Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: eval for free air History: hx of gastroparesis w persistent vomiting. abd and cp There has been complete resolution of the previously described bilateral pulmonary opacities.Heart size normal.No pneumothorax. No pleural effusion.

Output: Interval complete resolution of the bilateral pulmonary opacities. No acute cardiopulmonary findings.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with history of metastatic melanoma. Restaging prior to chemotherapy treatment. CHEST:LUNGS AND PLEURA: Stable right upper lobe nodule measuring 1.4 cm in diameter on image number 27/104. No new nodules.MEDIASTINUM AND HILA: Previous described nonenlarged multiple mediastinal nodes are smaller and have decreased in size. Previously mentioned borderline enlarged subcarinal lymph node now measures 9 x 7 mm on image number 46/230.CHEST WALL: Previously described multiple axillary lymph nodes are smaller in size.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Subtle hypoattenuating lesion in the spleen is unchanged. The spleen is enlarged measuring 14.1 cm craniocaudally.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: Small bowel masses difficult to evaluate but is likely unchanged measuring 4 x 4.1 cm on axial image number 132/230.Vague stranding of the fat in the mesentery in the midabdomen and borderline enlarged lymph nodes are unchanged.BONES, SOFT TISSUES: Symmetric lytic lesions within the sacrum and pelvis are unchanged and likely due to osteopenia.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval decrease in the size of the mediastinal lymph nodes. Lung nodule, small bowel mass, hazy increase in the density of the mesentery fat, retroperitoneal and mesenteric lymph nodes are stable to minimally increased..


Instruction: Generate impression based on medical findings.

Input: Female, 91 years old.Reason: intubated, ETT eval History: recently intubated Endotracheal tube tip approximately 2.5 cm superior to the carina. Enteric tube now in place with tip overlying the gastric antrum.Stable cardiomediastinal silhouette. Pulmonary anterior enlargement again seen.Emphysematous changes with chronic left lung volume loss. Grossly stable left retrocardiac opacity with at least an element of atelectasis/scarring. Slight worsening in right basilar opacity may relate to atelectasis as well.

Output: 1.Endotracheal tube tip approximately 2.5 cm above the carina.2.Bibasilar predominant interstitial opacities may reflect atelectasis/scarring, but correlate with concern for aspiration. Attention on followup imaging recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: 62M w/ lymphoma on tx, neutro fever, new hypoxia History: see above Persistent low lung volumes with basilar opacities atelectasis. Heart size is magnified. No interval pneumothorax.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: r/o acs, edema History: AICD firing Cardiomegaly with a suggestion of basilar edema.Status post sternotomy.Right subclavian ICD, lead intact and unchanged.

Output: Possible edema, intact ICD.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p lung resection History: s/p lung resection Moderately large residual right pleural effusion, with underlying atelectasis, not significantly changed. The effusion may be partly loculated.Multiple surgical clips in the neck. No pneumothorax or other new findings.

Output: Moderately large partially loculated right pleural effusion, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Back pain, evaluate for dissection CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No evidence of aortic aneurysm. No evidence of dissection. Mild cardiomegaly.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Gallbladder wall is minimally thickened. The phase of the study is not optimal for evaluation of the gallbladder. If cholecystitis is clinically suspected, further evaluation with ultrasound is recommended.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 noted

Output: No evidence of aortic dissection.Mild gallbladder wall thickening. Clinical correlation is recommended. Further evaluation with ultrasound may be helpful.Dr. Ward was notified about the above findings at the time of the dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: R/o PNA History: Cough w/ green sputum There is no focal consolidation, pleural effusion, or pneumothorax. The cardiac and mediastinal contours are within normal limits for size. The bones and upper abdomen are without remarkable findings.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Diminished breath sounds and prolonged cough. Evaluate for pneumonia or other pathology. No cardiopulmonary abnormalities. No focal abnormal pulmonary opacities. No pleural effusion, or pneumothorax.Cardiac silhouette is within normal limits.

Output: No acute cardiopulmonary abnormalities. No radiographic evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: cough, evaluate for infection; history of breast cancer History: cough Nodular opacity at the right apex which has increased slowly since 2010. Further evaluation with a CT thorax is recommended. Lower zone bronchial wall thickening may represent post radiation fibrosis. No focal consolidation, pleural effusion or pneumothorax. Mild tortuosity of the descending thoracic aorta. The heart size is normal.

Output: Nodular opacity at the right apex for which CT thorax is recommended. Right infrahilar opacities suggestive of post radiation fibrosis.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with pulmonary nodules. Compare to prior and recommend follow-up. LUNGS AND PLEURA: Biapical scarring, unchanged. Numerous scattered bilateral pulmonary nodules are reidentified, unchanged. One pulmonary micronodule within the right middle lobe (axial image 52/96) is not clearly evident on prior exams and may be new.No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: Small mediastinal and hilar lymph nodes, some of which are calcified, unchanged. No pathologically enlarged hilar or mediastinal lymph nodes are identified. The cardiac size is normal. No pericardial fluid. Aortic atherosclerotic calcifications are noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Diffuse low attenuation of the liver is suggestive of fatty infiltration

Output: One new pulmonary micronodule among numerous scattered stable nodules and micronodules.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: s/p cardiac surgery History: above Median sternotomy for aortic valve replacement.Chest tubes are present with no pneumothorax.Small pleural effusions are seen postoperatively.ET tube tip approximately 3 cm above the carina.Right jugular Swan-Ganz catheter, tip in main pulmonary artery.

Output: No pneumothorax or complication following aortic valve replacement.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with congenital heart disease, scleroderma, UIP, GERD. LUNGS AND PLEURA: Stable mild subpleural honeycombing is again noted predominantly at the right lung base.No new areas of involvement can be identified.There is no evidence of air trapping on expiration imaging.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy can be identified.Cardiac size is normal without evidence of pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Stable hepatic hypodensity.

Output: Minimal UIP like interstitial abnormality at the right lung base without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infiltrates History: near syncope, h/o CHF and HTN Normal heart size with a tortuous aorta.No significant pulmonary or pleural abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 42-year-old man with gist tumor on Gleevec. Follow-up exam. CHEST:LUNGS AND PLEURA: Right lower lobe subpleural calcified granuloma is unchanged. MEDIASTINUM AND HILA: Unchanged right hilar calcified granuloma. Small scattered mediastinal lymph nodes areCHEST WALL: Small non-pathologically enlarged lymph nodes in the right axilla are unchanged. ABDOMEN:LIVER, BILIARY TRACT: Reference hypodense lesion in segment 8 measures 1.8 cm x 2.1 cm (image 65, series 7), previously measuring 2.2 cm x 2.2 cm. Reference segment 7 lesion measures 0.6 cm x 0.5 cm (image 69, series 7), producing measuring 0.7 cm x 0.6 cm. no new lesions identified. Diffuse fatty infiltration of the liver with focal areas of sparing in the left hepatic lobe.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 other significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1. No significant interval change in the reference lesions as described above. No evidence of new metastatic disease.2. Unchanged hilar and right lower lobe calcified granulomas.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: fever, cough, history of kidney transplant, eval for PNA History: cough New opacity in the mid aspect of the left lung, likely in the left upper lobe. Previously demonstrated right basilar opacity has resolved. No large pleural effusion or pneumothorax. No acute bony abnormality. Unchanged heart size.

Output: Waxing and waning pulmonary opacity, most consistent with recurrent aspiration or pneumonia. Consider chest radiographic follow-up in 8 weeks to ensure resolution.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: acute path, pulm edema, cardiomegaly History: inferior mi No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male status post 4/8/2015 Ivor-Lewis esophagectomy with feeding jejunostomy. Right thoracotomy. Resection of distal esophagus and proximal stomach with the esophagogastrostomy in the right chest with mediastinal dissection. Follow up Stable postsurgical changes of gastric-pull up procedure. Previously noted contrast within the intrathoracic stomach is no longer seen. No focal airspace opacities. Small right pleural effusion with adjacent atelectasis. No pneumothorax. Stable cardiomediastinal silhouette. Partially imaged catheter in the left upper quadrant.

Output: 1. Small right pleural effusion. 2. Residual contrast within the intrathoracic stomach has resolved.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.History of mantle cell lymphoma. There is a new small right and trace left pleural effusion of indeterminate nature.The heart is normal in size, partially obscured.No evidence of pulmonary venous hypertension.Lung volumes are normal. Few scattered bilateral basilar septal lines, suggestive of minimal interstitial pulmonary edema.

Output: Suggestion of interstitial pulmonary edema associated with small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Unknown, 61 years old.Reason: s/p arrest with intubation History: as above Mild cardiomegaly.Interstitial and airspace opacities most pronounced in the right upper lobe consistent with acute pulmonary edema and possible superimposed aspiration or infection.ET tube tip approximately 2 cm above the carina.NG tube, the side port well above the GE junction and possibly the tip.

Output: Pulmonary opacities consistent with acute edema and possible aspiration. Low ET tube and high NG tube.


Instruction: Generate impression based on medical findings.

Input: Reason: accidental CT pull History: None Interval removal left chest tube with no significant residual pneumothorax.Large bilateral pleural effusions, greater on the left, with underlying atelectasis and consolidation.

Output: Left chest tube removal with no visible pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: FemaleReason for Study: Reason: eval ETT History: hypoxia ET tube with its tip 3 cm above the carina.NG tube with its tip in the stomach.Stable cardiomediastinal silhouette.Nonspecific basilar opacities compatible with atelectasis.No focal areas of consolidation.No large pleural effusions

Output: Support devices unchanged. Stable cardiopulmonary appearance with basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Fever No cardiopulmonary abnormality.

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with history of non-small cell lung cancer. Status post chemoradiation CHEST:LUNGS AND PLEURA: Large right apical mass, measuring 6.9 x 9.2 cm in axial dimension ( Series 10200, image 12) with invasion of the upper thoracic vertebral bodies and encroachment on the central canal. Scattered ill-defined micronodules, greatest in right upper lobe, are too small to characterize. Mild peribronchial wall thickening and mild paraseptal emphysema are also seen. MEDIASTINUM AND HILA: No lymphadenopathy.CHEST WALL: Lateral chest wall invasion by right apical mass. The mass invades the spinal canal with dural thickening.ABDOMEN:LIVER, BILIARY TRACT: Minimal intrahepatic biliary dilatation. Cystic mass in inferior right hepatic lobe is unchanged in size from prior. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Bilateral adrenal nodules again noted: right adrenal nodule measures 1.6 x 0.9 cm as seen on series 10200, image 101 (previously 1.4 x 1.1 cm); left adrenal nodule measures 2.0 x 1.4cm as seen on series 10200, image 96 (previously 2.0 x 1.4 cm), previously characterized as adrenal adenomas. 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: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1) Large right apical mass with chest wall and spinal canal encroachment.2) Bilateral adrenal nodules, unchanged in size, compatible with benign adrenal adenomas.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: sob History: asthma Chronic blunting right costophrenic angle, otherwise unremarkable.No complication of asthma or other significant finding.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: pneumonia, pulmonary edema History: Tylenol overdose No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: Refractory ascites, evaluate for hepatic hydrothorax prior to possible TIPS Cardiomediastinal silhouette is unremarkable. Mild left costophrenic angle blunting compatible with scarring also seen on prior CT. No pneumothorax. No focal pulmonary opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: evaluate for pulmonary edema, pneumonia History: dyspnea, rales/rhonchi Heart size normal, with a prominent main pulmonary trunk, normal variant.Median sternotomy status post mitral valve replacement.No significant pulmonary or pleural abnormality.

Output: Status post sternotomy for mitral valve replacement. No acute abnormality. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: PLEURISY IMMUNOSUPPRESSED History: CHEST PAIN Small lung volumes with nonspecific opacities in the left lower lung zone possibly subsegmental atelectasis.No specific evidence of infection or edema.

Output: Small volumes with stable lower lung zone opacities likely scarring or subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Chondrosarcoma, check for metastatic disease No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Cough and backache. Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Bilateral shoulder prostheses.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Metastatic bladder cancer with pulmonary nodule, long-standing tobacco abuse presenting with DOE question pneumonia Right lower lobe nodule unchanged. No focal airspace opacities to suggest pneumonia. Normal heart size. No signs of pulmonary edema.

Output: No specific signs of pneumonia. Unchanged right lower lobe nodule, presumably a metastasis.


Instruction: Generate impression based on medical findings.

Input: Inactive, indolent lymphoma CHEST:LUNGS AND PLEURA: 2-mm left upper lobe nodule, unchangedMEDIASTINUM AND HILA: Numerous borderline enlarged mediastinal lymph nodes are stable.CHEST WALL: Surgical clips are noted in the right axillaABDOMEN:LIVER, BILIARY TRACT: The liver is mildly enlarged without focal lesion.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: Again noted is retroperitoneal and retrocrural adenopathy. The left para-aortic reference lesion is grossly unchanged, measuring 20 x 12 mm (series 3, image 111). BOWEL, MESENTERY: Numerous large mesenteric lymph nodes are again noted, unchanged. The reference mesenteric lymph node is also unchanged measuring 13 x 11 mm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Masses within the uterus are likely fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcentimeter sclerotic focus in the right iliac bone is unchanged, nonspecific.OTHER: No significant abnormality noted.

Output: Stable adenopathy.


Instruction: Generate impression based on medical findings.

Input: Lung cancer Right hilar mass with postobstructive minimal changes in the right upper lobe similar to prior exam. Left lung and right lung base appear clear. Mild volume loss and shift of mediastinum, exaggerated by scoliosis.Cardiac silhouette appears within limits.

Output: Right upper lobe mass grossly unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: eval ETT position History: SOB Endotracheal tube terminates approximately 3 cm from the carina. PICC terminates at the cavoatrial junction. Low lung volumes again noted. Patchy bilateral opacities again noted. Dense left lower lobe opacity and small left pleural effusion, as before.

Output: Endotracheal tube terminates 3 cm from the carina. Otherwise, no substantial change.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: iabp History: iapb Intra-aortic balloon pump superior metallic marker terminates 9 cm from the top the aortic arch. Swan-Ganz catheter, unchanged. Cardiac leads, unchanged. Unchanged diffuse pulmonary opacities. Unchanged cardiomegaly.

Output: Intra-aortic balloon pump, as above. Unchanged congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Coughing up blood Moderately elevated right hemidiaphragm without a distinct superimposed additional acute cardiopulmonary process. Specifically no distinct superimposed airspace process. No effusions.Cardiac and mediastinal contours significant for mild tortuosity of the aorta and atherosclerotic changes.Marked degenerative changes of both shoulders greater on the right

Output: Elevated hemidiaphragm without superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: Tube placement History: Intubation The endotracheal tube terminates 4.5 cm from the carina. Low lung volumes with basilar atelectasis. Moderate cardiomegaly. No pneumothorax. Large patient body habitus.

Output: Endotracheal tube, as above.


Instruction: Generate impression based on medical findings.

Input: Hypoxemia Persistent mild bilateral basilar opacities again suggesting minimal edema with suspected small effusions. No discrete new superimposed focal air space process. Moderate nonspecific cardiomegaly.Mediastinal chest tube, LVAD, ICD and Swan-Ganz are all otherwise similar

Output: Swan-Ganz unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: 45F s/p MVC with right anterior chest wall tenderness. Eval for fracture History: right anterior chest wall tenderness, around 4th/5th rib Unremarkable cardiomediastinal silhouette.No focal pulmonary opacities, pneumothorax, or pleural effusions.No displaced rib fractures.

Output: No significant abnormality or displaced rib fractures.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with history of leiomyosarcoma CHEST:LUNGS AND PLEURA: Previously mentioned right lower lobe nodule is not seen on today's study. Paramediastinal fibrosis and scarring has slightly progressed. Mild subpleural scarring in both lungs towards the lower lobes.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Large hepatic hypodense masses are again identified. Index right lobe lesion measures 15.2 by 11.7 cm on image number 107, series number 3, slightly increased compared to previous study. Index left lobe lesion measures 7.9 by 8.1-cm image number 102, series number 3, increased in size compared to previous study.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable increased density in the mesentery. Small focus of increased attenuation inferior to the right lobe of the liver is unchanged on image number 148, series number 3.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: Interval increase in the size of the hepatic masses. Previously measured right lung nodule is not well seen on today's study.


Instruction: Generate impression based on medical findings.

Input: Female, 92 years old.Desat, new oxygen requirement evaluate for signs of aspiration pneumonia. No signs of aspiration or infection. The main pulmonary artery is markedly dilated, suggesting severe pulmonary hypertension. No signs of pulmonary edema. No pneumothorax.

Output: Dilatation of the main pulmonary artery suggesting severe pulmonary hypertension, but no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.S.O.B. evaluate for cause of shortness of breath, concern for volume overload. No specific signs of pulmonary edema. Low normal lung volumes, similar to previous. Normal heart size. No focal air space opacities. Osteophyte formation and mild scoliosis of the thoracic spine.

Output: No acute pulmonary abnormality. No signs of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Check for pneumonia. Shortness of breath Again extensive bony abnormalities are observed without substantial interval change. Similar limitations on the evaluation of the lungs are also noted without superimposed new abnormalities.The cardiac and based on contours are grossly within limits. Distorted. Right jugular dual port unchanged

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Chest tubes replaced. Evaluate pneumothorax. Pulmonary hypertension.VIEWS: Chest AP/crosstable lateral (two views) 09/19/15, 2028 and 2035 Endotracheal tube tip is at thoracic inlet. Two left and one right chest tubes are again seen. Two of the chest tubes have their tips anteriorly and one has its tip posteriorly. The posterior chest tube most likely is on the left side. Umbilical venous line tip is in right atrium. Umbilical arterial line has its tip at T9.Moderate soft tissue edema persists.Left-sided pneumothorax is moderate in size and is predominantly anterior and subpulmonic in location. No definite right pneumothorax is present. The left lung is stiff and has not collapsed. There appears to be bilateral pulmonary interstitial emphysema. Hazy opacities are noted bilaterally Right hemidiaphragm is between eighth and ninth posterior ribs and left is between ninth and 10th.. Cardiac silhouette size is normal.

Output: Continued left pneumothorax. One of the left chest tubes has its tip located posteriorly.


Instruction: Generate impression based on medical findings.

Input: 50 year old female. Shortness of breath on exertion. Firm nodule in medial right supraclavicular space underneath the sternocleidomastoid muscle. Chest x-ray on 10/13/09 showed a left lower lobe abnormality. History of recurrent right leg DVT and questionable PE in the past. ABDOMEN:LUNG BASES: Pleural-based mass in the left lower lobe measures more than 3 cm in diameter. Please refer to the chest CT scan examination report from the same date. No acute infiltrates or effusions.LIVER, BILIARY TRACT: Multiple subcentimeter hepatic hypodensities are too small to characterize. No biliary duct dilatation. Hepatic vasculature is patent.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:UTERUS, ADNEXA: Enlarged myomatous uterus measures 8.7 x 9.5 cm on axial image 110/146.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: ConstipationBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Left lower lobe mass. See chest CT report. No definite evidence of distant metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: iABP History: as above Iatrogenic devices are unchanged. As before, the Swan-Ganz catheter is looped within the right atrium before extending into the main pulmonary artery. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax.

Output: Lines and tubes, as above. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Swan-Ganz placement Swan-Ganz remains in the right pulmonary flow tract. ICD and underlying cardiopulmonary appearance is also similar with moderate nonspecific cardiomegaly

Output: Unchanged Swan-Ganz


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: post op, eval ETT, lung fields History: s/p AVR Median sternotomy with chest tubes but no significant pneumothorax.Basilar consolidation left greater than right, with the left predominant pleural effusion.ET tube tip within 1 cm of the carina.Right jugular Swan-Ganz catheter tip in proximal right main pulmonary artery.

Output: No pneumothorax postop. A more recent radiograph has been interpreted.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: pneumonia, cardiomegaly, effusion History: psych eval history of sickle cell disease. Prominence of the right ventricle and main pulmonary artery. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: Enlargement of the central pulmonary vasculature and right heart consistent with pulmonary hypertension in the setting of sickle cell disease. No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Acute bronchitis due to mycoplasma pneumonia. Cardiomediastinal silhouette is unremarkable.On the lateral view, there is an opacity in the left midlung zone overlying the thoracic spine which could represent pneumonia. No pleural effusion or pneumothorax.

Output: Opacity in the left midlung zone could represent pneumonia. Follow-up radiograph in 8-12 weeks is recommended to document resolution.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: chest pain History: chest pain Severe bilateral diffuse chronic interstitial pattern, compatible with chronic fibrosis. Apical cysts are again noted. Stable cardiomediastinal silhouette. No new focal pulmonary opacity, pleural effusion, or pneumothorax, accounting for differences in technique.

Output: Chronic fibrotic changes without evidence of superimposed acute opacities. No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: eval lung fields History: s/p AVR, MVR Median sternotomy for valve replacement with moderate cardiomegaly.Chest tubes are present with no pneumothorax.Mild basilar edema and atelectasis are seen, improved on the left.Right jugular Swan-Ganz catheter tip in right main pulmonary artery.

Output: No significant pneumothorax. Unchanged edema with improving retrocardiac atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: CHF History: SOB, CP, crackles on lung exam Right central catheter and central vascular stents remain unchanged in position.Increasing opacities of moderate pulmonary edema with small pleural effusions. Cardiomegaly stable. No pneumothorax.

Output: Increasing pulmonary edema with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with history of renal cell cancer, status post 22 cycles of therapy. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Severe fatty infiltration and postsurgical changes in the liver. Numerous metastatic lesions throughout the liver are again identified. These lesions are high attenuation in comparison to the background fatty replaced liver. Exact number cannot be counted, however, overall, no new lesions appear to have developed. Reference lesion in segment 4 now measures 11 x 11 mm in image number 72, series number 3, unchanged, previously measured 11 x 11. Other numerous metastatic lesions are also grossly stable. Hepatomegaly, stable. Hepatic vessels appear patent. Segmentectomy clips appear intact.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. Left renal cyst is stable.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: Status post hysterectomy. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change of metastatic disease to the liver.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: wheezing crackles History: wheezing crackles No interval change in interstitial opacities and mild cardiomegaly. No pneumothorax. No pleural effusion.

Output: No significant radiographic change.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney transplant The heart size is normal. There is no focal pulmonary opacity, pleural effusion, or pneumothorax. Cholecystectomy clips noted.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.IABP. Lines and hardware are unchanged in position. Stable mild cardiomegaly. Diffuse hazy opacity of left lung believed to represent layering effusion, and is unchanged from the prior study. Lingular opacity silhouetting the left cardiac border is unchanged. Lung volumes slightly diminished from the previous exam.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 74 yearsGender: MaleReason for Study: Reason: post op, eval ETT, lung fields History: s/p CABG ET tube with its tip 4 cm above the carina.Right IJ introducer in place.Left-sided chest tube with its tip at the apex.Stable cardiomediastinal silhouette.Basilar opacities are compatible with atelectasis.No pneumothorax.

Output: Postoperative chest without complications.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: Asthma exacerbation, rule out PNA History: As above No pleural effusion or pneumothorax. Increased flattening of the diaphragms and large lung volumes in comparison to prior examination is compatible with given history of asthma exacerbation. No new focal pulmonary opacity. Cardiomediastinal silhouette is within normal limits.

Output: Findings compatible with asthma exacerbation without superimposed focal pulmonary opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Fever of unknown origin, ESRD on HD. Rule out infectious process. Motion artifact limits evaluation.Right jugular catheter tip at the right jugular vein level. No pneumothorax. Low lung volumes. Dense pleural calcifications unchanged.Lung volumes remain low with chronically increased lung density and basal atelectasis but no signs of a superimposed acute process.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: intubated, t1rf, hypoxic History: hypoxia The endotracheal tube terminates approximately 6.5 cm from the carina. Enteric tube terminates within the proximal aspect of the stomach. Worse interstitial pulmonary edema with small pleural effusions. Unchanged heart size. No pneumothorax.

Output: Worse interstitial pulmonary edema with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 6 years old. Bilateral chest tubes. Evaluate for interval change.VIEW: Chest AP (one view) 3/27/15, 1601 Bilateral chest tubes, unchanged in position. ET tube tip below the thoracic inlet and above the carina. Enteric tube terminates in the stomach.The cardiothymic silhouette is normal.Bilateral pulmonary opacities, unchanged from the prior exam, but significantly improved compared to 3/24/2015. No new focal opacities. No pleural effusion or pneumothorax.

Output: Improving bilateral pulmonary opacities, without significant pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Swan placement, CHF. Right jugular Swan-Ganz catheter tip projects over the expected location of the right descending pulmonary artery. Mild pulmonary edema and atelectasis. Probable small pleural effusions. Right jugular catheter unchanged in position. No pneumothorax.

Output: Swan-Ganz catheter tip in the projection of the right descending pulmonary artery. Mild CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Basilar crackles. Scarring or atelectasis in the right upper lobe near the fissure. No focal airspace opacity, pleural fluid or pneumothorax. Mild scarring or atelectasis at the lung bases. Normal heart size.

Output: Mild scarring or atelectasis, but no signs of CHF or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: interval change s/p bilateral chest tubes History: interval change s/p bilateral chest tubes Interval increase in right pneumothorax with the apex of the lung about 3 cm from the chest wall.Small left pneumothorax, not significantly changed.Extensive mediastinal and subcutaneous emphysema. Diffuse cystic interstitial lung disease.Bilateral chest tubes in place.

Output: Increased right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Marked nonspecific hernia megaly is again observed without evidence of significant interval change. Lungs remain clear.Multiple tarsal collapse vertebrae unchanged.

Output: Marked cardiomegaly without superimposed acute new abnormality


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? History: poor PO, AMS Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Ventilator associated PNA. A tracheostomy is in stable position. A right internal jugular central venous catheter in stable position terminating in the cavoatrial junction. There is interval improvement in pulmonary edema. Small pleural effusions and basilar opacities are stable. No pneumothorax. Unchanged cardiomegaly.

Output: While there is interval improvement in pulmonary edema, small pleural effusions and basilar opacities are not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: eval for cause of hypoxia History: no hx lung disease, spo2 93% on 2L Cardiac silhouette is normal in size.Low lung volumes in the setting of a focally elevated right hemidiaphragm and mild bibasilar streaky atelectasis/scarring. Left apical surgical staple line with mild pleural thickening. No focal consolidation or sizable pleural effusion.

Output: Limited evaluation due to low lung volumes with streaky bibasilar atelectasis/scarring and evidence of prior left lung surgery.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Swan placement. Ischemic cardiomyopathy. Severe cardiomegaly again noted. However, the lungs are essentially clear without significant interstitial edema, effusion, or consolidation. Right jugular Swan-Ganz catheter tip suboptimally visualized but most likely within the right descending pulmonary artery. Other devices stable. No pneumothorax.

Output: Right jugular Swan-Ganz catheter tip suboptimally visualized but likely over the right descending pulmonary artery. Otherwise no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: pre OLT eval History: current smoker, pre OLT The heart is normal in size.Lung volumes are normal. Mild bilateral bronchial wall thickening.The pleural spaces are within normal limits.No osseous lesions are present.

Output: Mild bilateral bronchial wall thickening may represent smoking related chronic bronchitis.


Instruction: Generate impression based on medical findings.

Input: Metastatic ovarian cancer. Check for pneumonia shortness of breath Interval enlarging bilateral pleural effusions greater on the right with underlying compression atelectasis and mixed interstitial and patchy opacities in both lung bases. Concern for superimposed mild edema and failure given previously identified borderline cardiomegaly most also be considered in addition to sympathetic pleural effusions given patient's underlying pelvo-- abdominal malignancy.Right jugular single port unchanged. Left PICC line removed

Output: Enlarging bilateral pleural effusions greater on the right


Instruction: Generate impression based on medical findings.

Input: 65-year-old female status post thoracotomy and decortication, postop day 3 and right lung surgery in 2/2009. Evaluate for effusion. LUNGS AND PLEURA: Interval reduction in previously described large right loculated hydropneumothorax with a small to moderate loculated hydropneumothorax remaining. Extensive edema affects the right lung.MEDIASTINUM AND HILA:The cardiac size is normal. A small pericardial effusion is evident. Mediastinal lymph nodes are not enlarged by size criteria.CHEST WALL: Asymmetric soft tissue density in the right chest wall with adjacent surgical clips, unchanged. Postoperative change status post right thoracotomy, right lower lobectomy, and interval placement of three right sided chest tubes. Two chest tubes are directed towards the apex and an additional chest tube lies at the base. Right basilar chest tube sidehole is at the pleural margin and there is extensive gas tracking within the subcutaneous and soft tissues surrounding the right chest wall.Multiple right-sided rib fractures, likely postoperative.UPPER ABDOMEN: Splenic calcifications likely represent prior granulomatous disease. Small hiatal hernia.

Output: Loculated right hydropneumothorax, decreased since prior exam with interval placement of chest tubes as described above. Basilar chest tube sidehole at the level of the pleural margin. Postsurgical changes with extensive soft tissue and subcutaneous gas tracking along the right chest.


Instruction: Generate impression based on medical findings.

Input: Check for pneumothorax Motion degrades sensitivity. Persistent small apical right pneumothorax without new interval cardiopulmonary abnormality. Right chest tube again projects into the apex with some mild overlying chest wall emphysema.

Output: Unchanged right chest tube and small apical pneumothorax


Instruction: Generate impression based on medical findings.

Input: 79-year-old female history of chondrosarcoma. METs to lung status post resection. MALT lymphoma of lung status post resection and adenocarcinoma status post resection. Evaluate for PD. Multi-nodules described. CHEST:LUNGS AND PLEURA: Postsurgical changes right upper lobe. There is a fibrosis redemonstrated.Referenced nodule left base 4.5 mm series 6 image 62.Referenced nodule medial aspect of the left base C6 image 73, 7 x 5.9 mm slightly increased.Pleural-based posterior costophrenic angle nodule in the left series 6 image 79, 13.8 x 8 mm. slightly increased.Other areas of fibrosis and a few micronodules are probably unchanged. Specifically micronodules seen in the right lower lobe series 6 image 44 which is unchanged from the prior exam series 4 image 42.MEDIASTINUM AND HILA: Thyroid nodules unchanged. Rim-like calcification in one of the right thyroid nodules is also unchanged.Postsurgical changes mediastinum. Small nodes. No new nodes. Hiatal hernia.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made. LIVER, BILIARY TRACT: Small hypoattenuating lesion inferior aspect of segment 6 unchanged measuring about 5.7 mm, series 5 image 89.Gallstones. No biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys with bilateral nonspecific lesions which are soft tissue are high density attenuation unchanged in size and appearance.RETROPERITONEUM, LYMPH NODES: Small shotty retroperitoneal nodes are unchanged. Atherosclerotic changes aorta no evidence of aneurysm. Small nodes in the peri-pancreatic and portacaval region are also unchanged.BOWEL, MESENTERY: Diverticulosis. No evidence of ascites or carcinomatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis.BONES, SOFT TISSUES: 329 no definite lytic or blastic disease. A few bone islands. Degenerative changes.OTHER: No significant abnormality noted.

Output: Given limitations no oral or IV contrast lesion measurements as above with no new sites of disease. Increase in size of some of the pulmonary nodules. Nonspecific hepatic and renal lesions are unchanged. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: s/p lung transplant History: POST-OP LUNG TRANSPLANT POD#2 Interval extubation and removal of nasogastric tube. Interval removal of Swan-Ganz catheter. Jugular introducer sheath unchanged. Slightly decreased lung volumes with slightly increased basilar edema and atelectasis.

Output: Slightly decreased lung volumes with slightly increased basilar edema and atelectasis, s/p extubation.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.AML and respiratory distress. Left midline catheter tip at the SVC/RA junction. Interval worsening of right middle lobe airspace opacities. Diffuse septal thickening and nodularity elsewhere not significantly changed.

Output: New right middle lobe airspace opacity suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Chest tightness and pain Mildly shifting streaky densities in both bases again suggesting atelectasis, however aspiration cannot entirely be excluded, specifically on the left. Upper lungs are clear. No effusions.The cardiac silhouette is significant for mild nonspecific cardiomegaly. Mediastinal contours are within limits

Output: Nonspecific basilar changes concerning for possible aspiration, specifically on the left. Serial imaging will be indicated


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: eval for infection History: cva Cardiac size is within normal limits. No large pleural effusions or pneumothorax. No focal pulmonary opacity. Eventration of the right diaphragm or fat deposition noted.

Output: No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 24-year-old male with tachycardia and hypotension CHEST:LUNGS AND PLEURA: Again noted right-sided pleural effusion with a chest tube in place. Effusion has slightly increased in size. Compressive atelectasis has also increased in the interval.Small left-sided pleural effusion.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Subcutaneous emphysema, significant on the right side, not significantly changed from previous study.ABDOMEN:LIVER, BILIARY TRACT: There is a large, predominantly subcapsular hematoma measuring 16 x 8.5 cm compressing the liver parenchyma. Contrast is identified within the hematoma consistent with active extravasation. Hematoma also extends to the peritoneal space.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: Mild ileus.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: Small amount of ascites.

Output: Large, new predominantly subcapsular hematoma with active extravasation. Hematoma also extends into the peritoneal space.Interval increase in the right-sided pleural effusion and compressive atelectasis.These findings were discussed and acknowledged by Dr. Kim at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: neutropenic stem cell transplant patient with neutropenic fever History: sinus congestion, febrile Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Bilateral jugular catheters terminate in the SVC.

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


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: PA cath History: PA cath No significant cardiopulmonary abnormality.Right jugular Swan-Ganz catheter tip in right interlobar pulmonary artery.

Output: No significant abnormality. Swan-Ganz unchanged.


Instruction: Generate impression based on medical findings.

Input: 48 year-old female with persistent fever and malignancy of unknown origin. LUNGS AND PLEURA: Scattered pulmonary micronodules, seen predominately throughout the right lung. A reference, right middle lobe nodule measures 4 mm (image 40, series 5).Calcified granuloma right apex.MEDIASTINUM AND HILA: Moderate pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Multiple hypodense foci throughout the liver, compatible with metastatic disease.

Output: 1. Scattered pulmonary micronodules. Continued follow-up recommended.2. Moderate pericardial effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: right and left pleural effusions; metastatic breast cancer History: none Unremarkable cardiac and mediastinal silhouette. Interval resolution of small pleural effusions.Mild tracheal deviation consistent with asymmetric thyroid enlargement.Port catheter with its tip in the SVC.Vertebral abnormalities consistent with metastatic disease, previously confirmed by CT scan.

Output: Interval resolution of pleural effusions and no new findings.


Instruction: Generate impression based on medical findings.

Input: Reason: Malignant neoplasm of upper lobe of right lung History: Malignant neoplasm of upper lobe of right lung Unremarkable cardiac and mediastinal silhouette. Volume loss in the right hemithorax compatible with previous right upper lobectomy. No specific evidence of tumor recurrence or other appreciable change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: heart transplant, shortness of breath with exertion, ho cmv History: dyspnea Surgical changes related to heart transplant again seen.Unchanged cardia mediastinal silhouette.No focal consolidation pleural effusion, or pneumothorax.

Output: Status post heart transplant without acute cardiopulmonary abnormality or significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: hx IIa testicular cancer, post chemo, on surveillance History: hx IIa testicular cancer, post chemo, on surveillance Lungs and pleural spaces are clear. The cardiomediastinal silhouette is unremarkable. No visible pulmonary nodules.

Output: No visible pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: ETT placement History: intubated The ET tube has been retracted and is localized approximately 7.6 cm above the carina. Advancement 2 cm is recommended.Stable position of right upper extremity PICC overlying the proximal right atrium. The left IJ HD catheter overlies the proximal right atrium, unchanged in position.Single lead pacemaker in place.Persistent bilateral lower lobe subsegmental atelectasis, stable from prior. Small bilateral associated pleural effusions are unchanged. No pneumothorax.

Output: Persistent small bilateral pleural effusions and bilateral basilar subsegmental atelectasis.Recommend advancement of the ET tube approximately 2 cm.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: Line placement, eval for PTX History: Line placement, eval for PTXPatient had tunneled catheter placed but could not be done under fluoroscopy due to patient size. New right IJ dialysis catheter tip projects in the central right internal jugular vein.Second smaller caliber tunneled right IJ catheter tip at the superior cavoatrial junction.No pneumothorax.Stable cardiopulmonary appearance.

Output: New right IJ catheter tip projects in the central right internal jugular vein. It has been repositioned on subsequent image.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: 56-year-old male with metastatic renal cell cancer, baseline disease evaluation prior to systemic treatment CHEST:LUNGS AND PLEURA: Small right middle lobe nodule with adjacent subpleural nodule (image 57, series 6) are unchanged.MEDIASTINUM AND HILA: Calcification of the thoracic aorta.CHEST WALL: Reference left posterior fifth rib metastasis is enlarged and measures 6.0 x 3.3 cm and previously measured 4.1 x 3.3 cm (image 29, series 4). Worsened reference right T6 vertebral body metastasis measures 4.3 x 4.0 cm (image 39, series 4) and previously measured 4.4 x 4.0 cm. This lesion encroaches on the spinal cord and is associative with a >50% compression fracture of the vertebral body.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measures 1.8 x 1.8 cm (image 84 series 4) and previously measured 1.8 x 1.8 cm.KIDNEYS, URETERS: Right renal nodule measures 1.7 x 1.5 cm and previously measured 1.6 x 1.4 cm. Multiple bilateral additional hypodensities are too small to characterize. On delayed imaging prompt excretion of contrast in bilateral collecting systems and proximal ureters is visualized.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Severe degenerative disease of the thoracolumbar spine.PELVIS:PROSTATE, SEMINAL VESICLES: Prostate seeds from prior radiotherapy are again identified.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right iliac metastasis measures 2.5 x 5.1 cm (image 168 series 4) and previously measured 1.9 x 3.6 cm. Additional lesion of the right inferior pubic ramus appears larger. Severe degenerative disease of the thoracolumbar spine.

Output: 1. Multiple enlarged osseous metastases as described above. The T6 vertebral body lesion is now associated with worsened spinal compression fracture and cord encroachment. This finding was relayed to Dr. Strasbaugh (pager 4067) at the time of dictation. 2. Left adrenal, and right renal nodules suspicious for metastatic disease not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Reason: Concern for heart failure due to pressence of crackles on physical exam and abdoimnal swelling. History: See above. Unremarkable cardiac and mediastinal silhouette.Severe coronary artery calcification.Abdominal aortic stent partially visualized.No significant pulmonary or pleural disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Esophagectomy and septic shock ETT remains 5 cm above the carina. Swan-Ganz extends into the right pulmonary outflow tract. NG terminates in the mid to distal esophagus.Right chest tube projects towards the upper right hilar region unchanged. No significant associated pneumothorax or complicationUnderlying cardiopulmonary appearance continues to demonstrate largely diffuse bilateral interstitial opacities without new superimposed focal process.

Output: Right chest tube unchanged


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with shortness of breath status post lung transplant. Interval resolution of right pneumothorax. Persistent severe fibrosis of the right native lung.No acute focal airspace opacity.No pneumothorax or pleural effusion.

Output: Interval resolution of right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: pna History: pna Normal heart size with a tortuous calcified aorta.Small lung volumes with new basilar airspace and interstitial opacity compatible with pneumonia, possibly secondary to aspiration.

Output: New basilar opacities compatible with infection and aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old, with shortness of breath, recently postpartum. Evaluate for PE. PULMONARY ARTERIES: Limited examination due to poor contrast opacification. No large central pulmonary embolus to the lobar level. Nondiagnostic more distally.LUNGS AND PLEURA: Diffuse bilateral ground glass and patchy dense air space opacity, worse on the left, with small bilateral pleural effusions. Aspiration is favored, with other etiologies such as atypical edema, hemorrhage and amniotic fluid embolism considered less likely.MEDIASTINUM AND HILA: The cardiac size is normal. A small pericardial effusion is evident. No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.No large central PE to the lobar level. Suboptimal examination of the more distal vessels.2.Bilateral patchy air space disease. Aspiration is favored with other options as described above less likely.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: is there an infiltrate History: cough and fever Cardiomediastinal silhouette is within normal limits.No focal air space abnormality. No pleural effusions.

Output: No acute cardiopulmonary abnormality. Specifically, no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 95 yearsGender: FemaleReason for Study: Reason: r/o infectious etiology History: altered mental status Increased lung lines compatible COPD.Cardiac size is normal.Marked tortuosity of the aorta.No focal areas of consolidation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Heart failure and ETT check ETT remains 3 cm above the carina. Swan-Ganz projects into the SVC just beyond the confluence of the innominate. Right jugular catheter terminates in the right atrium, however particular note is the right PICC line extending into the external jugular approximately x 2 cm. Repositioning suggestedNG coiled in the proximal stomach. Incomplete visualization of the IVC filter.Underlying cardiopulmonary appearance otherwise similar.

Output: ETT unchanged. Right PICC line also similar in position, and please note point of termination described


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: dobhoff History: dobhoff Feeding tube has been repositioned slightly now pointing distally. Lines and tubes are unchanged otherwise. Left greater than right basilar opacities and small left pleural effusion again noted. No pneumothorax. Unchanged heart size.

Output: Left greater than right basilar opacities and small left pleural effusion again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: interval change History: interval change Airspace opacities somewhat sparing the left upper lobe are intense but unchanged. Severe cardiomegaly is stable.Small pleural effusions are stable.Chest tubes remain in place with no pneumothorax.Right jugular catheter, tip in SVC.A Dobbhoff tube terminates in the stomach.

Output: No change in pulmonary airspace opacities, and no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: patient with RIGHT pectoral, abdominal and lower back subcutaneous emphysema; s/p VATS pleurodesis and blebectomy History: chest/abdominal/back pain Right chest tube in place with no significant pneumothorax.Bilateral patchy opacities compatible with atelectasis and small effusions.Subcutaneous emphysema on the right.

Output: Chest tube in place with no pneumothorax or other acute change.


Instruction: Generate impression based on medical findings.

Input: 59-year-old man with history of left heart failure, complete heart block status post cardiac pacemaker placement in 2011. Evaluate placement of pacemaker leads. Left subclavian pacemaker with transvenous leads projected in the right atrial appendage and right ventricular positions. Median sternotomy intact with evidence of a prior CABG. Cardiac size is mildly enlarged with tortuosity of the aorta. No pulmonary or pleural abnormalities are seen.

Output: Left subclavian pacemaker with transvenous leads projected in the right atrial appendage and right ventricular positions.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT in place History: ETT in place ET tube tip about 8.5 cm above the carina.Nonspecific airspace opacity with pulmonary nodules and pleural effusions, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: post op, eval lung fields History: s/p AVR Chest tubes with no pneumothorax.Right jugular catheters removed.Stable basilar atelectasis.

Output: Right jugular catheters removed, otherwise unchanged with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 83 years old Male. Status post right hemicolectomy for colon cancer. CHEST:LUNGS AND PLEURA: Centrilobular emphysema. Pleural based plaque in the right middle lobe is unchanged from previous CT dated 3/13/2009 some of which contain calcifications and could be related to asbestos exposure. Focal areas of atelectasis in the left lung base.Left lower lobe nodule seen on image 63 of series 4 is unchanged from prior scan.MEDIASTINUM AND HILA: Coronary artery calcifications and coronary artery stent are noted.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple large hemangiomas and benign cysts in the liver are unchanged. Some of the lesions are too small to accurate characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of aorta and iliac arteries. Left common iliac artery aneurysm measures 2.2-cm in diameter on coronal image 46 of series 8024.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Minimal wall thickening of the bladder, more prominent anteriorly.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Coarse trabeculation of the pelvic bones, most prominent in the left iliac bone is unchanged and may represent changes secondary to Paget's disease. Sclerotic L4 vertebral body may also represent Paget's disease.OTHER: No significant abnormality noted

Output: No significant change from previous study. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Seizures. Evaluate pneumonia. The cardiomediastinal silhouette is within normal limits. The hila and pulmonary vasculature are also within normal limits. There is no airspace disease, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: s/p MVR and TVR. s/p Chest tube removal History: s/p MVR and TVR 16 mm right apical pneumothorax, slightly larger than on the prior study.Stable cardiomegaly.Slight improvement in basilar atelectasis and small pleural effusions.

Output: Enlarging right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Clinical question: Crohns, may getvremicade this admission, please r/o TB or any infectious process Lung volumes remain low. Basal atelectasis has improved. No focal airspace opacities. No radiographic signs of active intrathoracic tuberculosis.

Output: Low lung volumes with patchy atelectasis. No signs of active intrathoracic TB or other conclusive evidence of active infection.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: ? Resolution of infiltrate History: sob Gas fluid level within cystic regions in the left lung base suggests an active process. Slight increase in reticular nodular opacities in the peripheral aspect of the right lung. No pneumothorax. No large pleural effusion. Heart size unchanged.

Output: Newly apparent gas fluid level within cystic areas at the left lung base suggestive of an active process such as infection and/or hemorrhage.Increased reticulonodular opacities in the lateral aspect of the right lung, possibly edema or aspiration/pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: CM s/p OHT History: CM s/p OHT Median sternotomy for heart transplant. Heart size normal.No significant pulmonary or pleural abnormality.

Output: Status post heart transplant without other significant findings.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Right pleural drain with an enlarging right pleural effusion, and smaller left.Increasing basilar consolidation.No significant pneumothorax.

Output: Enlarging right pleural effusion. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.With infection and altered mental status. Persistent left pleural effusion with improving adjacent subsegmental atelectasis. No pneumothorax. The cardiomediastinal silhouette is within normal limits.

Output: Persistent left pleural effusion with interval improvement in retrocardiac opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT History: intubated ET tube tip in the proximal right main bronchus, about 1.5 cm distal to the carina.NG tube tip projected over lower mediastinum consistent with gastric interposition.Catheter tip in the SVC.Right chest are in place with no significant pneumothorax.Diffuse bilateral interstitial opacity with no significant interval change.

Output: Distal location of ET tube.


Instruction: Generate impression based on medical findings.

Input: Reason: eval infection History: AMS Right jugular catheter extending to the right atrium.No significant cardiopulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old. ET tube tip approximately 1 cm above the carina.Catheter tip in the SVC.Bilateral pulmonary opacities compatible with acute pulmonary edema with moderate bilateral pleural effusions, not significantly changed from previous.

Output: Slightly low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.2 weeks of cough. Mild to moderate diffuse interstitial abnormalities with possible bronchial wall thickening. Heart size within normal limits. No airspace consolidation or significant pleural effusions. No pneumothorax.

Output: Diffuse significant interstitial pattern with bronchial wall thickening, new from previous. Consider viral or other atypical infection.


Instruction: Generate impression based on medical findings.

Input: Endocarditis Mild motion again degrades sensitivity. Within this limitation, the mixed interstitial and patchy changes largely in the perihilar distribution with moderate effusions appear similar.Mediastinal and tracheostomy tubes are otherwise similar in position right PICC line terminates in the axilla unchanged Extensive mixed sclerotic and mildly expansile osseous changes are grossly unchanged, specifically the clavicles.

Output: Mediastinal chest tube similar position


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: r/o cardiopulm process History: altered mental status. Small left pleural effusion.No focal air space opacity.No pneumothorax or pulmonary edema.Mild cardiomegaly and signs of pulmonary hypertension.Severe dextroscoliosis is noted.

Output: Small left pleural effusion. Mild cardiomegaly and signs of pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: MaleReason for Study: Reason: chf History: chf Decreased lung volumes with moderate cardiac enlargement.Perihilar/basilar interstitial opacities compatible with edema.Right pleural effusion similar to the prior exam.

Output: CHF with mild increase in pulmonary edema compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Respiratory failure status post extubation. Interval extubation. Other hardware and devices appear similar in position.Interval worsening of pulmonary edema, atelectasis and pleural fluid which is now severe.

Output: Severe CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Determine cause of hemoptysis. Severe emphysema. Coarse linear and nodular opacities at the lung bases of unclear chronicity given the presence of edema and pleural fluid in this region on the prior examinations of 2014, but the finding is new compared to 4/23/2013. Blunting of the posterior costophrenic angles. Upper normal heart size. Basal bronchiectasis.

Output: Bronchiectasis with coarse opacities at the lung bases. Differential considerations include acute pathology such as aspiration with endobronchial plugging/bronchiolitis or aspirated blood products versus a more chronic manifestation of interstitial lung disease.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female with pleural effusion. Evaluate chest tube status post pleurodesis. Right-sided chest tube unchanged overlying the upper lung with sidehole overlying the pleural space.No definite interval change in loculated right-sided pleural effusion with adjacent subcutaneous emphysema. No new pulmonary opacities. No pneumothorax. Unchanged cardiac mediastinal silhouette.

Output: Right-sided chest tube unchanged overlying the upper lung with sidehole overlying the pleural space.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: PNA History: lactate and tachy with leukocytosis Streaky left basilar opacities suggest atelectasis/scarring. Blunting of the left costophrenic angle is new from the prior. The cardiac and mediastinal contours are unchanged from the prior examination. There is moderate rightward curvature of the thoracic spine.

Output: Left basilar atelectasis/scarring. Blunting of left costophrenic angle may be secondary to atelectasis, aspiration or effusion. A PA and lateral radiograph may be of benefit.


Instruction: Generate impression based on medical findings.

Input: Rule out cardiomegaly Mild cardiomegaly with prominent pulmonary arteries suggesting hypertension. Lungs are clear

Output: Mild cardiomegaly with suspected pulmonary hypertension


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Trach, ARDS, SICU History: Trach, ARDS, SICU Trachea stomach cannula, right IJ central venous catheter and left IJ dialysis catheter remain unchanged.Stable cardiomediastinal silhouette.Redemonstration of bilateral patchy and somewhat nodular airspace disease and a partially loculated left pleural effusion.Esophagojejunostomy stent in place.

Output: No significant change in patchy airspace disease again likely representing suspected resolving ARDS.


Instruction: Generate impression based on medical findings.

Input: Chest pain and shortness of breath Questionable mild bilateral basilar streaky densities, most pronounced on the lateral projection and suspected left lower lobe. Concern for aspiration versus early infection cannot be excluded. Serial imaging may be needed.Upper lungs are clear. No distinct effusions. Cardiac and mediastinal contours are within limits

Output: Suspected left lower lobe faint opacity, concerning for aspiration versus infection


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: MaleReason for Study: Reason: Pt is a 44 yo male; potential stem cell donor History: Evaluate The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: chf, pneumonia History: shortness of breath, gi bleed Small lung volumes.No specific evidence of infection or edema.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: Chest pain History: Chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: r/o cardiopulm History: chest pain Cardiomediastinal silhouette is normal.No pleural effusion or pneumothorax. No focal pulmonary opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: eval for lung disease History: same Patch bibasilar opacities. No definite pneumothorax or pleural effusion on this portable study. Normal heart size. No acute bony abnormality on radiography.

Output: Patchy bibasilar atelectasis or consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 16 years old, history of pulmonary blastomycosis in 2007, ASD repair in 2008. Now with 3 months of left sided chest pain, pleuritic in nature for two weeks. LUNGS AND PLEURA: Previously seen left upper lobe opacity has improved with some persistence of segmental airspace disease or scarring. No pleural fluid, pleural thickening or enhancement.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Interval improvement with persistence of left upper lobe segmental air space disease or scarring.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: rule out disease process pt presents with cough History: cough x 3 months Significant cardiomegaly. Mild vascular redistribution. No specific evidence of acute pulmonary edema. Blunting of costophrenic angles.No air space or interstitial opacities

Output: Significant cardiomegaly with mild vascular redistribution. No specific evidence of acute pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old. Cardiopulmonary monitoring and support devices, unchanged.Small lung volumes with diffuse opacity compatible with pulmonary edema and moderate pleural effusions.

Output: Pulmonary edema and pleural effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: Evaluate position of DHT Interval advancement of Dobbhoff tube with tip now located in gastric body. Remainder of exam without significant change. Please see same day chest radiography for additional findings.

Output: Interval advancement of Dobbhoff tube as above, seen in satisfactory position.


Instruction: Generate impression based on medical findings.

Input: Reason: Chest pain and cough History: Chest pain and cough Unremarkable cardiac and mediastinal silhouette. Mild lower zone scarring, unchanged.No sign of pneumonia or other acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: pna History: pna Unremarkable cardiac and mediastinal silhouette. Chronic appearing interstitial opacity, mainly in the apices and lung bases.No specific evidence of pneumonia.

Output: Chronic appearing interstitial opacity with no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with metastatic prostate cancer -- assessment after 8 cycles of investigational therapy. CHEST:LUNGS AND PLEURA: No infiltrates, nodules or effusions.MEDIASTINUM AND HILA: No significant change in the reference AP window lymph node (series 4 image 33) measuring 1.4 by 1.0-cm. Other small subcentimeter mediastinal lymph nodes are unchanged in size and appearance. Coronary artery calcification again seen.CHEST WALL: No change in appearance of scattered sclerotic bony metastatic foci.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Again, small benign renal cyst left upper pole kidney. No other abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted -- no enlarged lymph nodes identified..BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No change in the diffuse sclerotic metastatic bony lesions seen.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prior prostatectomy. No change in appearance of surgical bed.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No change in the distribution of bony sclerotic metastatic fociOTHER: No significant abnormality noted

Output: 1. Stable appearance to small mediastinal lymph nodes measured and visualized above. 2. No change in appearance or distribution of bony sclerotic metastatic foci throughout chest abdomen and pelvis. 3. No other abnormality seen in stable appearance compared with prior CT examination.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate right pleural fluid collection History: anemia Interval partial withdrawal of the right pleural drain with the tip now projected over the lateral right hemithorax, possibly external to the pleura.Persistent extensive opacity consistent with loculated pleural effusion and underlying atelectasis.

Output: Interval withdrawal of right chest tube and no other significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: ETT placement History: n/a Patchy interstitial and airspace opacities unchanged.Right pleural effusionReaccumulating. No significant pneumothorax.ET tube tip approximately 3 cm above the carina.An NG tube extends below the lower margin of the image.Right PICC, tip in the SVC.

Output: ET tube tip approximately 3 cm above the carina. Reaccumulating right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: acute changes, swan pulled History: swan pulled, acute changes Interval removal of a Swan-Ganz catheter.Heart size about upper normal with no significant pulmonary abnormalities.

Output: Interval removal of Swan-Ganz catheter and no acute change.


Instruction: Generate impression based on medical findings.

Input: Age: 91 yearsGender: FemaleReason for Study: Reason: r/o PNA History: tachypnea Right IJ venous catheter with its tip in the SVC.Dobbhoff tube with its tip in the stomach.Stable cardiac enlargement with basilar opacities compatible with pleural effusions and atelectasis.No new pulmonary opacities identified.

Output: Basilar opacities compatible with atelectasis and pleural effusions similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: 64 y/o man w/ dyspnea History: 64 y/o man w/ dyspnea Small lung volumes with basilar subsegmental atelectasis.No specific evidence of pulmonary edema or pneumonia.

Output: No specific evidence of pulmonary edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.New ETT placement. Respiratory failure, hypercarbia. ETT tip 3 cm above the level of the carina. Enteric tube tip abuts the lateral wall of the stomach. Clamshell sternotomy hardware.Circumferential pleural fluid collections appear similar.Extensive bilateral airspace opacities, which appear increased in the upper lobes.Multiple loops of mildly prominent large bowel in the upper abdomen, consider abdominal radiographs to exclude ileus or obstruction.

Output: Worsening upper lobe airspace opacities. ETT tip 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Age: 97 yearsGender: FemaleReason for Study: Reason: leukocytosis, eval for infiltrate History: see above The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: evaluate for pna History: productive cough Interval extubation. Left base better aerated. No new opacity. Compression fracture, age indeterminate, of a midthoracic vertebral body.

Output: No focal opacity to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old, with hemoptysis. Evaluate for PE versus bleeding lung mass. PULMONARY ARTERIES: Technically adequate exam with no evidence of pulmonary embolus.LUNGS AND PLEURA: Large, heterogeneously enhancing right upper lobe tumor has not significantly changed, extending from the chest wall laterally to the right pericardial surface superiorly, the paratracheal region and inferiorly to the right hilum. The right main pulmonary artery and right mainstem bronchus are narrowed and the right upper lobe bronchus is obliterated. The size of reference lesions has not significantly changed.Interval resolution of small right pleural effusion and left hydropneumothorax. A few scattered micronodules in the left lung are unchanged.MEDIASTINUM AND HILA: Subcarinal and right hilar adenopathy is unchanged. A small pericardial effusion is also unchanged. The cardiac size is normal.CHEST WALL: Supraclavicular adenopathy is unchanged. Left IJ central venous catheter, tip at the RA/SVC junction. Fracture of the lateral right second rib is redemonstrated. Mild bilateral gynecomastia.UPPER ABDOMEN: Limited evaluation of the abdomen redemonstrates segment VI/VII liver lesion and right adrenal lesion.

Output: 1.No pulmonary embolus.2.Right upper lobe mass lesion with associated compression of the right main pulmonary artery, right mainstem bronchus and right upper lobe bronchus, unchanged.3.Stable hilar, mediastinal and supraclavicular lymphadenopathy.4.Probable metastatic disease in the abdomen is partially visualized.


Instruction: Generate impression based on medical findings.

Input: 45-year-old male with lung cancer CHEST:LUNGS AND PLEURA: Right upper lobe mass measures 2.3 x 1.8 cm image number 34, series number 3, not significantly changed from previous study.MEDIASTINUM AND HILA: Small pericardial effusion. Stable calcified right hilar and subcarinal lymph nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse, predominantly sclerotic bone metastases are unchanged. Again noted is narrowing of the spinal canal at the level of the L3 vertebral body.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse sclerotic metastases are stable.OTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: evaluate for active tb History: Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality. Apical scarring unchanged

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Hypoxemia. Burn patient. Visualized tubes and lines similar in position. Skin staples. Layering pleural fluid, edema-like opacities and atelectasis similar to recent previous.

Output: No acute change in pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with headache; history of leiomyosarcoma with metastases. Evaluate the extent of metastases. CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary metastases of varying sizes; the largest of which is in the right lung measures 6.2 x 6 cm (series 6, image 50). MEDIASTINUM AND HILA: There is mediastinal and hilar lymphadenopathy. A subcarinal mass measures 3.2 x 1.4 cm (series 4, image 36) and appears to extend into the right mainstem bronchus (series 6, image 33). Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: A hypodense lesion in the right hepatic lobe as seen on series 4, image 79 that is too small to characterize.Gallstones are seen in the gallbladder without evidence of obstruction or inflammation.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.PELVIS:UTERUS, ADNEXAE: The uterus is absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple subcutaneous nodules are identified (series 4, images 160, 175, 194).

Output: Pulmonary and subcutaneous metastatic disease as above


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: reassess ptx History: reassess ptx The right upper lobe remains atelectatic with right hemithorax volume loss and a right pleural effusion.Prior right apical pneumothorax no longer visible.Left lung unremarkable.Left subclavian catheter, tip in SVC.

Output: No pneumothorax. Unchanged right upper lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.HIV and SOB. Question cardiopulmonary process or pneumonia. Normal heart size. No focal airspace opacities, visible pleural fluid or pneumothorax.

Output: No specific signs of pneumonia by plain film technique. Consider thoracic CT if there is continued concern for opportunistic pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: respiratory failure Distal location of the Swan-Ganz catheter in a branch of the right descending pulmonary artery, unchanged.ET tube, ICD leads and LVAD unchanged.Chest tubes in place with no pneumothorax.Mild basilar opacity compatible with atelectasis and small effusions.

Output: Peripheral location of Swan-Ganz catheter and no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.CVA. Mild basilar atelectasis/scarring. Stable cardiomediastinal silhouette. No focal airspace opacity or pneumothorax. Severe bilateral rotator cuff arthropathy.

Output: Minimal basilar atelectasis/scarring without acute abnormality or significant interval change.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: Age: 93 yearsGender: FemaleReason for Study: Reason: acute shortness of breath History: see above Decreased lung volumes with stable cardiac enlargement.Mild basilar atelectasis without focal areas of consolidation.No new pulmonary opacities.No large pleural effusions.Degenerative changes of the left glenohumeral joint with superior migration of the left humeral head consistent with a chronic rotator cuff tear.

Output: No interval change without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Status post bilateral lung transplant. No reported missing guidance in the operating room. Status post bilateral lung transplant with two chest tubes on each side.Moderate pneumothoraces, left larger than right, subsequently improved.Dual-lumen endotracheal tube noted. Left subclavian Swan-Ganz catheter tip in main pulmonary artery.No radiodense foreign object identified.

Output: Bilateral pneumothoraces. No radiodense foreign object. Findings were discussed with the attending surgeon Dr. Wigfield in the operating room at 11:06 PM by the radiology by the radiology resident on call.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: PT with IABP, position? History: In CCU with IABP Moderate cardiomegaly without edema or pleural effusions.Left subclavian ICD, leads unchanged in position.IABP proximal marker 2 cm below the top of the aortic arch.

Output: Unchanged IABP, and no acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: 8/25 Right sided, video-assisted forward/robotic-assisted wedge resection History: none Interval removal of right chest tube. No evidence of pneumothorax. Lung bases better aerated. No new findings.

Output: Interval removal of right chest tube. No evidence of pneumothorax. Lung bases better aerated. No new findings.


Instruction: Generate impression based on medical findings.

Input: Age: 74 yearsGender: FemaleReason for Study: Reason: PNA History: cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Reason: ETT History: ETT ET tube tip approximately 4 cm above the carina.NG tube tip in the stomach.No acute cardiopulmonary abnormalities.Pleural thickening of the left apex of uncertain chronicity which could be better evaluated with erect PA and lateral radiographs when feasible.

Output: 1. ET tube in acceptable position.2. Nodular pleural thickening at left apex of uncertain chronicity which could be better evaluated with erect PA and lateral radiographs, and comparison with any available radiographs or CT scans from elsewhere.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Generalized abdominal pain Heart size is enlarged. Lungs are clear. Severe degenerative changes affects the shoulders. The bowel gas pattern is nonobstructive. Above average stool burden within the colon.Degenerative changes affects the lumbar spine. Lateral hip arthroplasties.

Output: Findings suggestive of constipation; no definite evidence of small bowel obstruction.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: FemaleReason for Study: Reason: eval for effusions History: s/p thora on R Right PICC line unchanged.Stable cardiomediastinal silhouette.Pleural effusions improved on the right from the prior exam post thoracentesis.No evidence of a pneumothorax.Persistent left retrocardiac consolidation/atelectasis.

Output: Bilateral pleural effusions decreased on the right post thoracentesis. No evidence of a pneumothorax. Persistent left retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: new DOE and LE edema; eval for infiltrate, edema New left basilar opacity and small left pleural effusion. Query very small right pleural effusion. Mild cardiomegaly again noted. No pneumothorax.

Output: New left basilar opacity and small left pleural effusion which certainly may represent aspiration, pneumonia, and/or atelectasis.


Instruction: Generate impression based on medical findings.

Input: 75-year-old with CNS lymphoma CHEST:LUNGS AND PLEURA: Left lower lobe atelectasis. Minimal bilateral pleural effusions. NG tube is in place.MEDIASTINUM AND HILA: Thrombus in the right lower lobe pulmonary artery.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Ill-defined small hypodense areas adjacent to the gallbladder bed from the right lobe best seen on image number 94 and 95, 99 series number 3. The etiology is unknown and may represent focal fat infiltration. Further evaluation with liver MRI may be helpful.SPLEEN: No significant abnormality notedPANCREAS: 10-mm cystic lesion in the tail of the pancreas, most likely benign.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral simple appearing renal cysts, largest measuring 6.4-cm on the left side.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: Enhancing focus in the right apical prostate. Correlation with prostate MR and PSA is recommended.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Fat containing bilateral inguinal hernias, more prominent on the right compared to the left.

Output: Right lower lobe pulmonary embolus.Indeterminant likely benign liver lesions. Further evaluation with liver MRI is recommended.Small pancreatic cyst.Enhancing focus in the right apex of the prostate. Correlation with PSA and/or prostate MRI is recommended.Dr. Halpern was notified of knowledge about the pulmonary embolus in the right lower lobe although lung at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.History of uterine cancer status post radiation/onc treatments with 3 cycles of Taxol/Carbo. No focal lung opacity, pleural effusion, or pneumothorax. The heart size is normal. A circular calcification is noted within the left upper quadrant; please refer to CT abdomen and pelvis report from the same date.

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: 79 years, Male. Reason: G tube placement History: G tube placement Pelvis excluded from field-of-view. A new percutaneous G-tube tip is seen in the distribution of the greater curvature of the distal gastric body. Bowel gas pattern unchanged with some mildly distended transverse colon. Opacities in the lungs redemonstrated. Please refer to chest x-ray reports.

Output: New percutaneous G-tube tip overlies the region of the greater curvature of the body of stomach.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: FemaleReason for Study: Reason: left sided pleural effusion History: left sided pleural effusion Moderate size left pleural effusion and underlying atelectasis similar to the prior exam.The cardiomediastinal silhouette is unremarkable.Right lung is clear.Right PICC line with its tip in the SVC.

Output: Moderate sized left pleural effusion and underlying atelectasis without significant interval change.