Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: s/p ICD History: s/p ICD Nonspecific nodular interstitial opacities are present, suggestive of edema.Left subclavian single chamber ICD, with no pneumothorax.

Output: Nodular interstitial opacities are suggestive of edema, without evidence of infection. Uncomplicated ICD placement with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: eval cause of hypoxemia History: heart transplant Iatrogenic devices are unchanged.. Improvement in pulmonary edema and bibasilar opacities. Unchanged cardiomegaly. No pneumothorax.

Output: Improvement in pulmonary edema and bibasilar opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: cxr prior to bronchoscopy/bal History: sob Normal heart size with a focal fluid collection adjacent to the right cardiac border as previously demonstrated by CT scan which may represent a seroma or loculated pleural effusion.Small lung volumes with streaky opacities on the right consistent with scarring.Subpleural consolidation which was present previously possibly secondary to pulmonary infarcts, has resolved.

Output: Right pericardiac fluid collection and right basilar scarring, with interval resolution of subpleural consolidation.


Instruction: Generate impression based on medical findings.

Input: 63 years old Female. Reason: sob History: sob. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Cough LVAD and ICD are unchanged. Mild nonspecific cardiomegaly. Persistent mild basilar scarring and/or atelectasis also similar to prior studies and without superimposed new acute cardiopulmonary abnormality. No effusions.

Output: Cardiomegaly without superimposed new acute disease


Instruction: Generate impression based on medical findings.

Input: Seizures and ICD battery is ending No cardiopulmonary abnormality. A residual ICD generator is projected over the left chest wall at the level of the hemidiaphragm with questionable soft tissue swelling and stranding of the subcutaneous fat. A single faint lead or wire extends in the soft tissues towards the axilla without apparent extension into the vascular system. Please correlate with physical exam for possible infection considering these images may be exaggerated due to motion and technique

Output: No cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: chest pain History: chest pain Port catheter terminates in the RA, as before. No new focal pleural parenchymal opacity. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: CHF History: CHF Small lung volumes with bilateral nonspecific opacity compatible with edema, atelectasis and effusions.Catheter tip in the SVC.

Output: Findings compatible with CHF, with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Swan-Ganz placement. Cardiomegaly with small pleural effusions, right greater than left, as well as mild basilar interstitial abnormality suggesting edema are all stable to slightly improved. Right jugular Swan-Ganz catheter tip in the interlobar pulmonary artery. Cardiac pacer again noted. No pneumothorax.

Output: Mild CHF pattern slightly improved. Swan-Ganz catheter tip in the interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Age: 41 yearsGender: MaleReason for Study: Reason: cp History: cp The cardiomediastinal silhouette is unremarkable.Mild bronchial wall thickening.No focal areas of consolidation.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: infitrate, IABP placement History: advanced heart failure Cardiomegaly with dextrocardia and situs inversus.No specific evidence of infection or edema.IABP proximal marker 4 cm below the top of the aortic arch, slightly advanced.

Output: IABP marker 4 cm below the top of the aortic arch, slightly advanced.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: assess for pulmonary edema History: SOB, CP Mild cardiomegaly with mild basilar edema or atelectasis. No significant pleural effusions. Linear scarring or atelectasis at right lung base. Calcified granulomas.

Output: Mild cardiomegaly with mild basilar edema or atelectasis. No significant pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: eval of lung fields History: postop cardiac surg patient Cervical immobilization hardware is again visualized. Endotracheal tube has been placed which terminates 4 cm above the carina. Interval placement of left IJ Swan-Ganz catheter that terminates in the distal right pulmonary artery. Postoperative subxiphoid mediastinal drains and bilateral chest tubes are in place.Mild, left greater than right, postoperative edema with basilar atelectasis and small pleural effusions. No pneumothorax.

Output: Postoperative mild edema with small pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: r/o lung path History: chest tightness more than 2 weeks Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Mild scoliosis and pectus excavatum deformity.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: pulmonary edema, cardiomegaly History: lightheadedness, shortness of breath, pericardial effusion Stable cardiac mediastinal silhouette.Slightly increased inspiration compared to the prior exam.Small pleural effusions similar to the prior exam.No new pulmonary opacities identified.Pericardial drain has been removed.

Output: Cardiomegaly with mild basilar atelectasis and small effusions. No specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: MaleReason for Study: Reason: temp History: temp Right IJ venous catheter unchanged.Stable cardiomediastinal silhouette.Interval improvement in patchy airspace opacities in the right lung.No new pulmonary opacities identified.No pleural effusions.

Output: Interval improvement in the ill-defined patchy pulmonary opacities in the right lung. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 70-year-old female with abdominal pain and diarrhea. Evaluate for cardiopulmonary disease. Enlargement of the central pulmonary vasculature, unchanged.Redemonstration of blunting of the left costophrenic angle, likely secondary to scarring and unchanged when compared to the prior.Mildly increased pulmonary interstitial opacities likely chronic.Right upper quadrant surgical clips are noted.

Output: No specific signs of mild edema. Signs of pulmonary hypertension, possible secondary to mitral valve disease.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Recent pneumonia with right-sided chest pain. Basal air space opacities, left greater than right, not significantly changed. Normal heart size. No pneumothorax.

Output: Persistent basal air space opacities. Recommend follow-up PA and lateral chest radiographs 6 weeks from date of presentation (on or near 2/17/2015). If the abnormalities persist upon follow-up, CT will be recommended to exclude non-infectious etiology in the adult patient. ED notified of recommendation via STAT consult.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with history of cervical cancer CHEST:LUNGS AND PLEURA: Bilateral, scattered small nodules are unchanged.MEDIASTINUM AND HILA: Enlarged left lobe of the thyroid gland extending into the mediastinum is unchanged.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: Left renal cysts unchanged.RETROPERITONEUM, LYMPH NODES: Index right pericaval lymph node measures 8 by 7-mm image number 127, series number 3, significantly changed from previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Endometrial cavity is again dilated. There is an enhancing lesion within the endometrial cavity which may represent cancer versus a submucosal fibroid. Left ovary is again slightly enlarged, not significantly changed from previous study. Right ovary is unremarkable.Possible small thrombi within the right ovarian vein.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. Heterogeneous uterus with an enlarged ill-defined left ovary is grossly stable.Small filling defects within the right ovarian vein representing small thrombi.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: evalute lung fields, lines History: IABP Balloon pump marker unchanged at the level of aortic arch. Swan-Ganz catheter tip in right pulmonary artery.Lower lung zone edema and pleural effusions, stable.

Output: Balloon pump marker unchanged at the level of aortic arch.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: concern for pulm edema History: shortness of breath, inc O2 requirement Continued worsening of acute severe pulmonary edema, with enlarging pleural effusions.Heart size upper normal. Right jugular catheter, tip in SVC.Gastrostomy tube.Left upper quadrant drainage catheter.

Output: Worsening CHF with enlarging pleural effusions and edema.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: 55F new admit to MICU with AMS and acute liver/renal failure requiring RIJ Trialysis catheter for CVVHD and NGT for lactulose, ?line placements History: 55F new admit to MICU with AMS and acute liver/renal failure requiring RIJ Trialysis catheter for CVVHD and NGT for lactulose, ?line placements Right port remains unchanged with redundancy at the right axilla. Interval placement of a right IJ central catheter terminating at the level of the azygos vein. Nasogastric tube terminates inferior to the caudal margin of the image.Interval decreased lung volumes. No pneumothorax, edema or pneumonia. Heart size is normal.

Output: Successful placement of a nasogastric tube and right IJ central catheter.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Acute and chronic respiratory failure. ETT advancement. Right chest port tip at the SVC. Right perihilar opacity suggestive of radiation reaction. Bronchial wall thickening and patchy endobronchial opacity in the right lung unchanged. Elevation of the right hemidiaphragm, unchanged. Enteric tube tip in the caudal margin of the film. Endotracheal tube tip difficult to visualize but approximately 3 cm above the level of the carina.

Output: ETT tip roughly 3 cm above the carina but difficult to visualize.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: fluid overload History: dyspnea Stable position of left dual-lumen port catheter. The terminal portions of several catheters are visualized in the right upper abdomen.Increasing airspace opacities in both lungs, predominantly in a program referral and lower zone distribution. Associated small pleural effusions are stable. Heart size is normal

Output: Progressive airspace and interstitial opacities suspicious for edema with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: MaleReason for Study: Reason: r/o pulmonary process History: respiratory failure Significantly decreased lung volumes with nonspecific pulmonary opacity similar to the prior exam.No new pulmonary opacities identified.Stable cardiac enlargement..

Output: Stable cardiopulmonary appearance with significantly decreased lung volumes, cardiomegaly, and nonspecific pulmonary opacities which may represent edema.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: LVAD placement Stable appearance of support devices.Stable cardiomegaly.Improving pulmonary edema with small residual right pleural effusion.

Output: Improving pulmonary edema. LVAD unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: SOB History: SOB Mild interstitial pulmonary edema with small pleural effusions and persistent mild cardiomegaly. No pneumothorax.

Output: Congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: hypoxiaVIEW: Chest AP ET tube tip at the thoracic inlet. The feeding tube courses into the stomach. There are two right and three left chest tubes as well as a right pleural pigtail catheter, all of which are unchanged in position. A left upper extremity PICC tip is in the SVC. A pericardial drain is in place. Moderate right pneumothorax. Multifocal pulmonary opacities and pneumatoceles/cavities, are unchanged. The cardiac silhouette cannot be evaluated. Bilateral subcutaneous emphysema at the neck and chest walls again noted.

Output: Moderate right pneumothorax with multifocal pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: T2N0 SCC esophagus s/p laparoscopic Ivor Lewis esophagectomy complicated with hiatal hernia and hernia repair (6/11) History: none Gastric interposition extending to the right of the mediastinum.Blunting of the right costophrenic angle consistent with residual pleural effusion.Interval clearing of a left effusion.Large lung volumes with no acute abnormalities.

Output: Small residual right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: History of CHF. Lower extremity edema and crackles on exam Mildly improving aeration with improved volumes and mild basilar changes suggesting atelectasis and/or scarring, however minimal more acute process such as aspiration or even very early edema with small effusions cannot entirely be excluded. Mild cardiomegaly. Moderate tortuosity of the aorta with atherosclerotic disease. Midline sternotomy

Output: Intimal atelectasis, however very early edema cannot entirely be excluded. Serial imaging may be indicated given patient history and appearance


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: FemaleReason for Study: Reason: et tube History: et tube Support devices unchanged.Diffuse pulmonary opacities similar in appearance to prior exam.No new opacities noted.

Output: Support devices unchanged. Stable cardiopulmonary appearance with diffuse pulmonary opacities compatible with ARDS.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Intubated. Shortness of breath. Interval development of airspace opacities in the right middle and lower lobes. Moderate to large volume of loculated pleural fluid on the right is also new.Large right upper lobe bulla. Endotracheal tube tip 6 cm above the level of the carina. NGT can be followed to the stomach. Mild atelectasis on the left.Apparent mediastinal widening could be the result of slight decrease in lung volumes and differences in patient position and may be monitored on subsequent films.

Output: New airspace opacities and loculated pleural fluid in the right lung suspicious for aspiration or infection. Apparent mediastinal widening of unclear clinical significance, most likely artifactual. Follow-up to resolution suggested.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Chest pain question pneumonia or pleural effusions. Unremarkable cardiomediastinal silhouette. No focal airspace opacities, pleural fluid or pneumothorax.Mild degenerative changes of the mid thoracic spine with subtle vertebral body height and intervertebral space loss, unchanged.Tiny focal calcification in the right neck incompletely visualized but may reflect atherosclerotic calcification in the carotid vasculature.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: cough, sob History: cough, sob Cardiac size is upper normal. No focal pulmonary opacity, pneumothorax, or large pleural effusions. Central pulmonary vasculature appears prominent which could indicate pulmonary hypertension.

Output: No acute cardiopulmonary abnormalities. Prominent central pulmonary vasculature could indicate pulmonary hypertension.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, 49 years old.Reason: S/P MVR, rheumatic mitral valve disease Status post median sternotomy and mitral valve replacement. Epicardial pacer wires in the mediastinum. Mild residual right basilar subsegmental atelectasis, with marked interval improvement. No pleural effusion or pneumothorax. The heart size is normal.

Output: Mild residual right basilar subsegmental atelectasis with marked interval improvement.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: line placement History: R IJ Right jugular catheter tip at RA/SVC junction. No evidence of pneumothorax. Other findings stable.

Output: Right jugular catheter tip at RA/SVC junction. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: s/p OHT, annual exam History: s/p OHT, annual exam Median sternotomy.Heart size normal.Mild perihilar bronchial wall thickening.No other significant abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: r/o pna History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Cough and neutropenic fever Interval improving lung volumes with clearance of the nonspecific and more diffuse interstitial and airspace abnormality, however the focal airspace opacity adjacent to the right minor fissure remains. Concern for a focal underlying pneumonia and or nodular mass again cannot entirely be excluded. This finding correlates with the CT abnormality described on 10/4/2015 and associated with a persistent small right effusion.The cardiac and mediastinal contours remain within limits. Right jugular PICC line removed

Output: Improved overall aeration with persistent focal opacity in the right middle lobe adjacent to the minor fissure again concerning for atypical infection given the patient's history.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: Sensation of mucous in the throat, frequent throat clearing. ? Pulmonary source. History: As above Subsegmental scarring at the left apex. Lungs are otherwise clear. No pleural effusion or pneumothorax. Normal heart size. No acute bony abnormality.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Left-sided chest pain. The cardiomediastinal silhouette is normal. There is no pleural effusion, pneumothorax, or abnormal pulmonary opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 48 year-old female with 4-cm splenic lesion, left lower lobe infiltrate, recent sepsis. AML refractory to treatment. Flank pain, cough. CHEST:LUNGS AND PLEURA: Moderate emphysematous changes remain. Bilateral groundglass opacities have developed, greatest centrally.Infiltrate in the left base is most likely due to atelectasis, not significantly changed from 5/25/10. Right basilar atelectasis persists. Small bilateral pleural effusions remain, left greater than rightMEDIASTINUM AND HILA: Small mediastinal lymph nodes remain. Atrophic right lobe of the thyroid glandCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged. Numerous small hypodensities are identified in the right lobe of the liver, most located posteriorly. Some of these lesions are clustered.SPLEEN: Hypodense splenic lesion with a few septations has increased in size, measuring 7.6 x 5.0 cm, suggestive of abscess. It now demonstrates decreased densityPANCREAS: 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: Trace ascitesPELVIS:UTERUS, ADNEXA: Uterine lesion is compatible with a fibroidBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace ascites

Output: Splenic lesion, increasing in size, likely representing abscess.Numerous small hypodensities developed in the right lobe of the liver, likely representing abscesses, though leukemic infiltrate is also possible.Development of groundglass opacities throughout both lungs, which may represent edema or drug reaction.


Instruction: Generate impression based on medical findings.

Input: Reason: 62 yo M s/p liver surgery, intubated History: eval lines and ETT ET tube tip approximately 5 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery. Small lung volumes with mild basilar opacity compatible with effusions and atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: assess lungs preoperatively, periprosthetic fracture around right hip joint. Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Surgical clips noted in the left axilla. Status post left breast surgery.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.ET tube placement ET tube tip approximately 2-3 cm above the carina. NG tube tip in the distal stomach. Vascular coils and pigtail catheter project over the left upper abdominal quadrant.Layering large left pleural effusion with underlying left basilar atelectasis, not significant changed.Cardiomegaly.

Output: ET tube tip 2-3 cm above the carina. Otherwise no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: hx acute chest p/w cp History: above Basilar reticulation, unchanged. No pleural effusion or pneumothorax. No acute bony abnormality. Mild cardiomegaly, as before. Enlarged central pulmonary arteries again noted.

Output: No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with history of gastric cancer status post gastrectomy. CHEST:LUNGS AND PLEURA: Ill-defined, 1 cm focal consolidation in the superior segment of the right lower lobe (series 5, image 39), which may represent scarring versus treated metastatic lesion. No prior imaging is available for comparison.Linear bibasilar scarring/atelectasis. Mild centrilobular emphysema, predominantly upper lobe.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Left chest Port-A-Cath with catheter tip in right atrium. ABDOMEN:LIVER, BILIARY TRACT: Ill-defined, hypoattenuating lesion in posterior segment of the right hepatic lobe (series 4, image 96), measuring 2.3 x 1.9 cm; consistent with a metastatic focus.Intrahepatic and extrahepatic biliary ductal dilatation; the common duct is dilated approximately 8 mm with acute tapered narrowing (series 80360, coronal image 60) within an ill-defined area of soft tissue density. Patient's surgical history at this location is unknown upon discussion with the clinical service, and therefore we cannot differentiate between a postsurgical etiology versus an obstructive lesion at this location.The main portal vein is not identified and appears to be thrombosed with cavernous transformation of the collateral vessels. The splenic vein and the SMV also appear to be thrombosed within the aforementioned ill-defined soft tissue density near the region of the pancreatic head. Multiple collateral varices are seen in this area as well, some of which are thrombosed.SPLEEN: Patient status post splenectomy per clinical service. A hypertrophied accessory spleen is seen (series 4, image 92).PANCREAS: Vague soft tissue density adjacent to the pancreatic head as mentioned above. Significance is unclear due to lack of detailed surgical history.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Significant renal scarring on the left with minimal on the right, likely from prior resolved infections.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Patient status post gastrectomy and esophagojejunostomy. Note is made periduodenal varices.BONES, SOFT TISSUES: No significant abnormality noted.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: Surgical clips in left hemipelvis of uncertain etiology.

Output: 1. Ill-defined lesion in right hepatic lobe as above consistent with metastatic disease.2. Acute tapered narrowing of the common bile duct within an ill-defined region of soft tissue density at the level of the pancreatic head with upstream biliary ductal dilatation. Given the lack of details regarding patient's prior surgery, postsurgical etiology versus an obstructing lesion at this location are both possible considerations. Additionally, multiple varices are seen in the region of the soft tissue density as described above.3. Thrombosis of the main portal vein with cavernous transformation of the collateral vessels.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Patient presented with chest pain. Cardiac size is mildly enlarged. No focal airspace opacities, pleural effusion, or pneumothorax are identified.

Output: Mild cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: recurrent pneumonia History: cough and fever Iatrogenic devices are unchanged. Low lung volumes makes detailed cardiopulmonary assessment difficult. Basilar pleuroparenchymal opacities, not substantially changed. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Normal heart size and large hiatal hernia, unchanged.No significant pulmonary abnormalities.Prominent vertebral spurring in the lower thoracic spine creating a nodular opacity over the spine on the lateral view.

Output: No sign of metastatic disease and no significant change.


Instruction: Generate impression based on medical findings.

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

Output: Stable exam from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: cardiac History: presyncope Normal heart size with tortuous, ectatic thoracic aorta.Stable bibasilar scarlike opacities.No pleural effusion or pneumothorax.Scoliosis of the thoracic spine.

Output: Ectatic, tortuous thoracic aorta. Otherwise no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: S/P pig tail placement History: pigtail placement New right basilar pigtail drain is noted. Other lines and tubes, unchanged. Improvement in right pleural effusion. No significant pneumothorax. Probable atelectasis at the left lung base again noted. Query mild pulmonary edema. Unchanged heart size.

Output: New right basilar pigtail drain is noted. Other lines and tubes, unchanged. Improvement in right pleural effusion. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: assess lines History: hypotensive on inotropes Intra-aortic balloon pump has been repositioned slightly. Metallic marker now terminates 1.9 cm from the top the aortic arch. Swan-Ganz catheter has been pulled back terminating in the distal aspect the right pulmonary artery. Unchanged cardiac lead. Mild interstitial pulmonary edema. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Intra-aortic balloon pump has been repositioned slightly. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: s/p BL lung transplant History: hypoxia Bilateral hydropneumothorax, now with the majority of the fluid component on the right in the upper chest, presumably related to patient positioning. Stable pulmonary edema. Enteric tube extends beyond the field-of-view of study.

Output: Bilateral hydropneumothorax, now with the majority of the fluid component on the right in the upper chest, presumably related to patient positioning. Stable pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: s/p left thora, r/o PTX History: cough No pneumothorax.Right chest port unchanged in position.Small pleural effusions with increase in basal atelectasis.

Output: Increased basal atelectasis, no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: MaleReason for Study: Reason: s/p bronch, left pleurectomy and decortication for biphasic mesotheiloma, 80% sarcomatoid, 20% epitheiloid History: leg swelling, incisional swelling Left-sided chest tube has been removed.Persistent left hydropneumothorax with a large collections of subcutaneous air along the left lateral chest wall which have multiple air-fluid levels.Stable cardiac mediastinal silhouette.The right lung is clear.

Output: Interval removal of a left-sided chest tube with increasing left hydropneumothorax. Large collections of air with air fluid levels are noted in the left chest wall possibly representing lung and/or bowel herniation or even abscess formation. Recommend CT of the chest for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old, hypotensive and desaturating. Evaluate for pulmonary embolus. PULMONARY ARTERIES: Suboptimal examination secondary to poor contrast opacification and motion. No large central PE is seen. Nondiagnostic beyond the segmental level.LUNGS AND PLEURA: Dense right lower lobe consolidation with patchy right upper lung groundglass centrilobular nodules most likely represents aspiration given the presence of fluid within the trachea and right lower lobe bronchi. A superimposed infectious process, however, cannot be excluded. Much less severe consolidation is evident within the left lower lobe. Small bilateral pleural effusions.MEDIASTINUM AND HILA: ET tube tip above the carina. An NG tube is in place. The cardiac size is not enlarged. No evidence of RV strain. No significant pericardial effusion.No pathologically enlarged hilar or mediastinal lymph nodes.Left upper extremity PICC, tip at the RA/SVC junction.CHEST WALL: Healed or healing fractures of the posterior left second through ninth ribs. UPPER ABDOMEN: No significant abnormality noted.

Output: 1.Suboptimal exam for evaluation of pulmonary embolism. No PE to the segmental level.2.Dense right lower lobe consolidation, centrilobular nodules and fluid opacification of the trachea and right lower lobe bronchi compatible with aspiration. A superimposed infectious process cannot be excluded.3.Multiple healed or healing left-sided rib fractures as above.


Instruction: Generate impression based on medical findings.

Input: Reason: RO PNA History: SOB Normal heart size with a moderately tortuous aorta.Bilateral basilar airspace and interstitial opacity, improved on the left but unchanged or increased on the right, suggestive of aspiration, or possibly infarction related to recent pulmonary embolism.Large lung volumes compatible with COPD.Port catheter with its tip in the SVC.Filter device in the suprarenal IVC.

Output: Bilateral basilar airspace and interstitial opacities, improved on the left but persistent or increased on the right, with a differential diagnosis including aspiration and infarction.


Instruction: Generate impression based on medical findings.

Input: Reason: 44yo M s/p VT arrest and intubation History: VT ET tube tip approximately 3 cm above the carina.ICD leads unchanged.New focal consolidation in the superior segment of the left lower lobe, likely related to aspiration, with subsegmental atelectasis on the right.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 35-year-old female with history of fatigue. Preoperative evaluation for ASD repair. There is prominence of the right heart border. No focal air space opacities, pleural effusions, or pneumothorax.

Output: Prominence of the right atrium, but no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 42-year-old male with newly diagnosed lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Minimal intrahepatic biliary dilatation. Plastic stent in the distal common bile duct and the pancreatic duct. No focal liver lesions except for a subcentimeter simple cyst.SPLEEN: There is normal in size without any focal lesions.PANCREAS: Mass in the pancreatic head measures 6.1 x 5.0 cm, not significantly changed on image number 110, series number 3. The dilatation and the pancreatic duct has resolved.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right nephrolithiasis without hydronephrosis. Right simple renal cyst.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: No significant change in the pancreatic head mass. Interval placement of plastic stents into the CBD and pancreatic duct. Biliary dilatation has improved and pancreatic ductal dilatation is nearly completely resolved.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: eval for pna/infiltrate History: weight loss No new opacity to suggest pneumonia. No evidence of pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 47-year-old female with shortness of breath. Cardiomediastinal silhouette is within normal limits.No acute focal airspace opacity.No pneumothorax or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: CP History: CP Mild cardiomegaly with tortuous aorta.Nonspecific linear atelectasis or scarring left lung base.Scoliosis with internal stabilization hardware noted.

Output: Minimal left basilar subsegmental atelectasis or scarring, but no other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Check for pneumonia. Hypoxemia No acute cardiopulmonary abnormality. Persistent borderline cardiomegaly with a tortuous aorta grossly unchanged when compared to prior study given differences in positioning and rotation.Basilar suspected scarring similar to prior and small lung volumes

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Evaluate for active tuberculosis. Normal cardiac and mediastinal silhouettes.No evidence of pulmonary or pleural disease.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: chest tube placement History: s/p right VATS wedge Status post right lung wedge resection with a moderate right pneumothorax despite a right chest tube.Mild right basilar subsegmental atelectasis.

Output: Right chest tube with a moderate right pneumothorax postop.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: 76 M s/p PICC line placement History: PICC Pleural effusions and basilar atelectasis left greater than right, unchanged.Left PICC, tip in the SVC.

Output: Left PICC, tip in the SVC. Unchanged pleural effusions and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: MaleReason for Study: Reason: patient s/p thoracentesis for right pleural effusion History: SOB, DOE Left perihilar and paramediastinal fibrosis with volume loss unchanged.Right pleural effusion slightly decreased from the prior exam.Small left pleural effusion not as well appreciated as on recent CT.No evidence of a pneumothorax postthoracentesis.

Output: Interval decrease in right pleural effusion postthoracentesis. No pneumothorax identified.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: infection, infiltrate History: SOB Central venous catheter, unchanged. Mild interstitial pulmonary edema. Patchy bibasilar opacities, likely atelectasis or scarring. Question of small pleural effusions. No pneumothorax. Unchanged heart size. Percutaneous gastrostomy tube again noted.

Output: Mild interstitial pulmonary edema. Probable patchy bibasilar atelectasis or scarring.


Instruction: Generate impression based on medical findings.

Input: Chest pain radiating to back -- rule-out aortic dissection. CHEST:LUNGS AND PLEURA: Several subcentimeter lung nodules of uncertain significance noted. Left upper lobe ( series 4, image 20) nodule measures 6 mm in diameter and right middle lobe laterally (series 4, image 47) measures 6.5 mm. No pleural effusions are seen. Marked elevation left hemidiaphragm is seen without etiology evident..MEDIASTINUM AND HILA: Aorta is normal in appearance with no evidence of dissection, aneurysm or periaortic abnormalities. Large multinodular changes in the thyroid with marked enlargement of both lobes extending into the anterior/superior mediastinum and displacing trachea to the left and posterior. Mildly enlarged subcarinal lymph node is seen measuring 2.1 x 1.3 cm. No other areas of adenopathy or other mediastinal abnormality seen.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Normal arterial supply to the liver. Arterial phase imaging is difficult to evaluate liver parenchyma -- there is a question of two hypoattenuating lesions in segment 3 (series 9, image 99 and 104). These measure slightly greater than a centimeter in size and are nonspecific. If concern exists over potential for malignancy in the liver, standard liver evaluation would be recommended. No other abnormalities are seen in the liver or biliary tract..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 -- scattered normal sized lymph nodes are seen in the periaortic location without significant enlargement..BOWEL, MESENTERY: Descending colon shows circumferential submucosal low attenuation most consistent with fat deposition from prior colitis. No signs of active inflammation are seen. No abnormal fluid collections..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Anterior ventral abdominal wall hernia containing only mesenteric fat without complication bowel..PELVIS:UTERUS, ADNEXAE: Small uterus with hypo-attenuating regions most consistent with fibroid tumor..BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Rectosigmoid colon shows submucosal low attenuation most consistent with fat deposition from an old colitis. No signs of active inflammation are noted..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. No evidence of aortic dissection or other aortic abnormality. 2. Markedly elevated left hemidiaphragm of uncertain etiology. 3. Markedly enlarged nodular thyroid with extension into the anterior mediastinum as described above 4. Nonspecific subcentimeter lung nodules of uncertain significance and etiology 5. Question of nonspecific hypoattenuating liver lesions in segment 3 -- see above.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Pre-op respiratory examination. Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: fever History: ? Pneumonia Severe cardiomegaly with pleural effusions right larger than left and basilar edema, consistent with CHF.Left subclavian to SVC vascular stent.No specific evidence of infection.

Output: CHF. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Cardiac arrest. Assess ETT. Patient is rotated, limiting evaluation.Endotracheal tube tip 5.5 cm above the level of the carina.Right jugular catheter tip at the level of the SVC.Temperature probe projects over the distal esophagus above the GE junction.Enteric tube looped in the stomach.Left lower lobe is collapsed; the distal left main bronchus appears to contain an internal fluid level, likely the result of aspiration.Right lung reexpanded with moderate edema and airspace opacities.Diffuse lytic and sclerotic skeletal lesions in the spine and ribs compatible with metastases.

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


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: evaluate source of abnormal lung sounds History: abnormal lung sounds Severe cardiomegaly.Eventration left hemidiaphragm.No specific evidence of infection or edema.Left subclavian ICD, leads unchanged in position.Right jugular catheter, tip in SVC.

Output: Severe cardiomegaly, but no reliable evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: lung cancer History: RLL lung cancer s/p chemo/radiation followed by bilobectomy Unchanged right hemithorax opacity and volume loss.Left lung unremarkable.

Output: Unchanged left-sided opacities consistent with known lung cancer. No sign of superimposed edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.ARDS, apical pneumothorax status post chest tube removal evaluate for worsening. Tracheostomy tube unchanged in position. Left PICC tip at the SVC. Upper abdominal tubing external to the patient, partially visualized.Lung volumes remain low with diffuse interstitial abnormality bilaterally which relatively spares the right upper lobe. Tiny left apical pneumothorax is decreased in size, now with maximal pleural separation from the chest wall of about 3 mm.

Output: Interval decrease in size of left apical pneumothorax, now about 3 mm. No acute change in diffuse interstitial opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: Cocaine use, stroke code History: sob Mild bronchial wall thickening, which could indicate bronchitis or asthma.Otherwise, the lungs are unremarkable.Unremarkable mediastinal contours and cardiac silhouette.

Output: Nonspecific bronchial wall thickening, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: rule out possible aspiration History: SOB, pulled dobhoff Heart size least upper normal, with near resolution of prior retrocardiac opacity and left pleural effusion.Right hemithorax unremarkable.Left side thyroid goiter indents the trachea at the level of the thoracic inlet. Right jugular catheter tip in SVC.

Output: Near resolution of prior left lower lobe opacity and left pleural effusion with no new findings.


Instruction: Generate impression based on medical findings.

Input: Reason: Concern for aspiration History: Vomit s/p NG tube placement Diffuse mainly lower zone interstitial and airspace opacity, compatible with edema or aspiration.Bilateral pleural thickening and calcified pleural plaques on leftCatheter tip in the SVC.NG tube tip in the stomach.

Output: Diffuse mainly lower zone pulmonary opacity compatible with edema or aspiration, new since 7/7/2015 but generally unchanged since the previous day.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infectious cause, abnormality History: decreased BS Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Healed left sixth rib fracture.NG tube tip in the area of the gastric pylorus.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: 58M s/p partial nephrectomy now with chest pain, SOB History: chest pain, SOB Decreased lung volumes of mild cardiac enlargement.Nonspecific basilar opacities are compatible with atelectasis.No focal airspace consolidation.No large pleural effusions.

Output: Decreased lung volumes with basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with history of recurrent hemoptysis presenting with hemoptysis. Please evaluate for apical lung lesion or endobronchial tumor. LUNGS AND PLEURA: Moderate to severe emphysema. Right apical wedge resection.A spiculated mass lesion in the right upper lobe measures 1.2 x 1.3 cm on axial image 37/112 and is suspicious for neoplasm.Numerous additional nodular and scarlike opacities are scattered throughout both lungs.Diffuse bronchial and bronchiolar wall thickening and bronchiectasis are suggestive of chronic aspiration, bronchitis or asthma. Peribronchial ground glass nodular opacity in the left lower lobe suggests hemorrhage versus aspiration bronchiolitis or early infection.No pleural effusion. No significant airtrapping is seen and expiration views.MEDIASTINUM AND HILA: Evaluation for mediastinal and hilar lymphadenopathy is slightly limited secondary to the noncontrast technique. However, several prominent pretracheal, prevascular and subcarinal nodes are evident. For reference, the subcarinal lymphoid tissue measures 2.8 x 1.4 cm on axial image 46/112.The cardiac size is normal. No pericardial fluid.CHEST WALL: Rib deformities in the right upper thorax are likely postsurgical.UPPER ABDOMEN: Surgical clips in the gallbladder fossa.

Output: 1.Right upper lobe spiculated mass suspicious for malignancy.2.Diffuse bronchial abnormality as described above suggestive of chronic aspiration or bronchitis/asthma.3.Left lower lobe peribronchial nodularity and ground glass opacity may represent aspiration or early infection, or hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: follow up apcial pneumo History: follow up apical pnuemo Right chest port with tip at the superior cavoatrial junction. Left neck skin staples and mediastinal clips are unchanged. Surgical staples in the midabdomen. NG tube with side-port in the mid to lower esophagus.Mediastinal widening consistent with recent esophagectomy. Small bilateral pleural effusions. No pneumothorax. Bibasilar atelectasis. Improved pulmonary edema pattern.

Output: No pneumothorax is evident. Improved pulmonary edema pattern.


Instruction: Generate impression based on medical findings.

Input: Reason: OG placement History: OG placementt ET tube tip within 2 cm of the carina.Impella device unchanged, with the tip angulated.Swan-Ganz catheter in the left descending pulmonary artery.Cardiomegaly pulmonary edema, not significantly changed.

Output: Unchanged Impella with the tip angulated in the area of the left ventricle.


Instruction: Generate impression based on medical findings.

Input: Reason: pna History: pna ET tube tip approximately 3 cm above the carina. Mild blunting of the costophrenic angles consistent with small effusions.No evidence of pneumonia.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Obesity preprocedural evaluation Cardiomediastinal silhouette is normal. No pleural effusion or pneumothorax. No specific evidence of infection or edema.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Patient presents with chest pain. Evaluate for pneumothorax or pulmonary edema. The cardiomediastinal silhouette is unremarkable. No focal airspace opacity, pleural effusions or pneumothorax.

Output: No acute cardiopulmonary abnormality or significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: L empyema s/p pigtail, COPD exacerbation History: SOB Severe bullous emphysema, interstitial opacities and focal areas of consolidation, without significant change. Left pleural pigtail catheter and bronchial valves, also unchanged.No new findings.

Output: Extensive abnormalities with no significant change.


Instruction: Generate impression based on medical findings.

Input: 77-year-old female with history of non-lymphoma. CHEST:LUNGS AND PLEURA: Mild emphysema. Bilateral small pleural plaques are unchanged.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: Small right renal lower pole simple cyst is unchanged.RETROPERITONEUM, LYMPH NODES: Mild ectasia of the infrarenal abdominal aorta is unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: Preop for Descending aortic replacement History: Aortic Aneurysm New small right pleural effusion.No other significant abnormality.Heart size normal.Right supraclavicular soft tissue emphysema with a surgical drain noted.

Output: New right pleural effusion, unknown etiology.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infection History: increasing leukocytosis Moderately severe cardiomegaly, unchanged.Right jugular catheter extending to the SVC.Small calcifications compatible with previous granulomatous infection.No sign of pneumonia or other acute disease.

Output: Cardiomegaly with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: pleural effusions History: leg edema Cardiomegaly and evidence of pulmonary hypertension, unchanged.Presternal ICD lead in place.No visible effusions or other acute findings.

Output: Cardiomegaly and pulmonary hypertension with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: eval lung fields History: intubated ET tube tip 3-4 cm above carina. Dobbhoff extends beyond the field-of-view.Slightly increased pulmonary opacities, especially retrocardiac, likely due to edema with possible aspiration.

Output: Slightly increased pulmonary opacities, especially retrocardiac, likely due to edema with possible aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: MaleReason for Study: Reason: SOB History: SOB, Hypoxia Right-sided pacemaker unchanged.Stable cardiomediastinal silhouette.Right pleural effusion increased from the prior exam.No focal areas of consolidation.

Output: Increasing right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Fracture after fall? Convulsions. History of smoking. Normal heart size. No pneumothorax or pleural fluid. Nodular opacities in the right upper lobe new from previous.Subsegmental atelectasis left lower lobe.Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended. Healed rib fracture deformities noted on the left.

Output: New nodular opacities in the right upper lobe, recommend further evaluation with thoracic CT when feasible. Please note that fracture may not be evident by chest technique.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: f/u pleural effusion History: f/u pleural effusion Pleural effusions and basilar opacities are unchanged.A Dobbhoff tube extends below the lower margin of the image.Right subclavian ICD stable.

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


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: enlarging lung mass, assess for infectious signs History: on NRB Normal cardiac silhouette.Solid right upper lobe mass similar to seen on chest CT of chest on 10/25/2016.Biapical emphysematous changes and chronic appearing bibasilar interstitial reticular opacities/scarring.Mild right middle lobe and lingular subsegmental atelectasis.Right perihilar fullness consistent with lymphadenopathy.No pneumothorax or large effusion.

Output: When compared to prior CT, stable appearance of large right upper lobe mass and lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: 30F s/p PEA arrest, History: intubated, sedated Right jugular catheter, unchanged.Low lung volumes with decreased aeration on the right compared to prior.Left basilar atelectasis and small pleural effusion, unchanged

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: malignant effusion, re-eval History: as above The right hemithorax is now completely opacified by pleural fluid.Left lower lobe consolidation and a left pleural effusion are unchanged.Left upper lobe nodule stable.

Output: Enlargement of right pleural effusion, the right hemithorax now completely opacified.


Instruction: Generate impression based on medical findings.

Input: Reason: 73 y/o F w/ Hx of bil adrenalectomy for Cushings, DM, HTN, recurrent UTI's who p/w AMS r/o cardiopulmonary process History: AMS Unremarkable cardiac and mediastinal silhouette. Calcified right upper lobe granuloma and calcified lymph nodes compatible with previous infection.No acute abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Evaluate for pneumonia History: Leukocytosis, stroke with dysphagia and impaired airway protection Nodular basilar opacity on the left in expected location for nipple shadow. Infrahilar opacities of aspirated secretions or atelectasis. Cardiomegaly is stable. No interval pulmonary edema.

Output: Infrahilar opacities of aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: etiology of pain, near xiphoid, since delivery History: chest pain lower chest Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Mild thoracolumbar scoliosis.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Acute upper respiratory infection No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Painful respiration No underlying cardiopulmonary abnormality, specifically the ribs and chest wall appear unchanged. Mild scoliosis

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Cough, evaluate for pneumonia. Segmental consolidation in the right lower lobe, statistically most likely the result of pneumonia though in the absence of leukocytosis follow-up PA and lateral chest radiographs are advised to exclude bronchopulmonary sequestration in a young patient.

Output: Segmental right lower lobe consolidation radiographically appears compatible with pneumonia. However in the absence of leukocytosis follow-up PA and lateral chest radiographs are recommended in 6 weeks. If the abnormality does not resolve by that time, further evaluation to exclude noninfectious cause such as congenital bronchopulmonary sequestration in a young patient may be necessary. ETT notified of recommendation via Stat Consult Web Page Dialogue at the time of final interpretation.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: r/o pneumonia History: cough Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Surgical clips in the upper abdomen. Port catheter terminates at the cavoatrial junction.

Output: Clear lungs.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: rule out infection vs worsening pleural effusions History: cough, crackles at bases Improving left lower lobe consolidation and increased inflationBilaterally. Residual reticular opacity left lower lobe, and small pleural effusions seen on the lateral view.Right jugular catheter, tip in SVC.

Output: Improving left lower lobe consolidation with persistent nonspecific opacity and bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old. Cardiomediastinal silhouette and vasculature are normal. Lungs are clear airspace and interstitial opacities. No pleural effusion. No pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: to eval lung fields post B/T procedure History: wheezing Increasing left basilar opacity consistent with aspiration or infection.Small lung volumes.

Output: Increasing left basilar opacity consistent with aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: assess for PNA History: fever, AMS No significant cardiopulmonary abnormality.

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


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: chest pain History: as above Stable position of ICD leads.Lungs clear.No change in cardiomediastinal silhouette.No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: eval pna History: MS flair Low lung volumes. Mild bibasilar subsegmental atelectasis or scarring. No pleural effusion pneumothorax. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p reintubation History: s/p reintubation ET tube tip approximately 4 cm above the carina.Pacemaker leads unchanged.Perihilar and basilar airspace opacity compatible with atelectasis and consolidation, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: TAVR History: TAVR Interval removal of external defibrillator pads. Right IJ sheath unchanged in position. Evidence of prior coronary artery revascularization. A Core valve is located at the aortic position.No evidence of edema or pneumothorax. The heart size is normal.

Output: Stable position of Core valve at the aortic position without edema.


Instruction: Generate impression based on medical findings.

Input: 21 year-old male with ulcerative colitis presents with right-sided abdominal pain which is not typical of his ulcerative colitis. Previous cholecystectomy for this pain without relief CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Numerous tiny lymph nodes are seen along the mesenteric border of the entire colon, related to known ulcerative colitis.BOWEL, MESENTERY: Short segment minimal thickening of the distal descending colon without surrounding inflammation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted LYMPH NODES: Numerous tiny lymph nodes are seen along the mesenteric border of the entire colon, related to known ulcerative colitisBOWEL, MESENTERY: No significant abnormality.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Minimal focal thickening of the distal descending colon without surrounding inflammatory changes, likely related to known history of ulcerative colitis.


Instruction: Generate impression based on medical findings.

Input: 56 year old female with newly diagnosed lung cancer. Please evaluate disease status. CHEST:LUNGS AND PLEURA: Right hilar mass (series 3, image 58) measures 5.5 x 3.5 cm. Scattered pulmonary nodules, many of which are calcified. A noncalcified, subpleural nodule is identified on series 4, image 56; it is nonspecific but may represent a metastatic lesion.Predominantly upper lobe centrilobular emphysema. Patchy ground glass opacities are noted as well.MEDIASTINUM AND HILA: Mediastinal and hilar lymphadenopathy is identified. Reference precarinal lymph node (series 3, image 49) measures 1.8 x 1.1 cm.. Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: No mass lesions identified. Portal vasculature is patent. No intra-or extrahepatic biliary ductal dilatation. Cholelithiasis without evidence of acute inflammation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Bilateral adrenal lesions, consistent with metastatic disease. For reference, the right adrenal lesion measures 5.3 x 4.4 cm (series 3, image 106).The left adrenal lesion invades the left renal vein at its confluence with the left gonadal vein (series 3, image 121).KIDNEYS, URETERS: No significant abnormality noted in the kidneys. Invasion of the left renal vein left adrenal mass as above.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the aorta.BOWEL, MESENTERY: A metastatic deposit within the mesentery of the left hemiabdomen (series 3, image 112) measures 3.2 x 3 cm.BONES, SOFT TISSUES: Nonspecific, scattered subcentimeter subcutaneous nodules. Degenerative disease of the spine.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: Nonspecific, scattered subcentimeter subcutaneous nodules. Degenerative disease of the spine.

Output: 1. Right hilar mass in the lungs with mediastinal and hilar lymphadenopathy as described above.2. Multiple lesions within the abdomen consistent with metastatic disease are described above as well. The left adrenal lesion invades the left renal vein at its confluence with the left gonadal vein.


Instruction: Generate impression based on medical findings.

Input: 22 years old Female. Reason: Neutropenic fever, sepsis History: As above. There is no evidence for infiltrate in both lung or pneumothorax. The prominence of the right minor fissure with a small right pleural effusion. The central venous line is stable in position.

Output: Small right pleural effusion


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old, with tachycardia. Evaluate for PE. PULMONARY ARTERIES: Filling defect within a segmental branch of the left lower lobe pulmonary artery is compatible with pulmonary embolus (image 156 of series 5).LUNGS AND PLEURA: Dependent atelectasis. Calcified granulomas and a few scattered micronodules in the lower lobes bilaterally. Subtle, patchy ground glass opacity in the left lower lobe may be due to the pulmonary embolus described above. No pleural fluid.MEDIASTINUM AND HILA: No pathologically enlarged hilar or mediastinal lymph nodes. The cardiac size is normal. No evidence of RV strain. No pleural fluid.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Pulmonary embolus in a left lower lobe segmental branch.


Instruction: Generate impression based on medical findings.

Input: Age: 35 yearsGender: FemaleReason for Study: Reason: lung eval History: lung eval Support devices unchanged.Stable cardiac enlargement.Diffuse airspace opacities, basilar atelectasis, and pleural effusions, right greater than left, slightly increased from the prior exam.

Output: Support devices unchanged. Interval increase in perihilar groundglass opacities suggestive of edema and basilar atelectasis/consolidation.


Instruction: Generate impression based on medical findings.

Input: Reason: lung eval History: Cardiac arrest. Aortic balloon catheter and Swan-Ganz catheter unchanged.ICD leads, LVAD and mediastinal drains also unchanged. Cardiomegaly with basilar opacity compatible with consolidation and atelectasis.No new findings.

Output: Basilar consolidation and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Bladder cancer No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Reason: IABP, eval positiion History: IABP Cardiomegaly with ICD lead unchanged.Aortic balloon catheter tip at the level of the aortic arch.No significant pulmonary abnormalities.

Output: Balloon catheter tip at the level of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Reason: left lung white out, suspected collapse, re-evaluate History: hypoxia Complete opacification of the left hemithorax with proximal air bronchograms, suggestive of atelectasis and pleural effusion.Nodular air space opacities in the right upper lung are less conspicuous, but still present, suggestive of infection Dense calcification in the mitral annulus.No significant mediastinal shift.

Output: 1.Continued complete opacification of the left hemithorax, without substantial volume loss, compatible with pleural effusion and atelectasis. 2. Nonspecific nodular opacities in the right upper lung.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: cause of shortness of breath History: dyspnea Decreased lung volumes with moderate/marked cardiac enlargement.Perihilar/basilar interstitial opacities compatible with edema.Mild blunting the right costophrenic angle compatible with small effusion.No focal airspace consolidation.

Output: CHF.


Instruction: Generate impression based on medical findings.

Input: Mantle cell lymphoma No acute cardiopulmonary amount. Moderately elevated right hemidiaphragm. Left subclavian single port terminates in the proximal SVC

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: patient with tachycardia, significant cardiac history History: tachycardia, septic picture, fevers Mild retrocardiac subsegmental atelectasis, the lungs otherwise unremarkable.Heart size normal.Left subclavian dual-chamber pacemaker, lead tips in appropriate position all of the ventricular lead has a small loop.

Output: Left basilar subsegmental atelectasis, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Worsening pulmonary opacities especially on the right but no pneumothorax.Heart size normal.

Output: Worsening pulmonary opacities especially in the right lower lobe, suggestive of edema and superimposed pneumonia or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: if needed after thoracentesis History: dyspnea Pulmonary nodules with pleural effusions left larger than right and left basilar consolidation, improved since the prior CT.Heart size normal.Contrast material is seen in colon.Minimal right apical pneumothorax following thoracentesis.

Output: Small right apical pneumothorax following thoracentesis. Widespread metastatic disease unchanged.


Instruction: Generate impression based on medical findings.

Input: Lung transplant Unchanged nonspecific basilar appearance, likely scarring with questionable minimal edema. Bilateral small effusions No new superimposed focal air space processPostsurgical sternotomy and left jugular port unchanged.

Output: Probable old extensive bilateral scarring in both lung bases with small effusions unchanged


Instruction: Generate impression based on medical findings.

Input: 44 year old female with myelofibrosis. Patient is neutropenic and will have bone marrow transplant in the future; evaluate for infection. CHEST:LUNGS AND PLEURA: Interval resolution of nodule in the superior segment of the right lower lobe. Minimal lingular atelectasis. Single new right upper lobe micronodule; nonspecific. Other micronodules are unchanged.MEDIASTINUM AND HILA: Extensive coronary arterial calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Unchanged hepatomegaly to 23 cm (image 80 of 154, series 80320).SPLEEN: Unchanged splenomegaly to 14 cm (image 57 of 154, series 80320).PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Unchanged left adrenal nodule measures 3.1 x 3.3 cm (image 95 of 215, series #4).KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: 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: 1. New nonspecific nodule within right upper lobe; however, no specific evidence of infection. Interval resolution of nodule in the superior segment of the right lower lobe.2. Unchanged hepatosplenomegaly.3. Unchanged adrenal nodule; incompletely evaluated on this examination.


Instruction: Generate impression based on medical findings.

Input: Reason: preop History: preop . Right upper quadrant abdominal pain. Elevated right hemidiaphragm with overlying opacities suggestive of pleural effusion and atelectasis.Mild opacity at the left base may also be due to effusion. Focal opacity in the anterior segment of the right upper lobe is most likely due to subsegmental atelectasis and can be reevaluated on subsequent radiographs.

Output: Basilar opacity suggestive of pleural effusions and atelectasis, greater on the right.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: Patient with respiratory failure with concern for infection vs. pulmonary edema, please evaluate for interval change History: As above Right PICC remains in stable position. Large lung volumes compatible with COPD. Stable bilateral pleural effusions and basilar edema with atelectasis. The heart size is normal.

Output: Diffuse opacities of edema with right greater than left pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: cp History: 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: Age: 52 yearsGender: MaleReason for Study: Reason: Aortic Dissection repair History: Aortic Dissection Repair Chest/mediastinal tubes unchanged.Right IJ Swan-Ganz has been removed with introducer in place.Stable cardiomediastinal silhouette.Left retrocardiac consolidation/atelectasis and perihilar edema unchanged.No new pulmonary opacities identified.

Output: Swan-Ganz catheter has been removed. No other significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: Advance ET tube History: ET tube advanced 2cm Right basilar platelike atelectasis. Borderline cardiomegaly with vascular congestion unchanged. Line position is stable. No pneumothorax

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: 71-year-old male history metastatic prostate carcinoma with rising PSA. Restaging please compare to previous scans. CHEST:LUNGS AND PLEURA: Centrilobular emphysema. Scattered micronodules some calcified. No interval change.MEDIASTINUM AND HILA: Coronary artery calcifications. No pathologic size lymph nodes.CHEST WALL: Previously seen parasternal soft tissue mass is increased in size. As seen on series 2 image 53 to measure 34.3 x 13.3 mm. It previously measured 20.1 x 16.7 mm however a more comparable measurement repeated on the previous scan would be on series 3 image 53/221 where the lesion would measure 21.8 x 5.9 mm. This should be used for comparison. Diffuse sclerotic osseous metastases. These are unchanged.ABDOMEN:LIVER, BILIARY TRACT: Few scattered hypoattenuating foci in the liver are again seen. There unchanged in size and number. Mild central biliary prominence status post cholecystectomy is also unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule measures 9.2 x 7.8 mm on series 2 image 91. Previously measured 10 x 9.2 mm.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multifocal diffuse sclerotic osseous metastases unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: More conspicuous enhancing soft tissue in the prostate bed suggesting recurrence. As the series 3 images 173 -- 178.BLADDER: No significant abnormality notedLYMPH NODES: Right obturator lymph node is increased in size. It measures 43.3 x 14.8 mm on series 3 image 161. The previously measured 22.1 x 14.3 mm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Multifocal diffuse sclerotic metastases unchanged.OTHER: No significant abnormality noted

Output: Increase in size of parasternal mass. Increase in size of pelvic lymph node. Possible increase in size of soft tissue in prostate bed. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Esophageal neoplasm Moderate scoliosis without superimposed new cardiopulmonary abnormality. Mild lung scarring and chronic interstitial changes, unchanged.

Output: No new superimposed acute abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: SOB History: SOB Unchanged port catheter. Question of mild interstitial pulmonary edema. No large pleural effusion or pneumothorax. Skinfold overlies the left hemithorax. Normal heart size.

Output: Mild interstitial pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male 89 years old Reason: eval for obstruction History: constipation Heart is normal in size. Mildly tortuous and calcified thoracic aorta. Basilar atelectasis/scarring present similar to prior. There is a new superimposed right middle lobe airspace opacity compatible with infection/aspiration. No pleural effusion or pneumothorax.Nonobstructive bowel gas pattern. Average stool burden within the colon. No intraperitoneal free air. Unchanged nonspecific amorphous calcification in the tail of the pancreas better seen on prior CTs.

Output: 1. Nonobstructive bowel gas pattern.2. New right middle lobe opacity compatible with infection/aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: assess for PNA History: SOB and productive cough No focal consolidation, pleural effusion or pneumothorax. The heart and mediastinal contours are within normal limits for size. Calcified mediastinal or hilar lymph nodes are present, likely representing sequelae of prior granulomatous disease. The bones and upper abdomen are unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for atelectasis History: eval for atelectasis Interval placement of NG tube with its tip coiled in the gastric fundus.Very mild basilar subsegmental atelectasis.No sign of pneumonia.Skin fold at the right apex but no pneumothorax.

Output: Very mild basilar subsegmental atelectasis and no significant change.


Instruction: Generate impression based on medical findings.

Input: Male 25 years old Reason: evaluate and r/o TB History: positive ppd test No focal airspace opacity.No pleural effusion or pneumothorax.The cardiomediastinal silhouette is normal.

Output: No acute cardiopulmonary abnormality. No specific evidence of active tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: assess for infiltrate History: Cough, malaise, chest pain s/p esophagectomy Right dual-lumen port catheter is accessed with a single needle.Persistent, left greater than right, pleural effusions and lower zone atelectasis. Postoperative findings compatible with gastric interposition. No interval appearance of edema or infection. No pneumothorax.

Output: No specific evidence of edema or infection. Persistent pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 42-year-old male with stage III colon cancer, status post resection in 2004 CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Near complete resolution of previously described superimposed mild edema highlighting persistent moderate diffuse four-quadrant interstitial changes greater both bases representing chronic scarring. COPD. Cardiomediastinal contours remain grossly within limits given scoliosis of the then moderate atherosclerotic disease

Output: Interval resolution of superimposed mild CHF upon chronic interstitial and COPD changes


Instruction: Generate impression based on medical findings.

Input: Reason: esoph ca sp chemorads and surg ck response History: cough Small bilateral pleural effusions, greater on the left. Interval removal of right chest tube. Port catheter with its tip in the SVC.Retrocardiac opacity compatible with esophagectomy and gastric pull-up procedure.

Output: Bilateral pleural effusions and no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: IABP, swan placement History: as above Low lung volumes without specific evidence of infection or edema. No pneumothorax. Cardiomegaly is unchanged.Swan-Ganz catheter tip projects over the right pulmonary artery. ICD lead position is unchanged. IABP marker is approximately 3.6 cm below the upper contour of the aortic arch.

Output: Swan-Ganz catheter and IABP positions as described above.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: Non-small cell lung cancer, on chemo. Status of tumor, right shoulder mets. Lack of IV contrast limits the sensitivity for solid organ pathology and lymphadenopathy.LUNGS AND PLEURA: Previously described irregular mass in the left upper lobe (image 26. series 3) has decreased in size, now measuring 21 x 32 mm (this previously measured 45 x 45 mm). Proximal left subclavian and carotid arteries are better seen compared to the previous.Nodular pleural thickening on the left is less prominent in comparison to the prior study.An 8 mm well circumscribed nodule abutting the left major fissure is unchanged in size. Stable two micronodules in the right upper lobe. A micronodule near the right minor fissure was not visualized on the prior study. A few other previously seen nodules in the right lower lobe are no longer present on today's CT.No pleural effusion.MEDIASTINUM AND HILA: Previously described prevascular, AP window, left hilar lymphadenopathy has slightly decreased in size. Reference lymph node abutting the left pulmonary artery now measures 15 x 19 mm (previously measured 21 x 16 mm).CHEST WALL: Erosion of the left side of the 1st and 2nd thoracic vertebral bodies, consistent with direct tumor invasion, are again seen. Sclerotic lesion in the 2nd thoracic vertebral body, likely metastasis. Early pathologic fracture of T2 on the left.Sclerotic lesion in the left iliac wing is partially visualized. Healing fracture of the left 11th posterior rib.Subchondral cysts in the glenoid on the right; no metastatic lesion seen in the visualized right shoulder. Lesion in the right proximal humerus, seen on the recent PET/CT, is not included in the field of view.Hypoplastic right 1st rib.UPPER ABDOMEN: Multiple small scattered retroperitoneal lymph nodes, unchanged. Aortic stent graft is noted in the abdominal aorta, which covers the site of aneurysm. No mass lesion in the adrenal glands.

Output: 1. Decrease in size of the left upper lobe/paramediastinal irregular mass and lymphadenopathy.2. Decreased in size of left pleural nodules and left pleural effusion.3. Stable multiple pulmonary nodules, likely metastases. Some of the previously seen nodules in the right lower lobe no longer noted.4. Upper thoracic vertebral metastases, possible early pathologic fracture; recommend thoracic spine MRI.9


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: Infiltrates History: fever Cardiomegaly.Mild basilar interstitial opacities could be artifact or edema.No specific evidence of infection.

Output: Cardiomegaly and possible edema, but no reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: OLT for HCV cirrhosis and HCC in 6/2015. Diffuse pulmonary nodules appear more conspicuous on the current exam. Right upper lobe conglomerate mass with associated architectural distortion and pleural retraction about the same. Normal heart size. Mild lymphadenopathy about the same. No pleural fluid. Multiple surgical clips project over the upper abdomen and left axilla.

Output: Innumerable pulmonary nodules and a conglomerate mass in the right upper lobe, previously described as pulmonary sarcoidosis. Findings are slightly progressed compared to the prior study of 2015. Please note that any underlying metastatic disease may not be visible given the extent of parenchymal lung abnormalities and would require CT for exclusion if necessary.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: FemaleReason for Study: Reason: acute worsening of sob and chest pain. interval change? pneumo? History: as above Stable paramediastinal silhouette. Left basilar air space opacity and small left pleural effusion similar to prior exam.No new pulmonary opacities identified.

Output: Left basilar opacity similar to prior exam may represent infection or infarction.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: s/p intubation History: s/p intubation Cardiomegaly status post aortic and pulmonic valve replacements.Unchanged pulmonary edema with pleural effusions.New intubation, the tip 3 cm above the carina.Left jugular venous access sheath unchanged.Chest tubes remain in place with no pneumothorax.

Output: Reintubation. Unchanged pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Heart failure, third PICC adjustment. Left PICC tip remains in the projection of the left jugular vein, directed cranially.Enteric tube unchanged in position.Cardiomegaly and enlargement central pulmonary vasculature unchanged.Moderate left and small right pleural effusions unchanged.Basal and dependent atelectasis unchanged.Mild septal thickening consistent with pulmonary edema.

Output: Left PICC extends cranially into the left jugular vein. No acute change in pleural fluid, atelectasis and mild edema.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: Mucous plug History: as above Stable cardiomediastinal silhouette.Persistent left upper lung zone opacities and bibasilar atelectasis, not significantly changed.Tracheostomy tube and expected location.

Output: No significant interval change in left upper lobe opacities favoring aspiration and basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: line placement History: line placement Mild cardiomegaly.Nonspecific subtle interstitial opacities but no definite evidence of edema.No specific evidence of infection.Right jugular Swan-Ganz catheter, tip pulled back to the main pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Right jugular Swan-Ganz catheter repositioned, the tip now in the main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Status post cardiac surgery Support devices are unchanged.Moderate cardiomegaly is unchanged. Retrocardiac atelectasis/consolidation with bilateral moderate pleural effusions.Superimposed edema type pattern is not significantly changed.No pneumothorax.

Output: No significant interval change in pleural effusions, atelectasis and edema.


Instruction: Generate impression based on medical findings.

Input: Female; 71 years old. Reason: fever, decreased BS, known PE History: fever, decreased BS Low lung volumes. Mild streaky bibasilar opacities, most likely due to subsegmental atelectasis and/or scarring. Small left pleural effusion.Normal cardiac and mediastinal silhouettes.

Output: Bibasilar atelectasis/scarring and small left pleural effusion. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: ETT position History: ETT retracted Extensive upper lobe fibrosis and volume loss with small pleural effusions or pleural thickening, unchanged.ET tube tip approximately 2 cm above the carina.An NG tube extends below the lower margin of the image.

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


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Cough Cardiomediastinal silhouette is unremarkable. Tortuous aorta unchanged. No pleural effusions or pneumothorax. No focal pulmonary consolidation.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infection, edema, effusion History: cp and sob, h/o copd Normal heart size with large central pulmonary arteries suggestive of pulmonary hypertension.Moderate bronchial thickening and apical scarring, unchanged.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: Pneumonia History: Infiltrates, lethargy Unchanged basilar opacities and pleural effusions more suggestive of edema and atelectasis than infection.Unchanged support devices.

Output: Stable basilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: s/p TECAB History: s/p TECAB Pleural effusions left larger than right with increasing left basilar consolidation.Left chest tubes removed with no pneumothorax.Right jugular catheter withdrawn.

Output: No pneumothorax following chest tube removal, although there is increasing left basilar consolidation and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with history of urothelial cancer status post cystectomy CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Ill-defined hyperdense heterogeneous area in the left lobe of the liver superiorly measuring 14 x 10 mm number 88, series number 3 is better seen on today's study and may represent an extension of the vessel or possibly focal lesion which is more likely benign. No other focal lesions in the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Moderate left sided hydronephrosis with dilated ureter new from previous CT. The right 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: Not visualized. Neobladder is unremarkable.LYMPH NODES: Bilateral small inguinal lymph nodes are unchanged or smaller.BOWEL, MESENTERY: Previously described postoperative changes around the vessels have completely resolved.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: New left-sided hydronephrosis and hydroureter. Left ureter is dilated throughout its course.Previous described postoperative changes in the pelvis nearly completely resolved.Heterogeneous hyperdense area in the left lobe of the liver near the dome is better seen on the current study. The etiology is more likely to be benign. MRI of the liver may be obtained if further characterization is clinically indicated. l


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: FemaleReason for Study: Reason: lung infiltrate History: chest pain There is moderate/marked cardiac enlargement with considerable tortuosity of the aorta. Right pleural effusion with septal lines and evidence of pulmonary edema.No focal areas of consolidation.

Output: CHF. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male 61 years old Reason: sepsis History: sepsis Redemonstration of right upper lobe peripheral opacity, which is obscured by an EKG lead and better visualized on CT.No new focal airspace opacities.Absent left medial fourth rib retrospectively correlated with lytic lesion on CT as well as multiple healed rib fractures.Stable heart size.No significant pleural effusions or pneumothorax.

Output: Redemonstration of right upper lobe opacity compatible with known history of cancer. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields/subq emphysema History: persistent subq emphysema Small left apical pneumothorax with a chest tube in place.Elevation of the left hemidiaphragm.Diffuse severe subcutaneous emphysema and mediastinal emphysema. No new findings.

Output: Small left pneumothorax and diffuse subcutaneous and mediastinal emphysema with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: eval SOB History: SOB, DOE The heart size is normal.Platelike opacities in the right middle lobe, lingula, and lower lobes suggestive of multilobar discoid atelectasis and/or scarring without significant interval change.Biapical emphysema.Moderate bibasilar bronchial wall thickening without new focal consolidation, pleural effusion, or pneumothorax.

Output: Findings consistent with emphysema without acute superimposed abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Chest pain Stable cardiomegaly.No abnormal focal lung parenchymal opacities to suggest pneumonia or pulmonary edema.The pleural spaces are within normal limits.

Output: No radiographic findings to suggest fluid overload or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: lung eval History: lung eval Moderate cardiomegaly with pulmonary edema and pleural effusions, unchanged.ECMO cannulae stable in position.Left subclavian ICD, leads unchanged in position.Tracheostomy tube tip 4 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: evaluate fluid collection, Lung fields History: Shortness of breath, Chest pain Multiple right chest tubes removed with a new moderate right pleural fluid collection or loculated hemothorax, compressing the right lung.Left lung unremarkable.

Output: Right loculated pleural effusion or hemothorax following chest tube removal, compressing the right lung.