Instruction: Generate impression based on medical findings.

Input: 40 year-old male status post liver transplant in November now with persistently positive blood cultures despite antibiotic therapy ostensibly appropriate by culture data. Please evaluate for thoracic or intra-abdominal source of infection. CHEST:LUNGS AND PLEURA: Dependent consolidations in the lung bases is not significantly changed.MEDIASTINUM AND HILA: Tracheostomy tube. Several small paratracheal and subcarinal lymph nodes are again identified.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post liver transplant with expected pneumobilia. Again identified are clustered hypodensities in the hepatic dome and in segment VIII/IV, compatible with abscess, only minimally increased in size. These two foci are similar in size, with the one at the dome measuring approximately 2.3 x 2.1 cm.Extensive periportal edema is identified. Hypodensities throughout the porta hepatis can be a combination of fluid and infiltrative changes. The portal and hepatic veins appear patent. SPLEEN: Moderate splenomegaly remains (17 cm).PANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal hematoma has decreased in size, measuring 2.1 x 1 .4 cm, previously 5.1 x 3.3 cm.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastrojejunostomy tube.BONES, SOFT TISSUES: No significant abnormality notedOTHER: IVC filter is again identified with mild thrombus noted within the IVC and extending to portions of the left common iliac vein and bilateral external iliac veins. However this is improved. A small amount of thrombus is noted superior to the IVC filter, also improved. The renal veins are patent.Minimal ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter within the urinary bladder.LYMPH NODES: Small pelvic lymph nodes are stable.BOWEL, MESENTERY: Presacral edema is seen.BONES, SOFT TISSUES: Thickening of the right obturator and internus muscle is identified with a mildly hyperdense appearance, suggestive of hematomaAvascular necrosis of the hips is seen, left worse than right, with subchondral collapse on the left.OTHER: No significant abnormality noted

Output: Status post liver transplant.Clustered hepatic hypodensities measuring approximate 2 cm in size, compatible with abscess, only minimally increased in size. Extensive periportal edema, mildly increased.Partial thrombosis of the IVC and its major branches, improved.Hematoma of the right obturator internus.Unchanged mild dependent consolidations in the lung, atelectasis favored.


Instruction: Generate impression based on medical findings.

Input: Reason: eval infection vs edema History: increased wob Heart size upper normal.Catheter tip in the SVC.Lower zone predominant chronic interstitial disease, previously characterized by CT scan, not appreciably changed.No acute findings.

Output: Chronic interstitial disease with no specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with left shoulder pain. Infiltrate? CHEST:PULMONARY VASCULATURE: No PE. Study is of diagnostic quality.LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. Elevation of the left hemidiaphragm with overlying atelectasis, new since chest radiograph from 12/2009.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.Possible small hiatal hernia.Nodular right thyroid gland.CHEST WALL: Mild degenerative changes of the spine. UPPER ABDOMEN: Subcentimeter hypoattenuating lesion in the right hepatic lobe is too small to characterize.

Output: No evidence of pulmonary embolus and no other acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female 31 years old Reason: Eval reposition PA catheter History: Adjustment 2-3cm Postsurgical changes related to bilateral lung transplant.Interval repositioning of a Swan-Ganz catheter, looped in the main pulmonary arteryEndotracheal tube with the tip located 2 cm above the carina.Remaining support tubes and lines unchanged.Bibasilar and right perihilar streaky opacities consistent with atelectasis.Subcutaneous emphysema unchanged.Large partially loculated right pleural effusion increased from the prior exam. No pneumothorax.

Output: 1.Large loculated right pleural effusion increased from the prior exam.2.Swan-Ganz catheter looped in the main pulmonary artery


Instruction: Generate impression based on medical findings.

Input: Reason: trend pneumothorax, chest tube History: trend pneumothorax, chest tube Right chest tube in place with a moderate right pneumothorax and small effusion.Lower zone opacity compatible with pleural effusion with underlying consolidation.Catheter tip in the SVC. No new findings.

Output: Persistent right hydropneumothorax and left effusion with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: asthma History: as above No significant cardiopulmonary abnormality.

Output: No significant abnormality. No complication of asthma identified.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: check for ptx History: right lung mass s/p ct guided biopsy Large right sided mass and additional pulmonary nodules better characterized on CT but no evidence of pneumothorax.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Leukemia with neutropenic fever. Pulmonary vascular redistribution with moderate interstitial edema, slightly worse. Bilateral basal consolidation seen previously has cleared. Small to moderate residual pleural fluid collections, improved.

Output: Hypervolemia/CHF is worse, but the basal consolidation has cleared.


Instruction: Generate impression based on medical findings.

Input: 57 year old female with history of esophageal cancer. CHEST:LUNGS AND PLEURA: Biapical scarring. Left upper lobe 5-mm nodule (series 4 image 8), unchanged. Few scattered micronodules are unchanged. Small subpleural nodular opacity right upper lobe posteriorly (series 4 image 35) likely post inflammatory.MEDIASTINUM AND HILA: Thickened or edematous patulous esophagus with air-fluid level, increased. Right thyroid lobe calcification, unchanged. Small pericardial effusion.CHEST WALL: Bilateral breast prosthesis with surgical clips in the right breast parenchyma. Borderline enlarged right axillary lymph nodes, similar to prior.ABDOMEN:LIVER, BILIARY TRACT: Scattered hypodense lesions, unchanged from prior amount, likely representing benign hepatic cyst.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Previous identified lymph node in the porta hepatis (series 3 image 87), now measures 11 x 8 mm (previously 15 x 13 mm).BOWEL, MESENTERY: Asymmetric enhancing wall thickness of the second part of the duodenum (coronal series image 52) is similar to prior, cannot exclude a small bowel malignancy.BONES, SOFT TISSUES: Moderate vascular calcifications.OTHER: No significant abnormality noted.

Output: 1) Subtle interval increased esophageal thickeness/edema with no discrete mass.2) Possible enhancing duodenal mass, cannot exclude small bowel malignancy. 3) Decrease in size of gastrohepatic lymph node.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old.History: Seizure disorder, aspiration pneumonia. Query: pneumonia Tracheostomy tube and right central venous catheter unchanged in position. NG tube with tip projected off the visualized field, unchangedStable cardiomediastinal silhouette.Areas of scarring/discoid atelectasis in the lung bases, similar to previous exam..No pleural effusions.

Output: Stable cardiopulmonary appearance without evidence of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Fever, leukemia evaluate for infiltrate. Right peripheral catheter tip at the SVC level.No focal airspace opacities. No visible nodular opacities.

Output: No visible signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: FemaleReason for Study: Reason: r/o pneumonia History: SOB, chest pain Patient is rotated.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Patient status post lung transplant, now post closure of thoracotomy. 4 left sided chest tubes and 3 right-sided chest tubes unchanged. ET tube tip above the carina. Enteric tube and ECMO cannula tips beyond the field-of-view. Surgical staples and sternotomy suture again noted.Dense areas of consolidation, interstitial opacity, and loculated pleural effusions not significantly changed and appear similar to exam from 12/12/2015. Small amount of subcutaneous emphysema noted.

Output: 1.Cardiopulmonary appearance similar to 12/12/2015.2.Support devices as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: fever, immunoompromised pt. please assess for evolving pulmonary process. History: fever Port catheter terminates at the cavoatrial junction. Mild interstitial pulmonary edema again noted. Slight increase in left basilar subsegmental atelectasis. No pleural effusion pneumothorax. Unchanged heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: afib History: sob1 Mild to moderate cardiomegaly.Pleural effusions and basilar atelectasis/edema improved.Left PICC, tip in axillary region.

Output: Improvement in basilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: CP History: CP The cardiac silhouette and vasculature are within normal limits. No airspace or interstitial opacities. No pleural effusion. No pneumothorax.Once again noted is a hiatal hernia.

Output: No acute cardiopulmonary abnormality. Hiatal hernia again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old. Reason: cardiopulmonary process History: wheezing Moderate cardiomegaly, unchanged.Linear scarring or subsegmental atelectasis of the left lung base.No specific evidence of infection or edema.Small left pleural effusion. No pneumothorax.Old healed left rib fractures.Metallic foci overly the left neck, unchanged.

Output: Cardiomegaly without acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 88 year-old female with lung cancer, preop evaluation. Evaluate for changes since last CT. History given on prior report of scleroderma. CHEST:LUNGS AND PLEURA: Stable previously described right upper lobe nodule contiguous with the pleura currently measures 19 x 18 mm, (image 26, series 5) previously 18 x 18 mm (image 20, series 7). Other scattered small nodular opacities are unchanged.Diffuse interstitial lung changes with associated groundglass abnormalities, microcystic honeycombing and traction bronchiectasis have not changed. MEDIASTINUM AND HILA: Dilated esophagus with an air-fluid level consistent with scleroderma unchanged. Coronary artery calcifications are present.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Large calcified gallstones. No other significant abnormality noted.

Output: 1. Unchanged interstitial lung disease.2. Stable right upper lobe nodule consistent with lung cancer.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.History of end-stage renal disease scheduled for kidney transplant. The cardiac silhouette is enlarged.There are no focal pulmonary opacities or pleural effusions.

Output: Cardiomegaly without acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pneumothorax History: attempted central line No pneumothorax or other acute change.Right chest wall mass with associated rib destruction and additional skeletal findings consistent with multiple myeloma.Small lung volumes with basilar opacity compatible with atelectasis and probably small effusions.

Output: No pneumothorax or other acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: Infiltrates History: Fever Port has tip overlying the superior vena cava.The cardiomediastinal silhouette is unremarkable. No new focal pulmonary opacity suggestive of pneumonia. Bandlike opacities in the left upper lobe and bilateral lower lobes are in keeping with history of organizing pneumonia, stable to improved since prior. No pleural effusion or pneumothorax.

Output: Stable appearance of the chest without acute cardiopulmonary disease or evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: vent History: vent Right jugular catheter tip in the area of the SVC with no pneumothorax.ET tube tip approximately 3 cm above the carina.NG tube tip in the gastric fundus. Basilar opacity, greater on the left, compatible with effusion and atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Fevers and dry cough. History of lung cancer. Right upper lobe volume loss with apical scarring consistent with radiation therapy. Left lower lobectomy with bronchial stump opacity similar to recent CT. Poorly defined nodule in the right upper lobe near the fissure about the same. Right posterior apical cavity chronic and unchanged. Chronic periosteal thickening right upper ribs posteriorly.

Output: Extensive abnormalities similar to recent CT without specific findings to suggest an acute infectious process.


Instruction: Generate impression based on medical findings.

Input: 78 year old female with marginal zone lymphoma (gastric) CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Simple cyst in segment two of the liver. 2.6 x 1.4 cm hypodense lesion in segment 6 of the liver one for and series 3; image 95), previously 2.3 x 1.3 cm when remeasured.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right lower pole renal cyst, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Hiatal hernia, moderate in size, not significantly changedBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: The urinary bladder is decompressed, limiting evaluation.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Severe diverticulosis affecting the sigmoid colonBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Minimally increased size of the indeterminate hepatic lesion. Otherwise, stable exam.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: ? rib fracture History: TTP over left lower chest wall after seizure Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities, although there is streaky atelectasis at the periphery of the right lung base.

Output: No significant abnormality. No evidence of displaced fracture or other cause of the patient's pain.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: lvad History: lvad Swan-Ganz catheter tip in main/proximal right pulmonary artery. Other support hardware stable.Cardiomegaly with vascular redistribution as on prior.

Output: Cardiomegaly with vascular redistribution as on prior.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: evaluate pulmonary edema, pleural effusions History: shortness of breath Loculated right pleural effusion compressing the right lung unchanged.Increased interstitial and airspace opacities bilaterally.Left pleural drain with no pneumothorax.Left subclavian catheter, tip at right atrial level.

Output: Resistant large right pleural effusion with increasing interstitial and airspace opacities consistent with edema.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: evaluate for sarcoidosis History: Erythema nodosum The cardiomediastinal silhouette is unremarkable.No pleural effusions. Lungs are clear.No pneumothorax.

Output: No acute cardiopulmonary abnormalities. No evidence of hilar or mediastinal lymphadenopathy by plain film.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o fx History: altercation Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.SOB/DOE. Right jugular catheter has been retracted, the tip is now at the level of the SVC.Cardiomegaly with signs of pulmonary hypertension and calcification at the aortic arch level unchanged. Air in the esophagus. No pneumothorax. Right posterior costophrenic angle blunting unchanged, with some adjacent atelectasis. Mild interstitial opacities suggestive of edema. Right humeral head surgical anchors.

Output: Mild edema with basal and dependent atelectasis. Possible small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old. ET tube with its tip approximately 3 cm above the carina.NG tube with its tip beyond the margin of the image.Right IJ venous catheter with its tip in the SVC.No evidence of a pneumothorax.Markedly decreased lung volumes with mild cardiac enlargement.Nonspecific basilar opacities are compatible with atelectasis and possible small effusions.

Output: ET tube tip in satisfactory position. Right IJ venous catheter placed without complication. Markedly decreased lung volumes with basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: intubation History: intubation ET tube tip approximately 3 cm above the carina.Small lung volumes with basilar opacity consistent with consolidation and atelectasis, likely secondary to aspiration.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 66 years old Female. Reason: evaluate for source of cough History: as above. There is apparent increased density in the upper lungs symmetrically. The cardiomediastinal silhouette is normal. There is no evidence of pneumothorax or pleural effusion.

Output: Symmetrical increased attenuation in the upper lobe lungs, which can be due to pneumonia or artifact. Suggest follow-up if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o fluid History: difficulty breathing Large increasing right pleural effusion with underlying atelectasis and a smaller left effusion.No other significant change.

Output: Large increasing right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old. ET tube tip approximately 3 cm above the carina.Bilateral venous catheters unchanged.Bilateral pleural effusions, larger on the right, with underlying atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.History of MF/acute myeloblastic leukemia. Pre allo stem cell transplant evaluation. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Cough and pleuritic chest pain for one month evaluate for pneumonia. Normal heart size. No pneumothorax or pleural fluid. No focal airspace opacities.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: S/P R thoracotomy History: NA Right chest tube with no pneumothorax postop. Mild basilar subsegmental atelectasis.An NG tube traverses a gastric pull-up . Right jugular catheter, tip in SVC.

Output: No significant pneumothorax. Nonspecific basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: 59F hx bladder cancer s/p TURBT History: as above Increase in mild interstitial pulmonary edema. Subtle nodular opacities noted within the mid aspect of the lungs, increased from previous studies. No large pleural effusion or pneumothorax. Mild to moderate cardiomegaly again noted.

Output: Increase in interstitial pulmonary edema.Increase in subtle nodular opacities within the mid aspect the lungs. Given history, correlation with chest CT is suggested if not recently performed.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: s/p TECAB History: s/p TECAB Stable cardiomediastinal silhouette.Interval increase in bilateral pleural effusions with perihilar and bibasilar atelectasis/consolidation.No evidence of significant pneumothorax.Interval removal of chest tubes and right jugular catheter.

Output: (1) Interval increase in bilateral pleural effusions with perihilar and bibasilar atelectasis/consolidation.(2) Interval removal of chest tubes and right jugular catheter.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: eval pulm edema, Swan placement History: ADHF Swan-Ganz catheter tip in proximal right pulmonary artery. Left jugular catheter unchanged.Stable cardiomegaly with mild pulmonary edema. Small right pleural effusion unchanged.

Output: Stable mild pulmonary edema. Swan-Ganz catheter tip in proximal right pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: evaluate for abnormality History: 1 month history of left sided chest wall pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. No evidence of traumatic injury.


Instruction: Generate impression based on medical findings.

Input: TEF repairVIEW: Chest AP ET tube tip below thoracic inlet and above the carina. Right chest tube in place. Right upper lobe opacity minimally increased. Cardiothymic silhouette normal. No pleural effusion or pneumothorax.

Output: Right upper lobe opacity minimally increased.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old. ET tube with its tip 4 cm above the carina.IJ venous catheter with this tip in the SVC.NG tube with its side port in the distal esophagus.Cardiomediastinal silhouette is unremarkable.Lungs are clear.Extensive subcutaneous emphysema along the left lateral chest wall unchanged.No evidence of a pneumothorax.

Output: Right IJ venous catheter placed without complication. Persistent subcutaneous emphysema along the left lateral chest wall.


Instruction: Generate impression based on medical findings.

Input: Male 2 years old Reason: 2 yo male intubated, on ecmo, assess for interval changes in position of tubing and atelectasis VIEW: Chest AP (one view) 2/8/2016 at 0520 hours. Bone changes from trichothiodystrophy, Left-sided ECMO cannulas, ET tube, mediastinal drains, atrial lines and bilateral chest tubes as well as soft tissue edema are unchanged.Cardiac silhouette is non-sizable due to persistent diffuse lung haziness. No interval change in lung aeration with persistent lung haziness right greater than left.

Output: Normal examination.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate diaphgram, s/p surgery near phrenic nerve History: above Minimal elevation of left hemidiaphragm, not necessarily significant.Feeding tube with its tip in the gastric fundus.No significant pulmonary abnormalities.

Output: Minimal left hemidiaphragm elevation, not necessarily significant.


Instruction: Generate impression based on medical findings.

Input: 82-year-old female with weakness. Further evaluate mass seen on chest x-ray. CHEST:LUNGS AND PLEURA: Dense consolidation in the left upper lobe along the oblique fissure in a peribronchovascular distribution with a large cavitary component as well (series 5, image 34). A separate, focal area of consolidation is also noted in the left upper lobe anteriorly (series 5, image 55).Diffuse micronodules bilaterally also raise the possibility of miliary spread of infection.Bibasilar scarring.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy on this noncontrast exam. Note is made of a calcified subcarinal lymph node. Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Left renal cysts.

Output: Dense left upper lobe opacities, one of which appears to be cavitating. Diffuse micronodules bilaterally. TB is a strong consideration. A less likely consideration includes a cavitating malignancy with diffuse lung metastases.


Instruction: Generate impression based on medical findings.

Input: Check for pneumonia, cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Mesothelioma, follow-up Lungs: Extensive nodular pleural thickening is again observed throughout the right hemithorax extending into pleural fissures and consistent with patient's known mesothelioma. For reference the previously described subpleural nodule in the left lung base remains approximately 14 mm (image 7 series 3). Additional reference measurements are as follows:1. At the level of pulmonary artery (image 40 series 2) the 3:00 and 10:00 measurements are currently 16 and 14 mm, previously 11 and 13 mm.2. At the level of the left atrium (image 35 series 2) , the 4 and 9:00 measurements are 14 and 7 mm, previously 9 and 4 mm3. At the level of the right atrium (image 19 series 2), the 3:00 measurement currently is 33 mm, previously 29 mm. The previously identified 7:00 measurement is currently 10 mm and previously 7 mmAtelectasis and calcifications on pleural plaques in the right lung base again observedMediastinum and hila: Extensive lymphadenopathy with mild enlargement. Reference subcarinal conglomerate nodal mass currently measures 4.6 cm, previously 4.3 cm. The right hilar lymph node or nodal mass, currently measures 3.9 cm, previously 3.2 cm (image 48 series 2).Enlarged cardiac silhouette without specific additional focal cardiac or pericardial abnormality. Dense calcification the mitral annulus.Coronary artery calcification: ModerateChest wall: Right upper chest portAbdomen:Visualized portions of the abdomen are extremely limited. Exam does not continuing or complete visualization of the lung bases.

Output: Mild interval progression of previously described mesothelioma involving the right hemithorax with increased reference measurements and lymphadenopathy as measured.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: Checking for appropriate triple lumen central line placement. History: see above. Increased patchy opacities left side predominantly, suggestive of aspiration.Left jugular catheter, tip in SVC.

Output: New left jugular catheter, and new opacity suggestive of aspiration.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with history of follicular lymphoma. Reevaluate and compare to previous. CHEST:LUNGS AND PLEURA: Stable biapical scarring. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: Stable mediastinal adenopathy with the reference right paratracheal lymph node is unchanged and measures 0.7 cm x 0.4 cm (image 30, series 3). The reference posterior mediastinal retroaortic soft tissue focus has regressed and is no longer measurable.The reference retrocrural node is equivocally smaller and measures 1.5 x 1.0 cm (image 82, series 3).CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Multiple stable benign hepatic cysts are again seen. There is no ductal dilatation and the hepatic vessels are patent.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: Retroperitoneal adenopathy appears stable. The reference left para-aortic lymph node is unchanged and measures 1.1 cm x 1.7 cm (image 134, series 3). The reference aortic bifurcation lymph node has regressed and is no longer measurable.BOWEL, MESENTERY: The mesenteric adenopathy is also stable. The reference pericecal mesenteric mass is unchanged and measures 2.2 cm x 1.2 cm (image 150, series 3).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: The reference right perirectal soft tissue focus is unchanged and measures 1.2 cm x 1.4 cm (image tool 1, series 3).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: Stable or mild interval regression of disease with measurements provided above.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: pulm edema History: pulm edema Improving left lower lobe consolidation with no new pulmonary findings.Right PICC, tip in right subclavian.An NG tube terminates in the stomach.Tracheostomy tube tip at the thoracic inlet level.

Output: Improving left lower lobe consolidation, with no new findings. A tracheostomy tube is now in place.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Rule out pneumonia. Interval development of right basilar opacity which may represent pleural effusion, and atelectasis or infection.

Output: Possible right basilar airspace disease and/or small pleural effusion. Follow-up until resolution recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: please evaluate for recurring PNA (recent LLL PNA, now with worsening cough, chest congestion, and T 101) History: cough, fever Stable volume loss, right apical scarring/thickening, and other post therapeutic findings in the right hemithorax.Persistent small right pleural effusion.Minimal left basilar scarring.No new focal airspace opacity.

Output: No specific evidence of pneumonia. Ground glass opacities noted on recent CT are not visible on radiograph.


Instruction: Generate impression based on medical findings.

Input: Reason: Wet lung sounds and productive cough. Previous chest x-ray with possible consolidation History: As above Focal masslike left upper lobe opacity measuring approximately 3.5 cm in diameter which may represent infection or neoplasm.Catheter and pacemaker leads unchanged.

Output: Left upper lobe rounded masslike opacity compatible with neoplasm or atypical infection. A CT scan is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Patient with tachypnea. Evaluate for fluid overload or pneumonia Right internal jugular central venous catheter with tip in the right atrium. Cardiomediastinal silhouette is unchanged. Chronic elevation of the left hemidiaphragm with persistent left basilar compressive subsegmental atelectasis. No new pulmonary consolidation. No pneumothorax.

Output: No significant interval change in the cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: r/o edema History: chest pain, ef 25% Coronary stents or calcification noted.Unremarkable mediastinal contours and cardiac silhouette.No significant pulmonary or pleural abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 93 years old.Presenting with possible syncopal episode. Please evaluate pacer lines. Right-sided pacer lead is unchanged from previous. Normal heart size with dense aortic calcifications consistent with advanced age. Small lung volumes with basilar scarring unchanged. Moderate-sized hiatal hernia.

Output: No acute cardiopulmonary abnormality. Right-sided pacer lead appears unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Confirm PICC placement- pulled it back to midline The heart is normal in size.Left basilar discoid atelectasis again noted. No new abnormal lung parenchymal opacities.The left upper extremity PICC has been retracted and the tip overlies the proximal left brachycephalic vein.Stable position of right subclavian port catheter overlying the distal SVC.Left chest tube in place. No residual pneumothorax. Trace left pleural effusion is unchanged.Healed left rib fractures are noted.

Output: Interval retraction of the left PICC with tip overlying the proximal left brachycephalic vein.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumonia History: cough, fever Unremarkable cardiac and mediastinal silhouette. Interval clearing of basilar opacities compatible with pneumonia.No sign of pneumonia on the current radiograph.Mild perihilar bronchial thickening compatible with bronchitis or asthma.

Output: Bronchial thickening but no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: eval for infiltrate History: sob Right internal jugular central venous catheter tip is in the right atrium.Right lower lung opacity likely reflects pleural effusion and atelectasis/consolidation. Left basilar interstitial and airspace opacities.No pneumothorax.Mild cardiomegaly.

Output: Moderate CHF with large right pleural effusion and atelectasis/consolidation. Follow-up imaging is recommended to document clearance or alternatively, CT may be obtained.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: 52F with CHF on milrinone. History: LE edema, CHF Right pleural effusion possibly loculated.Moderate to severe cardiomegaly status-post sternotomy.Small left pleural effusion.Possible basilar edema.

Output: CHF with a new right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male withmani metastatic gist tumor on Gleevec. ABDOMEN:LUNG BASES: Stable bilateral micronodules.LIVER, BILIARY TRACT: Stable biloba or cystic lesions. Index segment two lesion measures 21 x 17 mm image number 82, series number 9, not significantly changed from previous study. Other hypodense lesions also stable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Subcentimeter left adrenal nodule is unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes from a partial gastrectomy, unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous CT.CT CHEST ABDOMEN PELVIS W, 10/22/2010 3:44 PMCLINICAL INFORMATION:TECHNIQUE: COMPARISON: FINDINGS:CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, 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.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: eval pleural effusions History: s/p L chest tube Interval placement of left chest tube no significant pneumothorax. Endotracheal tube tip approximately 2 cm above the carina. Right Swan-Ganz catheter tip in the main pulmonary artery. IABP radiopaque marker in the proximal descending thoracic aorta, unchanged. NG tube extends down the impairment of the image. Subxiphoid drain, unchanged. Midline sternotomy hardware, unchanged.Stable cardiac and mediastinal silhouettes. Bibasilar opacities and pleural effusions, greater on the left, not significantly changed.

Output: No new pulmonary findings. New left chest tube. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: ? SOB History: ? PTX No significant cardiopulmonary abnormality.No significant pneumothorax.Cholecystectomy clips.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: eval PICC History: eval PICC Right upper extremity PICC has tip at the junction of the right brachiocephalic vein and superior vena cava.The cardiomediastinal silhouette is unremarkable. Low lung volumes. No focal pulmonary opacity suggestive of pneumonia. Small bilateral pleural effusions. No pneumothorax.

Output: RUE PICC tip overlies the junction of the right brachiocephalic vein and superior vena cava.


Instruction: Generate impression based on medical findings.

Input: Reason: free air? History: chest pain, abdoinal pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: source of infection History: tachypneic, tachycardic Right IJ sheath has been removed. Patchy left basilar pleural-parenchymal opacity, unchanged. Unchanged mild cardiomegaly. No pneumothorax. Patient status post cholecystectomy.

Output: No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Cardiomyopathy Nonspecific moderate cardiomyopathy again observed with otherwise clear lungs and diminished lung volumes. ICD leads are otherwise similar in position, however the right jugular sheath has been removed

Output: Right jugular sheath removed


Instruction: Generate impression based on medical findings.

Input: 39-year-old male with history of metastatic sarcoma. Reevaluate disease prior to new therapy. CHEST:LUNGS AND PLEURA: Reference right upper lobe nodule is increased in size and now measures 14 x 11 mm (image 35 series 5), previously 9 x 9 mm. Additional nodules in both lungs have increased in size and number, consistent with progression of metastatic disease. Postsurgical changes in the right lung are unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Postsurgical changes, unchanged. Right chest port, tip in the right atrium.ABDOMEN:LIVER, BILIARY TRACT: Punctate hypodensity in the right dome is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Ill-defined hypodense lesion in the posterior right kidney is increased in size and now measures 3.3 x 3.4 cm (image 33 series 4), previously 1.8 x 2.3 cm. Again noted is thrombus in the right renal vein extending partially into the IVC. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Reference right external iliac lymph node is not significantly changed, measuring 9 x 8 mm (image 27 series 4), previously 8 x 7 mm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Progression of pulmonary metastatic disease, as well as, right renal mass.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Cough for one month. Bone marrow transplant 2012. Interval clearance of previously seen right middle lobe opacity. Minimal subpleural, but no specific signs of pneumonia. Normal heart size. Scarring in the right middle lobe and lingula

Output: No specific signs of acute pneumonia by plain film technique. Minimal scarring in the right middle lobe and lingula. Reduced dose thoracic CT may be considered if there is continued clinical suspicion for occult infection.


Instruction: Generate impression based on medical findings.

Input: DesaturationVIEW: Chest AP ET tube tip at the level of the thoracic inlet. NG tube tip in the stomach. Again noted chest tubes on the right and lower extremity PICC. Cardiothymic silhouette normal. Diffuse lung haziness in a background of pulmonary interstitial emphysema not significantly changed. No evidence of pneumothorax. Diffuse soft tissue edema noted.

Output: Diffuse lung haziness in a background of pulmonary interstitial emphysema not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Pericardial effusion. Lemierre syndrome. Respiratory failure.VIEW: Chest AP (one view) 02/29/16, 0536 Endotracheal tube tip is at thoracic inlet. Feeding tube tip is distal to proximal gastric body and not included on image. Three right and three left chest tubes are present. There is a pericardial drain. Left upper extremity PICC has its tip superior vena cava.Subcutaneous emphysema in left neck and chest has decreased. Subcutaneous emphysema in the right neck and chest are unchanged.Small to moderate bilateral pleural effusion is identified. No pneumothorax is seen. Left lower lobe opacity persists. Innumerable cysts/pneumatoceles are again seen. Cardiac silhouette size is probably upper limits of normal.

Output: Increase in bilateral pleural effusion.


Instruction: Generate impression based on medical findings.

Input: History of Ewing sarcoma. Status post limb salvage chemotherapy. Off therapy evaluation. LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted. Incidental note is made of a normal variant bovine aortic arch.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: 68 F, ongoing cough, r/o PNA History: LLL crackles, cough Stable chest radiograph with no evidence of pneumonia.

Output: Stable chest radiograph with no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: new tachypnea. History: see above Enteric tube terminates in the stomach. Cardiomediastinal within normal limits.Low lung volumes.No acute focal airspace opacity.No pneumothorax or pleural effusion.

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


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: Category P? History: productive cough; cold s/s Cardiomediastinal silhouette is unremarkable.Right basilar subsegmental atelectasis at the periphery, unchanged.No specific evidence of infection or edema.No pleural effusion or pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: reason why pt feels he can't breathe? 69M new dx adenoca lung, CVA History: MRI suggests possible embolic strokes Extensive bilateral consolidation and interstitial opacity suspicious for lymphangitic spread of tumor and edema, not appreciably changed.Interval extubation.No pneumothorax.

Output: Extensive consolidation and interstitial disease consistent with metastatic carcinoma.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Pneumonia versus pleural effusion. SOB and a postop patient. Right lower lobe consolidation consistent with infection. Associated atelectasis in the middle and lower lobes. Right chest port unchanged in position. Tortuous aorta.

Output: Right lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with metastatic prostate cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST 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: Extensive metastatic disease involving the entire skeleton of the abdomen and chest.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: Extensive metastatic disease involving the entire skeleton in the pelvis.OTHER: No significant abnormality noted

Output: Extensive skeletal metastases.Left lower anterior abdominal wall lesion which may represent an abscess or a soft tissue mass. Clinical correlation is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: s/p cardiac surgery History: s/p cardiac surgery Support devices in unchanged position.Stable cardiomegaly.Nonspecific basilar opacities, compatible with atelectasis and possible small effusions. No new focal air space abnormality.

Output: Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.CHF, Swan. Swan-Ganz catheter has been advanced with tip projecting over the mid to distal right pulmonary artery. Left subclavian ICD unchanged. Cardiomegaly, about the same. Patchy air space opacities in the right lower lobe suspicious for aspiration or infection. Retrocardiac atelectasis on the left has cleared. No signs of CHF.

Output: No signs of CHF. Patchy right lower lobe opacities may reflect aspiration or developing infection.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: pneumonia, other infection History: fever Small lung volumes with subsegmental atelectasis and possible mild edema.Heart size normal.No specific evidence of infection.

Output: Subsegmental atelectasis and possible edema, but no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: Eval for effusions History: S/P CABG MVR with Low EF Bilateral small pleural effusions versus thickening. No new focal lung consolidation. Reticular abnormality again noted at the lung bases. Unchanged heart size, again at the upper limit of normal. No pneumothorax. Patient status post sternotomy.

Output: Small pleural effusions/thickening.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: Infiltrates History: Fever, history of esophageal cancer status post stent, pulmonary metastasis Right chest port tip at the atriocaval junction.Esophagogastric stent, unchanged.Stable cardiomediastinal silhouette. Multiple nodular opacities, better characterized on recent CT. Small left pleural effusion and left basilar subsegmental atelectasis/consolidation without significant interval change. No pneumothorax.

Output: Small left pleural effusion and left basilar subsegmental atelectasis/consolidation without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Exploratory laparoscopy for free air, remains intubated, evaluate ETT placement. Endotracheal tube tip 6 cm above the level of the carina. Enteric tube looped in the stomach. Decreased volume of free intraperitoneal air. Moderate right pleural effusion, small volume of pleural fluid on the left. Edema and atelectasis in the dependent lung fields about the same.

Output: ETT tip 6 cm above the level of the carina.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with history of mucous in respiratory tree, evaluate for interval changes. Right IJ catheter unchanged in position.Large lung volumes consistent with COPD.No interval change in right lower lobe opacification from prior exam, however, interval improvement from 7/28/15.No pleural effusions.

Output: Residual atelectasis and consolidation is nonspecific but consistent with aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: UPRIGHT please eval for free air History: abdominal pain Presternal ICD unchanged.Stable cardiomediastinal silhouette evidence of an LAD stent.The lungs are clear.No pleural effusions.No free peritoneal air.

Output: No acute cardiopulmonary abnormalities identified without interval change. No evidence of free peritoneal air.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: IABP History: IABP Cardiomegaly unchanged. No signs of pulmonary edema. Left subclavian ICD unchanged IABP marker projects 4-cm below the top of the aortic arch, overlying the proximal descending thoracic aorta

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: evidence of infections History: cough and fever Cardiomegaly is unchanged though there is progression of perihilar and basilar opacities likely representing pulmonary edema.No pleural effusion.Support devices unchanged.

Output: Interval significant progression of perihilar and basilar opacities likely representing pulmonary edema. Superimposed infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: Cough History: Cough Large right-sided anterior mediastinal mass with probable right paratracheal lymphadenopathy.Scattered pulmonary nodules are about 1 to 2 cm in diameter.Small right pleural effusion.No specific evidence of infection or edema.Heart size normal.

Output: Large anterior mediastinal mass with pulmonary nodules most likely lymphoma especially Hodgkin's disease. CT follow-up is recommended, preferably chest abdomen and pelvis.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: FemaleReason for Study: Reason: s/p 2/5/15 Bronchoscopy (flexible with bronchoalveolar lavage), Median sternoscopy, Right upper lobe lobectomy via right-sided thoracotomy History: follow up Right apical pneumothorax more prominent than the prior exam.Air fluid level in the right mid chest compatible with a hydropneumothorax.Stable cardiomediastinal silhouette.The left lung is clear.Right paramediastinal surgical clips redemonstrated.

Output: Mildly enlarging right apical pneumothorax. New right sided hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out atypical infection especially TB and endemic fungus History: chronic cough since January; HIV w good CD4 Unremarkable cardiac and mediastinal silhouette. Very mild streaky opacities at the lung bases suggestive of scarring. No specific evidence of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 27 yearsGender: MaleReason for Study: Reason: s/p OHT, annual History: s/p OHT, annual The cardiac mediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.Median sternotomy is intact.Surgical clips are identified in the right axillary region.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: 74 yo M with h/o AML, neutropenic, presents with neutropenic fever, r/o infection History: neutropenic fever Ill-defined opacity projected lateral to the right paratracheal region suggestive of focal infection.Elsewhere, the lungs are unremarkable.Unremarkable mediastinal contours and cardiac silhouette.Right jugular catheter, tip in SVC.Spinal stabilization hardware.Prior right PICC removed

Output: Possible right upper lobe opacity, for which CT is recommended for verification.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: Evaluate for bite block being swallowed History: pls see above The bite block is not identified on this chest radiograph.Marked cardiomegaly, unchanged. Stable to marginal interval worsening of diffuse patchy pulmonary opacities. No large pleural effusions. No pneumothorax.Right PICC unchanged. Enteric tube projects inferiorly beyond the visualized field. Sternotomy wires appear unchanged, with discontinuity of the superior wire again noted. Aortic valve replacement again noted. Right axillary staples.

Output: No unexpected radiopaque foreign body is seen. Findings were discussed with Anjali Gera (Pager #3262) on 4/25/2016 at approximately 3:45pm.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: ETT History: ETT ET tube tip is 4 cm above the carina. ICD with lead is unchanged. NG tube courses below the field-of-view. Esophageal probe is coiled in the patient's oropharynx.Moderate cardiomegaly. No pleural effusion or pneumothorax. No focal pulmonary opacity.

Output: ET tube is in appropriate position. Esophageal probe is coiled in the oropharynx.Findings discussed with Pager 3182 at 0914 on 3/27/15.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT History: ETT ET tube tip approximately 5 cm above the carina. Small lung volumes with mild basilar atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: eval for obstructive pattern. Hx of large fibroid and constipation here with abd discomfort and vomiting. Last bowel movement 5am. Passing gas History: n/v The cardiomediastinal silhouette is within normal limits. No consolidation, pleural effusion, or pneumothorax. Regional bones show no acute abnormality.The known large abdominopelvic mass superiorly displaces the small bowel loops. Mild gaseous distention of the small bowel loops. No abnormal air-fluid levels or evidence of pneumoperitoneum.

Output: 1. Mild gaseous distention of small bowel loops favored to represent an ileus. Superior displacement of the bowel related to the known large abdominopelvic mass.2. No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Progressively worsening shortness of breath. ILD versus pneumonia versus MTX induced lung injury. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax. No visible groundglass opacity.Lung volumes are slightly decreased compared to 2011 and there is the suggestion of very subtle, nonspecific interstitial abnormality, though this could be due to differences in lung volumes. Focal linear scarlike opacity in the left midlung nonspecific but new from previous.

Output: No conclusive evidence of an acute pulmonary abnormality. Lung volumes are slightly decreased compared to 2011. If there is continued clinical suspicion for an interstitial lung disease/drug toxicity, ILD protocol CT may be obtained.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.CF exacerbation. Upper lobe volume loss, architectural distortion, bronchiectasis, bronchial wall thickening and endobronchial debris consistent with history of cystic fibrosis. Allowing for patient rotation and differences in technique there is still a slight increase in opacities in the right upper lobe. There is no significant change elsewhere. Heart size remains normal. Central pulmonary vasculature appears enlarged. Peripheral catheter from the left terminates over the left axillary/subclavian region.

Output: Slight increase in opacities in the right upper lobe which may be due to endobronchial debris and/or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: post-intubation History: sob Interval intubation with endotracheal tube high, terminating 6 cm above the carina. The cuff is at the cords. Advancement is recommended. Left ICD electrode and left ventricular assist device unchanged. Sternotomy hardware remains well aligned.Severe cardiomegaly with retrocardiac atelectasis. No interval pulmonary edema or pneumothorax.

Output: Endotracheal tube is high with the cuff at the cords. Advancement recommended.


Instruction: Generate impression based on medical findings.

Input: 68 year old female with weakness, history of malignancy Right chest port catheter tip in the SVC and is no longer accessed. No focal airspace opacities. Bilateral pleural effusion with adjacent atelectasis unchanged. No pneumothorax. Cardiomediastinal silhouette is unremarkable.

Output: Bilateral pleural effusions unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Intubated. ETT tip 4 cm above the level of the carina. Enteric tube sidehole below the GE junction. Spinal fixation hardware. No focal pulmonary opacities.

Output: ETT tip 4 cm above the level of the carina.


Instruction: Generate impression based on medical findings.

Input: Fever No cardiopulmonary acute abnormality. Minimal scarring in sternotomy changes

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: evaluate for lung abnormality History: cough x 4 weeks with shortness of breath Hazy basilar opacities. No pleural effusion or pneumothorax. Normal heart size. No acute bony abnormality.

Output: Hazy basilar opacities which may represent aspiration or pneumonia. Consider repeat imaging in 8 weeks for reassessment after treatment.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: recent RML atelectasis and ? of cuffing in the lingula. Comparison film is in PACS History: cough Unremarkable cardiac and mediastinal silhouettes. Loss of the inferior cardiac silhouettes likely related to epicardial fat. No pulmonary or pleural abnormality. Hiatal hernia.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: PNA? History: cough, SOB Heart size upper normal.Mild basilar interstitial opacities are suggestive of edema, more so than pneumonia.Very small pleural effusions are seen on the lateral view.

Output: Mild CHF with pleural effusions and edema.


Instruction: Generate impression based on medical findings.

Input: Reason: preop eval to r/u pulmonary disorders prior to surgery History: fatigue . Aortic valve insufficiency. Normal heart size with a moderately tortuous aorta.No significant pulmonary or pleural abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 19 year-old male with abdominal pain status post esophageal dilatation. Evaluate for esophageal perforation. VIEWS: Chest PA/lateral (two views) 2/19/2015 at 2333 Normal cardiomediastinal silhouette. No pneumomediastinum. No focal pulmonary opacity, pleural effusion, or pneumothorax. Left chest port tip in SVC.

Output: Normal examination.


Instruction: Generate impression based on medical findings.

Input: Reason: Pre-Op TRANSPLANT baseline assessment History: Pre-Op TRANSPLANT Unremarkable cardiac and mediastinal silhouette. Small lung volumes with mild lower zone linear scarring, and vascular stent in the left axilla.No acute abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: eval PICC line insertion History: wound infection Clear lungs. No pleural effusion or pneumothorax. Patient status post sternotomy and CABG. Normal heart size. Cervical spinal fusion hardware, incompletely visualized.

Output: No PICC is visualized. Clear lungs.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: edema, effusion History: above No appreciable change in a moderate to large right pleural effusion with right lung atelectasis. No focal lung opacity or large pleural effusion on the left. No pneumothorax. The visualized cardiomediastinal contours are unchanged. Postsurgical changes of the right lower chest wall.

Output: No appreciable change in a moderate to large right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: chest pain History: chest pain Relatively low lung volumes. The lungs and pleural spaces are clear. The heart size is normal.

Output: No edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.POD 1 post BiVAD. Evaluate respiratory status. Interval placement of ECMO.Right jugular Swan-Ganz catheter tip at the level of the right main PA.ETT tip 4.5 cm above the level of the carina. Left-sided chest tube tip projects near the left main bronchus. Central lines terminate at the SVC. IABP marker from a right subclavian approach projects 2 cm below the top of the aortic arch.Layering pleural effusions with diffuse edema, atelectasis and patchy airspace opacity. Retrocardiac opacity persists.

Output: Devices as described. Interval worsening of pleural fluid, edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female patient with atypical chest pain, concern for GERD. Scout radiograph of the chest showed no mediastinal widening or pleural effusions. Note that the left lateral chest wall was excluded from the field of view. Double contrast evaluation of the esophagus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. There are postsurgical changes from a gastric bypass surgery with a gastric pouch. There was brisk emptying from the pouch into the enteric loop of small bowel. No entero-enteric fistulas were seen. A small hiatal hernia was also noted. During the exam, provoked gastroesophageal reflux was observed to the level of the aortic arch. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave (cine series 17).TOTAL FLUOROSCOPY TIME: 4:03 minutes

Output: 1.Provoked gastroesophageal reflux to the level of the aortic arch.2.Post surgical changes from gastric bypass surgery with brisk flow of barium from the gastric pouch to the enteric loop.3.Small hiatal hernia.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Very small right pleural effusion with basilar subsegmental atelectasis.Elsewhere, the lungs are unremarkable.Heart size upper normal.Placement of presternal ICD without complication.

Output: Presternal ICD placement without complication.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: PNA History: SAH Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Chest pain History: Chest pain Unremarkable cardiac and mediastinal silhouette.Vascular stent in the area of the LAD coronary branch.No significant pulmonary or pleural disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: 74 y/o woman with endocarditis who is now s/p single chamber PPM extraction History: endocarditis, altered mental status Approximately normal heart size with evidence of previous median sternotomy.Interval removal of a single lead pacemaker.Dense calcification in the mitral annulus.Bilateral pulmonary opacity compatible with edema and atelectasis.Moderate pleural effusions.

Output: CHF with interval removal of a single lead pacemaker.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA, Hypoxemia History: Dyspnea Large right paratracheal mass consistent with lymphadenopathy.Port catheter with its tip in the SVC.Diffuse bilateral interstitial and airspace opacities suggestive of edema or hemorrhage, unchanged since the previous day.Underlying pulmonary nodules, although partly obscured, appear to have significantly decreased.

Output: Diffuse airspace and interstitial opacities suggestive of edema or hemorrhage.Apparent decrease in multiple pulmonary nodules, which remain consistent with metastases based on previous CT scans.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: post op, eval lung fields History: s/p MVR Right chest tube with no pneumothorax.Status post mitral valve repair with cardiomegaly.Stable basilar subsegmental atelectasis.Right jugular catheters removed.

Output: No significant pneumothorax. No significant change.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male with CAD, status post stent, complains of severe shortness of breath evaluate for PE, ILD LUNGS AND PLEURA: The pulmonary arterial vasculature is adequately opacified. No pulmonary embolus can be identified. There is mild perihilar bronchial wall thickening which are nonspecific and may represent bronchitis. No parenchymal abnormalities are identified. There is no evidence of pleural effusions or pulmonary masses.MEDIASTINUM AND HILA: There is mild cardiac enlargement. There is no evidence of hilar or mediastinal lymphadenopathyCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. There is no evidence of a pulmonary embolus2. No underlying parenchymal lung disease is identified.3. Mild bronchial wall thickening centrally


Instruction: Generate impression based on medical findings.

Input: Metastatic colon cancer status post 3 months of chemo evaluate for response LUNGS AND PLEURA: Thickened septal lines seen diffusely throughout the lungs, slightly more prominent in the bases, have slightly worsened in lung bases compared to 6/28/10. Nodularity along of the fissures have increased compared to the previous. Moderate amount of bilateral pleural effusions, not significantly changed, with dependent atelectasis.Previously seen patchy ill-defined foci of ground glass nodularity are less conspicuous compared to the prior study.A calcified granuloma in the left lower lobe, unchanged.MEDIASTINUM AND HILA: An AP window lymph node measuring 12 mm in diameter (image number 51, series number 3), has slightly increased in size (it previously measured 8 mm). Small pericardial effusion, increased compared to the previous. Central line tip in the right brachiocephalic vein. Normal heart size.CHEST WALL: Right chest wall port. Mild degenerative changes in the lower thoracic spine.UPPER ABDOMEN: Scattered hepatic hypodense lesions, some of which are slightly better visualized than the previous CT, appear unchanged compared to the prior MRI study (6/22/10).

Output: 1. Slightly worsened thickened septal lines in lung bases nodularity along the fissures, likely representing worsening of lymphangitic spread of tumor . 2. Slight increase in size of a mediastinal lymph node. 3. Previously seen patchy ground glass nodules in the right upper lung are less conspicuous on the current study.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: Cough with concerns for pneumonia. The cardiomediastinal silhouette is normal. There is a right lower lobe opacity with an air-fluid level. There is a round 3 cm left upper lobe opacity. There are small bilateral pleural effusions.

Output: 1. Right lower lobe opacity with an air-fluid level left upper lobe somewhat round opacity concerning for multifocal pneumonia/abscess or cavitary mass. Followup to resolution recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: hypoxia, chest pain History: hypoxia, chest pain Left base slightly better aerated. Other nonspecific opacities are unchanged. Venous catheter tip in SVC.

Output: Left base slightly better aerated. Other nonspecific opacities are unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: hypoxemia w intubation History: see above ET tube tip at the thoracic inlet the with the cuff above the vocal cords. This has been corrected on subsequent radiographs.NG tube tip in the stomach with the sidehole in the distal esophagus.Other extensive chronic and acute abnormalities unchanged.

Output: High location of ET tube and NG tube.


Instruction: Generate impression based on medical findings.

Input: 85 year-old female with history of parotid lymphoma. Status post surgery and RT. LUNGS AND PLEURA: Numerous foci of subpleural nodular opacities, nonspecific. Peribronchial and airspace opacities are evident throughout both lungs which may reflect infection given the basilar distribution and tree in bud opacities. MEDIASTINUM AND HILA: Cardiac size is normal. No pericardial fluid. Aortic atherosclerotic calcification noted. Calcified hilar lymph nodes. Aortic atherosclerotic and mitral annulus calcification noted. Chest port tip in SVC.CHEST WALL: Significant dextroscoliosis causing deformity of the thorax. Extensive degenerative changes are evident throughout the thoracic spine. Right chest port.UPPER ABDOMEN: Hypervascular lesion in the dome of the liver is incompletely evaluated on this chest CT but may reflect a hemangioma. Low attenuation lesion in the right lobe of the liver probably reflects benign cyst.

Output: Nonspecific nodular opacities may reflect infectious bronchopneumonia and/or aspiration bronchiolitis, short term CT follow-up in 6 weeks is recommended to exclude neoplasm.1)


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: s/p total pancreatectomy with autoislet cell transplant on 11/3 now w/ productive cough History: productive cough Right internal jugular catheter is in the SVC. Postoperative findings noted in the abdomen.Multiple gas-distended loops of bowel are seen.The cardiomediastinal silhouette is normal.Lung volumes are low, and there are small bilateral pleural effusions.

Output: 1.Small bilateral pleural effusions and low lung volumes.2.Dilated loops of bowel which could represent ileus or obstruction. Dedicated abdomen radiographs suggested in the appropriate clinical scenario.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: shortness of breath History: shortness of breath Unremarkable cardiac and mediastinal silhouettes. Trace right pleural effusion.. Right axillary surgical clips.

Output: Trace right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Assess position of IABP. IABP marker overlies the aortic arch. Left chest wall ICD appears unchanged.Mild increase in bilateral interstitial opacities and right basilar atelectasis. Unchanged right pleural effusion versus pleural thickening. No pneumothorax.Unchanged cardiomegaly.

Output: IABP marker overlies the aortic arch. Mild increase in pulmonary edema and right basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: ETT check ETT repositioned, tip projects 5 cm above the carina. NG extends in inferior edge of the image, side port is not visualizedLungs are improved in overall aeration with interval decreased patchy nonspecific opacities

Output: ETT repositioned


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: eval for change in right sided opacity after BiPAP trial (c/f mucus plug vs atelectasis) History: worsening hypoxia Low lung volumes makes detailed cardiopulmonary assessment difficult. New lucency adjacent to the aortic arch. Focal masses within the mid aspect the left lung and lower aspect the right lung again noted. Slight improvement in right basilar opacity is no diffuse opacities in right lung appear to have increased slightly. No pneumothorax.

Output: New lucency adjacent to the aortic arch which may represent a small focus of ectopic gas such as foal pneumomediastinum though its appearance is somewhat atypical for this diagnosis. Close imaging follow-up is suggested.Improvement in right basilar opacity. Diffuse opacities in the right lung have increased. Unchanged lung masses.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: MaleReason for Study: Reason: eval for infiltrate History: cough The cardiac mediastinal silhouette is unremarkable.There are decreased lung volumes with mild basilar subsegmental atelectasis.No focal areas of consolidation. Bilateral apical pleural thickening.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Hx of metastatic head and neck cancer with loculated pleural effusion, evaluate for progression of pleural effusion History: Shortness of breath Unchanged pulmonary and pleural nodules with a right pleural effusion.Heart size normal.Right jugular catheter, tip in SVC.

Output: Unchanged pulmonary and pleural metastases with right pleural effusion. No new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Reason: Evaluate for PNA, pulmonary edema vs. effusion History: SOB after dialysis today, assoicated with cough. Hx ESRD and CHF Severe cardiomegaly with pulmonary vascular redistribution, unchanged from the prior. Bilateral airspace and interstitial opacities are also stable. Small bilateral pleural effusions. No new focal consolidations. No pneumothorax.

Output: Unchanged severe cardiomegaly and diffuse opacities in both lungs. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: please eval for persistent pneumothorax History: shortness of breath, persistent air leak Despite a right chest tube the right pneumothorax appears larger.Unchanged basilar predominant interstitial opacities and a right pleural effusion.

Output: Enlarging right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: eval position of DHT History: s/p replacement of DHT. The lower pelvis is excluded from view. The Dobbhoff tube has been repositioned. The tip now terminates in the region of the pylorus. Remainder of exam without significant change. There are persistent dilated loops of large bowel. Degenerative disease of the spine, left greater than right airspace opacities, cardiomegaly, and partially imaged cardiac leads are again seen.

Output: 1. The Dobbhoff tube terminates at the region of the pylorus.2. Persistent dilated loops of bowel, which likely represent a pattern of ileus, similar to prior exams. No definite bowel obstruction.3. Partially imaged left greater than right airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: s/p PICC, confirm placement History: s/p PICC New PICC line from the left arm extending to the SVC/R atrium junction.Catheter from the right arm extending to the right subclavian vein.Small lung volumes with mild basilar atelectasis.

Output: New catheter without complications.


Instruction: Generate impression based on medical findings.

Input: Female; 63 years old. Reason: eval volume status History: esrd New left jugular dialysis catheter tip in SVC. Right axillary vascular stent.Normal heart size.Low lung volumes. Mild streaky left basilar opacity is most compatible with subsegmental atelectasis. No specific evidence of edema or infection.

Output: No specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Reason: pna? History: weakness Approximately normal heart size with pacemaker leads in the area of the right atrial appendage and right ventricular apex.Extensive bilateral pleural calcification, which partially obscures the underlying lungs, compatible with previous asbestos exposure.Blunting of the costophrenic angles, greater on the right, consistent with small pleural effusions, with possible mild underlying interstitial edema.

Output: 1. Small pleural effusions and mild interstitial edema suggestive of CHF.2. Calcified pleural plaques consistent with previous asbestos exposure.


Instruction: Generate impression based on medical findings.

Input: 48 year-old female with hemoptysis; leg swelling; shortness of breath; d-dimer elevated. Evaluate for PE. CHEST:PULMONARY VASCULATURE: No PE. Study is diagnostic to the level of the segmental pulmonary arteries.LUNGS AND PLEURA: Patchy areas of groundglass opacities with more focal areas of nodular consolidation in the lower lobes. No pleural effusion identified. Scattered pulmonary micronodules and calcified granulomata. No suspicious nodules or masses.MEDIASTINUM AND HILA: Hilar fullness bilaterally may represent mild lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Patchy areas of groundglass opacities with more focal areas of nodular consolidation in the lower lobes. Differential considerations include pulmonary hemorrhage versus edema versus an atypical infection such as a viral pneumonia.2. No PE. Study is diagnostic to the level of the segmental pulmonary arteries.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: evaluate for cause of fatigue History: fatigue, CMV viremia The heart is normal in size. Status post median sternotomy.Intact sternotomy wires.Lung volumes are normal. No abnormal focal lung opacities.The pleural spaces are within normal limits.Mild degenerative changes of the thoracic spine.

Output: Chest radiograph within normal limits. Specifically, no abnormal radiographic findings to explain patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 45 year old female with cough, sob, fever. No focal airspace opacities.No pleural effusion or pneumothorax.Cardiomediastinal silhouette is unremarkable.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: r/o pna, edema History: sob Heart size upper normal versus magnification artifact.Mediastinal contours otherwise unremarkable.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: acute resp failure, with chest tube History: as above Left chest tube unchanged with a left subpulmonic pneumothorax and consolidation of the left lower lobe.Small right pleural effusion.Right jugular catheter, tip in SVC.

Output: Left chest tube left subpulmonic pneumothorax and left basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: 86-year-old female with shortness of breath, hypoxia, tachypnea. Right PICC is unchanged in position with tip within the SVC and directed medially. Unchanged cardiomediastinal silhouette with mild cardiomegaly. Decreased lung volumes. Perihilar and bibasilar reticular and airspace opacities, and bilateral small pleural effusions, unchanged. No pneumothorax. Atherosclerotic calcifications of the aortic arch are again noted. Kyphoplasty cement noted.

Output: Right PICC is unchanged in position with tip within the SVC and directed medially. Unchanged appearance of congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: chest pain, eval for ptx/pna History: chest pain, eval for ptx/pna Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No significant pneumothorax.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.Reason: f/u effusion History: SOB, tachypnea Large, unchanged left pleural effusion. Small amounts of the left upper lobe remain aerated, unchanged from prior. Rightward mediastinal shift. Minimal right pleural effusion is unchanged. No pneumothorax.

Output: No significant change from prior examination.


Instruction: Generate impression based on medical findings.

Input: 74 years old Male. Reason: sp lobectomy History: air leak. There is interval near complete resolution of the right large pneumothorax. There is a small right pneumothorax. There is interval decrease of the right chest wall subcutaneous emphysema. The tip of the chest tube projects over the mediastinum.

Output: Interval near complete resolution of large right pneumothorax. Small residual right pneumothorax. Interval improvement of the right chest wall subcutaneous emphysema.


Instruction: Generate impression based on medical findings.

Input: ASD repair ETT in one of the right jugular sheaths have been removed without complication. One jugular sheath remains in the proximal jugular. The right chest tube again projects towards the subcarinal region without evidence of change.Decreased lung volumes without superimposed focal distinct abnormality other than patchy suspected atelectasis

Output: ETT removed


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: r/o pna History: chest pain No significant cardiopulmonary abnormality.

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


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz check Swan-Ganz remains in right pulmonary flow tract. Unchanged anterior ICD. Underlying cardiopulmonary appearance was similar with minimal patchy streaky densities in both bases suggesting atelectasis or less likely aspiration. See subsequent report

Output: Swan-Ganz unchanged


Instruction: Generate impression based on medical findings.

Input: On ECMO. Changes may to ventilator.VIEW: Chest AP (one view) 02/07/16, 1613 Endotracheal tube tip is at thoracic inlet. Left neck ECMO cannulas remain in place. Right atrial cannula is again seen. A chest tube is present in each hemithorax. A mediastinal drain is identified. Right and left atrial lines are present. ECMO support improvement in the mediastinum is seen.Soft tissue edema persists. Bone changes from trichothiodystrophy continue.The right lung is slightly better aerated especially at the costophrenic sulcus. Air bronchograms are noted. The right upper lung is almost completely opacified. Left-sided air bronchograms and hazy opacities are seen. Right hemidiaphragm is at the posterior ninth rib. Left hemidiaphragm is at the posterior 10th rib. Cardiac silhouette size cannot be evaluated.

Output: Slightly improved aeration of right lung.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: pna? History: sob cough No evidence of pneumonia. No significant change.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 50 year-old male with medullary thyroid cancer status post 15 cycles of chemotherapy. Please compare to 11/14/09. Provide measurements and evaluate disease status. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Postsurgical changes consistent with thyroidectomy.Stable punctate anterior mediastinal node measures 9 x 5 .7 mm, series 3 image 34.CHEST WALL: Gynecomastia unchanged.ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions. Gallstones.SPLEEN: No significant abnormality notedPANCREAS: Fatty pancreas.ADRENAL 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: Lytic lesion right iliac wing unchanged 90.7 x 0.5 .9 mm as measured on series 3 image 172. Sclerotic focus left femoral diametaphysis, unchanged. Lytic changes right sacrum and L2 vertebral body are stable.OTHER: No significant abnormality noted

Output: Osseous metastases unchanged. Cholelithiasis. Gynecomastia. Punctate anterior mediastinal lymph node unchanged. No new sites of disease.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: eval for PNA, edema, effusion History: SOB, fatigue Lower lung zone interstitial opacities and small pleural effusions noted.Focal consolidation right lower lobe.Heart size normal.

Output: Interstitial opacities suggestive of edema or fibrosis, with right basilar consolidation either infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Exposure to asbestos. Family history of mesothelioma and lung cancer. Cough. Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Heart size at the upper limit of normal.

Output: Heart size at the upper limit of normal. Otherwise, normal chest.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: assess for infection History: as above Possible right basilar atelectasis is projected behind the diaphragm, otherwise unremarkable.Heart size normal.

Output: Possible right basilar atelectasis, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: assess for CHF History: PND, chest pain Chronic elevation of the right hemidiaphragm. No interval pleural effusion, edema or consolidation. Heart size remains stable. Multiple surgical clips occupy the right upper abdomen.

Output: Stable elevation of the right hemidiaphragm.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: eval for pna History: new fever and cough overnight Minimal scarring left base periphery.Heart size normal.Surgical artifacts left axillary region.Overall range artifact left upper lung zone, but probably not actual lung lucency.

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


Instruction: Generate impression based on medical findings.

Input: Status post cystectomy and ileal conduit formation, complicated by persistent nausea and vomiting, evaluate for ileus versus SBO New from earlier study are multiple mildly dilated small bowel loops with air and small to moderate residual enteric contrast seen in colon. Previously visualized right pelvic drain not well seen currently, presumably related to interval removal. Left-sided thin caliber nephroureteral stent seen on earlier study not well visualized. Right upper quadrant surgical clips. Bi-iliac vascular stent grafts. Pelvic clips, multiple skin staples.

Output: Findings concerning for developing SBO versus postoperative ileus, appearance of multiple dilated small bowel loops is new when compared to earlier 4/18/2016 radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: evaluate for active tb History: evaluate for active tb No significant cardiopulmonary abnormality.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: r/o pna/lung infection History: coughing up blood Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: ETT placement History: ETT placement Cardiomegaly with mild interstitial edema, improved, but persistent left lower lobe consolidation and a left pleural effusion.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: Improvement in edema with persistent left lower lobe consolidation. ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.History of cough, rule out pneumonia. No focal airspace opacities concerning for pneumonia. There is bronchial wall thickening and the lungs appear hyperinflated. A right perihilar lucency may represent a bulla. Small bilateral pleural effusions/pleural thickening. No pneumothorax. The heart size is within normal limits.

Output: Although there is no evidence of pneumonia the lungs appear hyperinflated with peribronchial cuffing compatible with COPD/bronchitis.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: AMCXr History: AMC Left IJ catheter tip in the left brachiocephalic vein, unchanged. Left chest tube and esophageal stent are unchanged. No significant pneumothorax.Small pleural effusions with overlying atelectasis, unchanged.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: hx of bladder cancer s/p radical cystectomy, evaluate for metastatic disease History: see above Heart size near upper normal.No significant pulmonary or pleural abnormality.Right focal pleural fat deposition.No sign metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Evaluate pneumothorax. Low lung volumes. Minimal right apical pneumothorax. Mild pulmonary edema. No pleural effusions.Unchanged cardiomegaly.Right chest wall pigtail drain unchanged.

Output: Minimal right apical pneumothorax. Mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: Preop TECAB The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.No suspicious pulmonary nodule or mass.

Output: No acute cardiopulmonary process is identified.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: evaluate for pneumonia Patient status post left pneumonectomy, as before. No new focal pleural parenchymal opacity in the right hemithorax. Heart size difficult to assess. No pneumothorax. Patient status post cholecystectomy.

Output: No new focal pleural parenchymal opacity in the right hemithorax.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and atrial fibrillation Increasing diffuse mild 4 quadrant changes consistent with CHF. See subsequent report. Partial collapse of the left lower lobe is also observed, likely compression atelectasis.Extensive coronary and annular calcifications. ICD unchanged

Output: Increasing CHF


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: eval for infiltrate, edema; hx of r-sided lung CA with mets History: chest pain, SOB, concern for PE Stable cardiomediastinal silhouette.Right perihilar mass similar in appearance to the prior exam.Probable small right pleural effusion, right basilar airspace opacity, and mild interstitial edema in the right lower lung zone are new from the prior exam.Left lung is clear.

Output: New right pleural effusion and right basilar opacity representing right middle lobe consolidation. See current CT of the chest.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: intubated History: intubated ET tube approximately 2 cm above the carina.Significant interval improvement in the bilateral airspace opacities representing acute edema.NG tube coiled in stomach.No pneumothorax. No pleural effusion.

Output: Significant interval improvement in pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: FemaleReason for Study: Reason: eval ptx, pna History: L cp The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Reason: Pt s/p RYGB now with persistent nausea and vomiting, r/o obstruction History: nausea and vomiting Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Single contrast evaluation of the esophagus reveals incomplete, high-grade stenosis at the proximal anastomosis of the gastric remnant and alimentary limb. After a few minutes some contrast is revealed to pass from the gastric remnant into the small bowel without evidence of extravasation.Visualized portions of the esophagus reveal no contour abnormalities.Total fluoroscopy time: 3 minutes 20 seconds

Output: 1. Incomplete high-grade stenosis of the proximal anastomosis of previous Roux-en-Y procedure.


Instruction: Generate impression based on medical findings.

Input: Chest pain and SOB evaluate acute process. Upper normal heart size. No focal airspace opacities, pleural fluid or pneumothorax.

Output: Upper normal heart size but no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old. Status post two weeks enucleation of a right upper lobe nodule and mediastinal lymph node dissection for a suspected lung cancer. Interval removal of two right chest tubes. No significant pneumothorax.Basilar opacities consistent with pleural effusions and atelectasis, greater on the right, unchanged. Stable right hemithorax post-surgical volume loss.Decreased right chest wall subcutaneous emphysema.

Output: Interval removal of two right chest tubes without a significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old with DKA. Evaluate for pneumonia. Unremarkable cardiomediastinal silhouette.No focal consolidation, pleural effusion or pneumothorax. Bibasilar scarring/discoid atelectasis.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: copd v chf History: sob Lower lung zone edema and small pleural effusions are present, unchanged.Moderate cardiomegaly.No specific evidence of infection.Left subclavian ICD, leads unchanged in position.

Output: CHF with cardiomegaly, pulmonary edema and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: Evaluate for PNA History: L sided chest pain associated with cough Cardiomediastinal silhouette is normal in size.Bronchial wall thickening. No focal airspace opacity, pleural effusion or pneumothorax.

Output: Bronchial wall thickening can be seen with asthma or chronic bronchitis. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with metastatic ovarian cancer CHEST:LUNGS AND PLEURA: Stable micronodules. By apical scarring, unchanged.MEDIASTINUM AND HILA: Not enlarged mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense lesions are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left-sided hydronephrosis with double-J ureteral stent is unchanged. Atrophy of the left renal parenchyma is again unchanged.RETROPERITONEUM, LYMPH NODES: Left para-aortic index lymph node is slightly smaller measuring 8 x 10 mm image number 114, series number 3. Other retroperitoneal lymph nodes are also slightly smaller.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left adnexal/pelvic mass measures 5 x 3.4 cm on image number 174, series number 3, not significantly changed.BLADDER: No significant abnormality noted.LYMPH NODES: Reference right external iliac lymph node measures 12 x 12 mm image number 164, series number 3 smaller compared to previous study. Reference right obturator lymph node measures 4-mm in diameter on image number 175, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in the size of the retroperitoneal and pelvic lymph nodes. Pelvic/left adnexal mass is stable. No other significant change.