Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: resolution of PNA History: PNA Stable cardiomediastinal silhouette.Redemonstration of right mid and basilar consolidative opacities with a slightly decrease in size of right basilar effusion. Left lung remains clear.

Output: Redemonstration of right midlung and basilar pneumonia/aspiration with slight decrease in right basilar pleural effusion. Follow-up radiographs in 4-6 weeks after completion of treatment is recommended to ensure resolution.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with prostate cancer , status post radiotherapy. Complicated by radiation cystitis/proctitis enterovesicular fistula. CHEST:LUNGS AND PLEURA: Left pleural enhancing nodules suspicious for metastatic disease. A reference lesion measures 12 x 15 mm image number 67 on the left side posteriorly.MEDIASTINUM AND HILA: Small subcentimeter mediastinal lymph nodes. Small pericardial effusion.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: Air in the collecting system of both kidneys. Mild left hydronephrosis and hydroureter is unchanged. Mild calyectasis involving the right side. Punctate calcifications in the left kidney are unchanged.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: Proximal bowel loops are distended measuring up to 4.2 cm up to a transition point in the pelvis best seen on image number 174, series 9674, likely secondary to the ill-defined soft tissue density in the pelvis which may represent postradiation changes. The date dilatation of the small bowel as progress since previous CT.BONES, SOFT TISSUES: Sclerotic lesions in the left scapula, multiple thoracic vertebral bodies, sternum, ribs are highly suspicious for metastatic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Ill-defined, infiltrative soft tissue density encases the rectum, native bladder, bilateral pelvic sidewalls. It does not significantly change from previous CT. And ill-defined soft tissue density extends from the bladder to the subcutaneous tissue which may represent an old fistula tract.BLADDER: Negative bladder is encased by the dense fibrosis in the pelvis. Air in the major bladder may be secondary to infection versus N. Terry communication, unchanged from previous CT. Neobladder in the right lower quadrant.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic lesions in the pelvic bones and sacrum are suspicious for metastatic disease.OTHER: No significant abnormality noted

Output: Dense, infiltrative soft tissue density in the pelvis encasing the native bladder, causing small bowel obstruction.Extensive bone metastases. Left pleural based nodules suspicious for metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Cough and S.O.B.. Question resolving pneumonia. Normal heart size. Interval clearance of left lower lobe opacities. No signs of pneumonia. Unchanged micronodules, likely granulomas. Eventration of the right hemidiaphragm. Tortuous thoracic aorta with atherosclerotic calcifications.

Output: Interval clearance of left lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: eval L sided rib fx History: kicked in L side of chest, pain over L breast Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No displaced rib fracture or other traumatic abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: s/p extended pleurectomy, decort. CT in place History: asx Two right chest tubes, with a small amount of pleural air as well as right chest wall soft tissue emphysema. Basilar interstitial opacities are consistent with fibrosis

Output: Two right chest tubes with no large pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Parkinson's disease. DBS table migration through skin No appreciable underlying cardiopulmonary acute or subacute abnormality. Mild apical scarring greater on the right similar to prior studies and possibly partially exaggerated due to patient rotation and scoliosisG-tube projects over left upper quadrant.A pair radiopaque wires or tables project over the right shoulder and chest wall extending beyond the upper image of the image, possibly within the subcutaneous tissues. No underlying associated intrathoracic complication. CT evaluation may be indicated if further characterization or detail is needed

Output: Underlying mild scarring without acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: 35 year male non-seminoma germ cell tumor status post chemo. CHEST:LUNGS AND PLEURA: Punctate nodule into pulmonary nodes seen along the fissure on the left series 5 image 51 unchanged from several scans dating back to 7/15 2006. No new nodules. No effusions.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: Postsurgical changes. No pathologic-sized adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable punctate nodule left lung. No evidence of recurrence.


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old, alveolar soft part sarcoma with metastases, increasing pain and stool incontinence. Evaluate for change in tumor burden. CHEST:LUNGS AND PLEURA: Innumerable bilateral pulmonary nodules are again seen. The largest is in the right parahilar region adjacent to the minor fissure and measures 12 x 12 mm on axial image 44, series 4, not significantly changed. Many additional nodules are unchanged in size. However, several do appear to have increased slightly, including a nodule in the left major fissure which measures 9 x 10 mm on axial image 30, series 4, compared to 8 x 9 mm. A nodule at the right base on axial image 52, series 4, measures 6 mm compared to 4 mm previously. A left lower lobe nodule measuring 8 mm on axial image 51, series 4, may have increased slightly from 7 mm.MEDIASTINUM AND HILA: Left subclavian port catheter, tip in the right atrium.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Minimal pericholecystic fluid is seen again.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: A heterogeneously enhancing, partially necrotic left paraspinal mass measures 7.2 x 9.2 cm on axial image 112, series 5, which is slightly smaller when compared to 9.6 x 8.1 cm on the prior exam. Necrosis appears slightly more extensive on the current exam. BOWEL, MESENTERY: Feeding tube tip in the stomach.BONES, SOFT TISSUES: Laminectomy has been performed at the L3 and L4 levels. A lytic lesion within the lateral aspect of the L2 vertebral body measures 1.6 x 2.2 cm on axial image 102, series 5, not significantly changed. A lytic lesion with sclerotic margins within the vertebral body of L3 measures 2.1 x 2.3 cm, not significantly changed. A lytic, expansile lesion with sclerotic margins within the left pedicle of L4 measures 1.4 x 2.6 cm, not significantly changed. The vertebral bodies of L1, L2 and L3 demonstrate mild loss of height.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: Trace pelvic ascites.BONES, SOFT TISSUES: See above.OTHER: No significant abnormality noted.

Output: 1.Innumerable pulmonary nodules, a few of which demonstrate a slight interval increase in size.2.Interval decrease in the size of the left paraspinal mass.3.Stable vertebral body metastatic disease.4.No specific finding to account for bowel symptoms.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Left basilar scarring or subsegmental atelectasis, unchanged.Moderate cardiomegaly.No significant pneumothorax.Left subclavian dual-chamber pacemaker, leads unchanged in position.

Output: No pneumothorax following recent pacemaker placement.


Instruction: Generate impression based on medical findings.

Input: Clinical information: 50 year-old female with cough and wheezing. LUNGS AND PLEURA: Centrilobular emphysematous changes in the upper lung zones. No evidence of mosaic attenuation or air trapping.MEDIASTINUM AND HILA: Cystic nodule in the left lobe of the thyroid. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Large hypoattenuating lesion in the right lobe of the liver with peripheral nodular enhancement likely represents a hemangioma.

Output: Upper lobe predominant centrilobular emphysema.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: post biopsy evaluate for pneumothorax History: post biopsy Heart size is normal.Right apical nodule better seen on recent CT. No pneumothorax.No large pleural effusions.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with history of chest pain. Evaluate for edema or pneumonia. The cardiomediastinal silhouette is unremarkable. Diffuse bilateral reticular opacities are unchanged. No specific evidence of edema or pneumonia.

Output: Chronic bilateral reticular opacities with no specific evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: eval for lesions History: s/p OLT 1/17/16 for HCC, HCV Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Right lung calcified granuloma.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: r/o pneumonia History: leukocytosis of unknown origion Interval removal of right IJ central. Improved aeration of bilateral lungs compared to prior with faint residual reticular opacities noted at the bases. No associated consolidation or pleural effusion. Heart size remains normal.

Output: Significantly improved aeration when compared to prior. There are basilar groundglass opacities which are nonspecific. In the setting of fever, infection is a consideration and can be better evaluated with CT thorax.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: acute chest pain, type B dissection on CT History: as above Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Widening of the superior mediastinum noted consistent with given history of aortic dissection. Contrast noted within the bilateral renal collecting systems.

Output: Widening of the superior mediastinum consistent with history of aortic dissection.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.SOB. Status post AVR/CABG question pneumonia. Multifocal subsegmental atelectasis at the lung bases, slightly increased on the left. Volumes have decreased compared to prior.Partially visualized loops of dilated small bowel consistent with known PSBO. Valve prosthesis, sternotomy hardware and central skin staples are present.

Output: Multifocal basal atelectasis with slight increase on the left. No signs of pneumonia. Dilated bowel loops in the upper abdomen partially visualized; a high-grade PSBO was reported on a recent CT.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Altered mental status. Evaluate for pneumonia. Low lung volumes.No focal pulmonary opacity, pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: FemaleReason for Study: Reason: eval ETT History: cardiac arrest ET tube with its tip 4 cm above the carina.NG tube with its tip in the stomach.Stable cardiomediastinal silhouette.Bilateral perihilar dense pulmonary opacities are similar in appearance to the prior exams.Pleural effusions and basilar atelectasis, better seen on recent CT.

Output: Support devices unchanged. Cardiopulmonary appearance with dense perihilar opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for acute cardiopulmonary process History: AMS Dilated aorta with a stent graft in place.Blunting of the left costophrenic angle compatible with pleural effusion or scarring.No evidence of CHF or infection.

Output: Possible left pleural effusion versus scarring and no other acute findings.


Instruction: Generate impression based on medical findings.

Input: Mental status change. Rule out bleed. Mildly to moderately motion degraded exam. Within this limitation, no evidence of intracranial bleed. Mildly prominent extra-axial space and sulci consistent with brain parenchymal volume loss. Minor patchy periventricular and subcortical white matter low attenuation again seen. Gray-white differentiation is preserved. No hydrocephalus or midline shift. Mild to moderate vascular calcifications. Marked opacification of right mastoid air cells and right middle ear cavity, new since previous. Nasopharyngeal tube in place. Mild left maxillary sinus mucosal thickening, amount of healing change. Mild opacification of the left inferior mastoid air cells. Otherwise, the rest of the chest are new sinuses are clear.

Output: 1. Motion degraded exam. Within this limitation, no acute intracranial abnormalities. 2. Interval development of new congestive/inflammatory disease, severe in the right and mild left mastoid, new in the right middle ear cavity.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: ACS History: CP Low lung volumes without specific evidence of infection or edema. No large pleural effusion or pneumothorax. The heart size normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: pna? History: sob Unremarkable cardiac and mediastinal silhouettes. No pulmonary or pleural abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: ett placement History: ett placement ET tube about 2.5 cm above the carina.Gastric tube extending below the inferior margin of the radiograph.Other findings unchanged.

Output: Slightly low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Age: 77 yearsGender: FemaleReason for Study: Reason: cardiac History: CP The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.Marked degenerative joint disease involving the glenohumeral joints bilaterally suggesting this is neuropathic in origin.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: eval for RLL PNA History: cough, RUQ abd pain Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: FemaleReason for Study: Reason: swan placement History: swan device Right IJ Swan-Ganz and left-sided ICD unchanged.Stable cardiac enlargement.Mild basilar subsegmental atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Port device unchanged with Swan-Ganz catheter tip in the pulmonary artery. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male status post esophagectomy for adenocarcinoma, now presenting with elevated white cell count and foul smelling discharge from an open midline abdominal wound. Evaluate for anastomotic leak and intra-abdominal abscess. CHEST:LUNGS AND PLEURA: Postoperative changes as described below cause volume loss and compressive atelectasis of the right lung. A pleural effusion is noted on the right. No evidence of air within the effusion. No suspicious nodules or masses.MEDIASTINUM AND HILA: The patient is status post esophagectomy with gastric pull-up. No evidence of anastomotic leak. The stomach is distended with contrast material somewhat more than expected, but contrast passes freely through the anastomosis into the small bowel.The previously referenced AP window lymph node is not identifiable on the current exam.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: A previously referenced EG junction lymph node is no longer identifiable.BOWEL, MESENTERY: No evidence of free or loculated intra-abdominal fluid.BONES, SOFT TISSUES: A midline abdominal wall defect is evident with some subcutaneous gas.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: See above.OTHER: No significant abnormality noted

Output: 1.Postoperative changes as described above. The anastomosis is intact. 2.No evidence of loculated fluid within the abdomen to suggest abscess. 3.Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: r/o pneumonia History: febrile, SOB No significant cardiopulmonary abnormality.Right jugular catheter, tip in SVC.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: r/o pneumonia History: cough Moderate to severe cardiomegaly with pulmonary vascular redistribution.Increased interstitial markings are present but there is no reliable evidence of edema or pneumonia.

Output: Cardiomegaly, without acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: ETT placement after 3 cm advancement. Endotracheal tube tip 3.5 cm above the level of the carina. Left jugular introducer, Swan-Ganz catheter and Impella device similar in position. The right chest tube takes an unusual course, looping over the apex prior to terminating inferolaterally in the projection of the lower thorax. No pneumothorax.

Output: ETT tip 3.5 cm above the level of the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Positive TB skin test. No significant cardiopulmonary abnormality.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: 63 M with h/o MDRO infection here with AMS, r/o PNA History: AMS There are decreased lung lies a stable mild cardiac enlargement.Mild basilar atelectasis without focal areas of consolidation.No pleural effusions.

Output: Mild basilar subsegmental atelectasis. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Leukocytosis Persistent and relatively unchanged retrocardiac left lower lobe opacities with a small layered bilateral pleural effusions. Right lung otherwise remains unchanged and grossly clear.Mild cardiomegaly and unchanged mediastinal contours

Output: Retrocardiac nonspecific consolidation and effusions


Instruction: Generate impression based on medical findings.

Input: Age: 81 yearsGender: FemaleReason for Study: Reason: 81F with SOB, c/f PNA , vs MI, obstructive disease History: SOB, CP Decreased lung volumes with stable Carty mediastinal silhouette.The lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Shortness of breath, decompensated heart failure. Left subclavian ICD unchanged.Interval improvement in pulmonary edema pattern, now mild to moderate.No pneumothorax.Right jugular catheter can be followed to the SVC level but the tip is obscured.

Output: Mild to moderate CHF.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: eval for NP fever source History: NP fever Left PICC line with its tip in the SVC.Stable mild cardiac enlargement.Nonspecific basilar opacities compatible with atelectasis.No new pulmonary opacities identified.

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


Instruction: Generate impression based on medical findings.

Input: 62 year old female with history of pancreatic cancer CHEST:LUNGS AND PLEURA: Previously described, increased attenuation adjacent to the minor fissure on the right side is unchanged measuring 1 x 0.5 cm on image number 45, series number 5. Right lower lobe nodule is unchanged image number 58 on series number 5. Left lower lobe nodule in image number 92, series number 5, unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Pneumobilia, unchanged. Metallic stent in the common bile duct, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Severe atrophy of the pancreas with abrupt cutoff near the region of the pancreatic head, unchanged. Ill-defined mass adjacent to the superior mesenteric vein cannot be well differentiated from the surrounding tissues and cannot be accurately measured. Within these limitations of smaller measuring 2.1 x 1.6 cm on image number 109, series number 3. Soft tissue infiltration in the porta hepatis region is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild wall thickening of duodenum is unchanged. Enlargement and thick vessels are unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Although difficult to measure, patient's known pancreatic head mass is slightly smaller. Otherwise, no significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Reason: Respiratory failure History: Respiratory Failure ET tube, esophageal stent and left pleural drain unchanged.Diffuse nonspecific airspace and interstitial opacity. No new findings.

Output: Extensive bilateral nonspecific pulmonary airspace opacity, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: sickle cell cp History: cp No focal lung opacity, pleural effusion, or pneumothorax. Cardiomegaly is unchanged. Osseous stigmata of sickle cell disease. Right upper quadrant surgical clips.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain, eval for edema, PNA History: as above ICD leads and venous catheter unchanged.Cardiomegaly and diffuse chronic interstitial disease, better demonstrated on a recent CT scan possibly with a component of superimposed interstitial edema.No new findings.

Output: Severe cardiomegaly and chronic interstitial disease, possibly with superimposed interstitial edema at the lung bases.No sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: FemaleReason for Study: Reason: s/p lung transplant History: POST-OP LUNG TRANSPLANT; ADMISSION TO ICU ET tube is in place with its tip 1 cm above the carina.Right IJ Swan-Ganz in place with its tip in the pulmonary artery.Two left-sided chest tubes placed with their tips at the lung base and apex.No pneumothorax identified.Minimal moderate subcutaneous emphysema along left lateral chest wall.Stable cardiomediastinal silhouette.Decrease lung volume on the right with diffuse interstitial opacities compatible with known pulmonary fibrosis.Postoperative left lung without complication.

Output: Status post left lung transplant. ET tube is somewhat low position with its tip 1 cm above the carina. Subsequent imaging demonstrates appropriate positioning.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Acute myocardial infarction, trach. Markedly low lung volumes with architectural distortion related to bodily habitus. Small left pleural fluid collection. Bilateral basal and dependent atelectasis, left greater than right.Endotracheal tube is present. The carina is not clearly visualized but the tube tip is just above the expected level.

Output: Bilateral basal atelectasis, left greater than right. Possible small left pleural effusion. Given asymmetry, the possibility of infection on the left may be considered in the appropriate clinical context.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: eval fluid overload History: rr 50s The patient has been intubated. Endotracheal tube terminates 3 cm above the carina. Nasogastric tube terminates inferior to the caudal margin of the image. A right subclavian catheter is visualized to the mid superior vena cava.There has been significant progression of the bilateral airspace opacities over the last 24 hours. The differential diagnosis includes pulmonary edema, aspiration or multifocal infection. No significant pleural effusion or interval pneumothorax is identified. The cardiac silhouette is obscured by the parenchymal opacities.

Output: Marked progression in the bilateral airspace opacities which are nonspecific. Considerations include pulmonary edema, multifocal infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: s/p intubation History: as above Moderate cardiomegaly with focal atelectasis in the right mid lung and patchy opacity in left lung base.ET tube tip approximately 4 cm above the carina.Right subclavian catheter, tip in SVC.

Output: ET tube tip approximately 4 cm above the carina. Nonspecific atelectasis may be from aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: s/p TECAB History: s/p TECAB Unchanged 11 mm right apical pneumothorax.Left lower lobe consolidation improved with persistent left effusion.Minimal atelectasis right lung base.Heart size normal.A Dobbhoff tube terminates in the stomach.Right jugular catheter removed.

Output: Improving left lower lobe consolidation with no new findings. Stable right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: pleurx catheter manipulation, rule out PTX History: see above Pleural drains do not appear substantially different position compared to previous study. The right pleural drain may have been pulled back slightly. Other iatrogenic devices, not substantially different. Low lung volumes, as before. Left greater than right bibasilar opacities. Small pleural effusions, as before. Unchanged cardiomegaly. No pneumothorax.

Output: Right pleural drain have been pulled back slightly. Left greater than right bibasilar opacities persist. Persistent small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p LVAR, RVAD Interval extubation. Other devices unchanged.Small lung volumes with basilar nonspecific opacity compatible with atelectasis and small effusions.No pneumothorax.

Output: Interval extubation and no other acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old. Metastatic colon cancer. Persistent tachycardia. Concern for effusion or related intrathoracic process. Unremarkable cardiac and mediastinal silhouette. Unchanged left chest port.Bilateral nodules consistent with known metastases.No evidence of infection or edema. No large pleural effusion.

Output: Bilateral pulmonary metastases without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: r/o PNA, aspiration History: AMS Small lung volumes.Left subclavian pacemaker, leads unchanged in position.

Output: Small lung volumes, without acute infection or edema. No evidence of aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Lung cancer and CHF. Motor vehicle collision. Left ICD with leads unchanged. Asymmetric opacity at the left apex which could represent costochondral junction calcification. No focal consolidation, pleural effusion or pneumothorax. Unchanged extra pulmonary opacity along the lateral hemithoraces. Normal cardiomediastinal silhouette.

Output: No acute cardiopulmonary process. Asymmetric opacity at the left apex which could represent costochondral junction calcification. However, this may represent an underlying lung lesion. Correlation with chest CT is suggested if not recently performed.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: History of sarcoma status post 20 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: Stable 4 mm micronodule adjacent to the right oblique fissure (series 5, image 40), consistent with intrapulmonary lymph node. No new suspicious nodules or pleural effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right chest port tip in the SVC. Small hiatal hernia.ABDOMEN:LIVER, BILIARY TRACT: Stable moderate intrahepatic biliary ductal dilatation. Cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Stable mild pancreatic ductal dilatation with atrophy of the body.ADRENAL GLANDS: Stable left adrenal nodule.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The large, heterogeneous retroperitoneal mass which is situated posterior to the pancreatic head has mildly increased in size, now measuring 6.0 x 5.4 cm (image 96 series 4), previously 5.2 x 4.8 cm. The mass displaces and compresses the adjacent IVC without a defined fat plane between the two. The vasculature remains patent.Left periaortic lymph node is unchanged.Mild infrarenal abdominal aortic aneurysm with extension to the bifurcation is stable as is the borderline aneurysmal dilatation of the right common iliac artery.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Hysterectomy. The hypodense right adnexal lesion again measures 3.4 x 2.6 cm (series 4, image 156), not significantly changed.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Severe degenerative changes in the spine without suspicious focal osseous lesion.OTHER: No significant abnormality noted.

Output: Slight enlargement of retroperitoneal mass. Otherwise, stable examination.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: r/o pneumonia History: cough Cardiomegaly with large central pulmonary arteries consistent with pulmonary arterial hypertension. Mild chronic scarring, but no acute edema or pneumonia.IVC catheter or biliary stent unchanged.

Output: Mild cardiomegaly with pulmonary arterial hypertension. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with history of breast cancer CHEST:LUNGS AND PLEURA: Index right upper lobe nodule has increased in size and now measures 9 by 6 mm on image number 18, series number 5. Other bilateral nodules are also increased in size within the interval.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Ulcerated, fungating right breast mass with solid and cystic components is increased in size now measures 19.6 by 8.8 cm on image number 41, series number 3. It's difficult to separate this mass from right axillary lymph nodes.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: IVC filter is in place. Shotty retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right adnexal mass measures 3 by 2.9 cm on image number 164, series number 3, stable.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: Left external iliac vein thrombus.

Output: Interval increase in the size of the right breast mass and bilateral lung metastases.Right ovarian mass is unchanged. Left external iliac vein thrombus.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluation POD 1, s/p wedge resection left side History: s/p left wedge resection Left chest tube directed medially at the level of the hilum with no significant pneumothorax.Volume loss and opacity in the left lower lung consistent with atelectasis and a small effusion.

Output: Postoperative findings with no acute change.


Instruction: Generate impression based on medical findings.

Input: 79 year-old female with metastatic neuroendocrine tumor. CHEST:LUNGS AND PLEURA: Stable bilateral micronodules.MEDIASTINUM AND HILA: Reference left supraclavicular adenopathy measures 3.6 x 2.3 cm on image number 4, series number 8. Reference left paratracheal lymph node best seen on image number 7, series number 8 measures 2.4 x 1.7 cm , not significantly changed. Reference left paratracheal lymph node measures 15 x 14 mm image number 30, series number 8, again not significantly changed from previous study.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable, numerous bilobar hepatic metastases. Reference segment 6 right lobe mise lesion measures 6.9 x 5.5 cm image number 121, series number 8.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant change in the extensive bulky retroperitoneal, portacaval and mesenteric adenopathy. Reference left pararenal mass measures 5.9 x 4.9 cm in image number 96, series number 8, not significantly changed compared to previous study.BOWEL, MESENTERY: No change in mesenteric adenopathy.BONES, SOFT TISSUES: Sclerotic T7 vertebral body lesion is unchanged. Sclerotic focus on L2 vertebral body is also unchanged.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pneumonia History: neutropenic fever Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Retrocardiac midline opacity consistent with a hiatal hernia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: Is there freely flowing fluid on the L side? History: shortness of breath Left down decubitus radiograph shows free flowing left-sided effusion.

Output: Free flowing left-sided effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Evaluate lines/tubes/devices. Support devices unchanged.Cardiomegaly with mild vascular congestion suggesting mild CHF. No pneumothorax.

Output: Mild CHF. Interval slight improvement in vascular congestion.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: MaleReason for Study: Reason: eval ETT, lung fields History: s/p AVR ET tube with its tip approximately 4 cm above the carina.Right IJ Swan-Ganz with its tip in the pulmonary artery.Chest/mediastinal tubes in place without evidence of a pneumothorax.Mild cardiac enlargement with left retrocardiac atelectasis increased from the prior exam.

Output: ET tube in satisfactory position. Increasing left retrocardiac atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: history of ABPA, lost to follow up History: shortness of breath/wheeze Large lung volumes with extensive bilateral opacity consistent with bronchiectasis and ABPA.Focal tubular opacities in the left upper lobe are compatible with mucoid impaction secondary to ABPA.Interval resolution of a small right apical pneumothorax with surgical staples in the right apical area.Pleural scarring at right costophrenic angle.

Output: Extensive pulmonary abnormalities consistent with known ABPA (Allergic Bronchopulmonary Aspergillosis). No new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: evaluating for pna History: fever, Tm 103, cough worsening x 10d, Mild bronchial wall thickening, otherwise unremarkable. No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female 59 years old with cough and fever, dilated for infection Left axillary surgical clips noted.Stable cardiomediastinal silhouette. Mild basilar predominant interstitial opacities with septal lines and trace pleural effusions. No pneumothorax.

Output: Mild pulmonary edema. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p AVR/CABG History: SOB Small lung volumes with basilar opacity compatible with atelectasis and effusions, not significantly changed.Intact sternotomy fixation devices.

Output: Atelectasis and pleural effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: Shortness of breath, COPD. The cardiomediastinal silhouette is normal. Prominent hila compatible with known sarcoidosis. Mild bibasilar atelectasis. No pleural effusion or pneumothorax.

Output: Bibasilar subsegmental atelectasis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: required for job overseas History: asymptomatic Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: rule out pneumonia History: coughing Known pulmonary metastases and moderate size left pleural effusion.Small right effusion.Left jugular catheter tip at SVC level.Contrast material remains in the colon where there are numerous diverticula.

Output: Pulmonary metastases and pleural effusions unchanged, with no new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Tachypnea, pneumonia. History of amyloidosis postobstructive pneumonia. Bulky ossified lymphadenopathy in the chest and visualized neck with poor visualization of the lobar airways on the left. Interval near complete opacification of the left hemithorax. Small volume of pleural fluid on the right is unchanged.

Output: Near complete opacification of the left hemithorax, likely a combination of pleural fluid and postobstructive pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Reason: evaluate for pneumonia History: cough, fever, shortness of breath Cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax. No focal pulmonary opacity.

Output: No specific findings of pneumonia. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Question heart failure and infected pacemaker. Volume overload. Cardiomegaly and severe enlargement of the central pulmonary vasculature. The right subclavian pacemaker lead extends in a redundant fashion for short distance cranially into the right jugular vein before descending to terminate in the right ventricle. I am unable to assess the integrity of the lead where it is angulated on this frontal radiograph. Surgical staples project over the right pulse generator pocket. A left jugular single lead pacemaker also terminates in the projection of the right ventricle.Mild atelectasis and hazy opacity suspicious for edema.

Output: Mild CHF. The right subclavian pacemaker lead is angulated as it extends into the right jugular vein for a short distance before coursing centrally.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: s/p R lung transplant, eval for new opacities or changes History: s/p R lung transplant Endotracheal tube terminates 4 cm above carina. Nasogastric tube has been retracted with the sidehole immediately inferior to the level of the carina. The left port remains accessed.Mid to lower zone opacities with left greater than right pleural effusions have remained stable compared to 4.5 hours earlier. The chin obscures the right apex. No significant pneumothorax is present.

Output: No significant change in the mid to lower zone bilateral pulmonary opacities and right greater than left pleural effusions. Nasogastric tube side hole is in the mid esophagus.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: assess for pulm edema History: s/p OHT Left-sided pacemaker unchanged.Stable mild cardiac enlargement.No focal airspace opacities.No pleural effusions.Median sternotomy is intact.

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


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Shortness of breath. Evaluate effusion. Low lung volumes. Interval enlargement of large right pleural effusion, with adjacent compressive atelectasis.Cardiomediastinal silhouette is unchanged.Right chest wall port with tip in SVC.

Output: Interval enlargement of large right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male continues to spike fevers despite antibiotics. Increased white cell count. Characterize any infection abdomen or pelvis or chest. The study is limited due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Consolidation in the right upper lobe and apical segment of right lower lobesuspicious for pneumonia. Endotracheal tube is in place.Additional patchy groundglass opacities in the lingula and bilateral lower lobes may also represent pneumonia versus atelectasis. Subsegmental atelectasis in lung bases.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Bilateral borderline enlarged axillary lymph nodes of uncertain etiology.ABDOMEN: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: Limited study due to lack of IV contrast. Right upper and lower lobe consolidation and bilateral patchy ground glass air space opacities suspicious for pneumonia. No CT evidence of intra-abdominal infection.Nonspecific bilateral axillary lymph nodes.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with history of vaginal cancer CHEST:LUNGS AND PLEURA: Interval appearance of numerous nodules, predominantly in the right lung suspicious for metastatic disease. Changes secondary to partial resection of the right lower lobe. There is diffuse pleural thickening in the right lower lobe and an ill-defined mass that cannot be differentiated from the atelectatic residual right lower lobe. This mass invades the anterior abdominal wall and fistulized to the skin. These are suspicious for recurrent and metastatic disease.Reference right upper lobe nodule measures 7 x 7 mm image number 49, series number 5.Interval increase in the size of the left lung nodules, largest is in the left lower lobe.MEDIASTINUM AND HILA: New mediastinal necrotic adenopathy and interval increase in the size of some of the mediastinal lymph nodes. A reference precarinal lymph node measures 2.1 x 1.3 cm on image number 41, series number 3..CHEST WALL: New necrotic metastases in the anterior right chest wall. A reference nodule measures 16 x 10 mm image number 1031, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific, subcentimeter hypodensity left lobe liver is stable. Minimal prominence of the intrahepatic biliary tree persists.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: New subcentimeter soft tissue nodules inferior to the right lobe of the liver, suspicious for peritoneal carcinomatosis. A reference lesion measures 5-mm image number 119, series number 3.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval progression of disease with development of numerous new lung metastases, new mediastinal adenopathy, chest wall lesions and peritoneal carcinomatosis.Interval development of an infiltrative soft tissue mass in the right lower lobe causing pleural thickening and also invading the anterior abdominal and chest wall.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: r/o pneumonia History: leukocytosis The heart is normal in size.Lung volumes in the upper limits of normal. No abnormal focal lung opacities.Right posterior pleural thickening is noted. No pneumothorax.No osseous lesions are present.The partially visualized catheter in the left upper quadrant of the abdomen is no longer seen. Cholecystectomy clips are noted.

Output: No radiographic findings to suggest pneumonia, as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: rising WBC, assess for infection History: rising WBC Right tunneled internal jugular catheter tip projects over the cavoatrial junction.Low lung volumes. Continued improvement in left basilar opacity with some residual left basilar atelectasis. No new focal pulmonary opacities. No pleural effusions or pneumothorax.

Output: Continued improvement in left basilar opacity without evidence of new infection.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: 35yr old male with history of testicular cancer; pre-auto sct evaluation History: evaluate Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Right jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.COPD Mediastinal tubes/drains are unchanged.Severe cardiomegaly with decrease in pneumopericardium.Right basilar airspace opacity compatible with atelectasis/scarring not significantly changed since the prior exam.No pneumothorax. Probable small pleural effusions.

Output: No significant change in cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Swan Gantz placement Right jugular Swan-Ganz catheter tip projects over the proximal right superior pulmonary artery.Unchanged cardiomegaly.Diffuse hazy opacity and septal thickening consistent with mild/moderate pulmonary edema, about the same.No pneumothorax.

Output: Unchanged mild to moderate pulmonary edema. Stable position of the Swan-Ganz catheter tip.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: post-op day 2 History: post-op day 2 Left chest tube removed with no pneumothorax.Small left pleural effusion and left basilar subsegmental atelectasis, the lungs better inflated.Right jugular catheter removed.

Output: No pneumothorax following left chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: ? pna History: rll wheeze Unchanged cardiomegaly.Interstitial opacities suggestive of pulmonary edema are stable to minimally worsened when compared to prior.No significant pleural effusion or pneumothorax.

Output: Cardiomegaly and pulmonary edema, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old. IABP marker identified in the proximal descending aorta.The cardiomediastinal silhouette is unremarkable.Calcified granuloma in the right lower lung zone.No focal airspace opacities.No pleural effusions.Again noted are bilateral shoulder arthroplasties and cervical stabilization hardware.

Output: IABP marker in the proximal descending aorta. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: intubated, assess interval change History: see above ET tube now advanced to 2.5 cm above the level of carina. Support devices unchanged.Redemonstration of mediastinal mass. No new focal opacities.

Output: ET tube advanced to 2.5 cm above the carina. No significant change in the cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with COPD and right upper lobe nodule. LUNGS AND PLEURA: Right upper lobe nodule is unchanged measuring approximately 6 x 4 mm on high-resolution axial image 81/281. A follow-up exam is recommended in 9/2008. Left lower lobe scarlike opacity has decreased in size (axial image 74/94).Mild centrilobular emphysema unchanged. No pleural effusions.MEDIASTINUM AND HILA: Cardiac size is normal with no pericardial effusion. No significant hilar or mediastinal lymph nodes.CHEST WALL: Patient is status post median sternotomy. A left chest wall pacemaker generator is noted. Diffuse irregularity of bone mineralization noted which is unchanged and probably not clinically significant.UPPER ABDOMEN: No significant abnormality noted.

Output: Unchanged right upper lobe nodule. Continued follow-up recommended for September 2008. Left lower lobe scarlike nodule has decreased in size.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with retroperitoneal hematoma CHEST:LUNGS AND PLEURA: Centrilobular emphysematous changes. Trace bilateral pleural effusions are now seen. Bibasilar consolidations are noted, mildly increased.MEDIASTINUM AND HILA: ET tube. NG tube. Small mediastinal nodes unchanged. Central venous catheter tip in the superior vena cava.Visualization of the walls of the cardiac chambers is compatible with anemia.CHEST WALL: No significant abnormality notedABDOMEN: The exam is not sensitive for detecting lesions in the bowel or solid organs due to the lack of intravenous and lack of oral contrast. Given the limitations, the following observations are made.LIVER, BILIARY TRACT: The amount of perihepatic/subcapsular fluid has slightly decreased, with a significant decrease in the hyperdense component.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No adenopathy. Focal bulging right aspect of the mid abdominal aorta unchanged.BOWEL, MESENTERY: No significant abnormality.BONES, SOFT TISSUES: Midline surgical staples consistent with a history of recent surgery. OTHER: No significant abnormality. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of layering fluid.

Output: Evolution of the perihepatic/subcapsular fluid collection, with slight decrease in size. Mild increase in the bibasilar consolidations.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: is there free air History: abdomen pain No specific evidence of infection or edema.Small lung volumes.No free air.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female history metastatic pancreatic cancer per history, has ? biliary obstruction. Please evaluate pancreatic mass, biliary dilatation, metastases. Nausea. Rectal bleeding. CHEST:LUNGS AND PLEURA: There is a large right pleural effusion and a somewhat smaller left pleural effusion. There are several lung nodules at least 4 on the left and 3 on the right concerning for metastases. The largest lesion is in the left upper lobe series 4 image 18, measuring 1.2 x 1.1 cm.MEDIASTINUM AND HILA: Heavy calcification in the distribution of the left lobe of the thyroid. Atherosclerotic changes in the aorta. Small midline cardiophrenic node.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs and for measuring tumor due to the lack of intravenous contrast. Given that limitation, the following observations are made:LIVER, BILIARY TRACT: The liver has a retracted nodular surface and underlying cirrhosis cannot be excluded. Heterogeneous large hypodensities replace the liver parenchyma consistent with metastases, but too ill-defined and irregular to measure for baseline purposes. There is no obvious biliary dilatation.SPLEEN: Calcification is seen in the splenic artery and there is a probable small splenic artery aneurysm measuring about 1.1 cm in diameter, series 3 image 78.PANCREAS: There is a soft tissue mass in the distribution of the body of the pancreas with loss of fat plane to the posterior gastric wall. I estimate the mass at the 5 x 2.9 cm as seen on series 3 image 90.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Probable cyst right upper pole with an adjacent punctate calcification.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymph nodes. Atherosclerotic calcifications. No evidence of aneurysm.BOWEL, MESENTERY: There is moderate generalized ascites concerning for carcinomatosis but no solid masses seen. Adenopathy is seen in the gastrohepatic ligament. The largest node is seen on series 3 image 84 measuring 2 x 1.3 cm. BONES, SOFT TISSUES: Anasarca.PELVIS:UTERUS, ADNEXAE: Atrophic.BLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Generalized ascites. Some thickening of small bowel folds possibly related to hypoproteinemia. Also thickening of folds in the right colon. No evidence of obstruction.BONES, SOFT TISSUES: Anasarca. Infra-umbilical soft tissue nodule in the anterior abdominal wall could represent a metastatic focus. It measures 2.3 x 1.9 cm is seen on series 3 image 150.OTHER: Left femoral venous catheter.

Output: Probable mass pancreatic body with adenopathy in the gastrohepatic ligament. Generalized ascites. Hepatic masses likely metastases a retracted contour also concerning for underlying cirrhosis correlate clinically. Pleural effusions. Multiple lung nodules consistent with metastases. Small splenic artery aneurysm. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and check for CHF Marked interval decrease in the size of what is now a small to moderate right and small left pleural effusions. Underlying compression atelectasis with mild nonspecific cardiomegaly. Upper lungs otherwise clear.Right PICC line remains well positioned, tip extends into the upper SVC

Output: Interval decreased right pleural effusion, currently moderate in size


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old. Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Scoliosis with a narrow AP diameter. No pneumothorax. The lungs are clear. No pleural effusion. The heart size is normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: eval lungs and mediastinum History: chest pain Median sternotomy presumably for CABG.No significant pulmonary or pleural abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Pulmonary edema. Hypoxic respiratory failure. Left subclavian ICD unchanged. Cardiomediastinal silhouette is enlarged, similar to previous.Diffuse pulmonary opacities without significant change. Moderate volume of pleural fluid.

Output: Diffuse pulmonary opacities and pleural fluid, most consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: 74 years old Female. Reason: r/o pneumonia History: dyspnea, tachycardia. Cardiomegaly with small lung volumes.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions, unchangedSmall right upper lobe nodule, previously characterized by CT scan and consistent with a hamartoma.

Output: Cardiomegaly with probable CHF, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: Evaluate for right-sided etiologies of chest pain History: Acute onset SOB last night, right sided, comes and goes, non-exertional Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: Status post mediastinal drain removal History: Removal of mediastinal drain Interval removal of mediastinal drain. Lines and tubes are otherwise unchanged. Bibasilar opacities and pleural effusions again noted. Unchanged heart size. No pneumothorax.

Output: Interval removal of mediastinal drain. Lines and tubes are otherwise unchanged. Bibasilar opacities and pleural effusions again noted.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumothorax, improvement in pleural effusion History: s/p thoracentesis Very small right apical pneumothorax which is increased on the subsequent radiograph.Interstitial opacity, lymphadenopathy and small effusions unchanged.

Output: Small right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Chest tightness and SOB. Normal cardiac mediastinal silhouette. No focal airspace opacities, pleural fluid or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Cardiomegaly with lower lung zone opacities suggestive of edema.No significant pneumothorax.

Output: CHF with edema. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: ? PNA History: wheezing and SOB (L>R) Cardiomediastinal silhouette is within normal limits. No large pleural effusions or pneumothorax. No focal pulmonary opacity. Bronchial wall thickening.

Output: Bronchial wall thickening may be secondary to asthma or URI.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: chest tube placement, PTX resolution History: chest tube in place Stable right chest tube with no large pneumothorax.Extensive right chest wall soft tissue emphysema still extends into the supraclavicular region.Severe emphysema is stable.

Output: Unchanged right chest tube with no large pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Presented with hypoxia. Dual-chamber ICD lead positions are unchanged. The heart size is within normal limits. No focal lung opacities are visualized. No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate ppm placement History: recent ppm placement Pacemaker device with a single lead extending to the area of the anterolateral wall of the right ventricle.Status post TAVR.Basilar interstitial edema and small pleural effusions.No significant change allowing for inflation and projection.

Output: CHF with no significant change.


Instruction: Generate impression based on medical findings.

Input: 32-year-old female with colorectal cancer metastatic to the lung status post colectomy and lung resection. CHEST:LUNGS AND PLEURA: Large partially loculated right-sided pleural effusion. Numerous lung nodules in the left lung. The reference nodule measures 10-mm in diameter on image number 56, series number 3.Multiple peritoneal right-sided nodules suspicious for metastatic disease. Smaller deposits male some present on the left side.MEDIASTINUM AND HILA: Ill-defined soft tissue mass invading the right hilum measuring 5.3 x 2.6 cm image number 38, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatic cyst in the left lobe. Peritoneal thickening around the liver suspicious for carcinomatosis. Ill-defined hypodense area in segment 4 inferiorly may represent focal fatty infiltration or less likely an infarct Rotterdam metastatic lesion. Further follow-up is recommended.SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Both kidneys demonstrate moderate caliectasis. Persistent nephrogram despite the delayed phase of imaging. Correlation with renal function tests is recommended.RETROPERITONEUM, LYMPH NODES: Ill-defined mass anterior to the aortic bifurcation measuring 2.2 x 2.9 cm image number 136, series number 3 likely represents recurrent disease. Some of the small bowel loops in that area may be involved.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Enhancing mass in the left iliac is muscle consistent with metastatic disease. The mass measures 5.3 x 2.9 cm image number 133, series number 3.OTHER: Postsurgical changes involving the pelvis. Ill-defined soft tissue densities in the pelvis which cannot differentiated from the uterus may represent peritoneal carcinomatosis. Left lower quadrant ileostomy.

Output: Bilateral metastatic lung disease. Right mediastinal mass invading the right hilum. Left iliac is and retroperitoneal metastatic lesions.Indeterminate lesion in the liver likely representing an infarct or focal fat infiltration. Further follow-up imaging is recommended to exclude metastatic disease.Persistent nephrogram in both kidneys and moderate hydronephrosis. Correlation with kidney function tests is recommended. The ureters may be invaded by the retroperitoneal mass and this may explain the hydronephrosis and persistent nephrogram with delayed excretion.Postsurgical changes in the pelvis and peritoneal carcinomatosis.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: FemaleReason for Study: Reason: ETT History: as above ET tube has been retracted with its tip now 4 cm above the carina.Stable cardiac enlargement.Basilar opacities compatible with subsegmental atelectasis.No new pulmonary opacities identified.

Output: ET tube readjusted with its tip now 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: lvad History: lvad Cardiomegaly with pulmonary edema and left lower lobe consolidation, unchanged.Stable support devices.

Output: No change in cardiomegaly pulmonary edema and left lower lobe consolidation. Tubes and devices are unchanged.


Instruction: Generate impression based on medical findings.

Input: Chest tube placement with history of pneumothoraxVIEW: Chest AP 4/10/15 ET tube tip at the level of the thoracic inlet. NG tube tip in the stomach. Umbilical lines unchanged. There are two chest tubes on the right. Cardiothymic silhouette normal. Moderate size right pneumothorax has increased in size. Coarse lung opacities in the left lung.

Output: Recurrence of moderate size right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: s/p bronch History: sob Elevation left hemidiaphragm. Left basilar pleuroparenchymal opacity, not substantially changed. No new focal pleural parenchymal opacity. Unchanged heart size. No pneumothorax.

Output: Elevation left hemidiaphragm. Left basilar pleuroparenchymal opacity, not substantially changed.


Instruction: Generate impression based on medical findings.

Input: Hypoxia Motion degrades sensitivity.Mildly improving aeration in the left upper lobe, however overall volumes remain diminished with elevated left hemidiaphragm with probable near complete or total collapse of the left lower lobe. Superimposed left lower lobe consolidation cannot entirely be excluded. Pronounced nonspecific cardiomegaly is also again partially observed.Left PICC line has been retracted minimally, tip again persist in the SVC just beyond the confluence.

Output: Left PICC line repositioned in shifting aeration, see description provided


Instruction: Generate impression based on medical findings.

Input: Acute renal failure, line placement Right jugular dialysis catheter extends into the right atrium. No associated postprocedural complication.Mild to moderate CHF is otherwise observed with mild cardiac magnet, moderate effusions and basilar edema

Output: Right jugular catheter placed


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: abnormal chest Xray, intermittent cough History: as above The heart size is normal. Large lung volumes. The lung bases are now better aerated. Gastrostomy tube partially imaged in the upper abdomen.

Output: The lung bases are now better aerated with no significant residual opacity. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: pleural effusion History: assess prior to PleurX removal Moderately large right pleural effusion, with underlying atelectasis, slightly decreased from the previous radiograph.Pleurx catheter in place with the catheter tip projected in the area of the right upper lobe, located anteriorly.Interval decrease in left upper lobe nodules.

Output: Moderately large residual right pleural effusion with Pleurx catheter in place. Decreased left lung nodules.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Status post are can resuscitation for heroin overdose. No signs of pulmonary edema. Patchy dependent opacities consistent with aspirated secretions. No pneumothorax. Metallic BB fragments project over the left chest.

Output: Mild aspiration of secretions. No evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Patient rolled in bed which pulled on catheter nurse feels that infused fluids are leaking slightly. Check TLC positioning. Right jugular catheter tip unchanged in position, projecting over the superior cavoatrial junction.Left jugular catheter tip at the SVC level.Low lung volumes. No focal pulmonary opacities. Stents project over the upper abdomen, incompletely included in the field-of-view. No pneumothorax.

Output: Bilateral jugular catheters are unchanged in position.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: 75M history of a-flutter and recent removal of tunneled central line History: tachycardia, hypotension Interval removal of right central venous catheter. No evidence of pneumothorax.No significant change in small to medium sized pleural effusions. Slight worsening of left lower lobe atelectasis.Unremarkable cardiomediastinal silhouette.

Output: Interval removal of right-sided central venous catheter. No pneumothorax. Stable pleural effusions with slight interval worsening of left lower lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with large colon mass CHEST:LUNGS AND PLEURA: Mild emphysema. Scarring in the right middle lobe and left lower lobe. Mild pleural thickening in the lung bases.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver appears cirrhotic. Nonspecific 8mm hypodensity in image number 82, series number 5, cannot be optimally characterized on this noncontrast CT.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Bilateral enlarged adrenal glands, likely secondary to hyperplasia.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Significant amount of ascites. Proximal small bowel loops are dilated, measuring up to 2.7 cm. And distal small bowel loops are relatively decompressed. These findings may represent a mild partial small bowel obstruction. Ill-defined, nodular soft tissue density throughout the omentum and peritoneum as well as in the small bowel, mesentery, may represent peritoneal carcinomatosis. Lack of IV contrast severely limits optimal characterization of this finding.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: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Limited study due to lack of IV contrast. CT findings suspicious for mild distal small obstruction and possible peritoneal carcinomatosis.


Instruction: Generate impression based on medical findings.

Input: Reason: follow up exam for b/l effusions History: bilateral pleural effusions ET tube tip approximately 5 cm above the carina.Catheter tip in the SVC.An NG tube terminates in the stomach.Pleural effusions, greater on the left, unchanged.No new findings.

Output: Pleural effusions, greater on the left, with no significant change.


Instruction: Generate impression based on medical findings.

Input: Age: 82 yearsGender: FemaleReason for Study: Reason: fever History: fever Left-sided pacemaker unchanged. Stable cardiac enlargement.Increasing left retrocardiac consolidation/atelectasis.Small bilateral pleural effusions.Median sternotomy intact with evidence of mitral valve prosthesis.

Output: Small pleural effusions and increasing left retrocardiac consolidation/atelectasis. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Backache, febrile, look for infiltrate. Low lung volumes. Apparent mediastinal widening likely exaggerated by underinflation but appears similar to limited image of the thoracic spine frontal radiograph from 9/17/2015. Thoracic aorta appears tortuous, unable to exclude dilatation.Coarse lung markings, especially surrounding the hila, right greater than left. Pleural fluid or thickening on the left.Prominence of the central pulmonary vasculature also incompletely assessed due to underinflation may be exaggerated. Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended.

Output: Low lung volumes with coarse opacities bilaterally. The appearance may indicate extensive aspiration of secretions; serial monitoring is suggested to exclude development of aspiration pneumonia on the right. Mediastinal widening incompletely assessed, consider erect PA and lateral chest radiographs when feasible unless there is a high level of clinical suspicion for mediastinal pathology in which case CT may be obtained.


Instruction: Generate impression based on medical findings.

Input: Heart transplant Two left chest tubes are unchanged in position without a significant underlying pneumothorax. Cardiopulmonary appearance is also otherwise similar with mild left basilar suspected atelectasis. Dobbhoff otherwise placed since prior exam and incompletely visualized, tip extends into the proximal duodenum. Left jugular sheath unchanged

Output: Dobbhoff tube placed


Instruction: Generate impression based on medical findings.

Input: 7-year-old female with pancreatitis, increased PEEP requirement overnightVIEW: Chest AP (one view) 01/27/15, 0255 ET tube tip is at the thoracic inlet. Enteric tube is in place. There is leftward curvature of the thoracolumbar spine. Vagal nerve stimulator device overlies the left chest with leads in the left neck. New moderate bilateral layering pleural effusions with bilateral pulmonary opacities. No pneumothorax. Cardiothymic silhouette is normal. Increased chest wall edema.

Output: New moderate bilateral layering pleural effusions with bilateral pulmonary opacities may represent ARDS.


Instruction: Generate impression based on medical findings.

Input: 70 year old female with history of renal cancer, assess for recurrence or progression. CHEST:LUNGS AND PLEURA: Stable bilateral pulmonary micronodules. MEDIASTINUM AND HILA: Small scattered mediastinal lymph nodes are unchanged. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:The evaluation of solid abdominal organs is limited by the lack of IV contrast. Within this limitation, the following findings are noted.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: Postsurgical changes status post left nephrectomy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Hiatal hernia is unchanged. Spigelian hernia involving a nondilated loop of small bowel is unchanged. Small ventral hernia involving a loop of small bowel is also unchanged. There is no evidence of obstruction or bowel wall thickening to suggest ischemic compromise.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is atrophic or has been surgically removed.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic changes of the right femoral head are unchanged.OTHER: No other significant abnormality noted.

Output: 1. No evidence of disease recurrence or metastatic disease.2. Stable pulmonary micronodules.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: s/p BiVADF and central ecmo History: s/p BiVAD and central ecmo Improvement in left basilar opacity.Multiple chest tubes with no significant pneumothorax.ECMO cannulae are unchanged in position.Right jugular Swan-Ganz catheter tip in right ventricular outflow tract. Left subclavian catheter, tip in SVC.

Output: Improvement in left basilar opacity. No significant pneumothorax. Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: Meniscal tear, swelling Moderate osteoarthritic change with narrowing, sclerosis and chondrocalcinosis observed bilaterally. Mildly greater on the left. Small questionable effusion. Please also note evaluation of the menisci is not possible plain radiography, consider MR imaging

Output: Moderate osteoarthritis, please see description and details above


Instruction: Generate impression based on medical findings.

Input: Tachypnea and shortness of breath Interval complete opacification of the left hemithorax with cut off of the left mainstem bronchus similar to prior exam. Consider for postobstructive atelectasis and a large effusion remains. Right lung clear. See subsequent report

Output: Suspected postobstructive collapse of the left lung with a large effusion


Instruction: Generate impression based on medical findings.

Input: 58-year-old female with history of ET tube adjustment. Right chest port with tip in the SVC. ET tube tip 2 cm above the carina. The endotracheal tube balloon has been deflated. NG tube tip outside the field of view. Esophageal temperature probe is no longer visualized. The heart size is at the upper limits of normal. Improved aeration of the left lower lobe.

Output: ET tube tip 2 cm above the carina. Improved aeration of the left lower lobe.


Instruction: Generate impression based on medical findings.

Input: Line placement A new right jugular catheter extends into the right atrium. No additional postprocedural complicationsCardiopulmonary appearance remains similar with pronounced central pulmonary vessels concerning for pulmonary hypertension. Marked nonspecific cardiomegaly. Persistent apical scarring

Output: Right jugular catheter placed


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: cough, fever, immunocomprimised. History: cough, chills, The cardiomediastinal silhouette and vasculature are unremarkable. Lungs are clear of airspace and interstitial opacities. There is no pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: History of Hodgkin's lymphoma, baseline pretreatment to evaluate for infection. Status post biopsy and chemotherapy. CHEST:LUNGS AND PLEURA: Right upper lobe subpleural micronodules are stable to smaller (axial images 16/89 and 30/89). A left basilar nodule is also smaller (axial image 69/89). The previously noted anterior mediastinal mass has decreased in size from approximately 104 x 56 mm (coronal image 70/133 on the prior exam) to approximately 69 x 16 mm (coronal image 49/97). Adjacent lingular consolidation is also less prominent.No new pulmonary nodules, consolidation, edema or pleural effusion.MEDIASTINUM AND HILA: The cardiac size is normal with no pericardial effusion. No pathologically enlarged mediastinal or hilar lymph nodes are identified. A left-sided central venous line is in place with its tip in the right atrium.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: A focus of low attenuation adjacent to the falciform ligament is unchanged and likely represents focal fatty replacement. The liver parenchyma is otherwise unremarkable.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: 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 noted

Output: Interval decrease in the size of the anterior mediastinal mass with decrease in size of a left basilar nodule as well. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 101 years old.Reason: eval for pna History: AMS, cough Increase in patchy left basilar opacity. Right lung remains clear. Unchanged cardiomegaly. No pneumothorax. Question small left pleural effusion.

Output: Increase in patchy left basilar opacity consistent with aspiration or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old, with history of tonsil cancer status post chemo/RT/surgery. CHEST:LUNGS AND PLEURA: Medial right middle and lower lobe glass opacities are consistent with aspiration. Scattered micronodules unchanged. No new nodules or pleural fluid.MEDIASTINUM AND HILA: Postop change status post right neck dissection.No significant hilar or mediastinal lymphadenopathy.The cardiac size is normal. No pericardial fluid.CHEST WALL: Right chest wall deformity, unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cystic lesions, unchanged and too small characterize.PANCREAS: Cystic lesion in the tail of the pancreas is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Interval G-tube removal.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: Extubated yesterday, on going diuresis s/p liver transplant History: as above Left hemithorax volume loss and asymmetric consolidation consistent with lobar collapse.Patchy right-sided opacities are new.A Dobbhoff tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.Left subclavian catheter, tip in SVC. Additional catheter is projected over the trachea.

Output: Left lower lobe collapse probably from mucous plugging with increased pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: ARDS History: ARDS Endotracheal tube terminates 3 cm above the carina. Right PICC terminates in the mid right atrium. Enteric tube terminates inferior to the caudal margin of the image. Curvilinear opacity favoring stent or tube in the common duct. A short pigtail catheter and metallic devices project over the left upper abdomen.No significant change in the left greater than right pulmonary opacities and pleural effusions. No significant pneumothorax. Retrocardiac atelectasis unchanged.

Output: No significant interval change


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: pna? edema? History: faint wheeze? dialysis patient Question of minimal pulmonary edema. Patchy areas of subsegmental atelectasis or scarring. Mild cardiomegaly. No large pleural effusion or pneumothorax. Central venous catheter terminates near the cavoatrial junction. Focal convexity along the left paraspinal stripe of indeterminate significance. Correlation with cross-sectional imaging is suggested.

Output: Focal convexity along the left paraspinal stripe of indeterminate significance. Correlation with cross-sectional imaging is suggested. Dr. Helland was informed of this additional finding.Question of minimal pulmonary edema. Mild cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with weight loss despite good food intake. Screen for malignancy. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: Multiple nonspecific mediastinal lymph nodes. Reference right hilar lymph node measures 1.3 cm x 1.1 cm (image 44/224, series 6) and is of questionable significance. Heart size 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: There are punctate renal calculi in the left upper pole and right lower pole. Two hypodense lesions are seen in the right kidney, consistent with renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1. Multiple mediastinal lymph nodes of questionable significance; no evidence of malignancy2. Nephrolithiasis


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: rule out infection, assess for pneumonia or fluid overload History: sob, fever, positive blood cultures Cardiomegaly. Lower lung zone mild interstitial edema. No specific evidence of pneumonia. Retrocardiac opacity consistent with previously noted hiatal hernia. Dual-chamber pacemaker with leads in appropriate position.

Output: Cardiomegaly with mild interstitial pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Line evaluation. Heart failure. New small streaky retrocardiac opacity may reflect aspiration of secretions or possibly infection. Right Swan-Ganz catheter has been pulled back with jugular catheter tip now over the SVC. Chest drainage catheters again noted without demonstrable pneumothorax. Left subclavian ICD again present.

Output: New streaky retrocardiac opacity not entirely specific but may reflect aspiration of secretions. Swan-Ganz catheter has been pulled back with right jugular tip now over the SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Status post right IJ ECMO cannulation. Right jugular cannula terminates at the level of the suprahepatic IVC. No pneumothorax. Other tubes and lines unchanged in position.Signs of cystic fibrosis with mucoid impaction and debris in the airways. Progressive worsening in extent and density in some regions is highly suspicious for a superimposed pneumonia.

Output: No pneumothorax. Right jugular ECMO cannula terminates at the level of the suprahepatic IVC. Progressive worsening of opacities suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: FemaleReason for Study: Reason: infiltrate/abnormality History: cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: eval for pneumonia History: fever Cardiac silhouette is normal in size.Bibasilar subsegmental linear atelectasis/scarring, left greater than right. No focal consolidation, large pleural effusion or pneumothorax.

Output: Bibasilar subsegmental linear atelectasis/scarring.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: flu like symptoms x 1 week History: cough, chills 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: 50 year-old female with history of lung cancer CHEST:LUNGS AND PLEURA: Large right lung mass replacing almost all of the right lung parenchyma except for small portions of right middle lobe and lower lobe. The mass invades the mediastinum possibly heart. Postobstructive pneumonia and atelectasis is present in the nonaffected portions of the right middle lobe and lower lobe. The mass also invades the pleura and posterior chest wall, bases are image number 83, series number 3.Left lower lobe pneumonia which measures secondary to aspiration. Multiple left lung nodule suspicious for metastatic disease. An index nodule measures 1.7 x 0.9 cm on image number 48, series number 3.MEDIASTINUM AND HILA: Metastatic mediastinal adenopathy. Index lesion measures 1.6 1.1 cm on image number 36 on series number 3.CHEST WALL: Right axillary skin lesions. Metastatic disease cannot be excluded.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: Retrocrural and upper retroperitoneal adenopathy.BOWEL, MESENTERY: The appendix is slightly prominent especially near the tip measuring 9 mm. Wall is slightly thickened. These findings are nonspecific but may represent early appendicitis. Clinical correlation is recommended.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesion involving the left iliac on image number 142, series number 3 suspicious for metastatic disease.OTHER: No significant abnormality noted.

Output: Large right lung mass invading the mediastinum, chest wall and possibly heart. Left lower lobe pneumonia with metastatic left lung lesions.Dilatation of the tip of the appendix with mild wall thickening which may represent early appendicitis. Clinical correlation is recommended.Dr. Chaney was notified and acknowledged about the above findings at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: 47-year-old female with history of hypoxia. Evaluate ET tube. Endotracheal tube tip 2 cm above carina. Enteric tube tip within the distal stomach. Right IJ central venous catheter tip in the SVC. Left IJ central venous catheter tip at the cavoatrial junction.Stable cardiomediastinal silhouette. Low lung volumes. Diffuse bilateral pulmonary opacities suggestive of edema, not significantly changed.

Output: Lines and tubes unchanged. Unchanged mild pulmonary edema pattern.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Large and partially loculated right pleural effusion appears similar. Drain again coiled overlying the right lung base. Underlying atelectasisLeft lung clear.Cardiac and mediastinal contours are grossly unchanged

Output: Right chest tube unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Postoperative day 2 status post AVR. Tubes and lines similar in position with ETT 2 cm above the level of the carina. Moderate pulmonary edema with subsegmental atelectasis at the left lung base and small pleural effusions unchanged.

Output: No acute change in pulmonary edema, pleural fluid or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for fluid overload History: SOB and chest pain, ESRD Severe cardiomegaly with ICD leads in place, unchanged.Pulmonary vascular redistribution consistent with increased circulating blood volume.Basilar opacities compatible with atelectasis and edema and moderately large right pleural effusion extending into the pleural fissures.

Output: Findings consistent with fluid overload.


Instruction: Generate impression based on medical findings.

Input: 69 year old male with view pancytopenia. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Liver is enlarged measuring 19 cm. No focal liver lesions other than a simple cyst in the left lobe.SPLEEN: Splaying measures 10.6 cm. Multiple ill-defined hypodense lesions in the spleen. A reference lesion on image number 32 measures 2.2 x 2.2 cm. The etiology of these lesions is on.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The patient status post radical prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Well-defined lytic lesion with sclerotic borders in the right iliac bone likely benign in etiology. Punctate sclerotic lesion in the left femur neck.OTHER: Penile prosthesis.

Output: Ill-defined splenic lesions. The etiology is unknown. Lymphoma or metastatic disease cannot be excluded. Mild hepatomegaly.