Instruction: Generate impression based on medical findings.

Input: 54-year-old female with DOE. Evaluate for opacity. No focal airspace opacities, pleural effusions or pneumothorax. Heart size upper limits of normal.

Output: No evidence of infection or edema. Heart size upper limits of normal.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Intubated. Hypoxemia. Tubes and lines unchanged in position. Low lung volumes. Extensive air space opacities predominantly in the right with relative sparing of the periphery of the left upper lobe appear less dense and more diffuse.

Output: Perhaps slight worsening of diffuse pulmonary opacities, favoring pulmonary edema over infection although the latter cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: intubated History: intubated No significant cardiopulmonary abnormality.ET tube tip approximately 6 cm above the carina.Shunt tubing courses over the right side of the chest.Status post sternotomy.

Output: ET tube tip approximately 6 cm above the carina, subsequently repositioned.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: new pneumonia History: fever, tachycardic Interval extubation. Nasogastric tube coiled in the gastric fundus, the stomach is markedly distended.There is progression of the left basilar opacity.Mid and upper lung zones clear with no pneumothorax.

Output: 1. Progression of left basilar opacity2. Distended stomach


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: Daily CTICU History: Daily CTICU Limited examination due to significant patient rotation and body habitus.Interval removal of right IJ sheath. Right basilar pigtail chest tube and mediastinal chest tubes remain unchanged. Status post median sternotomy.Stable cardiomediastinal silhouette.Persistent and grossly unchanged bibasilar pleural effusions and atelectasis. No pneumothorax.

Output: Grossly stable bilateral pleural effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Heart failure Moderate nonspecific cardiomegaly with retrocardiac nonspecific opacities and minimal air bronchograms and moderate effusion. Suspected compression atelectasis, however superimposed airspace process such as aspiration or infection cannot be excluded.Remaining lungs are grossly clear of than mild vascular redistribution possibly secondary to semiupright portable positioning.ICD is observed with leads in expected location

Output: Left lower lung nonspecific focal opacity and probable atelectasis, however concern for aspiration versus infection, as described


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: eval ETT, lung fields History: s/p heart/liver transplant Status post heart transplant with mild basilar atelectasis but no significant pneumothorax.Multiple chest tubes are present.ET tube tip approximately 5 cm above the carina.Right jugular Swan-Ganz catheter, tip in main pulmonary artery.An NG tube extends below the lower margin of the image.Remnants of a left subclavian ICD are seen.Catheter tubing projected over the right axilla also seen on a follow-up study could be external to the patient or a malpositioned venous line.

Output: Status post heart transplant with mild basilar atelectasis but no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: chf, iabp History: chf, iabp Balloon catheter marker at the level of the aortic arch, unchanged. Venous catheter and ICD leads also unchanged. Cardiomegaly with no evidence of CHF.

Output: Balloon catheter marker at the level of the aortic arch, unchanged from previous.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: Intubated urgently in preparation for TEE for possible aortic dissection found incidentally on renal ultrasound History: intubated urgently Endotracheal tube and tip approximately 4 segments of the carina. Enteric tube and right central catheter are unchanged.Unchanged cardiomegaly and widened mediastinal silhouette. Bilateral airspace opacities mildly increased from prior exam.

Output: Again seen is a dilated thoracic aorta with possible aneurysm. Enteric tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.IABP position Right upper extremity PICC tip in SVC. IABP marker 3.5cm distal to the aortic arch. Mild cardiomegaly. Bilateral patchy opacities and septal lines compatible with edema. Right costophrenic angle is excluded from the field-of-view.

Output: IABP marker 3.5cm distal to the aortic arch. Cardiomegaly and pulmonary edema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: 27 y/o with cough and leukocytosis r/o infectious etiology History: leukocytosis Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Baseline chest radiograph preoperative examination. Mitral valve regurgitation. Low lung volumes with moderate pulmonary edema. Left basal air space opacity is new. Hazy opacity projects over the distal left main bronchus suggestive of internal debris.

Output: Development of diffuse pulmonary opacities which may reflect pulmonary edema and superimposed aspirate, correlate for clinical signs of infection.


Instruction: Generate impression based on medical findings.

Input: Fever and tachycardia Small to moderate left pleural effusion with underlying atelectasis. Lungs are otherwise clearCardiac and mediastinal contours are within limitsEmbolization coils projected over right upper quadrant with extensive biliary gas secondary to probable GI procedure and papillotomy

Output: Small-to-moderate left effusion with overlying atelectasis


Instruction: Generate impression based on medical findings.

Input: Reason: pulm infiltrate? History: hemoptysis Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: r/o new opacity, ptx History: pleuritic cp Orphaned right-sided ICD leads redemonstrated.Sternotomy wires and clips again noted.Cardiomediastinal silhouette appears unchanged, with stable prominence of the ascending aortic contour and an aberrant right subclavian artery.No evidence of significant pleural effusion.Stable left lower lung zone with scarring and atelectasis noted.No focal opacities. No pneumothorax.

Output: Stable cardiopulmonary appearance. No new focal opacities or pneumothoraces. 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, 16 years old.Reason: s/p ICD History: s/p ICD Left chest presternal ICD with tip overlying the mediastinum.No pneumothorax or pleural effusion. Cardiac silhouette is normal. No specific evidence of infection or edema.

Output: Left chest ICD with tip overlying the mediastinum.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: eval for chest pain History: see above No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: f/u mediastinal air History: pain Persistent pneumomediastinum without significant change.No significant pulmonary abnormalities.

Output: Persistent pneumomediastinum without significant change.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with history of asthma who presents with shortness of breath. Cardiomediastinal silhouette is unremarkable.No consolidation, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality or interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: positive PPD. Exclude TB History: Positive PPD. Mild scarring both lung bases, otherwise unremarkable.Unremarkable mediastinal contours and cardiac silhouette.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: swan placement History: swan The Swan-Ganz catheter has been advanced, with the tip terminating in the right main pulmonary artery. Endotracheal tube tip terminates 6 cm above the carina. Sternotomy hardware is intact. The NG tube tip terminates out of the field of view inferiorly. Left pleural drainage catheter unchanged in position. The IABP tip terminates in the proximal descending thoracic aorta.Patchy left upper lobe and right lower lobe opacities appear similar to the prior. Stable right pleural effusion.

Output: Swan-Ganz catheter tip in the right main pulmonary artery. Effusions and pulmonary opacities similar to prior.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval pulmonary edema/effusions History: s/p transplant, bilateral chest tubes New pigtail catheter in the left pleural space.Right pleural catheter and tracheostomy tube unchanged.Small lung volumes with lower zone opacity compatible with atelectasis and effusion, unchanged from previous.No other new findings.

Output: New left pleural catheter at the left lung base.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: chest tube History: chest tube No change in pulmonary opacities.Right chest tube, tip in apex with a small right apical pneumothorax and right chest wall soft tissue emphysema.Mild cardiomegaly.

Output: Unchanged small right apical pneumothorax and edema like opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Shortness of breath, rule out pneumonia. No cardiopulmonary abnormalities to suggest infection.Bilateral chest wall surgical clips and an IVC filter are present.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: chest pain History: as above Increasing pulmonary opacities suggestive of infection or aspiration.An NG tube extends below lower margin of the image.

Output: Increasing pulmonary opacities suggestive of infection or aspiration. New NG tube.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infection History: fall Normal heart size with coronary artery stents in place.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Abdominal and right groin pain, no bowel movement for 5 days, assess for small bowel obstruction No free air on upright imaging. IVC filter. Right upper quadrant surgical clips. Above average stool burden in ascending colon. Mildly dilated small bowel loops with air noted distally in colon, overall appearance suggestive of ileus. Partially imaged right chest wall port with tip in proximal SVC.

Output: Bowel gas pattern suggesting ileus as described. Above average stool burden in ascending colon.No free air.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: short of breath, COPD History: short of breath Extensive bilateral interstitial opacities with architectural distortion unchanged compared to the prior study. Heart size is essentially normal and unchanged.No large pleural effusion. No pneumothorax identified.

Output: There is no significant change in the extensive bilateral interstitial opacities representing fibrotic changes and bullous emphysematous disease.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Evaluate for PICC line placement Left upper extremity PICC tip in the SVC. Enteric tube tip in the stomach. Cardiomediastinal silhouette is unremarkable. Low lung volumes. No large pleural effusions or pneumothorax. Mild bibasilar subsegmental atelectasis.

Output: Left upper extremity PICC tip in SVC.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: Daily CXR History: S/p aortic arch repair Pleural effusions appear larger but this may be due to differences in patient positioning.Stable left basilar atelectasis.Mild cardiomegaly status post sternotomy with chest tubes but no pneumothorax.Right jugular Swan-Ganz catheter removed leaving the introducer.Distended loops of bowel are seen in the upper abdomen.

Output: Persistent pleural effusions. No significant pneumothorax.. Dilated loops of bowel are seen in the upper abdomen.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: SOB History: rule out infiltrate No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 46 yearsGender: MaleReason for Study: Reason: evaluate for pneumothorax, pneumonia History: right sided chest pain, pleuritic Decreased lung volumes but stable cardiomediastinal silhouette.Right IJ introducer unchanged.Lungs are clear.No pleural effusions.No evidence of pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: 47M metastatic cancer with cough and shortness of breath. Eval for pneumonitis vs pneumonia. History: cough, dyspnea Innumerable pulmonary metastases identified but no acute edema or pneumonia. Heart size normal.Mediastinal lymphadenopathy noted.

Output: Innumerable pulmonary metastases but no acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: assessment of hardware History: IABP, central line, swan ganz catheter, history of cardiomyopathy, CHF Left internal jugular Swan-Ganz catheter with tip projecting at least at the level of the right main pulmonary artery. AICD with leads in unchanged position. IABP marker in unchanged position 1 cm inferior to the inferior border of the aortic arch. Stable low lung volumes. Stable patchy perihilar and retrocardiac airspace opacities accounting for differences in technique. Surgical clips in the right axilla. No large pleural effusion or pneumothorax.

Output: Stable unchanged CHF and devices.


Instruction: Generate impression based on medical findings.

Input: Reason: mass? History: reproducible left sided cp Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: MaleReason for Study: Reason: hypoxic resp failure s/p lung bx History: hemothorax Support devices unchanged.Increasing extrapulmonary right upper lobe opacity compatible with hemothorax/loculated pleural effusion.Possible small right subpulmonic pneumothorax.Stable cardiomediastinal silhouette.

Output: Increasing right upper lobe extrapulmonary opacity compatible with increasing amount of hemothorax or loculated pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 74 years old Female. Reason: assess for evidence of infection History: febrile. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Linear density is seen in the left lung base, which is consistent with atelectasis.Cardiac silhouette is normal. There is an interval resolution of the patchy opacity in the right lower lung.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with history of metastatic colorectal cancer. CHEST:LUNGS AND PLEURA: Interval decrease in size of multiple lung nodules, some of which are cavitary, representing metastatic disease. Reference left lower lobe nodule (image 58, series 5) measures 9 x 10 mm, previously 12 x 12 mm. No new nodules are present. No pleural effusions. MEDIASTINUM AND HILA: No lymphadenopathy. Calcified hilar/mediastinal lymph nodes from prior granulomatous disease, stable. Heart size is normal.CHEST WALL: Right-sided chest port, catheter tip in the SVC/right atrial junction.ABDOMEN:LIVER, BILIARY TRACT: No hepatomegaly or focal lesions. No biliary ductal dilatation. Gallstones, stable.SPLEEN: Splenic calcifications from prior granulomatous disease are stable.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: Right lower quadrant ileostomy, no evidence of obstruction.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: Presacral soft tissue density in the pelvis likely representing postsurgical changes.

Output: Interval decrease in size of pulmonary nodules representing metastatic disease. No new sites of disease are visualized.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.COPD. Shortness of breath evaluate for cause. Upper normal heart size. Atherosclerotic calcification of the thoracic aorta. No pleural fluid or signs of pulmonary edema. No pneumothorax. Linear scarring in the left lower lobe. No signs of pneumonia or other acute pulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: evaluate for pneumonia in pt with neutropenic fever History: febrile Sternotomy wires unchanged in appearance. Right arm PICC, tip in the subclavian vein.Cardiomediastinal silhouette is within normal limits.Redemonstration of surgical changes in the right hemithorax, with reduced right lung volume. No new focal air space opacity.

Output: Stable postsurgical findings in the right hemithorax, without specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.History: neutropenic fever Left-sided PICC terminates in the superior aspect of the RA. Unchanged right subclavian line crossing midline and terminating in the left brachiocephalic vein. Low lung volumes makes detailed cardiopulmonary assessment difficult. New patchy left lower lobe opacities. No large pleural effusion or pneumothorax. Heart size likely unchanged given low lung volumes.

Output: New patchy left basilar opacity which may represent aspiration or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.NG tube placement Interval NG tube advancement into the gastric body. Right chest wall Port-A-Cath tip unchanged. Patchy bilateral airspace opacities without interval change. Markedly distended bowel loops in the abdomen are incompletely evaluated.

Output: Interval NG tube advancement into the gastric body.


Instruction: Generate impression based on medical findings.

Input: 56 year old female with newly diagnosed cervical cancer CHEST:LUNGS AND PLEURA: Two nodular densities in the left upper lobe (series 4, image 34) ribs and pulmonary nodules versus mucous plugs.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.A small hiatal hernia may be present.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: Renal sinus cysts are noted on the right. Cystic densities in the left renal hila may be due to renal sinus cysts rather than hydronephrosis given the absence of hydroureter.RETROPERITONEUM, LYMPH NODES: Multiple mildly enlarged retroperitoneal lymph nodes are identified, the largest measuring 23 x 13 mm at the aortic bifurcation (series 3, image 143).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: A heterogeneous, septated lesion with multiple low density foci measuring approximately 17.6 x 9.1 x 18.0 cm is identified in the midline of the pelvis. It displaces the adjacent colon and the urinary bladder. Contact with both pelvic sidewalls is present. The margins of the uterus are obscured by the mass.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple enlarged lymph nodes are noted along the right common iliac and right external iliac chains. The largest pelvic lymph node measured 4.4 x 2.5 cm in the right obturator region.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: The right common iliac vein is greatly narrowed by adjacent adenopathy.

Output: Large pelvic mass that is inseparable from the uterus which contacts the pelvic sidewalls. Abdominal and pelvic metastatic adenopathy..Mild left hydronephrosis versus parapelvic cysts. Left ureter is normal in size


Instruction: Generate impression based on medical findings.

Input: High NG tube output Enteric tube seen with side-port in gastric fundus. Persistent concerning findings for SBO with multiple dilated small bowel loops seen. Again visualized suspected nephroureteral stent placement. Left pelvic drain. Pelvic and midline surgical clips. Cholelithiasis. Basilar atelectasis and increased interstitial markings. Pacer leads in stable location. Bilateral total hip arthroplasties. Multilevel spinal degenerative disease.

Output: Findings remain suspicious for small bowel obstruction.


Instruction: Generate impression based on medical findings.

Input: Reason: Pt s/p PICC placement, cxr to eval placement History: see above PICC tip in the SVC.Cardiomegaly and ICD leads unchanged.

Output: Catheter tip in the SVC with no visible complications.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: pna? effn? History: ESRD, SOB Heart size upper normal.No specific evidence of infection or edema.

Output: Heart size upper normal, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Oxygen requirement check fluid status. Peripheral catheter from the right terminates at the level of the azygos arch.Tortuosity of the thoracic aorta at the level of the arch, nonspecific. Heart size appears normal. Small left pleural fluid collection may be partially loculated. Basal atelectasis, left greater than right.

Output: Left pleural effusion and basal atelectasis, nonspecific.


Instruction: Generate impression based on medical findings.

Input: Reason: post op CABG History: post op CABG Moderate cardiomegaly and postoperative mediastinal widening. ET tube tip approximately 5 cm above the carina. Swan-Ganz catheter tip in the right main pulmonary artery.Basilar atelectasis and small pleural effusions.A more recent radiograph has been interpreted.

Output: Atelectasis and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Cough. ET tube. ETT tip 4.5 cm above the level of the carina.A cannula from a left internal jugular approach extends into the low right atrium.Dobbhoff tube tip beyond the caudal margin of the radiograph.A presumed drain projects over the right thoracic inlet then extends cranially at the midline, the tip is obscured by overlying spinal hardware.No pneumothorax.Moderate bilateral pleural effusions.Left lower lobe atelectasis/consolidation.

Output: ETT tip 4.5 cm above the carina. Moderate pleural effusions. Persistent basal atelectasis, especially on the left, is disproportionate to the volume of pleural fluid and may be due to bronchial mucus plugging.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Heart failure and concern for CHF. Moderate cardiomegaly. Biventricular ICD in place. Median sternotomy hardware noted. No focal airspace opacity, pleural effusion, or specific evidence of pulmonary edema.

Output: Cardiomegaly without pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: resp failure History: hypoxia Tracheostomy tube and port unchanged.Left apical scarring or fibrosis is unchanged. No new opacity to suggest pneumonia. No significant pulmonary edema.

Output: Left apical scarring or fibrosis is unchanged. No new opacity to suggest pneumonia. No significant pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: Left ventricular assist device Lines and tubes are unchanged. Diffuse pulmonary opacities and probable loculated pleural effusions again noted. Unchanged cardiomegaly. No pneumothorax.

Output: Diffuse pulmonary opacities and probable loculated pleural effusions again noted, not substantially different.


Instruction: Generate impression based on medical findings.

Input: Check for pneumonia. Pleural neoplasm 2 right chest tube again observed without change in position, one extending towards the right hilar region and the other towards the apex. No associated significant pneumothorax.The underlying cardiopulmonary appearance remains unchanged with post resection and surgical changes on the right hemithorax along with patchy nonspecific opacities in both bases, suggesting probable atelectasis and small effusions

Output: Chest tubes and cardiopulmonary appearance unchanged


Instruction: Generate impression based on medical findings.

Input: 52 years, Female. Reason: pt with large bowel obstruction s/p NG tube placement with high output History: high output NG, nausea Cardiomediastinal silhouette within normal limits. Mild bibasilar subsegmental atelectasis and likely small left pleural effusion. No pleural effusions or pneumothorax. No specific radiographic evidence of edema or infection.Enteric tube tip projects over the mid gastric body with sidehole project over the expected position of the gastroesophageal junction. Bilateral percutaneous nephrostomy catheters with pigtails projected over the expected positions of the renal hila. Surgical clips right upper quadrant. There is enteric contrast material within the large bowel, presumably related to the patient's recent CT scan. The large bowel remain slightly distended, but in a nonobstructive pattern.There is no evidence of intraperitoneal free air.

Output: 1. Enteric tube tip projects over the mid gastric body with sidehole project over the expected position of the gastroesophageal junction. Recommend advancement.2. Nonobstructive bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: eval for edema History: shortness of breath Right chest port and left pacemaker unchanged. Stable marked cardiomegaly and prominence of the central pulmonary vasculature. No pleural effusion or pneumothorax. Diffuse interstitial opacities with basilar predominant and septal lines. Perihilar calcified granulomatous disease.

Output: Findings compatible with CHF and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: infiltrate History: desaturation Interval placement of a nasogastric tube with the sidehole positioned at the gastric fundus. Interval removal of external defibrillator pads.Patient is mildly rotated to the left. No interval consolidation, pulmonary edema or pneumothorax. Mild blunting of the left costophrenic angle may be attributed to scar or trace left pleural effusion.

Output: Nasogastric tube is now position with the sidehole at the fundus. Blunting left costophrenic angle may be attributed to scar or trace pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: rt IJ central History: rt IJ central Mild right basilar atelectasis, unchanged.A more recent radiograph showed a large left pneumothorax.ET tube tip approximately 6 cm above the carina.Right jugular catheter, tip in SVC.

Output: Unchanged right basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: eval for L sided effusion, PNA History: severe L sided pain Heart size normal.Lower lung zone predominant interstitial opacities correlate with those seen on recent CT and may have progressed.No substantial pleural effusions.Right subclavian catheter, tip in SVC.

Output: Progressive interstitial opacities suggestive of atypical infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 17 years old.Reason: Pt is a 17 yo male w/ hx of nodular sclerosing HL; pre-asct evaluation History: evaluate High left paratracheal mass also seen on prior PET/CT.Heart size normal.No significant pulmonary or pleural abnormality.Right jugular port catheter, tip in SVC, looped just below the clavicle similar to the prior CT.

Output: Left paratracheal mass. No other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infection History: AMS Unremarkable cardiac and mediastinal silhouette. Slightly increased opacity at the right base compatible with previously evident scarring combined with underinflation.No specific evidence of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Check for improvement of atelectasis versus pneumonia. History of asthma Overall improving aeration with mild improved expansion of the left lower lung previously partially obscured. No distinct effusions. Questionable mild cardiomegaly with moderate tortuosity aorta and atherosclerotic changes similar to prior study

Output: Mildly shifting but overall improving nonspecific patchy opacities again suggesting atelectasis as opposed to superimposed more acute process. Serial imaging will continue to be useful to exclude an underlying abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Self extubated. ETT tip 6 cm above the level of the carina. Enteric tube tip at the level of the GE junction, with sidehole at the level of the distal esophagus.Bilateral lower lobe and left upper lobe aspiration and atelectasis, unchanged.

Output: ETT 6 cm above carina. No acute change in findings most consistent with aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.ET tube placement Interval removal of ET tube. The enteric tube is coiled within the fundus of the stomach with the tip projecting towards the level of the body of the stomach. Right jugular catheter tip terminates at the level of the SVC.Low lung volumes. Cardiomegaly with underlying atelectasis/consolidation. Linear right basilar opacity most consistent with scarring/atelectasis. Small bilateral pleural effusions. No evidence of pneumothorax.

Output: Interval removal of ET tube. Persistent retrocardiac atelectasis/consolidation. Small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: 67M w/ AMS s/p fall History: AMS s/p fall Loculated right-sided pleural effusion unchanged. No new opacity to suggest pneumonia. No evidence of pneumothorax.

Output: Loculated right-sided pleural effusion unchanged. No new opacity to suggest pneumonia. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 31 yearsGender: FemaleReason for Study: Reason: hand cellulitis, recent surgery getting worse ro gas in tissues History: swelling, pain, redness to dorsal hand Right central venous catheter with its tip in the SVC. Stable cardiomediastinal silhouette.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: 63-year-old male with history of prostate cancer in 2008. Prekidney transplant evaluation. CHEST:LUNGS AND PLEURA: Scarring in the right apex. A small cavitary lesion is present in the right apex measuring 18 x 12 mm with relatively thicker walls compared to the other cystic changes. This lesion most likely represents a part of the scarring in the right apex, however, further follow-up imaging is recommended to exclude possibility of an infectious or much less likely neoplastic. Cavity. Bilateral significant emphysematous changes. Honeycombing in bilateral lung bases. Bilateral small pleural effusions.MEDIASTINUM AND HILA: Mediastinal adenopathy. There reference pretracheal lymph node measures 18 x 10 mm image number 34, series number 3. Prominent bilateral hilar lymph nodes.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: Atrophic kidneys. Benign-appearing right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate amount of ascites. A peritoneal dialysis catheter is seen in the left lower quadrant.PELVIS:PROSTATE, SEMINAL VESICLES: Changes secondary to prostatectomy.BLADDER: 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: Borderline enlarged mediastinal lymph nodes. Bilateral small pleural effusions and moderate ascites. Bilateral emphysema.Scarring in the right apex. Small cavitary lesion in the right apex, most like represents part of the scarring. Follow-up imaging is recommended for this cavitary lesion to exclude less likely possibility of an infectious or neoplastic etiology.


Instruction: Generate impression based on medical findings.

Input: IBD, evaluate for free air or toxic megacolonMale, 25 years old. Right upper quadrant surgical clips. Several differential air-fluid levels seen in colon. Colonic dilatation seen, sigmoid colon measures up to 8.5 cm (previously 6.7 cm) with relative paucity of rectal gas visualized. These findings may be seen in setting of megacolon, underlying distal colonic stricture or obstruction not excluded. Correlation with patient's clinical history and follow-up recommended. No free air on upright imaging.

Output: Several differential air-fluid levels seen in colon and colonic dilatation seen with relative paucity of rectal gas visualized. These findings may be seen in setting of megacolon, underlying distal colonic stricture or obstruction not excluded. Correlation with patient's clinical history and follow-up recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: COPD, lung cancer History: increasing SOB Increasing opacity right mid lung periphery, where there had been a nodule on a 3/6/2015 CT, suggestive of recurrent tumor for which a thoracic CT is recommended.Marked COPD. Mild cardiomegaly.

Output: Increasing right midlung opacity suggestive of recurrent tumor. A thoracic CT is recommended for follow-up.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: r/o infection History: sob and fever Cardiac silhouette is normal in size. Left upper lobe consolidation. No pleural effusion or pneumothorax.No acute osseous abnormality.

Output: Left upper lobe consolidation likely representing pneumonia given clinical presentation. Follow-up imaging to resolution recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: eval trach placement History: fever, increasing O2 req Bilateral pleural effusions with basilar consolidation left greater than right, unchanged.Tracheostomy tube tip at or above the thoracic inlet level.

Output: Unchanged basilar opacities and pleural effusions. Left lower lobe pneumonia is possible.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: CP History: CP Heart size normal.Lungs clear.No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: PNA? History: SOB Stable cardiomediastinal silhouette.Minimal basilar scarring/discoid atelectasis.No focal or consolidation.No large pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with history of newly diagnosed gastrointestinal stromal tumor CHEST:LUNGS AND PLEURA: 5 mm, nonspecific nodule in the right lower lobe on image number 47, series number 9MEDIASTINUM AND HILA: Retrosternal bladderCHEST 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: Large hypodense lesion measuring 5.7-cm in diameter image number 96 on series number 7 involving the right kidney. The lesion measures 51, Hounsfield units on postcontrast images, higher than fluid density. Further evaluation with dedicated renal mass protocol CT or MR is recommended. Small cysts in the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: 4.1 x 2.2 cm round well-defined mass involving the greater curvature of the stomach on image number 82, series number 7, likely representing patient's known Gist tumorBONES, 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: Nonspecific sclerotic lesion involving the left iliac boneOTHER: No significant abnormality noted.

Output: Well-defined gastric mass compatible with patient's known history of gist tumor.Dedicated renal mass protocol CT or MR evaluation of the right renal lesion is recommended for further evaluation. Retrosternal goiter.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: FemaleReason for Study: Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Left-sided pacemaker unchanged.Cardiomediastinal silhouette is unremarkable.The lungs are clear.Left pleural thickening/effusion and left retrocardiac atelectasis similar to the prior exam.No evidence of a pneumothorax.

Output: Left-sided pacemaker placed without complication. Stable cardiopulmonary appearance with small left pleural effusion and left retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: acute fever, hx of SCC of mouth, rule out aspiration History: see above No significant cardiopulmonary abnormality.Right jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: Prior to office visit after VATS biopsy History: interval change Diffuse interstitial opacities with relative sparing of the left upper lobe appears similar to the prior exam. No large pleural effusion or pneumothorax. Heart size is normal.

Output: Similar appearance of diffuse interstitial opacities compatible with interstitial lung disease as seen on prior CT.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with rectal cancer CHEST:LUNGS AND PLEURA: Reference left upper lobe nodule now measures 2.5 x 1.9 cm on image number 36, series number 5. Previously it was measuring 16 by 18 mm on image number 42, series number 6.Reference right upper lobe nodule now measures 2.2 x 2.6 cm on image number 35, series number 5. Previously, it was measuring 2.4 x 2 cm on image number 46, series number 6.There is surrounding air space opacity obscuring the reference left lower lobe nodule. Therefore it cannot be accurately measured. However other nodular density lesions in the left lower lobe have also demonstrated increase in size within the interval. A new index lesion on image number 81, series number 5 measures 2.3 x 2.1 cm. previously it was measuring 1.1 x 1.1 cm on image number 86, series number 6. MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ventral hernias containing nonobstructed small bowel segments are unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland is enlarged.BLADDER: Asymmetric wall thickening of the left wall of the bladder is again noted. Further evaluation with endoscopy may be helpful.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Surgical changes involving the right thumb and presacral soft tissue is stable from previous study.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size of the bilateral lung lesions.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: s/p PICC line placement History: PICC line placement Right PICC is looped on itself with the tip near the confluence of the brachiocephalic veins.

Output: Right PICC is looped on itself with the tip near the confluence of the brachiocephalic veins.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: possible bleed, dropping hgb History: hgb low not responsive to prbc Interval complete opacification of the left hemithorax. Likely both effusion and atelectasis. No change in right pulmonary opacities and small pleural effusion.ECMO catheter unchanged.Tip of Swan-Ganz catheter in the main pulmonary artery.Mediastinal drains unchanged.Endotracheal tube approximately 4 cm above carina.IABP B marker overlies descending thoracic aorta.

Output: 1. Stable support devices2. Interval complete opacification left hemithorax, likely progression of effusion and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old, status post left upper lobe lobectomy for stage one squamous cell carcinoma. Evaluate for interval change. CHEST:LUNGS AND PLEURA: Postoperative and posttherapy change on the left including volume loss, prevascular fluid and paramediastinal fibrosis compatible with prior left upper lobe resection and radiation, unchanged.Right apical scarring is unchanged. Scattered predominantly basilar tree in bud opacities compatible with aspiration bronchiolitis are unchanged. Mild centrilobular emphysema.Previously noted enhancing focus anterior to the left lower lobe is no longer evident. An enhancing lymph node in the same vicinity is slightly smaller (axial image 27, series 4).MEDIASTINUM AND HILA: Pretracheal and subcarinal lymph nodes are unchanged and not pathologically enlarged by CT criteria. No new pathologically enlarged hilar or mediastinal nodes.The cardiac size is normal. No pericardial effusion. Coronary and aortic atherosclerotic calcifications are evident.Small hiatal hernia.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Aortic atherosclerotic calcifications.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Postoperative and posttherapy change as described above with no evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: FemaleReason for Study: Reason: Removal of a line from R IJ. query PTX History: none Stable cardiac enlargement with marked prominence of the pulmonary artery compatible with pulmonary arterial hypertension.Lungs are clear.No pleural effusions.No evidence for pneumothorax.

Output: Stable cardiac enlargement and marked prominence of the pulmonary artery. No evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: eval for infil History: fevers and cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: r/o infection History: cough with fever Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: s/p thora. pls evaluate. History: s/p thora Left port is now accessed. Stable position of right pacemaker electrode.Decreased size of left pleural effusion following thoracentesis. Known expansile lesions myeloma in the setting of multiple myeloma, currently obscured. Convex margin at the left peripheral midlung; continued observation of this location is recommended to exclude underlying nodule. No evidence of pneumothorax. The left cardiac border is not well visualized.

Output: No pneumothorax following thoracentesis. Continued observation of the peripheral left lung is recommended to exclude nodule. Known left rib deformities in the setting of multiple myeloma obscured.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: 81 F s/p PICC placement History: PICC placement Left PICC, tip crossing the midline into the right jugular and extending into the neck. Minimal left basilar scarring or subsegmental atelectasis.Residual contrast material is seen in the colon.

Output: Left PICC, tip in the right jugular extending cephalad into the neck, requiring repositioning. Findings were relayed by text paged to Dr. Tepe pager 9682 at the time of dictation 7/27/2015 at 2:32 PM.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: MaleReason for Study: Reason: infection History: cough Left central venous catheter with its tip in the SVC.Cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.Demonstration of multiple surgical clips in the upper abdomen.Scattered air-fluid levels visualized upper abdominal loops of bowel suggesting possible obstruction.

Output: No acute cardiopulmonary abnormalities are identified. No specific evidence of infection. Air-fluid levels in multiple upper abdominal loops of bowel suggestive of a possible partial bowel obstruction.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: chest pain History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: eval new dialysis line position History: new R IJ dialysis line placed Mediastinal and pleural drains unchanged with no pneumothorax.Stable basilar consolidation left greater than right with a left pleural effusion.New tracheostomy tube, the tip 5 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.Right jugular catheter tip at cavoatrial junction.Right PICC, tip in right atrium.Unchanged LVAD.

Output: New tracheostomy tube, and right jugular dialysis catheter.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: 73 to F s/p open ventral hernia repair History: SBO decreased breath sound on right side Mild/moderate right hemidiaphragm elevation which may be related to overlying atelectasis.Both lung bases are clear than on the prior study and there are no new pulmonary findings.Right subclavian catheter, tip in SVC.

Output: Improved basilar opacities, but with persistent right basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: pna History: inc 02 requirement Moderate cardiomegaly and small lung volumes.Bilateral nonspecific airspace opacity, more extensive on the right, with lower zone atelectasis, not significantly changed.

Output: Cardiomegaly and airspace opacity without significant change.


Instruction: Generate impression based on medical findings.

Input: Female 58 years old Reason: Line placement History: None Interval placement of left IJ catheter with tip in the IVC/inferior RA.Decreased lung volumes.Stable cardiomegaly.Interstitial opacities as well as pleural effusions.

Output: Left IJ catheter tip within the IVC. Mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 54 year old female with history of ovarian cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple perihepatic peritoneal metastases are again noted, grossly stable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal nodule measures 3 x 1.7 cm on image number 93, series number 3, not significantly changed.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Peritoneal carcinomatosis, slightly increased in size compared to previous study. Index lesion on the left side of the abdomen now measures 1.7 x 1.9 cm on image number 100, series number 3. Multiple other deposits are also noted throughout the abdomen, more on the left side and in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: Right inguinal adenopathy measures 1.5 by 1.2 cm in image number 189, series number 3, slightly smaller compared to previous study.BOWEL, MESENTERY: Pelvic peritoneal metastases are again noted, increased in size compared to previous study. Previously measured left adnexal deposit now measures 3 x 1.8 cm on image number 177, series number 3. New ascites in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Progression of disease with interval increase in the amount of peritoneal carcinomatosis.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: pt with swan catheter, eval for placement History: see above The heart is normal in size.ICD in place overlies the inferior aspect of the aortic arch.Asymmetric pulmonary edema, bilateral basilar subsegmental atelectasis and bilaterally and pleural effusions are unchanged.The tip of the Swan-Ganz catheter overlies the main pulmonary artery, unchanged in position. ET and enteric tubes in appropriate position.

Output: Stable adequate position of support apparatus.Persistent asymmetric pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Status post cardiac surgery. Surgical drains and IVC Swan-Ganz unchanged. Metallic IABP marker approximately 4 cm below the apex of the aortic arch, unchanged.Stable cardiomediastinal slight including widened mediastinum which is likely postoperative in origin.Low lung volumes with patchy basilar opacities, likely atelectasis appearing similar to the prior exam.Small pleural effusions unchanged.

Output: Stable mediastinal widening likely postoperative in origin. Small pleural effusions and basilar atelectasis unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Endotracheal intubation. ETT tip 2.5 cm above the level of the carina. Left upper quadrant surgical clips. Sternotomy hardware. Embolization coils project over the left upper thorax.Unchanged low normal lung volumes. Worsening pulmonary edema.Bilateral pleural thickening or extrapleural fat deposition with small pleural effusions.

Output: Worsening pulmonary edema. ETT tip 2.5 cm above the level of the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Brachial plexus lesion assess for pneumothorax post left first rib resection. Inspiration and expiration images were obtained in the recovery room. Subcutaneous emphysema and a surgical drain project over the chest wall at the left thoracic inlet. No pneumothorax. Subsegmental atelectasis in the left lung, possibly due to aspirated secretions. Left first rib resection. Small extrapleural fluid collection, presumably a small postoperative hematoma at the resection site.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: infectious workup History: chills, amber urine Heart size about upper normal with a mild pectus excavatum deformity.Mild chronic appearing basilar interstitial opacities.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: DesaturationVIEW: Chest AP ET tube tip below thoracic inlet and above carina. NG tube tip in the stomach. The umbilical lines are unchanged. Left upper extremity PICC tip at the confluence of the brachiocephalic veins. Cardiothymic silhouette normal. Mediastinal shift from left to right unchanged. There are bilateral pulmonary interstitial emphysema left greater than right unchanged. The moderate size left pneumothorax has reaccumulated. There are two chest tubes on the left.

Output: Moderate size left pneumothorax has reaccumulated.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: eval interval change, position of tubes/lines History: hemoptysis, cavitary lesion, intubated ET tube tip 3 cm above carina, venous catheter tip at RA/SVC junction. NG tube tip in stomach.Slightly increased multifocal lung opacity consistent with hemorrhage superimposed on known infection.

Output: Slightly increased multifocal lung opacity consistent with hemorrhage superimposed on known infection.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: s/p ventricular tachycardia, assess for acute issue, s/p OHT in 1999 History: as above Dual-lead ICD with leads in the right atrial appendage and right ventricle. Right internal jugular central venous catheter with tip at the superior cavoatrial junction.Cardiomediastinal silhouette is normal. No pleural effusion or pneumothorax.No focal pulmonary opacities.

Output: No specific findings to suggest infection or edema. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: widened mediastinum; lung abnml History: chest pain , SOB No significant cardiopulmonary abnormality.Mediastinum unremarkable except for a tortuous aorta.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old. ET tube and NG tube unchanged.New right IJ venous catheter with its tip at the innominate/IJ junction.No evidence of pneumothorax.Decreased lung volumes with stable cardiomediastinal silhouette.Left retrocardiac consolidation/atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Interval placement of a right IJ catheter without complication. Stable cardiopulmonary appearance with left retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Seven week old former 23 week gestational age patient with chest tube.VIEWS: Chest and abdomen AP (two views) 07/26/16, 0844 Endotracheal tube tip is above carina. Feeding tube tip is in stomach. Right internal jugular line coils upon itself inferiorly. Right lower extremity PICC tip is in infrahepatic IVC. A urinary bladder catheter is identified. Right chest tube has its tip in subcutaneous tissues. Left chest tube tip overlies the left apex.Soft tissue edema persists. Changes from metabolic bone disease of prematurity are again seen.Right upper and middle lobes remain collapsed. The rest of the lungs are abnormal in appearance with overinflation, pneumatocele formation, and streaky opacities. No pneumothorax is identified. Cardiac silhouette size cannot be evaluated.A small amount of bowel gas is seen.

Output: Continued collapse of right upper and middle lobes. Chronic lung disease. Right chest tube is not within the pleural space.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Fluid overload status. Shortness of breath. Cardiomegaly, unchanged. Left subclavian pacemaker terminates in the projection of the right ventricle. No pneumothorax. No specific signs of pulmonary edema. Possible small right pleural effusion.

Output: Cardiomegaly but no specific signs of pulmonary edema. Possible small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Left ICD and leads, unchanged. No pneumothorax. Cardiomegaly, unchanged. Left basilar atelectasis. No new pulmonary finding.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: evaluate ETT and NG position History: post intubation Small lung volumes otherwise unremarkable.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.

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


Instruction: Generate impression based on medical findings.

Input: 81-year-old male with dysphagia. Evaluate for extrinsic esophageal compression. CHEST:LUNGS AND PLEURA: Scattered nonspecific micronodules. No suspicious nodules, masses, or pleural effusion.Left greater than right basilar scarring. Mild to moderate upper-lobe predominant centrilobular emphysema. Mild subpleural reticulation and fibrosis also noted.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Ectatic descending aorta impresses on the posterior aspect of the esophagus without upstream esophageal dilatation. No abnormal mass causing extrinsic compression of the esophagus identified.Heart size normal without pericardial effusion. Severe calcifications of the left circumflex artery.Left thyroid nodules.Multiple surgical clips are seen near the GE junction.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Multiple small retroperitoneal lymph nodes are partially visualized. Atherosclerotic disease of the descending aorta with partial visualization of an endovascular stent.Approximately 50% collapse of the L1 vertebral body.

Output: 1. No evidence of extrinsic esophageal compression. If further evaluation for dysphagia is clinically warranted, consider a fluoroscopic esophagram.2. Mild subpleural fibrotic changes in the lungs.3. L1 vertebral body compression fracture of indeterminate age.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: assess for cause of increased RR History: tachypneic, has hemoptysis Unchanged pulmonary opacities with small pleural effusions suggestive of edema or aspiration.Tracheostomy tube tip approximately 6 above the carina.Left subclavian catheter, tip in SVC.Gastrostomy tube.

Output: Unchanged pulmonary opacities suggestive of edema or aspiration.


Instruction: Generate impression based on medical findings.

Input: Dobbhoff tube retraction Dobbhoff tube without significant change in location and configuration. Air-containing dilated loops of small bowel now less apparent, remainder of study without significant change.Please refer to chest radiography from same day for additional findings.

Output: Enteric tube without significant change in location and configuration.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: r/o pneumothorax History: s/p chest tube removal Interval chest tube removal on the right with no evidence of significant pneumothorax. There is a small residual pleural effusion. Other findings stable.

Output: Interval chest tube removal on the right with no evidence of significant pneumothorax. There is a small residual pleural effusion.


Instruction: Generate impression based on medical findings.

Input: LUNGS AND PLEURA: Interval increase in scarring size of large right pleural fluid collection. Complete atelectasis of the right lower lobe with near complete atelectasis of the right middle lobe lateral segment. A portion of the medial segment is aerated. Right upper lobe is also atelectatic and contains groundglass opacities suggesting edema. Curvilinear subpleural opacity in the left lower lobe remains and may represent scarring. Unchanged granuloma and peribronchial lymph nodes in the the right lung base. Some of the collapsed lung in the right middle lobe appears slightly more prominent than expected however appeared normal on recent previous CTs and is unlikely to represent malignancy given the short time period.MEDIASTINUM: Calcified right subhilar lymph nodes surgical clips in the left thyroid bed. Right thyroid lobe is heterogeneous and enlarged, correlate with surgical history. Small left posterior paratracheal lymph node image 73.CHEST WALL:Unremarkable.UPPER ABDOMEN: Limited images. Moderate ascites. Cirrhotic appearing liver. Suggestion of ill-defined low attenuation of the hepatic dome image 77, new from previous and of uncertain etiology. Lipoma in the duodenal bulb region. Cholecystectomy clips. Retroperitoneal soft tissue stranding.  Reference periportal lymph node measures approximately 20 1 x 30 mm (image 106), previously 19 to 28-mm), difficult to measure.

Output: 1. Interval increase in size of large right pleural fluid collection with associated lobar and segmental collapse of areas of the right lung. Collapsed lung cannot be assessed for underlying malignancy.2. No conclusive pleural based lesions are appreciated.3. Upper abdominal findings as above with slight increase in size of periportal lymph node and suggestion of ill-defined low-attenuation in the hepatic dome of unclear etiology.4. Surgical clips in the left thyroid bed, with mildly enlarged, heterogeneous right thyroid lobe, unchanged in size but nonspecific by CT.5. Consider correlation with FDG-PET imaging if there is clinical suspicion for occult malignancy.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: eval for infection History: nausea, vomiting, cancer history Small lung volumes with subsegmental atelectasis at the left base. No sign of pneumonia.Heart size about upper normal with a tortuous aorta.Left shoulder joint prosthesis.

Output: Mild left basilar atelectasis and no other acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: re-eval pneumo after chest tube removal 1330 History: cp Small right apical pneumothorax unchanged following pleural drain removal.Pulmonary nodules unchanged.Right jugular catheter, tip in SVC.

Output: Small right pneumothorax stable following pleural drain removal.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Fever question empyema. Moderate to large loculated right pleural fluid collection containing numerous internal air foci which are better visualized on the current study.Pleural thickening and nodularity bilaterally, along with nodular pulmonary opacities, consistent with metastatic disease. The presence of this abnormality makes it difficult to assess for superimposed infection in the pleural space which may appear similar. The right middle and lower lobes remain collapsed.

Output: Increasingly visible air in the right pleural space may be from empyema with gas producing organisms versus a small lower lobe pathologic bronchopleural fistula with slow air leak. Persistent right middle and lower lobe collapse; underlying pneumonia cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: Short of breath History: Short of breath There is a metallic jewelry noted in the anterior chest wall. The lungs and pleural spaces are clear. Heart size is upper limits of normal , stable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: assess intra aortic balloon pump placement History: cardiogenic shock Balloon catheter marker immediately inferior to the aortic arch, unchanged. ICD leads also unchanged.No new findings.

Output: Balloon catheter in the descending aorta with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: concern for aspiration History: concern for aspiration Persistent low lung volumes and bilateral basilar consolidative opacities, not significantly changed from prior studies, likely multifactorial. The assessment for superimposed infection is very limited.Moderate right and small left pleural effusions, unchanged from prior. No pneumothorax.

Output: Persistent bilateral basilar consolidative opacities, likely multifactorial in nature. Associated moderate right and small left pleural effusions are unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Cough. Linear scarring in the right midlung lower lobes.Normal heart size. Tortuous thoracic aorta which might may be mildly ectatic, unchanged.No signs of pulmonary edema or pneumonia.No pleural fluid or pneumothorax.

Output: No acute cardiopulmonary abnormality. Scarring in the right lung.


Instruction: Generate impression based on medical findings.

Input: Age: 26 yearsGender: MaleReason for Study: Reason: AM cxr s/p decort History: am cxr s/p decort Left-sided chest tubes unchanged. Left pleural effusion/thickening similar to prior exam.Diffuse interstitial opacities in bronchiectasis similar in appearance to the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance. No evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Rule out pulmonary edema shortness of breath. History of renal malignancy. Right chest wall metastasis with osseous destruction and associated soft tissue mass, appearing increased in size and density compared to studies earlier this year which could indicate pleural or parenchymal invasion. Within the right upper lobe adjacent to the mass, there is new atelectasis or consolidation. Please refer to recent chest CT regarding pulmonary nodules.Right hilar prominence is new and may reflect enlarged vasculature or lymph node enlargement, the latter is considered less likely given absence of lymphadenopathy on CT earlier this month. The SVC is distended. Focal atelectasis or infarct left lower lobe.Mild pulmonary edema on the right with small pleural effusions.

Output: Worsening abnormalities in the right lung suggesting asymmetric edema and pleural fluid. Small peripheral opacity at the left base could potentially reflect an infarct but is nonspecific. Constellation of findings at least mildly suspicious for pulmonary embolus.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: ? pneumonia History: chills and tachycardia Bilateral percutaneous nephrostomy and nephroureteral catheters are partially visualized in the upper abdomen.Relatively low lung volumes with streaky right lower zone opacities compatible with subsegmental atelectasis. No evidence of infection. Heart size is normal.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: VP shunt check SHUNT DEVICE: An unchanged intracranial shunt exits through a right posterior parietal burr hole and courses down the soft tissues of the scalp, neck, anterior chest and enters the abdomen terminating in the right lower quadrant/pelvis. The radiopaque portions remain unremarkable, and without frank kinking or discontinuity. The notch on the pressure valve points now in-line with the tubing and inferiorly towards the neck, change from a previous 9 o'clock position.SKULL: Two views of the skull show the aforementioned shunt device with additional unchanged postoperative changes in the posterior parietal/occipital regionCERVICAL SPINE: Two views of the cervical spine show the aforementioned shunt device. Mild degenerative disk disease at C5-C6 and C6-C7.CHEST: No focal pulmonary opacities. Cardiomediastinal silhouette is within normal limits.ABDOMEN: Nonobstructive bowel gas pattern.

Output: Unchanged shunt device


Instruction: Generate impression based on medical findings.

Input: 58 years old Male. Reason: Evaluate pneumonia. History: cocaine use. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Small radiopaque foreign body is seen in the left lower chest. The cardiac silhouette is normal.

Output: Small radiopaque foreign body in the left lower chest suggest further evaluation with lateral chest x-ray if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Difficulty breathing. Right chest port with tip in the SVC.Unremarkable cardiomediastinal silhouette.Slightly increased right pleural effusion with underlying basilar atelectasis and edema.

Output: Slightly increased right pleural effusion with underlying pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: retinopathy in setting of h/o bladder cancer, concerning for autoimmune related retinopathy History: bilateral decrease in vision, retinal detachment Cardiomegaly noted.Small pleural effusions are new, although there is no overt edema and no evidence of infection.No evidence of metastases.

Output: Cardiomegaly and new small pleural effusions, suggestive of mild CHF or hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: pleuritic pain following URI; h/o sarcoid History: pain Emphysema with large biapical bullae. Architectural distortion of the pulmonary hila secondary to fibrosis with evidence of calcification of left hilar nodes. Nodular opacity left perihilar location with ill-defined opacity in the anterior to mid thoracic vertebral bodies noted on the lateral view. While there is scarring and consolidation noted on previous cross-sectional imaging in this location, exclusion of an interval nodule is warranted with follow-up CT.

Output: Emphysema and extensive bullous formation with perihilar architectural distortion. Further characterization with a CT thorax is warranted for a opacities on the left.


Instruction: Generate impression based on medical findings.

Input: Age: 71 yearsGender: MaleReason for Study: Reason: s/p implant of a subcutaneous ICD --> evaluate lead position History: as above Left sided presternal ICD identified.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.No pneumothorax.

Output: Placement of presternal ICD without complications.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: follow up ? History: Right chest tube removed with no pneumothorax but persistent right chest wall soft tissue emphysema.Mild atelectasis and postoperative findings right midlung.

Output: Right chest tube removal with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: evaluate for chest metastasis History: hx of renal cell carcinoma Chronic elevation or eventrated right hemidiaphragm.No significant pulmonary or pleural abnormality.Unremarkable mediastinal contours and cardiac silhouette.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: 56yoM w/ esophag ca, productive cough x 2 weeks, fevers History: cough and fevers Right port catheter terminates in the midsuperior vena cava and is currently accessed. A metallic stent is noted right of midline, suspected to occupy a gastric interposition. The superior aspect initiates below the right clavicular head and terminates approximately 3 cm above the right hemidiaphragm.Scattered bilateral pulmonary nodules suspicious for metastases. Heart size is normal. Pleural spaces are clear. No pneumothorax or specific evidence of infection..

Output: Bilateral scattered pulmonary nodules suspicious for metastases with stent right of midline, likely within the gastric interposition. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: Exclude TB. Positive PPD. History: Exclude TB. Positive PPD. Normal cardiac and mediastinal contours.No pleural or parenchymal abnormalities.Small area of linear scarring in the left lower lung.

Output: No evidence of active pulmonary tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: Please re-eval after Dialysis, to distinguish edema vs. possible infiltrate / chronic aspiration? History: h/o ESRD, CHF, COPD, recurrent admissions for SOB, wheezing. Persistent mild basilar opacities suggestive of scarring and atelectasis rather than infection.Probable emphysema.Median sternotomy.

Output: Nonspecific opacities more likely subsegmental atelectasis than infection, improved.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with pancreatic mass on CT, likely adenocarcinoma, awaiting tissue diagnosis. Evaluate for evidence of metastatic disease. CHEST:LUNGS AND PLEURA: Ground glass and tree-in-bud opacities in the left lung with more nodular opacities seen along the oblique fissure and at the left lung base. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.Enteric tube tip is in the distal esophagus.CHEST WALL: Degenerative changes of the spine. UPPER ABDOMEN: Ill-defined pancreatic mass (series 4, image 111) with adjacent lymphadenopathy (for example series 4, images 104 and 105) with soft tissue infiltration around the celiac axis similar to comparison study from outside institution and compatible with suspected pancreatic malignancy.

Output: 1. Patchy left lung opacities most suspicious for acute infection versus aspiration; however, continued follow-up is recommended.2. Enteric tube tip is in the distal esophagus.3. Ill-defined pancreatic mass and adjacent adenopathy compatible with suspected pancreatic malignancy.


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Age: 27 yearsGender: FemaleReason for Study: Reason: evaluate for etiology of fever History: fever, tachypnea The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infection or edema History: shortness of breath Normal heart size with mild superior mediastinal widening which may be due to lipomatosis and/or enlarged lymph nodes.Streaky basilar opacities consistent with subsegmental atelectasis which may be related to aspiration, bronchial mucous plugging or pulmonary embolism.

Output: Abnormal basilar opacities consistent with atelectasis and nonspecific consolidation which may be secondary to aspiration, mucous plugging or pulmonary embolism.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Cough and congestion. Unremarkable cardiomediastinal silhouette.Mild central bronchial wall thickening which can be seen with bronchitis.No focal pulmonary opacities, pneumothorax, or pleural effusions.

Output: Bronchitis without acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: FemaleReason for Study: Reason: eval for rib fracture or soft tissue abnormality History: side pain, Right The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.No obvious rib fracture noted.No pneumothorax.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for infection, heart failure History: fever, cough, dyspnea, h/o COPD Unremarkable cardiac and mediastinal silhouette. Focal nodular opacity adjacent to the left heart border corresponding to an area of subsegmental atelectasis shown on a previous thoracic CT scan.Large lung volumes consistent with COPD.No sign of CHF or pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Multiple myeloma No cardiopulmonary abnormalities observed, specifically lungs are clear. Moderate tortuosity aorta is observedMultiple lucencies scattered throughout numerous ribs, changes are observed bilaterally. Mild wedge deformity of multiple mid thoracic vertebral bodies with mild loss of height of what appears to be T10 and L1, please correlate with pending bone survey given greater sensitivity.

Output: Vertebral osseous changes correlating with known underlying myeloma


Instruction: Generate impression based on medical findings.

Input: Testicular cancer CHEST:LUNGS AND PLEURA: Stable micronodules in the left lower lobeMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodensity in the right lobe liver is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Benign-appearing right renal cyst.RETROPERITONEUM, LYMPH NODES: Index left para-aortic lymph node is stable, measuring 1.2 x 0.9 cm on image number 12 3, series number 3.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: Stable left external lymph node measuring 1.2 x 1 cm image number 176 on series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: cough, possible history of leukemia History: cough Unremarkable cardiac and mediastinal silhouette. Mild scar like opacity at the right lung base.Probable splenomegaly.No sign of pneumonia.

Output: Left upper quadrant abdominal mass effect suggestive of splenomegaly.Mild right basilar scarring with no acute pulmonary disease.


Instruction: Generate impression based on medical findings.

Input: 93-year-old female with increasing lactate, mixed acidosis. CHEST:LUNGS AND PLEURA: Large bilateral pleural effusions are seen with associated passive atelectasis. Ground glass opacities have developed in the right upper lobe, mostly in the periphery.MEDIASTINUM AND HILA: Endotracheal tube in satisfactory position. The right central line terminates in the SVC. The heart size is enlarged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatic granulomata are seen. Cholelithiasis.SPLEEN: Splenic granulomataPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are small in sizeRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of pneumatosis. Collapse of the colon limits evaluation for wall thickening. Diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Anasarca. Mild ascites. Diffuse atherosclerotic disease.Hyperdensity in the proximal SMA is compatible with previously described short segment thrombosisPELVIS:UTERUS, ADNEXA: Uterine fibroids, calcified.BLADDER: A Foley catheter is seen within the bladderLYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: DiverticulosisBONES, SOFT TISSUES: No significant abnormality noted.OTHER: Anasarca. Mild ascites.

Output: Large bilateral pleural effusions with associated atelectasis. Patchy opacities have developed in the right upper lobe, which can be related to infection.No definite wall thickening, though collapse of the large bowel limits evaluation.Cholelithiasis.Atrophic kidneys.Anasarca and mild ascites.Atherosclerotic disease.Diverticulosis.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Tachypnea and recent pleural effusion. Malignant neoplasm of tonsil. Chronic elevation right hemidiaphragm with nonspecific opacity in the right costophrenic angle likely a combination of pleural fluid and atelectatic lung. Mild blunting of the left cardiophrenic angle also consistent with a small volume of pleural fluid. Left chest port tip in the left brachiocephalic vein. Gastrostomy tube retention device overlies the left upper quadrant. Tracheostomy tube in place.Extensive perihilar opacities about the same when comparing back to the patient's admission exam. These may be a combination of aspiration/infection and mild edema; lymphangitic tumor is not excluded given lack of resolution.

Output: Mild hypervolemia with edema and pleural fluid superimposed upon chronic axial interstitial opacities of indeterminate etiology.


Instruction: Generate impression based on medical findings.

Input: Male, 89 years old.Reason: PTX s/p RUL biopsy History: PTX s/p RUL biopsy Right upper lobe opacity unchanged. No pneumothorax.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 5-day-old female with pneumothorax.VIEW: Chest cross table lateral (one view) 5/3/2016 9:47 Endotracheal tube below the thoracic inlet and above the carina. 2 left-sided chest tubes unchanged in position. Partially imaged umbilical venous and arterial catheter tips unchanged in position.Persistent bilateral diffuse hazy opacities with pattern of PIE. Small anterior lower mediastinal lucency most compatible with pneumothorax.

Output: Small pneumothorax along the lower anterior mediastinum.


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old.Reason: eval lung fields History: sob, cp The cardiomediastinal silhouette is within normal limits. Lungs clear of interstitial and airspace opacities. No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: S/P cardiac surgery day #1 History: s/p cardiac surgery day #1 Unchanged chest tubes with no pneumothorax following cardiac surgery.Mild to moderate cardiomegaly, with mild basilar edema and small pleural effusions.ET tube tip approximately 4 cm above the carina.Right jugular introducer.

Output: No significant pneumothorax. Mild postop basilar edema and small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 35-year-old male with newly diagnosed Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: Right lower lobe nodule on image number 83, series number 3 measuring 11 x 9 mm. Other subcentimeter nodules are also present.MEDIASTINUM AND HILA: Extensive mediastinal adenopathy. Reference anterior mediastinal mass measures 10.6 x 5 cm image number 40, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly. No focal liver lesions.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Bilateral inguinal adenopathy. Reference left inguinal lymph node measures 21 x 12 mm image number 2032, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Enlarged mediastinal and inguinal lymph nodes.Bilateral lung nodules.Hepato- splenomegaly.


Instruction: Generate impression based on medical findings.

Input: 10 day old former 24 week twin gestation with dusky belly and crackles.VIEWS: Chest and abdomen AP (two views) 03/15/15, 1021 Endotracheal tube tip is between thoracic inlet and carina. Feeding tube tip is in gastric body. Left upper extremity PICC tip is in right atrium. Umbilical arterial line has its tip at T8/9.Lung volumes are large with hemidiaphragms at the 10th posterior ribs. Coarse bilateral lung opacities with round lucencies are present bilaterally. Cardiac silhouette size is mildly enlarged.Bowel gas pattern is abnormal. Multiple mildly dilated bowel loops are present in left abdomen. No bowel is seen in right abdomen. No pneumatosis intestinalis, portal venous gas, or free peritoneal air is seen.

Output: Continued pulmonary interstitial emphysema. Cardiac silhouette mildly enlarged may be due to PDA. Disorganized bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Sternotomy status post lead extraction. Interval removal of right jugular pacemaker lead. Hardware and devices otherwise without significant change in position.Slight worsening of edema, pleural fluid and atelectasis.Severe vascular calcifications.No pneumothorax on the right.Subcutaneous emphysema left chest wall.

Output: Worsening pleural fluid and atelectasis.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female L5 mass replacing the vertebral body CHEST:LUNGS AND PLEURA: Right upper lobe mass measuring 4.1 x 3.7 cm suspicious for a primary bronchogenic carcinoma. Numerous bilateral lung nodules are also present consistent with metastatic disease. An index lesion measures 7-mm in image number 38, series number 5.MEDIASTINUM AND HILA: Precarinal adenopathy measuring 4.1 by 1.9-cm image number 34, series number 3.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: Left adrenal mass measuring 2.9 x 2.8 cm image number 84, series number 3. Right adrenal gland is normal.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Patient's known L5 vertebral body mass is again identified.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Lobulated contours of the uterus with possible fibroids.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: Right upper lobe mass highly suspicious for primary bronchogenic carcinoma. Bilateral lung, left adrenal and L5 vertebral body metastatic lesions.Heterogeneous uterus with lobulated contours. Pelvic ultrasound may be helpful for further evaluation, if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Chest pain Minimal suspected scarring with possibly small left effusion. No additional cardiopulmonary abnormality

Output: Suspected pulmonary scarring and/or small effusion.


Instruction: Generate impression based on medical findings.

Input: 8-day-old former 23 week gestational age patient with chest tube removal.VIEW: Chest AP (one view) 04/30/16, 1906 Left chest tube has been removed. No pneumothorax is seen.Endotracheal tube tip is below thoracic inlet. Umbilical venous line has its tip at level of left portal vein.Moderate soft tissue edema is seen.Focal opacity is noted in right upper lobe and in the right hemidiaphragm is elevated. Innumerable round lucencies of varying sizes are present bilaterally. Lung volumes are large with right hemidiaphragm between eighth and ninth posterior rib and left hemidiaphragm between 10th and 11th posterior ribs. Cardiothymic silhouette is normal in size.

Output: No pneumothorax. Segmental atelectasis in right upper lobe. Pulmonary interstitial emphysema.


Instruction: Generate impression based on medical findings.

Input: Central line placement Motion degrades sensitivity.New right jugular catheter projects into the proximal SVC and questionably the right atrium, tip obscured by motion. CABG clips and TIPS stent otherwise unchanged.Underlying cardiopulmonary appearance otherwise similar with small effusions and patchy left-sided opacities representing probable aspiration and/or infection

Output: New right jugular catheter placed


Instruction: Generate impression based on medical findings.

Input: 65 years old Male. Reason: ETT placement History: ETT. Tubes and lines similar in position.Extensive nodules, consolidation and interstitial opacities about the same.Consolidation of the right lower lobe and the right middle lobe, worse as compared with prior study.Loculated left pleural fluid near the base..No pneumothorax.

Output: Interval worsening of the consolidation of the right lower lobe and right middle lobe.


Instruction: Generate impression based on medical findings.

Input: 47-year-old male with GIST status post partial gastrectomy/pancreatectomy CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Cystic right paratracheal focus is compatible with a foregut cyst, unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Tiny hypodensity in segment two of the liver is unchanged and too small to definitively characterizeSPLEEN: SplenectomyPANCREAS: Status post removal of the distal tail of the pancreas. The fluid collection in the post-surgical bed has basically resolved.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small lymph node in the gastrohepatic ligament, stable.BOWEL, MESENTERY: Status post excision of the gastric fundal mass.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 examination.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: s/p L chest tube, r/o pneumothorax History: cough, pleural effusion Moderate cardiomegaly.Large left pleural effusion improved following left subpulmonic chest tube placement.Decreased lung volumes with basilar atelectasis left greater than right.

Output: Left chest tube placement partially draining a left effusion with no pneumothorax. Increased basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Patient status post CABG. Left chest tube, mediastinal drains, sternotomy fixation hardware are unchanged. Swan-Ganz catheter has been removed.Small left pleural effusion is noted, slightly increased prior examination. There is increased adjacent consolidation along with streaky basilar opacities in the right lung. No pneumothorax is appreciated.

Output: Slightly increasing left pleural effusion with bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: + Quant Gold History: asymptomatic Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with history of bladder cancer, status post cystectomy, ileal conduit. Assess for recurrence This study is limited due to lack ofCHEST:LUNGS AND PLEURA: Stable bilateral micronodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Left breast lesion measures 2.4 x 2 cm on image number 40, series number 4, slightly smaller.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: Atrophic right kidney with moderate hydronephrosis and moderate left-sided hydronephrosis are stable.RETROPERITONEUM, LYMPH NODES: Stable retroperitoneal adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not seen.BLADDER: Status post cystectomy, ileal conduit is again noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat containing periumbilical hernia.OTHER: No significant abnormality noted.

Output: No significant change from previous study. Bilateral moderate hydronephrosis with atrophic right kidney and retroperitoneal adenopathy are unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: IABP placement History: IABP placement Cardiomegaly without acute edema.Unchanged support devices.IABP catheter proximal marker projects over the aortic arch.

Output: Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: Female 18 months old with history of increased work of breathing and fever, evaluate for pneumoniaVIEWS: Chest AP/lateral (two views) 3/9/2016 Interval extubation and removal of right IJ catheter. Enteric tube with tip in the gastric antrum.Normal cardiothymic silhouette. Bronchiolitis pattern without focal consolidation or pleural effusions.

Output: Bronchiolitis pattern without focal consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: Chest tube, pneumothorax Interval placement of left-sided chest tube. Significant reduction of left tension pneumothorax on the left side with moderate reexpansion of the left lung. Subcutaneous emphysema left side. ECMO cannulae and a right-sided chest tube are unchanged. Left jugular catheter tip is unchanged in the left brachiocephalic vein at the midline.Fibrotic right lung unchanged.

Output: Left-sided chest tube placement with significant reduction of left-sided pneumothorax with moderate expansion of the left lung.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: ICD History: SOB Left subclavian ICD with leads in the RA appendage and RV apex. Cardiomegaly. No significant pleural effusion or pulmonary edema. Status post sternotomy. The inferior wire has a fracture but there is no evidence of significant displacement.

Output: Left subclavian ICD with leads in the RA appendage and RV apex.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Lung CA post right upper lobectomy question pneumothorax. Left subclavian chest port tip at the SVC/RA junction. Two right apical chest tubes. Postoperative volume loss on the right with at least a small to moderate anterior pneumothorax, not measurable due to position. Opacity caudal to the suture line may reflect postoperative contusion however is nonspecific and should be followed to complete radiographic resolution on subsequent studies.

Output: Small to moderate right pneumothorax, not measurable due to its location.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: evaluate for enlarging right effusion History: hypercapnia Unchanged moderate to large right pleural effusion and left basilar edema.Right jugular catheter, tip in SVC.A Dobbhoff tube terminates in the stomach.

Output: Unchanged moderate to large right pleural effusion.