiograph. The cyst measures 2 x 3 cm in size. No additional airspace opacity is evident. No pneumothorax or pleural effusion is seen. The cardiothymic silhouette is normal in size.

Output: Cystic lesion with air-fluid level just below the level of the hilum corresponding to the hazy opacity seen on the frontal radiograph, likely representing the reported prenatally diagnosed congenital pulmonary airway malformation or other bronchopulmonary foregut malformation.