Instruction: Generate impression based on medical findings.

Input: Postoperative changes. Aortic valve stenosis Prosthetic aortic valve with superimposed catheters overlying the right hilar region and extending towards the apex appear unchanged. Right jugular sheath extends into the proximal jugular just above the confluence with the subclavian. ETT removedDecreased pulmonary lung volumes with mild persistent edema-like changes again observed, greater in a perihilar distribution

Output: ETT removed


Instruction: Generate impression based on medical findings.

Input: Chest pain Bilateral basilar and mediastinal chest tubes remain unchanged without significant pneumothoraces. Small effusions and decreased lung volumes with cardiomegaly and nonspecific basilar intrapulmonary changes.Swan-Ganz removed with a persistent right jugular sheath

Output: Swan-Ganz removed


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Interval placement of Dobbhoff tube The new Dobbhoff tube demonstrates an abnormal endotracheal and intrabronchial trajectory towards the right lower lobe, repositioning recommended.Subsequent chest radiograph demonstrates retraction of the tube.Persistent very low lung volumes and bilateral basilar subsegmental atelectasis.The right IJ venous catheter overlies the mid SVC.

Output: Multiple position and Dobbhoff tube likely within the right lower lobe due to endotracheal/bronchial trajectory. Repositioning recommended.Subsequent chest radiograph of the same day demonstrates interval retraction of the tube.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: new sob History: as above Worsening mixed interstitial and alveolar pulmonary edema. New small pleural effusions. Mild cardiomegaly again noted. No pneumothorax.

Output: Congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Concern for pneumonia. Status post right mastectomy. Right axillary surgical clips again noted.Diffuse right pleural thickening and small bilateral pleural effusions again noted.Right lower lobe partial collapse previously noted to represent a round atelectasis again noted. No new abnormal lung parenchymal opacities.The heart is normal in size.

Output: Stable size of bilateral pleural effusions. Diffuse right pleural thickening again noted.Assessment for underlying pneumonia in the collapsed right lower lobe is limited. No new abnormal parenchymal opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: r/o PNA, CHF exacerbation History: increased SOB Lower lung zone opacities with atelectasis, edema and pleural effusions.Moderate to severe cardiomegaly unchanged with a wireless pacemaker.

Output: Worsening CHF with increased edema and atelectasis and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: eval ett History: ett Mild basilar opacities right greater than left suggestive of atelectasis.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.Gas distended colon.

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


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: eval lung fields History: s/p TVR Iatrogenic devices are unchanged. Pneumopericardium again noted. Moderate cardiomegaly, as before. Patchy scarlike opacities again noted at the right lung base. Right lung base cavity appears to be filled with slightly more debris or atelectasis and can be reevaluated on imaging follow-up. No pneumothorax.

Output: Increased debris or atelectasis associated with the right base lung cavity. This can be reevaluated and imaging follow-up. Otherwise, no substantial difference.


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 68 years old Male. Reason: white count, tachypnea History: as above. The study is limited due to positioning. Within the limitations, there may be small right pleural effusion and moderate cardiomegaly. The tip of the NG tube is stable in position.

Output: Limited study due to positioning. Stable mild cardiomegaly and small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: enlarged cardiac History: CP, SOB Lungs hypoinflated with minimal subsegmental atelectasis. Heart size stable.

Output: Lungs hypoinflated with minimal subsegmental atelectasis. Heart size stable.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: ETT position History: intubated ETT 5 cm above the carina.Enteric tube extends beyond the field of view.Left pacer device with leads in the right atrium and right ventricle.Right PICC tip in the right subclavian.Persistent mild cardiomegaly and retrocardiac consolidation/atelectasis.Stable small left pleural effusion. No pneumothorax.

Output: ETT 5 cm above the carina. Stable exam without interval change.


Instruction: Generate impression based on medical findings.

Input: Cough Interval improvement with decreased pleural effusions, specifically diminished on the right with mildly persistent mixed interstitial and airspace opacities greater in both bases. No superimposed focal abnormality and improved aeration is particularly evident in both lung basesCardiac and mediastinum contours remain within limits for technique

Output: Improved bilateral opacities, resolving edema and suspected atelectasis


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Esophageal reflux. PICC placement. Right upper extremity PICC tip projects over the central pulmonary vasculature approximately 15 mm above the azygos arch. Surgical staples and clips partially visualized overlying the midline upper abdomen. No signs of aspiration. Minimal basilar scarring and a new focus of atelectasis adjacent to the fissure on the right. Previously described nodular densities otherwise unchanged, poorly visualized by this technique.

Output: Right upper extremity PICC projects over a central vein.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: r/o infection History: VOS, hx hbSS, No significant cardiopulmonary abnormality.No evidence of infection or infarction.Cholecystectomy clips.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 62 years old Male. Reason: ro pna History: ro pna. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Manipulation of the chest tubes.VIEW: Chest AP (one view) 12/9/2016 at 0809 hours. ET tube tip is above the carina. Both right-sided chest tubes, central line, gastrostomy tube and mediastinal clips unchanged.Cardiac size is top normal. Multifocal streaky opacities of the right upper lobe, left upper lobe and both lung bases on a background of diffuse lung haziness. Persistent small right apical hydropneumothorax.

Output: Multifocal airspace opacities and right apical hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Hypoxia Bilateral moderate to large layering pleural effusions with underlying moderate diffuse edema greater both bases. Mild cardiomegaly and moderate CHF. Tracheostomy tube unchanged, tip projects 7 cm above the carina

Output: Persistent moderate CHF with questionable mild progression


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: rule out chest metastasis History: hx of renal cell carcinoma sp partial nephrectomy Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Multiple myeloma Minimal streaky densities in the left lung base suggesting atelectasis and/or scarring with mild decreased lung volumes yet without superimposed additional cardiopulmonary acute abnormality.Mottled osseous appearance with both shoulders clavicles with numerous ribs. No distinct focal myelomatous lesion to suggest an acute pending fracture however dedicated imaging and reference to prior surveys is recommended given differences in technique. This includes wedge deformities involving the lower thoracic spine previously observed

Output: Extensive osseous changes compatible with known myeloma, yet no associated acute new cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Small left-sided pneumothorax.VIEW: Chest AP (one view) 02/23/15, 1029 Endotracheal tube tip is below the thoracic inlet. Feeding tube has been removed. Umbilical venous line tip is at level of left hepatic vein. Right chest tube is again seen. Side port is in subcutaneous tissues.Cardiothymic silhouette is normal in size. Right pneumothorax is small to moderate in size. Mediastinum remains slightly shifted. No left pneumothorax is identified. No focal lung opacity is present.

Output: Decrease in size of right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: eval for CHF or infiltrate History: SOB with cough for 4 days No pleural effusion or pneumothorax. No superimposed focal pulmonary abnormality. Moderate cardiomegaly, unchanged.

Output: Cardiomegaly without superimposed acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 80 year-old female with history of urothelial cancer, status post nephroureterectomy and oophorectomy CHEST:LUNGS AND PLEURA: Bilateral scattered micronodules are again noted. There are new larger nodules predominantly in the right lower lobe best seen on image number 188, series number 7. An index nodule measures 6 mm. Bronchiectasis. New small right-sided pleural effusion and dependent atelectasisMEDIASTINUM AND HILA: Calcified lymph nodes in the mediastinum are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: New hypodense lesion in the liver best seen image number 87, series number 9. This lesion is adjacent to the falciform ligament. MRI may helpful for further evaluation. Patient's known hepatic cyst in the right lobe is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Small lipoma in the pancreatic tail is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. Right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: New small lung nodules.New hypodense lesion in the liver. MRI of the liver is recommended for further evaluation to rule out a perfusion abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Intubation. The lungs are underinflated with minimal bibasilar atelectasis, stable.. ET tube is 1 cm above the carina. Dobbhoff tube at least in the stomach. No pneumothorax.

Output: Underinflated lungs with minimal bibasilar atelectasis, stable.


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old.Reason: eval for PNA. hx ulcerative colitis on immunosuppression History: fever The heart, mediastinum, lungs, pleural spaces and visualized bones are within normal limits.

Output: No radiographic findings to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: Assess for pneumo s/p lung biopsy History: s/p CT-guided lung biopsy No evidence of pneumothorax. Known nodule was better seen on CT.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Calcified right hilar lymph nodes suggest prior granulomatous disease.Unremarkable cardiomediastinal silhouette.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.HM3 placement evaluate LVAD. An LVAD is present, somewhat angulated compared to what is typically seen and should be correlated with the surgical anatomy. Left subclavian single lead ICD. Right jugular Swan-Ganz catheter terminating in the projection of the right main pulmonary artery. Mediastinal drain and chest tubes are in place. No significant pneumothorax. Low lung volumes with basal atelectasis.

Output: The LVAD appears slightly more angulated than expected which should be correlated with the patient's surgical anatomy.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: concerning lymphadenopathy noted on outside CT History: as above Stable cardiac mediastinal silhouette with decreased lung volumes.Minimal basilar atelectasis.No focal areas of consolidation.The large pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: left lung bx History: none No significant pneumothorax. Known lung nodule was better seen on CT.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: RLL PNA; ARDS, ETT History: Type 1 respiratory failure ET tube tip is just above the carina. Enteric tube tip extends out of the field-of-view.Right central venous catheter tip in the right atrium. Stable right basilar chest tube and right subcutaneous emphysema.Stable cardiomediastinal silhouette.Diffuse pulmonary opacities are again seen, not significantly changed.The right lower lobe opacities not readily distinguished from background diffuse pulmonary opacities.No significant pneumothorax.

Output: No significant interval change in diffuse pulmonary edema pattern and cardiopulmonary support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Left thoracentesis. Tubes and lines unchanged.Left loculated pleural fluid collection decreased in volume, no significant left pneumothorax.Right subpulmonic hydropneumothorax about the same. Pulmonary opacities similar to recent previous, some of which appear nodular and may represent infection.

Output: No pneumothorax post left thoracentesis. Decreased volume of pleural fluid on the left.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: new upper thorax swelling, likely soft tissue History: soft tissue swelling No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 58-year-old female with history of metastatic sarcoma CHEST:LUNGS AND PLEURA: Again noted multiple metastatic lesions in the lungs. Index left upper lobe nodule measures 2.4 by 2 cm on image number 46, series number 4, not significantly changed from previous study. Other multiple nodules are also stable.MEDIASTINUM AND HILA: Unremarkable.CHEST WALL: Soft tissue mass affecting the anterior first rib measures 5.9 x 5.3 cm in image number 29, series number 3, increased in size compared to previous study. Second rib metastases on the right side is also increased in size. Known T6 vertebral body lesion is again noted.ABDOMEN:LIVER, BILIARY TRACT: Splenomegaly. Diffuse fatty infiltration of the liver limits the ability of CT to evaluate focal lesions. Previously mentioned hypodense lesion in the right lobe of the liver is very difficult to differentiate from the surrounding low-density liver and measures 2.5 x 2 cm on image number 17, series number 3, not significantly changed from previous study. A second hypodense lesion in the left lobe is unchanged on image number 107, series number 3.SPLEEN: New hypodense lesion in the upper pole of the spleen measuring one .4-cm in diameter image number 74, series number 3.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left acetabular metastatic lesion and soft tissue mass is increased in size and now measures 6.1 by 4.5 cm on image number 183, series number 3. Right acetabular metastases is also slightly progressed.Sclerotic lesion in the left iliac bone is stable.OTHER: No significant abnormality noted.

Output: Interval increase in the size of the rib and pelvic bone metastases.New small splenic hypodense lesion suspicious for metastatic diseaseStable lung and hepatic metastases.


Instruction: Generate impression based on medical findings.

Input: Reason: pleuritic of chest pain History: as above Mild cardiomegaly with a tortuous aorta.Vascular redistribution and mild basilar scarring, not significantly changed.Blunting of the posterior and lateral costophrenic angles, is new since 8/22/2016 compatible with small pleural effusions.

Output: New small pleural effusions likely related to CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Palpitations and S.O.B., cardiomegaly, infiltrate history of stent and CHF. Unchanged cardiomegaly and prominent mediastinum.Small pleural effusions. Faint opacity suggestive of edema and atelectasis, though no septal thickening is observed.

Output: Cardiomegaly and small effusions consistent with hypervolemia. Nonspecific faint pulmonary opacities may reflect atelectasis; superimposed mild edema cannot be entirely excluded.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with IABP placement and SG placement. IABP catheter proximal marker projects over the proximal descending aorta.Right jugular Swan-Ganz catheter tip in the right main pulmonary artery.Enteric tube tip extends beyond the lower margin of the image.Status post median sternotomy with subcutaneous emphysema and surgical clips projecting over the right upper hemithorax, reflecting recent surgery.Cardiomegaly, unchanged.No focal pulmonary consolidation or pleural effusion.

Output: Unchanged support devices. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.NSCLC with S.O.B. and chronic airway obstruction. Right upper lobe collapse/consolidation due to central mass obstructing the right upper lobe bronchus. Right paratracheal and hilar lymphadenopathy. Rightward mediastinal shift. Blunting of posterior costophrenic angles nonspecific and could be due to trace pleural fluid. Opacity at the right apex may be secondary to pleural retraction or loculated pleural fluid, unchanged from previous film.

Output: Right upper lobe is collapsed to to centrally obstructing mass.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for AMS History: as above Normal heart size with surgical clips and sutures compatible with previous CABG surgery.Small lung volumes with no significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: eval interval in consolidation History: pna Improvement in patchy bibasilar opacities. Mild pulmonary edema, as before. Right IJ line again noted. Unchanged cardiomegaly. No pneumothorax.

Output: Improvement in basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Line pulled back, history of PE. Right jugular catheter tip at the SVC level. Endotracheal tube and enteric tube unchanged in position. Tubing overlying the left thoracic inlet may be external to the patient. Low lung volumes with basal scarring or atelectasis. Moderate pleural effusions, right greater than left. Areas of atelectasis in the upper lung fields unchanged.

Output: Repositioning of right jugular catheter with tip at the SVC level. No acute change in pleural fluid or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Chest pain. Left-sided pacemaker with displacement of the right atrial lead, now directed less cranially.Marked cardiomegaly, unchanged. Stable cardiomediastinal silhouette.Mild bibasilar subsegmental atelectasis/scarring, unchanged. No specific evidence of infection or edema.

Output: 1. Displaced right atrial pacemaker lead. 2. No evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: effusions improved? History: hypoxia, hypercarbia TAVR and pacemaker leads in place, unchanged.Left jugular catheter tip in the left brachiocephalic vein.Moderate cardiomegaly with moderately large bilateral pleural effusions and underlying atelectasis. Large lung volumes consistent with COPD with interstitial opacity compatible with scarring and edema.No new findings.

Output: Unchanged or possibly increased pleural effusions consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with history of metastatic renal cell cancer. Restaging status post 14 cycles of chemotherapy. Please evaluate for response and provide bidimensional measurements. CHEST:LUNGS AND PLEURA: Unchanged right middle lobe scarring.MEDIASTINUM AND HILA: Heterogeneous nodular thyroid is unchanged. Subcentimeter mediastinal lymph nodes are again noted.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Large right gallbladder lesion with enhancing soft tissue component may represent metastatic or primary disease . No evidence of cholecystitis. SPLEEN: No significant abnormality noted.PANCREAS: Multiple rim enhancing lesions with internal hypodensity, one which is enlarged. Reference lesion in the head of the pancreas measures 2.7 x 2.8 cm (image 101, series 4) and previously measured 2.4 x 2.4 cm. Reference lesion in the body of the pancreas measures 2.6 x 2.0 cm (image 74, series 4) and previously measured 2.6 x 2.0 cm.ADRENAL GLANDS: Reference left adrenal mass measures 3.2 x 2.9 cm (image 83 series 4) and previously measured 3.1 x 2.9 cm.KIDNEYS, URETERS: Multiple left renal masses are not significantly changed from the prior study. Reference superior pole lesion measures 3.9 x 3.5 cm (image 90 series 4) and previously measured 3.9 x 3.8 cm. Reference mid pole lesion measures 2.8 x 2.2 cm (image 92 series 4) and previously measured 2.8 x 2.3 cm. Status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: Scattered, small retroperitoneal lymph nodes are present.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative disease of the thoracic spine.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Unchanged sclerosis in the left ilium. L4 hemangioma is unchanged.

Output: 1. Overall stable metastatic disease with the exception of one enlarged pancreatic head lesion.2. Gallbladder lesion with enhancing soft tissue component which could represent primary or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Kidney donor No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Intubation ETT placed, tip extends into the right mainstem bronchus, subsequent images interpreted

Output: ETT over advanced


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: ETT History: ETT Left lower lobe consolidation and a left pleural effusion are consistent with pneumonia.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.

Output: Left lower lobe consolidation consistent with pneumonia.


Instruction: Generate impression based on medical findings.

Input: Neck and abdominal pain check for pneumomediastinum and free air Minimal postsurgical suture and clips observed in the upper abdomen without associated cardiopulmonary abnormality. Specifically no pneumomediastinum or free abdominal air.

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Enteric tube placement Nonvisualization of reported enteric tube. IVC filter present. Bilateral drainage catheters. Mild interval worsening of small bowel dilatation, for example, now measuring up to 6.2 cm in the right lower abdomen, previously 5.4 cm. Partially imaged lung fields demonstrate basilar atelectasis and pleural effusion on right.

Output: Nonvisualization of reported enteric tube, may be located more superiorly in the esophagus, re-imaging recommended. Please refer to body of report for additional findings.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: abnormality? History: cath tomorrow No acute abnormality.Mild chronic appearing interstitial opacities right upper lobe.Heart size normal.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: eval for R sided scapular lesion, hx of bladder ca now with R sided back pain radiating down R arm. History: arm pain The heart size is normal. Calcified, tortuous thoracic aorta. Enlargement of the main pulmonary vasculature, unchanged. Large lung volumes, suggestive of COPD. No focal pulmonary opacities, pleural effusion, or pneumothorax. No specific findings to account for the patient's arm pain.No gross suspicious osseous abnormality.

Output: No specific findings to account for the patient's pain.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, 64 years old.Generalized weakness Questionable nodule in the right lower lung.Otherwise no focal airspace opacity, pleural effusions or pneumothorax.Cardiomegaly with aortic arch calcifications.

Output: Cardiomegaly without acute pulmonary abnormality. Questionable right lower lung nodule. PA and lateral chest radiographs with subtraction are recommended when the patient can tolerate.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: s/p cabg History: s/p cabg Small lung volumes with basilar opacities compatible with atelectasis. Mediastinal and pleural drains in place with no pneumothorax or other acute change.

Output: Basilar atelectasis and no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: febrile neutropenia -- assess for pneumonia History: as above Mild interstitial opacities are nonspecific, and there is no reliable evidence of infection.Heart size normal.

Output: No specific evidence of infection. Mild interstitial opacities are nonspecific and continued follow-up is recommended if the patient remains febrile.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: evalaute for infiltrate/pneumonia History: patient with HIV, unknown CD4 with cough/DOE Low lung volumes. Question of focal opacity in the medial aspect of the right lung base. Mild left basilar subsegmental atelectasis or scarring. No large pleural effusion or pneumothorax. Normal heart size.

Output: Question of focal opacity in the medial aspect of the right lung base; correlation with PA and lateral chest radiograph is suggested.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: Eval for hilar lymphadenopathy History: lymphadenopathy Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No sign of lymphadenopathy.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: r/o infectious etiology History: altered mental status Chronic appearing left hemidiaphragm elevation, otherwise unremarkable examination.Heart size normal.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: Admission History: Check PA cath Cardiomegaly with the suggestion of pulmonary edema, with low lung volumes.IABP catheter proximal marker 3 cm below the top of the aortic arch.IVC Swan-Ganz catheter tip in main pulmonary artery.

Output: CHF. Swan-Ganz catheter and IABP in place.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.PICC placement for chemotherapy. AML. Right PICC terminates at the SVC level.Coarse interstitial opacities bilaterally, nonspecific. Subsegmental atelectasis right lower lobe.

Output: Appropriate position of right PICC. Coarse pulmonary opacities nonspecific but may reflect bronchiolitis from infection or inflammation.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Status post chest tube removal. Rule out pneumothorax. Interval removal of left chest tube. No significant pneumothorax is identified. No significant interval change in bilateral pleural effusions and basilar opacities. Surgical clips and sternotomy plates project over the midline, unchanged.

Output: Interval removal of chest tube without evidence of significant pneumothorax. Stable pleural effusions and pulmonary opacities.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, 65 years old.Reason: LVAD History: LVAD Swan-Ganz catheter tip in proximal right interlobar pulmonary artery. Other support hardware is unchanged.No change in cardiomegaly with basilar edema and atelectasis.

Output: Swan-Ganz catheter tip in proximal right interlobar pulmonary artery. Other support hardware is unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: cp History: cp Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: s/p extraction History: s/p extraction Interval removal of right ICD.New perihilar opacities suggestive of edema in the setting of cardiomegaly. Possible trace pleural effusions. No pneumothorax.

Output: No pneumothorax following ICD removal.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.ET tube reposition ET tube tip is approximately 2 cm above the carina. Right internal jugular central venous catheter tip is unchanged.Low lung volumes. Moderate cardiomegaly.Bilateral airspace opacities appear slightly increased most notably in the right lower lung zone.No pleural effusion or pneumothorax.

Output: Slight interval increase in extent of bilateral airspace opacities. ET tube tip is 2 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with head and neck cancer. Left iliac node. CHEST:LUNGS AND PLEURA: Scarring in the left lung base.Subcentimeter intrapontine there lymph nodes near the right major fissure.MEDIASTINUM AND HILA: 1 cm right-sided thyroid nodule. Right- it sided port with its tip in the distal SVC. Hypodensity within the right atrial appendage which may represent thrombus.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Simple left lobe hepatic cyst. Other subcentimeter densities in the liver are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland is enlarged.BLADDER: Diffuse wall thickening involving the anterior wall of the bladder. This may secondary to cystitis, or, neoplasm cannot be excluded.LYMPH NODES: Right inguinal adenopathy measuring 16 x 13 mm image number 186 on series number 4.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Enlarged prostate gland.Focal wall thickening involving the anterior abdominal wall the bladder.Writing adenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old. Reason: Evaluate lung fields History: sob Interval removal of the right upper extremity PICC.Multiple surgical clips and suture material are noted in the mediastinum and left upper quadrant.Cardiomediastinal silhouette is unremarkable.No focal airspace opacity, pleural effusion or pneumothorax.Bilateral breast prostheses again noted.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: ARDS ETT remains 4 cm above the carina. NG is under transfixed with side port seen at or just above the GE junction. Right jugular catheter unchanged with tip projected into the proximal SVC.New extensive punctate scattered lucencies across the upper exam, presumably external blanket or device. Please correlate with patient bedsideMild cardiomegaly with underlying diffuse bilateral airspace and interstitial opacities not significantly changed and consistent with suspected underlying ARDS. No discrete new superimposed focal airspace process. Small effusions

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: MaleReason for Study: Reason: PNA (worsening) History: increasing O2 requirements, becoming more SOB Extensive airspace and nodular opacities throughout both lungs similar in appearance to prior exam.The lungs are better aerated.Stable cardiac enlargement.Small pleural effusions/thickening and calcification unchanged.

Output: Upper lobe predominant groundglass and nodular opacities similar to the prior exam however increased from the exam dated 9/27/2015 and may represent infection, however other etiologies including hypersensitivity pneumonitis should be considered.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: eval for pneumonia vs atelectasis History: leukocytosis Basilar atelectasis and pleural effusions unchanged allowing for differences in patient positioning.

Output: Unchanged basilar atelectasis and pleural effusions, without reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: r/o infiltrate History: cough/sob Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: s/p open heart History: SOB Median sternotomy, heart size normal.No significant pulmonary or pleural abnormality.

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


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: Hypoxia History: As above Bibasilar subsegmental atelectasis or scarring again noted. Multiple calcified granulomas again noted within the lungs. Heart size and at the upper limit of normal. Aortic atherosclerosis.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: ET tube placement History: sob ET tube tip about 7 cm above the carina.No change in pulmonary opacities and other support devices.

Output: ET tube tip about 7 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male; 60 years old. Reason: pulled back PICC line, check placement History: n/a Left PICC retracted with tip now in the mid SVC. Otherwise, no significant interval change.Normal heart size.Mild right basilar opacity suggestive of small effusion with underlying atelectasis.Azygos pseudolobe, normal variant.

Output: Left PICC tip in SVC.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for rib fracture, infiltrate History: left chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Enteric tube placement, nausea/emesis Nasojejunal tube seen with tip located in pylorus. Multiple chest and right upper quadrant abdominal surgical clips. Small residual contrast seen, stomach distended containing debris. Small patchy airspace disease seen in partially imaged lower lung fields.

Output: Enteric tube as above.Stomach distended containing debris.Small patchy airspace disease seen in partially imaged lower lung fields.


Instruction: Generate impression based on medical findings.

Input: Reason: eval infiltrates History: hypoxia Moderate cardiomegaly with vascular redistribution.Partial clearing of bilateral airspace opacities compatible with edema or hemorrhage.Moderate pleural effusions and basilar atelectasis, unchanged.

Output: Resolving pulmonary airspace opacities compatible with edema or hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: COPD, niv History: sob Increase basilar consolidation left greater than right, consistent with infection or aspiration, with pleural effusions.Heart size normal.

Output: Increased basilar consolidation left greater than right, consistent with infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of mantle cell lymphoma. New palpable epigastric mass. CHEST:LUNGS AND PLEURA: Scattered granulomata and micronodules, unchanged. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Stable right hilar node, again measuring 12 x 8 mm (3, image 42). Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Minimal soft tissue infiltration around the celiac axis has been stable on multiple prior studies and is compatible with patient's history of lymphoma.BOWEL, MESENTERY: Scattered colonic diverticulosis without evidence of acute inflammation.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Stable exam without evidence of any new lesions to account for patient's physical exam findings.


Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.Reason: r/o infiltrate vs. pulm edema History: increased DOE, ho CHF and COPD No focal air space opacity, pleural effusions or pneumothorax. Increased lung volumes with flattening of the diaphragm suggestive of COPD/emphysema. Mild blunting of the costophrenic angles may be due to scarring or small effusions. The cardiomediastinal silhouette is unchanged. Thoracic kyphosis with multilevel degenerative disk disease.

Output: No evidence of pneumonia or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Cough. History of lung CA. Right basal opacity nonspecific and may reflect scarring and atelectatic lung however underlying nodularity is suspicious for underlying tumor. Right hilar and inferior interlobar lymphadenopathy. Small pleural effusions, right greater than left. Old, healed right lateral mid thoracic rib fracture deformities.Mild cardiomegaly with tortuosity and atherosclerotic calcification of the thoracic aorta.

Output: Small right pleural effusion with basal atelectasis or scarring containing internal nodularity and ipsilateral hilar region lymphadenopathy. In the absence of underlying signs of infection this is suspicious for tumor. If patient is neutropenic, nodularity from a superimposed fungal pneumonia could not be excluded. Suggest a baseline contrast enhanced thoracic CT for further characterization.


Instruction: Generate impression based on medical findings.

Input: Reason: follow up right basal opacity History: cough Partial clearing of right basilar opacity compatible with atelectasis and consolidation, likely related to aspirated secretions.Interval extubation.No new findings.

Output: Partial clearing of right basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: Evaluate ETT placement History: Endotracheally intubated ET tube tip 5-6 cm above carina. NG tube extends beyond the field-of-view of study.Stable pulmonary edema with pleural effusions. Increased left lower lobe atelectasis.

Output: ET tube tip 5-6 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Hypoxia. Rule out pulmonary edema or pneumonia. Bilateral consolidation in the dependent posterior lung fields, left greater than right, consistent with pneumonia.

Output: Bilateral left greater than right pulmonary opacities, most consistent with pneumonia. Follow-up to complete radiographic resolution with serial plain films recommended in an adult patient.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz check Swan-Ganz retracted, tip remains within right pulmonary outflow tract. IABP projects in the aortic arch. No additional cardiopulmonary change. See subsequent report

Output: Swan-Ganz catheter positioned


Instruction: Generate impression based on medical findings.

Input: Reason: poss pna History: cough and fever Heart size upper normal with moderate distention of mediastinal veins suggestive of increased circulating blood volume.No evidence of pulmonary edema or pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: 8/13/15 Lung resection wedge, VATS History: none Left chest tube removed with no pneumothorax.Resolution of prior right basilar atelectasis and improvement on the left; there is still a small left pleural effusion.

Output: Residual left basilar atelectasis but no new findings and no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: eval for pna History: fever, crackles to right lower lung Foci of subsegmental atelectasis, the lungs otherwise unremarkable.Heart size normal.No specific evidence of infection or edema.

Output: Subsegmental atelectasis, but no evidence of infection or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Pneumothorax. Interval placement of a right apical chest tube with tip directed far medially towards the junction line.Right pneumothorax is larger, now with maximal pleural separation from the chest wall of about 34 mm, previously 24 mm.The lungs are otherwise clear.

Output: Interval increase in right pneumothorax size, now with 34 mm of maximal pleural separation from the chest wall. Right chest tube tip is directed far medially.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: SOB History: SOB NG tube with its tip in the stomach.There are decreased lung volumes with a stable cardiomediastinal silhouette.Basilar opacities compatible atelectasis/edema similar in appearance to the prior exam.No new pulmonary opacities identified.

Output: Decreased lung volumes and basilar atelectasis/edema similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with postoperative increased work of breathing and hypoxemia. Rule out CHF, pneumothorax, and severe atelectasis. Cardiomegaly.Silhouetting of the medial left hemidiaphragm with overlying bronchograms is compatible with left lower lobe atelectasis or consolidation. Diffuse interstitial opacities and perihilar haziness is suggestive of edema. Blunting of the left costophrenic angle may represent a small left pleural effusion or scarring. No pneumothorax. Left lateral chest/abdominal wall subcutaneous emphysema, likely post-operative.

Output: Left lower lobe atelectasis or consolidation. Diffuse interstitial opacities and perihilar haziness is suggestive of CHF. Small left pleural effusion or scarring. No pneumothorax but extensive subcutaneous emphysema.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with metastatic neuroendocrine tumor. CHEST:LUNGS AND PLEURA: 3-mm nodule in the right lung base (series 5, image 72) has not significantly changed. An additional 3-mm nodule in the present in the left lower lobe (series 5, image 72), stable. Nodular opacity adjacent to the minor fissure (series 5 comment 58) is most likely an intrapulmonary lymph node, unchanged. Calcified granuloma in the left upper lobeMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Numerous enhancing hepatic lesions are seen throughout. The reference lesion in the left lobe is unchanged, measuring 9.2 x 6.1 cm (series 3, image 100). No gross change in the remainder of the lesions.SPLEEN: No significant abnormality notedPANCREAS: Status post Whipple procedure.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive adenopathy is again visualized. The reference mesenteric node measures 3.7 x 2.7 cm (series 3, image 136), previously 3.3 x 2.8 cm. this lesion involves the SMV, causing thrombosis (series 80216; image 61) unchanged from 11/1/08.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Collateral vessels are identified in the mesentery.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No change. Possible tiny pulmonary nodules, stable. SMV thrombosis secondary to invasion by the reference mesenteric lymph node, unchanged from 11/1/08.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: FemaleReason for Study: Reason: ETT History: ETT ET tube and NG tube unchanged.Decreased lung volumes with stable cardiomediastinal silhouette.Basilar opacities are compatible with atelectasis.New pulmonary opacities identified.

Output: Support devices unchanged. Nonspecific basilar opacities compatible with atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: pna, History: shortness of breath, wheezing No significant cardiopulmonary abnormality.

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


Instruction: Generate impression based on medical findings.

Input: 18 year old female with history of Ewing's sarcoma status post amputation, chemotherapy. LUNGS AND PLEURA: Linear scarlike opacities within the right middle lobe and left lower lobe are unchanged. No suspicious pulmonary nodules or masses. No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: No significant hilar or mediastinal lymphadenopathy. The cardiac size is normal. No pericardial fluid.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Nonobstructing left renal calculus unchanged when compared to the study of 9/25/07.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: ETT tube position History: intubated Small lung volumes with minimal subsegmental atelectasis in the retrocardiac region.ET tube tip approximately 6 cm above the carina.

Output: ET tube tip approximately 6 cm above the carina.. Minimal left basilar subsegmental atelectasis noted.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for bony abn, pneumonia History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain, eval for PTX/fluid overload History: chest pain, eval for PTX/fluid overload Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: FemaleReason for Study: Reason: s/p CABG and chest tube removal History: CT removal Right IJ venous catheter with its tip in the SVC.Chest tubes have been removed.No evidence of pneumothorax.Mildly decreased lung volumes with stable cardiomediastinal silhouette.Mild basilar atelectasis.No large pleural effusion.Median sternotomy is intact.

Output: Interval removal of chest tubes. No significant pneumothorax identified.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: ETT advanced, verify placement History: verify ETT location ET tube tip 3-4 cm above carina. Other findings stable in short interval.

Output: ET tube tip 3-4 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: Evaluate endotracheal tube, lung fields History: s/p LVAD exchange The endotracheal tube tip terminates 2 cm above the level of the carina. Multiple devices including LVAD and left chest wall ICD are unchanged. Exchange of left jugular catheter, the tip is in the right atrium. Sternal wires and clips are again identified.Cardiomegaly is stable. Opacities are unchanged. Probable small pleural effusions.

Output: Interval intubation without significant change in cardiopulmonary findings. Exchange of left jugular catheter, the tip is in the right atrium.


Instruction: Generate impression based on medical findings.

Input: Reason: preop History: Incisional hernia. Marked volume loss, scarring and rib deformities the left hemithorax compatible with previous thoracotomy.Fixation rods in the thoracolumbar spine.Heart size about upper normal or mildly enlarged but no evidence of CHF.

Output: Postsurgical abnormalities on the left and no acute disease.


Instruction: Generate impression based on medical findings.

Input: Female 62 years old Reason: eval lung fields History: s/p CABG, MVR Interval removal of Swan-Ganz catheter. Median sternotomy hardware noted.Support devices unchanged in position.Post-surgical changes stable from prior exam.Small pleural effusions with bibasilar atelectasis slightly increased from prior.

Output: Interval removal Swan-Ganz catheter. Stable post surgical changes with slight increase in pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old. ET tube and right IJ venous catheter unchanged.Bilateral extensive airspace opacities similar in appearance to prior exam.No new pulmonary opacities identified.Decreased lung volumes with cardiac enlargement.

Output: Support devices unchanged. Stable cardiopulmonary appearance with diffuse and extensive airspace opacities compatible with ARDS and diffuse alveolar damage.


Instruction: Generate impression based on medical findings.

Input: 40 year-old male with Crohn's status post resection periumbilical pain. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Multiple splenic hypodensities are unchanged, likely cysts.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small lymph nodes are seen in the right lower quadrant, unchanged.BOWEL, MESENTERY: Total colectomy with end ileostomy without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No evidence of abscess.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Minimal fat stranding in the left lower quadrant is unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace free fluid layers in the pelvis.

Output: No acute abnormality.End ileostomy without evidence of obstruction or abscess.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Respiratory failure. No focal airspace opacities, pleural fluid or pneumothorax.Interval extubation and removal of enteric tube.Lung volumes remain low normal.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.SOB question pneumonia or effusion. Hardware, tubes and lines unchanged.Unchanged cardiomediastinal silhouette, nonspecific in the postoperative setting. Central pulmonary vasculature appears prominent.Improving basal atelectasis. Minimal pleural fluid on the right, but no specific evidence of edema.

Output: Improved lung volumes with clearance of edema and improvement in basal atelectasis. Very small right pleural fluid collection.


Instruction: Generate impression based on medical findings.

Input: Female 70 years old Reason: s/p chest tube removal, assess for pneumothorax History: none Interval removal of right chest tube with small right pneumothorax.Low lung volumes.Stable cardiomediastinal silhouette.Left basilar atelectasis and/or scarring.No new focal airspace opacity.

Output: Interval removal of right chest tube with small right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for effusion, pulmonary edema History: SOB with known CHF Cardiomegaly with ICD leads in place. New diffuse pulmonary opacity with multiple septal lines and perihilar airspace opacity mainly in the left upper lobe, compatible with acute pulmonary edema. Small left pleural effusion.

Output: CHF with acute pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Displacement of surgical disc. Moderate emphysematous changes without discrete superimposed acute pulmonary process. Lungs otherwise clear. No effusions.The cardiac and mediastinal contours are within limits

Output: Moderate diffuse emphysematous changes


Instruction: Generate impression based on medical findings.

Input: Reason: s/p pleurodesis History: s/p pleurodesis Small left apical pneumothorax grossly apex of the lung about 2 cm from the chest wall.Venous catheter and chest tubes unchanged.Airspace opacity and atelectasis in the left lung and bilateral pleural effusions, not significantly changed.Interstitial edema in the right lung however has improved.

Output: Small left pneumothorax with residual pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Coronary artery disease with chest and abdominal pain. Rule-out dissecting aneurysm. CHEST:LUNGS AND PLEURA: Bilateral pleural effusions are seen left slightly greater than right.No parenchymal lung masses, nodules or infiltrates are identified.MEDIASTINUM AND HILA: Descending aortic aneurysm beginning just distal from the left subclavian artery. Maximal dimension is 5.5 x 5.9 cm (series 3, image 75). It extends for approximately 11 cm to the supradiaphragmatic location. There is peripheral mural calcification scattered throughout this length but no definite displacement of calcification to suggest displaced intimal flap. There is moderately high attenuation are noted draping over the anterior and left lateral margin of the aneurysm extending into the mediastinum to the retro-parietal and paraesophageal regions and extending inferiorly to just above the diaphragm. Maximal thickness of this is approximately 1.5 cm (series 3, image 60) This high attenuation material is worrisome for blood which may represent a leaking aneurysm.CHEST WALL: Pacemaker apparatus within the left anterior chest wall with pacer wires in expected location. Surgical sutures through the sternum from prior thoracic surgery.ABDOMEN: Within the limits of a non-IV contrast enhanced examination the following observations can be made;LIVER, BILIARY TRACT: Liver appears normal the lack of IV contrast limits ability to evaluate for parenchymal masses. Multiple gallstones are seen without other complication in the gallbladder. No intrahepatic or extrahepatic biliary duct dilatation is seen.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate calcification is seen scattered throughout both kidneys with an appearance most consistent with small vascular calcifications. Within the limits of non-IV contrast enhanced exam, no masses or other abnormalities are seen in the kidneys.RETROPERITONEUM, LYMPH NODES: Abdominal aorta shows normal caliber with extensive mural calcification. No periaortic abnormalities are seen. No lymphadenopathy. No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes are seen throughout the thoracolumbar spine.OTHER: No significant abnormality noted

Output: 1. Descending thoracic aorta aneurysm with anterolateral moderately high attenuation material extending in the mediastinum worrisome for leaking aneurysm. 2. Bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: monitor iabp History: iabp Balloon catheter, PICC line and ICD leads unchanged. Small lung volumes with no significant abnormalities.Healing rib fractures on the right.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: sp ex lap for colonis anastomoric breakdown History: shortness of breath Interval removal of nasogastric tube. Increasing pleural effusions and basal atelectasis. Pulmonary cysts are accentuated by pleural fluid. The cardiac silhouette is now obscured by the parenchymal opacities. Multiple staples project over the left upper abdominal quadrant.

Output: Increasing pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p afib ablation Interval extubation. Venous catheters and chest tubes unchanged.Cardiomegaly with nonspecific pulmonary opacity compatible with edema, atelectasis and pleural effusions.No pneumothorax.

Output: Interval extubation and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: assess for pulm edema History: crackles, ventilator Lower lung zone edema unchanged but improvement in basilar atelectasis.Small pleural effusions noted.Tracheostomy tube tip approximately 2 cm above the carina.A VP shunt courses over the right side of the chest.

Output: Moderate pulmonary edema unchanged, but basilar atelectasis has improved.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: postop, chest tubes in place History: eval PTX Three right chest tubes with a right subpulmonic pneumothorax.Basilar edema and left lower lobe consolidation with pleural effusions noted.Right PICC crosses the midline into the left brachiocephalic vein, unchanged.

Output: Right subpulmonic pneumothorax. Unchanged pulmonary opacities and pleural effusions. Right PICC still retrograde in the left brachiocephalic vein.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with retroperitoneal adenocarcinoma CHEST:LUNGS AND PLEURA: Diffuse emphysema with upper lobe predominance. No evidence of suspicious nodules. Small left-sided pleural effusion. Linear atelectasis at the lung bases.MEDIASTINUM AND HILA: Pretracheal adenopathy measures 18 by 18-mm image number 37, series number 4. Previously it was measuring 16 by 15-mm image number 36, series #3. This index lymph node is slightly enlarged compared to the study dated 4/30/2010, however, it is significantly enlarged compared to study dated 1/25/2010.Other mediastinal enlarged lymph nodes are stable to minimally increased in size. Retrocrural lymph nodes are also stable. A reference left retrocrural lymph node measures 10 by 8mm image number 87, series number 4. Previously it was measuring 12 x 9 mm image number 85, series number 3 on 4/2010.. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Numerous cysts in both lobes of the liver are unchanged. No solid focal liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal gland nodule is stable measuring 20 x 14 mm on image number 94, series number 4. Nodular left adrenal gland is unchanged.KIDNEYS, URETERS: Atrophic left kidney. Nephroureterostomy catheter in proper position. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Confluent soft tissue mass in that could not be differentiated from left psoas muscle measures 5.6 by 2.7-cm, slightly smaller compared to previous study. This lesion is very difficult to measure since it cannot be distinguished from the left psoas muscle. Extensive retroperitoneal adenopathy is stable. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in the lumber vertebral bodies are unchanged.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Pelvic adenopathy, stable. Reference left obturator lymph node measures 17 x 9 mm on image number 165, series number 4. Previously closed measuring 15 x 5 mm image number 164, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Ill-defined soft tissue nodules in the pelvis suspicious for metastatic deposits are stable.

Output: Minimal interval increase in the size of the mediastinal adenopathy. Retrocrural lymph nodes are stable.Extensive retroperitoneal adenopathy and ill-defined left retroperitoneal mass are stable.Presumed peritoneal nodules in the pelvis are stable..


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with metastatic renal cell carcinoma ABDOMEN:LUNG BASES: Nonspecific hazy ground glass opacity in the left apex is unchanged.LIVER, BILIARY TRACT: Cholelithiasis is unchanged. Punctate hypodensity in the inferior aspect of the right lobe of the liver is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule measuring 11 x 13 mm on image number 106 causes number 5, stable.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of recurrence in the surgical bed.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node measures 7 x 6 mm image number 120, series number 5.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previous described soft tissue invading the right aspect of the L1 vertebral body is unchanged measuring 24 x 19 mm on image number 114, series number 5.Expansile lytic lesion invading the left third lateral rib is unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable bone metastases.


Instruction: Generate impression based on medical findings.

Input: 13-week-old male with line and tube placement.VIEW: Chest AP (one view) 5/24/2016 15:34 Right internal jugular venous catheter tip in the SVC. Endotracheal tube tip between the thoracic inlet and carina. Enteric tube tip in the stomach. No focal pulmonary opacity, pleural effusion or pneumothorax. Mildly prominent cardiothymic silhouette. Partially imaged dilated bowel loops in the upper abdomen.

Output: Right internal jugular venous catheter tip in the SVC. Endotracheal tube tip between the thoracic inlet and carina.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Bronchitis with productive cough and fever Intraperitoneal air presumably postoperative. Atelectasis at the left lung base with some patchy airspace opacity suggestive of aspirate; an evolving aspiration pneumonia may be considered in the appropriate clinical context. Normal heart size. No pneumothorax.

Output: Postoperative pneumoperitoneum. Left basal atelectasis and faint patchy opacity may be secondary to aspiration; an evolving aspiration pneumonia may be considered in the appropriate clinical context.


Instruction: Generate impression based on medical findings.

Input: 61 year-old woman with history of total shoulder arthroplasty. A left total shoulder arthroplasty device is seen in near anatomic alignment. There is no evidence of hardware complication. Left chest wall port is noted.

Output: Left total shoulder arthroplasty without evidence of complication.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: Pre-op CXR History: N/A Cardiomediastinal silhouette is unremarkable. No focal airspace opacity or pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: confirm line in position History: TLC Right jugular catheter tip in the area of the SVC with no pneumothorax or other complications.Moderate volume loss in the left hemithorax which may be transient or positional.No other significant change.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: 58 year old female with history of metastatic head and neck cancer. Compare to outside CTs. CHEST:LUNGS AND PLEURA: 4-mm nodule seen in right lung base (series 5, image 50) and left lung base measuring 0.9 x 0.5 cm (series 5, image 74). No pleural effusions or pleural masses are seen.MEDIASTINUM AND HILA: No significant adenopathy or other masses identified.CHEST WALL: Infusion port is in the anterior left superior chest wall with the infusion catheter tip in the proximal right atrium.ABDOMEN:LIVER, BILIARY TRACT: Too numerous to count solid mass lesions are seen throughout the liver diffusely. Representative reference lesions from measurement include superior segment 8 (series 3, image 84) measuring 3.7 x 2.1 cm; posterior segment 6 (series 3, image 103) measuring 2.3 x 2.1 cm.Gallbladder and biliary tract appearsSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered small subcentimeter cortical hypodensities, most likely benign cysts. Larger parapelvic cysts are seen, particularly in the left kidney. No other significant abnormality seen.RETROPERITONEUM, LYMPH NODES: Normal size, subcentimeter scattered periaortic lymph nodes are seen no enlarged lymph nodes or other retroperitoneal masses are seen.BOWEL, MESENTERY: Surgical clips seen in region of antrum/duodenum. Bowel itself shows no diagnostic abnormalities. No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Multiple masses in and protruding from the uterus -- CT is not able to characterize uterine masses most likely these represent 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: 1. Bibasilar lung nodules as measured above. 2. Innumerable masses in the liver most likely liver metastases. 3. Multiple masses in uterus, most likely fibroid tumors. 4. If old films are submitted into the department of radiology PAC system, I would be glad to dictate an addendum comparison report.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: infiltrates History: dyspnea No focal lung opacity. Heart size normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for ETT placement History: intubated ET tube tip approximately 3 cm above the carina.NG tube coiled in the stomach.Mild cardiomegaly and mild basilar subsegmental atelectasis.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: elevated LA, infection? History: Elevated Lactic Acid No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old. Reason: pna History: fever, cough Cardiomediastinal silhouette is within normal limits.No focal airspace consolidation. No pleural effusions or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Cardiomyopathy Swan-Ganz has been minimally retracted, tip remains in the pulmonary right outflow tractLungs remain decrease in overall volume without superimposed new cardiopulmonary abnormality. Mild cardiomegaly

Output: Minimally repositioned Swan-Ganz


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: intubated sedated patient History: intubated patient Increasing left basilar atelectasis with small pleural effusions, possibly aspirated secretions or mucous plugging.ET tube tip approximately 3 cm above the carina.Left subclavian catheter, tip in SVC.An NG tube terminates in the stomach.

Output: Increasing basilar atelectasis particularly on the left.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pna History: sob Unremarkable cardiac and mediastinal silhouette. Small lung volumes with mild opacity at the left base suggestive of atelectasis.No specific evidence of pneumonia.

Output: Small lung volumes with mild left basilar opacity, most likely atelectasis, possibly related to aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: Evaluate etiology of SOB, hypoxia History: SOB, hypoxia Unchanged basilar interstitial opacities suggestive of edema and atelectasis.Mild cardiomegaly status post sternotomy.

Output: Unchanged basilar opacities suggestive of atelectasis and edema.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Shortness of breath. Mild elevation left hemidiaphragm. Lungs are otherwise clear. Heart normal in size. No pneumothorax.

Output: Clear lungs. Mildly elevated left diaphragm.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: hx of kidney cancer, evaluate for metastatic disease History: see above The cardiac mediastinal silhouette is unremarkable.The lungs are clear.Right pleural thickening and mild right basilar subsegmental atelectasis unchanged.No new suspicious pulmonary nodules or masses.

Output: No acute cardiopulmonary abnormalities identified without interval change. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: LUNGS AND PLEURA: Stable left pneumonectomy with fluid filling the pneumonectomy cavity. Stable small nodular opacity at the right apex, probably a scar. Centrilobular emphysema of the right lung.MEDIASTINUM: Leftward mediastinal shift. Atherosclerotic disease of the aorta and coronary vasculature. Main pulmonary artery remains markedly enlarged consistent with pulmonary arterial hypertension. No lymphadenopathy. Small hiatal hernia.CHEST WALL: Healed fracture of the left seventh rib.UPPER ABDOMEN

Output: Stable exam.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: Question about pulm edema or atelectasis in ckd pt History: coarse bs Right-sided PICC again terminates in the axilla. Mild leftward patient rotation, as before. Increased left basilar opacity. Unchanged heart size. No pneumothorax.

Output: Increased left basilar opacity which may represent aspiration and/or atelectasis. Small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: re-evaluate ptx History: hypoxia No visualized pneumothorax.Line position stable.Diffuse nonspecific pulmonary opacities and bilateral effusions are unchanged.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Cough Interval resolution of previously observed pleural effusions near the lungs otherwise remain clear. Mild tortuosity of aorta without associated cardiac or mediastinal abnormality. Midline sternotomy

Output: Interval resolution of bilateral pleural effusions


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: swan position History: poor cvp wave form Swan-Ganz catheter tip in the interlobar right pulmonary artery.Left subclavian AICD unchanged.Left costophrenic angle is excluded from the field-of-view.Stable basilar opacities. No new focal pulmonary opacity, significant pleural effusion, or pneumothorax.Stable cardiomediastinal silhouette.

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


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: hypoxemia History: hypoxemia Left central venous catheter unchanged.Mild advancement of NG tube.Almost complete opacification of the left hemithorax compatible with increasing left pleural effusion and atelectasis in the left lung.The right lung is clear.

Output: Almost complete opacification of the left hemithorax compatible with increasing left pleural effusion and increasing atelectasis in the left lung.


Instruction: Generate impression based on medical findings.

Input: Age: 77 yearsGender: FemaleReason for Study: Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Left-sided ICD unchanged.Stable cardiac enlargement.Increased interstitial opacities compatible with edema.Small pleural effusions.No evidence of a pneumothorax

Output: Left-sided ICD with CHF unchanged. No evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with non-Hodgkin lymphoma. Reevaluate and compare to previous. CHEST:LUNGS AND PLEURA: Bilateral mild emphysema, unchanged. Scarring in the upper lobes, unchanged. New subcentimeter nodule measuring 6-mm in the upper lobe wall the left lung. Another new subcentimeter nodule in the lower lobe of the left lung adjacent to the pleura measuring 5-mm on image number 71.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Air froe wedge-shaped hypodense areas about the knee Kapseal of the left lobe in segments 3 and 4. The lesion in segment 3 measures 2.7 x 1.7 and the lesion in segment 4 measures 2.5 x 1.4 cm on image number 92/196. Subcentimeter hypodense lesion in the right lobe on image number 94 is unchanged and likely represents a cyst. Another hypodense lesion in the segment 6 of the right lobe, on image number 108/196 is unchanged compared to previous study.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilobular cystic lesion in the lower pole of the right kidney is slightly increased in size and now measures 2.7 x 1.3 cm. Left upper pole cystic lesion is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: New two subcentimeter nodules in the left lung. The upper lobe nodule is ill-defined. Close follow up with imaging is recommended.New hepatic lesions abutting the capsule of the left lobe. The etiology of these lesions is not clear. They may represent true lesions versus focal fatty infiltration. MRI of the liver is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: s/p removal of left chest tube / resolving pneumothorax History: s/p removal of left chest tube Minimal left apex pneumothorax is not significantly changed. Other findings also stable.

Output: Minimal left apex pneumothorax is not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old. Subcutaneous emphysema. Chest tube. Interval removal of previously seen left chest tube and placement of two new chest tubes, tips terminating at the mid and lower hemithorax.Small left apical pneumothorax, unchanged.Elevation of left hemidiaphragm with a small left pleural effusion and underlying atelectasis, unchanged.Diffuse severe subcutaneous emphysema and pneumomediastinum, unchanged.Right chest port tip in the SVC, unchanged.

Output: Interval removal of previously seen left chest tube and placement of two new chest tubes. Small left apical pneumothorax, unchanged.


Instruction: Generate impression based on medical findings.

Input: 80 year-old female with history of chest pain and cough. Evaluate for pneumonia. Blunting of the costophrenic angles likely represents small pleural effusions or scarring. Linear opacities at the left base likely represents subsegmental atelectasis. Stable cardiomediastinal silhouette. No specific evidence of infection.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.History of cough and weight loss. No focal airspace opacity, pleural effusion, or pneumothorax. Large lung volumes with flattening of the diaphragms suggestive of COPD. Calcified right hilar granulomas.The cardiomediastinal silhouette is within normal limits.

Output: Large lung volumes suggestive of COPD.


Instruction: Generate impression based on medical findings.

Input: Reason: right chest pain with deep inspiration, improves with change in position History: as above. New small subpleural air space opacity in the right lower lung laterally, with a differential diagnosis that includes infection and infarct. If there is a high suspicion for pulmonary embolism a CT scan may be appropriate for further evaluation.Unremarkable cardiac and mediastinal silhouette.A text page was sent to pager 4054 at the time of reporting.

Output: New focal right subpleural air space opacity which may be due to infection or infarct.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: Eval for reaccumulation of pleural effusion History: cough, SOB Rapid reaccumulation of pleural fluid now large in size. Associated leftward mediastinal shift. Left lung remains clear. No pneumothorax.

Output: Rapid reaccumulation of pleural fluid now large in size. Associated leftward mediastinal shift.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old. Interval intubation with tip of endotracheal tube 4 cm above carina.No change in right lung opacity and pleural effusion.Heart size normal. No pneumothorax.Interval placement of nasogastric tube with tip in projection of gastric fundus.

Output: 1. No change in right pulmonary opacity and effusion.2. Interval intubation


Instruction: Generate impression based on medical findings.

Input: Reason: 57yo M w/ swan, assess placement History: as above Swan-Ganz catheter tip in the right descending pulmonary artery.ICD lead unchanged.Cardiomegaly with pulmonary edema, slightly increased.

Output: Slightly increased pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: resp failure History: intubated ET tube with its tip 3 cm above the carina.NG tube with its tip in the stomach.Stable cardiomediastinal silhouette.Right perihilar consolidation and diffuse bilateral interstitial opacities unchanged.No new opacities identified.

Output: ET tube with its tip 3 cm above the carina. Pulmonary opacities unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: interval change History: f/u xr Persistent retrocardiac consolidation with small lung volumes and mild edema.Small pleural effusions.Borderline cardiomegaly.

Output: Persistent retrocardiac consolidation with edema and small lung volumes.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: SOB, eval for CHF/PNA History: SOB, eval for CHF/PNA The support devices are unchanged in position.Interval development of central mid to lower zone opacities favoring edema. Small pleural effusions. Cardiomegaly is unchanged. No interval pneumothorax.

Output: Development of central airspace opacities compatible with edema in the setting of cardiomegaly. Evaluation following diuresis to assess for persistent opacity recommended if pneumonia is also suspected.


Instruction: Generate impression based on medical findings.

Input: 58 year old with thyroid cancer. Total body scan on 8/5/08 with uptake in the mediastinum. Evaluate for neck/lung metastases. LUNGS AND PLEURA: No suspicious pulmonary nodules. No pleural effusions.MEDIASTINUM AND HILA: Multiple surgical clips are identified in the thyroid bed along with high attenuation tissue likely residual thyroid. Enlarged lymph nodes are identified at the level of the origins of the great vessel, the largest measures 1.6 x 1.0 cm (image 20/103). Additional smaller nodes are seen in the right paratracheal region. No significant hilar lymphadenopathy. Normal cardiac size. No pericardial effusion.CHEST WALL: No significant axillary lymphadenopathy. Sclerotic focus seen in the left sixth rib posteriorly. Degenerative changes. No additional lesions are identified.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Enlarged lymph nodes at the level of the origins of the great vessels which most likely corresponds to the uptake identified on whole body I-131 scan2. Sclerotic focus in the left sixth rib most likely represents a bone island as the adjacent cortex is still intact and would be atypical for thyroid metastatic lesion.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, 73 years old.Reason: assess for ET tube placement History: s/p intubation Cardiomegaly with pulmonary opacities suggestive of edema. More focal opacity in the right upper lobe could represent a site of infection or aspiration, or localized edema if the patient has mitral regurgitation.ET tube tip approximately 1 cm above the carina.An NG tube terminates in the stomach.

Output: Stable pulmonary opacities suggestive of edema. ET tube tip still low.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: Evaluate for pulmonary edema History: new onset CHF An inferior vena cava filter overlies the abdomen and is incompletely visualized.The cardiomediastinal silhouette is unchanged. Tortuous and perhaps even ectatic aorta. No focal pulmonary opacity suggestive of pneumonia. Very subtle interlobular septal thickening at the bases consistent with minimal pulmonary edema and is improved when compared to the prior. Bibasilar atelectasis and/or scarring. Small bilateral pleural effusions. No pneumothorax.

Output: Minimal pulmonary edema and small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 28 year old woman history of med NHL in CR. Evaluate for staging. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Small mass in the abutting the anterior mediastinum is remeasured on image 54/225 is 1.7 x 1.5 cm.Previously measured mass or fluid dorsal to the aortic root is not seen on the current study. This may represent pericardial fluid.No new adenopathy.CHEST WALL: Mild inferior pectus excavatum.ABDOMEN:LIVER, BILIARY TRACT: Single punctate hyperdensity in segment 8, unchanged. No new lesions. Remainder of the liver is normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted, except for scoliosis.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable anterior mediastinal mass. Stable punctate hypodensity in the liver.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: ETT History: ETT Support devices unchanged.Interstitial opacities and pleural effusions similar to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged with ET tube tip approximately 4 cm above the carina. Stable cardiopulmonary appearance of pleural effusions and interstitial opacities suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Cough and SOB. Unchanged cardiomegaly. No specific signs of pulmonary edema. No focal airspace opacities.Degenerative changes of the thoracic spine. No pleural fluid or pneumothorax.

Output: Mild cardiomegaly, but no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: cardiopulmonary abnormality? History: SOB, cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Intubation. Cardiomegaly with diffuse interstitial abnormalities but no significant pleural effusions may reflect ARDS or possibly infection. ET tube is 6 cm above the carina, just below the thoracic inlet. NG tube is colon and stomach. No pneumothorax.

Output: Diffuse interstitial abnormality suggesting ARDS/edema or possibly infection. ET tube 6 cm above the carina, just below the thoracic inlet.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: rule out pneumonia History: desaturation Right basilar atelectasis, a small right pleural effusion, and moderate cardiomegaly, unchanged.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.

Output: Nonspecific right basilar atelectasis, not clearly infection.


Instruction: Generate impression based on medical findings.

Input: Line placement Interval right PICC line placed, tip extends into the proximal SVC. Underlying large pulmonary volumes with associated cystic fibrotic changes appear similar without new superimposed focal abnormality. Left basilar scarring

Output: Right PICC line placed


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: evaluate for pulmonary edema History: dyspnea, chest pain Heart size upper normal,Basilar opacities suggestive of edema with pleural effusions.Focal right base opacity could represent superimposed infection or aspiration.

Output: Pulmonary edema and possible right basilar infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infiltrate History: niece who lives with her dx with TB on triple Rx. She is asymptomatic Normal heart size with a tortuous aorta, unchanged.No significant pulmonary abnormalities.

Output: No sign of infection or other significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: Intubated ET tube between the thoracic inlet and the carina. NG tube extends a field-of-view. Midline skin staples.Low lung volumes, without focal consolidation, pleural effusion, or pneumothorax.Cardiomegaly and prominent mediastinum, which may be exaggerated by technique.

Output: Prominence of the mediastinum, likely exaggerated by portable supine technique and probable fat deposition in the mediastinum, consider lateral radiograph or CT if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: 82-year-old female status post thoracentesis. Cardiomediastinal silhouette is within normal limits.Small right pleural effusion. No large left pleural effusion. No pneumothorax or dense consolidation. Patient is status post left mastectomy.

Output: Small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Endotracheal tube Lines and tubes are unchanged. Loculated right pleural effusion again noted. Mild pulmonary edema. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. Small amount of pneumopericardium.

Output: Loculated right pleural effusion again noted. Mild pulmonary edema. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: heart transplant, evaluate for abnormal lung sounds History: abnormal lung sounds. Median sternotomy, heart size normal.Apart from calcified granulomata, the lungs are unremarkable.Surgical clips overlie the left upper lobe.Bilateral shoulder arthroplasties.

Output: No significant abnormality, status post heart transplant.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: assess for infiltrates; history of MAI and M. Kansasii and Actinomycosis; worsening cough and CP History: cough, chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Wedge resection left upper lobe.

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


Instruction: Generate impression based on medical findings.

Input: 61-year-old male. Patient with gastric mass, CT to evaluate for metastases. Please only give p.o. contrast given renal dysfunction. CHEST:LUNGS AND PLEURA: Linear micro-nodule right lower lobe series 5 image 70. No other nodules. No effusions.MEDIASTINUM AND HILA: Pacer wires. Coronary artery calcifications. Clusters of small prevascular and AP window nodes.CHEST WALL: Mild gynecomastia.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Small right adrenal nodule unchanged. Measures 1.8 x 1.1 cm is seen on series to image 99. Left adrenal gland is normal.KIDNEYS, URETERS: Probable cyst right kidney.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes aorta. No evidence of aneurysm.BOWEL, MESENTERY: Oral contrast outlines an intragastric rounded mass in the fundus Series III image 92, measuring 3.7 x 3.6 cm. Remainder of the stomach is normal. Perigastric fat is normal. The mass is homogeneous soft tissue density.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: Postsurgical and posttraumatic changes left hip and adjacent soft tissues.OTHER: No significant abnormality noted

Output: Gastric mass grossly unchanged. Stable small right adrenal nodule. Micronodule right lower lobe. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: 57 years old Female. Reason: Is there pneumonia? History: Neutropenic fever. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Interval resolution of hazy opacity in the right lower lung. Stable patchy opacity in the left lower lung. The bilateral IJ catheters and Port-A-Cath are stable in position.

Output: Stable patchy opacity in the left lower lung. Interval resolution of the hazy opacity in the right lower lung.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Shortness of breath rule out pneumonia versus changes from prior x-ray. History of ILD with productive cough and increased short of breath x1 week. Unilateral leg swelling. Sharp left-sided chest pain when coughing. Along the left mediastinal border there is thin linear opacity of unclear etiology which could represent pleural line from a posterior and medial pneumothorax without lung collapse due to underlying pulmonary fibrosis. This could also be an artifact from something external to the patient.Vertically oriented linear opacity parallel to the right lateral chest wall most likely a skinfold.Pulmonary fibrosis is without significant change from the most recent prior study. No specific signs of pneumonia.

Output: Pulmonary fibrosis without signs of superimposed acute pneumonia. Unable to exclude a left medial pneumothorax, though the appearance is more likely to be artifactual. Recommend follow-up inspiration and expiration technique PA chest radiographs for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Aortic valve stenosis, check for effusion and atelectasis. Valve replacement and CABG. Small left pleural effusion with mild basilar atelectasis. No definite additional cardiopulmonary acute abnormalities.

Output: Small left effusion


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with castrate resistant prostate cancer and rising PSA, back pain. CHEST:LUNGS AND PLEURA: No significant abnormality noted. Eventration of the left leaf of the diaphragm. See sagittal image 89/110MEDIASTINUM AND HILA: Atherosclerotic calcifications coronaries and aorta.CHEST WALL: Mild gynecomastia. Few scattered sclerotic foci in the vertebral bodies consistent with metastasis.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Several high density areas likely representing high density cysts particularly in the right kidney. No calcifications. No hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: In the axial plane S3 image 125, the aorta measures 4.9cm AP x 3.6cm transverse and in the coronal plane the maximal transverse diameter of aorta is 3.7-cm on image 40/84. This is in the mid to distal abdominal aorta well below the origin of the renal arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered new sclerotic foci consistent with metastases.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Left femoral and distal external iliac lymph nodes. Largest lymph node in the left external iliac distribution series 3 image 170 measures 3.3 x 3 cm. T he adjacent left femoral node measures 2.5 x 2.1 cm series 3 image 177. These lymph nodes are new compared to the 2006 study.BOWEL, MESENTERY: Postsurgical changes possibly related to lymph node dissection..BONES, SOFT TISSUES: . Sclerotic focus L5 and posterior inferior margin L2 concerning for metastases. Small nonspecific sclerotic focus left iliac wing coronal image 64/84.OTHER: No significant abnormality noted

Output: New, scattered sclerotic foci in the osseous tract structures concerning for metastases. New pelvic adenopathy. Abdominal aortic aneurysm. Other findings as above.