Instruction: Generate impression based on medical findings.

Input: 42-year-old male with abdominal distention and bilious emesis, please evaluate for obstruction. CHEST:LUNG BASES: Bilateral pleural effusions with associated compressive atelectasis are noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis and gallbladder wall thickening, suggestive of cholecystitis. There is no evidence of biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral atrophic kidneys with no evidence of nephrolithiasis or hydronephrosis. There are multiple bilateral renal lesions which cannot be further characterized on this noncontrast study.RETROPERITONEUM, LYMPH NODES: Subcentimeter periaortic lymph nodes of unknown significance are seen.BOWEL, MESENTERY: There is a hiatal hernia with distal esophageal dilatation noted.There is a right sided peritoneal dialysis catheter and small foci of intraperitoneal air and fluid which is a normal finding in patients on peritoneal dialysis; however, peritonitis cannot be excluded. Mixture of fluid and stool outlines the colon at the hepatic flexure. There is no evidence of pneumatosis intestinalis. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is perihepatic ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: A suprapubic catheter is visualized.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1.Cholelithiasis and gallbladder wall thickening, suggestive of cholecystitis. Recommend right upper quadrant ultrasound or HIDA scan for further follow-up.2.No evidence of pneumatosis intestinalis3.There is a right sided peritoneal dialysis catheter and small foci of intraperitoneal air and fluid which is a normal finding in patients on peritoneal dialysis; however, peritonitis cannot be excluded. 4.Perihepatic ascites


Instruction: Generate impression based on medical findings.

Input: 47 year old female with metastatic salivary gland cancer with pulmonary metastases. Admitted with neutropenic fevers and worsening chest x-ray. Given the limitations of a noncontrast study the following observations are made.LUNGS AND PLEURA: Bibasilar air space opacities with air bronchograms which may be secondary to mucous plugging of the airways leading to atelectasis or aspiration pneumonia given location of consolidation. Tree in bud opacities are seen in the anterior aspect of the right middle lobe which is suggestive of infection. Numerous, variable sized nodules consistent with metastatic disease. The reference nodule in the left upper lobe measures 13 x 11 mm as seen on image 40/77 (previously 11 x 10 mm). Interval appearance of indistinct nodular opacities in the left upper and lower lobes clustered around the airways which likely represents endobronchial infectious spread, however, repeat CT is recommended after treatment of infection. Posterior pleural thickening is reidentified.MEDIASTINUM AND HILA: The reference anterior mediastinal mass is stable in size and period measures 50 x 32 mm is seen on image 32/77 (previously 50 x 32 mm). Shotty mediastinal lymph nodes. No pericardial effusion or thickening.CHEST WALL: Stable sclerosis of upper thoracic vertebral body.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Bibasalar consolidations, air space opacities clustered around the airways, and tree in bud opacities suggestive of infectious process, likely fungal in etiology given neutropenia.2. Stable widespread metastatic disease.These findings were discussed with Dr. Giles by the resident on-call at 3:05 a.m. on 5/9/2008.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: fever History: fever Right lower lung zone patchy airspace opacities suggestive of infection.Mild cardiomegaly and redistribution of the pulmonary blood flow noted.No evidence of edema.

Output: Cardiomegaly, and right lower lung zone pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Large right pleural effusion status post right chest tube removal. Interval removal of right-sided chest tube with increase in large right apical pneumothorax component. There is now about 6 cm in maximal pleural separation from the chest wall at the apex. The remaining right lung collapse has progressed. Loculated right pleural fluid collection slightly increased in volume with concurrent increase in basal opacity.Left lung volume remains low, with minimal atelectasis and hazy opacity possibly reflecting aspirated secretions.

Output: Interval increase in large right hydropneumothorax post chest tube removal, with worsening collapse of the remaining right lung. Maximal pleural separation from the chest wall at the apex is 6 cm.


Instruction: Generate impression based on medical findings.

Input: Cough Motion heavily degrades sensitivity.Persistent decreased diminished lung volumes with marked streaky densities in both lung bases suggesting atelectasis over aspiration or infection. Mild cardiomegaly suspected but difficult to confirm.

Output: Persistent extensive atelectasis and diminished lung volumes, however evaluation is limited. See description above


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: FemaleReason for Study: Reason: right VATS History: - Right IJ venous catheter, right PICC line, and right sided chest tubes unchanged.No significant pneumothorax.Pleural thickening right basilar consolidation similar to the prior exam.Stable cardiomediastinal silhouette.

Output: Postoperative chest without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: Eval for cardiopulmonary disease. History: Right atrial lead directed inferiorly, probably within the lumen of the right atrium, unchanged from the previous radiograph. Right ventricular ICD lead tip in the area of the apex of the right ventricle, also unchanged. The cardiomediastinal silhouette calcified right hilar lymph nodes are again noted. There are no new pleural or pulmonary abnormalities.

Output: Abnormal right atrial lead placement and normal right ventricular lead placement, without acute cardiopulmonary process evident.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out chest metastasis History: hx of renal cell carcinoma, sp partial nephrectomy Normal heart size with a tortuous aorta.Large lung volumes with no sign of metastases or other significant interval change.Kyphosis with partial collapse of several thoracic vertebral bodies, increased from previous, likely secondary to osteoporosis.

Output: No sign of thoracic metastases.


Instruction: Generate impression based on medical findings.

Input: Metastatic renal cell carcinoma. CHEST:LUNGS AND PLEURA: Previously described pleural effusions have resolved. Punctate right middle lobe nodule is unchanged.MEDIASTINUM AND HILA: Previously described mild paratracheal adenopathy has almost completely resolved. Previously measured referenced lymph node now measures 7 x 5 mm on image number 34. Subcarinal adenopathy is also decreased in size.CHEST WALL: No change in the expansile rib lesion measuring 3.7 x 2.3-cm.ABDOMEN:LIVER, BILIARY TRACT: Numerous hepatic metastases replacing the liver parenchyma are again noted. Previously mentioned reference metastases in the right lobe measures 6.5 x 4.9 cm on image number 99/206. The second reference mass in the left lobe measures 8.2 x 6.5 cm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. No evidence of recurrence. Left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval decrease in the size of the bilateral pleural effusions and mediastinal adenopathy. Extensive liver metastases and the expansile rib lesions are grossly unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.SOB with fever and sputum. Severe multichamber cardiomegaly.Diffuse groundglass opacities, appearing more faint enhancement malignant, most consistent with improving pulmonary edema.There may be a trace volume of pleural fluid on the left, with blunting of the costophrenic angle.

Output: Improving CHF, but no specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: copd History: as above Basilar opacities and pleural effusions unchanged.Heart size normal.

Output: Unchanged basilar opacities and pleural effusions, possibly aspiration or infection in the left lower lobe.


Instruction: Generate impression based on medical findings.

Input: 57-year-old man with pancreatic cancer status post chemotherapy and radiation therapy. Pre-operatively needs repeat scan to evaluate resectability. Patient had lung nodules at baseline scan. Please check for any changes. Evaluate extent of pancreatic cancer and its proximity to major vessels as well as any evidence of metastatic disease. CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules are seen in the apices of both lungs some of which contain calcifications. This is likely consistent with old granulomatous disease. Emphysematous changes are also evident. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy.CHEST WALL: Chest port is seen in in the right anterior chest with the tip of the catheter in the SVC RA junction.ABDOMEN:LIVER, BILIARY TRACT: No intraparenchymal lesions are visualized. There is intrahepatic biliary ductal dilatation, greater in the left lobe of the liver, with pneumobilia. The gallbladder is normal in appearance without evidence of calcified gallstones.SPLEEN: No significant abnormality notedPANCREAS: There is a heterogeneous largely hypoattenuating mass in the head of the pancreas measuring 2.2 x 1.7 cm as seen on image 124/228 of series 11. This lesion seems smaller than prior scan. There is pancreatic ductal dilatation distal to this mass. Pancreatic stent is noted. There is no vascular encasement by this tumor and the celiac artery, superior mesenteric artery, splenic vein, and portal vein appear normal. There is a cystic collection in the lesser sac which measures 4.5 x 3.2 cm as seen on image 101/228 of series 11. This collection likely represents a pseudocyst and a metastatic etiology is less likely. There is regional lymphadenopathy with reference portocaval node measuring 2.1 x 1.3 cm as seen on image 102/228 of series 11.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: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Pancreatic mass in the head of the pancreas appears smaller without any evidence of vascular encasement.2. Lesser sac cystic collection likely represents pseudocyst.3. Old granulomatous disease seen in the apices of the lungs.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: R/O TB lesions/pneumonia to start infliximab today History: Abdominal pain, hematochezia No evidence of active TB.

Output: No evidence of active TB.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: Resp Failure History: Resp Failure Small lung volumes with a diffuse interstitial abnormality suggestive of edema and/or aspiration.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.Left PICC, tip in axillary region.

Output: Unchanged interstitial opacities suggestive of edema and/or aspiration, or ARDS.


Instruction: Generate impression based on medical findings.

Input: Male 72 years old Reason: assess for aspiration, p/w seizure History: assess for aspiration Subtle focal retrocardiac opacity suggests mild atelectasis.No pleural effusion or pneumothorax.The cardiomediastinal silhouette is unremarkable.

Output: Mild retrocardiac atelectasis, perhaps related to aspiration, but otherwise, no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: r/o infection and injury History: productive cough x 3 days and she was kicked in sternum and right upper chest 5 days ago Cardiomediastinal silhouette is within normal limits.No focal air space abnormality. No pleural effusions or pneumothorax.No acute osseous abnormalities identified.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: s/p tunneled catheter History: s/p R IJ tunneled catheter Right IJ central venous line tip in the distal SVC. Left PICC tip at the SVC/RA junction.Bibasilar pulmonary opacities compatible with aspiration or mucous plugging, right worse than left. Likely small right pleural effusion. No pneumothorax.

Output: Right IJ central venous line tip at distal SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Cough. History of heart and kidney transplant. Unchanged cardiomediastinal silhouette.Status post median sternotomy.Right central venous catheter tip projects over the distal SVC.No focal pulmonary opacity, pleural effusion or pneumothorax.

Output: Heart size upper normal, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: baseline eval pre kidney transplant Unremarkable cardiac and mediastinal silhouette.Vascular stents in the left axilla.No significant pulmonary or pleural disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for effusions History: somnolence, RLL opacity Right lower lobe nonspecific airspace opacity compatible with aspiration and/or infection, not significantly changed.A more recent radiograph has been interpreted.

Output: Right lower lobe opacity compatible with aspiration and infection.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: evaluate effusion History: R sided effusion Improvement in right pleural effusion with less overlying atelectasis.Mild to moderate cardiomegaly.Left subclavian ICD, leads unchanged in position.

Output: Cardiomegaly, with improvement in the right pleural effusion and overlying atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: Post RML nodule biopsy - pneumothorax? History: Post RML nodule biopsy Status post biopsy with a 2 cm right pneumothorax.Left lung unremarkable.Nodular opacity right lower lung zone probably related to biopsy.

Output: Right postprocedure pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 25 yearsGender: FemaleReason for Study: Reason: cough, right-sided pleuritic CP, fever, sickle cell disease. Eval infiltrate History: cough + fever The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube placement History: s/p L VATS wedge Chest tube extending to the left apex with no significant pneumothorax.Focal left apical opacity with surgical staples compatible with postoperative hematoma and contusion.Mild basilar atelectasis.

Output: Chest tube in place with no significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: FemaleReason for Study: Reason: want to evaluate position of triple lumen catheter in L IJ History: oozing around cath site Support devices unchanged.Stable cardiomediastinal silhouette.Pleural effusions and basilar atelectasis/consolidation similar to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance with pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: assess for infiltrate. History: positive for human metapneumovirus, want to assess for superimposed bacterial PNA Increasing bilateral reticulonodular interstitial abnormality consistent with pneumonia.

Output: Increasing bilateral reticulonodular interstitial abnormality consistent with pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male 59 years old Reason: evaluate for chest tube placment History: pneumothorax. Interval placement of a right-sided chest tube. Endotracheal tube tip approximately 3 cm above the carina. NG tube is in the stomach.Redemonstration of extensive subcutaneous emphysema overlying the entire chest wall and supraclavicular regions bilaterally.Marked decrease in right-sided pneumothorax. Cardiomediastinal silhouette is changed.

Output: 1. Interval placement right-sided chest tube with marked decrease in right-sided pneumothorax.2. Appropriate positioning of iatrogenic support devices.


Instruction: Generate impression based on medical findings.

Input: Reason: confirm stable IABP placement History: advanced heart failure with IABP Balloon catheter marker at the level of the aortic arch with the balloon in the descending aorta.PICC line and ICD leads unchanged.No significant pulmonary abnormalities.

Output: Balloon catheter in the descending aorta, slightly more proximally located than previously.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: 60M intubated s/p ETT adjustment History: ETT Patchy left lower lobe consolidation worsening over the last several studies is consistent with infection or aspiration.ET tube tip high, at least 8 cm above the carina.An NG tube terminates in the stomach.

Output: Increasing left lower lobe opacity suggestive of infection or aspiration. High ET tube.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Status post right CT removal evaluate for effusion and atelectasis and pneumothorax. Right chest tube has been removed. Moderate volume of pleural fluid on the right about the same. No significant pneumothorax. Significant basal atelectasis on the right, minimal on the left. Mediastinal widening consistent with known aneurysm similar to recent previous. Dobbhoff tube may be advanced with tip currently just beyond the GE junction. Surgical hardware similar in position.

Output: Moderate right pleural fluid collection with associated atelectasis.


Instruction: Generate impression based on medical findings.

Input: 70 old female with pancreatic mass now with fevers and abdominal pain 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: Fatty infiltration of the liver and pneumobilia. Status post cholecystectomy. Biliary stent is in place. No biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Ill-defined hypodense area around the biliary stent with prominent pancreatic duct is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Previously described retroperitoneal lymph node is unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral pleural effusions, otherwise no significant change in the size of the pancreatic mass or retroperitoneal lymph node.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: cardiopulmonary arrest post trach History: post trach Interval tracheostomy tube placement with removal of endotracheal tube. Right PICC, unchanged.Coronary stent. Stable cardiac size. No new pulmonary opacities.

Output: Interval tracheostomy with no new pulmonary opacities or pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Removal of chest tube Interval removal of NG tube and left chest tube. No significant residual pneumothorax. Underlying cardiopulmonary appearance otherwise similar

Output: Left chest tube removed


Instruction: Generate impression based on medical findings.

Input: Male 29 years old with Hx of hypertensive emergency and acute renal failure, placed IJ line for RRT, evaluate placement/location Motion degrades image. Interval right IJ catheter placement with tip overlying the cavoatrial junction. Cardiac size upper limits of normal. Bibasilar edema/atelectasis with trace pleural effusions. No evidence of a pneumothorax.

Output: Right IJ catheter tip overlies the cavoatrial junction. Bibasilar edema/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: pleural effusion History: na Left pleural effusion slightly improved. Support hardware other findings stable.

Output: Left pleural effusion slightly improved.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: s/p Fontan History: s/p Fontan Median sternotomy with cardiomegaly.Small lung volumes but no specific evidence of edema or pneumonia.Status post extubation.Right jugular catheter remains in place.

Output: No change in lung appearance following extubation.


Instruction: Generate impression based on medical findings.

Input: Reason: pruritus of unknown etiology, malignancy screen History: pruritus Unremarkable cardiac and mediastinal silhouette.Benign type calcification in the right breast.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Hodgkin's lymphoma status post stem cell transplant. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Scattered small mediastinal lymph nodes are stableCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable disease without evidence of adenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Chest tube removed. Lung transplant status. Right jugular catheter terminating at the superior cavoatrial junction. Interval removal of left chest tube with a trace, less than 5 mm, left apical pneumothorax. Emphysema on the left with probable bronchial mucus plugging at the base.Elevation of right hemidiaphragm. Coarse interstitial opacities in the right lung with the suggestion of developing bronchial wall thickening in the lower lobe. Mild edema and pleural fluid on the right. There are couple of subcentimeter air and fluid collections projecting over the right fourth/fifth rib interspace which could be within the cranial aspect of the major fissure or possibly in the chest wall and should continue to be monitored.Improving subcutaneous emphysema right chest wall laterally.

Output: Less than 5 mm left apical pneumothorax post chest tube removal. Small air and fluid foci projecting over the right upper thorax could be in the chest wall or contained within the fissure and may be monitored on subsequent exams.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: please evaluate for pneumothorax History: Please evaluate for pneumothorax New left subclavian ICD with leads project over the right atrial appendage and over the right ventricle with tip directed toward the apex. Midline retrocardiac opacity is again appreciated, most compatible with calcified subcarinal lymph nodes. Mild basilar subsegmental atelectasis. Apparent increase in retrocardiac opacity may reflect differences in patient rotation.

Output: Interval placement of a left subclavian ICD.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with a renal cyst. Evaluate for malignancy. LUNG BASES: No significant abnormality noted.ABDOMEN: LIVER, BILIARY TRACT: Focal area of calcification measuring approximately 2 cm in the right hepatic lobe (series 7, image 27)SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts bilaterally measuring water density without evidence of abnormal enhancement are compatible simple cysts. Multiple other smaller cysts are too small to characterize.RETROPERITONEUM, LYMPH NODES: Heavy atherosclerotic calcifications of the descending aorta and its major branch vessels.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine.PELVIS:PROSTATE, SEMINAL VESICLES: Prostatic hypertrophy.BLADDER: Bladder diverticula.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Multiple simple renal cysts bilaterally. No evidence of malignancy.2. Prostatic hypertrophy with note also made of bladder diverticula.3. Heavy atherosclerotic calcifications of the descending aorta and its major branch vessels.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: Central line manipulation History: Central line manipulation Pulmonary opacities are unchanged, primarily renal failure related calcifications.Heart size normal.Both jugular catheter was then pulled up to the SVC/RA junction level.IVC stent and filter unchanged.

Output: Catheter repositioning. No other change.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: rule out effusion/pneumonia History: chest pain/rib pain R side Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.No obvious rib abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male 47 years old Reason: respiratory distress History: respiratory distress Enteric tube tip is below the inferior margin of the image. Decreased lung volumes. Retrocardiac consolidation/atelectasis, unchanged. No pleural effusion or pneumothorax.

Output: Left basilar atelectasis, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Status post pleural vent placement. Evaluate for pneumothorax. There is moderate improvement in the left-sided pneumothorax, now small. There is interval placement of a left chest tube with tip projecting over the descending aorta. Left chest tube is unchanged. Pneumomediastinum again noted. Unchanged basilar interstitial opacities.

Output: Interval placement of a new left-sided pleural vent with interval improvement in pneumothorax, now small.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: R/o pulmonary edema and opacities History: crackles on examination Increased right basilar subsegmental atelectasis, with a slightly large heart.Right PICC, tip in right subclavian.

Output: Increasing right basilar subsegmental atelectasis, which may be the result of mucous plugging or aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: evaluate for new pneumonia History: signs of sepsi New near complete left-sided atelectasis. Given the rapid change this is likely due to mucous plugging or aspirate. This should be followed to resolution to exclude an underlying obstruction.

Output: New near complete left-sided atelectasis. Given the rapid change this is likely due to mucous plugging or aspirate.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Interval resolved right basilar atelectasis with minimally shifting similar changes again observed. Borderline cardiomegalyRight jugular dialysis catheter extends into the proximal SVC unchanged

Output: Shifting minimal atelectasis without superimposed acute abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: intubated History: intubated Enteric tube courses below the field-of-view. ET tube tip is 5 cm above the carina.Cardiomediastinal silhouette is normal.No pleural effusion or pneumothorax.Nonspecific opacity at the left base compatible with atelectasis and scarring, unchanged.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: RRT, desat Small lung volumes with streaky basilar opacity compatible with subsegmental atelectasis and possibly small effusions.Multiple healed rib fractures bilaterally.A more recent radiograph has been interpreted.

Output: Basilar nonspecific atelectasis, possibly related to aspiration or embolism.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: assess for worsening pulmonary edema History: shortness of breath, tachypnea Cardiomegaly with pulmonary edema and small pleural effusions, unchanged.

Output: Cardiomegaly with pulmonary edema and small pleural effusions, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.Reason: lung mass History: weakness, sob, headaches, recent hx of lung cancer Right hemithorax post treatment volume loss.Heart size normal, the aorta tortuous.No evidence of tumor recurrence.

Output: No sign of tumor recurrence following right lung cancer resection.


Instruction: Generate impression based on medical findings.

Input: 19-year-old male with chest tightness, shortness of breath, cough and asthma. Cardiac silhouette is within normal limits.Mild peribronchial thickening.No abnormal focal pulmonary opacity.No pneumothorax or pleural effusions.

Output: Mild peribronchial thickening compatible with asthma.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: 25-year-old female with right chest pain, sickle cell disease, prior HCAP Right chest port catheter tip in the SVC.Chronic appearing interstitial opacities in the lower lobes with focal peripheral opacity in the right midlung unchanged, better characterized on recent CT study. No pleural effusions or pneumothorax. Normal cardiomediastinal silhouette.

Output: No significant interval change in cardiopulmonary appearance without superimposed acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: assess subclavian IABP position History: low augmentation No change position of the intra-aortic balloon pump, projecting approximately 3 cm below aortic knob.Support devices unchanged.Cardiomegaly unchanged.Lungs remain grossly clear.

Output: No significant change in position of support devices. Stable cardiomegaly with no other interval change.


Instruction: Generate impression based on medical findings.

Input: 48-year-old female with shortness of breath and fever. Evaluate for pneumonia. Heart size at the upper limits of normal.Bibasilar streaky opacities likely representing atelectasis or scarring. No specific evidence of infection or edema.

Output: Bibasilar atelectasis. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 74 years old Female. Reason: effusion vs PNA History: cough and sob. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Cardiomediastinal silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: AMS with questionable aspiration, hypoxia, evaluate infiltrate, history of pulmonary hypertension, end-stage renal disease, heart failure Right internal jugular catheter tip projects over the SVC. Left pacemaker with leads in the right atrium and right ventricle.The heart size is normal.No radiographic evidence of infection, large pleural effusion, or pneumothorax.Persistent enlargement of the pulmonary arteries. Extensive atherosclerotic calcifications in the soft tissues.

Output: Stable exam without radiographic evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: tube in good place? History: intubated ET tube tip approximately 4 cm above the carina.No significant cardiopulmonary abnormalities.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: cause of sob History: sob, h/o asthma Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: cp History: cp Normal cardiomediastinal silhouette.Lungs clear.No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: s/p thoracotomy, pleurectomy and decortication History: chest tubes Interval intervention with placement of 2 right-sided chest tubes that are directed apically. The medial chest tube terminates at the level of the posterior right third rib.Interval decreased size of previous right pleural effusion. There is a moderate to large right hydropneumothorax with peripheral opacities of the atelectatic lung. Lucency at the right hemidiaphragm is suggestive of pneumoperitoneum. Subcutaneous emphysema is partially visualized at the right infralateral chest wall.The left lung is fully inflated. Streaky basilar opacities of subsegmental atelectasis.

Output: 2 right-sided chest tubes status post lobectomy and decortication in the setting of a moderate to large right hydropneumothorax. Pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: FemaleReason for Study: Reason: r/o esophageal abnormality History: nausea/vomting Right Port-A-Cath with its tip in the SVC.The cardiomediastinal silhouette is unremarkable.Minimal basilar atelectasis.No new pulmonary opacities identified.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: pneumonia, dissection History: chest pain Cardiomediastinal silhouette within normal limits. No pleural effusions or pneumothorax. No specific radiographic evidence of edema or infection.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: Eval effusions and Edema History: Hx of RV and LV Dysfunction S/P CABG TV and MV repair Cardiopulmonary monitoring and support devices are unchanged. Persistent large layering right effusion and smaller left pleural effusion with underlying pulmonary opacities suggestive of pulmonary edema/atelectasis, not significantly changed.

Output: Stable bilateral effusions and pulmonary edema/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: cough, fevers, sob History: cough fevers, sob. Minimal basilar subsegmental atelectasis/scarring.No focal consolidation, pleural effusion, or pneumothorax.Stable cardiomediastinal silhouette.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with metastatic pancreatic cancer. CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules are again noted. Referenced nodule in the lingula measures 13 x 8 mm on image number 56, series number 4.MEDIASTINUM AND HILA: Mediastinal and bilateral hilar adenopathy. Reference precarinal lymph node measures 14 x 14 mm image number 47, series number 3, not significantly changedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Large mass in the pancreatic body and tail measures 10 by 6.1 cm, slightly enlarged compared to previous study. This mass invades celiac trunks, splenic vein, SMA and extends into the mesentery. Multiple peripancreatic nodes. Gastric varices.ADRENAL GLANDS: Left adrenal gland is invaded by the mass. Right adrenal gland is unremarkable.KIDNEYS, URETERS: Bilateral cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites. Omental implants are unchanged. Reference omental nodule measures 12-mm in diameter image number 99, series number 3.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of fluid. Left common femoral lymph node measures 22 x 20 mm on image number 187, series number 3.

Output: Interval increase in the size of the pancreatic mass and left common femoral lymph node. Peritoneal carcinomatosis and chest metastases are unchanged.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with a subchondral (illegible), status post CRT and surgery. History of base of tongue cancer obtained on prior radiology requisitions. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules. Ground glass opacity of the right lung base may reflect aspiration of secretions.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left parapelvic cysts/extrarenal pelvis unchanged.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: G-tube in place. Nonspecific, mild and unchanged fat stranding in the left lower quadrant, unclear etiology.

Output: Stable examination with no evidence of metastatic disease to the chest or upper abdomen.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: r/o pna History: cough, sob The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process is identified.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: R/o pneumonia vs. Copd History: SOB, wheezing Cardiomegaly, with lower lung zone edema consistent with CHF.No specific evidence of infection.

Output: CHF with pulmonary edema. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 79-year-old female history of chondrosarcoma. METs to lung status post resection. MALT lymphoma of lung status post resection and adenocarcinoma status post resection. Evaluate for PD. Multi-nodules described. CHEST:LUNGS AND PLEURA: Postsurgical changes right upper lobe. There is a fibrosis redemonstrated.Referenced nodule left base 4.5 mm series 6 image 62.Referenced nodule medial aspect of the left base C6 image 73, 7 x 5.9 mm slightly increased.Pleural-based posterior costophrenic angle nodule in the left series 6 image 79, 13.8 x 8 mm. slightly increased.Other areas of fibrosis and a few micronodules are probably unchanged. Specifically micronodules seen in the right lower lobe series 6 image 44 which is unchanged from the prior exam series 4 image 42.MEDIASTINUM AND HILA: Thyroid nodules unchanged. Rim-like calcification in one of the right thyroid nodules is also unchanged.Postsurgical changes mediastinum. Small nodes. No new nodes. Hiatal hernia.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made. LIVER, BILIARY TRACT: Small hypoattenuating lesion inferior aspect of segment 6 unchanged measuring about 5.7 mm, series 5 image 89.Gallstones. No biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys with bilateral nonspecific lesions which are soft tissue are high density attenuation unchanged in size and appearance.RETROPERITONEUM, LYMPH NODES: Small shotty retroperitoneal nodes are unchanged. Atherosclerotic changes aorta no evidence of aneurysm. Small nodes in the peri-pancreatic and portacaval region are also unchanged.BOWEL, MESENTERY: Diverticulosis. No evidence of ascites or carcinomatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis.BONES, SOFT TISSUES: 329 no definite lytic or blastic disease. A few bone islands. Degenerative changes.OTHER: No significant abnormality noted.

Output: Given limitations no oral or IV contrast lesion measurements as above with no new sites of disease. Increase in size of some of the pulmonary nodules. Nonspecific hepatic and renal lesions are unchanged. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Chronic systolic congestive heart failure. Stable support devices.Bilateral small to moderate pleural effusions, left greater than right.Unchanged moderate cardiomegaly and mediastinal widening.

Output: Stable cardiopulmonary appearance with pleural effusions, left greater than right.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: eval lungs History: CHF, on IABP Progression of these opacities and small effusions. Line position is stable with no other change.

Output: Progression of basilar opacities and small effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Status post MVR. Small to moderate right pleural fluid collection. Very small right hydropneumothorax. Skin folds on the right.Left subclavian pacemaker and mitral prosthesis in place.

Output: Very small right hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: 79-year-old male status post multiple resections of left shoulder invasive squamous cell carcinoma. Patient now has positive axillary lymph node of left axilla. Metastatic squamous cell. Evaluate extent of disease and if any metastatic disease. The evaluation of solid abdominal organs is limited by the lack of IV contrast. Within this limitation, the following findings are noted.CHEST:LUNGS AND PLEURA: A suspicious nodule in the right lower lobe is seen, measuring 6.2mm x 2.4mm (Image 54, Series 5). Bilateral apical calcification are also noted, likely granulomas. Additionally, at the T8 -- T9 vertebral body level there is an irregular exophytic lesions with osteoid matrix with surrounding adjacent atelectasis. This likely represents an exophytic bony lesion such as exostoses over metastatic disease. MEDIASTINUM AND HILA: A few subcentimeter scattered lymph nodes are seen in the mediastinum. The largest node measures 0.8cm x 1.0cm (Image 40, Series 4). A few other nodes are calcified. Heart size is normal without pericardial effusion.CHEST WALL: An enlarged left axillary lymph node is noted. It measures 1.5 cm x 2.0 cm (image 39, series 4).ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: A few splenic granulomas are noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 0.9-cm calcification is noted within a calyx of the right kidney, likely a non obstructing renal calculus.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerosis of the aorta and its branches is seen.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerosis of the aorta and its branches is seen.

Output: 1. Right lower lobe nodule suspicious for metastatic disease.2. Heterogeneous exophytic lesions with osteoid matrix arising from the body of T8-T9 vertebral bodies; favor osteochondromas over metastatic disease. 3. Enlarged left axillary lymph node and nonspecific mediastinal adenopathy as described above. 4. Non-obstructing right renal calculus.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: eval lung fields History: s/p AVR Chest tubes removed with no pneumothorax.Unchanged basilar atelectasis and small pleural effusions.Low lung volumes.

Output: Chest tubes removed with no pneumothorax. Unchanged basilar atelectasis with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Cough evaluate for fluid versus infection. Cough S.O.B. Unchanged cardiomegaly. Postsurgical changes suggestive of CABG. Tortuous thoracic aorta unchanged.Chronic elevation of the right hemidiaphragm with associated compressive atelectasis at the lung base. Atelectatic or consolidated lung in the right posterior costophrenic angle unchanged from the most recent prior study but appears more pronounced compared to earlier radiographs.Mild pleural thickening bilaterally has been present since at least 2012 and appears unchanged.

Output: No acute change from the most recent previous examination of 4/29/2014. Consolidation in the right posterior costophrenic angle may represent chronic organizing pneumonia or scarring but is incompletely assessed. The possibility of chronic indolent atypical infection or indolent non-benign lesion is considered much less likely but the area can be further assessed with CT if further evaluation is required.


Instruction: Generate impression based on medical findings.

Input: 28-year-old female presents with productive cough with green sputum. Evaluate for pneumonia. The cardiomediastinal silhouette is normal. No focal pulmonary opacity suggestive of pneumonia. No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: r/o PNA History: CP, vomiting Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Balloon pump. Cardiomyopathy. IABP marker projects over the proximal descending thoracic aorta at approximately the T5/T6 vertebral level. Right jugular catheter and left subclavian ICD unchanged. No pneumothorax or focal pulmonary opacity.

Output: Unchanged position of IABP marker projecting over the proximal descending thoracic aorta.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Tachycardia, question of acute pulmonary process. POD 5 from cystectomy. Pneumoperitoneum, please refer to subsequently performed abdominal plain film.Postsurgical volume loss on the right and the pattern suggestive of middle lobectomy. Bilateral basal atelectasis. Dependent opacities elsewhere also most likely atelectatic lung. No pneumothorax. Small pleural effusions.

Output: Small pleural effusions. Pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male presents with dyspnea after surgery. A coronary stent is noted.The cardiomediastinal silhouette is normal. Bibasilar atelectasis, left greater than right. No pneumothorax. No right sided pleural effusion. Left-sided pleural effusion.Again seen is a lentiform homogenous opacity without air bronchograms adjacent to the left chest wall with smooth obtuse tapering borders, consistent with loculated left pleural fluid. This opacity has decreased in size since the prior radiograph.

Output: Interval decrease of loculated left pleural fluid. No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Asthma exacerbation evaluate for pneumonia. Unchanged crit mediastinal silhouette. No focal airspace opacities to suggest pneumonia. Mild basilar scarring.

Output: No specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: check position w/ ETT History: 4428 The endotracheal tube has been retracted from the right mainstem bronchus and is now positioned 2 cm superior to carina. Interval placement of a nasogastric tube with the side hole positioned inferior to the GE junction. Stable position right IJ Swan-Ganz catheter.Interval improved aeration of the left lung with residual left lower lobe atelectasis, small pleural effusion and consolidation. Right basilar opacities have increased, suggestive of atelectasis and small effusion. No pneumothorax. Persistent gaseous distention of the stomach.

Output: Improved aeration of the left lung following repositioning of the endotracheal tube. Nasogastric tube side hole is inferior to the GE junction.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: assess for change in pulmonary status History: dyspnea Right IJ central catheter is unchanged in position.Interval layering pleural effusions with retrocardiac atelectasis and consolidation.

Output: Progressive pleural effusions and opacities favoring edema. Interval retrocardiac consolidation and atelectasis suspicious for mucous plug.


Instruction: Generate impression based on medical findings.

Input: Reason: location of NG tube, mediastinal widening (known chronic aortic dissection) History: s/p TEE placement Ectatic aorta compatible with known chronic aortic dissection. Right jugular catheter extending to the right atrium. NG tube tip in the area of the gastric antrum.

Output: NG tube tip in the gastric antrum.


Instruction: Generate impression based on medical findings.

Input: Bladder cancer evaluate for metastatic disease. Thoracic kyphosis with degenerative changes of the spine.Large air and debris filled hiatal hernia obscures the paramediastinal lung parenchyma.The remainder of the lungs are without specific signs of metastatic disease or acute abnormality.

Output: No acute pulmonary abnormality. No visible signs of pulmonary metastases.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with B-cell lymphoma CHEST:LUNGS AND PLEURA: Calcified granulomas are unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter nonspecific hypodense lesions in the liver and benign hepatic cyst are unchanged. Cholelithiasis without evidence of cholecystitis or biliary dilatation is unchanged.SPLEEN: Stable mild splenomegaly.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Previously measured left external iliac low density lesions which represent lymph nodes have now coalesced together and slight lyincrease in size. Previously measured reference lymph node now measures 19 x 14 mm image number 197, series number 3, slightly enlarged compared to the study.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size of the left external iliac low density lesions which may represent enlarged lymph nodes or lymphoceles.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Pre-Op TRANSPLANT baseline assessment History: Pre-Op TRANSPLANT Chronic blunting left costophrenic angle and left base scarring. No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.

Output: Left lower lung zone pleural and parenchymal scarring, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Concern for pneumonia. The cardiac contours are within normal limits, considering technique.Assessment of the mediastinum is very limited in this single expiratory AP projection. There is asymmetric lobulation of the right hilum, considered indeterminate.Left basilar discoid atelectasis.No pleural effusion or pneumothorax.Mild thoracolumbar scoliosis

Output: Assessment of the cardiac mediastinum is very limited. Asymmetric lobulation of the right hilum may be artifactual given scoliosis, although an underlying space occupying lesion is difficult to exclude. Consider repeat PA and lateral chest radiograph or further assessment with chest CT, according to patient's history.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with non-Hodgkin lymphoma 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: Bilateral small ovarian cysts, not significant changed.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Evaluate status of firm right chest mass. There is a right chest wall heterogeneous mass within the subcutaneous tissue measuring 4.7 x 1.3 x 4.6 cm, previously 3.6 x 1.0 x 2.7 cm. There is peripheral and central internal vascularity.

Output: Increased size of right chest wall mass which contains internal vascularity. Neoplasm must be considered. This is amenable to ultrasound-guided biopsy.


Instruction: Generate impression based on medical findings.

Input: Reason: pna? History: altered mental status Moderate cardiomegaly. Basilar interstitial opacities compatible with subsegmental atelectasis or scarring.The differential diagnosis includes mild aspiration.No specific evidence of pneumonia.

Output: Nonspecific basilar interstitial opacities with atelectasis and scarring, possibly related to aspiration.Erect PA and lateral radiographs are recommended when feasible.


Instruction: Generate impression based on medical findings.

Input: Reason: NGT placed. Confirm placement in stomach. History: AS above. Unchanged marked distention of numerous loops of small bowel, similar to prior examination. There has been interval placement of enteric tube, tip terminating in the distal antrum of the stomach.

Output: 1. Interval placement of enteric tube terminating in the distal antrum.2. Unchanged marked dilation of numerous loops of small bowel again favoring ileus pattern, however obstruction cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: 75 year old with chronic renal insufficiency, question of hilar lymphadenopathy CHEST:LUNGS AND PLEURA: MEDIASTINUM AND HILA: There is no significant hilar or mediastinal lymphadenopathy.Nodule at mid body of thyroid gland 20 x 29 mm (10/111). Cyst in the left lobe of thyroid. The heart size is normal. The main pulmonary artery measures approximately 35 mm which is enlarged and can be seen in the presence of pulmonary arterial hypertension. CHEST WALL: Gynecomastia is present.UPPER ABDOMEN: The superior apex of an infrarenal IVC filter is observed. Evaluation of the upper abdominal viscera is limited without contrast. There is a metal linear density which may represent a surgical clip in the central upper abdomen of uncertain etiology.There is an ill-defined area of relative low density in the right hepatic lobe. On image 285/419, this measures approximately 26 Hounsfield units. The adjacent higher density parenchyma is approximately 56 Hounsfield units. Therefore, this represents fatty infiltration.

Output: 1. No mediastinal or hilar lymphadenopathy. 2. Fatty hepatic infiltration.3. Mild pulmonary artery enlargement.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Postop atelectasis, consolidation, line placement. Tubes and lines unchanged.Bilateral basal bronchiolitis pattern with patchy areas of atelectasis or developing consolidation, about the same. Subcutaneous emphysema on the right is improving. Trace 1 to 2 mm right apical pneumothorax.Unchanged cardiomegaly and enlargement of the central pulmonary vasculature.

Output: Bilateral basal bronchiolitis pattern with areas of atelectasis or consolidation suspicious for active infection. Trace 1 to 2 mm right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 87 yearsGender: FemaleReason for Study: Reason: ett check History: ett check ET tube with its tip 2 cm above the carina.NG tube with the tip beyond the margin of the image.Markedly decreased lung volumes with stable cardiomediastinal silhouette.Perihilar and basilar opacities compatible with atelectasis/edema.No new pulmonary opacities identified.

Output: ET tube in satisfactory position with its tip 2 cm above the carina. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with mesothelioma CHEST:LUNGS AND PLEURA: No suspicious lesions are identified. The previously described focus in the right midlung at the 4 clock position (series 5; image 43) has decreased in size and is consistent with atelectasis. No discrete pleural lesions are identified. Surgical clips are noted in the right costophrenic sulcus.MEDIASTINUM AND HILA: Calcified left hilar lymph nodesCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodensity at the dome of the liver with adjacent enhancing focus has not significantly changed (series 3; image 62).Cholecystectomy.SPLEEN: Calcified splenic granulomas.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Circumaortic left renal vein.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: At least partial omentectomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: HysterectomyBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of disease in the thorax.Subcentimeter hypodensity at the dome of the liver, too small to definitely characterize and not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Reason: 36 yoF w/ DLBCL, PE on anti-coag w/ SOB. Any infiltrate? History: Dyspnea Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Catheter tip in the SVC.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 37 year old female with metabolic acidosis. Evaluate for abscess, obstruction, ischemia, and pneumonia CHEST:LUNGS AND PLEURA: There are bilateral pleural effusions with associated compression atelectasis. An endotracheal tube is seen terminating above the carina. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense lesions measuring around 50 HU are seen throughout the liver cannot be completely evaluated due to lack of dedicated liver protocol. Sludge is noted in the gallbladder. There is no ductal dilatation, and the vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: There is heterogeneous enhancement of the pancreas with an are of focal hypoattenuation of the head and neck measuring 1.2 cm x 4.9 cm (image 89/204, series 4), suspicious for necrosis. There is adjacent fat stranding and free fluid. Fat plane between the head and duodenum is obscured. Additionally, there is narrowing at the portal vein confluence with thrombus in the splenic vein and superior mesenteric vein best seen on images 90 and 91/204, series 4.There is also attenuation of the celiac axis with thrombus seen in the splenic artery best seen on image 84/204, series 4. The branches of the splenic artery are narrowed around the region of suspected necrosis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Old scarring noted in inferior pole of right kidneyRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The duodenum is thickened with fat stranding and obscuring of the adjacent fat plane. Additionally, the jejunum and distal transverse colon, descending colon, sigmoid colon also appeared thickened, with adjacent fat stranding and free fluid. This appears secondary to pancreatitis. Cecum is distended with normal wall thickening. An NG tube terminates in the stomach.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Free fluid is noted anterior pararenal fascia and paracolic gutters bilaterally. There is mild perihepatic ascites and generalized anasarca. PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1. Hypoattenuation of the pancreatic head and neck, suspicious for necrosis with vascular compromise of the splenic artery and its branches to the pancreas, celiac axis at its origin, portal confluence, splenic vein and superior mesenteric vein. Peri pancreatic fat stranding and fluid, findings consistent with acute pancreatitis with area of necrosis.2. Wall thickening of the duodenum, jejunum, and distal colon, likely secondary to pancreatitis. However, given the significant vascular compromise described above ischemia cannot be excluded.3. Bilateral pleural effusions with associated atelectasis4. Multiple hypodense lesions throughout the liver, better evaluated with a dedicated liver protocol


Instruction: Generate impression based on medical findings.

Input: 44-year-old male status post esophagectomy, jejunal interposition with dysphagia CHEST:LUNGS AND PLEURA: Biapical emphysema unchanged from previous CT dated 2/2009. New, small, patchy groundglass opacities in the right upper lobe as seen on image number 32, series number 5, nonspecific may represent early pneumonia.A new 5-mm nodule in the right upper lobe on image number 34, series number 5 adjacent to the groundglass opacities. Further follow-up is recommended.MEDIASTINUM AND HILA: Postsurgical changes secondary to esophagectomy and jejunal interposition. Borderline enlarged lymph nodes near the esophageal hiatus under the diaphragm are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Punctate, hypodense liver lesions and mild intra-and extrahepatic biliary dilatation is unchanged from previous study.SPLEEN: No significant abnormality notedPANCREAS: Mildly dilated pancreatic duct is unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Two small to characterize hypodensities in the kidneys are unchanged.RETROPERITONEUM, 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: Posttraumatic changes in the left acetabulum, ileum and the pubic bone are reidentified.OTHER: No significant abnormality noted

Output: New small areas of patchy groundglass opacities, nonspecific. Early pneumonia cannot be excluded. Subcentimeter nodule in the region of these groundless opacities. Follow-up imaging is recommended. No other significant change from prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: post CV surgery, eval CT position / r/o effusion / pneumo History: as above Left chest tube with tip near the apex, with no pneumothorax.Minimal postop subsegmental atelectasis.Right jugular catheter, tip in SVC.

Output: Left chest tube with no pneumothorax or pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: chest pain with SOB, diaphoresis History: chest pain, SOB Small lung volumes with possible basilar subsegmental atelectasis, unchanged.Heart size normal.

Output: Small lung volumes with possible basilar subsegmental atelectasis, unchanged. No reliable evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Reason: evaluate for pneumonia History: cough, fever, shortness of breath Left lower lobe consolidation compatible with pneumonia.Cardiomediastinal silhouette is within normal limits. No pleural effusions or pneumothorax.

Output: Left lower lobe consolidation compatible with pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male 73 years old Reason: r/o infection Streaky basilar opacities, left greater than right, suggestive of atelectasis.No pleural effusion or pneumothorax.The heart size is normal.

Output: No specific evidence of infection. No significant interval change.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: SOB, desat to 71 History: sob Left basilar atelectasis and scarring.Elsewhere the lungs are unremarkable.Unremarkable mediastinal contours and cardiac silhouette.

Output: Persistent left basilar scarring or subsegmental atelectasis. No new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: hx of kidney cancer, evaluate for metastatic disease Unremarkable cardiomediastinal silhouette, unchanged.Mild unchanged chronic basilar subsegmental atelectasis/scarring without new focal opacities. No pneumothorax or pleural effusions.No suspicious pulmonary nodules or masses.

Output: No significant abnormalities or interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: Dizziness, neutropenia History: As above No significant cardiopulmonary abnormality.Right jugular catheter, tip at cavoatrial junction.

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


Instruction: Generate impression based on medical findings.

Input: Reason: s/p picc adjustment. History: s/p picc adjustment Catheter tip in the SVC.Feeding tube traversing the esophagus.Focal basilar opacities compatible with subsegmental atelectasis and scarring, unchanged.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: Assess for infection History: Febrile, rising white count Interval removal of endotracheal tube and enteric tube.Markedly low lung volumes as before.Left sided atelectasis and pleural effusion and Subsegmental atelectasis in right lower lobe lung base.

Output: No definitive evidence of pneumonia, though difficult to exclude in left lung base due to overlying atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Cough, evaluate lung fields. Mild cardiomegaly. Tortuosity of the thoracic aorta. No specific signs of pulmonary edema. Blunting of the posterior costophrenic angles is chronic. Retrocardiac atelectasis. Questionable faint opacity in the right upper lobe abutting the minor fissure, best seen on the lateral radiograph. Bronchial wall thickening and atelectasis in the lung bases. Mild thickening of the fissures.Possible 7 mm left apical nodule in projection of the left first rib. This was not present on patient's last chest CT scan dated 5/29/2013 or on previous plain films.

Output: 1. Possible new 7 mm left apical pulmonary nodule. Recommend follow-up erect PA and lateral chest radiographs to assess for clearance. If the abnormality persists at that time, then a thoracic CT may be recommended for further evaluation.2. Bronchial wall thickening and mild thickening of the fissures may be secondary signs of very mild interstitial edema in the absence of clinical signs of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: sob, esrd/chf with missed hemodialysis session Mild rightward patient rotation. No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Unchanged cardiomegaly.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: MaleReason for Study: Reason: eval for cp History: midsternal cp The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: eval pulm edema History: SOB, bradycardia Cardiomegaly.No specific evidence of infection or edema.Right jugular catheter tip at the RA level.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o cardiopulm process History: chest pain, fever Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 82-year-old male with lymphoma follow up restaging. Concern about right lung abnormality an outside chest x-ray. Any adenopathy or lung lesions. CHEST:LUNGS AND PLEURA: Along the lateral periphery of the right lung there is a broad area of dense focal scarring bronchiectasis and small cystic spaces consistent with prior inflammatory process.5.9-mm nodule pleural-based along the posterior aspect of the upper left chest as seen on series 4 image 38. Micronodules left upper lobe periphery series 4 image 45. No other nodules seen. No effusions.MEDIASTINUM AND HILA: Atherosclerotic changes aorta. No aneurysm. Heavy coronary artery calcification. No pathologic size nodes.CHEST WALL: No significant abnormality notedABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of IV contrast.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality noted .KIDNEYS, URETERS: Right upper pole renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Heavy calcification abdominal aorta. No evidence of aneurysm.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis. No evidence diverticulitis. No free or loculated fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Surgical clips correlate nature prior surgery.

Output: No pathologic-sized adenopathy. At least two micronodules left lung. Postinflammatory changes periphery right lung probably correspond to the abnormality on the chest x-ray as described in the requisition. Heavy atherosclerotic calcifications. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: eval for acute process History: sob, pain with inspiration s/p assault. The cardiomediastinal silhouette is normal. No pulmonary opacity, no pleural effusion, no pneumothorax.

Output: No acute cardiopulmonary disease. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: CT in place, patient s/p R VATS, decort, History: CT in place, assess for acute process Moderate right pleural effusion and underlying atelectasis. Persistent left lower lobe subsegmental atelectasis. Right chest tube in unchanged position. No significant pneumothorax. Moderate cardiomegaly.

Output: Moderate right pleural effusion and bibasilar atelectasis without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: assess for pna History: sob Heart size upper normal status post sternotomy.Nonspecific pulmonary opacities are unchanged suggestive of edema or aspiration.Right axillary vascular stent.

Output: Unchanged pulmonary opacities suggestive of edema or aspiration.


Instruction: Generate impression based on medical findings.

Input: Effusion Swan-Ganz remains in the right pulmonary outflow tract at the takeoff of the upper lobe. Underlying cardiopulmonary appearance is otherwise similar with a large layering left effusion and possible small right fluid collection. Right PICC line extends into the right atriumRetrocardiac opacity is also observed, likely atelectasis, however partial consolidation cannot be excluded

Output: Swan-Ganz unchanged


Instruction: Generate impression based on medical findings.

Input: Age: 50 yearsGender: FemaleReason for Study: Reason: POD #3 History: 6666 Left IJ venous catheter has been removed.Stable cardiomediastinal silhouette.Left retrocardiac consolidation/atelectasis and small pleural effusions similar in appearance to the prior exam.No new pulmonary opacities identified.

Output: Persistent left retrocardiac consolidation/atelectasis and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: eval for pulm source of infection History: none Normal cardiac and mediastinal silhouette.No focal airspace opacity, pleural effusions, or pneumothorax.

Output: No significant cardiopulmonary abnormalities. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 7-month-old male status post right chest tube removal, rule out pneumothorax.VIEW: Chest AP (one view) 1/16/2015 11:14 Right internal jugular central venous catheter tip is in the superior vena cava. Epicardial pacing leads unchanged. Interval removal of the right-sided chest tube.Cardiothymic silhouette is enlarged. Lucency at the level of the left costophrenic angle is nonspecific, but could represent a small loculated pneumothorax, not evident on the prior examination. Unchanged perihilar and right basilar opacity.

Output: Mild pulmonary edema is unchanged. Questionable small loculated left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male 62 years old Reason: worsening shortness of breath Motion limits sensitivity.Unchanged right middle lobe opacity and stable retrocardiac opacity suggest atelectasis/consolidation.Multifocal lung nodules and masses consistent with known metastatic disease.Diffuse interstitial opacities consistent with edema unchanged.Unchanged moderate bilateral pleural effusions.

Output: No significant interval change allowing for differences in technique.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, 71 years old.Reason: Intubated History: as above Unchanged basilar edema with right basilar atelectasis and pleural effusions.Heart size normal. ET tube tip approximately 4 cm above the carina.An NG tube extends below the lower margin of the image.Left PICC, tip in the SVC.

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


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: FemaleReason for Study: Reason: 52 yo with heart transplant with acute rejection History: swan Right IJ venous catheter and left IJ Swan-Ganz unchanged.Decreased lung volumes with stable cardiac enlargement.No new pulmonary opacities identified.No pleural effusions.

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: icu History: icu Moderate edema like opacities unchanged with pleural effusions.An NG tube traverses a gastric pull-up is been slightly advanced.Right jugular catheter, tip in SVC.ET tube tip 8 cm above the carina.

Output: Changed pulmonary opacities. High ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Check ETT position. ETT tip 2.5 seen above the level of the carina. Esophageal temperature probe remains in the cervical esophagus, directed laterally, possibly in the pyriform sinus. Enteric tube looped in the stomach with tip at the fundus.Lung volumes remain low. Slight improvement in basal atelectasis. No pneumothorax.

Output: ETT tip 2.5 cm above the carina. Temperature probe projects over the pyriform sinus.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with malignant neoplasm of large intestine CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Calcified right hilar lymph nodesCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific subcentimeter hypodensity near the dome of the liver, which is too small to accurate characterize. Another punctate hyperdensity is adjacent to the gallbladder, again too small to accurately characterize.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: Borderline enlarged retroperitoneal lymph nodes.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: 9-mm lymph node at the aortic bifurcation on image number 143, series number 3.BOWEL, MESENTERY: Sigmoid wall thickening. Correlation with endoscopy is recommended.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Borderline enlarged retroperitoneal lymph nodes. Sigmoid colonic wall thickening.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: rule out effusion vs pneumonia History: pain and dyspnea No substantial change in bibasilar pleural-parenchymal opacities. Pleural effusions again noted. Unchanged heart size. No pneumothorax.

Output: No substantial change in bibasilar pleural-parenchymal opacities. Pleural effusions again noted.


Instruction: Generate impression based on medical findings.

Input: Female 34 years old Reason: Vomiting and chest pain History: vomiting and chest pain Cardiomediastinal silhouette is unremarkable. No focal airspace opacity, pleural effusion or pneumothorax.

Output: No acute abnormalities or significant interval change. No pneumomediastinum.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: PICC placement. The cardiomediastinal silhouette is normal. The left PICC tip terminates overlying the cavoatrial junction. The enteric tube courses below the diaphragm. No focal opacity, pleural effusion or pneumothorax.

Output: The left PICC tip terminates overlying the cavoatrial junction. A new enteric tube courses below the diaphragm.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female presents with cough, shortness of breath, and right-sided crackles. Evaluate for pneumonia. Surgical clips project over the right chest wall, mediastinum, and upper abdomen.The cardiomediastinal silhouette is normal. Poorly defined opacity in the right lower lobe in the lung consistent with pneumonia. No pleural effusion or pneumothorax.

Output: Right lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: Evaluate for cardiopulmonary disease. History: fever The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: eval for infiltrate History: left arm numbness Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: eval fx, pneumo/hemo. fall History: chest pain Lower zone opacities are chronic, better characterized on previous CT examinations. No pneumothorax or displaced rib fracture. Multilevel thoracic osteophytes.

Output: No displaced rib fracture or pneumothorax. Lower zone opacities better characterized on cross-sectional imaging, chronic.


Instruction: Generate impression based on medical findings.

Input: Cough Persistent mild nonspecific cardiomegaly exaggerated by supine portable technique. No definite distinct superimposed additional airspace abnormality within this limited evaluation, however mild early edema cannot entirely be excluded.

Output: Questionable early CHF which may be artifact. Consider serial imaging to confirm


Instruction: Generate impression based on medical findings.

Input: 48-year-old female with history of ovarian cancer CHEST:LUNGS AND PLEURA: Large right-sided pleural effusion has slightly increased in size compared to previous CT. New area of consolidation in the right middle lobe may be secondary to infection, however, if there is any history of radiation to the right breast area these changes may also be reflecting postradiation changes. Nodularity along the fissures of the right lung has not significantly changed. The pendent atelectasis in the right lower lung. No nodules in the left lung.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Lobulated high attenuation mass in the right pectoralis muscle measures 3.5 x 2.7 cm on image number 43, series number 6, slightly smaller compared to previous study. Other small high attenuation nodules along the pectoralis major muscle on the right have minimally increased in size. A reference nodule on image number 53, series number 6 now measures 13 by 12-mm where it was measuring 9 x 7 minutes on image number 53, series number 4 on the previous study.Subcutaneous nodule in the midline on image number 79, series number 6 is also slightly increased in size.ABDOMEN:LIVER, BILIARY TRACT: Hypodense lesion in the lateral segment of the left lobe is unchanged measuring 15 x 13 mm image number 94, series number 4. Second hypodense lesion in the right lobe measures 15 x 12 minutes on image number 95, series number 6, not significantly changed.Again seen additional peripheral calcified lesions on the surface of the liver, not significantly changed. Calcified implants along the gallbladder fossa are also unchanged.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: Stable cardiophrenic lymph nodes.BOWEL, MESENTERY: This is a hernia to the right of the midline containing nonobstructive bowel loops is unchanged.BONES, SOFT TISSUES: Multiple subcutaneous nodules throughout the anterior abdominal wall consistent with metastatic disease. Reference lesion along the incision has significantly increased measuring 17 x 13 mm image number 115, series number 6. Other subcutaneous nodule or metastatic lesions also slightly increased in sizeOTHER: Small amount of ascites.PELVIS:UTERUS, ADNEXA: Surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: Calcified right external iliac lymph node measures 5.7 x 2.8 cm on 153, series number 6, not significantly changed.BOWEL, MESENTERY: Irregularly shaped calcified lesion in the pelvis measures 4 x 2.8 cm on image number one and 68 on series number 6, not significantly changed. Other smaller calcified implants are are also stable. Index lesion in the left lower quadrant is difficult to measure but grossly unchanged measuring 3.5 x 1 cm on image number 162, series number 6.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval no increase in the size of the large right pleural effusion with new consolidation in the right middle lobe which represent pneumonia or postradiation changes.Large right chest wall mass is stable, however, small chest wall and abdominal wall metastatic nodes are slightly increased in size.Intra-abdominal and pelvic lesions representing peritoneal carcinomatosis are grossly stable.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: rule out pneumonia due to persistent cough and fevers History: fever, cough, CHF Unremarkable cardiomediastinal silhouette. Mild bibasilar atelectasis/scarring. No pleural effusion or pneumothorax. Atherosclerotic calcifications affect the aortic arch.

Output: No acute cardiopulmonary abnormality. Stable exam. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female 54 years old Reason: neutropenic stem cell transplant patient with first neutropenic fever History: History of stem cell transplant. Left subclavian central venous catheter and right internal jugular central venous catheter terminate in the SVC.Cardiomediastinal silhouette is within normal limits and unchanged.No focal opacity, pneumothorax, or significant pleural effusion.

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


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Nausea and vomiting. Cardiac size within normal limits. No focal airspace opacity, pleural effusion, or pneumothorax. There is mild elevation of the right hemidiaphragm with possible scarring. Surgical clips project over the right mediastinum, compatible with known history of gastric pull up. Surgical clip projects over the left upper quadrant. Degenerative changes in the lumbar spine with vertebral body height loss at multiple levels.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Pneumonia assess for worsening opacity. Increase in density at anterior right upper lobe opacity, though it remains similar in size. Normal heart size.

Output: Focal right upper lobe opacity increased in density but not size.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: r/o PNA History: SOB, fever No acute cardiopulmonary abnormality.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Liver mass, nighttime fevers with night sweats for 3 days, assess for infection. Low normal lung volumes with unchanged mild elevation of the right hemidiaphragm. No pneumothorax or pleural fluid. No signs of mediastinal or hilar lymphadenopathy. No focal pulmonary opacities. Normal heart size.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Status post posterior chest tube removal Interval removal of the left chest tubes. Trace, 2 millimeter left apical pneumothorax and minimal air lucency in the left costophrenic sulcus. There is opacity at the left base along the chest tube tract which may be fluid or blood products within the tract. Minimal subcutaneous emphysema. Small lung volumes. Small right pleural effusion. Small bibasal, left greater than right, patchy opacities, unchanged.

Output: Interval removal of the left chest tubes. Small left pneumothorax. Fluid or hematoma in the left chest tube tract.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, 69 years old.Heart failure, evaluate effusion. Large right and small left pleural fluid collections about the same. Hazy opacity on the left suggestive of dependent atelectasis, possibly the result of aspirated secretions.Sternotomy hardware.

Output: No acute change in large right and small left pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: intubated/sedated History: above NG tube tip in stomach. ET tube tip 4 cm above carina. Venous catheter tip in SVC. Left PICC tip in left axillary/subclavian vein.Stable diffuse interstitial opacities with a small left pleural effusion unchanged.

Output: Stable diffuse interstitial opacities with a small left pleural effusion unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Acute respiratory failure, evaluate ET tube. Endotracheal tube tip 6-cm above the level of the carina. The proximal portion of the Dobbhoff tube is looped in the hypopharynx.Right jugular catheter unchanged in position.Diffuse edema and atelectasis with layering effusions slightly worse.

Output: Slight worsening of edema and atelectasis. Dobbhoff tube proximal portion looped in the hypopharynx. ETT 6-cm above carina.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: aspiration? History: as above Cardiac silhouette is enlarged. Bilateral interstitial and airspace opacities most suggestive of edema. An element of bibasilar atelectasis and small pleural effusions suspected.An electronic device overlies the patient's right upper quadrant.

Output: Cardiomegaly with bilateral pulmonary opacities most suggestive of edema pattern with element of bibasilar atelectasis. Underlying superimposed pneumonic consolidation/aspiration remain possible.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: line placement. Exchanged RIJ over a wire History: MICU Endotracheal tube terminates 4.2 cm from the carina. Right IJ line terminates at the cavoatrial junction. Enteric tube extends inferiorly off the field-of-view. Left basilar subsegmental atelectasis or scarring again noted. No new focal opacity. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pneumonia and asthma changes +smoker History: cough productive of brown sputum, chest tightness,+ wheezes, diminished at bases Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with known metastatic colon cancer; baseline study prior to starting treatment CHEST:LUNGS AND PLEURA: Interval resolution of previously seen bilateral pleural effusions. Nonspecific micronodule in the superior segment of the left lower lobe (series 4, image 49) is of indeterminate significance.MEDIASTINUM AND HILA: Stable mediastinal and hilar lymphadenopathy. Previously referenced right hilar adenopathy measures 2.8 x 1.2 cm (series 3, image 42), unchanged; a pretracheal node measures 1.9 x 1.2 cm (series 3, image 36) and is also unchanged.CHEST WALL: Left ICD device with multiple leads is reidentified. Right Port-A-Cath. Previously seen sclerotic appearance to the T3 vertebral body appears similar to prior study. ABDOMEN:LIVER, BILIARY TRACT: There has been interval increase in the size of the previously seen bilobar metastatic lesions; for reference, the segment 5 lesion on series 3, image 120 measures 3.8 x 3.6 cm.The portal vasculature remains patent, and there is no evidence of biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable appearing left renal cystRETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcification and mural thrombus formation throughout the abdominal aorta as seen previouslyBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: The prostate remains enlarged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously seen soft tissue nodule is again seen on series 3, image 155 and measures 1.5 x 0.9 cm (stable).Stable SI joint ankylosis.

Output: 1. Interval progression of bilobar hepatic metastases as above2. Interval resolution of bilateral pleural effusions with a nonspecific micronodule seen in the superior segment of the left lower lobe


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: Evidence of multifocal infiltrates to suggest disseminated mycobacterial or fungal infection History: H/o heart transplant and exposure to Mycobacterium, admitted w/ scattered skin lesions and L elbow wound Normal heart size. Blunting of the right costophrenic sulcus may reflect a minimal amount of pleural fluid or scarring. The lungs are clear; no nodules, masses or airspace opacities are appreciated. Postsurgical changes of a median sternotomy and surgical clips in the right axilla.There appears to be some soft tissue thickening along the undersurface of the right clavicle, similar to most recent prior study and not reported to be FDG avid on PET scan, correlate with physical exam.

Output: No acute cardiopulmonary abnormality. Apparent chronic right subclavicular soft tissue swelling, correlate with physical exam.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.ETT placement. Right mainstem bronchus intubation.Right hemithorax volume loss with elevation of the right hemidiaphragm due to atelectasis.The right lower lobe airspace opacities persist.Cardiomegaly and enlargement of the central pulmonary vasculature, consistent with pulmonary hypertension.Nonspecific retrocardiac opacity which may reflect atelectasis.

Output: Right mainstem bronchus intubation.