Instruction: Generate impression based on medical findings.

Input: 31-year-old female with history of gastric cancer. CHEST:LUNGS AND PLEURA: 5-mm nodule in the right lower lobe image number 66 on series number 4.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hemangioma in segment 7 is unchanged measuring 2.8 x 2.7 cm. Other small hemangioma and cysts in the liver are also unchanged. No new lesions suspicious for metastatic disease.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: Focal wall thickening at the greater curvature of the stomach is improved.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: Small amount of free fluid in the pelvis.

Output: Interval decrease in the wall thickening at the greater curvature compatible with patient's known history of gastric cancer.Right lower lobe nonspecific nodule. Benign lesions in the liver are unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Chest pain Unremarkable cardiomediastinal silhouette.No specific evidence of infection or edema.

Output: No acute cardiopulmonary abnormality evident.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: interval History: s/p RLL 8/2015 squamous cell carcinoma Right hemithorax volume loss with pleural thickening unchanged.No evidence of new or recurrent tumor.Heart size normal.

Output: Right hemithorax posttreatment volume loss, without evidence of recurrence.


Instruction: Generate impression based on medical findings.

Input: Right middle lobe nodule A questionable subcentimeter nodular density is projected over the right lung base not clearly correlating with an abnormality on the lateral projection. The finding overlies the posterior right eighth rib and may represent superimposed structures. Serial imaging will be helpful for further characterization utilizing CT given patient's age, however the appearance does appears to correlate with the 2012 exam both in position in gross size.The remaining lungs are otherwise clear of acute abnormality. No effusions. The cardiac and mediastinal contour and tortuosity of the aorta are similar in within limits

Output: A grossly unchanged right middle lobe subcentimeter nodule, see description above


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Malignant neoplasm of upper lobe of left lung. Postsurgical changes of a left upper lobectomy with architectural distortion. Left hilar region unchanged in appearance. Low lung volumes. No pleural fluid. No visible pulmonary nodules or masses. Normal heart size.

Output: No acute change to suggest recurrent disease. No visible pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: intubated History: intubated Chronic appearing interstitial opacities, with possible superimposed edema although this cannot be said definitively.Left upper lobe emphysema.ET tube tip approximately 3 cm above the carina.Right jugular catheter, tip in SVC.

Output: Chronic appearing interstitial lung disease and emphysema, with possible superimposed edema.


Instruction: Generate impression based on medical findings.

Input: Metastatic prostate carcinoma. Rising PSA, bony pain. CHEST:LUNGS AND PLEURA: 5-mm subpleural micronodule in the posterior right lower lobe was not clearly seen on the prior examination.Scarlike opacities are seen in the lung bases, stable.MEDIASTINUM AND HILA: Calcified left hilar lymph node, unchanged.No evidence of cardiomegaly or significant pericardial effusion.CHEST WALL: Left chest wall port has its tip at the RA/SVC junction.Small bilateral axillary lymph nodes are stable.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesions within the T8, T10, L3, and L4 vertebral bodies are more conspicuous than on the prior study.Stable sclerotic lesions in the T12 vertebral body and right posterior 4th rib.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Stable scattered small pelvic nodes without evidence lymphadenopathy. Stable reference right inguinal lymph node (series 4, image 196), measuring 1.8 x 1.3 cm (previously 1.8 x 1.4 cm).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable sclerotic foci involving the bilateral iliac wings, and right sacrum.

Output: Stable reference right inguinal lymph node.5 mm micronodule in the left lung base was not seen on the prior study. The appearance is nonspecific, and it should be followed on subsequent studies.Sclerotic lesions in the T8, T10, L3, and L4 vertebral bodies are more conspicuous than on the prior examination. Other sclerotic osseous lesions appear stable.


Instruction: Generate impression based on medical findings.

Input: Aspiration No interval change in the pulmonary edema and pleural effusions. Small lung volumes unchanged. Left PICC line remains unchanged with the tip projected into the mid SVC and potentially into the azygous.Mild retained contrast in the splenic flexure.

Output: Left PICC line unchanged in position, please see detail.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: fluid overload vs pna History: sob Lower lobe opacities suggestive of edema.No sizable pleural effusions.Heart size upper normal.

Output: CHF, more likely than pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: s/p chest tube History: pleural effusion s/p chest tube Pleural effusions and basilar opacities unchanged following placement of a right pigtail pleural catheter.No significant pneumothorax.Tracheostomy tube tip approximately 3 cm above the carina.Dobbhoff tube tip in descending portion of the duodenum.Right jugular catheter tip at SVC/artery junction level.

Output: Persistent pleural effusions and basilar opacities following uncomplicated right pleural training placement.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: hx of PNA and pleural effusion History: nausea, vomiting, shortness of breath, fever Worsening interstitial opacities suggestive of edema, with persistent pleural effusions and left lower lobe consolidation.Heart size normal.

Output: Worsening pulmonary opacities suggestive of edema although superimposed pneumonia particularly in the left lower lobe is possible.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: hx of syncope at work. Dr. Cart in DCAM. History: syncope Bronchial wall thickening, otherwise unremarkable. This may correlate with asthma or chronic bronchitis.Heart size normal.Surgical clips left chest wall.

Output: Bronchial wall thickening, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 96 years old.Reason: r/o PNA History: hx COPD, cough productive of green sputum New focal opacity in the right lung apex is nonspecific but may be due to infection. Chronic interstitial changes are stable. Basilar scarring and atelectasis also unchanged.Significant colonic distention. Severe degenerative change involving the shoulders.

Output: New focal opacity in right lung apex is nonspecific but may be due to infection. Given the patient's age this should be followed to resolution to exclude neoplasm.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: Pleural effusions vs pneumonia History: worsening cough, O2 requirement Mild basilar atelectasis, with small pleural effusions, slightly improved.Right jugular catheter, tip at cavoatrial junction.

Output: Improving basilar atelectasis and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: afib, eval for fluid overload History: tachycardia, afib on EKG Small lung volumes. Complete atelectasis of the left lower lobe, right lower lobe, and lateral right middle lobe with relative sparing of the medial segment, likely compressive atelectasis from bilateral pleural effusions. Reevaluation recommended after resolution of the pleural effusion. Interstitial opacity bilaterally compatible with edema. Surgical clips noted in the upper mid abdomen.

Output: Pleural effusions with associated atelectasis and pulmonary edema. Findings consistent with congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: PNA History: productive cough Known pulmonary nodules consistent with metastases.Patchy left upper lobe opacity could represent overlying soft tissue artifact rather than pneumonia or aspiration.Large lung volumes consistent with COPD.

Output: Pulmonary nodules, but no reliable evidence of infection or aspiration of the thin a probable soft tissue artifact over the left upper lung zone.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old. Reason: sarcoidosis History: SOB, chest pain, chest tightness Cardiac size is within normal limits. Right paratracheal and bilateral hilar opacities consistent with sarcoid lymphadenopathy. No pleural effusions or pneumothorax. No focal pulmonary opacity.

Output: Unchanged lymphadenopathy consistent with sarcoidosis. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: eval for pneumonia History: leukocytosis The cardiomediastinal silhouette is normal. Large lung volumes are suggestive of COPD. There is no focal pulmonary opacity or pleural effusion.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields, pleural effusion History: eval lung fields, pleural effusion Small lung volumes with moderately large bilateral pleural effusions and underlying atelectasis.Right jugular introducer catheter in place.No new findings.

Output: Pleural effusions and atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: Metastatic colorectal cancer on chemotherapy. CHEST:LUNGS AND PLEURA: Numerous pulmonary nodules bilaterally are again noted. Reference nodule in the right lower lobe measures 18 x 17 mm and slightly enlarged from previous CT. Reference nodule in the lingula measures 11 x 11 mm. Other nodules are also stable in size.MEDIASTINUM AND HILA: Retrosternal goiter with left thyroid lobe noduleCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Again noted numerous metastatic liver lesions. Reference lesion in segment 8 has increased in size and now measures 6.3 x 5.7 cm. segment two lesion measures 5 x 4.2 cm on image number 79/217.SPLEEN: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal adenopathy is stable. The reference left para-aortic nodule measures 16 x 14 mm on image number 112/217. Extensive adenopathy extends along the bilateral para-aortic, para iliac space.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: Pelvic adenopathy is also unchanged. The reference right inguinal node measures 19 x 14 mm on image number 174 /217.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in the size of the right lower lobe reference nodule. The other lung nodules are stable in size.Interval increase in the size of the liver metastases.Extensive retroperitoneal and pelvic adenopathy is stable.


Instruction: Generate impression based on medical findings.

Input: Female 35 years old. Reason: 35 yo with lethargy and high fever, concern for infection History: concern for sepsis. Cardiomediastinal silhouette is within normal limits.Low lung volumes.No focal opacity, pneumothorax, or significant pleural effusion is identified.Deviation of the trachea above the thoracic inlet suggestive of asymmetric thyroid enlargement.

Output: 1. No acute cardiopulmonary abnormality. No specific evidence of infection.2. Deviation of the trachea above the thoracic inlet suggestive of asymmetric thyroid enlargement.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p 6/18 Left thoracotomy and left lower lobectomy History: none Postsurgical abnormalities in the left hemithorax with a small residual pleural effusion.Interval clearing of right pleural effusion. No new findings.

Output: Resolving postsurgical findings.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for focal consolidation; volume overload; Swan placement History: Swan pulled back by attending Left jugular catheter and Swan-Ganz catheter unchanged.ICD lead unchanged.Marked cardiomegaly with left lower lobe consolidation and atelectasis, slightly improved compared to previous.No new findings.

Output: Resolving retrocardiac atelectasis and consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: confirm placement of ETT after moving back History: ETT Endotracheal tube remains low, approximately 2 cm superior to carina. Nasogastric tube side hole is located at the GE junction. Right central catheter are unchanged.Interval reduction of lung volumes with basilar opacities of atelectasis. No interval pneumothorax. Multiple dilated loops of small bowel and stomach in an obstructive pattern.

Output: Decreased lung volumes with basilar atelectasis. Obstructive bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with concern for mediastinal/thoracic mass with right atrial compression as well as renal failure. Cholangiocarcinoma with shortness of breath. CHEST:LUNGS AND PLEURA: Calcified left lower lobe granuloma. Numerous bilateral pulmonary nodules are identified, compatible with metastases. For reference purposes, one of the nodules in the left lung base measures 11 x 8 mm (series 8; image 59).Mild to moderate right pleural effusion, increased in size.MEDIASTINUM AND HILA: Diffuse mediastinal adenopathy is identified. The largest lymph node in is seen in the subcarinal region measuring approximately 21 x 18 mm (series 6; image 48)The right lateral aspect the right atrium is concave. However no extrinsic mass is seen in this region. No dilatation of the SVC. Coronary artery calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. Numerous masses are again identified in the liver, increased in size from the prior examination. A previously measured conglomerate lesion in the right lobe measures approximately 17.0 x 10.0 cm from previously 12.7 x 9.2 cm. One of the discrete lesions in segment two of the liver measures approximately 4.1 x 4.4 cm, previously approximately 3.5 x 3.1 cm (series 3; image 33).SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter exophytic cyst with layering hyperdensity is seen in the midpole of the left kidney, unchanged, suggestive of a complex cyst with layering calcium, hemorrhage or protein. RETROPERITONEUM, LYMPH NODES: Diffuse abdominal adenopathy is again identified. The reference lymph node in the portacaval region measures 4.0 x 2.4 cm (series 6; image 108), previously 3.7 x 2.1 cm. Enlarged periaortic node measures approximate 3.3 x 2.0 cm (series 6; image 116), previously 3.2 x 1.8 cmBOWEL, MESENTERY: Nodules in the omentum are now more discrete, consistent with worsened peritoneal carcinomatosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate ascites, increasedPELVIS: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: Progression of widespread metastatic disease comment including peritoneal carcinomatosisMild-moderate right pleural effusion comment increased.Moderate ascites, increased.


Instruction: Generate impression based on medical findings.

Input: Male 43 years old Reason: rule out bowel obstruction History: abdominal pain, IBD Lungs are clear. No evident pleural effusion. Bowel gas pattern is nonobstructive. Focally dilated loop of small bowel in the left upper abdomen possibly representing focal ileus. Above average stool burden. No evident pneumoperitoneum.

Output: Nonobstructive bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: follow up pneumothorax History: right apical pneumothorax s/p thoracentesis Resolution of prior pneumothorax.Pleural effusions and basilar consolidation, the latter worse compared to the prior studies.Right jugular catheter, tip in SVC.

Output: Worsening basilar consolidation but no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: PNA? History: SOB New patchy upper lobe opacities may be due to aspiration or infection.Calcified, tortuous thoracic aorta better evaluated on recent CT.Mild to moderate cardiomegaly.

Output: New patchy upper lobe opacities may be due to aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Age: 31 yearsGender: FemaleReason for Study: Reason: Preop PFO closure History: Preop PFO closure The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.Again identified is an Amplatz closure device.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: last CXR w apical calcified node, given new symptoms would like comparison History: new b/l jaw pain, night sweats The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.Stable left basilar scarring/atelectasis.Previously identified right apical nodule is not well visualized on this study likely secondary to overlying anatomy.

Output: No acute cardiopulmonary process is identified. At the time of this dictation, a follow-up radiograph demonstrated the calcified nodule.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Question free air, pneumonia or pleural effusions. Epigastric pain. Normal heart size. Enlargement of the central pulmonary vasculature suggestive of pulmonary hypertension, unchanged. Lung volumes remain low. No focal airspace opacities, pleural fluid or pneumothorax.Chronic degenerative changes of the spine with thoracic kyphosis and lower thoracic spine mild anterior vertebral body wedging. Surgical clips in the upper abdomen.No visible free intraperitoneal air.

Output: No acute pulmonary abnormality or free intraperitoneal air.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: r/o pna History: cough Mild bronchial wall thickening, otherwise unremarkable.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: check swan placement History: swan for ADHF Lung bases are excluded from view. Swan-Ganz catheter has been pulled back slightly. Other lines and tubes, unchanged. No new focal lung opacity. Unchanged cardiomegaly. No pneumothorax.

Output: Swan-Ganz catheter has been pulled back slightly.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: MaleReason for Study: Reason: 73M with leukocytosis and vasodilation in CCU, ?infiltrate/pneumonia History: 73M with leukocytosis and vasodilation in CCU, ?infiltrate/pneumonia ] IJ Swan-Ganz with its tip in the right main pulmonary artery.Decreased lung volumes with stable cardiac enlargement.Nonspecific basilar opacities are compatible with atelectasis.No new pulmonary opacities identified.

Output: Swan-Ganz tip in the right pulmonary artery. Stable cardiopulmonary appearance with basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Cardiac arrest Persistent moderate largely basilar mixed interstitial airspace opacities with questionable small effusions and decreased lung volumes. Appearance remains limited and exaggerated due to pronounced scoliosis. No definite new focal abnormality, however a mild increase in nonspecific opacities in the right upper lobe now cannot be excluded. Difficult to discern given overlying equipment.ETT has been placed, tip projects into the right bronchus. Dr Checkett calledUnchanged left rib fracture

Output: ETT extends into the right mainstem bronchus


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: sickle cell crisis History: as above Right IJ line terminates near the cavoatrial junction.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: pulmonary edema History: dyspnea Decrease in right pleural effusion and patchy right basilar opacity. Increase in central left perihilar opacity. Unchanged mild-to-moderate cardiomegaly. No pneumothorax.

Output: Decrease in right pleural effusion and right basilar opacity. Slight increase in left perihilar opacity consistent with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 39-year-old female, questionable interstitial lung disease, question sarcoid, complains of wheezing and shortness of breath. Evaluate for lymphadenopathy LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: There is cardiac enlargement no evidence for pericardial effusion.No hilar or mediastinal lymphadenopathy can be identified.CHEST WALL: Left sided ICD with a single lead within the right ventricle.UPPER ABDOMEN: No significant abnormality noted.

Output: No pulmonary or pleural abnormalities identified. There is no evidence of interstitial lung disease or evidence of mediastinal or hilar lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: eval for pna, aspiration History: increased RR, WOB Stable position right IJ central catheter and nasogastric tube.Diffuse streaky opacities suspicious for aspiration. Elevation right hemidiaphragm with opacities in the right costophrenic angle favoring atelectasis. Cardiomegaly is unchanged. Possible small right pleural effusion. No interval pneumothorax.

Output: Streaky opacities suspicious for aspiration. Elevation right hemidiaphragm with atelectasis in the right base and possible small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o acute cardiopulmonary abnormalities History: fall with bilateral lateral chest and flank pain Healed rib fracture deformities and a lytic expansile lesion of the right scapula consistent with myeloma as previously described.Nodular medial right upper lobe opacity measuring approximately 2.5 x 4.5 cm, not appreciably changed from a shoulder radiograph of 2/17/2016, of uncertain significance. In spite of the lack of visible change over the past 5 months, comparison with previous outside imaging, or a CT scan is recommended for further evaluation. The differential diagnosis includes primary lung cancer and a soft tissue mass related to multiple myeloma.

Output: Right upper lobe nodular opacity for which further evaluation is recommended.This was communicated to the ED via stat consult and telephone call.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.IABP placement. IABP marker in the proximal descending thoracic aorta, unchanged.Cardiomegaly with unchanged ICD leads.No evidence of infection or edema.

Output: Balloon catheter in the descending thoracic aorta without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Fever and lymphoma Mild COPD without superimposed acute or subacute cardiopulmonary abnormality. Dual right jugular port extends into the mid SVC

Output: COPD without superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Reason: CTICU, assess volume status History: CTICU Swan-Ganz catheter tip in the right main pulmonary artery.Pacemaker lead extending to the apex of the right ventricle.Cardiomegaly with pulmonary edema, atelectasis and pleural effusions not significantly changed.

Output: CHF with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: chest pain History: chest pain No specific evidence of infection or edema.Linear scarring left upper lung zone, otherwise unremarkable. Heart size normal.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: please verify PICC placement History: PICC Cardiomegaly status post sternotomy with unchanged basilar atelectasis or scarring.Left PICC, tip in the SVC.Right jugular catheter, tip in SVC.

Output: Left PICC, tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Reason: + cough History: + productive cough Unremarkable cardiac and mediastinal silhouette.Air-filled distended stomach with mild elevation of left hemidiaphragm.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Rule out edema versus infection. Crackles on lung exam. Low lung volumes. No focal airspace opacities. Unchanged cardiomediastinal silhouette.

Output: No acute pulmonary abnormality. Specifically, no visible signs of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 44-year-old male with CLL staging CHEST:LUNGS AND PLEURA: 5 mm right upper lobe nodule best seen on image number 21, series number 5 is stable. No new nodules.MEDIASTINUM AND HILA: Extensive mediastinal and hilar adenopathy. Reference subcarinal lymph node measures 3.1 x 1.9 cm, slightly enlarged compared to previous study. Other mediastinal lymph nodes are also slightly enlarged.CHEST WALL: Bulky axillary lymphadenopathy versus. Reference left axillary lymph node measures 3.7 x 2.8 cm number 22, series number 3. All of them axillar lymph nodes increased in size.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Splenomegaly, unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Bulky retroperitoneal adenopathy is increasing size. Reference portacaval lymph node measures 4.8 x 7-cm image number 95, series number 3.BOWEL, MESENTERY: Present thick adenopathy is also increased in size.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Reference left external iliac lymph nodes measures 17 x 13 and image number 167, series number 3, not significantly changed. Most of the other pelvic lymph nodes have slightly increased in size.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size of the mediastinal, hilar, axillary, abdominal and pelvic adenopathy.Stable splenomegaly. Stable right upper lobe nodule


Instruction: Generate impression based on medical findings.

Input: Worsening SOB, hypoxia, wheezing. Please reevaluate. Severe pulmonary edema pattern.Superimposed linear and reticular opacities in the left lower lobe suggestive of endobronchial debris.Granular and groundglass opacities, left greater than right, with interval progression.No pneumothorax.

Output: Severe pulmonary edema pattern with superimposed reticulonodular opacity highly suspicious for atypical infection such as viral, mycobacterial and/or fungal pneumonia. Please refer to same day CT scan report.


Instruction: Generate impression based on medical findings.

Input: Male 16 years old Reason: Evaluate for abnormalities that could explain chest pain History: s/p Ravitch procedure 2 years ago for pectus carinatum. Now with severe chest pain with activity.VIEWS: Chest AP/lateral (two views) 11/6/2015 at 1349 hours. Stable positioning of hardware in the anterior chest wall with no evidence of complications. Cardiac silhouette size is normal. No focal opacities, effusions or pneumothorax.

Output: Stable positioning of hardware of pectus carinatum repair. No radiological findings to explain patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Congestive heart failure Unchanged right jugular catheter extending into the upper SVC. Underlying decreased lung volumes, moderate nonspecific cardiomegaly with retrocardiac opacity again observed, likely atelectasis with persistent moderate pulmonary edema. Suspected small effusions

Output: Similar CHF pattern


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: s/p TECAB History: s/p TECAB with increasing SOB Persistent bilateral pleural effusions with overlying atelectasis.Mild cardiomegaly. No new findings.

Output: No change in pleural effusions and basilar atelectasis. No new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: PICC line placement History: new PICC Basilar opacities left greater than right suggestive of aspiration.Left PICC, tip in the SVC.

Output: Left PICC, tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: 48-year-old female with shortness of breath. Positive d-dimer. Evaluate for PE. CHEST:PULMONARY VASCULATURE: No PE. Study is of diagnostic quality.LUNGS AND PLEURA: Few scattered micronodules. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: 7 mm subcutaneous nodule in the right chest wall (series 7, image 271) is of uncertain etiology but may represent a sebaceous cyst. UPPER ABDOMEN: Variant vascular anatomy of the celiac axis with separate origins of the left gastric, splenic, and hepatic arteries; left hepatic artery arises from the left gastric artery.

Output: No evidence of pulmonary embolism.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: swan placement History: s/p swan readjustment Right jugular Swan-Ganz catheter has been advanced with tip left lower lobe pulmonary artery. Right internal jugular central venous catheter with tip in the left atrium.Cardiomediastinal silhouette is top normal. No pleural effusion or pneumothorax. Patchy perihilar opacities suggestive of pulmonary edema with bibasilar atelectasis.

Output: Mild CHF. Swan-Ganz catheter tip is in the left lower lobe pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Cough Cardiomediastinal silhouette is within normal limits. No pleural effusions or pneumothorax. No focal pulmonary opacities. Mild dextroscoliosis again seen.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: PNA? History: shortness of breath Increasing right basilar opacity highly suggestive of pneumonia or aspiration. Support hardware is unchanged.

Output: Increasing right basilar opacity highly suggestive of pneumonia or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: eval pacemaker leads History: as above Focal area of reticulation again noted in the upper aspect the right lung, worrisome for adenocarcinoma. No new focal pleural parenchymal opacity. No pneumothorax. Unchanged heart size. Unchanged cardiac leads.

Output: No acute cardiopulmonary process on radiography.Focal area of reticulation again noted in the upper aspect the right lung, worrisome for adenocarcinoma.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.History of pericardial and pleural effusion. Stable position of pericardial drain. The cardiac silhouette is normal in size and stable in appearance from priors.Persistent left lower lobe partial atelectasis and trace bilateral pleural effusions, also unchanged.No pneumothorax.

Output: The size of the cardiac silhouette is stable. Pericardial drain unchanged in position.Persistent small bilateral pleural effusions and left basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: Respiratory failure History: s/p trach Tracheostomy remains in place. Low lung volumes makes detailed cardiopulmonary assessment difficult. Increase in basilar opacities, likely atelectasis. No large pleural effusion or pneumothorax. Unchanged cardiomegaly.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. Increase in basilar opacities, likely atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: eval lung fields History: s/p AVR, CABG Status post median sternotomy for aortic valve replacement.Chest tubes are present with no pneumothorax.Small lung volumes with mild postop atelectasis.Right jugular Swan-Ganz catheter is been removed.

Output: No change in mild atelectasis, and no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Shortness breath status post Pleurx placement. Severe left pleural effusion and moderate right pleural effusion. Adjacent atelectasis. Interval placement of left Pleurx catheter. No pneumothorax. Left chest port terminates in the right atriocaval junction.

Output: Interval placement of left Pleurx catheter without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: eval ETT, lung fields History: s/p AVR, CABG ET tube with its tip 4 cm above the carina.Right IJ Swan-Ganz with its tip in the pulmonary artery.Mediastinal drains in place.Decreased lung volumes.The cardiac mediastinal silhouette is unremarkable.Left basilar atelectasis and small left pleural effusion.No evidence of pneumothorax.Median sternotomy intact.

Output: Postoperative chest without complications.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with metastatic renal cancer. CHEST:LUNGS AND PLEURA: Reference nodule in the right upper lobe measures 6 lm of image number 85, series number 4. Interval increase in the wedge-shaped subpleural density in the right lower lobe. The etiology is unknown.MEDIASTINUM AND HILA: Multiple borderline enlarged. Mediastinal lymph nodes are unchanged. Filling defect in the right upper lobe pulmonary artery and is right lower lobe and segmental lower lobe pulmonary arteries consistent with multiple pulmonary emboli.CHEST WALL: Lytic lesions in bilateral ribs, with associated pathologic fracture are stable.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Postsurgical changes involving the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: New extensive pulmonary embolus involving the right lung. No other significant change.Dr. Posadas was notified and acknowledged about the above findings at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab ICD device with leads in the expected locations, unchanged from previous. No pneumothorax or other complications.Moderate cardiomegaly and diffuse interstitial opacity compatible with edema with small pleural effusions.

Output: ICD device with leads in expected locations and no visible complications.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: Infiltrates History: fever Cardiac mediastinal silhouette is normal.Lungs clear.Stable position of single lumen chest port.No pleural effusion. No pneumothorax.Surgical clips again seen overlying right hemithorax.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: SOB History: SOB. Acute chest Moderate cardiomegaly, unchanged.Right internal jugular venous catheter with tip at the cavoatrial junction.Bibasilar opacities and pleural effusions are essentially stable.

Output: No significant change in the degree of moderate cardiomegaly with bibasilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old.Reason: evaluate for pneumonia History: illness x 1 month, worsening cough with shortness of breath Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: ET tube position Endotracheal tube terminates 3 cm from the carina. Unchanged cardiac lead. Low lung volumes makes detailed cardiopulmonary assessment difficult. Patchy basilar perihilar opacities, likely atelectasis. No large pleural effusion or pneumothorax. Prominent loops of bowel in the upper abdomen.

Output: Endotracheal tube terminates 3 cm from the carina. Prominent loops of bowel in the upper abdomen.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.History of chest pain. The cardiomediastinal silhouette is normal and unchanged.No focal pulmonary opacities or large pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: IVC filter removal. The cardiac silhouette is normal. Slight leftward deviation of the upper trachea and expansion of the right paratracheal stripe is likely due to previously seen enlarged right thyroid lobe. Accessory azygos fissure noted. There is no focal opacity or pneumothorax.There are surgical clips in the left axilla.

Output: No pneumothorax post IVC filter removal.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, 34 years old.Reason: cf, acute dyspnea hypoxia eval History: hypoxia Right chest wall port catheter tip at superior cavoatrial junction.Chronic bronchiectasis and bronchial impaction reflecting known cystic fibrosis.No definite new airspace opacity to suggest acute infection.Unremarkable cardiomediastinal silhouette.

Output: Findings consistent fibrosis with no interval change


Instruction: Generate impression based on medical findings.

Input: Right lung mass Persistent right upper lobe 4 cm lung mass with marked nonspecific artery medically and tortuosity of the aorta. No discrete new superimposed intrapulmonary abnormalities however exam limited with rotation and semiupright positioning. Right basilar scarring and/or atelectasis essentially unchangedMild scoliosis

Output: Right upper lobe lung mass, grossly unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: eval for cause of SOB, 52 yo female with breast CA and known left supraclavicular mass History: SOB Worsening pulmonary metastases.New right and enlarging left pleural effusion with overlying left lower lobe consolidation.Mild to moderate cardiomegaly.Left subclavian catheter, tip in SVC.

Output: Worsening metastases and pleural effusions left larger than right. A more recent CT has been scheduled.


Instruction: Generate impression based on medical findings.

Input: Reason: 39M in CCU with CMP s/p IABP, ?placement History: 39M in CCU with CMP s/p IABP, ?placement Balloon catheter marker in the proximal descending aorta, unchanged.Swan-Ganz catheter tip in a proximal right upper lobe branch of the pulmonary artery.ICD lead extending to the area of the apex of the right ventricle.Severe cardiomegaly compatible with cardiomyopathy but no sign of pulmonary edema or visible effusion.

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


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: f/u post chest tube removal and neck incision History: same Stable retrocardiac consolidation and bilateral pleural effusions. The tip of the NG tube projects over the distal portion of esophagus. The Port-A-Cath tip in the atriocaval junction. No evidence of pneumothorax.

Output: NG tube in suboptimal position. Bilateral pleural effusions and retrocardiac opacities, unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia? History: cough with sputum production x1 month per patient report Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Lung cancer, status post chemotherapy CHEST:LUNGS AND PLEURA: Nodular opacity in the right upper lobe is unchanged measuring 13 x 9 mm on image number 26/214. Right lower lobe nodule adjacent to the fissure is also stable measuring 6-mm image number 36. Additional numerous pulmonary nodules are also unchanged.MEDIASTINUM AND HILA: Right infrahilar adenopathy is unchanged measuring 14 x 12 mm on image number 47/214.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter lesion in the liver is unchanged.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: Postsurgical changes in the pelvis. Prostate is not visualized.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No change in the lung nodules and right infrahilar adenopathy. No evidence of disease in the abdomen and pelvis.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: cough, r/o CHF vs infection History: cough, esrd on hemodialysis Stable widening of superior mediastinum with tracheal displacement suggestive of a goiter. Heart size stable. Basilar scarring and atelectasis but no evidence of significant pulmonary edema.

Output: Basilar scarring and atelectasis but no evidence of significant pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: Eval for pneumo History: S/P Thoracentesis Bilateral pleural effusions with no pneumothorax following thoracentesis.Persistent left lower lobe consolidation.Left subclavian pacemaker, leads unchanged in position.

Output: No pneumothorax following thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Reason: post op CXR TECAB History: SOB Mild cardiomegaly with aortic valve prosthesis in place.Decreased retrosternal opacity consistent with recent median sternotomy.Small residual right pleural effusion.

Output: Resolving postoperative findings.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Hypoxemia. Severe cardiac megaly with bilateral interstitial, airspace and pleural opacities are slightly progressed from previous and may reflect progression of CHF or possibly infection. Tracheostomy tube again noted. I see grossly intact. Other devices are stable.

Output: Severe cardiomegaly with progression of extensive bilateral opacities suggesting progression of CHF or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: Is there evidence of lung pathology (pulm edema, effusion, opacity) to explain chest pain? History: chest pain No significant change.Left lower lung zone scarring, otherwise unremarkable examination.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o ptx, enlarged mediatstinum 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: Male, 59 years old.Reason: eval pna History: seizure Minimal streaky basilar opacities may represent atelectasis or aspiration. Metallic density overlying left chest is nonspecific.

Output: No specific evidence of infection or edema, or interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old. Right IJ venous catheter is tip in the SVC.No pneumothorax identified.There are decreased lung volumes with minimal basilar atelectasis.Mild interval increase in the cardiac size.No large pleural effusions.

Output: Right IJ central venous catheter place without complication. Mild interval increase in cardiac size.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with rectal cancer. CHEST:LUNGS AND PLEURA: Subcentimeter nonspecific nodules in the right middle and lower lobe are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Numerous liver metastases are again noted and overall smaller. There afferents lesion in the dome now measures 6.7 cm by 6 cm on image number 73, series number 3. Reference right hepatic lobe mass measures 4.7 x 4.4 cm image number 85, series number 3.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymph nodes are also smaller. Reference lymph node measures 7 x 5 Polito was number 110, series number 3.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: Patient's known rectosigmoid mass is not well seen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in the size of the hepatic metastases and retroperitoneal lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Focal nodular opacity in the mid left lung correlates with the prior recent CT. Similar patchy nodular opacities are also again seen in the right hilar and lung base also similar. No definite effusions or new superimposed focal airspace abnormality. Mild cardiomegaly

Output: Bilateral nonspecific right over left nodular opacities similar to prior recent CT. No new findings


Instruction: Generate impression based on medical findings.

Input: Altered mental status Marked nonspecific cardiomegaly with mild basilar atelectasis and scattered minimal nonspecific interstitial opacities in both bases. Appearance is exaggerated by extensive scoliosis. No effusions.

Output: No distinct superimposed acute pulmonary abnormality, however old chronic changes from prior CHF suspected


Instruction: Generate impression based on medical findings.

Input: 55-year-old male metastatic renal cell carcinoma. Evaluate disease status status post 34 cycles therapy. Compared to 9/1408. CHEST:LUNGS AND PLEURA: Right lower lobe micronodules series 5 image 67 unchanged. Left lower lobe nodule series 5 image 89 measures 4.8 mm. No new nodules seen. No effusions.MEDIASTINUM AND HILA: Right hilar node series 2 image 47 measures 9.6 x 9.6 mm, unchanged coronary artery calcification noted.CHEST WALL: No significant abnormality notedABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to the lack of IV 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: No evidence of recurrence in the right renal fossa. Exophytic probable cyst of lateral aspect left kidney cyst image 142 measures 2.3 x 2.1 cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis. No evidence of ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for lung masses, PNA, effusions History: Pt with 4-6 mos increasing SOB and DOE, hx of sarcoma "attached" to his R lung 16 mos ago, s/p resection Multiple bilateral metastatic nodules and large masses in the right hemithorax, better defined on a CT scan performed the same day.Healing fracture of the right third rib posterolaterally and partial resection of the right sixth rib consistent with recent surgery.Moderate right pleural effusion, also better shown on the CT scan.

Output: Extensive bilateral metastatic disease, better demonstrated on a CT scan of the same day.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: eval for lower lobe PNA History: pain with inspiration Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: tachycardia, cough, eval for PNA History: tachycardia, cough, eval for PNA Nonspecific interstitial opacities with areas of scarring, seen on a follow-up CT to represent mild fibrosis and emphysema.No reliable evidence of infection or edema.Heart size normal.No substantial pleural effusions.Two jugular catheters terminate in the SVC region.Left upper extremity vascular stent.

Output: Chronic lung disease with emphysema. Follow-up CT failed to reveal infection.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with history of cough and shortness of breath. Evaluate for pneumonia. Severe interstitial fibrosis again noted. Moderate cardiomegaly. No specific evidence of infection. Cholecystectomy clips are present.

Output: Severe fibrosis without interval change. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: Re-evaluate PTX History: Re-evaluate PTX Bilateral chest tubes are unchanged in position. IABP marker is approximately 2 cm from the upper contour of the aortic arch.No significant change in bilateral pneumothoraces. Pneumomediastinum/pneumopericardium is again noted. No large pleural effusion. The heart size is stable. There is extensive left chest subcutaneous emphysema.

Output: No significant change in bilateral pneumothoraces and pneumomediastinum/pneumopericardium.


Instruction: Generate impression based on medical findings.

Input: Colon cancer. Metastatic to the liver. Postchemotherapy. CHEST:LUNGS AND PLEURA: Scattered, date calcified granulomas in both lungs are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted. Hiatal hernia is unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Fatty liver. Previously described bilobar subcentimeter low-attenuation foci are unchanged. The reference lesion in segment 4 again measures 9 x 9 mm on image number 91/228. No new lesions. No ductal dilatation.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: 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: Subcentimeter hypodense lesions throughout the liver are unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: ? evidence for CHF History: SOB Cardiomegaly with valve prostheses and ICD lead unchanged.Small lung volumes with mild interstitial opacity compatible with scarring and atelectasis.No specific evidence of pulmonary edema or effusions on the current radiograph.

Output: Cardiomegaly with no specific evidence of CHF or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Wheezing, worsening cough evaluate for pneumonia. Mild bronchial wall thickening and subtle hazy opacity at the right base. Normal heart size. The left lung is clear. No pneumothorax or pleural fluid.

Output: Bronchial wall thickening and hazy opacity at the right lung base may be the result of bronchitis. If the patient remains symptomatic, follow-up films may be obtained after a few days to exclude development of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with history of mantle cell non-Hodgkin lymphoma. Evaluate continued remission. CHEST:LUNGS AND PLEURA: Multiple stable calcified micronodules.Previously noted noncalcified right middle lobe nodule (series 4 axial image 56/122) appears stable.No new nodules are seen. MEDIASTINUM AND HILA: Right hilar lymph node is seen on series 3, axial image 49/228. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense liver lesions remain stable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral simple renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Degenerative changes of the lumbar spine.PELVIS:PROSTATE, SEMINAL VESICLES: Stably enlarged prostate.BLADDER: No significant abnormality noted.LYMPH NODES: Stable referenced right inguinal lymph node, measuring 1.6 cm x 0.8 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild images of the lumbar spine.OTHER: No other significant abnormality noted.

Output: Stable examination without evidence of recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: s/p chest tube removal History: NA Interval removal of right-sided chest tubes without evidence of significant pneumothorax. Patchy areas of subsegmental atelectasis or scarring again noted. Unchanged cardiomegaly. Cardiac leads, unchanged.

Output: Removal right-sided chest tubes without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 84-year-old male with heart failure, shortness of breath, dyspnea on exertion. Heart size is mildly enlarged.Bibasilar opacities, likely representing atelectasis/scarring.No focal pulmonary consolidation or pleural effusion.Status post median sternotomy. Mitral valve prosthesis is noted.Chronic right chest wall deformity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: CVC placement History: as above Interval placement of left subclavian catheter with tip in SVC. No evidence of pneumothorax. NG tube tip in tube tip 5 cm above carina. Other findings stable.

Output: Interval placement of left subclavian catheter with tip in SVC. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: shortness of breath History: shortness of breath, out of asthma meds No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Hypoxemia evaluate hemoptysis. Endobronchial occlusion device extends to the left lower lobe bronchus.Bronchial embolization coils project mediastinum.Endotracheal tube tip about 3.5 cm above the level of the carina.Significant interval decrease in left pleural fluid volume with interval reexpansion of the upper lobe and majority of the lower lobe.Diffuse groundglass opacity throughout the right lung with atelectasis and consolidation at the base appearing slightly worse. Right pleural fluid similar in volume allowing for differences in patient position.

Output: Decreased volume of pleural fluid on the left with significantly improved expansion of the left lung.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: hypopharyngeal squamous cell carcinoma with productive cough and crackles on exam History: as above Large lung volumes suggestive of COPD.Mild left basilar scarring.No specific evidence of infection or edema.Tracheostomy tube tip 7 cm above the carina.Right jugular catheter, tip in SVC.

Output: COPD. Left basilar scarring, less likely atelectasis from aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female status post line placement. Right internal jugular catheter terminates at the SVC, unchanged.Cardiomegaly with central pulmonary arterial enlargement, unchanged.No focal pulmonary consolidation or pleural effusion.

Output: Stable right central venous catheter. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: evaluate line placement History: right ventricular failure Left basilar opacity and left pleural effusion unchanged consistent with infection or aspiration.Right jugular catheter, tip at right atrial level already corrected.

Output: Lower right jugular catheter. Stable left basilar opacity.


Instruction: Generate impression based on medical findings.

Input: 42-year-old female with cough for 4 days, fever. Evaluate for infection, bronchitis. Retrocardiac consolidation with air bronchograms most compatible with pneumonia. No pleural effusions or pneumothorax. Normal cardiomediastinal silhouette.

Output: Findings are most compatible with left lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: assess VP shunt- Please ask pt where valve is located to get best images of valve setting. History: head Pain SHUNT DEVICE: Two shunts projected over the posterior parietal and occipital lobes extending anteriorly towards the midline above the sella unchanged. The radiopaque portions remain unchanged and intact without evidence of new complication or discontinuity. The pressure valve is directed toward the 500 position. The left shunt overlies the cervical spine with additional abandoned left shunt within the left neck, unchanged. SKULL: No significant abnormality noted.CERVICAL SPINE: Mild degenerative changes, unchanged.CHEST: Catheter shunt tubing courses along the right lateral neck and chest wall, in unchanged position. Additional orphaned catheter shunt tubing projects over the left chest and upper abdomen.ABDOMEN: Shunt catheter tubing enters the abdomen, with its tip coiling in the left upper quadrant.

Output: Bilateral shunts as described above without evidence of shunt discontinuity or kinking. The pressure valve level is directed toward the 5:00 position.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: Pt with febrile neutropenia. Assessing for source. URI sx History: neutropenic fever Heart size upper normal.No specific evidence of infection or edema.Left PICC, tip in left axillary region.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: chest pain History: chest pain, eval for PNA/PTX Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No significant pneumothorax.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Cardiac arrest Improving aeration with considerable improvement in the left lower lobe. Persistent moderate nonspecific megaly with underlying fibrotic changes. No new airspace processes.Chest tubes, ETT, ICD, LVAD are all otherwise similar

Output: ETT unchanged with improving aeration and decreasing suspected edema


Instruction: Generate impression based on medical findings.

Input: Reason: sob History: copd Extensive airspace opacity in the left lower lobe compatible with pneumonia, not significantly changed over the past few days.Large lung volumes consistent with emphysema.Probable small left effusion.

Output: Left lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: 63F with pulm HTN and progressive SOB, eval with CXR to look for signs of pulm edema History: SOB Right central venous catheter with its tip in the RA.Stable cardiac enlargement with prominence of the pulmonary artery.Mild perihilar and basilar interstitial opacities may represent interstitial edema.No large pleural effusions.

Output: Cardiomegaly with mild increased interstitial opacities suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: eval lung fields History: s/p MVR, afib ablation 82, right-sided chest tubes, and right IJ venous catheter removed.Decreased lung volumes a stable cardiac enlargement.Basilar opacities compatible with pleural effusions, atelectasis, and edema similar to the prior exam.No significant pneumothorax.

Output: Interval extubation. Stable cardiopulmonary appearance with cardiomegaly, pleural effusions, and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for interval change History: severe asthma exacerbation, intubation Bronchial thickening compatible with asthma.Partial clearing of basilar atelectasis. Enteric tube looped in the hypopharynx.ET tube tip approximately 4 cm above the carina.

Output: Tube looped in the hypopharynx.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p left partical nephrectomy- kidney cancer History: s/p left partical nephrectomy- kidney cancer Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: MaleReason for Study: Reason: is there an infiltrate History: fever The decreased lung volumes.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusion.

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


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Unchanged right basilar opacity consistent with a lung mass on prior CT.No significant pneumothorax.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Aortic valve replacement Persistent mild cardiomegaly with splaying of the carina and suspected enlarged left atrium. Prosthetic aortic valveLungs are decreased in overall volume with minimal basilar atelectasis. No superimposed acute abnormalityETT terminates 2 cm above the carina.2. Right jugular catheters well-positioned in the upper and mid-SVC. Chest tube overlies the right lower chest

Output: ETT well-positioned


Instruction: Generate impression based on medical findings.

Input: Reason: intubation History: ett placement Image quality is markedly degraded by motion artifact and body habitus.ET tube tip approximately 4 cm above the carina.Catheter tip in area of the SVC but not clearly visible.Small lung volumes with nonspecific mainly lower zone opacity, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: CT in place for iatrogenic PTX. Eval for interval change History: asx Lines and tubes are unchanged. No substantial change in mild pulmonary edema, bibasilar opacities, and small pleural effusions. No pneumothorax. Unchanged heart size.

Output: No substantial change in pulmonary edema and bibasilar opacities. Small pleural effusions again noted.


Instruction: Generate impression based on medical findings.

Input: 1-year-old male with cough and increased work of breathing.VIEWS: Chest AP/lateral (two views) 6/28/2016, 23:03. The cardiothymic silhouette is normal. Peribronchial thickening is present. There are patchy retrocardiac opacities. No pleural effusion or pneumothorax is identified.Gaseous distension of loops of bowel are noted in the upper abdomen.

Output: Bronchiolitis/airway hyperreactivity pattern. Patchy retrocardiac opacities likely reflect subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: chest tube with increased drainage, eval for interval change History: as above Interval increase in right pleural fluid filling in most of the air component of the hydropneumothorax. The amount of aerated lung on the right is the same.

Output: Interval increase in right pleural fluid filling in most of the air component of the hydropneumothorax. The amount of aerated lung on the right is the same.


Instruction: Generate impression based on medical findings.

Input: Head and neck cancer No cardiopulmonary abnormality observed. Specifically no findings to suggest metastatic disease. Scattered surgical clips overlying the right and left lower neck.

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: sob History: sob Pleural effusions and underlying opacity compatible with atelectasis, not significantly changed.Port catheter with its tip in the SVC.No new findings.

Output: Stable cardiopulmonary findings


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: eval lung fields History: s/p MVR Right chest tubes with no pneumothorax.Mild left base subsegmental atelectasis.Status post mitral valve repair.Two large right jugular catheters are unchanged.

Output: Mild left base subsegmental atelectasis. No pneumothorax with two chest tubes.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: re-evaluation left sided pleural effusion History: re-evaluation left sided pleural effusion Unchanged left pleural effusion with overlying consolidation likely compressive atelectasis.No significant right effusion.Right subclavian single lead pacer unchanged.Left subclavian and left jugular catheters are unchanged in position.

Output: Stable left pleural effusion with overlying consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.SOB rule out pneumothorax. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax.

Output: No pneumothorax or other acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: intubated History: intubated, ards ET tube with its tip 5 cm above the carina.Markedly decreased lung volumes.Extensive pulmonary opacities in both lungs significantly increased.

Output: ET tube in satisfactory position with its tip 5 cm above the carina. Increasing extensive pulmonary opacities compatible with edema/ARDS.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old. Catheter tip in the SVC.No significant cardiopulmonary abnormalities.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: cardiomegaly, effusion, widened mediastinum History: chest pain, palpitations, acs rule out No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: MaleReason for Study: Reason: pna History: pna Stable cardiomediastinal silhouette.No focal areas of consolidation..Pleural calcifications identified overlying the right hemidiaphragm.No pleural effusions.Multiple surgical clips again noted in the right upper abdomen.

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


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with metastatic neuroendocrine tumor to liver. CHEST:LUNGS AND PLEURA: Linear atelectasis in the left upper lobe is unchanged. No lung nodules suspicious for metastatic disease.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Innumerable bilobar metastatic hepatic lesions are again noted. The reference lesion in segment 5 measures 2.4 x 2.9 cm on image number 96, series number 10 3 75, not significantly changed.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate stone in the lower pole of the right kidney.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node is unchanged measuring 16 x 10 millimeters on image number 96/222. Other small retroperitoneal lymph nodes are also unchanged.BOWEL, MESENTERY: Soft tissue density mass encasing SMA measures 2.6 x 1 . 8-cm on image number 120, unchanged. Stable ventral hernia without bowel obstruction. Other small mesentery nodules are also unchanged.Small subcentimeter omental lymph nodes and small nodule adjacent to the tip of the liver are also unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change in the hepatic, mesenteric, peritoneal and retroperitoneal metastatic disease as described above.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: evaluate lungs for COPD signs History: diffuse wheeze There are decreased lung volumes.Stable cardiomediastinal silhouette.Minimal basilar scarring/discoid atelectasis.No new pulmonary opacities.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: confirm ET tube placement History: intubated, HF The endotracheal tube remains 5 cm above the carina. The intra-aortic balloon pump tip terminates at the inferior wall of the left mainstem bronchus; consider advancement by 2 to 3 cm. The remaining support devices are unchanged in position.Diffuse pulmonary opacities not significantly changed, compatible with moderate to severe edema. Right greater than left layering pleural effusions with basilar atelectasis. Heart size remains stable.

Output: No significant change in pulmonary edema and pleural effusions. Advancement of intra-aortic balloon pump by 2 to 3 cm recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Endotracheal tube placement. Respiratory failure. New nasogastric tube terminates within the fundus of the stomach.Lines and tubes are otherwise unchanged. Unchanged bibasilar opacities. Bilateral pleural effusions are noted. Heart size is difficult to assess but is likely unchanged. Large loops of bowel again noted.

Output: New nasogastric tube is noted, as above. Otherwise, no substantial change compared to previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: assess for PNA/edema History: SOB, 2L NC The heart is normal in size.Bilateral upper lobe heterogeneous opacities more consolidative in the left base again noted, stable from prior studies and still concerning for atypical pneumonia..The pleural spaces are within normal limits.

Output: No interval change in diffuse bilateral heterogeneous opacities previously noted, still suspicious for atypical infection.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Evaluate for acute cardiopulmonary History: shortness of breath after dialysis Unchanged mild basilar subsegmental atelectasis or scarring.Large right jugular catheter, tip at right atrial level.

Output: New dialysis catheter. Unchanged basilar subsegmental atelectasis or scarring.


Instruction: Generate impression based on medical findings.

Input: 50 year-old male with history of lymphoma. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Reference pretracheal adenopathy is unchanged measuring 17 x 16 mm image number 33, series number 4.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple ill-defined dense lesions in the liver suspicious for lymphoma involvement are unchanged.SPLEEN: Numerous ill-defined hypodensities in the spleen suspicious for lymphoma involvement are unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy is again noted. The density of the lymph nodes is decreased preference Conklin rate of note in the left para-aortic space now measures 2.3 x 2 cm smaller compared to previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Extensive pelvic adenopathy, unchanged. Left obturator adenopathy measures 4.9 x 2 cm (image number 185, series number 4. Previously closed measuring 4 . 9 x 1.7 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic lesions in vertebral bodies T10 and T11 are unchanged.OTHER: No significant abnormality noted

Output: Mediastinal, hepatic, splenic and pelvic adenopathy are unchanged. Interval decrease in the size of the abdominal adenopathy.


Instruction: Generate impression based on medical findings.

Input: 29-year-old female with shortness of breath, dyspnea on exertion. Evaluate for pleural effusion. Review of prior records indicates history of non-small cell lung cancer in the right lung. CHEST:LUNGS AND PLEURA: Persistent right lower lobe and posterior right upper lobe consolidation and atelectasis, slightly increased from prior exam. Mild narrowing of the right middle lobe bronchus and bronchus intermedius, unchanged. The known right lung mass remains indistinct from surrounding atelectasis and consolidation. Small right pleural effusion similar to prior study with areas of loculation (series 3, images 44 and 68 for example).Small left pleural effusion, slightly increased from prior exam.Innumerable left lung nodules are reidentified. Reference left apical nodule (series 5, image 17) measures 9 x 4 mm; previously measured 9 x 4 mm.MEDIASTINUM AND HILA: No pathologically enlarged lymph nodes. Heart size normal. Small pericardial effusion, increased from prior exam.CHEST WALL: Borderline enlarged right axillary lymph nodes, without significant change.Sclerosis of T6 vertebral body, again compatible with metastasis.UPPER ABDOMEN: Hypoattenuating lesions in liver (series 3, images 67 and 91) as seen previously and again compatible with metastases. Nodular adrenal glands similar to prior study.

Output: Increasing right lung consolidation and atelectasis again compatible with postobstructive pneumonia from known central tumor. Right pleural effusion with loculation. Innumerable left lung micronodules as seen previously. Slight increase in pericardial and left pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: 72 F trach replacement - would like to assess position History: see above Tracheostomy tube tip within 6 cm of the carina.Catheter tip in the SVC.Feeding tube tip in the stomach.Bilateral patchy air space opacities compatible with pneumonia with bilateral pleural effusions.

Output: Bilateral airspace opacities compatible with pneumonia, slightly improved.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: eval for pneumonia, TB History: fever, cough with blood streaks, night sweats, travel to China 8/2016 No pleural effusion or pneumothorax. No focal pulmonary abnormality. No significant mediastinal adenopathy. The cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: evaluate swan position History: see above Swan-Ganz catheter terminates within the proximal aspect of the interlobar pulmonary artery. Patchy bibasilar opacities again noted. Unchanged cardiomegaly. No pneumothorax.

Output: Unchanged bibasilar opacities. Swan-Ganz catheter, as above.


Instruction: Generate impression based on medical findings.

Input: Age: 28 yearsGender: FemaleReason for Study: Reason: r/o acute cardiopulmonary process History: chest pain, abdominal pain Mild cardiac enlargement.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: 57 years old Male. Reason: ETT position History: post-op: ax-fem bypass. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Right central vascular catheter tip is in the superior vena cava. The ET tube tip is 4 to 5 cm above the carina.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumonia, pulmonary edema History: chest pain, SOB Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Hypotension, lightheaded. Evaluate for infection. Low lung volumes with chronically elevated left hemidiaphragm. Diffuse interstitial pulmonary opacities, likely chronic, with basilar atelectasis/scarring.Cardiomegaly. Unchanged left chest wall 3-lead ICD. Interval removal of right IJ central catheter.

Output: No focal pulmonary opacities to suggest infection.


Instruction: Generate impression based on medical findings.

Input: 15-year-old male with persistent abdominal distention.VIEW: Chest AP (one view), Abdomen AP (one view) 2/9/2015 0435 Chest: Tracheostomy tip just above carina. Mild interval improvement in bilateral lower lobe opacities. No pleural effusion or pneumothorax. Abdomen: The feeding tube is coiled within the stomach. Persistent marked dilatation of bowel loops is identified, with increase in caliber of left lower quadrant loops. Thoracolumbar levoscoliosis and right developmental hip dysplasia again noted.

Output: 1.Persistently dilated bowel loops, which may represent ileus or obstruction.2.Mild interval improvement in bilateral lower lobe opacities.


Instruction: Generate impression based on medical findings.

Input: Male 20 days old Reason: What is lung expansion History: on HFOVVIEW: Chest AP (one view) 11/2/2015 at 0507 hours. ET tube tip is below thoracic inlet and above the carina. NG tube, right-sided chest tubes and central line unchanged.Cardiac silhouette size is normal. Persistent large lung volumes with diffuse, coarse lung haziness and pattern of PIE. No focal opacities, effusions or pneumothorax.

Output: Persistent diffuse, coarse lung haziness as described.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Cardiogenic shock evaluate Swan-Ganz placement. Left jugular Swan-Ganz catheter can be followed to the right descending pulmonary artery level. Right jugular catheter unchanged in position. Bilateral subclavian ICDs also unchanged.No pneumothorax. Moderate right pleural effusion. Minimal dependent atelectasis.

Output: Swan-Ganz catheter tip projects over the right descending pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: Evaluate cardiac and lung fields post heart transplant. The endotracheal tube terminates approximately 5 cm below the carina. Sternal wires and fixation devices are not present. Two mediastinal drains and one right-sided chest tube are in place. Right axilla surgical clips and drain in place. There are bilateral IJ sheaths in place and a right-sided Swan-Ganz catheter with the tip terminating at the proximal right main pulmonary trunk. Left retrocardiac atelectasis and likely small pleural effusion. No pneumothorax.

Output: Postsurgical changes from heart transplant. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Syncope, lower extremity edema history of CHF. Left subclavian ICD unchanged in position. A device external to the patient projects over the right costophrenic angle region.Cardiomegaly with enlargement central pulmonary vasculature.Mild septal thickening and vascular unsharpness consistent with edema. Mild bronchial wall thickening may also reflect edema but is nonspecific. No pleural fluid.

Output: Mild hypervolemia/CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: eval infection, edema, mass History: hemoptysis, sob, h/o lung ca Stable global cardiomegaly.Elevation of the left hemidiaphragm and trace left pleural effusion are noted.Signs of basilar predominant interstitial pulmonary edema.Mild elevation of the left hemidiaphragm again noted, which limits the assessment of the retrocardiac space.

Output: Low lung volumes and signs of interstitial pulmonary edema.Stable cardiomegaly.Limited assessment of the retrocardiac space to elevation of the left hemidiaphragm.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: FemaleReason for Study: Reason: postop TECAB History: cough Stable cardiomediastinal silhouette with interval clearing of the pleural effusions and right lower lobe consolidation.Left basilar scarring/discoid atelectasis with pleural thickening unchanged.No new pulmonary opacities identified.

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


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: shortness of breath History: as above Interval removal of right IJ central venous catheter.Stable cardiomediastinal silhouette.Right basilar pleural effusion with associated atelectasis. No pneumothorax.

Output: Stable to slight improvement right basilar pleural effusion with associated atelectasis.


Instruction: Generate impression based on medical findings.

Input: 62 year old with a previously noted right middle lobe nodule. History of smoking LUNGS AND PLEURA: Redemonstration of a 4-mm micronodular right middle lobe, unchanged since the previous examination. No other pulmonary, pleural abnormalities can be identified.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Degenerative changes throughout the dorsal spine with accompanying scoliosisUPPER ABDOMEN: No significant abnormality noted.

Output: Small stable micronodular right middle lobe without interval change over 6 months. In view of this patient's history of smoking a follow up examination in one year is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: assess for worsening of PNA, effusions History: leukocytosis with ongoing antibiotics Right upper lobe airspace opacity suggestive of pneumonia, unchanged. Left basilar opacity noted as well.Mild to moderate cardiomegaly.Small pleural effusions.

Output: No change in pulmonary opacities and effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: Please eval for ETT placement History: RE adjusted ETT ET tube tip approximately cm above the carina.PICC tip in the left axillary vein.Bilateral patchy airspace opacities which may be due to infection or aspiration, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: reasses pulmonary edema and atelectasis History: oxygen requirment Interval resolution of interstitial edema with septal lines.Bilateral lower lobe consolidation and atelectasis, greater on the left, probably with small pleural effusions.Surgical staples and a drain in the upper abdomen.

Output: Resolution of interstitial edema, but persistent basilar atelectasis and consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: ETT History: acute resp failure Stable line position.No change in cardiomegaly with bilateral pleural effusions.No pneumothorax.

Output: No change in cardiomegaly and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: FemaleReason for Study: Reason: r.o pneumonia History: dyspnea NG tube with its tip beyond the margin of the image.Right PICC line with its tip in the right subclavian vein.There are decreased lung volumes with stable cardiac enlargement and widening of the mediastinum.Mild left basilar atelectasis similar in appearance to the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance. No specific evidence of acute infection.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: sob History: sob Left subclavian dual-chamber pacemaker remains unchanged. Status post median sternotomy.Stably enlarged cardiac silhouette.Bilateral pleural effusions, right greater than left, with associated atelectasis remain grossly stable.

Output: Cardiomegaly with unchanged bilateral pleural effusions and associated atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 38 yearsGender: FemaleReason for Study: Reason: s/p bronchial thermoplasty History: chest tightness The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: CP Far right chest is excluded from the field-of-view. Stable cardiomediastinal silhouette with moderate cardiomegaly. Bibasilar subsegmental atelectasis/scarring. No pulmonary consolidations, pleural effusions or pneumothorax.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male 24 years old Reason: Swan Ganz placement History: As above Swan-Ganz catheter tip terminates in the proximal main pulmonary artery/right ventricular outflow tract.Left upper extremity PICC tip in the SVC.No focal airspace opacity or pleural effusion.The cardiomediastinal silhouette is normal.

Output: Swan-Ganz catheter tip in the proximal main pulmonary artery/right ventricular outflow tract.


Instruction: Generate impression based on medical findings.

Input: Heart transplant Similar basilar atelectasis with small effusions and borderline cardiomegaly. Mildly decreased lung volumes.Midline sternotomy. Unchanged left subclavian abandoned ICD

Output: Basilar atelectasis and small effusions unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: r/o acute process History: sob Pleural effusions diminished, and the right pleural drain removed.The underlying lung is grossly unremarkable.Heart size normal.Right subclavian pacemaker leads in unchanged position.

Output: Improvement in pleural effusions or pleural thickening, and removal of a right pleural drain.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: eval for focal pneumonia History: wheezing Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Left mid axillary pain. No focal airspace opacity, pleural effusions or pneumothorax. The cardiomediastinal silhouette is normal.

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


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: s/p esophagectomy - eval for pneumo History: s/p esophagectomy Enteric tube terminates over the mediastinum, as before. Decreased conspicuity of pneumoperitoneum. Small amount of pneumomediastinum is noted. Low lung volumes makes detailed cardiopulmonary assessment difficult. Query mild pulmonary edema. Left basilar pleuroparenchymal opacity, not substantially changed. Unchanged cardiomegaly.

Output: Expected appearance status post esophagectomy.


Instruction: Generate impression based on medical findings.

Input: Recurrent uterine cancer. CHEST:LUNGS AND PLEURA: Soft tissue changes in the right paramediastinal area likely secondary to radiation is unchanged measuring 2.7 x 1.2 cm image number 17, series number 20229.A new round soft tissue density nodule measuring 12 x 14 mm image number 23 adjacent to the SVC. Another similar nodule is more inferior located on image number 31.Previously measured AP window nodule as smaller measuring 14 x 9 minutes on image number 23. Other small mediastinal lymph nodes are unchanged.MEDIASTINUM AND HILA: See discussion above.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Surgically absent.PANCREAS: Unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild bilateral caliectasis. Scarring of the left upper pole. Right renal angiomyolipoma.RETROPERITONEUM, LYMPH NODES: IVC filter in place. Ill-defined soft tissue density surrounding the aorta and IVC likely representing metastatic adenopathy has increased in size. The reference aorta caval lymph node now measures 16 x 11 mm image number 120.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: New pelvic mass abutting the sigmoid colon measures 5.3 x 2.9 cm image number 152. This mass likely Meza sigmoid colon. The wall of the sigmoid colon is thick.Previous described enhancing soft tissue lesion in the vaginal apex it is slightly smaller compared to previous study measuring 17 x 17 mm on image number 169.BLADDER: No significant abnormality noted.LYMPH NODES: Peri-iliac adenopathy adjacent to the proximal left common iliac artery measures 2.5 by 1.5-cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval progression of disease with new mediastinal nodules adjacent to SVC, retroperitoneal and pelvic adenopathy and new pelvic mass as described above.Mild bilateral caliectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: rule out phrenic nerve injury History: labored breathing Right neck and right chest wall drains with no pneumothorax.Minimal basilar atelectasis.No evidence of phrenic nerve injury. Tracheostomy tube tip 7 cm above the carina.

Output: No evidence of diaphragmatic paralysis/phrenic nerve injury. Mild basilar atelectasis likely from aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out pneumonia due to cough and assymetric breath sounds (R worse then L) History: cough, assymetric breath sounds Normal heart size and mediastinal contours.Perihilar bronchial thickening compatible with bronchitis but no sign of pneumonia or other acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 22-year-old female patient with history of breast cancer, brain cancer, back pain. Evaluate for metastases. Thoracic spine: There are 11 rib bearing thoracic vertebra. We see no focal lesion in the bone to suggest metastatic disease. Vertebral body heights are preserved. Surgical clips are noted in the mediastinum and chest.Lumbar spine: No focal lesions are identified to suggest metastatic disease to the bone. Vertebral body heights are preserved. Alignment is within normal limits. Surgical clips are noted within the abdomen and pelvis.

Output: No focal lesions to suggest metastatic disease or other specific findings to account for the etiology of the patient's back pain. If further imaging is clinically warranted, MRI may be considered.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: pleural effusion? New small left-sided pleural effusion with presumed left basilar atelectasis. Heart size at upper limit of normal. No new focal pleural parenchymal opacity in the right hemithorax. No pneumothorax.

Output: New small left-sided pleural effusion with presumed left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 39 year-old female with metastatic breast cancer CHEST:LUNGS AND PLEURA: Again noted multiple nodules in both lungs suspicious for metastatic disease. Largest nodule in the right middle lobe measures 16 x 13 mm, not significantly changed from previous CT on image number 42, series number 3. Other nodules are also not significantly changed.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Left mastectomy with breast prosthesis.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter nonspecific hypodense lesion in the right lobe of the liver is unchanged. No other focal lesions.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.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic and sclerotic lesions in the iliac bones and L4 vertebral body unchanged.OTHER: No significant abnormality noted.

Output: No significant change in the lung metastases and lytic bone lesions in the pelvis.