Instruction: Generate impression based on medical findings.

Input: Male, 36 years old. Reason: aortic dissection History: abdominal pain Cardiomegaly. The aorta is somewhat prominent, compatible with a reported history of type B dissection. The aortic arch silhouette remains distinct, without apical cap to suggest hematoma.No focal airspace opacity. No large pleural effusions.Multiple small round metallic fragments project over the chest.

Output: Cardiomegaly and mediastinal widening, compatible with a known history of aortic dissection, without radiographic evidence of acute hemorrhage. If there is continued high clinical suspicion, CT angiogram may be considered for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Fever, Fatigue evaluate for pneumonia Cardiomediastinal silhouette is mildly prominent, unchanged.No pleural effusion or pneumothorax.Scattered areas of scarring/discoid atelectasis, no focal areas of consolidation.Endovascular stent noted in the upper abdomen.

Output: No specific evidence for infection.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Status post aortic valve replacement. Postsurgical changes of the chest.Chest tubes are unchanged in position.Unchanged heart size.Low lung volumes with increase in bibasilar opacities, which may represent aspiration and/or edema. Superimposed infection cannot be excluded.

Output: Worsening bibasilar opacities, which may represent aspiration and/or edema; superimposed infection cannot be excluded.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, 38 years old.Reason: where is CVC History: CVC readjustment Interval retraction right IJ central catheter which now terminates in the central superior vena cava. Bilateral anterior chest wall jewelry is presentHeart size is enlarged, stable. Scarring at the right costophrenic angle. Interval pneumothorax or other change.

Output: Moderate cardiomegaly is stable. Successful repositioning of the right IJ central catheter without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: R/o pneumonia or acute chest History: chest pain Heart size about upper normal. Mild lower zone interstitial opacity compatible with scarring and atelectasis, not significantly changed.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Left cordis with RV pacing wire Allowing for difference in patient position, the Swan-Ganz catheter appears to have been slightly advanced but remains in the projection of the main pulmonary artery. The Loc catheter appears slightly high however this may be due to patient positioning and repeat film is suggested.Endotracheal tube and visualized portion of the nasogastric tube unchanged. Diffuse groundglass opacity throughout the right lung and to a lesser extent seen on left along with atelectasis is improving in the lung bases.

Output: Improving opacities in the lung bases, favoring pulmonary edema. Alteration in device position could be artifact of patient positioning, suggest short-term follow-up.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: r/o pna History: fever Right IJ port catheter remains unchanged.Cardiomediastinal silhouette is normal in size. Calcified aortic knob. No hilar prominence again noted.Persistent low lung volumes with interval decrease in interstitial markings and less discrete left basilar patchy opacity.

Output: Slight interval decrease in interstitial edema and less discrete left basilar patchy opacity. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: eval lung fields History: LVAD Moderate cardiomegaly without edema, effusions or pneumonia.LVAD and ICD unchanged.Right jugular Swan-Ganz catheter tip in main pulmonary artery.

Output: Cardiomegaly, otherwise unremarkable. Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: ETT placement History: n/a Cardiomegaly and stable pulmonary opacities with a small left pleural effusion.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: INTUBATED History: AS ABOVE ET tube, NG tube, and right IJ venous catheter, and right-sided ICD unchanged.Stable cardiac enlargement.Focal right basilar opacity similar to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged. Persistent basilar opacity compatible with atelectasis/consolidation.


Instruction: Generate impression based on medical findings.

Input: Reason: please assess lung fields History: tracheostomy in place Tracheostomy tube and sternal fixation devices unchanged.Bibasilar airspace opacity, greater on the left, compatible with aspirated secretions, atelectasis and possibly infection.Probable small left pleural effusion.A few faint septal lines on the right compatible with mild edema, improved compared to previous, at least partly due to increased pulmonary inflation.

Output: Improved pulmonary inflation with mild edema and nonspecific basilar airspace opacity, unchanged from previous.


Instruction: Generate impression based on medical findings.

Input: 9-month-old girl, evaluate right lung volume.EXAMINATION: Chest radiograph AP (1 view) 8/24/2015 Tracheostomy tube is noted. The cardiothymic silhouette is partially obscured on the right. The left lung appears normal. There is opacity of the right upper lobe and the medial right middle lobe with elevation of the right hemidiaphragm.

Output: Opacity of the right upper and medial right middle lobes with elevation of the right hemidiaphragm suggestive of atelectasis.


Instruction: Generate impression based on medical findings.

Input: Hot flashes, check for lung pathology. Generalized hyperhidrosis and night sweats Minimal left basilar scarring without additional cardiopulmonary acute abnormality. Specifically lungs are clearLeft upper quadrant surgical staples unchanged

Output: Minimal scarring


Instruction: Generate impression based on medical findings.

Input: 70 or female with history of clear cell carcinoma of the uterus, status post chemotherapy CHEST:LUNGS AND PLEURA: Multiple small micronodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense focus in the dome the liver is unchanged. The no other focal lesions.Gallstones are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Double-J stent in the left kidney collecting system is unchanged. Mild left caliectasis is unchanged.RETROPERITONEUM, LYMPH NODES: Left para-aortic mass invading the lumber vertebral body now measures 5.6 x 4.7 cm image number 129, series number 3. The mass encases the left ureter. Adjacent retroperitoneal adenopathy is also slightly smaller.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Destruction of the L4 vertebral body is unchanged.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: Slight decrease in the size of the left allergic mass and retroperitoneal adenopathy. No other significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: Reason: airway patency, pulmonary pathology History: SOB, sensation of throat swelling Unremarkable cardiac and mediastinal silhouette. Small calcified nodule in the mid left lung compatible with previous infection.No acute disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Effusion and chest pain Mildly improving pulmonary changes suggesting resolving edema. Persistent nonspecific marked cardiomegaly with small effusions.ICD, chest tubes, LVAD and right jugular catheter are all otherwise unchanged

Output: Resolving CHF


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with chest pain. D-dimer is 0.51. Evaluate for PE. PULMONARY ARTERY: In this technically adequate study, no pulmonary emboli identified.LUNGS AND PLEURA: Right middle lobe granuloma. Minimal dependent changes at the bases. No pleural effusions. MEDIASTINUM AND HILA: Normal cardiac size. No pericardial effusions. No significant mediastinal or hilar lymphadenopathy. Calcified right thyroid hypodense lesion. Please refer to the ultrasound of the thyroid performed on 12/20/07.CHEST WALL: No significant axillary lymphadenopathy.UPPER ABDOMEN: Small hiatal hernia.

Output: No PE.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: Epigastric pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 27-year-old female with history of fever. Probable minimal right pleural effusion visible on lateral view. Normal cardiomediastinal silhouette.No pleural or lung abnormalities.

Output: Minimal right pleural effusion of uncertain significance. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: FemaleReason for Study: Reason: pulmonary edema, acute pathology? History: sob, tachycardia Basilar opacities are compatible with edema/atelectasis. Small pleural effusions, right greater than left.Right basilar consolidation/atelectasis.Borderline cardiac enlargementMultiple surgical clips are noted in the left upper abdomen.

Output: Basilar atelectasis /edema and small pleural effusions, right greater than left , suggestive of CHF. Concomitant infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: eval for infiltrate History: body aches, cough The cardiomediastinal silhouette is normal. No pulmonary opacity, no pleural effusion, no pneumothorax. A small amount of fluid tracks into the left major fissure, only seen on the lateral view.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Epigastric pain, check for right lower lobe opacity Mildly increasing mixed interstitial airspace opacities greater on the right and now in the right upper lobe suggesting advancing minimal edema. Persistent mildly decreased lung volumesBorderline cardiomegaly otherwise unchanged mediastinal contours given mild rotation.

Output: Nonspecific increasing mixed interstitial airspace changes suggesting edema versus aspiration


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with tachycardia and shortness of breath. Cardiac silhouette is unremarkable. Left lower lobe linear atelectasis is present. There is no other abnormal pulmonary opacities are identified. Pleural spaces are unremarkable.

Output: Left lower lobe linear atelectasis. No other abnormal pulmonary opacities are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: r/o infection History: copd, sob Severe upper lobe predominant emphysema and asymmetric bullous disease.There is a left apical masslike opacity which measures approximately 43 x 39 mm, concerning for a space occupying lesion, specifically lung cancer in the setting of smoking.Bilateral basilar subsegmental atelectasis.No pleural effusion or pneumothorax. Assessment of the mediastinum and hila.

Output: Left apical masslike opacity concerning for primary lung neoplasia in the setting of severe emphysema and smoking history. Further characterization with chest CT is recommended.


Instruction: Generate impression based on medical findings.

Input: COPD. Lung transplant workup. LUNGS AND PLEURA: Severe diffuse centrilobular emphysema.Focal scar like opacity posteriorly in the right upper lobe, unchanged.A previously described focal scar like opacity in the left upper lobe has resolved during the interval. A small left upper lobe nodule has also resolved.A small subpleural nodular opacity in the left lower lobe (65/113) is unchanged..MEDIASTINUM AND HILA: Mildly enlarged lymph nodes in the high right paratracheal and right hilar areas have not significantly changed.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Multiple subcentimeter hypodensities in the liver, unchanged, compatible with cysts.Calcified gallstones in the gallbladder. Mildly enlarged left adrenal gland, unchanged and probably benign.

Output: Severe emphysema with no acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 97 years old.Reason: aspiration PNA? History: coarse lung sounds, hypoxemia Unchanged basilar opacities and pleural effusions.Right jugular catheter tip at SVC/RA junction level.

Output: Unchanged basilar opacities and pleural effusions, suggestive of aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with history of cirrhosis CHEST:LUNGS AND PLEURA: Previously described right middle lobe nodule is unchanged, measuring 8 by 8mm image number 38, series number 10. A smaller inferior nodule is also unchanged. A subcentimeter nodule on the left side in the lingula on image number 35, series number 10 is also unchanged.MEDIASTINUM AND HILA: Enlarged thyroid gland is unchanged. Right hilar lymph node is unchanged, measuring 12 x 9 mm image number 43, series number 12.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic appearing liver is unchanged. On the arterial phase. There are numerous small enhancing foci throughout the liver parenchyma. On the portal venous and delayed phase. These foci do not demonstrate washout and, therefore, likely represent perfusion differences rather than true lesions.SPLEEN: Splenomegaly, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic bilateral kidneys, unchanged.RETROPERITONEUM, LYMPH NODES: IVC filter is in place.BOWEL, MESENTERY: Significant amount ascites, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted..

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: FemaleReason for Study: Reason: eval for ET tube placement, pleural effusions History: SOB Support devices unchanged.Stable cardiac enlargement.Right upper zone masslike opacity associated with the right second rib is noted on prior CT .Pleural effusions and basilar atelectasis improved since the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged with ET tube tip 3 cm above the carina. Improving pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 74 year-old female with papillary serous fallopian tube cancer CHEST:LUNGS AND PLEURA: Stable emphysematous changes. Previously described subcentimeter right middle lobe nodule is not visualized.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Serosal implant or the left lobe liver is significantly smaller now measuring 19 x 10 mm image number 71, series number 4. Previously measured second implant near the dome is also smaller now measuring 21 x 14 mm image number 65, series number 4. Other perihepatic implants are also smaller.SPLEEN: Previously seen splenic lesion is no longer visualized.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference gastrohepatic lymph node is smaller measuring 8 x 7 mm summary 6, series number 4.BOWEL, MESENTERY: Nonobstructive incisional hernias are unchanged.Left lower quadrant omental implant is significantly smaller measuring 21 x 18 mm image number 108, series number 4.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: Previous described near heterogeneous soft tissue density in the cul-de-sac is not well seen on today's study. This may be secondary to the decrease in the size of the lesion, however, it may also be possible that the lesion cannot be differentiated from the surrounding soft tissues. Presence or absence of diffusion can be better determined with pelvic MRI clinically indicated.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in the size of the peritoneal implants.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: eval ETT, lung fields History: s/p AVR Endotracheal tube terminates approximately 3.3 cm from the carina. Swan-Ganz catheter terminates within the pulmonary artery. Mediastinal drains are noted. New patchy left basilar opacity and small left pleural effusion. No large pneumothorax. Slight increase in heart size. Status post sternotomy.

Output: Expected postoperative appearance status post aVR.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for PNA History: assess for PNA Dense focal subpleural opacity posteriorly in the right lower lobe. The differential diagnosis includes pneumonia and infarct.Neoplasm is unlikely in view of the patient's age, but follow-up chest radiographs are recommended to confirm resolution.

Output: Focal right lower lobe subpleural opacity compatible with pneumonia or infarct.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p cardiac surgery History: s/p cardiac surgery Interval extubation.Venous catheters unchanged.Small lung volumes with basilar atelectasis and small effusions.Aortic valve prosthesis in place.

Output: Interval extubation with decreased lung volumes and slightly increased basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: infiltrates History: cough NG tube tip in stomach. No new opacity to suggest pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: infection History: fever, tachycardic Small lung volumes with bilateral opacity compatible with edema, atelectasis and pleural effusions.Catheter tip in the SVC.Focal scarring or atelectasis in the right upper lobe.

Output: Pulmonary edema and effusions with no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with metastatic bladder cancer. CHEST:LUNGS AND PLEURA: Bilateral pulmonary nodules, more numerous and larger on the right. The pulmonary nodules appear larger. A reference pulmonary nodule (series 5, image 53) in the right lower lobe measures 1.2 x 1.3 cm. MEDIASTINUM AND HILA: Diffuse mediastinal lymphadenopathy. A reference pretracheal lymph node measures 2.2 x 2.6 cm (series 3, image 35), previously measuring 1.8 x 2.3 cm. A right hilar reference lymph node measures 1.7 x 2.2 cm (series 3, image 54), previously measuring 1.7 x 2.1 cm.Coronary artery and aortic atherosclerotic calcifications.CHEST WALL: An enlarged left axillary lymph node measures 1.5 x 1.8 cm (series 3, image 15), previously 1.4 x 1.7 cm.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. Subcentimeter liver cysts unchanged.SPLEEN: Splenic calcifications compatible with granulomata.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Asymmetric kidney size, right larger than left. Multiple right renal cysts. No hydronephrosis. Ileal conduit in the right periumbilical region.RETROPERITONEUM, LYMPH NODES: Abdominal aortic atherosclerotic calcifications.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Status post right lower extremity proximal femoral amputation with expected disuse osteopenia. Degenerative changes in the lumbosacral spine and pelvis. Old healed fracture of right ilium OTHER: No significant abnormality noted

Output: 1. Slight increase in size of bilateral pulmonary nodules, compatible with metastases.2. Sight increase in size of mediastinal lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with history of kidney cancer CHEST:LUNGS AND PLEURA: Postoperative changes and scarring in the suture line identified in the left lobe was again. Nodule in the superior segment of the right lobe is less well seen and is more flat appearing on today's study measuring 4-mm image number 47, series number 5. Left lower lobe nodule measures 9-mm image number 193, series number 5. No significant change. No new nodules. Other nodularities along the left fissure is unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Metastatic lesion in the left lobe measures 4.5 x 2.4 cm image number 82, series number 3, not significantly changed. Another metastatic focus lateral to this lesion is also present. These lesions are difficult to differentiate from the surrounding liver but are grossly unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Mass in the tail of the pancreas is unchanged measuring 3.7 by 2.8-cm image number 95, series number 3.ADRENAL GLANDS: Right adrenal nodule is unchanged measuring 19 x 16 mm.KIDNEYS, URETERS: Status post left nephrectomy.The right midpole wedge shaped protruding defect is unchanged. Its etiology is unknown.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 16 years old.Reason: sarcoid r/o History: central scotoma, HA Cardiomediastinal silhouette is unremarkable. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No evidence of pulmonary sarcoidosis or lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: SOB. Cardiomyopathy. Mild cardiomegaly. Left subclavian ICD with proximal coil projects over the left brachiocephalic vein and distal coil projecting over the RV. Epicardial leads project over the lower mediastinum. No pneumothorax. No specific signs of pulmonary edema. No focal airspace opacities. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.

Output: Mild cardiomegaly but no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Congestive heart failure, intubated question pneumonia Moderate pleural effusions, right greater than left. Diffuse pulmonary opacities consistent with edema and atelectasis, right greater than left, about the same allowing for differences in patient positioning.

Output: No acute change in pulmonary opacities which may be a combination of edema, aspiration and atelectasis. Superimposed pneumonia cannot be ruled out.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: ETT placement History: ETT placement Lines and tubes are unchanged. Tubes and diffuse pulmonary opacities again noted. Unchanged cardiomegaly. No pneumothorax.

Output: Unchanged diffuse pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: 55-year-old man with AML with neutropenic fevers, persistent. Evaluate for infectious source or abscess. CHEST:LUNGS AND PLEURA: Diffuse groundglass pattern persists. Some of the micro-nodularity seen in the bases is less conspicuous. No effusions. No focal areas of consolidation.MEDIASTINUM AND HILA: Scattered small mediastinal nodes particularly in the AP window prevascular area unchanged. No new adenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Several small and large hypodensities scattered in the liver all consistent with simple cysts. No biliary dilatation. Questionable gallstones in a collapsed gallbladder.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Mild thickening left adrenal gland, unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic changes aorta no evidence of aneurysm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Levoscoliosis. No lytic or blastic disease.OTHER: 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: Persisting groundglass appearance in the lungs concerning for CMV pneumonia as previously indicated. Hepatic cysts. No evidence of abscess. Questionable gallstones in a collapsed gallbladder.


Instruction: Generate impression based on medical findings.

Input: Evaluate gastric distention. Mesothelioma of peritoneum. Postsurgical counts were correct per Dr. Waxman. Large volume of pneumoperitoneum. Intraperitoneal fluid also noted. Basal atelectasis with a small focus of consolidation in the left cardiophrenic angle, new from prior. The stomach bubble is distended with air and debris.Suture line in the left upper quadrant was discussed with Dr. Turaga.

Output: Large volume of intraperitoneal air as well as intraperitoneal fluid. Stomach remains distended with air and fluid. Small focal consolidation left cardiophrenic angle may be the result of aspiration, suggest serial follow-up until resolution.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: 3-4 day history of cough, low grade fevers rule out PNA History: cough, low grade fevers No acute abnormality. No specific evidence of infection.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 97 years old.Shortness of breath. Very low lung volumes. Persistent left midlung and basilar coarse reticular opacities and suggestion of bronchiectasis. Right midlung bandlike opacities suggestive of scarring, also unchanged. Respiratory motion artifact limits the assessment of both pulmonary bases.The cardiac and mediastinal contours are partially obscured by motion. The enteric tube has been removed in the interval.No pneumothorax.Slightly displaced left rib fractures again noted, of indeterminate chronicity.

Output: Low lung volumes and motion artifact limits assessment of the lungs.Multiple slightly displaced left rib fractures again noted, age indeterminate.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: eval for acute chest History: hx acs, hb ss, chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Right jugular catheter, tip at cavoatrial junction.Cholecystectomy clips noted.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 29-year-old female with right upper quadrant and epigastric tenderness ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small scar in the midpole of the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal appendix .BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: Rule out pneumonia History: Altered mental status The heart size is normal.Tortuous aorta with prominent aortic arch. Density behind the right atrium is nonspecific but may represent left atrial enlargement.No pleural effusion or pneumothorax.No specific radiographic evidence of infection.Severe osteoarthritis of the glenohumeral joints and diffuse osseous demineralization.IVC filter noted.Lumbar vertebral body defect represents compression fracture of indeterminate age.

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


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: ETT placement History: ETT placement Increasing basilar opacities suggestive of edema and subsegmental atelectasis.ET tube tip 8 cm above the carina. A Dobbhoff tube terminates in the stomach.

Output: High ET tube. Increase in basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? History: fever Diffuse bilateral nodular opacities compatible with known metastatic disease, not significantly changed for slightly increased inflation.No specific evidence of infection though underlying infection is difficult to exclude in the presence of such extensive disease.

Output: Extensive metastatic disease with no appreciable change.


Instruction: Generate impression based on medical findings.

Input: Headache, CP shunt placed 6 weeks prior. SHUNT DEVICE: Again seen is an intracranial shunt exiting the skull via a right frontal burr hole which courses down the right scalp, neck, and anterior chest wall, entering the abdomen and terminating in the pelvis. Portions of the shunt overlying the skull are relatively radiolucent and thus difficult to evaluate, but we see no evidence of shunt discontinuity or kinking. The pressure level is 1.5, representing an increase from prior study.SKULL: Impacted molars are again seen.CERVICAL SPINE: No significant abnormality noted, however the lower cervical spine is not well-seen on the lateral view due to overlying anatomy.CHEST: The lungs are underinflated.ABDOMEN: Nonobstructive bowel gas pattern. A T-shaped contraceptive device is noted in the pelvis.

Output: Shunt device as described above. Interval increase in the pressure level but no findings to suggest shunt discontinuity or kinking.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Right lower lobectomy. Postoperative changes right hemithorax with volume loss and a small apical pneumothorax. 2 right-sided chest tubes are directed towards the apex. Right chest port terminates at the level of the right atrium.Mild basal atelectasis.Subcutaneous emphysema right chest wall.

Output: Small right pneumothorax post lobectomy.


Instruction: Generate impression based on medical findings.

Input: Reason: IABP History: IABP Aortic balloon catheter and venous catheter unchanged.Cardiomegaly with bilateral lower zone opacity compatible with edema, consolidation, atelectasis and pleural effusion, greater on the right.

Output: Balloon catheter in the descending aorta. Findings consistent with CHF and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: 88 yo M with hypotension, s/p R THA History: see above Unremarkable cardiac and mediastinal silhouette. Focal small scar or subsegmental atelectasis at the left base but no sign of edema or pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p impella placement and d/c of IABP History: s/p impella placement Impella device with its tip projected in the area of the apex of the left ventricle.Swan-Ganz catheter tip in the main pulmonary artery.Cardiomegaly and ICD leads unchanged.

Output: Swan-Ganz catheter and Impella in expected locations.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Left-sided chest pain after smoking. Normal cardiomediastinal silhouette. No focal airspace opacities, pleural fluid or pneumothorax.

Output: Normal chest. No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Retained portion of portacath Left Upper Chest History: accidental removal of portacath Normal heart size with a moderately tortuous aorta. Dense calcification in the mitral annulus. No sign of a retained catheter fragment. Gastrostomy tube in place.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Shortness of breath and cough. Moderate right pleural fluid collection, increased in volume. Small volume of pleural fluid on the left, unchanged.Diffuse reticulonodular pulmonary opacities with areas of consolidation in the lingula and lung bases appearing progressed. Peripheral septal thickening appearing similar to recent CT and may reflect infiltrative disease and/or a component of pulmonary edema.

Output: Continued progression of pulmonary opacities with enlarging right pleural fluid collection, suggesting a component of pulmonary edema superimposed upon the patient's known pulmonary Kaposi's sarcoma


Instruction: Generate impression based on medical findings.

Input: Female, 11 months old. Swallowed button battery. Cough.VIEWS: Chest AP/lateral (two views) 07/22/2016, 2023 hrs. The aortic arch, cardiac apex, and stomach are left-sided.The cardiothymic silhouette is normal.No focal pulmonary opacities, pleural effusions, or pneumothorax.The button battery is not visualized within the chest.

Output: No radiopaque foreign body is identified.


Instruction: Generate impression based on medical findings.

Input: Check IABP The IABP marker remains within the aortic arch and the 3-lead left subclavian ICD is otherwise unchangedPersistent clear lungs with borderline cardiomegaly

Output: IABP marker unchanged


Instruction: Generate impression based on medical findings.

Input: Reason: sepsis History: sepsis ET tube tip approximately 2 cm above the carina.ICD leads unchanged.Small lung volumes with hazy bilateral opacity compatible with atelectasis and pleural effusions.No new findings.

Output: Bilateral effusions and atelectasis with no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: shortness of breath History: as above Extensive and severe chronic interstitial lung disease as previously described with pleural thickening and possibly effusion on the left.Pneumoperitoneum, not significantly changed.PICC line tip in the right subclavian vein.

Output: Extensive abnormalities with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o acute chest History: chest pain, cough Unremarkable cardiac and mediastinal silhouette. Small lung volumes with no acute findings.Skeletal abnormalities consistent with sickle cell disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Right chylothorax status post thoracic duct ligation evaluate for effusion or fluid collection. High chest tube output. Small loculated right apical hydropneumothorax.Masslike opacity adjacent to the right hilar suture line may be postoperative. Right chest tube unchanged in position. Left PICC tip at the SVC/artery junction.

Output: Small loculated right apical hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: eval for PTX History: s/p thoracentesis R lung, 1.4L removed, Hx metastatic SCC Improvement in right base but progression of left base and right upper lobe opacities, suggestive of recurring aspiration.Pulmonary metastases unchanged.No pneumothorax following thoracentesis.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Bilateral lung transplant. Large pneumoperitoneum not visible previously.Small hydropneumothoraces, left greater than right.Atelectasis and edema bilaterally, not significantly changed. Tubes and lines similar in position.Bowel incompletely visualized, with probable ileus.

Output: Large volume of intraperitoneal air, Dr. Martin (6666) notified via Web exchange text page at 9:19 a.m. on 5/10/2016. No acute change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: 58 y/o F with dysphagia; esophagram to further evaluate History: as above Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed prominent gastric folds, otherwise 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. There is a small hiatal hernia.TOTAL FLUOROSCOPY TIME: 5:01

Output: Small hiatal hernia. Otherwise, unremarkable esophagram.


Instruction: Generate impression based on medical findings.

Input: Reason: eval worsening infection or edema History: s/p heart transplant Increased airspace opacity and volume loss at the left base compatible with atelectasis and consolidation which may be secondary to aspiration. Feeding tube tip in the gastric fundus.

Output: Increased left basilar opacity with atelectasis and consolidation suggestive of aspiration.


Instruction: Generate impression based on medical findings.

Input: 36-year-old female. Evaluate for progression of metastatic disease. Prior records indicate history of chondrosarcoma. CHEST:LUNGS AND PLEURA: Scattered micronodules, unchanged. No new suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Hypoattenuating lesion near hepatic dome (series 3, image 84) has been present since study from 7/11/2006 without significant change and likely representing a benign hemangioma.Hypoattenuating lesion in segment 7 (series 3, image 90) correlates with the flash filling lesion seen in this location on study from 7/11/2006 and also likely represents a benign hemangioma, not significant changed since most recent prior study.The additional flash filling lesion seen on study from 7/11/2006 is not present on the study, likely due to phase of contrast.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. No evidence of metastatic disease.2. Probable benign hemangiomas in the liver without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: fall, altered mental status History: fall Bilateral healed rib fractures but no acute displaced fracture identified.Calcified granulomata.No other significant abnormality.

Output: Healed rib fractures, but no acute displaced fracture identified.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: lines, opacities History: tachypnea Cardiomegaly.No specific evidence of infection or edema.Right subclavian and left jugular catheters still terminate in the SVC.ET tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.

Output: Cardiomegaly with resolution of prior basilar opacities. Stable support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: Hx of RCC. Eval for mets History: As above Low lung volumes with bibasilar atelectasis. No large pleural effusion or pneumothorax. The heart size is normal. A left subclavian vascular stent is noted.

Output: No radiographic evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: eval for edema History: heart failure Left-sided ICD and right IJ Swan-Ganz unchanged.Stable cardiac enlargement.Mild perihilar/basilar edema.No new pulmonary opacities noted.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: History of necrotizing pneumonia. Reidentification of dilated right internal jugular vein and likely absent left jugular vein.LUNGS AND PLEURA: Right-sided chest tube again noted. Persistent right-sided hydropneumothorax, bibasilar and right apical air space opacities. Bilateral pneumatoceles, left greater than right.MEDIASTINUM AND HILA: No significant abnormality noted. Feeding tube is present.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No interval significant change.


Instruction: Generate impression based on medical findings.

Input: Male 63 years old with history of pleural mesothelioma, COPD, hypoxia Right port unchanged in position.Stable cardiomediastinal silhouette.Increased lung volumes. Mild lower lobe predominant interstitial opacities with trace pleural effusions/thickening appearing similar to prior exam. No focal consolidation.Left pleural nodularity consistent with history of mesothelioma, please refer to CT chest dated 2/26/2016 for additional findings.

Output: 1. Nonspecific bilateral interstitial opacities, which appear stable from prior exam, without specific evidence of infection.2. Left pleural nodularity consistent with history of mesothelioma and better evaluated on recent CT dated 2/26/2016.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: pulmonary edema? History: shortness of breath, history of chf Moderate to severe cardiomegaly, with new pulmonary edema consistent with CHF.No specific evidence of infection.

Output: CHF with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: eval for flash edema History: shortness of breath Improving basilar opacities suggestive of edema with persistent pleural effusions.No new findings.

Output: Improvement in basilar opacity still consistent with edema/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: ETT placement History: as above Patchy interstitial and airspace opacities are unchanged with a small right pleural effusion.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.

Output: ET tube tip approximately 5 cm above the carina. Unchanged pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: r/o effusion vs pna History: sob Mild cardiomegaly.The aorta is tortuous for age consistent with systemic hypertension.Prominence of the right peritracheal stripe likely represents distended deep systemic veins rather than lymphadenopathy.No specific evidence of infection or edema.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Organ donor ETT remains 3 to 4 cm above the carina. NG well-positioned with persistent mildly decreased lung volumes demonstrating small effusions and basilar atelectasis

Output: Well-positioned ETT


Instruction: Generate impression based on medical findings.

Input: Reason: CP, SOB with h/o prior CP History: CP, SOB Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.History of right upper quadrant abdominal and rib pain. The cardiomediastinal silhouette is normal.There are no focal opacities or large pleural effusions. No pneumothorax.No displaced rib fractures identified.

Output: No finding to account for the patient's pain. No displaced rib fractures identified.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: eval position of ETT, position of NG, eval status of PNA vs low-pressure effusion History: intubated, ?ARDS, MRSA bacteremia Small lung volumes with basilar interstitial opacities right predominant, suggestive of aspirated secretions.ET tube tip approximately 4 cm above the carina.An NG tube extends below the lower margin of the image.2. Right jugular catheters, one in the SVC and the other at the cavoatrial junction level.

Output: Basilar interstitial opacities suggestive of aspirated secretions. ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Chylothorax. Right upper lobectomy. Right chest tubes similar in position. Moderate right apical pneumothorax not significantly changed. Rounded opacity at the resection site may reflect loculated fluid/blood products but should be followed for resolution.Basal opacities consistent with mild edema, atelectasis and aspirated secretions on the right, unchangedSubcutaneous emphysema on the right.Left lung remains clear.

Output: Moderate right apical pneumothorax without significant change.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with breast cancer. Lymphoma. CHEST:LUNGS AND PLEURA: Right apical scarring is again noted. Interstitial thickening in the right middle lobe is stable.MEDIASTINUM AND HILA: The reference prevascular lymph node has mildly increased in size, measuring 2.1 x 1.2 cm (series 6; image 36), previously 1.9 x 0.9 cm. Enlarged supraclavicular and mediastinal (especially subcarinal) lymph nodes have minimally enlarged. CHEST WALL: Surgical clips are identified in the right breast. A left axillary lymph node has also mildly enlarged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Increased mesenteric adenopathy has developed. The previously noted reference lesion cannot be accurately compared due to development of nodal confluence. A new reference mesenteric lymph node will be created, measuring 2.2 x 1.6 cm (series 6; image 122), previously measuring 1.5 x 1.1 cm.BOWEL, MESENTERY: No significant abnormality.BONES, SOFT TISSUES: Surgical clips are now seen in the anterior abdominal wall. However, a small ventral hernia remains.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: Increased thoracic and mesenteric adenopathy, most significantly involving the mesentery.


Instruction: Generate impression based on medical findings.

Input: Current smoker complaining of central chest pain for 2 days. Low normal lung volumes unchanged. Normal heart size. No mediastinal widening. Thickening no focal airspace opacities, signs of pulmonary edema or pleural fluid.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: lung eval History: lung eval 2 radiographs were obtained in order to include the lower portion of the chest completely. On the first, obtained at 0904 hours the balloon catheter distal marker is 5 cm below the top of the aortic arch. On the second radiograph obtained at 0905 hours the marker is 9.5 cm distal to the top of the aortic arch. No significant cardiopulmonary abnormalities.

Output: Balloon catheter marker in the descending aorta, with a change in position between the 2 radiographs as described.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: eval pulm effusions/edema History: SOB Support devices unchanged.Stable cardiac enlargement with mild basilar atelectasis/edema.No new pulmonary opacities identified.No large pleural effusions.No pneumothorax.

Output: Support devices unchanged. Stable cardiopulmonary appearance with cardiac enlargement and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: assess ETT position History: intubation Improving pulmonary opacities which may have been atelectasis from aspiration.ET tube tip approximately 5 cm above the carina.A Dobbhoff tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: Improved atelectasis with no new findings. ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.SOB, missed last HD day. Question pulmonary edema. Right jugular catheter tip at the SVC level.Multifocal subsegmental atelectasis. Mild vascular redistribution and unsharpness suggesting hypervolemia, though no frank interstitial edema is appreciated.

Output: Signs of hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: confirm placement of OG tube in the stomach s/p advancement of OG History: Intubated ET tube with tip 3 cm above the carina. NG tube with side-port and tip in the gastric body. Right internal jugular central venous catheter with tip at the superior cavoatrial junction. Scoliosis of thoracic spine and levorotoscoliosis of the thoracolumbar spine.Moderate cardiomegaly. Increased right middle and lower lobe consolidation with bilateral pleural effusions. Retrocardiac atelectasis. No pneumothorax.

Output: Increased middle and lower lobe consolidation now with bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: pna, edema History: sob Low lung volumes with basilar atelectasis as well as findings of pulmonary edema, virtually unchanged. Cardiomediastinal silhouette remains stable. No pneumothorax.

Output: Low lung volumes with basilar atelectasis as well as no change in appearance of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 78-year-old male status post trach tube placement Interval tracheostomy with tip approximately 4 cm above the carina. Interval placement of left internal jugular central venous catheter tip overlying the distal left brachycephalic vein. Right Swan-Ganz catheter tip unchanged overlying the main pulmonary artery. Left-sided chest tube unchanged. Enteric tube tip extends beyond the inferior margin of image.There is slight increase in interstitial edema, atelectasis and pleural effusions. No pneumothorax.Stable cardiomediastinal silhouette.

Output: Interstitial edema, atelectasis and pleural effusions slightly increased. Tracheostomy tube tip in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: eval ETT History: eval ETT Unchanged pleural effusions.ET tube tip approximately 3 cm above the carina.An NG tube extends below the lower margin of the image.Left jugular catheter, tip in SVC.Right jugular catheter, tip in SVC.

Output: ET tube tip approximately 3 cm above the carina. Unchanged pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: Patient S/p R. IJ tunnelled catheter, now w/ pain around site, please eval for appropriate placement, pneumothorax History: As above RIJ catheter terminates in the SVC. No pneumothorax. Increase in moderate-sized left pleural effusion. Increased left basilar opacity. Unchanged cardiomegaly.

Output: Right IJ line terminates in the SVC. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: ETT placement History: ETT placement ET tube tip 5 cm above carina. Other findings stable in short interval.

Output: ET tube tip 5 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval lines/tubes/devices History: Eval lines/tubes/devices Cardiopulmonary monitoring and support devices, unchanged.Moderate cardiomegaly and small lung volumes with basilar opacity compatible with atelectasis and effusions.No new findings.

Output: Unchanged support devices with small effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: ETT check ETT has been advanced, tip projects 4 cm above the carina. NG and right subclavian port are otherwise unchangedThe previously and relatively new bilateral basilar opacities suggesting aspiration and/or pneumonitis are again observed. Small effusions. Overall appearance is unchanged over 2 hours and again serial follow-up imaging is suggested to exclude infection over a longer period

Output: ETT repositioned


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: Am cxr History: am cxr Left chest tube unchanged in position this stable effusion, atelectasis and edema.Right lung unremarkable.

Output: Stable left chest tube with pleural fluid, atelectasis and effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: hx of HTN p/w AMS and productive cough History: AMS and productive cough Markedly decreased lung volumes.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: Markedly decreased lung volumes. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Chest pain, left-sided pleuritic pain, evaluate for infiltrate The previous left basilar opacity is no longer visualized. The lungs and pleural spaces are clear. The heart size is normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 82-year-old male with shortness of breath. No CHF. LUNGS AND PLEURA: Moderate pleural effusions are noted, greater on the right. Predominantly upper lung ground glass and interstitial opacities, worse on the left, may represent interstitial and air space pulmonary edema, less likely hemorrhage or infection. Associated mild bronchial wall thickening is noted as well.Scattered calcified micronodules likely represent prior granulomatous disease. No suspicious nodules or masses.MEDIASTINUM AND HILA: Prominent mediastinal lymph nodes demonstrate benign morphology. The cardiac size is mildly enlarged with a small pericardial effusion. Atherosclerotic calcification of the aorta and coronary arteries is noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Findings as above most compatible with CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: central line placement History: ACS in sickle cell disease patient Interval placement of right IJ catheter with tip in the proximal SVC.Stable cardiomegaly.Right infrahilar airspace opacity unchanged.Left lower lobe consolidation is worsened in the interim.No pleural effusion or pneumothorax.

Output: New right central venous catheter tip in the SVC. Worsening pulmonary opacities.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.CHF evaluation Cardiomegaly with moderate diffuse bilateral interstitial opacities and small pleural effusions are again present. Allowing for differences in technique with improved penetration currently, the appearance is not significantly changed. Postsurgical appearance with valvular replacement again noted. No pneumothorax.

Output: Moderate CHF pattern, stable.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.History of complicated diverticulitis with abdominal pain. Chest: No acute cardiopulmonary abnormality.Abdomen: There is mild gaseous distention of several loops of small and large bowel with air-fluid levels on upright films. Gas is seen throughout the colon. No intraperitoneal free air. Bilateral hip prostheses noted.

Output: 1. Gaseous distention of several loops of large and small bowel with air-fluid levels. These findings may represent developing partial large bowel obstruction versus ileus.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: evaluate for pulmonary edema History: wheeze, SOB Mild cardiomegaly.No specific evidence of infection or edema.

Output: Mild cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: septic History: fever, chills Hilar and mediastinal prominence compatible with lymphadenopathy. The cardiac silhouette is unchanged compared to 7/3/2015. No specific evidence of infection, edema, or effusions.

Output: Lymphadenopathy without evidence of acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: evaluate PTX, s/p R thora today History: see above No pneumothorax following thoracentesis.Right pleural effusion slightly improved, with persistent adjacent consolidation.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: s/p thora. Eval for PTX History: none Right pleural effusion and interstitial opacities unchanged.Right sided opacity diminished following thoracentesis.No significant pneumothorax.Central lines are unchanged in position.

Output: No pneumothorax following thoracentesis


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Left thoracotomy and paraesophageal hernia repair. There appears to be a small caliber drain projecting over the midline mediastinum. Left apical chest tube in place. No significant sized pneumothorax. Minimal subcutaneous emphysema left chest wall. Lung volumes remain low with basal and dependent opacities consistent with atelectasis and possible mild edema. Blunting of the left cardiophrenic angle is new, favored to represent pleural fluid and atelectasis.

Output: Mild edema, atelectasis and a probable small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: eval ETT placement History: intubated Line position stable.Stable bilateral pleural effusions, left greater than right. Diffuse opacification of the left lung unchanged. Persistent mediastinal widening in patient with previously documented descending thoracic aortic aneurysm. If there is suspicion for acute aortic syndrome, recommend cross-sectional imaging.Progression of right lung opacities.

Output: 1. Stable support devices.2. Progression of right lung opacities suggesting increased pulmonary edemaMediastinal widening is again noted and as previously suggested, CT can be obtained for further evaluation. No other interval changes.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with history of lung cancer. Not on therapy. CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules, including the previously described right middle lobe nodules, are stable. No new nodules or masses. Postoperative change status post left lower lobectomy is redemonstrated. Mild emphysema is demonstrated.MEDIASTINUM AND HILA: Heterogeneous, enlarged right thyroid lobe is unchanged. Reference AP window lymph node measures 12 x 9 mm, essentially unchanged and is of unlikely clinical significance (image 39/14). Scattered additional small mediastinal lymph nodes are unchanged. A coronary artery calcifications stable.CHEST WALL: Postoperative rib deformity is redemonstrated on the left. Likely posttraumatic rib deformity on the right is also stable.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small right renal hypodensity is unchanged and likely represents a benign cyst.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Non enlarged retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable nonspecific findings as above with no definite evidence of metastatic disease to the chest or upper abdomen.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: lung transplant, shortness of breath, decline in spiro. History: as noted above Increased right pleural thickening or pleural fluid, unchanged on the left.Stable lingular nodule.Heart size normal.No specific evidence of infection or edema.

Output: Enlarging right pleural effusion are increased right pleural thickening.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: SOB History: as above Tracheostomy tube unchanged.Stable cardiomediastinal silhouette.Basilar opacities and pleural effusions similar in appearance the prior exam and compatible aspiration/edema.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance with small pleural effusions and basilar opacities suggestive of aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: MaleReason for Study: Reason: 62M hepatic abscess, new cough, shortness of breath History: cough, shortness of breath There are decreased lung lines are stable cardiac mediastinal silhouette.Interstitial and patchy airspace opacities in both lungs more prominently upper lobes suggestive of infection and/or aspiration.Pleural effusions bilaterally.Stable cardiomediastinal silhouette.New right upper quadrant drainage catheter with TIPS in place.

Output: Increasing interstitial and patchy airspace opacities in both upper lobes suggestive of infection and/or aspiration. Bilateral pleural effusions. New drainage catheter in the upper abdomen.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: ett placement History: ett placement Moderate pleural effusions and basilar atelectasis unchanged allowing for differences in patient positioning.New IVC large bore catheter or cannula, tip projected around the base of the heart to left of midline.Right jugular Swan-Ganz catheter tip in main pulmonary artery.Left subclavian ICD, leads unchanged in position.ET tube tip approximately 4 cm above the carina.

Output: New IVC catheter or cannula placement, location described above.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with history of cough, evaluate for aspiration pneumonia. Normal cardiac and mediastinal silhouette. Lungs and pleura are unremarkable.

Output: No cardiopulmonary abnormalities. No specific evidence of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: ET placement History: RF Interstitial and airspace opacities are unchanged.ET tube tip approximately 2 cm above the carina.An NG tube terminates in the stomach.Left PICC, tip in the SVC.

Output: ET tube tip approximately 2 cm above the carina. Unchanged pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for pulmonary issues. History: Shrapnel to R chest from tire blowout. Unremarkable cardiac and mediastinal silhouette. No significant pulmonary abnormalities.Suture anchor devices projected over the right clavicular head, unchanged.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: volume overload History: as above Interval improvement of left basilar opacities with worsening of right basilar and right upper lobe pulmonary opacities. Cardiomegaly is unchanged. Tortuous aorta. Enteric tube terminates out of the field-of-view.

Output: Shifting opacities as outlined above.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Fever. Rule out infection. No acute pulmonary opacities. No pleural effusions or pneumothorax.Cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: FemaleReason for Study: Reason: eval for interval change History: R ptx with persistent air leak Right-sided chest tubes and right-sided endobronchial valves unchanged.Subcutaneous emphysema along the right lateral chest wall and right supraclavicular region slightly improved.Right-sided apical pneumothorax stable.Left pleural thickening/effusion and nonspecific basilar opacity similar in appearance to the prior exam.Left apical bullae.No new pulmonary opacities identified.

Output: Persistent right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: history of CF History: SOB, hypoxia Large lung volumes with coarse interstitial opacities compatible with bronchiectasis secondary to cystic fibrosis.Blunting of the right costophrenic angle compatible with scarring, unchanged.Port catheter with its tip in the upper right atrium.No new findings.

Output: Extensive bronchiectasis with no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 60-year-old female presents with shortness of breath and fevers. Evaluate for infiltrate. The cardiomediastinal silhouette is at the upper limit of normal. No focal opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: s/p lvad, assess for pna or infection History: sob Clear lungs. No pleural effusion or pneumothorax. Unchanged cardiomegaly. Iatrogenic devices are unchanged.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Fever, evaluate infection. Right chest port unchanged in position. There is some increasing opacity overlying the right chest port which may be in the soft tissues of the chest wall or the underlying lung parenchyma. Correlate with physical examination and p.m. lateral chest radiographs.

Output: Opacity overlying the right chest port and may be within the chest wall or lung, correlate with physical exam for signs of port infection as well as PA and lateral chest radiographs to exclude pneumonia. Peggy Klein (Margaret) notified via email at 11:05 AM on 12/22/2016.


Instruction: Generate impression based on medical findings.

Input: Male; 83 years old. Reason: rule out PNA given cough and AMS History: cough and AMS Stable mild nonspecific left basilar opacity, most suggestive of small effusion with underlying atelectasis/consolidation.Stable mild cardiomegaly.

Output: Stable mild nonspecific left basilar opacity.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with metastatic cell carcinoma CHEST:LUNGS AND PLEURA: Stable micronodular on image number 43, series number 5. No new nodules.MEDIASTINUM AND HILA: Index subcarinal adenopathy measures 4.8 x 2.7 cm on image number 45, series number 3, slightly decreasing size compared to previous study. This lymph node is difficult to measure due to lack of IV contrast. Right parahilar adenopathy is unchanged measuring 1.5 x 1.2 cm on image number 56, series number 3. It's difficult to differentiate this lymph node from surrounding vessels and measurement may not be very accurate.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: Left renal mass cannot be well differentiated from the normal left kidney. It measures 5 by 4.9 cm on image number 103, series number 3, slightly increased compared to previous study. However measurement may not be accurate. Right kidney is not visualized.RETROPERITONEUM, LYMPH NODES: Small and borderline enlarged retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: Midline hernia containing nonobstructed transverse colon segment.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: Limited study due to lack of IV contrast. Subcarinal lymph node has decreased in size. Left renal mass is minimally increased in size. No other significant change. Please note that lack of IV contrast limits optimal measurement of the index lesions.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: dyspnea, respiratory distress History: as No change in left lower lobe consolidation and pleural effusions.Stable left pleural drain.An NG tube terminates in the stomach.

Output: Unchanged left basilar consolidation and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Coronary atherosclerosis, evaluate lung fields. History of septic shock. Interval placement of a Dobbhoff tube which terminates at the right of midline and may be either in the distal stomach or proximal duodenum. Other tubes and lines unchanged in position.Moderate to large layering pleural effusions with associated atelectasis, about the same.

Output: Moderate to large pleural effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: IABP placement History: see above Left-sided ICD and a BB marker unchanged.Cardiac mediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: IABP marker in the aortic arch. No acute cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumonia History: recent pneumonia The heart size appears upper normal with increased upper zone blood flow but no sign of pulmonary edema or infection.Status post median sternotomy. Focal scarring at the left base.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: Intubated History: ETT secretions ET tube tip approximately 3 cm above the carina.Venous catheters and aortic balloon catheter unchanged.Small lung volumes with subsegmental atelectasis on the right.Interval clearing of more diffuse opacity compatible with edema.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old. Reason: Eval lines/tubes/devices History: Eval lines/tubes/devices Right arm PICC, tip in the brachiocephalic vein. Left IJ catheter, unchanged in position, with tip overlying the aortic arch. ICD and LVAD unchanged in position.Stable cardiomediastinal silhouette.Nonspecific basilar opacities appear similar to prior, likely reflecting atelectasis. No new focal airspace opacity.

Output: Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: copd exacerbation History: SOB Left chest wall ICD with leads unchanged. Cardiomegaly is unchanged. No evidence of pulmonary edema or large effusions. No evidence of infection.

Output: Cardiomegaly without evidence of acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: 59F w/ afib w/ RVR overnight History: CP Mild cardiomegaly with left basilar subsegmental atelectasis.No specific evidence of infection or edema.Azygos pseudolobe, normal variant.Left subclavian dual-chamber pacemaker, unremarkable in appearance and location.

Output: No specific evidence of infection, edema or interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: FemaleReason for Study: Reason: Patient with chest pain, eval for acute process History: As above Decreased lung volumes with stable cardiac enlargement.Left retrocardiac opacity suggestive of atelectasis although this may be related to technique.The right lung is clear.

Output: Left retrocardiac consolidation/atelectasis may in part be related to technique. No definite acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 24 years, Female. Reason: is there free air or evidence of bowel obstruction History: abdomen pain, on chemo. No evidence of pneumoperitoneum. Surgical clips are seen scattered throughout the chest wall and abdomen. Nonobstructive bowel gas pattern. Average stool burden.

Output: Nonobstructive bowel gas pattern. No evidence of pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz checkup Swan-Ganz position remains unchanged with tip projected into the left lower lobe, essentially unchanged given differences in patient positioning and rotation.Additionally no other cardiopulmonary change since prior study. ETT remains 2 cm above the carina, please see subsequent report

Output: Swan-Ganz unchanged in position


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with reflux Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities or pleural effusions.Double contrast evaluation of the esophagus revealed no mucosal or mural abnormalities. Small hiatal hernia was identified. Spontaneous gastroesophageal reflux to the distal esophagus was identified. Fluoroscopic examination of esophageal motility demonstrated a primary peristaltic wave with intermittent proximal escape while in the prone position and a compensatory secondary wave.

Output: Small hiatal hernia and gastroesophageal reflux. Mild esophageal dysmotility.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: r/o mets History: RCC Unchanged smoothly marginated lingular nodule, previously reported as benign.No new abnormalities and no other evidence to support metastatic disease.Heart size normal.Left subclavian ICD, leads unchanged in position.

Output: Unchanged lingular nodule possibly granuloma, with no reliable evidence of metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: eval for infection History: liver tx with fever Left subclavian central catheter tip at the superior cavoatrial junction.No focal pulmonary opacity, pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with history of pneumonia s/p intubation. Nasogastric tube extending into the stomach. Endotracheal tube located about 1 cm above the carina. Bilateral patchy airspace opacities. Small bilateral pleural effusions.

Output: Nonspecific airspace opacities compatible with pneumonia and/or edema.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with neutropenic fever CHEST:LUNGS AND PLEURA: Stable micronodules.MEDIASTINUM AND HILA: Subcentimeter residual soft tissue cannot be well seen due to noncontrast technique on this study. Reference AP window node lymph nodes can also not be optimally evaluated and accurately measured due to lack of IV contrast.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: Small amount of residual contrast material in the collecting system of the kidneys, which may be from a previous contrast enhanced study. Left renal parapelvic cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Reference right mesenteric lymph node is smaller, measuring 8 x 7 mm image number 156, series number 4.There is moderate amount of wall thickening, predominantly involving the small bowel loops in the left upper quadrant, likely representing jejunal segments. Multiple borderline enlarged, mesentery lymph nodes are unchanged.Possible mild wall thickening of the terminal ileum. Ascending colon and cecum and other colon segments appear unremarkable.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: Diffuse wall thickening involving the proximal small bowel segments in the left upper quadrant likely representing jejunum. Differential diagnosis includes infection or graft versus host disease.Mesenteric lymph node is smaller. Neck and mediastinal lymph nodes cannot be optimally measured.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: eval for resolution of pneumothorax History: dyspnea set Right pleural drain unchanged with a small right apical pneumothorax, improved. No new findings.

Output: Small right apical pneumothorax, improved, pleural drain stable.


Instruction: Generate impression based on medical findings.

Input: Right pneumothorax Small right pneumothorax essentially unchanged. See subsequent report

Output: Right small pneumothorax


Instruction: Generate impression based on medical findings.

Input: Lactic acidosis, check for pneumonia Persistent mixed interstitial and airspace opacities greater in a perihilar distribution with vascular redistribution and mild cardiomegaly. Suspected mild pulmonary edema again suggested without additional superimposed focal airspace abnormality

Output: Suspected mild pulmonary edema


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: r/o volume overload History: SOB Severe cardiomegaly with small lung volumes.Questionable edema, but no sign of infection.Small pleural effusions.Right subclavian catheter, tip in SVC.Left subclavian pacemaker, tip in pulmonary outflow tract.

Output: Severe cardiomegaly with possible edema and small effusions. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: evaluate for infiltrate History: sob ICD electrodes are unchanged in position.Evidence of healed granulomatous infection. Cardiomegaly is unchanged. Small right pleural effusion and/or scarring. There is a convex character to an opacity at the posterior costophrenic angle, increased over the last 3 days which may represent developing infection. Continued short interval follow-up is recommended. No associated edema or pneumothorax.

Output: Convex margin to opacity in the posterior costophrenic angle noted on the lateral view. While this may represent loculated fluid, short interval follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Esophageal anastomotic leak. ET tube tip approximately 4 cm above the carina. Right PICC tip at the superior cavoatrial junction. Right jugular venous catheter tip at the superior cavoatrial junction.Gastric pull-up with esophageal stent noted. Drainage catheter projects over the right mid lung.Right greater than left bibasilar atelectasis, similar to prior.

Output: Postprocedural changes and atelectasis, without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Tachycardia Interval increasing patchy opacities in both lung bases and right upper lobe. Questionable small effusions.New interval NG tube placement, tip extends beyond the inferior edge of the image. Right jugular catheter terminates in the mid SVC and ICD is unchanged

Output: NG tube placed with additional nonspecific patchy opacities concerning for possible multifocal infection and/or aspiration


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with esophageal cancer status post chemoradiation. No history of surgery. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Single contrast evaluation of the esophagus revealed a short segment of fixed caliber narrowing and mild contour irregularity of the mid esophagus near the level of the carina. Also noted is a small sized sliding-type hiatal hernia.Fluoroscopic evaluation of the hypopharynx and upper esophagus demonstrate no evidence of aspiration. Fluoroscopic evaluation of esophageal peristalsis demonstrated cessation of the primary peristaltic wave to the level of the narrowing in the mid esophagus with mild proximal escape. Immediate recruitment of secondary waves were noted.During the exam, no spontaneous or provoked gastroesophageal reflux was observed. TOTAL FLUOROSCOPY TIME: 3:27 minutes

Output: 1.Short segment of fixed caliber narrowing at the mid esophagus compatible with patient's known esophageal cancer.2.Small sized sliding-type hiatal hernia.3.Mild motor abnormality of the esophagus as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infection History: productive cough and fever Focal opacity in the right infrahilar area, possibly in the right middle lobe and an additional faint opacity in the lingula, both of which are nonspecific though compatible with pneumonia in the appropriate clinical setting. Mild blunting of both posterior costophrenic angles may be due to small effusions or scarring.

Output: Bilateral nonspecific focal opacities compatible with pneumonia but nonspecific. A follow-up chest radiograph is recommended to confirm resolution.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: MaleReason for Study: Reason: pna? rib fracture? History: old rib fractures, cough, fever The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.No obvious rib fractures.Multiple buckshot pellets again noted overlying the left hemithorax .

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


Instruction: Generate impression based on medical findings.

Input: 63-year-old female status post laparoscopic total proctocolectomy with end ileostomy with recent fevers, increasing white blood cell count. Currently afebrile. Please evaluate for pulmonary abscess. LUNGS AND PLEURA: A well-defined, focal collection of fluid is noted at the right lung base abutting the diaphragm exhibiting a peripheral rim of increased attenuation with central hypoattenuation along with an eccentric pocket of aerated lung. It measures approximately 4 cm in longest axial dimension (series 5, image 62) and is new since the CT study from 2/17/2009. Adjacent pleural enhancement is also noted. Appearance is most compatible with a pulmonary abscess; less likely, this may also represent a small loculated pleural effusion with adjacent atelectasis. MEDIASTINUM AND HILA: No significant abnormality noted. Unenlarged mediastinal lymph nodes.CHEST WALL: Sclerotic T3 vertebral body with coarse trabecular pattern, compatible with Paget's disease. Degenerative changes of the spine.UPPER ABDOMEN: Sharply-defined, hypoattenuating lesions is again noted in the dome of the liver, best seen on series 8028, coronal image 34, as seen on prior study and likely representing vascular flow phenomenon.

Output: 1. Probable pulmonary abscess at right lung base. However, it is difficult to discern definitively if this lesion is entirely intrapulmonary in location and there may be a small loculated pleural fluid collection. Pulmonary infarct is a less likely consideration.2. Sclerotic T3 vertebral body with coarse trabecular pattern. In the absence of a history of a known primary malignancy, this most likely represents Paget's disease.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: LVAD History: SOB Stable cardiomegaly. Slight interval increase in pleural effusions and perihilar and bibasilar pulmonary opacities. Support devices are unchanged.

Output: Unchanged cardiomegaly and slight interval increase in findings consistent with mild to moderate CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: eval for infection vs edema History: shortness of breath Stable cardiomegaly. Right pleural effusion improved. No new opacity or significant edema.

Output: Stable cardiomegaly. Right pleural effusion improved. No new opacity or significant edema.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Fever question infiltrates. Right jugular chest port tip at the right atrium.Mild basal atelectasis or scarring. No pleural fluid or pneumothorax. No focal airspace opacities.

Output: No specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: Pre-Op TRANSPLANT baseline assessment History: Pre-Op TRANSPLANT The cardiomediastinal silhouette is normal.There is no focal pulmonary opacity or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: possible pulmonary process causing fever History: fever to 38.7 postpartum Unremarkable cardiac and mediastinal silhouette. Mild blunting of both costophrenic angles consistent with small pleural effusions.No sign of pneumonia.

Output: Small pleural effusions but no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: eval for pneumonia, fluid, History: acute change in status, hypoxemia. h/o esrd on PD Vascular stents again noted. Low lung volumes makes detailed cardiopulmonary assessment difficult. No new focal pleural parenchymal opacity. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: assess for infiltrate History: cough Stable cardiomediastinal silhouette.Streaky bilateral opacities suggestive of subsegmental atelectasis. Stable scoliosis and chronic right posterior ninth rib deformity.

Output: Streaky atelectasis without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 20-year-old female with sickle cell disease presents with chest pain. There is a clinical concern for acute chest syndrome. Cardiomediastinal silhouette is enlarged. New right lower lobe airspace opacity. No pneumothorax or pleural effusion.Chronic skeletal stigmata of sickle cell disease. Cholecystectomy clips.

Output: Right lower lobe opacity consistent with acute chest syndrome in a patient with sickle cell disease.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Shortness of breath rule out pneumothorax. Interval worsening of perihilar opacity, right greater than left. Bronchial wall thickening, atelectasis and nodularity bilaterally is suggestive of bronchiolitis and pneumonitis, most likely the result of aspiration.

Output: Worsening bilateral pulmonary opacities suspicious for pneumonia. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 53 years old Male. Reason: s/p intubation History: None. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Hypoinflated lungs. The tip of the ET tube pointing to the right main bronchus. Streaky and linear opacities are seen in the lung bases, consistent with atelectasis.

Output: Abnormal position of the ET tube. Subsequent chest x-ray of the correction of the ET tube position has been reported.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: DHT pulled, replaced History: as above Dobbhoff tube tip in the antropyloric region. Right jugular cannula tip is unchanged with tip directed to the tricuspid valve. Tracheostomy tube unchanged. Surgical clips in the right upper quadrant.Cardiomediastinal silhouette is unchanged. Diffuse pulmonary opacities and basal bronchiectasis suggestive of fibrosis is unchanged. Persistent bibasilar consolidation. Persistent focal lucency in the right lung base likely represents an pneumatocele or cavitary lesion.

Output: 1.Dobbhoff tube tip in the antropyloric region.2.Persistent bibasilar consolidation in a background of fibrotic lung.3.Unchanged pneumatocele or cavitary lesion in the right lung base.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male pancreatic cancer and chemotherapy. CHEST:LUNGS AND PLEURA: Innumerable diffuse sparing size pulmonary nodules are new consistent with diffuse metastatic disease.MEDIASTINUM AND HILA: The small nodes in the middle mediastinum and hila bilaterally has increased in size and now definitely pathologic. The hilar and perihilar nodes at bulky. Previously measured index node in the prevascular space is measured on series 2 image 37, 1 0.3 x 1.3 cm. however this is not representative of a more significant increase in the mediastinal adenopathy. Left infrahilar node series 2 image 57 measures 2.9 x 2.3 cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: There is new diffuse hepatic metastases as well most No spared parenchyma. Confluent disease in the lateral segment of the left lobe no bulges and possibly invades the anterior abdominal wall. Index lesion of the conglomerate left lateral segment masses as seen on series 2 image 94, measuring 13 x 8.5 cm.Cholecystectomy clips. Periportal adenopathy.SPLEEN: No significant abnormality notedPANCREAS: Mass in the body of the pancreas is increased in size and on series 3 image 100 measures 4.8 x 3.2 cm compressing adjacent structures and vessels but without evidence of venous thrombosis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Probable renal cysts unchanged.RETROPERITONEUM, LYMPH NODES: Nodes are demonstrated in the peripancreatic area and porta hepatis. Atherosclerotic changes aorta with some areas of ulcerated plaque. The previously identified reference in peripancreatic node lateral to the neck of the pancreas can no longer be identified discretely.BOWEL, MESENTERY: Some nodes are seen in the mesenteric root. There is new small amount of ascites. No evidence of bowel obstruction. Diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Thickened bladder wall.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Minimal ascites.BONES, SOFT TISSUES: Redemonstration of degenerative changes with deformity and old fracture involving left hip.OTHER: No significant abnormality noted

Output: Progression of disease. Particularly marked increase in pulmonary and hepatic metastases. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: pna History: sepsis Interval decreased lung volumes with basilar opacities favoring subsegmental atelectasis. No focal consolidation, pleural effusion or pneumothorax. The heart size remains normal.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old Reason: lung infiltrate History: Chest pain; sob. Cardiomediastinal silhouette is within normal limits. Mild tortuosity of the aorta.No focal opacity, pneumothorax, or large pleural effusion is identified.Redemonstration of chronic appearing interstitial opacities and emphysema, unchanged.

Output: Chronic interstitial opacities and emphysema, without superimposed acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old. Interval insertion of left chest tube extending to the apex with no significant residual pneumothorax.Pleural effusions, greater on the right with underlying atelectasis, not significantly changed.

Output: Resolution of left pneumothorax following chest tube insertion.


Instruction: Generate impression based on medical findings.

Input: Gait imbalance, positive paraneoplastic syndrome antibody. Occult neoplasm? CHEST:LUNGS AND PLEURA: Bilateral numerous subcentimeter nodules pain random distribution suspicious for hematogenous spread of infection versus metastatic disease.MEDIASTINUM AND HILA: Prevascular and bilateral hilar borderline enlarged lymph nodes. Reference right hilar lymph node measures 12 x 11 mm in image number 50, series number 3.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: Bilateral numerous subcentimeter nodules are suspicious for metastatic disease versus hematogenous spread of infection. Borderline enlarged bilateral hilar and prevascular lymph nodes


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.History of CVA and COPD, presented with chest pain. Rule out pneumonia or pneumothorax. No focal opacities. No evidence of pneumothorax. Minimal scarring or atelectasis in the lingula. No acute cardiopulmonary process.

Output: No evidence of pneumonia or pneumothorax.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, 54 years old.Esophageal cancer status post esophagectomy. The neoesophagus is massively dilated with fluid and a small volume of air.Small right pleural effusion. Compressive atelectasis of the right lung. Left lung is clear.Partially visualized catheter left upper quadrant.

Output: Massive dilatation of the neoesophagus containing a large volume of internal fluid, this is suspicious for distal obstruction. Recommend correlation with thoracic CT to exclude alternative diagnosis of a loculated pleural fluid collection and/or perforation.Erika Clark (1676) notified at 4:04 pm on 5/11/16 via Web exchange text page (PNR 3:58 PM).


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: eval for PNA History: see above The heart size is normal. Unremarkable cardiomediastinal silhouette. No focal pulmonary opacities, pleural effusion, or pneumothorax. The bones and soft tissues appear unremarkable. Postsurgical changes following median sternotomy are again noted.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o PNA, mediastinal widening History: new afib w/rvr Unremarkable cardiac and mediastinal silhouette. Mild blunting of the right costophrenic angle suggestive of a small pleural effusion and new streaky opacity in the right base compatible with subsegmental atelectasis.No sign of pneumonia.

Output: New blunting of the right costophrenic angle compatible with small pleural effusion and mild right basilar atelectasis. The differential diagnosis includes CHF and less likely pulmonary embolism.