Instruction: Generate impression based on medical findings.

Input: Female 20 years old Reason: Eval shunt for status, connectivity , and valve check History: headache,check for shunt malfunction. SHUNT DEVICE: The intrathecal shunt catheter tip overlies the spinal canal at approximately the T8 vertebral body level. It continues inferiorly and exits the spinal canal at the left L4/L5 neural foramen, continues around the left back and left flank and terminates inferiorly in the midline pelvis. There is no evidence of shunt kinking or discontinuity in the radiopaque portions the catheter.CHEST: The chest is incompletely imaged on this study. Lower thoracic ribs appear within normal limits.ABDOMEN: Nonobstructive bowel gas pattern.

Output: Lumboperitoneal shunt as described above without evidence of kinking or discontinuity.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: evaluate for new lung infiltrates given new blood in sputum History: blood tinged sputum, on heparin/warfarin, nose in R nare Increasing edema and pleural effusions and persistent left lower lobe consolidation, suggestion of CHF more so than infection.Stable cardiomegaly.Right jugular catheter, tip in SVC.Upper abdominal drains stable.

Output: Slight increase in pulmonary edema with persistent pleural effusions and left basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: R/o focal consolidation, fever History: See above No significant cardiopulmonary abnormality.An NG tube terminates in the stomach.

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


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.HIV, low grade fever, cough. Assess for PNA. Unremarkable cardiac and mediastinal silhouette.No evidence of infection or edema. Previously noted possible right middle lobe opacity is no longer visualized.

Output: No evidence of infection or significant acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old, history of chest pressure, bypass 2 months ago. Improved aeration of the left lower lobe with mild increase in interstitial markings likely representing mild pulmonary edema. There is left basilar atelectasis/scarring without evidence of pleural effusion. No areas of consolidation. Mild cardiomegaly is not significantly changed. Status post tricuspid valve repair. An epicardial pacing wire is present. Chest wall plate and screws, metallic sutures, as well as surgical clips are unchanged in position.

Output: Mild cardiomegaly with minimal pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infiltrate History: cough Unremarkable cardiac and mediastinal silhouette.Status post left mastectomy.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Heart failure Interval new right jugular sheath place with a Swan-Ganz extending into the right atrium. No immediate postprocedural complications or additional change to the cardiopulmonary appearance. See subsequent report

Output: Right jugular catheter placed


Instruction: Generate impression based on medical findings.

Input: History of neuroblastoma LUNGS AND PLEURA: Reidentification of multiple surgical sutures of the left upper lobe, previous described micronodules of the left upper lobe is no longer visualized. There is a superior segment of the left lower lobe and lingular air space opacity likely atelectasis, pneumonia cannot be excluded.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right 7 posterior arch rib deformity again noted.ABDOMEN:LIVER, BILIARY TRACT: Stable appearance of gallbladder stones.SPLEEN: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reidentification of right para-aortic mass of 16 x 7 mm into dimensions (image 57, series 3) and multiple surgical clips.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: Superior segment of the left lower lobe and lingular airspace opacities as described. Interval resolution of left upper lobe micronodules.Stable to slightly decrease in size right periaortic mass.Gallbladder stones.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain History: chest pain Normal heart size with a moderately tortuous aorta.Focal scarring at the left costophrenic angle.No acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: s/p dual chamber ICD implant --> r/o pneumothorax and evaluate lead positions History: as above No significant cardiopulmonary abnormality.Left subclavian dual-chamber ICD, with no pneumothorax following placement.

Output: No pneumothorax following successful left subclavian dual-chamber ICD implant.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Left lung wedge resection, left chest tube Left chest tube has been slightly retracted. Partially loculated hydropneumothorax in the left upper thorax overlying the scapula. Airspace opacities in the left lung may reflect postoperative contusion or hemorrhage are unchanged. Volume loss in the left lower lung field, about the same. Basilar and/or subpulmonic lucency on the left similar to recent previous. Mild atelectasis on the right, otherwise the right lung is unremarkable.

Output: Unchanged left hydropneumothorax and diffuse airspace opacities throughout the left lung.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: f/u pleural effusion History: pleural effusion Right atrial and ventricular ICD electrodes are unchanged in position.The lungs are clear. Mild blunting of the left costophrenic angle from scarring or trace left pleural effusion. Extensive atherosclerotic disease of the subclavian and mesenteric arteries. Heart size is normal.

Output: Persistent blunting left costophrenic angle from scarring or trace left pleural effusion. The lungs remain clear.


Instruction: Generate impression based on medical findings.

Input: Reason: S/p CABG x 1 and AVR. Post op xray prior to discharge. Thanks History: none Small lung volumes with small bilateral pleural effusions and mild basilar atelectasis, improved compared to previous.Small calcified nodules compatible with previous granulomatous infection. Status post median sternotomy with intact sternal fixation devices.

Output: Resolving basilar atelectasis and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 35-year-old male with recurrent testicular cancer CHEST:LUNGS AND PLEURA: Previous described left lower lobe cavitary lesion has resolved. No new lung nodules.MEDIASTINUM 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: Reference ill-defined right periotic soft tissue density which cannot be separated from IVC is smaller measuring 2.7 by 1.9-cm image number 117, series number 3. IVC cannot be well visualized around and below this lesion and is likely thrombosed. Intrahepatic IVC is patent. IVC is also patent at the level of the confluence with the renal veins. A left-sided IVC is patent and unremarkable.Previous described left retroperitoneal predominantly cystic lesion with a few heterogeneous solid components is unchanged measuring 9.5 by 7.9-cm image number 57, coronal series. Other retroperitoneal lymph nodes are also unchanged.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 from previous study other than resolution of the left lower lobe cavitary lesion.Right para-aortic soft tissue changes are stable.Indeterminant predominately cystic lesion with solid heterogeneous components is also stable. Its etiology is indeterminate.


Instruction: Generate impression based on medical findings.

Input: Age: 31 yearsGender: FemaleReason for Study: Reason: evaluate for pneumonia History: productive cough x2 weeks, RLL rhonchi The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: r/o acute fx History: lateral chest wall pain Heart size normal.Lungs clear.No pleural effusion. No pneumothorax.Nondisplaced fractures of the left seventh through ninth ribs.

Output: Nondisplaced fractures of left seventh through ninth ribs. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: Evaluate for interval change History: History of eosinophilic pneumonia, on steroids Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: new cough, fever History: cough, fever Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: lung eval post-op History: lung eval ET tube tip about 1 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.Aortic balloon catheter tip about 2 cm below the top of the aortic arch.Cardiomegaly with bilateral pulmonary opacity compatible with edema and atelectasis.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old. Dual-lumen ET tube in place with the distal limb in the left main bronchus.3 right chest tubes in place with an interval decrease in the right pleural effusion.Moderately large layering left effusion and underlying opacity suggestive of edema and atelectasis.No unexpected radiopaque foreign body.A more recent radiograph has been interpreted.

Output: Interval drainage of right pleural effusion. No radiopaque foreign body.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: assess ETT placement History: respiratory failure Lines and tubes are unchanged. No substantial change in bibasilar pleural-parenchymal opacities. Small pleural effusions. Unchanged cardiomegaly. No pneumothorax.

Output: Lines and tubes are unchanged. No substantial change in bibasilar pleural-parenchymal opacities. Layering pleural effusions again noted.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: eval for effusions History: sob Interval progression of basilar opacities which can represent edema or aspiration. Heart size normal. Mid and upper lung zones are clear. Line position stable.No pneumothorax.

Output: Interval progression of basilar opacities which could represent edema or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: s/p TECAB History: s/p TECAB Pleural effusions and basilar atelectasis unchanged.Heart size normal.No new findings.

Output: Unchanged pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: ? PNA History: ? Infection Low lung volumes without focal lung opacity, pleural effusion, or pneumothorax. Heart size is normal.

Output: Low lung volumes without evidence of infection.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, 49 years old.Reason: r/o dissection, ptx History: chest pressure, L arm pain No significant cardiopulmonary abnormality.No pneumothorax.Mediastinal contour is normal.

Output: No significant abnormality. No evidence of pneumothorax, but even a normal chest radiograph does not exclude dissection.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Chest pain Normal heart size. No focal airspace opacities. Upper abdominal surgical clips.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Neutropenic fever, rule out PNA or other infectious process History: Neutropenic fever, tachypnea Right chest wall port with tip terminating in the upper superior vena cava, but the catheter remains looped just inferior to the clavicle. There is a right central line with tip in the SVC. Cardiomediastinal silhouette normal. No focal lung opacity. Again noted left paratracheal mass. No pleural effusion or pneumothorax.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: PNA vs pleural effusion History: SOB Stable cardiomediastinal silhouette.Marked improvement in left midlung and basilar aeration with residual stable right lung and left upper lung opacities. Left basilar pleural effusion no longer evident. Right basilar pleural thickening and likely small pleural effusion. No pneumothorax.Moderate gaseous distention of bowel malignancy.

Output: Marked interval improvement in left midlung and basilar aeration favoring resolving edema.


Instruction: Generate impression based on medical findings.

Input: Female 81 years old Reason: Evaluate for acute cardiopulmonary abnormality History: hypoxia Median sternotomy hardware, unchanged. Decreased lung volumes with bibasilar atelectasis. No specific evidence infection. No pneumothorax.

Output: Decreased lung volumes with basilar atelectasis. No specific evidence infection.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: Pleural effusion History: pleural effusion s/p thora No pneumothorax following thoracentesis.The left pleural effusion is smaller than before, the right unchanged with overlying atelectasis.

Output: No pneumothorax following successful left thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Reason: cough History: as above Unremarkable cardiac and mediastinal silhouette. Partial clearing of basilar opacities suggestive of atelectasis.No specific evidence of pneumonia.

Output: Partial clearing of basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: Chest pain, sub sternal, tender to palpation History: Chest pain, sub sternal, tender to palpation No new focal lung consolidation. Mild to moderate cardiomegaly again noted. Prominent central pulmonary arteries on lateral radiograph. Calcified left hilar lymph nodes. Small pleural effusions versus pleural thickening versus Bochdalek hernias on lateral radiograph. Surgical clips noted in the left upper quadrant the abdomen. Aortic and coronary calcification. Coronary stent noted.

Output: Stable mild-to-moderate cardiomegaly.Question of pulmonary hypertension. Consider correlation with echocardiography if not recently performed.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: 31M s/p OLT now with chest tightness History: Chest tightness Bilateral pleural effusions and basilar opacities are unchanged.Stable cardiomegaly.Left jugular catheter, tip in SVC.

Output: Unchanged moderate to large pleural effusions and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: hx of bladder cancer s/p cystectomy, evaluate for metastatic disease History: see above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. No sign of metastases.


Instruction: Generate impression based on medical findings.

Input: Age: 24 yearsGender: MaleReason for Study: Reason: eval lung fields History: CF, s/p ECMO Tubes and lines are unchanged.Stable cardiomediastinal silhouette.Extensive pulmonary opacities compatible with bronchiectasis, mucous plugging, and possible superimposed infection/hemorrhage compatible with known cystic fibrosis.Increasing left retrocardiac consolidation/atelectasisSmall pleural effusions slightly increased on the right from the prior exam.

Output: Support devices unchanged. Extensive pulmonary opacities compatible with cystic fibrosis. Interval increase in left retrocardiac consolidation/atelectasis and right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: PNA History: as above Gradually worsening of pulmonary opacities consistent with infection and/or aspiration.ET tube tip approximately 4 cm above the carina.An NG tube extends below the lower margin of the image.Right subclavian catheter, tip in SVC.Right jugular catheter tip at right atrial level.Left axillary vascular stent.

Output: Gradually worsening pulmonary opacities consistent with infection or aspiration. Superimposed edema may also be present.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: evaluate for infitrate History: cough/sob Heart size normal.Lungs clear.No pleural effusion. No pneumothorax.

Output: No acute pulmonary process


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: pneumonia? History: sob/abd pain vomiting Stable elevation of left hemidiaphragm with chronic appearing left basilar pleural-parenchymal opacity. No new focal pleural parenchymal opacity in the right hemithorax. Unchanged heart size. No pneumothorax.

Output: No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Line placement Interval advancement of the Swan-Ganz currently terminating in the right pulmonary outflow tract. No associated postprocedural complication. Otherwise cardiopulmonary to similar with a moderate to large layered right pleural effusion and underlying nonspecific changes like representing edema and asymmetric CHF with atelectasis. See subsequent report

Output: Swan-Ganz repositioned


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: cough, shortness of breath, CVID, asthma History: worsening cough shortness of breath despite steroids The heart is normal in size. The mediastinal contours are within normal limits.Lung volumes are normal. There is an infrahilar lucent rounded opacity with intermediate wall thickness, not visualized in the AP view although projected over the infrahilar triangle the lateral view (measuring 31 mm).No additional abnormal lung parenchymal opacities are noted.The pleural spaces and visualized bones are within normal limits.

Output: Lucent rounded opacity of intermediate wall thickness overlies the infrahilar triangle in the lateral view, not visualized in the AP view. This cystic lesion is indeterminate in nature. No air-fluid levels are noted. Further assessment with nonemergent chest CT is recommended for further characterization.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: S/P Esophagectomy History: S/P Esophagectomy with bilateral CT Surgical staples, NG tube tip, right chest port, and bilateral chest tubes are unchanged in position.Cardiomediastinal silhouette is unchanged.Bibasilar opacities with left pleural effusion.No pneumothorax.

Output: No interval change in basilar atelectasis and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: sob History: sob Lower lung zone predominant interstitial opacities with pleural effusions are suggestive of edema from CHF although underlying fibrosis is possible.Mild cardiomegaly noted.Left Pleurx catheter unchanged in position.

Output: Unchanged interstitial opacities with pleural effusions suggestive of CHF and possible underlying fibrosis.


Instruction: Generate impression based on medical findings.

Input: Cough and SOB rule out pneumonia. Moderate bronchial wall thickening and peripheral peribronchial nodular opacities suspicious for bronchitis and possible bronchopneumonia.Normal heart size. No pleural fluid or pneumothorax.

Output: Bronchitis with opacities suspicious for evolving bronchopneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: chest pain etiology History: chest pain Mild cardiomegaly versus magnification artifact. No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: SOB, AMS, eval for PNA History: SOB, AMS, eval for PNA Small lung volumes.No specific evidence of infection or edema.Heart size normal, the aorta tortuous but consistent with age.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male 36 years old Reason: ? shunt malfunction History: VPS and HA SHUNT DEVICE: VP shunt device exits skull via right parietal burr hole. No evidence of discontinuity or kinking of radiopaque portions of the catheter which courses through the scalp, soft tissues of the right neck, anterior chest, entering the abdomen and terminating in the lower pelvis. Shunt pressure setting indicator pointing at the 12:00 position in line with the tubing.SKULL: Surgical changes about the apex.CERVICAL SPINE: Mild degenerative disc disease with anterior osteophyte formation and disc space narrowing at C5-6.CHEST: No focal lung opacity.ABDOMEN: Nonobstructive bowel gas pattern.

Output: No evidence of discontinuity or kinking of the radiopaque portions of the shunt catheter.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain History: chest pain Port catheter with its tip at the upper right atrium.No significant cardiopulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: pna? History: CHF/fever Stable mild cardiomegaly. Bilateral hilar and basilar interstitial opacities suggestive of edema. Small right pleural effusion. No specific findings of pneumonia.

Output: Bilateral hilar and basilar interstitial opacities suggestive of edema. 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, 85 years old.Reason: r/o PTX, mediastinal widening, PNA History: L sided CP not otherwise differentiated The patient is rotated to the right. Sternal wires are unchanged in position.Right upper lobe airspace opacities along with a moderately sized hiatal hernia suspicious for aspiration. Small right pleural effusion. Diffuse bronchial wall thickening. No pneumothorax. Heart size mildly enlarged.

Output: Right upper lobe opacities in the setting of a moderate hiatal hernia and right pleural effusion suspicious for aspiration. CT thorax recommended.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old Reason: Evaluate for pneumonia History: fever, chills Cardiomediastinal silhouette is normal. Right upper lobe scarlike opacity. No specific evidence of infection. No pleural effusion or pneumothorax.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: R/O PNA History: increase WOB Cardiomegaly with pacemaker lead extending to the area of the apex of the right ventricle.Tracheal deviation to the right in the neck consistent with a goiter.Mild basilar opacity compatible with atelectasis and scarring, unchanged.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with gastroesophageal junction cancer status post radiation and chemotherapy. CHEST:LUNGS AND PLEURA: A pleural based nodule in the left lower lobe measures 5 x 5 mm (series 4, 77), previously measuring 6 x 4 mm.Centrilobular emphysema is present predominantly at the lung apices.Right lung base scarring is unchanged.MEDIASTINUM AND HILA: No enlarged mediastinal or hilar lymphadenopathy. Coronary and aortic arch atherosclerotic calcifications are again visualized. The right chest wall Port-A-Cath tip is in the SVC.CHEST WALL: Right chest wall port.ABDOMEN:LIVER, BILIARY TRACT: Two subcentimeter hypodensities in the liver are unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral small renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy has increased and now encases the aorta. A left periaortic lymph node measures 1.9 x 2.5 cm (series 3, image 126), previously 0.5 x 2.2 cm.BOWEL, MESENTERY: The gastric wall thickening has improved and is now barely perceptible. There is a gastrohepatic lymph node (series 3, image 95) which measures 2.3 x 2.1 cm, previously measuring 1.4 x 1.5 cm.Multiple peritoneal and mesenteric implants are again visualized and have increased in size and number (series 3, images 119 and 157). An index lesion in the left anterior omentum (series 3, image 137) measures 1.5 x 1.4 cm, previously measured 1.0 x 0.8 cm. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Pelvic lymphadenopathy has increased with an index lesion (series 3, image 165) measuring 1.1 x 1.3 cm, previously 1.0 x 0.5 cm.BOWEL, MESENTERY: The gastric wall thickening has improved and is now barely perceptible. There is a gastrohepatic lymph node (series 3, image 95) which measures 2.3 x 2.1 cm, previously measuring 1.4 x 1.5 cm.Multiple peritoneal and mesenteric implants are again visualized and have increased in size and number (series 3, images 119 and 157). An index lesion in the left anterior omentum (series 3, image 137) measures 1.5 x 1.4 cm, previously measured 1.0 x 0.8 cm. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. The gastric wall thickening has improved and now is barely perceptible.2. Retroperitoneal and pelvic lymphadenopathy has increased.3. Mesenteric and peritoneal implants have increased.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: hx of bladder cancer evaluate for metastatic disease History: see above Cardiomediastinal silhouette is normal. Low lung volumes makes detailed cardiopulmonary assessment difficult. Chronic changes of COPD remain stable. No new focal opacity, pneumothorax, or pleural effusion.

Output: Moderate COPD without acute superimposed airspace disease.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: patient with h/o CHF, want to eval for volume overload. Also look for infiltrates History: fever, wbc increase Marked cardiomegaly again noted. Left basilar subsegmental atelectasis or scar and small left pleural effusion noted. No pneumothorax.

Output: Left basilar subsegmental atelectasis or scar and small left pleural effusion noted.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: Post op AVR History: Post op AVR Lower lung zone edema and atelectasis may be slightly worse.Chest tubes postop with no pneumothorax.Right jugular Swan-Ganz catheter tip in main pulmonary artery.Status-post extubation.

Output: Slight increase in basilar opacities following extubation, but no pneumothorax or other significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: pna History: cough, wheezing Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: Eval lung fields, pacemaker position History: Heart failure Left-sided ICD with right atrial lead wire in a more medial position than expected.Right ventricular and left ventricular venous leads are noted.No evidence of a pneumothorax.Decreased lung volumes with borderline cardiac enlargement.Lungs are clear.

Output: Interval placement of a left-sided ICD. The right atrial appendage lead appears to be more medially placed than expected.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: post op, intubated History: tubed Pleural effusions and nonspecific basilar opacities suggestive of atelectasis following recent surgery.An NG tube terminates in the stomach. ET tube tip approximately 4 cm above the carina.

Output: Pleural effusions and nonspecific basilar opacities suggestive of atelectasis. ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: Mycosis fungoides;staging History: Rash Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male 5 years old Reason: LPA stenosis, s/p TOF History: none The comparison chest radiograph performed on 7/1/2015 demonstrates no focal pulmonary opacities or pleural fluid. The perfusion images show markedly decreased perfusion to the entire left lung. Within the left lung, the apical region has the highest level of perfusion, although still significantly diminished. Quantitation of relative pulmonary arterial perfusion (using anterior and posterior geometric means):Left lung: 14.4% (upper lung 5.5%; middle lung 5.6 %; lower lung 3.3%)Right lung: 85.6% (upper lung 17.3%; middle lung 43.3%; lower lung 25.0%)

Output: Markedly decreased pulmonary arterial perfusion to the entire left lung.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with history of myelodysplastic syndrome. Pre-transplant evaluation. CHEST:LUNGS AND PLEURA: Scattered micronodules. 4-mm nodule along major fissure on the right (series 5 and image 52) statistically most likely represents an intrapulmonary lymph node. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of infection or other acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: iabp and swan placement History: iabp and swan in place Median sternotomy, pleural effusions and lower lung zone edema not significantly changed.Right jugular Swan-Ganz catheter tip directed towards the right interlobar pulmonary artery.Right subclavian IABP catheter marker 2 cm below the top of the aortic arch.Left subclavian pacemaker, leads unchanged in position.

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


Instruction: Generate impression based on medical findings.

Input: Solitary pulmonary nodule removed Interval removal of 2 right chest tubes and resolution of overlying chest wall emphysema. No postprocedural complications, specifically no pneumothorax.Mild residual chronic-appearing interstitial changes in both bases without new acute pulmonary abnormalityCardiac and mediastinal contours are within limits

Output: Chest tubes removed


Instruction: Generate impression based on medical findings.

Input: Reason: post pulm valve placement History: sob Small left pneumothorax without significant change.Chest tube and bronchial valves in place.Diffuse chronic interstitial disease, likely secondary to scleroderma.

Output: Persistent small left pneumothorax, without significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: AM CXR History: AM CXR history of cirrhosis. Left central venous catheter with tip at the superior cavoatrial junction. Tracheostomy tube is unchanged.Cardiomediastinal silhouette is unchanged.Right greater than left pleural effusions with adjacent atelectasis.

Output: Bilateral pleural effusions with adjacent atelectasis without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube placement History: ILD s/p lung biopsy Chest tube extending to the right apex with no significant pneumothorax.Diffuse interstitial disease as previously described.No new findings.

Output: Chest tube in place with no significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: FemaleReason for Study: Reason: s/p ICD insertion History: s/p ICD insertion Presternal ICDThe prior exam.Decreased lung volumes with stable cardiac enlargement.The lungs are clear.No pleural effusions.No evidence for pneumothorax.

Output: Placement of a left-sided presternal ICD without complication.


Instruction: Generate impression based on medical findings.

Input: Right lower lobe wedge resection Persistent right chest tube projected into the apex without a significant pneumothorax. Other than mildly decreasing lung volumes, possibly due to semiupright technique, no significant interval change. Specifically mild nonspecific interstitial and focal airspace changes observed in the right upper and lower lung appear similarCardiac and mediastinal contours are within limits

Output: Postsurgical changes without significant interval change, chest tube well-positioned


Instruction: Generate impression based on medical findings.

Input: Angina Motion degrade sensitivity. New right jugular catheter with Swan-Ganz extending into the proximal SVC. Left chest tube projects towards the apex without a significant pneumothorax.Decreased lung volumes with minimal basilar changes suggesting atelectasis. No discrete superimposed new additional cardiopulmonary abnormality

Output: Left chest tube placed


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.History: CHF Stable cardiomegaly.ICD in left chest wall with right ventricular electrode, unchanged in positionRight PICC line and IABP marker unchanged in position.No pulmonary or pleural abnormalities.

Output: Support devices unchanged. No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Productive cough despite azithromycin. Normal heart size. No focal airspace opacity, pleural fluid or pneumothorax.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 64 years, Female. Reason: POD #2, nausea, emesis x 2 History: nausea/vomiting There is gaseous distention of predominantly small bowel, measuring up to 4.5 cm, with a relative paucity of colonic gas. Less than average stool burden. Surgical staples overlie the mid abdomen and multiple surgical clips overlie the pelvis.Right-sided port with tip at the cavoatrial junction. Surgical clips overlie the bilateral hila and axillae. Linear opacity at the right lung base may reflect atelectasis or scarring. Small volume pneumoperitoneum is seen under the right hemidiaphragm, which is expected given the patient's postoperative state.

Output: Gaseous distension of the small bowel with a small amount of colonic gas may represent ileus however a developing small bowel obstruction cannot be excluded. Follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: 65 years old Female. Reason: Pneumonia. History: Pneumonia. Bibasilar subsegmental atelectasis, left greater than right. No evidence of acute infiltrate, pleural effusion or pneumothorax.

Output: Bibasilar subsegmental atelectasis. No specific evidence for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female 71 years old Reason: hx of bladder cancer s/p radical cystectomy, evaluate for metastatic disease History: see above Heart size normal with unchanged tortuous aorta.No focal lung opacities or effusion. Multiple degenerative changes of the thoracic spine with anterior wedging. Pigtail catheter projects over the left upper quadrant.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: ? Syncope History: ? PNA Improving basilar opacities with improved lung expansion.Residual atelectasis or scarring persists especially in the left lower lobe.Heart size normal.NG tube and right jugular catheter removed.

Output: Improving basilar opacities with residual in the left lower lobe. No new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: intubated, chest tubes, s/p VAD History: intubated, chest tubes, s/p VAD Cardiomegaly status post sternotomy with chest tubes but no pneumothorax.Small lung volumes with basilar atelectasis and small pleural effusions.ET tube tip approximately 5 cm above the carina.Left subclavian ICD, leads unchanged in position.Stable LVAD.Right jugular Swan-Ganz catheter tip in main pulmonary artery slightly pulled back.

Output: No significant pneumothorax. No new findings.


Instruction: Generate impression based on medical findings.

Input: 57 old female with ovarian cancer CHEST:LUNGS AND PLEURA: Biapical scarring is unchanged. Small pleural-based nodularities in the posterior aspect of the right lower lobe are nonspecific.MEDIASTINUM AND HILA: Pretracheal lymph node is slightly enlarged measuring 18 x 11 mm image number 27, series number 4. Precarinal lymph node is stable.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes involving the left lobe of the liver with persistent small perihepatic fluid.SPLEEN: Splenectomy.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Surgically absent.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: Very minimal increase in the size of the pretracheal lymph node, otherwise stable findings.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: MaleReason for Study: Reason: rule out pneumonia, edema, effusion, cardiomegaly History: AMS, BG >1400 admitted to MICU Stable mild cardiac enlargement.The lungs are clear.No large pleural effusions.

Output: Stable cardiomegaly without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Left-sided ICD unchanged in position. Status post sternotomy with fracture of the superior lead, as on prior. No change in heart size. Aortic ectasia with calcifications, as on prior.Lungs hypoinflated. No evidence of pneumothorax.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Intubated. Left central line and right internal jugular catheters are unchanged. Tracheostomy, unchanged.Severe bilateral perihilar distribution air space opacities, and enlarged cardiomediastinal silhouette, unchanged.The inferior aspect of the bilateral lower lobes and the diaphragm is excluded from the field of view.

Output: Diffuse edema-like opacities and cardiomegaly, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: hx of kidney cancer, evaluate for metastatic disease History: see above Right lower lung zone opacities suggestive of scarring or atelectasis, unlikely to represent metastases.Small right pleural effusion.Heart size normal.

Output: Right pleural thickening, worse than before but unlikely to represent metastases. A follow-up abdomen CT has been scheduled in reference could be made to this for further characterization. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 35 year old female with a history of Hodgkin's disease and completion of chemotherapy 12/2008. CHEST:LUNGS AND PLEURA: There is a right lower lobe. No evidence of pleural effusion, nodules or masses. MEDIASTINUM AND HILA: Reference anterior mediastinal lymph node is slightly decreased in size and measures 29 mm by 11 mm (image 37/209, series 3), compared to 31 mm x 14 mm on the previous exam. Reference cardiophrenic node measures 6 mm (image 69/209, series 3), not significant changed from the previous exam. Heart size is normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small, shotty retroperitoneal nodes are stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: There are bilateral adnexal cysts, normal for the patient's age.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: Stable exam; no significant interval change


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: Evaluate IABP positioning History: Arterial line malfunction Moderate cardiomegaly status post sternotomy.No specific evidence of infection or edema.IABP catheter proximal marker projects over the aortic arch.Right jugular catheter, tip in SVC.Left subclavian ICD, leads unchanged in position.

Output: No change in support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Shortness of breath. Relapse multiple myeloma. Port catheter terminates in the superior mid SVC. No focal lung consolidation. No substantial difference compared to previous study otherwise.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: pneumonia, effusion, cardiomegaly History: cough No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: FemaleReason for Study: Reason: 67y/o with persistent cough for the past 2 weeks, h/o URI symptoms, background h/o recent allogeneic stem cell transplant History: cough and stuffy nose Right jugular catheter with its tip in the SVC.Right IJ Hickman catheter has been removed.The current mediastinal silhouette is unremarkable.Lungs are clear.No pleural effusions.Multiple surgical clips in right axilla.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Aortic valve replacement Unchanged two right and two left basilar chest tubes with underlying decreased pulmonary volumes and cardiomegaly. Superimposed mild edema-like changes persist without definite new change or progression given differences in technique and semiupright positioning.Swan-Ganz, ETT and IABP marker are also similar position. Interval new Dobbhoff and NG tube at, both coiled in the proximal stomach

Output: Dobbhoff and NG tube placed


Instruction: Generate impression based on medical findings.

Input: Reason: CT History: CT Left chest tube in place with no pneumothorax.Large layered out pleural effusions with underlying atelectasis.Left jugular catheter, unchanged.

Output: Large pleural effusions and atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with liver failure and liver transplant workup CHEST:LUNGS AND PLEURA: Bilateral trace pleural effusions.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Diffusely heterogeneous liver with large areas of decreased attenuation. Focal liver lesion cannot be excluded with this single phase CT. This appearance may the secondary to inflammation and/or fatty infiltration. Paraumbilical vein is patent. Ascites is present. These findings are suggestive of portal hypertension.Cholelithiasis without evidence of biliary dilatation or cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is mild ligamentous with small amount of fluid around the tail, which can represent mild acute pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild wall thickening of the small bowel and colon is likely due to ascites.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: Mild wall thickening of the small bowel and colon is likely due to ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of ascites.

Output: Diffusely heterogeneous liver with large areas of heterogeneous decreased attenuation. These findings can be secondary to hepatitis and/or fatty infiltration. Portal hypertension evidenced by ascites, periesophageal varices and patent paraumbilical vein.Possible mild acute pancreatitis.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: line placement History: see above A feeding tube is been inserted extending deep into the right lung base, subsequently removed without complication such as pneumothorax.Mild basilar subsegmental atelectasis noted.ET tube tip approximately 5 cm above the carina.Right jugular catheter, tip at right atrial level. Left jugular catheter tip in left brachiocephalic vein near the midline.

Output: Feeding tube inserted far into the right lung base. Subsequent radiographs show this had been removed without pneumothorax. Residual basilar atelectasis, improved.


Instruction: Generate impression based on medical findings.

Input: Fever Bilateral minimal but left predominant suspected scarring with associated volume loss on the left; yet scarring can only be confirmed with prior imaging. No distinct superimposed acute pulmonary air space abnormality.Cardiac and mediastinal contours are within limits

Output: Asymmetric lung volumes with suspected left basilar scarring, see detail in need for serial imaging to confirm. No discrete superimposed airspace process to support infection given history


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old. Left IJ venous catheter has been placed with its tip in the IJ.No evidence of a pneumothorax.The cardiac mediastinal silhouette is unremarkable.Lungs are clear.No pleural effusions.

Output: Placement of left IJ venous catheter without complication. No acute cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: chest pain History: chest pain Basilar interstitial opacities and subtle septal lines suggest mild pulmonary edema. There is no focal consolidation or large pleural effusion. The cardiac and mediastinal contours are within normal limits for size. Multiple healed left-sided rib fractures are evident.

Output: Findings suggestive of mild interstitial pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female 12 months old; Patient is status post bidirectional, bilateral Glenn procedure.VIEWS: Chest AP/lateral (two views) 8/25/2016, 1805 hours Surgical clips can be seen in the left chest. The cardiothymic silhouette is within normal limits. The umbilical venous catheter is no longer seen. No focal opacities, pleural effusions or pneumothorax is seen. Pocket of air posterior to the heart may represent residual air from surgery, less likely a hiatal hernia.

Output: Pocket of air posterior to the heart may represent residual air from surgery, less likely a hiatal hernia.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: eval et tube position History: advanced 2 cm from prior No significant cardiopulmonary abnormality.ET tube tip approximately 1 cm above the carina.An NG tube terminates in the stomach.

Output: Low ET tube, within 1 cm of the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.8 weeks of productive cough evaluate for pneumonia. Malignant neoplasm of the endometrium. No specific evidence of pneumonia. Left basilar scarring or atelectasis.Anterior right upper lobe nodule seen on the lateral radiograph not significantly changed unchanged.Right inferior pulmonary ligament region lymphadenopathy, also best appreciated on the lateral radiograph, unchanged.

Output: No specific signs of pneumonia. Right upper lobe nodule and mediastinal lymphadenopathy not significantly changed compared to 4/11/2016 CT scan allowing for differences in technique.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: ? PNA History: ? PNA Moderate cardiomegaly.Interstitial and airspace opacities are unchanged, more likely edema than pneumonia.Pleural effusions noted.Right jugular catheter, tip at right atrial level.IVC filter noted.

Output: Unchanged pulmonary opacities most likely edema rather than infection.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: eval for infection History: recent PNA, SOB, tachycardia Interstitial opacities suggestive of edema persist, as well as airspace opacity in the left perihilar region.Mild cardiomegaly noted.Very small right pleural effusion.

Output: Cardiomegaly and mild interstitial edema with left perihilar airspace opacity, unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: FemaleReason for Study: Reason: Swan Ganz Placement History: Swan Ganz Placement Left-sided ICD unchanged.Right IJ Swan-Ganz with its tip in the right ventricle.IABP marker in the proximal descending aorta.Stable cardiac enlargement.No new pulmonary opacities identified.

Output: ]Swan-Ganz tip in the right ventricle. Subsequent imaging demonstrates repositioning into the main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: pneumonia? History: SOB, cough Confluent nodular opacities within the bilateral lungs, with relative sparing of the upper lobes. The partially visualized cardiomediastinal silhouette appears normal in size.

Output: Confluent nodular opacities within bilateral lungs, most concerning for extensive metastases. Consider correlation with prior imaging or dedicated CT may be obtained for further evaluation.Dr. Taylor was paged at 12pm, (pager 1609) on 12/11/2016.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: eval for lesions History: s/p OLT in July 2015 for HCC No significant pulmonary or pleural abnormalities.Mild cardiomegaly.Surgical clips project over mid upper abdomen and left lateral chest wall.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 27-year-old male with testicular cancer CHEST:Again noted multiple staple lines in the right lung. No suspicious pulmonary nodules or masses.Mediastinal lymph nodes are unchanged in appearance. Postsurgical changes involving the right hilumChest was unremarkable.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Postoperative findings of left liver lobe resection. Subcapsular lesion in segment 6 now measures 1.6 by 0.8 cm on image number 82, series number 3, not significantly changed from previous CT. Subcapsular lesion around segment 5 is also unchanged measuring 6 by 8 mm on image number 93, series number 3. The area of decreased attenuation adjacent the gallbladder is also unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: Index portacaval lymph node on image number 102, series number 3 measures two by 1 cm, not significantly changed from previous study.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 from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: neutropenic fever History: fever, left base crackles Cardiomegaly.No specific evidence of infection or edema.Right jugular catheter, tip in SVC.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: pericardial effusion, pleural effusions, please eval History: sob Massively enlarged cardiac silhouette compatible with pericardial effusion and/or cardiomegaly.Mild blunting of both costophrenic angles compatible with small pleural effusions.No specific evidence of pulmonary edema or pneumonia.

Output: Severely enlarged cardiac silhouette and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: PICC line placement No cardiopulmonary abnormality. A well-positioned left PICC line extends into the mid SVC, demonstrating mild retraction of approximately 5 cm.

Output: Left PICC line repositioned


Instruction: Generate impression based on medical findings.

Input: Reason: eval for IABP placement History: as above ICD lead and aortic balloon catheter unchanged. Right subclavian catheter tip in the area of the junction of the subclavian and brachiocephalic vein.No significant pulmonary abnormalities.

Output: Balloon catheter marker projected about 2 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: evaluate for mediastinal widening History: chest and back pain Cardiomediastinal silhouette is within normal limits.No focal air space abnormality. No pleural effusions or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: New fever History: s/p HIPEC and ventral hernia repair No significant abnormality.Note is made of large epicardial fat pad.

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


Instruction: Generate impression based on medical findings.

Input: 67 year-old male with resected malignant spindle cell sarcoma of the lung. Establish post operative baseline. CHEST:LUNGS AND PLEURA: Linear atelectasis and postsurgical changes in the apical segment of the left lobe as well as in the lingula. No parenchymal lung lesions.MEDIASTINUM AND HILA: Nodule in the right thyroid lobe. Calcified right hilar and mediastinal lymph nodes. Multiple nonenlarged mediastinal none calcified lymph nodes. A reference subcarinal lymph node measures 13 x 7 mm on image number 41, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Postsurgical changes in the left lung with small mediastinal lymph nodes.Right thyroid nodule


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with tachypnea. Heart size is normal. No focal areas of consolidation, pleural effusion, or pneumothorax.Mild scoliosis.Contrast nephrogram corresponding to prior CT.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with right breast cancer and increase in the axillary nodes CHEST:LUNGS AND PLEURA: Right apical scarring and bronchiectasis. Bilateral lung nodules, more prominent on the right side. These are suspicious for metastatic disease. An index nodule in the right middle lobe measures 10 by 7-mm image number 50, series number 4. There are also multiple pleural based masses in the right lower lobe.MEDIASTINUM AND HILA: Extensive mediastinal adenopathy. An index right tracheal necrotic lymph node measures 2.1 x 2 cm on image number 21, series number 3.CHEST WALL: Large right breast mass. Numerous enlarged right axillary lymph nodes. An index right axillary lymph node measures 1.9 x 1.7 cm on image number 45, series number 3.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: 1.4-cm hypodense lesion in the inferior pole of the spleen are to representing a simple cyst.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesions involving thoracic and lumber vertebral bodies consistent with metastatic disease.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: Lytic lesions in the pelvic bones compatible with metastatic disease.OTHER: No significant abnormality noted.

Output: Pulmonary, pleural, mediastinal and osseous metastatic disease.Right breast mass and right axillary metastatic adenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: infection History: pleuritic chest pain, fever, wbc Basilar scarring or subsegmental atelectasis.No significant pneumothorax or pleural effusions. Heart size normal.

Output: Basilar scarring or subsegmental atelectasis, otherwise unremarkable. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 80 year-old female with history of cough and shortness of breath. Fibrosis on outside CT. LUNGS AND PLEURA: Previously noted reticular interstitial abnormalities and groundglass opacities are again seen predominantly at the bases and remained stable. Stable basilar traction bronchiectasis. No honeycombing. No significant air trapping.MEDIASTINUM AND HILA: Unenlarged mediastinal lymph nodes. Stable coronary calcifications and unchanged lipomatous hypertrophy of the interatrial septum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Cholecystectomy clips. Calcified splenic artery aneurysm at the splenic hilum.

Output: Stable interstitial lung disease with an NSIP-type pattern without evidence of significant air trapping.


Instruction: Generate impression based on medical findings.

Input: Reason: IABP History: as above Aorta balloon catheter in place with the proximal marker at the level of the top of the aortic arch, and the distal marker in the descending aorta at the level of L1 -- L2. Cardiomegaly and coronary artery stent unchanged.PICC line tip in the right axilla.

Output: Aortic balloon catheter in a more proximal location as described.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with history of prostate cancer CHEST:LUNGS AND PLEURA: Stable right middle lobe micronodular. No new nodules or other parenchymal infiltrates.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Mild wall thickening of the gallbladder with septations, unchanged. Stable subcentimeter lesion in the right lobe.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral percutaneous nephrostomy catheters are in place. Double-J ureteral stents are also in place. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Again noted retroperitoneal adenopathy. Reference left para-aortic lymph node is unchanged measuring 10 x 10 mm image number 119, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is significantly enlarged and heterogeneous likely invading the bladder. Soft tissue density within the bladder may represent invasion from the prostate versus hemorrhage/debris. This appearance is grossly unchanged compared to previous study.BLADDER: Invasion of the bladder by prostate.LYMPH NODES: Reference left-sided pelvic lymph node is smaller measuring 10 x 9 mm on image number 166, series number 3. Other pelvic lymph nodes are also slightly smaller.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Several small sclerotic foci within the pelvic bones including erect a large focus in the left iliac bone are unchanged.OTHER: No significant abnormality noted

Output: Prostate mass invading the bladder, unchanged.The primary bladder neoplasm cannot be entirely excluded.Pelvic lymph nodes have slightly decreased in size. The abdominal retroperitoneal adenopathy is unchanged.Small sclerotic foci in the bones are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: evaluate for pneumonia, atelectasis History: tachycardia Mild basilar atelectasis seen on the prior study is resolved.Heart size normal.Fracture of the lateral aspect right fifth rib unchanged, possibly lytic.A Dobbhoff tube terminates in the stomach.Tracheostomy tube tip 6 cm above the carina.

Output: No acute abnormality. Unchanged right fifth rib fracture which could be lytic.


Instruction: Generate impression based on medical findings.

Input: IABP. IABP marker projects over the middescending thoracic aorta at the T6/T7 level, 5.5 cm below the top of the aortic arch.Other hardware and devices unchanged. Cardiomegaly, about the same.Minimal atelectasis with signs of mild hypervolemia/edema about the same.

Output: IABP marker projects about 5.5 cm below the top of the aortic arch


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: NG tube in correct place History: nonresponsive No significant cardiopulmonary abnormality.NG tube with tip in descending portion of the duodenum.Right jugular catheter, tip in SVC.

Output: Low NG tube, terminating in the second portion of the duodenum.


Instruction: Generate impression based on medical findings.

Input: 53 year old female with diffuse large B-cell lymphoma, status post 6 cycles of chemotherapy completed 1/2010. CHEST:LUNGS AND PLEURA: Bilateral lower lobe calcified granulomas are unchanged.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: The referenced right axillary lymph node measures 2.0 cm x 2.1 cm (image 37, series 3), previously measuring 2.4 x 2.7 cm. The remaining enlarged axillary lymph nodes are unchanged in size.ABDOMEN:LIVER, BILIARY TRACT: Unchanged right hepatic hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal para-aortic adenopathy is stable. The reference lymph node measures 1.6 cm x 0.9 cm (image 124, series 3), previously measuring 1.8 cm x 1.0 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly enlarged pelvic lymph nodes are unchanged. Reference right inguinal lymph node measures 1.9 cm x 1.6 cm (image 189, series 3), previously measuring 1.9 x 1.5 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: Stable examination with no significant change in the reference pelvic, retroperitoneal, and axillary lymph nodes as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: evaluate swan ganz catheter History: see above Mild to moderate cardiomegaly.Small lung volumes, without reliable evidence of edema.Right jugular Swan-Ganz catheter, tip in right pulmonary artery.

Output: Right jugular Swan-Ganz catheter, tip in right pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: endotracheal tube position History: intubated Basilar atelectasis, unchanged, suggestive of mucous plugging or aspirated secretions.Heart size normal. ET tube tip approximately 4 cm above the carina. An NG tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: ET tube tip approximately 4 cm above the carina. Unchanged basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: rule out infection History: leukocytosis Basilar atelectasis worsening on the left, with an enlarging left pleural effusion.Small lung volumes.Large left renal staghorn calculus.

Output: Worsening basilar atelectasis with an enlarging left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: s/p emergent trachestomy History: s/p emergent trachestomy Tracheostomy tube is identified with its tip 5 cm above the carina.The cardiomediastinal silhouette is unremarkable.Lungs are clear.No pleural effusions.

Output: Tracheostomy in place without evidence of acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: et tube History: et tube ET tube tip approximately 4 cm above the carina.Small lung volumes with lower zone nonspecific opacity compatible with resolving edema, atelectasis and small effusions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: eval for effusion or pneumothorax History: s/p L thoracentesis No pneumothorax following thoracentesis. Unchanged pulmonary opacities and pleural effusions.Left PICC still extends quite far laterally on the right, probably in the SVC with rightward rotation of the patient and venous distention.

Output: No pneumothorax following thoracentesis. Stable pulmonary opacities and pleural effusions, and PICC.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: swan placement History: swan placement Left chest wall presternal ICD redemonstrated.Right IJ Swan-Ganz placed with its tip in the right pulmonary artery.No evidence of a pneumothorax.Persistent cardiac enlargement.The lungs are clear.No pleural effusions.

Output: Placement of right IJ Swan-Ganz without complication. Stable cardiac enlargement without specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Reason: leukocytosis; eval for signs of infection History: see above Mild left basilar opacity suggestive of atelectasis and consolidation, slightly increased compared to previous.No specific evidence of pneumonia.Shunt catheter projected over the right hemithorax.

Output: Focal left basilar opacity compatible with increasing consolidation and atelectasis, possibly secondary to aspiration and/or infection..


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: evaluate for pneumonia or pulmonary edema History: hypotension, afib Cardiomegaly with vascular congestion and predominantly basilar interstitial opacities likely representing pulmonary edema.No pneumothorax or significant effusions.

Output: Cardiomegaly with pulmonary edema


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old. Reason: cardiomegaly, pneumonia, effusion History: acute onset of sob 30 min prior to arrival, hx of afib and htn. Mild cardiomegaly with a tortuous calcified aorta, unchanged.No focal airspace opacity. No evidence of pneumothorax pulmonary edema or pleural effusion.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: 60yo M s/p recent intubation, assess for ETT position History: as above ET tube tip approximately 3 cm above the carina.NG tube coiled in the stomach.Partial clearing of bilateral opacities consistent with edema.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with history of hepatobiliary cancer and latent TB p/w shortness of breath. Right IJ port unchanged in position.Stable mediastinal widening at the level of the pulmonary arteries as well as splaying of the carina consistent with lymphadenopathy.Redemonstration of a stable retrocardiac nodular opacity.Mild lower lobe interstitial edema with septal thickening along with small bilateral pleural effusions, worse on the right.Underlying bibasilar opacities, right greater than the left.

Output: Increase in small pleural effusions and basilar interstitial opacity, worse on the right. Interstitial opacifications may be partially related to lymphatic/venous obstruction at the right hilum.Underlying bibasilar opacities suggestive of edema and/or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Device placement The new left subclavian ICD appears unchanged without evidence of new complication or change in lead tip positioning. No underlying cardiopulmonary alterations.

Output: ICD unchanged without postprocedural associated complication


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: r/o pneumothorax History: r/o pneumothorax 2 chest tubes are again noted in the right hemithorax. Small to moderate size right apical pneumothorax again noted. Patchy opacities in the mid and lower aspect of the right lung again noted. Slight increased thickening of the minor fissure. Left lung remains clear. Unchanged heart size. No acute bony abnormality.

Output: Small to moderate-sized right apical pneumothorax again noted. 2 right-sided chest tubes again noted.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: eval ETT, lung fields History: s/p CABG Right IJ introducer in place.Bilateral chest tubes with right chest tube at the lung base and left chest tube at the left apex.Subcutaneous emphysema along left lateral chest wall.No evidence of a pneumothorax.Decreased lung volumes with mild basilar atelectasis.Stable cardiomediastinal silhouette.

Output: ET tube not identified on this exam. Postoperative chest without evidence of complications.


Instruction: Generate impression based on medical findings.

Input: Reason: 35 YO M, PICC placed today, initiailly 6 cm too proximal; PICC pulled back the same distance, please verify distance. History: PICC line Interval adjustment of PICC catheter with the tip now in the SVC.Mild right basilar atelectasis and no acute change.

Output: Interval adjustment of PICC line.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: r/o pneumothorax / hemothorax / fluid collection History: SOB Post-PROCEDURE Pleuroscopy / Thoracoscopy Right pleural drains placed with drainage of pleural fluid and mild reexpansion of the right lower lung zone.No significant pneumothorax, but there is new right chest wall soft tissue emphysema.Mild subsegmental atelectasis left lower lung zone.

Output: Right chest tubes placed with drainage of fluid but no significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: swan History: swan Median sternotomy with mild cardiomegaly.Small pleural effusions unchanged with basilar subsegmental atelectasis.LVAD and ICD unchanged.Right jugular Swan-Ganz catheter tip in main pulmonary artery.

Output: No change in small pleural effusions or in support devices.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: serial evaluation of prior PNA History: inspiratory crackles Exam and ICD lead again noted in the left innominate.Cardiomediastinal silhouette is unremarkable.Focal peripheral left lower lobe airspace opacity slightly more consolidated than on the prior exam.No new pulmonary opacities identified.Calcified hilar mediastinal lymph nodes compatible with prior granulomatous disease.Median sternotomy is intact.

Output: Left lower lobe airspace opacity slightly more consolidated than on the prior exam and is consistent with pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: r/o asp pna History: leukocytosis Small lung volumes. Unchanged cardiomegaly. Enteric tube with tip coiled within the stomach. Multiple skin folds on the right. No focal pulmonary opacity to suggest pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: assess swan placement History: hypotension on pressors Swan-Ganz catheter tip in the right main pulmonary artery.Cardiomegaly and hazy opacity in the right lower lung consistent with effusion, atelectasis and possibly edema, slightly increased.No pneumothorax or other acute change.

Output: Swan-Ganz catheter tip in the proximal right main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: s/p new trach History: s/p new trach Faint basilar opacities are consistent with aspiration as seen on recent CT.Heart size normal, following median sternotomy.Dobbhoff tube high, the tip in the distal esophagus.Tracheostomy tube tip approximately 6 above the carina.Dense contrast material is present in the colon.

Output: 1. Dobbhoff tube tip above the hemidiaphragm level.2. Mild basilar interstitial opacities suggestive of aspiration as seen on recent CT.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: Chest pain The ICD lead is unchanged since the most recent film, however as previously noted it has rotated on its long axis since the chest radiograph dated 5/14/2015. The cardiomediastinal silhouette is normal. No focal opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: 14-year-old male with history of stab wound to left chest, rule out residual pneumothoraxVIEW: Chest AP (one view) 2/10/15 14:54 Interval removal of left chest tube and resolution of left apical pneumothorax. No focal pulmonary opacities or pleural effusions. The cardiomediastinal silhouette is normal.

Output: No significant residual pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 17 years old.Reason: Low grade myxofibrosarcoma of the left arm, evaluate for metastasis History: above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No sign of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Rule out infectious process History: LA of 19, concern for sepsis Mild perihilar opacities and right infrahilar subsegmental atelectasis, but no reliable evidence of infection.Moderate cardiomegaly.Left jugular catheter, tip at cavoatrial junction.

Output: Perihilar edema but no sign of infection.


Instruction: Generate impression based on medical findings.

Input: 29 years, Female. Reason: r/o obstruction History: s/p colectomy, hx of colon ca, ab pain Lungs clear. Subclavian catheter tip projects over superior vena cava.Nonobstructive bowel gas pattern. Expandable stent projects over the lower chest - upper abdomen.IVC filter. Surgical clips right upper quadrant.

Output: No evidence of obstruction.


Instruction: Generate impression based on medical findings.

Input: Reason: follow up pleural effusion History: esrd, gi bleed Large left pleural effusion, increased compared to previous with underlying atelectasis in the left lung. Mild nonspecific opacity at the right base, unchanged.

Output: Increasing left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: CHF, pneumonia History: SOB, Orthopnea Persistent edema, slightly improved.The lungs are better inflated than on the last study.Small pleural effusions persist.Mild cardiomegaly.No specific evidence of infection.

Output: Improving, but not yet resolved, pulmonary edema with small pleural effusions consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: pathology present that would be contributing to acute weight loss of 30 lbs in 1 month History: nausea, weight loss The cardiac mediastinal silhouette is within normal limits. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: r/o PTX, PNA History: chest pain Dual-lead pacemaker. No acute cardiopulmonary abnormality.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: evalaute for increase in pneumothorax History: pneumothorax Low lung volumes.Bibasilar opacities similar to prior, likely reflecting aspiration or atelectasis.Cardiomediastinal silhouette is normal.There is moderate gaseous distention of the stomach.

Output: No significant interval change


Instruction: Generate impression based on medical findings.

Input: Female 67 years old Reason: r/o mets History: none No focal airspace opacity.No pleural effusion or pneumothorax.The cardiomediastinal silhouette is normal.

Output: No evidence of metastatic disease. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Aspiration pneumonia. Cough. Worsening atelectasis at the right base, now with at least a small volume of pleural fluid bilaterally.Patchy airspace opacities bilaterally appear worse in the right lung, consistent with aspiration pneumonia. Slight worsening of right basal atelectasis. No significant change in appearance of the left.Mild superimposed edema.The cervical spine fixation hardware partially visualized.

Output: Worsening pneumonia in the right lung.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA, rib fracture History: sob, productive cough x 2 weeks, lateral chest wall pain Blunting of both posterior costophrenic angles, greater on the left, compatible with small effusions.Underlying pulmonary opacity on the left compatible with atelectasis and nonspecific airspace opacity.No pneumothorax and no displaced rib fractures.

Output: Small pleural effusions and underlying pulmonary opacity, greater on the left, of uncertain etiology. The differential diagnosis includes infection.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: intubation, pneumonia History: intubation Enteric tube extends beyond the field-of-view of study. Venous catheter tip in SVC. ET tube tip 5 cm above carina.Left base slightly better aerated. Otherwise no change.

Output: Improved aeration of left lung base, presumably improving atelectasis given rapid change.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: Evidence of pneumonia? History: CT imaging Lower lung zone the opacities appear to be scarring or fibrosis rather than infection.The heart is at least moderately enlarged with pulmonary vascular redistribution.There is no evidence of edema.Cholecystectomy clips are present.

Output: Cardiomegaly with basilar opacities suggestive of scarring or fibrosis. No reliable evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male 59 years old Reason: Left Temp Line plcmnt History: End-stage renal disease. Interval removal of a right internal jugular chest port and placement of a left internal jugular central venous catheter. Tip of the left IJ central venous catheter is at the cavoatrial junction.Hilar vascular prominence. No focal consolidation, pneumothorax, or pleural effusion is identified, although the right costophrenic angle is not adequately imaged.

Output: Left internal jugular central venous catheter tip at the cavoatrial junction with no significant pneumothorax identified.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Intubated. Acute respiratory failure. Asymmetric lung volumes, right greater than left. Extensive atelectasis in the left lung. Peripheral airspace opacities in the left lower lobe and lingula are improving. Right basal air space opacity persists. No pneumothorax. Tubes and lines similar in position, the Dobbhoff tube is coiled in the stomach.

Output: Persistence atelectasis in the left lung, though some of the air space opacities appear to be improving.


Instruction: Generate impression based on medical findings.

Input: Age: 20 yearsGender: MaleReason for Study: Reason: pneumothorax, hemothorax History: stab wound to R posterior shoulder The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified. There is no evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: et tube location History: tube location ET tube remains at carina.Stable mild cardiomegaly with bilateral effusions and patchy lung opacities. No pneumothorax.

Output: No significant change in position of endotracheal tube or patchy lung opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Bladder cancer status post cystectomy Left-sided 2-lead ICD in place.Unremarkable cardiomediastinal silhouette.No focal lung opacities or pleural effusions.

Output: No acute cardiopulmonary abnormality. No metastatic disease on radiography.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with history of ovarian cancer status post chemotherapy and surgery. CHEST:LUNGS AND PLEURA: Resolution of previously seen pleural effusions. No pulmonary opacities are visualized.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. The heart size is normal. No pericardial effusion. Aortic arch atherosclerotic calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal. The portal system and hepatic vasculature are patent. The gallbladder is normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal surgical clips are visualized. A 5.5 x 4.0 cm lymphocele is visualized in the right lower pelvis (series 3, image 155) which previously measured 3.3 x 2.2 cm.BOWEL, MESENTERY: No peritoneal seeding or soft tissue lesions. The bowel is normal in appearance.BONES, SOFT TISSUES: Healing of surgical site in anterior abdominal wall with evidence of wound healing.OTHER: Resolution of previously seen ascites.PELVIS:UTERUS, ADNEXA: Status-post hysterectomy with post surgical changes.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. Resolution of pleural effusions and ascites.2. Enlarged right cystic lesion, likely a lymphocele.3. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: s/p lvad, chest tube pulled on right side, please assess for pneumo thorax History: ct out Interval removal of right chest tube. Again demonstrated is the hydropneumothorax on the right, not significantly changed from prior examination. Left pleural effusion. Cardiomegaly is unchanged. Other support devices remain unchanged. Sternotomy devices intact. Right PICC terminates within the right axillary vein. Extensive right subcutaneous emphysema is likely secondary to prior chest tube.

Output: Interval removal of right chest tube with stable right hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: PNA History: Chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 47 old female status post sarcoma and lung METs. Check for metastases and compare with previous studies. LUNGS AND PLEURA: Multiple bilateral pulmonary metastases are grossly stable in size and number in comparison to previous study. The reference nodule in the right lower lobe previously measuring 12 x 11 mm on image 61/105 now measures 11mm in diameter best seen on image 46/101, series 5. Incidental note of azygous pseudolobe is reidentified. MEDIASTINUM AND HILA: No mediastinal adenopathy. Heart size within normal limits. No pericardial effusion. Calcified ductus arteriosus.CHEST WALL: No axillary adenopathy. UPPER ABDOMEN: Multiple calcific densities throughout the spleen most consistent with prior granulomatous disease.

Output: Overall stable appearance of multiple pulmonary metastases.


Instruction: Generate impression based on medical findings.

Input: Age: 82 yearsGender: FemaleReason for Study: Reason: eval for pneumonia History: pneumonia Stable cardiac mediastinal silhouette.Bronchial wall thickening and bronchiectasis with basilar airspace opacities slightly more pronounced on the prior exam.No large pleural effusions.Persistent elevation of left hemidiaphragm.Marked scoliosis of thoracolumbar junction.Partially imaged right shoulder prosthesis.

Output: Bronchial wall thickening with patchy airspace opacities slightly more pronounced at the right lung base than on the prior exam and may represent infection/atelectasis. CT of the chest may be of value.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: eval lung fields History: trached, vented Right-sided central venous catheters, left-sided pacemaker, and tracheostomy tube unchanged.Stable cardiomediastinal silhouette. Mild perihilar opacities similar to the prior exam.Probable small pleural effusions with interval decrease in left retrocardiac consolidation/atelectasis.

Output: Improved aeration within the left lower lobe. Persistent pulmonary edema and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: post-op History: post op Swan-Ganz catheter tip in the right main pulmonary artery.Bilateral perihilar opacities suggestive of edema with basilar atelectasis and small effusions.No new findings.

Output: Mild residual edema, atelectasis and small effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: CP History: above Large lung volumes suggestive of COPD.No other significant abnormality.

Output: COPD, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female 42 years old Reason: 42 F pre-op CXR, Hx of CHF History: pre-op Probable cardiomegaly with otherwise unremarkable mediastinal contour.Low lung volumes without specific evidence of edema or infection. No large pleural effusions.

Output: Probable cardiomegaly without acute pulmonary abnormality. More accurate assessment of cardiothoracic ratio may be obtained with PA/lateral study.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female with right-sided pleuritic chest pain PULMONARY ARTERIES: Exam is diagnostic quality. Pulmonary embolus in the pulmonary artery branch of the posterior segment of the right upper lobeLUNGS AND PLEURA: Scattered non-specific micronodules. No focal air space opacity or pleural effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Exam is diagnostic and positive for pulmonary embolus.


Instruction: Generate impression based on medical findings.

Input: Reason: confirm ETT placement History: ETT placement in OR ET tube tip approximately 6 cm above the carina.Small lung volumes with perihilar opacity suggestive of edema or aspiration secretions.Stent grafts in the descending aorta.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: eval for worsening infection, CHF History: hypoxic respiratory failure No substantial change in diffuse pulmonary opacities given differences in inspiration. No substantial change in bibasilar pleural-parenchymal opacities. Unchanged cardiomegaly. Small pleural effusions. No pneumothorax.

Output: No substantial change in diffuse pulmonary opacities given differences in inspiration. No substantial change in bibasilar pleural-parenchymal opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: ett History: - No evidence of an endotracheal tube.Small lung volumes with nonspecific basilar opacity compatible with effusions and atelectasis.The cardiac margins are scattered and there is probably some degree of cardiomegaly. Nonspecific right paratracheal mediastinal widening, which may be due to excess fat or lymphadenopathy.

Output: Pleural effusions and atelectasis, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: 45 years old Female. Reason: interval change History: chest tubes. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. Stable bilateral interstitial changes. The supporting devices are unchanged. However the left chest tube is kinked.

Output: The above findings are consistent with mild CHF.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with history of recurrent ovarian cancer CHEST:LUNGS AND PLEURA: Right middle lobe pulmonary nodule measures 8 mm on image number 66, series number 4 not significantly changedMEDIASTINUM AND HILA: Mediastinal adenopathy, unchanged. Index prevascular node measures 2.1 by 0.9-cm on image number 30, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cystic lesion in the liver is unchanged measuring 7.5 by 5.7 cm number 93, series number 3. No other focal lesions in the liverSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nodular left adrenal gland is unchanged.KIDNEYS, URETERS: Bilateral hydronephrosis, more prominent on the right compared to left is unchanged. Double-J stent in the right kidney is unchanged.RETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy, unchanged. Thrombus in the right gonadal vein is unchanged.BOWEL, MESENTERY: Midline hernia containing small bowel. Mesenteric mass measures 2.5 x 2.6 cm image number 124, series number 3. There is a larger component of this mass, also unchanged from previous study.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: Index left external iliac lymph node is unchanged measuring 2.7 by 1.9 cm number 169, series number 3. Extensive pelvic adenopathy invading pelvic vessels and ureters, unchanged.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: Reason: 64M w/ DKA/HHS, emesis, ams, History: AMS, Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 70 years old Male. Reason: IABP History: IABP placement. Stable elevation of the left hemidiaphragm with basilar atelectasis. IABP catheter tip is stable in position. Cardiac silhouette is stable. There is no evidence of acute infiltrate, pleural effusion or pneumothorax.

Output: Elevation of the left hemidiaphragm with basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube in place History: O2 use Left chest tube in place with a moderate residual effusion but no significant pneumothorax.Underlying opacity compatible with atelectasis.Resolving atelectasis at the right base.

Output: Left chest tube unchanged with residual effusion and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Headache. Ventriculoperitoneal shunt.VIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 01/25/16 Ventriculostomy tube tip is adjacent to midline in middle cranial fossa. Shunt tubing courses along the left head, neck, and chest. It enters the peritoneal space in the left upper quadrant. The caudal tip is laterally in the left midabdomen. No discontinuity is seen. Bowel loops are not displaced from the shunt tip.No focal lung opacity is identified. Bowel gas pattern is disorganized.

Output: No evidence of extracranial shunt malfunction.


Instruction: Generate impression based on medical findings.

Input: Female 49 years old with history of thyroid cancer, evaluate for metastasis. There is subtle focus of increased activity in left neck, which washed away after drinking water. There Is expected I-131 activity in the salivary glands, stomach, colon, and urinary bladder. No increased activity consistent with functioning thyroid tissue is seen.Probe uptake of the neck is 0.05%.

Output: No functioning thyroid tissue identified.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: eval for pulmonary edema History: dyspnea, cough Focal eventration of the posterior left hemidiaphragm. Low lung volumes with streaky basilar opacities of subsegmental atelectasis. Heart size is within limits of normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: S/P LVAD. Post-op. Eval for left pleural effusion History: Post-op Moderate to severe cardiomegaly with mild edema and left lower lobe consolidation.Small pleural effusions are present, left larger than right.Unchanged LVAD and ICD.

Output: Unchanged pulmonary opacities, cardiomegaly and left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: intubated ET tube tip approximately 4 cm above the carina.Bilateral basilar opacities consistent with pleural effusions and atelectasis, not significantly changed allowing for position and projection.Port catheter with its tip in the SVC.

Output: ET tube in acceptable position.