{ "Contributors": "MIMIC-CXR", "Source": "MIMIC-CXR", "URL": "https://physionet.org/content/mimic-cxr-jpg/2.0.0/", "Categories": [ "Text Summurization" ], "Definition": [ "You will be given a description of the important aspects in the Chest X-ray image. Your task is to give a short summary of the most immediately relevant findings" ], "Reasoning": [], "Input_language": [ "English" ], "Output_language": [ "English" ], "Instruction_language": [ "English" ], "Domains": [ "Public Health", "Heathcare" ], "Positive Examples": [], "Negative Examples": [], "Instances": [ { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is a right lower lung opacity. There is no pulmonary edema, pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal.", "output": "Right lower lung opacity concerning for aspiration or pneumonia." }, { "input": "Left-sided dual-chamber pacemaker/AICD device is re- demonstrated with leads in unchanged positions. Mild enlargement of cardiac silhouette is again noted. The aortic knob is calcified. The mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Scarring is seen in the right lung base with tenting of the right hemidiaphragm. No focal consolidation, pleural effusion or pneumothorax is present. Lungs remain hyperinflated. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is no new consolidation or pleural effusion. The heart and mediastinum are within normal limits. Multilevel spinal degenerative changes are stable. An old right lower rib fracture is re-demonstrated. There is no pneumothorax.", "output": "No radiographic evidence of pneumonia." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "AP semi upright view of the chest provided. There is no focal consolidation, effusion, or pneumothorax. Bibasilar atelectasis is similar to prior. Mild cardiomegaly and large hiatal hernia are similar to prior. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "AP and lateral views of the chest. In the mid right lung, there is a new round opacity that is concerning for a mass however may represent focal infection. There is no pleural effusion or pneumothorax. No focal consolidation. Cardiomediastinal and hilar contours are normal.", "output": "Right mid lung rounded opacity may represent a new mass or infection. Recommend CT for further evaluation. These findings were emailed to the ___ nurses by Dr. ___ at 747am on ___." }, { "input": "In comparison to the chest radiographs obtained ___, no significant changes are appreciated. Lungs are fully expanded and clear without focal consolidation or suspicious pulmonary nodules. No pleural effusions. Mild cardiomegaly is unchanged without pulmonary vascular congestion or pulmonary edema. Descending thoracic aorta is tortuous, but unchanged. Median sternotomy wires are well aligned and intact.", "output": "No radiographic evidence of pneumonia, intrathoracic malignancy, or other acute cardiopulmonary abnormalities." }, { "input": "Patient is status post median sternotomy and CABG. Mild cardiomegaly is similar. The aorta remains tortuous, and the mediastinal and hilar contours are unchanged. Pulmonary vasculature is not engorged. There is minimal atelectasis at the lung bases without focal consolidation. No pleural effusion or pneumothorax is detected. Degenerative changes are seen throughout the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear without consolidation, effusion, or vascular congestion. Cardiomediastinal silhouette is within normal limits. Tortuous descending thoracic aorta is noted. Median sternotomy wires and mediastinal clips are again seen. Chronic changes identified at the shoulders as on prior. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Persistent subtle right lower lobe and retrocardiac opacity. Left basilar atelectasis is noted. No pulmonary edema. No pleural effusion or pneumothorax. Heart is top-normal in size. Mediastinal contour and hila are unremarkable. Intact median sternotomy wires. Mediastinal clips are noted.", "output": "Bilateral lower lobe bronchopneumonia, unchanged in appearance since prior examination. RECOMMENDATION(S): Recommend short interval followup chest radiograph ___ weeks after completion of treatment to assess for resolution." }, { "input": "Postoperative cardiomediastinal silhouette and hilar contours are stable. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process; specifically, no evidence of pneumonia." }, { "input": "AP view of the chest was provided. Midline sternotomy wires and mediastinal clips are noted. The lungs appear clear without focal consolidation, effusion, or pneumothorax. Subtle nodular opacities are noted in the left mid lung. No large effusion or pneumothorax. Cardiomediastinal silhouette appears stable. Bony structures are intact.", "output": "No acute findings. Subtle nodular opacities in the left mid lung. Please refer to subsequent CT of the chest for further details." }, { "input": "Support Devices: None. The lungs are clear. The sternotomy wires and mediastinal surgical clips are unchanged. Heart size normal. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal. There is a high riding right humeral head consistent with rotator cuff rupture.", "output": "No evidence of pneumonia." }, { "input": "Lung volumes are slightly low. Subtle opacity in the right infrahilar region as well as retrocardiac region is concerning for bronchopneumonia given the provided history. Atelectasis at the left lung base is mild. No edema, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is unchanged. Median sternotomy wires and mediastinal clips are also unchanged. The descending thoracic aorta is tortuous.", "output": "Bilateral lower lobe bronchopneumonia. Repeat chest radiograph in ___ weeks to ensure resolution after treatment is recommended. RECOMMENDATION(S): Repeat chest radiograph in ___ weeks to ensure resolution after treatment is recommended." }, { "input": "PA and lateral views of the chest. Sternotomy wires and mediastinal clips are stable. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process. These findings were discussed with Dr. ___ by Dr. ___ at 1:12 p.m. on ___ by telephone at the time of discovery." }, { "input": "The patient is status post median sternotomy with intact sternotomy wires. The lungs are clear without focal consolidation, effusion, or pneumothorax. A 4-mm nodular opacity in the right lower lobe is apparent on today's exam, as are the subtle nodular opacities in the left lower lobe previously noted on the ___ radiograph and better seen on the CT from ___. Bony structures are intact. Cardiomediastinal silhouette appears stable.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are slightly low, particularly on the frontal view. There is no focal consolidation, effusion or overt edema. Cardiac silhouette is within normal limits. Median sternotomy wires, mediastinal clips and coronary artery stents are noted. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiograph demonstrate clear lungs bilaterally. Linear lucencies paralleling the upper mediastinum extending into the neck is compatible with pneumomediastinum. Pulmonary vasculature is normal. There is no pneumothorax or pleural effusion. No air under the right hemidiaphragm.", "output": "Pneumomediastinum." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. Mild anterior wedge compression deformity of an upper lumbar vertebral body is age indeterminate.", "output": "No acute cardiopulmonary abnormality. Age indeterminate mild anterior wedge compression deformity of an upper lumbar vertebral body." }, { "input": "PA and lateral views of chest demonstrate clear lungs. Heart size is normal. No pleural effusion pneumothorax or pulmonary edema.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. The heart is normal in size. There is no focal consolidation or evidence of pulmonary edema. No pleural effusion or pneumothorax is seen. The mediastinal contour is normal. No free air is seen below the right hemidiaphragm. The bony structures are intact.", "output": "No acute intrathoracic process." }, { "input": "A single portable semi-erect chest radiograph was obtained. Low lung volumes exaggerate the heart size and interstitial markings. The lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The heart size is top normal. Mediastinal contours are normal. Cholecystectomy clips are visible in the right upper quadrant. There is no displaced rib fracture.", "output": "Top normal heart size." }, { "input": "Chest: The heart is not enlarged. No CHF, focal infiltrate, effusion, or pneumothorax detected. Ribs: No localizing history is available. No marker is placed to indicate the site of focal symptoms. No dedicated rib radiographs were included. Of note, the lower most right ribs are not fully included on the available views. Allowing for this, the possibility of slight cortical offset involving the right eighth rib anteriorly cannot be excluded.", "output": "No acute pulmonary process identified. No focal pneumonic infiltrate, pneumothorax or pleural effusion detected. Possible minimally displaced fracture of the right anterior eighth rib. Clinical correlation for any focal site of symptoms is requested. If there is ongoing concern for a a rib fracture, then dedicated rib radiographs could help for further assessment." }, { "input": "Single frontal chest radiograph demonstrates a right-sided subclavian venous catheter terminating at the cavoatrial junction. Endotracheal tube terminates at the level of the clavicles. Enteric catheter courses below the left hemidiaphragm terminating in the body of stomach. Cardiomediastinal and hilar contours are unremarkable. Left lung base opacification is poorly assessed given patient positioning, but may reflect combination of atelectasis and effusion. Underlying infectious process cannot be excluded.", "output": "Medical support devices are well positioned. Left lower lung opacification evident." }, { "input": "Frontal and lateral views of the chest demonstrate fully expanded and clear lungs. The cardiomediastinal and hilar contours are normal. There is no pneumothorax or pleural effusion. Pleural surfaces are unremarkable. There is no mediastinal air.", "output": "Normal chest radiograph. No evidence of mediastinal air." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is normal and the lungs are clear. No pleural effusion, focal consolidation or pneumothorax is demonstrated. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lung volumes are low. The heart size is normal. Aorta remains unfolded, and the mediastinal and hilar contours are unchanged. The pulmonary vascularity is not engorged. Minimal streaky opacity within the left lower lobe likely reflects atelectasis. There is no focal consolidation, large pleural effusion or pneumothorax identified. No acute osseous abnormalities detected.", "output": "Minimal left lower lobe atelectasis." }, { "input": "AP and lateral chest radiographs were provided. There is no focal consolidation, pleural effusion or pneumothorax. Lung volumes are slightly low. The cardiomediastinal silhouette is notable for a tortuous aorta. The bones are intact without evidence of displaced rib fractures. There are mild degenerative changes in the thoracic spine.", "output": "No acute cardiopulmonary process or displaced rib fracture." }, { "input": "There has been interval placement of an endotracheal tube, terminating at the carina. Recommend withdrawal by approximately 3 cm for more optimal positioning. A nasogastric tube has also been placed in the interval with distal tip at the GE junction, side port within the distal esophagus. Recommend advancement by approximately 15 cm so that it is well within the stomach. Subtle patchy left mid lung opacity is seen which may represent overlap of vascular structures however small focus of infection may be present. Minimal right costophrenic angle atelectasis is seen. There is no large pleural effusion or evidence of pneumothorax. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Endotracheal tube terminates at the level of the carina. Recommend withdrawal by approximately 3 cm for more optimal positioning. Nasogastric tube terminates at the GE junction, side port in the distal esophagus, Recommend advancement by approximately 15 cm so that it is well within the stomach. The above findings were discussed with Dr. ___ at 11:36AM on ___, via telephone 2 minutes after discovery. Small patchy opacity projecting over the left mid lung, may represent small focus of infection." }, { "input": "Cardiomediastinal and hilar contours are stable. There has been interval removal of a right internal jugular catheter. No new focal lung opacities are identified. There is no pleural effusion or pneumothorax. Blunting of the left costophrenic angle is again seen. Pulmonary vasculature is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. The aorta is mildly unfolded. Mediastinal and hilar contours otherwise are unchanged. Pulmonary vascularity is normal. Lungs are clear. No pleural effusion or pneumothorax is visualized. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The endotracheal tube has been withdrawn in the interval, now terminating approximately 3.5 cm above the level of the carina. Nasogastric tube tip remains at the GE junction with side port in the distal esophagus. Again, recommend advancement so that it is well within the stomach. A right-sided internal jugular central venous catheter again terminates in the mid-to-lower SVC. There is no pneumothorax. There is persistent slight blunting of the left costophrenic angle. No focal consolidation. Cardiac and mediastinal silhouettes are stable.", "output": "1. Endotracheal tube now in appropriate position. 2. Nasoenteric tube still remains high in position, as above. The above findings were discussed with Dr. ___ on ___ at 9:50 p.m. via telephone immediately after discovery by Dr. ___." }, { "input": "Previously seen endotracheal tube, right PICC, right central venous catheter, and orogastric tube have been removed. The heart size is normal. The mediastinal and hilar contours are unchanged. There is minimal blunting of left costophrenic angle suggestive of a trace effusion. No pneumothorax is seen, and there is no right-sided pleural effusion. Ill-defined nodular opacities are noted within the right mid lung field, which could reflect areas of infection or inflammation. No focal consolidation is demonstrated. There is no pulmonary vascular congestion.", "output": "Ill-defined nodular opacities within the right mid lung field could reflect an area of infection or inflammation. Trace left pleural effusion." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. No overt pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Midline sternotomy wires and left chest wall pacer device appear unchanged. The pacer leads extending to the region of the right atrium and right ventricle. The lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is unchanged. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The patient is status post median sternotomy and CABG. Left-sided dual-chamber pacemaker device is seen with leads terminating in the right atrium and right ventricle. The heart is normal in size. Mediastinal and hilar contours are unremarkable. The pulmonary vascularity is normal. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Multiple spiral radiopaque densities within the upper anterior abdominal wall are compatible with prior ventral hernia repair. No free air is seen under the diaphragms.", "output": "No acute cardiopulmonary abnormality. No free air under the diaphragms." }, { "input": "Rotated positioning. A left-sided pacemaker present, with lead tips over right atrium right ventricle. An NG tube is present, tip extending beneath diaphragm, off film. Surgical ___ are noted over the upper abdomen in the midline. Linear density overlying the left lung could represent an epidural catheter, best correlated clinically. The patient is status post sternotomy. Note is made that the lower most sternotomy wire is fractured. There is probable mild cardiomegaly. There is increased retrocardiac density with a probable small left effusion and partial obscuration the left hemidiaphragm. There is minimal atelectasis in the right cardiophrenic region. No pneumothorax is detected. There is pleural parenchymal thickening/scarring at the left lung apex. The right first rib may be truncated, but is unchanged. Aside from right base atelectasis, the right lung is grossly clear. No gross right effusion, though minimal pleural fluid could be present on the right. Suspect background hyperinflation/COPD. Note made of old rib fractures seen in lower right chest, similar to ___. Compared to ___ the heart size is larger. Left effusion and left lower lobe collapse and/or consolidation is new and right cardiophrenic atelectasis is more pronounced.", "output": "1. Small to moderate left effusion with underlying collapse and/or consolidation of the left base. 2. Atelectasis in the right cardiophrenic region. 3. Cardiac silhouette larger compared with ___. 4. Clinical correlation is required for full assessment. 5. Fractured inferior sternotomy wire, unchanged compared with ___." }, { "input": "Compared with the prior study, the cardiomediastinal silhouette is probably unchanged. There is upper zone redistribution, without overt CHF. Fractured inferior sternotomy wire again noted. The left hemidiaphragm and left costophrenic sulcus are now better defined, suggesting interval improvement in the the left effusion and left lower lobe collapse/consolidation. Some residual left lower lobe atelectasis persists. On the right, there has been slight improvement in the right cardiophrenic opacity. The small right effusion is again seen, similar to prior. Left-greater-than-right apical pleural thickening again noted. Fractures of the mid/lower posterior right ribs again noted, presumably old. No pneumothorax detected. NG tube, pacemaker, and presumed epidural catheter again noted.", "output": "Partial interval improvement in collapse/consolidation at the left base and in the right cardiophrenic opacity. Marked improvement in left pleural effusion. NG tube extends beneath the diaphragm off the film. The sideport is not well delineated, but appears to lie immediately beyond the GE junction." }, { "input": "There is no pleural effusion, pneumothorax or focal air airspace consolidation. The heart size is normal. The mediastinal contours and hilar structures are unremarkable. There is no pneumomediastinum.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Very small region of consolidation probably in the right middle lobe. No pneumothorax or pleural abnormality.", "output": "Right middle lobe consolidation could be atelectasis if there are no symptoms of acute pneumonia." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Study is slightly limited due to mild patient rotation. There is moderate to severe cardiomegaly. Endotracheal tube tip terminates 4.4 cm from the carina. Low lung volumes are noted with crowding of the pulmonary vascular structures, and probable mild pulmonary vascular congestion. Air bronchograms with opacification in both lung bases may reflect areas of infection. Patchy opacities are also noted within the right upper lung field as well as the left upper and mid lung fields, concerning for additional sites of infection or aspiration. No large pleural effusion or pneumothorax is seen. Prominent gaseous distention of the stomach is noted.", "output": "1. Endotracheal tube in standard position. 2. Consolidative opacities in the lung bases may reflect areas of infection. Additional patchy opacities within the left lung and right upper lung field are concerning for additional sites of infection or aspiration. 3. Cardiomegaly with possible mild pulmonary vascular congestion." }, { "input": "Since the prior exam, there is increasing opacification of the bilateral bases which is likely atelectasis. There is no pulmonary edema, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No definite evidence of pneumonia. New bibasilar opacities are likely atelectasis. Recommend a repeat chest radiograph later today or tomorrow to ensure the opacities are not increasing." }, { "input": "The lungs are hyper-expanded and clear. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Clips are noted in the right upper quadrant of the abdomen compatible prior cholecystectomy.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest were obtained. Low lung volumes result in bronchovascular crowding. There is bibasilar atelectasis without focal consolidation, pleural effusion or pneumothorax. A nodular opacity in the right upper lobe is superimposed over the right sixth posterior rib. The heart cannot be well evaluated due to lung volumes. The aorta is tortuous. Hilar contours are normal. Degenerative change is seen in the shoulder girdles bilaterally. There is no free air under the diaphragm. Compression deformities in the thoracic spine are noted.", "output": "1. No acute intrathoracic process. 2. Nodule in the right upper lobe is superimposed over the right posterior rib, new from ___. Shallow obliques off the frontal view could be performed for further evaluation. Findings and recommendations discussed with Dr. ___ by phone at 3:41pm ___." }, { "input": "A right PICC line terminates in the upper SVC. The heart is top normal in size. There is no definite pneumonia or pneumothorax. There is no pulmonary edema.", "output": "Stable chest examination with no definite pneumonia." }, { "input": "As compared to prior chest radiograph from ___, lung volumes have increased and there has been interval removal of a right-sided PICC line. The cardiomediastinal and hilar contours are within normal limits. Slight prominence of interstitial lung markings could relate to patient's known underlying emphysema. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary findings." }, { "input": "Since ___, left lower lobe pneumonia is significantly improved.i The right lung is clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. No pleural effusion or pneumothorax. No new focal consolidations are seen.", "output": "Significant improvement in left lower lobe pneumonia since ___. No new focal consolidations are noted." }, { "input": "PA and lateral views of the chest provided. Airspace consolidation is noted within the left lower lobe compatible with pneumonia. Right lung is clear. Cardiomediastinal silhouette is stable. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Left lower lobe pneumonia." }, { "input": "Cardiomediastinal silhouette is normal. The lungs are clear. There is no pneumothorax or pleural effusion. Coronary artery calcifications are noted. There is no acute osseous abnormality.", "output": "No radiographic explanation chronic cough. RECOMMENDATION(S): The findings were discussed by Dr. ___ with Dr. ___ on the ___ ___ at 1:15 PM, 1 minutes after discovery of the findings." }, { "input": "There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits. Sternotomy wires are unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. No prior. The lungs are clear. The cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are grossly unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs are clear. Cardiomediastinal silhouette is normal. Mid thoracic dextroscoliosis is noted. No acute osseous abnormality detected.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The cardiomediastinal and hilar contours are within normal limits. The lungs appear clear. There is no evidence of pneumothorax or effusion. Bony structures appear intact.", "output": "No acute findings." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No evidence of pneumomediastinum. No acute osseous abnormalities are identified. Lumbar spinal fusion hardware is partially imaged.", "output": "No pneumomediastinum or radiographic evidence of an intrathoracic mass." }, { "input": "Mild bronchial wall thickening is noted without focal consolidation. There is no pleural effusion, pulmonary vascular congestion, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Mild bronchial wall thickening suggesting bronchitis without evidence of pneumonia. NOTIFICATION: The findings were discussed with ___ with with with the, M.D. by ___, M.D. on the telephone on ___ at 11:06 AM, 1 minutes after discovery of the findings." }, { "input": "No consolidation, pleural effusion or pulmonary edema is seen, and the cardiac and mediastinal contours are normal. Hyperinflated lungs are seen.", "output": "No acute cardiopulmonary disease." }, { "input": "Moderate to severe cardiomegaly is stable. Patient has a hiatal hernia. Aside from minimal atelectasis in the right base, the lungs are clear. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary abnormality Stable cardiomegaly and hiatal hernia" }, { "input": "Lung volumes are low causing crowding and an apparent increase in the size of the only mildly enlarged cardiac silhouette. Lungs are otherwise clear. No pleural effusion or pneumothorax. Osseous structure appear unchanged since ___.", "output": "No evidence of pneumonia." }, { "input": "Frontal and lateral chest radiographs demonstrate clear, well-expanded lungs, with note made of eventration of the right hemidiaphragm. There is no pleural effusion or pneumothorax. The pulmonary vasculature is normal. The cardiac silhouette is mildly enlarged, unchanged. The aortic valve annulus and coronary arteries are heavily calcified. The mediastinal contours are normal. There is a small hiatal hernia, newly appreciated.", "output": "1. No acute chest abnormality. 2. Small hiatal hernia" }, { "input": "The patient is status post sternotomy. There is similar volume loss in the right hemithorax with opacification at the medial right apex and thickening of what appears to represent the minor fissure. Blunting of the right costophrenic sulcus has increased and suggests minor scarring or atelectasis with a potential small effusion. There is also patchy new opacification in the right lower lobe compared to the prior chest radiographs while the left lung remains clear.", "output": "Patchy new right lower lobe opacity with possible small pleural effusion. Depending on the clinical setting, mild pneumonia or sequelae of aspiration could be considered, although evolving scarring or atelectasis with associated with an interval effusion could also be considered." }, { "input": "AP and lateral views of the chest are compared to previous chest x-ray from ___ and images from prior PET-CT from ___. Again seen is evidence of right upper lobe scarring medially with associated volume loss. This appearance is similar compared to prior chest x-ray. Elsewhere, the lungs are clear without evidence of new consolidation or effusion. Cardiomediastinal silhouette is stable. Median sternotomy wires again seen. Osseous and soft tissue structures are unremarkable.", "output": "Post-treatment changes seen in the right upper lung. No evidence of acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. There is no pleural effusion or pneumothorax. The lungs appear clear. Mild degenerative changes are noted along the mid thoracic spine with small osteophytes and mildly narrowed interspaces.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The lungs are normally expanded and clear. The cardiomediastinal silhouette, hilar contours and pleural surfaces are normal. There is no pleural effusion or pneumothorax. There is slight indentation of the left side of the trachea.", "output": "1. No evidence of acute cardiopulmonary abnormality. 2. Indentation of the left side of the trachea possibly from thyroid enlargement. Please correlate with physical exam. Updated results were telephoned to Dr. ___ by ___ at 8:10 am, ___, 10 minutes after discovery." }, { "input": "PA and lateral views of the chest provided. Low lung volumes. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Streaky right basilar opacities are identified particularly in the right middle lobe. Elsewhere, the lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "Streaky right middle lobe opacities most suggestive of atelectasis." }, { "input": "Lung volumes are low. There is mild elevation of the right hemidiaphragm with new right lower lobe subsegmental atelectasis. The left lung is clear.", "output": "New right lower lobe subsegmental atelectasis." }, { "input": "Cardiac size is top normal. Bibasilar atelectasis larger on the right have minimally increased. There are low lung volumes. There is no pneumothorax or pleural effusion.", "output": "Bibasilar atelectases no pneumothorax." }, { "input": "Single portable view of the chest. The lungs are clear where not obscured by overlying cardiac leads and wires. The cardiomediastinal silhouette is normal. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. The hilar and mediastinal contours are within normal limits. There is no pneumothorax, focal consolidation, or pleural effusion.", "output": "No acute intrathoracic process." }, { "input": "No focal consolidation, pleural effusion or evidence of pneumothorax is seen. Cardiac, mediastinal, and hilar contours are stable. There is flattening of the diaphragm, suggesting chronic obstructive pulmonary disease.", "output": "No acute cardiopulmonary process. Flattening of the diaphragms suggests chronic obstructive pulmonary disease. No significant interval change since the prior study." }, { "input": "Moderate to severe bilateral pleural effusions and bibasilar consolidations, left side has increased in size from prior. Bilateral chest tubes are in place. Right sided PICC line, tip in the SVC. Mild pulmonary edema. Stable left sided rib fractures. Healed right sided rib fractures. Multiple compression fractures in the thoracic and lumbar spine. Innumerable osseous lucencies consistent with known multiple myeloma. Cardiomediastinal silhouette is obscured. This preliminary report was reviewed with Dr. ___, ___ radiologist.", "output": "Moderate to severe bilateral pleural effusions and bibasilar consolidations, left side has slightly worsened from ___." }, { "input": "Right-sided PICC terminates in the low SVC. Bilateral chest tubes are unchanged in position. There has been interval decrease in cardiomegaly. Mediastinal congestion has improved. Focal consolidation at the right lung base obscuring the right heart border reflects atelectasis versus pneumonia, better evaluated on most recent chest CT. A small right pleural effusion persists. Partial collapse of the left lower lobe and moderate left pleural effusion better evaluated on most recent chest CT. There is no pneumothorax.", "output": "1. No evidence of pneumothorax. 2. Cardiomegaly and mediastinal congestion have improved. 3. Consolidation in the right lower lobe better evaluated on most recent chest CT likely reflects pneumonia versus atelectasis. 4. Partial collapse of the left lower lobe and moderate left pleural effusion better evaluated on most recent chest CT." }, { "input": "Opacification of the right mid and lower hemithorax is new since ___, consistent with large pleural effusion and atelectasis. Concurrent pneumonia is possible. Remaining aerated right apex is clear. Opacification of the left lower hemithorax is also new, consistent with an increasing, now moderate pleural effusion. Concurrent pneumonia is possible. Aerated portions of the left lung are clear. Heart size cannot be assessed, borders obscured by the bilateral opacities. Dextroconvex curvature of the upper thoracic spine could be positional.", "output": "Bilateral large right and moderate left pleural effusion, markedly increased since ___. Underlying pneumonia cannot be excluded." }, { "input": "Bilateral moderate pleural effusions, left greater than right, and adjacent atelectasis are stable to mildly increased since ___. The heart size is somewhat obscured but appears enlarged. No pneumothorax.", "output": "Stable to mild interval increase in bilateral moderate pleural effusions, left greater than right, since ___." }, { "input": "Bilateral chest drainage tubes in situ. Right-sided PICC line in situ with the tip at the cavoatrial junction. No pneumothorax. Interval decrease in size of the bibasal pleural effusions. Adjacent subsegmental atelectasis seen in the lower lung zones. Coarsened appearance of the bones.", "output": "Interval improved as evidenced by decrease in the size of the bilateral pleural effusions." }, { "input": "Right-sided PICC terminates in the low SVC. Bilateral chest tubes are unchanged in position. Cardiomediastinal silhouette is unchanged within the limitations of patient rotation. Previously seen opacity at the right mid to lower lung has improved. There is increased retrocardiac and left lung base opacity. There is no pneumothorax .", "output": "Right basilar atelectasis has improved. Increased moderate left pleural effusion and left basilar atelectasis." }, { "input": "A right chest drain has been placed in the interim, projecting over the right mid hemithorax just under the superior aspect of the opacity that likely pleural effusion. The tip of the catheters straight and does not have the \"pigtail appearance. No significant subcutaneous emphysema. Mottled appearance of the bones is consistent with history of multiple myeloma with bilateral chronic rib deformities likely old pathologic fractures. No significant change in bilateral large right and moderate left pleural effusions. Underlying pneumonia cannot be excluded. No pneumothorax. Heart size cannot be assessed.", "output": "1. Interval placement of right chest drain with tip projecting over the mid-upper hemithorax, just below the uppermost aspect of the effusion without typical pig-tail configuration. The position of this drain may be inadequate to clear the pleural effusion. 2. No change otherwise." }, { "input": "Right pleural catheter appears to have been withdrawn by 3 cm but terminates within the chest cage. Small right pleural effusion is less than before. Large left pleural effusion is increased with increased rightward mediastinal shift. The right lung base opacity is probably atelectasis. There is persistent complete collapse of left lower lobe.", "output": "1. Large left pleural effusion and rightward mediastinal shift is increased than 1 day ago. Small right pleural effusion is less 2. right pleural catheter appears to have been withdrawn by 3 cm but terminates within the chest change. NOTIFICATION: Ipression 1 was discussed with ___, N.P. by ___, M.D. on the telephone on ___ at 9:52 AM, 5 minutes after discovery of the findings." }, { "input": "Compared to 4 days prior, no appreciable change in the size of the moderate bilateral pleural effusions. Lungs are otherwise clear. Heart size and cardiomediastinal hilar silhouettes are unchanged. Multiple compression deformities throughout the visualized spine are unchanged. Markedly abnormal sternum contour is similarly unchanged.", "output": "Unchanged moderate bilateral pleural effusions." }, { "input": "AP and lateral views of the chest. No prior. There is elevation of the left hemidiaphragm. The lungs are grossly clear of consolidation or large effusion. The cardiac silhouette is enlarged and the aorta is tortuous. Osseous and soft tissue structures are unremarkable.", "output": "Cardiomegaly. No definite acute cardiopulmonary process." }, { "input": "Dual lumen right-sided central venous catheter seen with the tip in the upper right atrium. There is mild prominence of interstitial markings without and bibasilar opacities potentially due to atelectasis. There is no large effusion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "Bibasilar opacities could be due to atelectasis however infection is not entirely excluded. Consider two views to further characterize." }, { "input": "Lungs are well-expanded and clear, with minimal atelectasis in the right lung base. There is mild cardiomegaly. The mediastinal hilar contours are unremarkable. There is no pleural effusion, pulmonary edema, pneumothorax, or focal consolidation.", "output": "Mild cardiomegaly. No evidence of pneumonia." }, { "input": "The lungs are clear. Cardiac silhouette is normal. No pleural effusion or pneumothorax. There is no free air. Previously, the left hilar region was thought to be slightly rounded in its contour however, recent chest CT demonstrated this was vascular in origin and not due to lymphadenopathy. There was a borderline lymphnode seen on that CT for which recommendation was for repeat limited CT with contrast.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. There is no pleural effusion, pneumothorax or focal airspace consolidation. The heart size is normal. The left hilus demonstrates a rounded opacity which is indeterminate but likely overlapping vessels. The hilar structures and pleural surfaces are unremarkable. There are no acute osseous abnormalities. The imaged upper abdomen is normal.", "output": "Rounded prominence of the left hilus is likely vascular, however, given the provided history a CT is recommended for further characterization. These findings were entered into the Critical Results dashboard on ___." }, { "input": "Lungs are mildly hypoinflated. No infiltrate or edema. The cardio-mediastinal silhouette is unremarkable. No significant pleural effusion or pneumothorax.", "output": "No acute pulmonary disease" }, { "input": "Lung volumes are slightly low, resulting in bronchovascular crowding. There is mild bibasilar atelectasis. Cardiomediastinal and hilar contours are unremarkable. No pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs demonstrate elevation of the left hemidiaphragm. This obscures the left heart border, but allowing for this the heart is likely normal in size. There is no focal consolidation. At the left lung base is atelectasis, likely a small amount of pleural fluid. No pneumothorax is seen.", "output": "Elevation of the left hemidiaphragm with atelectasis and possible small pleural effusion. No definite focal consolidation." }, { "input": "Heart size is normal. The aorta is tortuous. Pulmonary vascularity is normal and the hilar contours are within normal limits. No focal consolidation, pleural effusion or pneumothorax is present. Minimal linear opacities within the left lung base likely reflect subsegmental atelectasis. There is are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are mildly hyperinflated. There is a rounded opacity measuring 3.3 x 2.3 cm projecting over the descending aorta, best seen on the lateral view. There is no pleural abnormality. The heart size is normal. The mediastinal and hilar contours are normal.", "output": "Rounded opacity projecting over the descending aorta. Oblique views are recommended for further evaluation. RECOMMENDATION(S): Oblique views are recommended for clarification of the location of the opacity. NOTIFICATION: The findings were discussed with ___ at ___, ___, M.D.'s office by ___, M.D. on the telephone on ___ at 12:53 PM, 5 minutes after discovery of the findings." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal silhouette is unremarkable. There is no pneumothorax or pleural effusion. Visualized osseous structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are hyperinflated with flattened diaphragms, consistent with known COPD. There is a sublte predominantly linear opacity in the right lung base. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "1. Subtle opacity in the right lung base, which may represent atelectasis but an early focus of pneumonia is also possible. If the diagnosis is in doubt clinically, short-term followup radiograph could be obtained. 2. Pulmonary hyperinflation, consistent with known COPD." }, { "input": "Frontal and lateral chest radiographs demonstrate mildly hyperinflated lungs which are clear. No new consolidation or other findings concerning for infection. Symmetric biapical pleural thickening is noted. No pleural effusion or pneumothorax. Cardiomediastinal and hilar contours are unremarkable. There are degenerative changes of the thoracic spine.", "output": "No findings to suggest infection." }, { "input": "The heart size is normal. The hilar mediastinal contours are normal. Subtle retrocardiac opacity is seen. There is no large pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "Subtle opacity in the retrocardiac region, may be secondary to pneumonia." }, { "input": "The heart size is mildly enlarged. There is an opacity in the lingula, as well as faint opacities in the mid and upper right lung. Aside from mild pulmonary vascular congestion, the hilar and mediastinal contours are normal. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "Faint multifocal opacities in the lungs bilaterally may be secondary to aspiration. Continued close interval follow up is recommended." }, { "input": "There is pleural thickening and irregular linear opacity along the right lateral lower lung with adjacent soft tissue metallic clips, chronicity indeterminate. Mitral valve replacement hardware is seen. No focal pulmonary consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. Heart size is top normal. Mediastinal contours are within normal limits. Biliary stent is partially imaged.", "output": "Right pleural thickening with adjacent soft tissue clips, chronicity indeterminate. Although this could be postsurgical in nature, underlying lung pathology cannot be excluded and correlation with prior exams would be helpful." }, { "input": "PA and lateral views of the chest. The lungs are clear without consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. Hypertrophic changes are seen in the spine. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "Hilar lymph nodes have apparently decreased. The cardiac and mediastinal contours are unremarkable. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "PA and lateral views of the chest are compared to prior chest CT from ___. The lungs are clear. There is no effusion or pneumothorax. Cardiomediastinal silhouette is normal. Hypertrophic changes seen in the spine. Osseous and soft tissue structures are otherwise unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac, mediastinal, and hilar contours appear unremarkable. There is no pneumothorax. There is no evidence for pulmonary edema, pulmonary consolidation, or pleural effusion. Degenerative changes in the thoracic spine with prominent lower thoracic anterior endplate osteophytes, and asymmetric hypertrophic ossification of the right first costochondral junction, appear unchanged.", "output": "No evidence for acute cardiopulmonary abnormalities." }, { "input": "Lungs are well expanded. New left lower lobe consolidation and possibly a small left pleural effusion. Heart size is normal. Cardiomediastinal hilar silhouettes are normal.", "output": "Left lower lobe pneumonia. RECOMMENDATION(S): Recommend follow-up radiographs in ___ weeks to assess for resolution. At that point in time, dedicated chest CT should be considered to evaluate for an etiology predisposing to recurrent left lower lobe pneumonia. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at approximately 10:10 AM, approximately 45 minutes after discovery of the findings." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette. There is mild enlargement of the hila. A left lower lobe consolidation is concerning for pneumonia. There is a peculiar constellation of linear structures in the right lung extending from the right hilus, where it is thicker, to the periphery. These structures are of unclear etiology. There is no pleural effusion or pneumothorax.", "output": "1. Left lower lobe pneumonia. 2. Peculiar constellation of linear structures in the right lung, of unclear etiology. Unless there are pertinent findings in the clinical history to explain this, a CT chest may be required for further evaluation. The timing of the this CT, however, should be dictated by progression of the left lower lobe pneumonia. These findings were communicated via telephone by Dr. ___ to Dr. ___ at ___ on ___." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. Note, a crescentic lucency under the left hemidiaphragm is most likely air within a decompressed stomach.", "output": "No acute cardiopulmonary abnormality. Crescentic lucency on the left hemidiaphragm most likely represents air within a decompressed stomach. If there is any concern for possible pneumoperitoneum, dedicated abdominal radiographs or CT could be considered for further evaluation." }, { "input": "Lung volumes are persistently low. Heart size remains mildly enlarged. Mediastinal and hilar contours are similar. Pulmonary vasculature is not engorged. Patchy opacities in the left lung base likely reflect atelectasis. Right lung is clear. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormalities detected.", "output": "Patchy left basilar opacity, likely atelectasis. Infection cannot be excluded in the correct clinical setting." }, { "input": "Low lung volumes are present which accentuates the size of the cardiac silhouette. Mild enlargement of the cardiac silhouette is noted. The aorta is tortuous. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is not engorged. Patchy opacities the lung bases likely reflect areas of atelectasis. No focal consolidation, pleural effusion or pneumothorax is identified. There are no acute osseous abnormalities visualized.", "output": "Low lung volumes with bibasilar patchy opacities, likely atelectasis. Infection cannot be completely excluded in the correct clinical setting." }, { "input": "Right-sided internal jugular central venous catheter terminates in the proximal SVC without evidence of pneumothorax. No focal consolidation is seen. There is slight blunting of the left costophrenic angle which is nonspecific but could be due to a trace pleural effusion. Cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen.", "output": "Right internal jugular central venous catheter terminates in the proximal SVC without evidence of pneumothorax. Slight blunting of the left costophrenic angle, possible trace pleural effusion. No focal consolidation." }, { "input": "AP view of the chest provided. There are new bilateral interstitial opacities, pattern indicative of pulmonary edema. There is associated subpleural edema along the horizontal fissure. Heart size is normal. Mediastinal and hilar contours are normal. Of note, the vascular pedicle is non-dilated. There is no large amount of pleural effusion. T\\ere are no areas of parenchymal consolidation to suggest pneumonia.", "output": "1. Mild interstitial edema, new or increased since ___. 2. No pneumonia." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. No free intraperitoneal air.", "output": "No acute cardiopulmonary process." }, { "input": "The airways are clear. The chest is well expanded and clear without focal consolidation, pulmonary edema, or pneumothorax. The cardiac and hilar contours are within normal limits. No pleural abnormalities or effusions noted. Mild degenerative changes of the mid-thoracic spine noted.", "output": "Normal chest radiograph without evidence of pneumonia" }, { "input": "AP portable upright chest radiograph provided. Lung volumes are low, though allowing for this, there is no focal consolidation, effusion or pneumothorax. Tiny clips project over the right upper quadrant. The cardiomediastinal silhouette appears grossly unremarkable. The imaged osseous structures appear intact.", "output": "No acute findings in the chest." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Mild increased interstitial markings are demonstrated within the lung bases, and likely reflect a mild chronic interstitial abnormality, as suggested on the prior CT abdomen. Additionally, patchy opacity within the left lung base is concerning for an area of developing infection. No pleural effusion or pneumothorax is present. No acute osseous abnormality is detected.", "output": "Patchy opacity in the left lung base concerning for pneumonia. RECOMMENDATION(S):Follow up radiographs after treatment are recommended to ensure resolution of this finding." }, { "input": "PA and lateral views of the chest provided. Coarsened reticular interstitial markings noted which could reflect underlying emphysema or fibrotic lung disease. Perihilar linear densities could represent scarring as these appear stable from prior exam. No large effusion or pneumothorax. The heart size is normal. The mediastinal contour is unremarkable. Bony structures are intact.", "output": "Coarsened interstitial markings could reflect emphysema/fibrosis. Areas of perihilar scarring unchanged. No acute findings." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal in size with left ventricular configuration.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. New since prior chest x-ray is a right chest wall port with catheter tip at the RA SVC junction. Increased interstitial markings seen in the right upper lung which are new since prior chest x-ray but where visualized in part on prior chest CT, questionably progressed since then. Elsewhere the lungs are clear. The cardiomediastinal silhouette is unchanged. No acute osseous abnormalities detected.", "output": "Progression of right upper lung interstitial opacities new since ___, partially visualized on interval chest CT although have likely progressed since that exam given differences in technique. These could represent post postradiation changes although superimposed infection or tumor is possible." }, { "input": "Persistent widening of right paratracheal stripe, consistent with known lymph node enlargement in this region on prior CT. Additional calcified lymph nodes are seen in the subcarinal region and and are seen to better detail on the recent CT scan. Heart size is normal. Within the lungs, note is again made of a discrete nodule in the right upper lobe measuring approximately 2 cm. Lungs are otherwise clear, and there are no pleural effusions or pneumothoraces.", "output": "Mediastinal lymphadenopathy and right upper lobe lung nodule, which have been more fully characterized by recent CT. No evidence of pneumothorax." }, { "input": "Frontal the and lateral views of the chest. The right chest wall port is again seen with catheter tip at the RA SVC junction. Interstitial opacities in the right upper lung are again seen, partially obscured due to the port and likely in part due to postradiation changes. Elsewhere the lungs are grossly clear. The cardiomediastinal silhouette is unchanged. No acute osseous abnormality is detected.", "output": "No definite acute cardiopulmonary process." }, { "input": "A new oval ___ x 12mm radioopacity has developed in the right lung at the level of the ___ anterior interspace. There is a suggestion of greater fullness in the right paratracheal region of the mediastinum and increase in previous mild lobulation of the right hilus both suggesting interval lymph node enlargement. Two small calcifications in the left hilus are more radiodense today than in ___. Lateral view raises the question of a second lung nodule also oval in shape, ___ x 9 mm at projecting between the sternum and the ascending thoracic aorta. Mild loss of height is present at multiple thoracic vertebral bodies, probably a function of patient's age. There is no pleural effusion. Heart size is normal and pulmonary vasculature are unremarkable.", "output": "At least 1, perhaps 2 new lung nodules suspicious for malignancy accompanied by an increase in what may have been pre-existing lymph node enlargement in the right paratracheal station of the mediastinum and the right hilus. If there are any calcifications in the left hilus, it is possible that the lymphadenopathy preseason may not necessarily be related to the new lung nodules, due to sarcoidosis instead. I strongly recommend CT scanning and comparison with any pre-existing cross-sectional imaging of the chest." }, { "input": "The lungs are clear. There is no pleural effusion, pneumothorax or focal airspace consolidation. The cardiac and mediastinal contours are normal. Apical thickening is unchanged. The hilar structures are unremarkable. Old left-sided rib fractures are again noted.", "output": "No acute cardiopulmonary process." }, { "input": "Mild enlargement of the cardiac silhouette is unchanged. The aortic knob is calcified. The mediastinal contours are stable. Mild pulmonary edema is present. Prominent left epicardial fat pad is noted, as seen on prior exams, though a small left pleural effusion cannot be excluded. Bibasilar opacities may reflect atelectasis though infection is not excluded. There is no pneumothorax. Evaluation the lateral view is limited due to the patient's inability to raise her arms.", "output": "Mild pulmonary edema. Bibasilar airspace opacities may reflect atelectasis though infection or aspiration cannot be excluded. Prominent left epicardial fat pad; small left pleural effusion may be present." }, { "input": "Moderate pulmonary edema, worsening moderate cardiomegaly, and widening of the vascular pedicle suggests congestive heart failure exacerbation. Opacity of the left lower lung is likely due to pleural effusion and some component of atelectasis. However, underlying infectious process such as pneumonia cannot be excluded. There is no evidence of apical pneumothorax.", "output": "1. Worsening cardiomegaly, bilateral pulmonary edema, and widening of the vascular pedicle suggest CHF exacerbation. 2. Left lower lung opacity is likely pleural effusion with a component of atelectasis, however, underlying pneumonia cannot be excluded. The above results were communicated via telephone by Dr. ___ to Dr. ___ ___ at 3:10 p.m. on ___, 30 minutes after discovery." }, { "input": "The patient has been intubated since the prior examination, the endotracheal tube terminates about 2.5 cm above the carina. A dual-lead pacemaker/ICD device has leads terminating in the right atrium and ventricle, respectively. An orogastric tube terminates near the gastroesophageal junction. The stomach is mild to moderately distended. An interstitial abnormality with indistinct pulmonary vessels and peribronchial cuffing has increased since the prior study. Although somewhat asymmetric, more prominent on the right than left, pulmonary edema is the most likely reason. Widespread pneumonia could be considered, however. There is no definite pleural effusion or pneumothorax. Cholecystectomy clips project over the right upper quadrant.", "output": "Status post endotracheal intubation. Orogastric tube terminating short of the stomach, which appears mildly distended. Advancing the tube somewhat may be helpful if clinically indicated. Increasing opacities in both lungs, greater on the right than left, for which a somewhat asymmetric form of pulmonary edema, pneumonia, or even aspiration could be considered clinically." }, { "input": "Upright PA and lateral views of the chest demonstrate the lungs are well expanded, with no evidence of large pleural effusion, pneumothorax, overt pulmonary edema, or focal airspace opacity. The heart is chronically mildly enlarged, stable compared to prior studies. A dual-lead pacemaker device is unchanged in position, with leads terminating in the right atrium and right ventricle. The heart is mildly enlarged. Aortic arch calcifications are again noted. Multilevel degenerative changes are present in the thoracic spine.", "output": "Chronic mild cardiomegaly is stable. Otherwise, no acute cardiopulmonary process." }, { "input": "One AP view of the chest. There are low lung volumes. There is moderate cardiomegaly. A left-sided pacemaker is seen. Low lung volumes crowd the pulmonary vasculature. There appears to be slight increase in vascular markings consistent with pulmonary vascular engorgement. No focal consolidation.", "output": "Findings suggest pulmonary vascular engorgement." }, { "input": "PA and lateral images of the chest demonstrate mild interstitial edema, improved from to prior imaging on ___. There is no pleural effusion. There is mild cardiomegaly which is stable from prior imaging. Pacer is seen in left axillary position with intact leads in the expected course to the right atrium and right ventricle.", "output": "Mild pulmonary edema, improved since prior imaging." }, { "input": "Frontal and lateral views of the chest provided demonstrate dual-lead AICD with lead tips extending in the expected location of the right atrium and right ventricle, unchanged. The heart remains borderline enlarged. The mediastinum likely reflects patient's slightly rotated position. There are no signs of pneumonia or CHF. No pleural effusion is seen. No signs of pneumothorax. Bony structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The cardiac silhouette size is mildly enlarged. The mediastinal contours are unremarkable. There is mild perihilar haziness with upper zone vascular redistribution and vascular indistinctness compatible with mild pulmonary edema. More focal ill-defined opacities within the lung bases could reflect aspiration. No pleural effusion or pneumothorax is identified. There are no acute osseous abnormalities.", "output": "Mild pulmonary edema. More focal ill-defined opacities in the lung bases are concerning for aspiration." }, { "input": "Endotracheal tube tip terminates in standard position approximately 5.6 cm from the carina. The nasogastric tube tip courses below the diaphragm, off the inferior borders of the film, likely within the stomach. The cardiac and mediastinal contours are unchanged. There is continued mild pulmonary vascular congestion and bibasilar airspace opacities. No pneumothorax or pleural effusion is evident although the extreme left costophrenic angle is not fully included in the field of view.", "output": "Standard position of the right endotracheal tube. Nasogastric tube tip courses into the stomach, and off the inferior borders of the film." }, { "input": "The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "Normal chest." }, { "input": "The lungs are clear of focal consolidation, effusion, or congestion. There is mild to moderate cardiomegaly, new since prior exam. No acute osseous abnormalities identified.", "output": "Cardiomegaly without acute cardiopulmonary process." }, { "input": "Heart is moderately enlarged with left atrial enlargement. Lungs are clear and there is no pleural abnormality. Transvenous right atrial and left ventricular pacer leads and right ventricular pacer defibrillator leads are continuous from the left pectoral generator in follow their expected courses. Both hila are enlarged, right greater than left, due to pulmonary artery enlargement. No pneumothorax.", "output": "No pneumothorax. Defibrillator in standard position." }, { "input": "Marked cardiomegaly is unchanged since ___. Right atrial and left ventricular pacer leads and a right ventricular defibrillator leads are in unchanged position. Bilateral hilar enlargement is also stable. No pneumothorax. Blunting of the costophrenic angles is seen only on the lateral view and likely represents trace pleural effusions.", "output": "Moderate cardiomegaly is stable. Trace pleural effusions." }, { "input": "There is no visualized enteric tube. Left chest wall triple lead pacing device is again noted. Hilar enlargement is again seen. Lungs are grossly clear. No visualized free intraperitoneal air.", "output": "No visualized enteric tube." }, { "input": "Compared with the prior radiograph, the left chest wall pacer device leads projecting to the right atrium, left ventricle, and right ventricle are intact and unchanged in position. Marked cardiomegaly and bilateral hilar enlargement are unchanged since ___. There is no focal consolidation, pleural effusion, or pneumothorax.", "output": "1. No evidence of pulmonary edema. 2. Marked cardiomegaly due to enlargement of the left atrium." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs without focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes without pleural effusion, focal consolidation or pneumothorax. Heart size is normal. No pulmonary edema. Ascending aorta appears prominent, however no aortic abnormality is detected on CT chest of the same date.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The tip of the endotracheal tube is 2 cm from the carina. The first side port of the nasogastric tube is within the lower esophagus and needs to be advanced 5 cm. No focal consolidation or interstitial opacity. The cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax.", "output": "The nasogastric tube needs to be advanced approximately 5 cm. No acute intrathoracic pathology." }, { "input": "Left apical pneumothorax has improved, tiny pneumothorax remaining if any. A left sided pleural effusion is tiny. Left parenchymal consolidations have improved. There is bibasilar atelectasis. A left pigtail catheter terminates at the left lung base.", "output": "Tiny apical pneumothorax remains if any. Tiny left-sided pleural effusion. Improved left parenchymal consolidations." }, { "input": "There is a new pigtail catheter projecting over the left lower hemithorax with marked reduction in a pleural effusion, which is now small. There is a new small pneumothorax following insertion of the catheter. Reduction and pleural effusion reveals a similar cavitary lesion at the left lung apex to the earlier study. The right lung remains clear. The cardiac, mediastinal and hilar contours appear probably unchanged. The bones appear demineralized.", "output": "Marked reduction in left pleural effusion after catheter placement. Small new left-sided pneumothorax." }, { "input": "A new very large pleural effusion fills most of the left chest cavity with presumed collapse of much of the left lung. There is mild mediastinal shift toward the right. A small area of aerated lung is visible at the left apex. The right lung remains clear.", "output": "Very large new left-sided pleural effusion." }, { "input": "A left-sided pneumothorax is decreased in size. A left-sided pigtail catheter terminates at the left lung base, unchanged. There is a tiny left sided pleural effusion. Left parenchymal opacities are improving however a left apical opacity remains unchanged. Additionally, there is increased pulmonary vascular congestion within the right lung.", "output": "1. Small left-sided pneumothorax, decreased in size. 2. Improved left lung parenchymal opacities but stable left apical opacity. 3. Increased pulmonary vascular congestion in the right lung." }, { "input": "AP and lateral views of the chest were obtained. The lungs are clear. No signs of pulmonary edema or pneumonia. Mild left basilar atelectasis is noted. No pleural effusion. Cardiomediastinal silhouette is normal. Bony structures are intact. There is an old left sixth posterior rib deformity.", "output": "No acute intrathoracic process. Specifically, no signs of pulmonary edema." }, { "input": "Patient is status post median sternotomy. Heart size remains mild to moderately enlarged with a left ventricular predominance. The aorta is tortuous. Mediastinal and hilar contours are unchanged, and no pulmonary vascular congestion is present. Patchy opacities in the lung bases likely reflect areas of atelectasis, without focal consolidation. No pleural effusion or pneumothorax is identified. Moderate degenerative changes are noted in the thoracic spine.", "output": "Bibasilar atelectasis." }, { "input": "A right-sided dialysis catheter terminates in the right atrium. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Subtle airspace opacities are demonstrated throughout both lungs (right greater than left), predominantly at the bases which could represent atypical infection or mild pulmonary edema. No pleural effusion or pneumothorax is seen.", "output": "Subtle airspace opacities throughout both lungs, predominantly at the bases, which are increased from ___ and could represent atypical infection or mild pulmonary edema." }, { "input": "Frontal and lateral views of the chest were performed. A right subclavian dialysis catheter terminates within the right atrium. A surgical clip is seen projecting over the soft tissues of the right neck. Trace bilateral pleural effusions are seen only on the lateral view and are decreased in size from the prior study. The cardiac and mediastinal contours are normal. There is no pneumothorax. The imaged upper abdomen is unremarkable. There are no acute osseous abnormalities seen.", "output": "Trace bilateral pleural effusions which have decreased from ___." }, { "input": "A right dialysis catheter ends in the right atrium. The lungs are clear without focal opacity, pulmonary edema, pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal.", "output": "No acute intrathoracic process." }, { "input": "Single frontal view of the chest. No prior. The lungs are clear of focal consolidation or effusion. Cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is mild to moderate pulmonary edema. No focal consolidation is identified. The cardiac silhouette is unchanged. There is no pleural effusion or pneumothorax. A right chest Port-A-Cath terminates at the cavoatrial junction.", "output": "Mild-to-moderate pulmonary edema." }, { "input": "The cardiomediastinal and hilar contours are unchanged from 01:53. Bilateral perihilar and bibasilar opacities are new from the prior examination consistent with mild to moderate pulmonary edema, right greater than left. There is no evidence of pneumothorax.", "output": "Moderate pulmonary edema, increased from 01:53." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion, focal consolidation or pneumothorax is present. There are no acute osseous abnormalities, including no displaced fractures.", "output": "No acute cardiopulmonary process. No displaced rib fracture is seen. If there is continued concern, a dedicated rib series can be obtained." }, { "input": "Positioning on the lateral view is limited by slight rotation. Allowing for this, minimal patchy opacity at the left base likely represents atelectasis. An early infiltrate is considered much less likely. The lungs are otherwise grossly clear, without focal infiltrate, consolidation, or effusion. Heart size is at the upper limits of normal. The aorta is unfolded. No CHF is detected. Within the limits of plain film radiography, no hilar or mediastinal lymphadenopathy is detected. A small (7 mm) ovoid density projecting over the right scapula near the coracoid process could represent a small loose body or focus of hydroxyapatite.", "output": "No convincing infectious infiltrate identified. Minimal patchy opacity at the left base is non-specific and could represent minimal atelectasis. Otherwise, no evidence of acute pulmonary process." }, { "input": "The lungs are well-expanded. No focal consolidation, effusion, edema, or pneumothorax. The heart is normal in size. The mediastinum is not widened.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Low lung volumes accentuate bronchovascular markings. No overt pulmonary edema. No acute focal consolidation. No pleural effusions or pneumothorax.", "output": "Low lung volumes accentuate bronchovascular markings. No overt pulmonary edema." }, { "input": "Frontal and lateral views of the chest were obtained. Interval decrease in previously seen bilateral pleural effusions with possible very trace effusion persisting on the right. Right base atelectasis is seen. No definite focal consolidation. The patient is status post median sternotomy and cardiac valve replacement. A left-sided PICC is again seen, terminating in the mid-to-distal SVC. Cardiac silhouette is top normal. Mediastinal and hilar contours are unremarkable.", "output": "Significant interval decrease in bilateral pleural effusions with possible only trace right pleural effusion remaining. Right base atelectasis." }, { "input": "AP single view of the chest has been obtained with patient in semi-upright position. Comparison is made to the next preceding similar portable chest examination of ___. The patient is now extubated. The previously existing Swan-Ganz catheter has been removed, but the right internal jugular approach sheath remains in place terminating in the mid portion of the SVC. Bilateral chest tubes have been withdrawn. Lungs remain well expanded and no evidence of pneumothorax is present. Mild blunting of the lateral pleural sinuses persist, but no new evidence of pulmonary congestion or infiltrates is seen. Within the heart shadow, there is evidence of a mitral valve prosthesis and an open circular wire indicating a tricuspid valve annuloplasty.", "output": "o pneumothorax. No evidence of pneumothorax status post extubation and chest tube withdrawal." }, { "input": "Small bilateral pleural effusions are not significantly changed compared to the prior chest radiograph from ___. Moderate left and mild-to-moderate right basilar atelectasis is also not significantly changed. Mild cardiomegaly is unchanged. The mediastinal contours are normal. There is no pneumothorax. A left PICC ends in the mid SVC, as before. There is evidence of prior mitral valve annuloplasty. Midline sternotomy wires and multiple mediastinal surgical clips are again noted. Skin ___ overlie the thoracic midline, unchanged.", "output": "No significant interval change in small bilateral pleural effusions or left greater than right bibasilar atelectasis." }, { "input": "There is thickening of the bilateral peritracheal stripe is in the upper mediastinum compatible with the patient's known thyroid mass. The trachea is narrowed at this level appear the cardiac silhouette is normal in size. The hilar contours are within normal limits. Minimal calcification of the aortic knob is noted. Streaky opacities in the bilateral lung bases may reflect atelectasis; however, aspiration or pneumonia is not excluded. There is increase density projecting over the lower thoracic spine on the lateral view. No significant pleural effusion or pneumothorax is detected. The pulmonary vasculature is not engorged and there is no overt pulmonary edema.", "output": "1. Streaky opacities in the bilateral lung bases may reflect atelectasis; however, aspiration or pneumonia is not excluded. 2. Thickening of the bilateral paratracheal stripes corresponding to known thyroid mass." }, { "input": "Frontal and lateral chest radiographs were obtained. There are increased opacifications at the right lung base. No pleural effusion, pneumothorax, or pulmonary edema is seen. The heart remains moderately enlarged. Mediastinal contours are within normal limits.", "output": "Increased right lung base opacification, likely represents atelectasis, but in the appropriate clinical setting could represent a small developing consolidation." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. There is no definite evidence of a pneumothorax. Consolidation of the left upper lung corresponds to findings from prior chest CT, consistent with known left apical mass. There is bibasilar atelectasis. There are no pleural effusions.", "output": "No radiographic evidence of an acute cardiopulmonary process, no pneumothorax." }, { "input": "The heart size is normal. Mediastinal and hilar contours are within normal limits. Left apical opacification is new compared to the prior exam, and concerning for malignancy. Right-sided apical pleural scarring is demonstrated. The lungs are hyperinflated and bullae are again demonstrated in the lung apices. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities are definitely noted.", "output": "1. Left apical opacification concerning for malignancy. Further assessment with chest CT is recommended. 2. Bullous emphysema." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "Patient is status post left upper lobe wedge resection with postoperative changes noted. There has been interval removal of the right IJ central line. Cardiomediastinal silhouette is unchanged. Opacity at the left lung base, not significantly changed compared to multiple prior studies, likely reflects layering pleural effusion. There is minimal pleural effusion on the right. Focal opacity at the right mid to lower lung is worsening and may reflect pneumonia. There is no pneumothorax.", "output": "1. Worsening opacity at the right mid to lower lung is concerning for pneumonia. Recommend lateral views for further evaluation. 2. Small pleural effusion on the left and minimal pleural effusion on the right. RECOMMENDATION(S): Chest radiograph with lateral views. NOTIFICATION: The findings were discussed with ___ by ___ ___, M.D. on the telephone on ___ at 11:33 AM, 15 minutes after discovery of the findings." }, { "input": "Feeding tube tip seen to the edge of the film in the left upper abdomen. Worsened left perihilar, basilar infiltrate compared with prior exam. Worsened bibasilar consolidations. Worsened left pleural effusion. Tiny right pleural effusion, new. Shallow inspiration. Left perihilar fullness, likely from consolidation, development probably too rapid to represent adenopathy. Postoperative changes left upper lung. Remainder normal.", "output": "Feeding tube tip seen to the edge of the film in the left abdomen. Significant worsening of chest findings, as above" }, { "input": "Right internal jugular central venous catheter terminates in the low SVC at the cavoatrial junction. Left-sided chest tube and surgical sutures overlying the left upper lung are unchanged from ___. Left upper mediastinal convex contour is persistent, slightly decreased in size from ___. Moderate layering right pleural effusion is likely unchanged from ___. Left basilar opacity is increased from ___.", "output": "1. Moderate right pleural effusion, stable from ___, smaller than on ___. 2. Left upper mediastinal convex contour is persistent, slightly smaller since ___, which may represent postoperative changes or left upper lobe atelectasis. 3. Increased left basilar opacity since ___, likely represents atelectasis although aspiration could be considered." }, { "input": "The tip of the PICC line projects over the superior cavoatrial junction. The tip of the Dobhoff feeding tube projects below the level of the diaphragm but beyond the field of view of this radiograph. No focal consolidation or pneumothorax. Chain sutures are present in the left upper lung zone. There is persisting left predominant mediastinal widening as well as a layering left pleural effusion. The size of the cardiac silhouette is within normal limits.", "output": "Persisting mediastinal widening and a layering left pleural effusion. No focal consolidation is identified." }, { "input": "Left paratracheal anterior mediastinal and paucity is worrisome for mediastinal mass. No focal consolidation is seen. There is no pleural effusion or pneumothorax. Cardiac silhouette is not enlarged.", "output": "Anterior left paratracheal opacity is worrisome for an anterior mediastinal mass. It is possible the this could represent an enlarged thymus or lymphadenopathy. Chest CT would further assess." }, { "input": "Portable semi-upright radiograph of the chest demonstrates a right sided PICC with the tip terminating in the right atrium. A transesophageal tube is seen, traversing into the stomach, with the tip not completely visualized. The remainder of the examination is stable since 1 day prior.", "output": "Right-sided PICC with the tip terminating in the right atrium. Retraction by a 45 mm advised. NOTIFICATION: Referring physician ___." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest were reviewed and compared to the prior studies. New increased opacity over the superior portion of the right hilus could be a summation shadow of normal vessels or a new finding. Otherwise, there is no evidence of new consolidation or ground-glass opacities, however, ground-glass opacities are not easily seen on chest radiograph. There is no pleural effusion or pneumothorax. Cardiac and mediastinal contours are normal.", "output": "A new area of increased opacity superior portion of the right hilus could be due to shadow summation of vessels or a new finding. Oblique views are recommended for clarification. COMMENT: Findings were telephoned to Dr. ___ by Dr. ___ ___ at ___ on ___, one hour after the discovery." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is visualized. There are anterior osteophytes within the visualized thoracic spine. No acute osseous abnormalities demonstrated.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Left humeral head replacement noted. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Endotracheal tube terminates 1.3 cm above the carina and should be pulled back. A nasogastric tube is coiled with the tip projecting over the superior mediastinum. Lung volumes are low. Severe cardiomegaly is noted. Left lower lobe consolidation is present. The right lung and left upper lung are grossly clear. No pneumothorax.", "output": "1. Endotracheal tube positioned low, retraction by 1-2 cm advised. 2. NG tube coiled in the esophagus. Repositioning is needed. 3. Severe cardiomegaly and left lower consolidation which may represent pneumonia or aspiration." }, { "input": "Since ___, the dense left lower lobe consolidation is unchanged. New right lower lobe opacities may be atelectasis or developing pneumonia. Severe cardiomegaly is unchanged without pulmonary vascular congestion or pulmonary edema. We an ET tube terminates 3.1 cm above the carina. An OG tube is seen passing through the stomach and outside the field of view.", "output": "Dense left lower lobe consolidation could be pneumonia. New right lower lung opacities could be atelectasis and/or developing pneumonia." }, { "input": "The lungs and pleural spaces are clear without evidence of pneumothorax or pleural effusions. The heart is normal in size. There is no evidence of pneumoperitoneum and osseous structures are grossly intact.", "output": "No acute intrathoracic process." }, { "input": "The lungs are hyperexpanded. There is a wedge-shaped opacity in the left upper lobe with less dense opacity more diffusely involving the left upper lobe, with evidence of volume loss. There is a horizontal scar consistent with prior resection. There is extension of the left hilum compared to prior studies. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "Left upper lobe opacities likely secondary to infection superimposed on known worrisome spiculated nodule seen on the prior CT. Continued followup will be necessary after treatment for infection." }, { "input": "Since the prior exam, the right-sided chest tube has been removed. At the right apex, there is an air-fluid level consistent with a small pneumothorax, slightly increased in size from the prior exam. An opacity in the right upper lobe at the site of the wedge resection likely represents a small amount of hemorrhage. Surgical sutures are present. The lungs are otherwise clear. There is no new consolidation. There is no pleural effusion. The cardiomediastinal silhouette is normal. A small amount of subcutaneous emphysema over the right chest is unchanged.", "output": "1. After the right chest tube removal, a small right apical pneumothorax has slightly increased in size in comparison to the prior exam one day earlier. 2. Stable opacity in the right upper lobe, likely related to a small amount of hemorrhage." }, { "input": "AP portable upright view of the chest. There has been interval placement of a right IJ central venous catheter with its tip projecting over the expected region of the mid to low SVC. Consolidation in the left upper lobe is concerning for pneumonia. Suture material in the right upper lung noted. No pneumothorax is seen. Severe emphysema is again seen.", "output": "Intervally placed right IJ central venous catheter positioned appropriately in the mid SVC. Left upper lobe pneumonia." }, { "input": "The lungs are well expanded and clear. The patient is status post wedge resection of a right upper lobe nodule. Chain sutures are noted in the right apex. The opacity in the right apex is significantly decreased and likely represents resolving hematoma. The right apical pneumothorax has also resolved. The cardiomediastinal silhouette and hilar contours are normal. There is no pulmonary congestion. There is no pleural effusion.", "output": "1. Right apical opacity is improved, likely resolving hematoma. 2. Right apical pneumothorax has resolved." }, { "input": "PA and lateral views of the chest. In the right lower lobe, there is a vague opacity concerning for pneumonia. There is no pleural effusion or pneumothorax. The remainder of the lungs is clear. The cardiomediastinal silhouette is normal.", "output": "Vague opacity in the right lower lobe is concerning for pneumonia." }, { "input": "Compared to two days prior, there is increased density of the opacity in the right lower lobe, concerning for worsening pneumonia. Mild adjacent peribronchial cuffing likely represents focal adjacent small airways inflammation. No pleural effusion, pneumothorax, or pulmonary edema is detected. Heart and mediastinal contours are within normal limits.", "output": "Increased density of right lower lobe opacity, concerning for worsening pneumonia Findings reported to ___ by ___ by telephone at 5:50 p.m. on ___ at the time of initial review of the study." }, { "input": "The lungs are well expanded and clear. There is indistinctness of the right paratracheal stripe. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "Indistinctness of the right paratracheal stripe most likely due to technique and patient position but tracheitis cannot be excluded." }, { "input": "AP portable upright view of the chest. Lung volumes are low. Overlying EKG leads are present. Allowing for technical limitations, the lungs appear clear without focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette appears grossly unremarkable. Imaged osseous structures are intact. No definite signs of free air below the right hemidiaphragm.", "output": "No acute intrathoracic processon this limited exam. No signs of pneumoperitoneum." }, { "input": "The hazy opacifications on the right have resolved. The right lung is now clear without consolidation. At the left base, the previously seen opacification persists. There is no pleural effusion or pneumothorax. There is no pulmonary edema. The cardiomediastinal silhouette is normal.", "output": "1. Improvement in previously seen right-sided pneumonias. 2. Stable left opacification is likely a persistent pneumonia." }, { "input": "There has been interval improvement of the right lower lung consolidation and decrease in size of the right pleural effusion. No left pleural effusion is detected. No pneumothorax or new focal consolidation is seen. Heart and mediastinal contours are within normal limits. Right PICC courses along the expected location of the superior vena cava with tip likely in the region of the cavoatrial junction. Mass effect on the proximal trachea is again noted, better evaluated on prior CT.", "output": "Interval improvement of right lower lung consolidation with decrease in size of right pleural effusion." }, { "input": "The trachea is deviated rightward secondary to an enlarged thyroid. Hazy opacities are seen in the right upper lobe, right lower lobe, and left lower lobe. These appears similar to the opacities seen on the recent CT scan, and likely represent an atypical infection. It does not appear to be worsening. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "1. Multifocal pneumonia appears similar to recent CT scan and likely represents a viral or bacterial infection. Would recommend serial chest radiographs until resolved. 2. Stable rightward tracheal deviation secondary to known enlarged thyroid." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and hyperinflated lungs. Retrocardiac bronchial wall thickening and air bronchograms are unchanged compared to ___, and likely represent chronic bronchitis. There is no focal consolidation, pleural effusion, or pneumothorax. Apical pleural thickening is noted bilaterally. The visualized upper abdomen is unremarkable.", "output": "Retrocardiac opacity is likely chronic bronchitis, without evidence of acute pneumonia." }, { "input": "The lungs are hyperinflated without focal consolidation. Apical scarring is unchanged. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "1. No acute cardiopulmonary process. 2. Although no acute fracture or other chest wall lesion is seen, conventional chest radiographs are not sufficient for detection or characterization of most such abnormalities. If the demonstration of trauma to the chest wall is clinically warranted, the location of any referrable focal findings should be clearly marked and imaged with either bone detail radiographs or Chest CT scanning." }, { "input": "Cardiomediastinal silhouette is normal. There is a right basilar opacity. There is also mild obscuration of the right cardiac border. There is no pleural effusion or pneumothorax. There is no acute osseous abnormality. There is a moderate S-shaped scoliosis of the thoracic lumbar spine.", "output": "Findings consistent with right lower and middle lobe pneumonia. A followup chest radiograph ___ weeks after treatment is recommended to exclude lupus serositis or pneumonitis NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on ___ at 10:40 AM, 5 minutes after discovery of the findings." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "There is a new dense right central opacity approximately 7 cm x 3 cm on frontal view. Given the rapid onset of this finding, the differential is limited to airspace consolidation ___ atelectasis. Given previous radiographic evidence of slow neo-esophageal/gastric emptying, it is possible that patient had aspirated contrast material. This would also explain the dense opacity seen on lateral projection. However, other radiopaque fluid, such as fluid, pus, ___ ___, ___ be filling the airspace in this region. Adjacent to this dense opacity are ill-defined peripheral opacities which is not matched on the contralateral side. The left lung is unremarkable. There is no pleural effusion ___ pneumothorax. There is pronounced flattening of the hemidiaphragms. The cardiomediastinal silhouette is unchanged and within normal limits. The pleural surfaces are unremarkable.", "output": "Large dense right central opacity which ___ represent collapse ___ airspace consolidation with adjacent area of asymmetric pulmonary edema. Given history of lymphadenopathy, collapse could be secondary to nodal compression of an airway. Alternatively, given recent history of oral contrast and poor gastric emptying, opacity ___ represent aspirated contrast material. Consolidation also ___ be secondary to a fistula between the neo-esophagus and the right lung. If this finding represent consolidation, the radiopaque material cannot be identified definitely and ___ represent ___, fluid ___ pus. CT imaging is highly recommended for further evaluation of this finding. These findings were discussed with Dr. ___ at 12:45 p.m. via phone by ___." }, { "input": "A right-sided Port-A-Cath tip sits in the lower portion of the SVC. The heart and mediastinal contours are within normal limits. The lungs are largely clear with only minimal atelectasis in the right base in accordance with a small right pleural effusion. There is no pneumothorax.", "output": "Small right pleural effusion with associated atelectasis; no pneumothorax." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are hyperinflated. An esophageal stent is in place. A right basilar opacity is significantly improved from ___. Mild residual opacity may be scarring. No new opacity. Cardiac and mediastinal silhouettes and hilar contours are stable. Blunting of the right costophrenic sulcus is unchanged. No left effusion or pneumothorax. Loss of vertebral body height in the mid thoracic spine is unchanged.", "output": "Substantial clearing of the right lower lobe opacity. Mild residual opacity is likely scarring rather than new pneumonia. No new opacity." }, { "input": "There is continued opacification of the right base. It is not significantly worsened since the prior exam. This may be due to a combination of pleural effusion, atelectasis, and aspiration. In the proper clinical setting, pneumonia cannot be excluded. There is a stable moderate right pleural effusion. There is a small left pleural effusion. No new consolidation is identified. There is no pulmonary edema or pneumothorax. The cardiomediastinal silhouette is normal. An esophageal stent is unchanged in position. A drain is present overlying the mid abdomen.", "output": "1. Unchanged opacification at the right base. This may be due to atelectasis or aspiration. In the proper clinical setting, pneumonia cannot be excluded. 2. Stable moderate right and small left pleural effusions." }, { "input": "PA and lateral views of the chest were obtained. The lungs are hyperinflated with markedly widened AP diameter of the chest which is compatible with emphysema. An area of presumed scarring at the right lung base appears stable from most recent prior exam. There is no new consolidation, effusion, or pneumothorax seen. Cardiomediastinal silhouette appears stable. Bony structures intact.", "output": "COPD, scarring at the right lung base. No definite signs of pneumonia or CHF." }, { "input": "There has been interval removal of the right-sided Port-A-Cath. The heart size is within normal limits as well as the mediastinal contours. There is no evidence of pneumomediastinum. There is no pneumothorax. Mild bibasilar atelectasis is present with a small right pleural effusion.", "output": "1. No evidence of pneumomediastinum or pneumothorax. 2. Mild bibasilar atelectasis with small right pleural effusion." }, { "input": "There is no pneumothorax or pneumomediastinum. The cardiomediastinal silhouette is normal. A small right pleural effusion is unchanged. Since the prior radiograph, there has been increased nodular peribronchial opacification, most readily explained by chronic aspiration. Mild hazy opacification at the left base is unchanged and likely represents chronic atelectasis.", "output": "1. No pneumothorax or pneumomediastinum. 2. Increasing peribronchial opacification at the right base likely represents aspiration, possibly pneumonia." }, { "input": "Single portable view of the chest was obtained. There has been interval placement of a right transjugular central venous catheter, distal tip not well evaluated, appears to extend to the expected location of the mid SVC, although exact location is not well evaluated on this study. There is diffuse opacification of the right hemithorax which maybe due to underlying fluid and consolidation. The esophageal stent has migrated projecting over the right apex as compared to the prior study of ___. The left lung is grossly clear.", "output": "Right IJ extending to the expected location of the mid SVC, although not well evaluated due to overlying opacity. No definite pneumothorax. Right hemithorax nearly completely opacified which appears slightly increased as compared to the prior study, although in the prior study the patient was upright so there may be shift in fluid. The esophageal stent projects superiorly into the right apex, stable since the prior study but migrated in position as compared to ___." }, { "input": "PA and lateral chest views were obtained with the patient in upright position. Analysis is performed in direct comparison with the next preceding similar study of ___. Previously described right subclavian approach Port-A-Cath system remains in unchanged position. The heart size and mediastinal structures are also unaltered and grossly within normal limits. The pulmonary vasculature is not congested. The previously described local pleural densities have further regressed, in particular a rather bulging prominence and thickening of the pleural space in the mid portion of the right lateral chest wall has regressed. Basal right-sided pleural effusion blunting the lateral pleural sinus and extending into the posterior pleural sinus and corresponding posterior pleural space remain unchanged. No new abnormalities are identified. As before, general impression of COPD persists.", "output": "Mild regression of previously identified mostly loculated pleural effusions. No new pulmonary or cardiovascular abnormalities." }, { "input": "Frontal and lateral views of the chest were obtained. Esophageal stent is again seen, appears more inferior in position as compared to the prior study. Right perihilar chronic changes are seen. There is slight increase in the right mid lung opacity which could be due to underlying infection, possibly in the superior right lower lobes. No pneumothorax is seen.", "output": "1. Inferior migration of patient's esophageal stent as compared to the prior study. 2. Slight increase in right mid lung patchy opacity may due to consolidation in the superior right lower lobe which could be due to an infection. The above findings were discussed with Dr. ___ on ___ via telephone." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Kyphoplasty/vertebroplasty noted in the lower thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. The lungs are well-expanded and clear without focal consolidation concerning for pneumonia. Pulmonary vasculature is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "Mild cardiomegaly is stable compared to exams dated back to ___. Right perihilar mass appears slightly larger compared to the prior study from ___. Heterogeneous opacities at the right lung base likely secondary to mild pulmonary edema, and small right pleural effusion have increased compared to the most recent prior exam. Mild left basilar atelectasis is persistent. Small left pleural effusion is stable. There is no evidence of a pneumothorax.", "output": "Interval increase in both mild right lung base pulmonary edema and small right pleural effusion, could be due to progression of enlarging right perihilar lung cancer, or the earliest manifestion of heart failure. ___ findings d/w Dr. ___ by Dr. ___ by phone at 8:___a on the day of the exam." }, { "input": "Right hilar mass is consistent with possible post-radiation soft tissue characterized by the prior CT from ___. Tumor recurrence cannot be excluded by this exam. The cardiomediastinal contours are otherwise unremarkable. There is obliteration of the right costophrenic sulcus, overall unchanged since the prior study. Surgical fracture of the left sixth rib is unchanged. There is no evidence of a pneumothorax. There are stable small bilateral pleural effusions.", "output": "No new focal consolidations concerning for pneumonia identified. No evidence of pulmonary edema." }, { "input": "AP upright and lateral views of the chest reveal chronic changes related to both prior surgery and radiation. There is a stable right perihilar and posterior density which has not changed. There is no new consolidation. Cardiomediastinal silhouette is stable. Post-thoracotomy changes seen on the right. Osseous and soft tissue structures are otherwise unremarkable.", "output": "No acute intrathoracic process. Stable scarring/post-op changes in the right hemithorax." }, { "input": "Frontal and lateral radiographs of the chest demonstrate persistent large right perihilar mass, which is slightly larger as compared to the prior study. This is in a region of prior fiducial seed placement, and may correspond to post-radiation changes; however, recurrence of malignancy cannot be excluded. Again seen are heterogeneous opacities at the right base, with a small right-sided pleural effusion. The left lung is essentially clear. The cardiomediastinal and hilar contours are unchanged. There is no pneumothorax or focal consolidation.", "output": "1. Persistent large right perihilar mass, which is slightly larger as compared to the prior study. This is in a region of prior fiducial seed placement, and may correspond to post-radiation changes; however, recurrence of malignancy cannot be excluded. Recommend dedicated CT of the chest for additional evaluation. 2. No pneumonia." }, { "input": "CHEST: The lungs are well-expanded and clear. The cardiac silhouette is not enlarged. There is no pneumothorax, pleural effusion, or consolidation. No acute displaced rib fractures are identified. PELVIS: Comminuted right acetabular fracture, with superolatearl positioning of the right femoral head consistent with dislocation.", "output": "Comminuted right acetabular fracture and right hip dislocation. Although no acute fracture or other chest wall lesion is seen, conventional chest radiographs are not sufficient for detection or characterization of most such abnormalities. If the demonstration of trauma to the chest wall is clinically warranted, the location of any referrable focal findings should be clearly marked and imaged with either bone detail radiographs or Chest CT scanning." }, { "input": "The lung volumes are low. There is a dense left retrocardiac opacity silhouetting the left hemidiaphragm compatible with atelectasis and/or consolidation associated with a small left pleural effusion. Mild cardiomegaly. Enteric tube traverses below the diaphragm, distal tip not visualized. ET tube is high-riding terminating at the thoracic inlet and could be advanced by approximately 3 cm. EKG leads overlie the chest wall. Visualized bones are unremarkable.", "output": "1. Low lung volumes with left lower lobe atelectasis versus consolidation and a small left pleural effusion associated with mild cardiomegaly. 2. ET tube is high-riding, terminating at the thoracic inlet and could be advanced by 3 cm. RECOMMENDATION(S): High-riding endotracheal tube, to be advanced by about 3 cm. NOTIFICATION: The findings were discussed with ___, NP by ___ ___, M.D. on the telephone on ___ at 11:35 AM, 2 minutes after discovery of the findings." }, { "input": "The tip of the endotracheal tube projects at the level of the clavicular heads. A feeding tube extends into the body of the stomach. The other enteric tube extends beyond the field of view of this radiograph. Slight improvement of dense retrocardiac opacity consistent with left lower lobe atelectasis/consolidation. The right lung is clear. No pneumothorax identified. The size the cardiac silhouette is mildly enlarged but unchanged.", "output": "Slight improvement of left basal opacification compared with the prior examination. A feeding tube extends into the body of the stomach. The second enteric tube extends beyond the field of view of this radiograph." }, { "input": "The lungs are moderately well inflated. Again identified is a dense left retrocardiac opacity silhouetting the left hemidiaphragm compatible with left lower lobe atelectasis versus consolidation. ET tube terminates approximately 7 cm above the carina at the level of the clavicles an could be advanced by approximately 3 cm. The weighted feeding tube terminates in the distal stomach. Another enteric tube terminates in the proximal stomach. The right renal cases are opacified by contrast, likely related to a prior intravenous exam.", "output": "1. ET tube terminates at the level of the clavicles and could be advanced by approximately 3 cm. 2. Weighted feeding tube terminates in the distal stomach. Another enteric tube parallel to this weighted feeding tube terminates in the mid stomach. 3. Unchanged left lower lobe atelectasis versus consolidation. 1. ET tube terminates at the level of the clavicles and could be advanced by approximately 3 cm. 2. Weighted feeding tube terminates in the distal stomach. Another enteric tube parallel to this weighted feeding tube terminates in the mid stomach. 3. Unchanged left lower lobe atelectasis versus consolidation." }, { "input": "The lung volumes are low. The heart is normal in size. The mediastinal and hilar contours are unremarkable. The lungs appear clear. There are no pleural effusions or pneumothorax. Mild-to-moderate degenerative changes are noted along the mid thoracic spine. The patient is status post partly visualized left shoulder replacement.", "output": "No evidence of acute disease." }, { "input": "The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. Lung volumes are low, but there is no focal consolidation. There is no acute osseous abnormality.", "output": "No acute process. No radiographic explanation for chest pain." }, { "input": "PA and lateral views of the chest provided. Lung volumes are low, unchanged. Opacity in the right middle lobe likely represents an end on vessel. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest were obtained. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are stable, as are the hilar contours. A subtle 1.8-cm sclerotic focus projecting over the anterior right fifth rib is stable since the prior study and dating back to ___, thus likely benign. Mild degenerative changes are seen along the spine. There is relative lucency projecting over the inferior right scapular spine which may be artifactual, correlate with history of malignancy. If clinical concern at this location, suggest dedicated imaging of the area.", "output": "No acute cardiopulmonary process. Relative lucency projecting over the inferior right scapular spine which may be artifactual, correlate with history of malignancy. If clinical concern at this location, suggest dedicated imaging of the area. The above findings regarding the right scapula were discussed with ___ ___ on ___ at 2 p.m. via telephone." }, { "input": "Frontal and lateral chest radiographdemonstrates well expanded and clear lungs with a stable ovoid calcified nodule projecting over the right mid lung, unchanged from ___. No pleural effusion or pneumothorax. Prominence of the right hilum is due to patient rotation. Heart size, mediastinal contour, and hila are otherwise unremarkable. Limited assessment of the upper abdomen is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac silhouette size is normal. The aorta is mildly tortuous but unchanged. Pulmonary vascularity and hilar contours are normal. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. There is diffuse demineralization of the osseous structures. The patient is status post right mastectomy.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal contour is normal.", "output": "Normal chest radiographs." }, { "input": "The lungs are clear without focal consolidation. There is no pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are within normal limits. Posterolateral right 8th rib fracture.", "output": "Acute right ___ posterolateral rib fracture. No pneumothorax." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Left basilar atelectasis. Lungs are otherwise clear. No pleural effusion or pneumothorax is seen. Increased conspicuity of a right posterolateral eighth rib fracture. No new fractures.", "output": "Left basilar atelectasis. Increased conspicuity of a right posterolateral eighth rib fracture. No new fractures." }, { "input": "PA and lateral chest radiograph demonstrate clear lungs bilaterally. Lungs are well expanded symmetrically. Cardiomediastinal and hilar contours are within normal limits. There is no pleural effusion, pneumothorax, or evidence of pulmonary edema. Irregularity involving the lateral right seventh rib appears to have been present since ___, potentially sequela of prior trauma.", "output": "No opacity convincing for pneumonia." }, { "input": "Frontal and lateral views of the chest. There is no focal opacity, pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal. There is no free air beneath the hemidiaphragms. Irregularity on the lateral aspect of the right 7th rib is unchanged since ___.", "output": "No displaced fracture is identified. If there is continued clinical concern, dedicated radiographs of that area could be obtained." }, { "input": "Cardiomediastinal silhouette is within normal limits. There is no focal consolidation, pleural effusion, or pneumothorax. Left basilar opacities likely represent atelectasis. The bones are grossly unremarkable.", "output": "1. No acute intrathoracic abnormality. 2. Although no acute fracture or other chest wall lesion is seen, conventional chest radiographs are not sufficient for detection or characterization of most such abnormalities. If the demonstration of trauma to the chest wall is clinically warranted, the location of any referrable focal findings should be clearly marked and imaged with either bone detail radiographs or Chest CT scanning." }, { "input": "PA and lateral views of the chest. No prior. The lungs are clear of focal consolidation or effusion. The cardiomediastinal silhouette is normal. The osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is mildly enlarged. The aortic arch is calcified. The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Frontal and lateral views of the chest were obtained. The cardiac silhouette remains mildly enlarged. The aorta is calcified. No pleural effusion or pneumothorax is seen. The central pulmonary vasculature is slightly prominent suggesting mild fluid overload which may be minimally increased since the prior study versus differences in technique. No definite focal consolidation is seen. No displaced rib fracture is identified radiographically.", "output": "Persistent cardiomegaly. Suggestion of mild fluid overload." }, { "input": "Mild to moderate cardiomegaly is unchanged. Mediastinal contour is unremarkable. There is no focal lung consolidation, pleural effusion, or pneumothorax. There is increased interstitial markings bilaterally, consistent with mild interstitial edema.", "output": "1. No radiographic evidence of pneumonia. 2. Mild interstitial edema." }, { "input": "Mild cardiomegaly has been stable compared to prior exams dated back to ___. Mild pulmonary vascular congestion is persistent however no definite evidence of overt pulmonary edema. Calcifications are seen within the aortic knob. Note is made of mild bibasilar atelectasis. There is no large pleural effusion or evidence of a pneumothorax.", "output": "Stable mild cardiomegaly and pulmonary vascular congestion, without evidence of overt edema. Mild bibasilar atelectasis." }, { "input": "Mild vascular congestion appears improved since ___. The lungs are clear without focal opacity, interstitial pulmonary edema, pleural effusion or pneumothorax. Mild to moderate cardiomegaly is stable. Aortic knob calcifications are again noted.", "output": "Improved pulmonary vascular congestion since over 6, ___. No new focal opacity concerning for pneumonia. NOTIFICATION: Wet read called to Dr. ___ by ___ at ___ on ___." }, { "input": "Two views. Lung volumes are moderate. Interstitial markings remain prominent. No pneumothorax is identified. The heart appears large, as before. The aorta is calcified. The bony thorax is grossly intact.", "output": "Cardiomegaly. Redemonstration of prominence of the interstitial markings that appears chronic." }, { "input": "AP view of the chest demonstrates low lung volumes, which accentuate bronchovascular markings. There is no pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Partially imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Compared with prior radiographs on ___, there is improved vascular congestion and a decrease in mediastinal widening. There is no edema. There are at least small bilateral pleural effusions. There is at least moderate basilar atelectasis. No Pneumothorax. There has been interval removal of a Swan-___ catheter. The left IJ catheter in stable position, terminating in the left brachiocephalic vein just before the origin of the SVC. The feeding tube is in the upper stomach. A drainage tube passes into the stomach. An endotracheal tube is at the thoracic inlet. Mediastinal wires are stable in position.", "output": "Decrease in vascular congestion and mediastinal widening, indicating overall cardiovascular status improvement. At least small bilateral pleural effusions and moderate bibasilar atelectasis." }, { "input": "There is a small left apical pneumothorax. There are small bilateral pleural effusions, worse on the right and stable on the left. There is mild bibasilar atelectasis. The enlarged postop cardiomediastinal silhouette is stable. Pleural drainage catheter is in place. Right PICC terminates in the mid SVC. Tracheostomy is appropriately positioned.", "output": "1. Small left apical pneumothorax. 2. Worsening small right pleural effusion. NOTIFICATION: The findings were discussed by Dr. ___ with ___ ___ on the telephoneon ___ at 12:01 PM, 10 minutes after discovery of the findings." }, { "input": "Portable chest radiograph ___ at 10:46 is submitted.", "output": "Left basilar chest tube, right internal jugular Swan-Ganz catheter, right internal jugular pacer, endotracheal tube and nasogastric tube are unchanged in position. Stable postoperative cardiac and mediastinal contours status post median sternotomy with aortic valve replacement. Linear opacity the left base likely reflects subsegmental atelectasis. No pulmonary edema. No pneumothorax is seen, although the position in which the patient was imaged is not documented on this image. No large effusions." }, { "input": "Portable upright chest radiograph ___ at 18:06 is submitted. The lung apices and the lateral most aspects of the chest are not included.", "output": "Interval placement of feeding tube which has its tip projecting over the stomach. The patient is status post median sternotomy with aortic valve replacement and CABG. There continues to be mild to moderate pulmonary edema. There is layering left effusion with partial lower lobe atelectasis, although pneumonia cannot be entirely excluded. Incompletely visualized right subclavian PICC line with its tip unchanged in position. A larger bore catheter is also again seen with its tip projecting over the left brachiocephalic vein." }, { "input": "Left apical pneumothorax is slightly increased. There is increased left basilar atelectasis and pleural effusion. Right basilar atelectasis is improved.There is minimal if any right pleural effusion. Cardiomediastinal silhouette is slightly increased compared to prior. Again seen is a left pleural drainage catheter. There has been interval removal of a right-sided PICC. Again seen is a tracheostomy tube.", "output": "1. Slightly increased left apical pneumothorax. 2. Left basilar atelectasis and pleural effusion has increased. 3. Interval removal of right-sided PICC." }, { "input": "Tracheostomy tube again noted. Status post sternotomy, with prosthetic valve. The cardiomediastinal silhouette is probably unchanged allowing for differences in positioning. Again seen is the left chest tube. Also again seen is the left apical pneumothorax. An additional small vertically oblong lucency along the left chest wall adjacent to the chest tube is suggestive of an additional site of a small localized pneumothorax. As before, there is increased retrocardiac density, partial obscuration left hemidiaphragm, and opacity in the left costophrenic angle. Much of this likely represents collapse and/or consolidation. The possibility of a small amount of pleural fluid on the left side cannot be excluded. On the right, there is mild vascular blurring. Minimal density in the right midlung likely represents platelike atelectasis. Slight blunting of the right costophrenic angle is compatible with a small amount of pleural fluid, newly visible on the current study. There is atelectasis the right lung base, unchanged. Mild vascular plethora is seen in both upper zones and there is possible minimal vascular blurring, without other evidence of CHF.", "output": "Small left apical pneumothorax is similar to the prior study. Possible small focus of pneumothorax along the left chest wall, new or slightly larger on today's study. Attention to this finding on followup films is requested. Mild vascular plethora and possible mild vascular blurring again noted, possibly slightly improved. New blunting of the right costophrenic angle without gross effusion. Persistent opacity at the left base." }, { "input": "The left apical pneumothorax has increased in size compared to prior study. Compressive atelectasis on the left and basilar atelectasis on the right have also increased. Mild vascular congestion is unchanged. No other changes compared to prior exam.", "output": "Worsening left apical pneumothorax. RECOMMENDATION(S): The findings were discussed by Dr. ___ with ___ the telephoneon ___ at 12:04 AM, 10 minutes after discovery of the findings." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Portable semi-erect chest radiograph ___ at 08:20 is submitted.", "output": "Right jug Swan-Ganz catheter, endotracheal tube, left chest tube and nasogastric tube are unchanged in position. Interval placement of a right internal jugular pacing wire which has its tip projecting over the expected location of the right ventricle. Status post median sternotomy for CABG and aortic valve replacement with stable postoperative cardiac enlargement. The right lung is clear. Scattered linear opacities in the left lung likely reflect atelectasis. Interval resolution of mild pulmonary edema. There is cephalization of the vasculature consistent with pulmonary venous hypertension, however. No pneumothorax." }, { "input": "A tracheostomy is in-situ. A left-sided internal jugular catheter and right-sided PICC are unchanged in appearance compared to the prior study. An aortic valve prosthesis is also unchanged in appearance. Median sternotomy sutures are unchanged. Left lower lobe atelectasis and a layering left-sided pleural effusion are similar when compared to the prior study. The right lung appears grossly clear. No pneumothorax seen.", "output": "No significant interval change when compared to the prior study. Persistent left pleural effusion." }, { "input": "Portable semi-erect chest radiograph ___ at 12:41 is submitted.", "output": "Endotracheal tube, right internal jugular Swan-Ganz catheter, left basilar chest tube, mediastinal drains, and nasogastric tube are unchanged in position. Stable postoperative cardiac and mediastinal contours status post median sternotomy with aortic valve replacement. Interval decrease in pulmonary edema with residual mild edema. Persistent retrocardiac opacity which may reflect lower lobe atelectasis in the setting of a layering effusion. No obvious pneumothorax." }, { "input": "Moderate cardiomegaly is a stable. Opacities in the left perihilar region have improved. Retrocardiac opacities are unchanged consistent with almost complete collapse of the left lower lobe. Right lower lobe opacities are improving, a combination of small effusion and adjacent atelectasis. There is no evident pneumothorax. ET tube tip is in standard position. NG tube tip is out of view below the diaphragm.", "output": "Persistent retrocardiac opacities, representing left lower lobe collapse" }, { "input": "As compared to ___, the ETT remains 5 cm from the carina. Left IJ catheter remains near the origin of the upper SVC and left brachiocephalic vein. The feeding tube tip is not visualized. Increasing moderate left pleural effusion and right basal atelectasis. Mild pulmonary edema and and the heart size has minimally increased with moderate cardiomegaly.", "output": "ETT is 5 cm from the carina. Mild pulmonary edema increasing left moderate pleural effusion." }, { "input": "Lungs are fully expanded and clear. No pleural abnormalities. Heart size is normal. Cardiomediastinal and hilar silhouettes are normal.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Portable semi-upright radiograph of the chest demonstrates well expanded, clear lungs, with no evidence of a pulmonary edema. The cardiomediastinal silhouette is unchanged. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process. NOTIFICATION: Updated impression was discussed with Dr. ___ by Dr. ___ ___ telephone at 9:20am on ___, 90 minutes after discovery." }, { "input": "AP and lateral views of the chest. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes. Linear opacities projecting over right lung base likely represent atelectasis. There is no right pleural effusion. Left hemidiaphragm is obscured by overlying opacity, which may represent atelectasis or infection. Left costophrenic angle is obscured, suggestive of trace pleural effusion. Hilar and mediastinal silhouettes are unremarkable. The heart size is normal. There is no pulmonary edema. No pneumothorax is seen. Partially imaged upper abdomen is unremarkable.", "output": "Left lung base opacity, likely atelectasis or infection in the appropriate clinical setting with possible trace left pleural effusion." }, { "input": "The lungs are hyperinflated, with attenuation of the peripheral vessels, compatible with emphysema. In the periphery of the right mid lung, projecting over the anterior right fourth rib there is a vague opacity, which may represent pulmonary consolidation versus summation of structures. There is no pleural effusion or pneumothorax. Cardiomediastinal and hilar contours are unremarkable. Multiple small lucent lesions in the right clavicle and scapula are compatible with known history of multiple myeloma. There is less than ___% compression deformity of a mid thoracic vertebral body.", "output": "1. Vague opacity in the periphery of the right lung mass described above. Pulmonary consolidation cannot be excluded. Further assessment with chest CT is recommended. 2. Compression deformity of a midthoracic vertebral body of unknown chronicity. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 9:28 AM, immediately after discussion with the attending radiologist." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. The lungs are well-expanded and clear without focal consolidation concerning for pneumonia. Pulmonary vasculature is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear of focal consolidation, pleural effusion or pneumothorax. The heart size is normal. The mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is status post CABG. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. Small left pleural effusion. No pneumothorax. There are no acute osseous abnormalities.", "output": "Small left pleural effusion." }, { "input": "The lung volumes are low. There are bibasilar subsegmental/linear atelectasis. Possible small left pleural effusion. There has been interval extubation and removal of the enteric tube. Right-sided central venous catheter tip terminates at the cavoatrial junction. Mild cardiomegaly and postsurgical changes project over the middle mediastinum. Visualized bones are unremarkable. EKG leads overlie the chest wall. Sternotomy sutures are unchanged.", "output": "1. Low lung volumes with bibasilar linear atelectasis and likely a small left pleural effusion. 2. Interval extubation and removal of the enteric tube." }, { "input": "There are new small bilateral pleural effusions. There is mild pulmonary vascular congestion. There is mild cardiomegaly. There are aortic calcifications. There is no pneumothorax. There is no focal consolidation. There is minimal atelectasis at the right base. Moderate vertebral body height loss at T12 is unchanged.", "output": "New small bilateral pleural effusions and mild pulmonary vascular congestion." }, { "input": "PA and lateral views of the chest were provided. The lungs appear clear bilaterally without signs of pneumonia or CHF. No effusion or pneumothorax. Prominence of the right paratracheal stripe is unchanged likely representing vascular ectasia. Bony structures are intact.", "output": "Unremarkable study." }, { "input": "Frontal and lateral views of the chest were obtained. The cardiac silhouette remains enlarged. The aorta is calcified and tortuous. Right paratracheal opacity is stable since ___. No focal consolidation is seen. There is no pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are stable. There may be minimal interstitial edema.", "output": "Possible minimal interstitial edema. Persistent cardiomegaly." }, { "input": "The lateral view is slightly suboptimal due the patient's overlying arm. There is blunting of the right costophrenic angle consistent with a small/trace right pleural effusion. The cardiac silhouette is top-normal to mildly enlarged. No overt pulmonary edema is seen. Aorta is calcified and tortuous. Right paratracheal opacity is stable likely representing prominent vascular structure.", "output": "Small/trace right pleural effusion. No overt pulmonary edema. Persistent mild enlargement of the cardiac silhouette." }, { "input": "Frontal and lateral views of the chest were obtained. There is mild bibasilar atelectasis. No definite focal consolidation is seen. There is no large pleural effusion or pneumothorax. The cardiac silhouette is top normal. The aorta is slightly tortuous.", "output": "No acute cardiopulmonary process." }, { "input": "Supine portable chest radiograph was obtained. The lungs are clear. There is no pleural effusion or pneumothorax. The heart is normal in size with tortuous aortic contour. Multiple right rib fractures and left clavicular fracture are chronic.", "output": "No acute intrathoracic process." }, { "input": "The ET tube is 2.5 cm above the Carina. The NG tube tip is in the stomach. Right-sided PICC line tip is at the cavoatrial junction. There is dense retrocardiac opacity compatible with volume loss/infiltrate/ effusion. There is increased hazy vasculature on the left. There is a more focal area of consolidation in the left mid lung. Old rib fractures are again noted on the right.", "output": "Worsened appearance of the left lung. It is unclear how much of this is due to fluid overload or if there is an underlying infectious infiltrate." }, { "input": "A right sided PICC line has been retracted to the low SVC after initial low position on ___. The lungs are well inflated and clear. No focal consolidation, effusion, or pneumothorax is present. The cardiac and mediastinal contours are normal.", "output": "PICC line tip in the low SVC. No acute cardiopulmonary process to explain tachycardia. Findings were discussed via telephone with Dr. ___ at 10:50 on ___." }, { "input": "Since prior, there has been no significant interval change. An endotracheal tube, right PICC, and nasogastric tube are unchanged in position. A small left pleural effusion and left lower lobe atelectasis are stable. There are no new areas of consolidation.", "output": "No interval change." }, { "input": "Single portable view of the chest is compared to previous exam from earlier the same day at 4:19 p.m. performed at an outside institution and prior chest x-ray from ___. The lungs are clear. Cardiomediastinal silhouette is within normal limits. Multiple old healed right posterior rib fractures are noted. There is no acute displaced rib fracture visualized.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable chest radiograph demonstrates interval decrease in right-sided pleural effusion, now small. Residual linear opacification within the right lower lung likely represents atelectasis. Similar findings are noted on the left. Stable right upper lung mass better evaluated on recent CT chest. Otherwise, cardiomediastinal and hilar contours are unchanged.", "output": "Interval decrease in right-sided pleural effusion, now small in size. Small left pleural effusion. Bibasilar atelectasis. Stable right upper lung mass. No pneumothorax." }, { "input": "Portable frontal upright radiograph of the chest. Compared to the prior study there is stable heart size and tortuosity of the aorta. The right upper lung mass is again seen measuring approximately 4.5 cm. There is a small right pleural effusion and trace left pleural effusion with associated atelectasis. No pulmonary edema.", "output": "1. Small right and trace left pleural effusions. 2. Right upper lung mass should be further evaluated with chest CT if not previously evaluated. 3. No edema." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is mildly enlarged, exaggerated by low lung volumes. A fluid level is seen within the dilated appearing distal esophagus, which may be due to distal stricture or dysmotility. There is increased opacity at the bilateral lung bases. No pneumothorax or pleural effusion is seen. There is a compression deformity of mid thoracic vertebral body, of unknown chronicity. No radiopaque foreign bodies are seen.", "output": "1. Fluid level in the dilated esophagus, concerning for distal stricture or dysmotility. Consider esophagram or chest CT to further assess. 2. Bibasilar pulmonary opacities concerning for aspiration." }, { "input": "Single frontal view of the chest was obtained. Single atrial lead of the left chest wall generator has a similar course to prior and terminates in stable position. No wire fracture or rotation of generator pack is identified. The heart size and cardiomediastinal contours are normal. The lungs are clear. No focal consolidation, pleural effusion, or pneumothorax. The osseous structures are unremarkable. Right upper quadrant metallic surgical clips are unchanged.", "output": "Stable position of single atrial pacer lead, based on single frontal view." }, { "input": "PA and lateral views of the chest. No prior. The lungs are clear. There is no effusion or pneumothorax. Cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable. Surgical clips in the right upper quadrant suggest prior cholecystectomy.", "output": "No acute cardiopulmonary process." }, { "input": "A left pectoral pacemaker is unchanged in position with two leads. The right atrial lead appears in appropriate position on this single frontal view. The right ventricular lead appears retracted into the right atrium compared to the most recent prior study of ___. There is improved aeration at the right base from the most recent prior study with persistent elevation of the right hemidiaphragm. No significant focal consolidation, pleural effusion, or pneumothorax is detected. The pulmonary vasculature is not engorged. The cardiac silhouette is mildly enlarged but stable. The mediastinal and hilar contours are within normal limits and unchanged. The visualized upper abdomen shows surgical clips in the right upper quadrant compatible with prior cholecystectomy.", "output": "Retraction of right ventricular lead into the right atrium compared to the most recent prior study of ___. Findings were reported by Dr. ___ to Dr. ___ ___ cardiology via telephone at 3:50 p.m. on ___." }, { "input": "There is a hazy right basilar opacity projecting over the lower thoracic spine suspicious for developing consolidation. No pleural effusion or pneumothorax. Heart size and cardiomediastinal contours are normal.", "output": "Hazy right basilar consolidation, which can be consistent with developing infection in the appropriate clinical setting." }, { "input": "Severe cardiomegaly is stable with elongation of the thoracic aorta. There is central vascular congestion with few scattered ___ B-lines and upper zone redistribution, consistent with mild interstitial pulmonary edema. There is no focal consolidation, effusion or pneumothorax. Mediastinal and hilar contours are stable. Compression deformities of the thoracic spine are stable.", "output": "Stable severe cardiomegaly with mild interstitial pulmonary edema." }, { "input": "The heart is moderately enlarged, and there is mild pulmonary vascular congestion and interstitial edema. No focal consolidation or pleural effusion is noted. No pneumothorax seen. The visualized bony structures are unchanged in appearance compared to the prior study, a compression deformity at the cervical lumbar junction is similar in degree.", "output": "Moderate cardiomegaly with mild pulmonary vascular congestion and interstitial edema." }, { "input": "Cardiac silhouette remains enlarged. Pulmonary edema has improved with residual minimal interstitial edema remaining. Patchy and linear atelectasis at left lung bases is also slightly better. Small pleural effusions are probably unchanged in the interval. Compression deformity at the thoracolumbar junction has been present on older studies dating back to at least ___.", "output": "Improving pulmonary edema with residual mild interstitial edema remaining." }, { "input": "PA and lateral views of the chest provided. The lungs are clear and well inflated. No pneumothorax or pleural effusion. The heart and mediastinal contours are normal. No definite rib fracture is seen. No free air below the right hemidiaphragm. No signs of pneumomediastinum.", "output": "No acute findings in the chest." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are unremarkable. Scarring is seen at the lung apices. There is no pleural effusion or pneumothorax. At the left lung base, there is vague opacity, which likely represents atelectasis.", "output": "No acute intrathoracic abnormality." }, { "input": "The heart size is the upper limit of normal, and a new left moderate pleural effusion has appeared. No focal consolidation, pulmonary edema or pneumothorax is seen, and the mediastinal and hilar contours are normal.", "output": "New left moderate pleural effusion." }, { "input": "The heart is of normal size with normal cardiomediastinal contours. There is calcification of the aortic knob. Lung volumes are low, exaggerating bronchovascular markings. Blunting of the right costophrenic angle may represent a small pleural effusion. No focal consolidation or pneumothorax. No radiopaque foreign body. Osseous structures are unremarkable.", "output": "Small right pleural effusion. No focal consolidation." }, { "input": "Two PA and one lateral view of the chest demonstrate normal heart size and mediastinal contours. There is no pleural effusion or pneumothorax. There are mild to moderate chronic interstitial markings which are stable compared to the prior study. There is no focal consolidation concerning for pneumonia.", "output": "No evidence of pneumonia." }, { "input": "PA and lateral chest were provided. There is an area of consolidation at the right lung base, raises concern for pneumonia. There is no pneumothorax or pleural effusion. Cardiomediastinal silhouette is stable from prior study with the heart size being top normal.", "output": "Area of consolidation at the right lung base, raising concern for pneumonia" }, { "input": "Endotracheal tube in-situ with the tip at the level of the medial clavicles. 2 enteric tubes in situ in the stomach, 1 coursing out of sight inferiorly. Mild pulmonary edema, which is slightly increased compared to prior. Subsegmental atelectasis in the lower lung zones.", "output": "2 enteric tubes in situ in the stomach, 1 coursing out of sight inferiorly." }, { "input": "The lungs are clear except for unchanged biapical scarring. There is no pulmonary edema. The heart is normal in size, and the mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Nasogastric tube tip terminates within the stomach. Cardiac silhouette size is normal. Mediastinal and hilar contours are unchanged. Pulmonary vasculature is not engorged. Minimal patchy atelectasis is noted in the lung bases without focal consolidation. No pleural effusion or pneumo is detected. No acute osseous abnormality is identified.", "output": "Nasogastric tube tip terminates within the stomach. No acute cardiopulmonary abnormality apart from mild bibasilar atelectasis." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Compared to the prior study there is no significant interval change. No focal infiltrate or few", "output": "No change. No acute disease" }, { "input": "The lungs are relatively hyperinflated but clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. Slight tortuosity of the descending thoracic aorta is noted. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is status post median sternotomy and coronary bypass surgery. Heart size is normal. The mediastinal and hilar contours are normal. The aorta is diffusely calcified. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The patient is status post median sternotomy and CABG. The heart size is top normal. Mediastinal and hilar contours are unchanged. There is diffuse atherosclerotic calcification of the aorta. The lungs are clear. The pulmonary vasculature is normal. No pleural effusion, focal consolidation or pneumothorax is seen. There are mild degenerative changes within the thoracic spine. Amorphous calcifications adjacent to the left humeral head superolaterally may reflect calcific tendinopathy. Clips in the upper abdomen are again noted.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The patient is status post prior median sternotomy and coronary bypass surgery. Heart is upper limits of normal in size. Mediastinal and hilar contours are as well as pulmonary vascularity are normal. Lungs and pleural surfaces are clear.", "output": "No radiographic evidence of pneumonia or other explanation for cough." }, { "input": "Numerous mediastinal vascular clips and median sternotomy wires unchanged since the prior study reflect prior CABG. Top normal heart size is stable. The lungs are clear and there is no pleural effusion or pneumothorax. The pulmonary vasculature is not engorged. The trachea is midline. Right upper quadrant vascular clips are compatible with prior cholecystectomy. Left upper quadrant calcification is described in the report of abdomen radiographs, performed concurrently. There is no pneumoperitoneum.", "output": "1. No acute cardiopulmonary process. No pneumoperitoneum. 2. See report of concurrent abdomen radiographs." }, { "input": "Frontal and lateral chest radiographs were obtained. Again seen are mediastinal vascular clips and intact median sternotomy wires. No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. The heart size is normal. Mediastinal contours are within normal limits. There are degenerative changes of the right acromioclavicular joint.", "output": "No radiographic evidence of acute cardiopulmonary process. No mediastinal mass is detected." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The NG tube tip is difficult to visualize. Is probably just at the GE junction, too high. Again seen are dilated loops of small bowel compatible with patient's known small bowel obstruction. The visualized portions of the lungs show no new infiltrate. The known lingular granuloma is again visualized.", "output": "NG tube tip at the GE junction, too high. Findings were called to nurse ___ by Dr. ___ at the time of discovery of the finding at 9:45 AM on ___." }, { "input": "Enteric tube is seen coursing below the diaphragm, terminating in the left upper quadrant expected location of the stomach. There may still be some gastric distention of the stomach remaining. The lungs show no focal consolidation. A 5 mm nodular opacity projecting over the left lower lobe is stable since the prior study from ___ and likely represents a vessel on-end or granuloma. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal. Mediastinal contours are unremarkable. Hilar contours are stable", "output": "Enteric tube courses below the diaphragm, terminating left upper quadrant the expected location of the stomach. No acute cardiopulmonary process." }, { "input": "ng tube tip is in the stomach. multiple dilated loops of small bowel are again visualized. the appearance of the lungs are unchanged", "output": "NG TUBE TIP IN THE STOMACH" }, { "input": "An enteric tube extends below the diaphragm with the tip out of view of this film. The heart size is normal. The hilar and mediastinal contours are normal. Evaluation of the left lung is limited due to technique, however the right lung is unremarkable. The visualized subdiaphragmatic bowel appears to be distended, consistent with patient's known small bowel obstruction.", "output": "NG tube extends below the diaphragm, with the tip out of view of this film." }, { "input": "Frontal and lateral views of the chest were compared to previous exam from ___. The lungs are clear of confluent consolidation. Increased opacity at the lung bases on the lateral is likely due to atelectasis given low lung volumes. Cardiomediastinal silhouette is grossly stable given differences in patient positioning. Osseous and soft tissue structures are unchanged, noting degenerative changes at the acromioclavicular joints. There is, however, mild lower thoracic/upper lumbar dextroscoliosis.", "output": "No definite acute cardiopulmonary process." }, { "input": "The patient is status post median sternotomy and CABG. The heart is mildly enlarged and there is a suggestion of mitral annular calcifications. The aorta is tortuous and diffusely calcified. The pulmonary vascularity and hilar contours are normal. No focal consolidation, pleural effusion or pneumothorax is present. There is minimal patchy opacities in the lung bases likely reflective of atelectasis. No acute osseous abnormality is identified.", "output": "Minimal bibasilar atelectasis." }, { "input": "AP and lateral views of the chest. There are low lung volumes with associated bronchovascular crowding. No focal consolidation or mass is seen. There is no pleural effusion or pneumothorax. Chronic moderate to severe cardiomegaly is seen.", "output": "1. No acute cardiopulmonary process. 2. Chronic moderate to severe cardiomegaly." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Cardiac, mediastinal and hilar contours are normal. The pulmonary vascularity is normal. Consolidative opacity within the left lung base, mostly within the left lower lobe, is compatible with pneumonia. The right lung is clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Left basilar pneumonia. Followup radiographs after treatment are recommended to ensure resolution of this finding." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is unremarkable aside from an unfolded thoracic aorta. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "On the lateral view, there is increased opacity projecting over the lower thoracic spine. On remote prior CT scan there is no significant degenerative changes to account for this density. While this could be due to interval development of degenerative changes, underlying parenchymal opacity in the lungs, in one of the lower lobes is possible though not confirmed on the frontal view. Increased opacity at the left cardiophrenic angle is compatible with fat pad seen on prior CT. Superiorly, the lungs are clear cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "Opacity projecting over the spine on lateral view only. Given lack of significant degenerative changes on prior CT, this may represent a focal parenchymal opacity in the setting of pneumonia in the proper clinical setting. Followup after treatment suggested to document resolution. NOTIFICATION: Findings discussed with Dr. ___." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac silhouette and pulmonary vasculature are unremarkable. In the right infrahilar region, abutting the right cardiac border, there is a new opacity, which in the appropriate clinical context, may represent pneumonia. No pleural effusion or pneumothorax is present.", "output": "Possible right infrahilar pneumonia in the appropriate clinical context." }, { "input": "The heart is enlarged and the aorta is tortuous and calcified as before. Lung volumes are low which accentuates bronchovascular markings. There is pulmonary vascular congestion with mild pulmonary edema. Bibasilar opacities are most consistent with bibasilar atelectasis and small bilateral effusions however underlying infection should be considered in the appropriate setting. A right humeral prosthesis is demonstrated. A large hiatal hernia projects over the heart unchanged from the prior.", "output": "Low lung volumes with pulmonary vascular congestion and mild edema. Bibasilar opacities likely reflect atelectasis and small effusions however underlying infection should be considered in the appropriate setting." }, { "input": "Since the prior study the right internal jugular central venous line is been removed. Heart size appears normal and a tortuous aorta is again demonstrated. Opacification of the retrocardiac region is likely secondary to the known large hiatal hernia. Additional right lung base opacity could be from consolidation and a small pleural effusion. No evidence of pulmonary edema. Right shoulder arthroplasty appears unremarkable.", "output": "New right lung base consolidation and costophrenic angle obscuration may reflect pneumonia and a small right pleural effusion." }, { "input": "The lungs are clear without focal consolidation. No large pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Partially imaged surgical metallic hardware is seen projecting over the lower cervical spine. No displaced fracture is identified. Surgical clips are noted in the right upper quadrant.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest were obtained. A right chest wall port catheter terminates in the mid SVC. The heart is of normal size. A right cardiophrenic angle mass correlates to a heterogeneous mass seen at this location on ___ and in not appreciably changed allowing for differences in modality. The lungs are clear. No pleural effusion or pneumothorax.", "output": "1. Right chest wall port catheter terminating in mid SVC. 2. Large right cardiophrenic angle mass, not appreciably changed since ___. Findings were communicated via phone call by ___ to ___ on ___ at 9:35 a.m." }, { "input": "Large right cardiophrenic angle mass corresponding to bulky epicardial lymph nodes has increased in size since the ___ radiograph but are probably similar to the more recent CT torso of ___. Additional enlarged nodes are present in the retrosternal region, corresponding to known bilateral internal mammary lymphadenopathy. Lungs and pleural surfaces are clear. Porta catheter remains in standard position.", "output": "1. Bulky lymphadenopathy in the bilateral internal mammary and right epicardial regions, consistent with metastatic disease. 2. No evidence of pneumonia." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Evaluation of the lungs is limited due to low lung volumes and lordotic positioning. No obvious opacities to suggest pneumonia. No pleural effusion or pneumothorax is seen. Rotary dextroscoliosis of the thoracic spine is noted.", "output": "Bibasilar atelectasis without focal consolidation to suggest pneumonia." }, { "input": "Cardiomediastinal contours are normal. Lungs and pleural surfaces are clear. If there is clinical suspicion for pulmonary AVM, please note that chest CTA would be much more sensitive than portable chest radiograph for screening purposes.", "output": "No acute cardiopulmonary radiographic abnormality" }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear normal. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "They ET tube, NG tube, and left subclavian line are unchanged. Over the course of the past few days there has been interval increase in the amount of volume loss in both lower lobes such that there is now complete opacification of the hemidiaphragm bilaterally. There is pulmonary vascular redistribution and left greater than right effusion", "output": "Increased volume loss/ infiltrate in both lower lobes. Worsened fluid status." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "PA and lateral views of the chest demonstrate the bilateral lungs are well expanded and clear. The cardiomediastinal silhouette is unremarkable. There is no focal consolidation, pleural effusion, pulmonary edema or pneumothorax.", "output": "No acute cardiopulmonary process. No evidence of pneumothorax." }, { "input": "Chest, PA and lateral. The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal.", "output": "Normal radiographs of the chest." }, { "input": "AP and lateral views of the chest. No prior. The lungs are clear without focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. No displaced fractures identified.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest are provided. The lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "No acute findings in the chest." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "AP upright and lateral views of the chest were provided. Midline sternotomy wires and mediastinal clips are again noted. Small bilateral pleural effusions are again noted. There is a right perihilar opacity which is new from the prior exam and could represent a pseudo tumor/loculated pleural effusion with the possibility of atelectasis / infection also within the differential. There is no pneumothorax. The heart remains top-normal in size. The mediastinal contour is stable with atherosclerotic calcifications noted. The imaged osseous structures are intact.", "output": "Small bilateral effusions with right perihilar opacity which could represent loculated pleural effusion versus atelectasis / pneumonia. Followup to resolution is advised." }, { "input": "Frontal and lateral views of the chest are compared to previous exam from ___ as well as chest CT from ___. The size of the bilateral pleural effusions appears stable when compared to prior with some fluid seen laterally on the right. Superiorly, the lungs are clear. Cardiomediastinal silhouette is enlarged, but stable. No acute osseous abnormality is detected.", "output": "No significant interval change. Unchanged bilateral pleural effusions, right greater than left." }, { "input": "PA and lateral views of the chest demonstrate interval decrease in size of right pleural effusion and pleural fluid along the minor fissure. A small left pleural effusion is unchanged. No focal consolidation concerning for pneumonia is identified. The heart size is mildly enlarged, but stable, and median sternotomy wires are unchanged in configuration. There is no evidence of pulmonary edema.", "output": "Interval improvement in right pleural effusion, now small in size, with stable small left pleural effusion." }, { "input": "The right-sided pigtail catheter is again visualized. The right effusion is decreased. There continues to be a right pneumothorax most apparent on the current study medially with sharp margins of the right heart border and right medial lung. There is small left greater than right pleural effusions. Volume loss is present in both lower lungs. Mediastinal clips and sternal wires are again visualized.", "output": "Inferomedial pneumothorax." }, { "input": "Frontal and lateral chest radiographs were obtained. There is an area of increased opacity in the right lower lung anteriorly. Bilateral pleural effusions are unchanged. Mild pulmonary edema is stable. There is no pneumothorax. Scattered calcified granulomas are present, compatible with prior granulomatous disease. There is bibasilar compressive atelectasis. The heart size is enlarged but stable. Patient is status post CABG with a stable fracture of the second median sternotomy wire.", "output": "1. New right lower lobe opacity, likely secondary to volume loss but may be pneumonia in the appropriate clinical setting. 2. Stable small bilateral pleural effusions. 3. Mild cardiomegaly with unchanged interstitial edema." }, { "input": "The patient is status post median sternotomy and CABG. Fracture of the ___ most superior mediastinal wire is re- demonstrated. The heart size is mildly enlarged but unchanged. The aorta remains mildly tortuous and diffusely calcified. The pulmonary vascularity is mildly prominent but no overt pulmonary edema is noted. Small bilateral pleural effusions are noted, with adjacent bibasilar atelectasis. No pneumothorax is seen. Diffuse demineralization of the osseous structures is noted.", "output": "Small bilateral pleural effusions with bibasilar atelectasis." }, { "input": "Moderate cardiomegaly with a postoperative mediastinal contour unchanged from the prior exam. Hilar contours are unremarkable. Small bilateral pleural effusions with adjacent bibasilar atelectasis are minimally changed from prior examination with slight increase in right effusion tracking superiorly along the pleural surface as on prior CT. Lungs are otherwise clear without focal consolidation. There is no pneumothorax.", "output": "Small bibasilar pleural effusions with associated atelectasis. Slight increased in amount of right effusion tracking along the pleural surface. No evidence of edema or focal consolidation to suggest pneumonia." }, { "input": "Overall, there is no significant change since the prior radiograph. A large right pleural effusion and small left pleural effusion are stable. Left lower lobe atelectasis stable. The heart size remains enlarged. There is no pneumothorax.", "output": "No significant change since the prior exam." }, { "input": "AP and lateral views of the chest. There has been significant interval enlargement of the right-sided pleural effusion which is primarily loculated laterally. There is a moderate left-sided effusion which has also increased since prior. Underlying consolidation particularly at the left lung base cannot be excluded. Superiorly the lungs are clear. Cardiomediastinal silhouette is unchanged. Median sternotomy wires are again seen with fracture through the wire which is ___ from the top, unchanged. No acute osseous abnormalities detected.", "output": "Large right effusion which has increased in size and is largely loculated laterally. Enlargement of moderate left effusion since prior. Underlying consolidation particularly on the left cannot be excluded" }, { "input": "The right pleural catheter has been removed. Small bilateral pleural effusions, left greater than right, are stable in size allowing for small differences in positioning. Previous loculated fluid in the right major fissure has also decreased, however. The heart size is mildly enlarged with no pulmonary edema. No focal consolidation or pneumothorax is seen. Median sternotomy wires are unchanged with the ___ wire broken.", "output": "Persistent small bilateral pleural effusions. Status post removal of pleural drainage tube." }, { "input": "The patient is status post median sternotomy and CABG. As before, the ___ most superior sternotomy wire is fractured. Heart size is mildly enlarged but slightly increased compared to the previous exam. The aorta remains tortuous and calcified. Calcified right hilar lymph node as well as scattered calcified granulomas in the lungs are compatible with prior granulomatous disease. There is mild interstitial pulmonary edema, new compared to the prior exam. Small bilateral pleural effusions are re- demonstrated, with slight interval increase in the amount of pleural fluid on the right. Additionally there is increased amount of fluid loculated within the right major fissure. Mild bibasilar atelectasis is seen. No pneumothorax is identified. There are no acute osseous abnormalities.", "output": "Mild interstitial pulmonary edema and small bilateral pleural effusions, increased on the right." }, { "input": "PA and lateral views of the chest were provided. Midline sternotomy wires are again noted. Bilateral pleural effusions again noted. There is an ovoid opacity within the right mid-to-lower lung which is slightly increased from prior study and could represent a pseudotumor (loculated fluid within the fissure). Consider CT to further assess. The cardiomediastinal silhouette appears stable. No pneumothorax. Bony structures are intact.", "output": "Bilateral pleural effusions are small, with increasing size of ovoid opacity in the right mid lung, which likely represents loculated pleural fluid, though given lack of confirmation of this finding, a CT of the chest may be performed to further assess." }, { "input": "Portable semi-upright radiograph of the chest demonstrates low lung volumes with resulting bronchovascular crowding. Again seen is bibasilar atelectasis, left greater than right, which is not significantly changed from the prior study. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax. The left-sided PICC line ends at the distal SVC. The nasogastric tube is coiled in the stomach. There is persistent distension of multiple loops of bowel.", "output": "Nasogastric tube is coiled in the stomach." }, { "input": "No focal consolidation, large pleural effusion or evidence of pneumothorax is seen. The aorta is tortuous. The cardiac silhouette is not enlarged. A left-sided PICC is seen terminating in the mid to lower SVC. Surgical clips are noted overlying the upper abdomen. No evidence of free air is seen beneath the diaphragms.", "output": "No acute cardiopulmonary process. No evidence of free air beneath the diaphragms." }, { "input": "Right-sided PICC terminates in the upper to mid SVC, similar to prior. No pneumothorax is seen. There is persistent elevation of the left hemidiaphragm with overlying atelectasis. Left basilar linear atelectasis/ scarring is also noted. No focal consolidation is seen. There is no large pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are stable.", "output": "Persistent elevation of the left hemidiaphragm. Left basilar and midlung atelectasis. No focal consolidation to suggest pneumonia." }, { "input": "A nasogastric tube is seen, coursing below the level of the diaphragm, extending to the expected location of the stomach. There are air distended loops of bowel not well evaluated on this study. The lungs are clear without focal consolidation. No large pleural effusion or evidence of pneumothorax is seen. A tortuous aorta is again seen, similar in appearance to the chest radiograph from ___. Slight prominence of the ascending aorta may be technical and due to tortuosity, although mild dilatation of the ascending aorta is not excluded.", "output": "Nasogastric tube extends to the level of the diaphragm terminating in the expected location of the stomach. Air distended portions of the gastrointestinal tract not well evaluated on this study. Slight prominence of the ascending aorta may relate to tortuosity and technique, however, mild dilatation of the ascending aorta is not excluded on this study and could be further evaluated for with nonemergent CT." }, { "input": "PA and lateral views of the chest provided. Previously noted right upper extremity PICC line is re- demonstrated with tip in the mid SVC. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Gas distended loops of bowel are seen, further characterized on concurrently obtained abdominal radiograph.", "output": "No acute intrathoracic process. PICC line positioned appropriately." }, { "input": "Linear atelectasis seen at the right lung base. No focal consolidation is identified. Eventration of the left hemidiaphragm is unchanged. The cardiomediastinal silhouette and hilar contours are stable. There is no pleural effusion or pneumothorax. A right upper extremity PICC terminates in the mid SVC. Diffuse gaseous distension is seen in the visualized upper abdomen. Multiple vertebral body compression deformities are noted in the thoracic spine.", "output": "Atelectasis at the right lung base. No focal consolidation." }, { "input": "There has been interval removal of right-sided PICC line. There has been interval placement of an NG tube with its side port above the GE junction but the tip is projecting over the gastric bubble. The heart size is within normal limits. The mediastinal contours demonstrate a tortuous aorta. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "NG tube side port above the GE junction, consider advancing 6-7 cm. This recommendation was posted to the ED dashboard at 15:10 on ___ by ___." }, { "input": "PA and lateral chest radiograph demonstrates a left subclavian approach hemodialysis catheter, its tip which projects over the anticipated location of the right atrium. Heart size is upper limits of normal in size, likely exaggerated by slightly low lung volumes. Blunting of the right costophrenic angle is consistent with a small to moderate pleural effusion. There is mild central pulmonary vascular congestion without overt pulmonary edema. There is no pneumothorax. Imaged upper abdomen is unremarkable. Vascular stent projects over left upper extremity.", "output": "Mild central pulmonary vascular congestion without overt pulmonary edema. Small to moderate right pleural effusion. Left-sided dual lumen central venous catheter with distal tip in the right atrium." }, { "input": "Large bore right-sided catheter terminates in the right atrium. Heart size and mediastinal contours are normal. Aortic knob calcification is unchanged. Lungs are clear without pleural effusion, focal consolidation, or pneumothorax.", "output": "No focal consolidation or pleural effusion. Right tunneled catheter terminates in the right atrium." }, { "input": "Poor inspiratory effort time. There is evidence of increase in bibasilar pleural effusions. There is also some peribronchial cuffing and mild cephalization. Increased linear opacity in the left base identified, most consistent with atelectasis although an evolving infection might have a similar appearance. Findings are overall consistent with the clinical suspicion of congestive change.", "output": "Moderate congestive changes, enlarging pleural effusions Enlarging and worsening left basal changes, still thought most likely to reflect atelectasis flow continued attention and correlation for clinical findings suggestive of pneumonia is suggested" }, { "input": "Frontal and lateral radiographs of the chest demonstrate low lung volumes with resulting bronchovascular crowding. Increased opacities at the bilateral bases reflect small bilateral pleural effusions with adjacent atelectasis. There is cephalization of pulmonary vessels, indistinct hila bilaterally, and increased interstitial markings, consistent with pulmonary edema. Superimposed infection cannot be excluded. There is no pneumothorax.", "output": "Cephalization of pulmonary vessels, indistinct hila, and increased interstitial markings are consistent with pulmonary edema. Superimposed infection cannot be excluded." }, { "input": "There is persistent large right pleural effusion with overlying atelectasis. Minimal to no left pleural effusion is seen. No pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. There ___ be minimal central pulmonary vascular congestion.", "output": "Persistent large right pleural effusion. Minimal to no left pleural effusion." }, { "input": "The heart is mild-to-moderately enlarged. The aortic arch is calcified. A streaky right basilar opacity suggests minor atelectasis. There is also streaky left mid lung opacity suggesting minor atelectasis or scarring. The lungs appear otherwise clear. There are no pleural effusions or pneumothorax.", "output": "No evidence of acute disease." }, { "input": "AP portable upright view of the chest. There is a persistent opacity at the right mid to lower hemi thorax now with a pigtail drain in place. Given that the opacity persists, a mass is difficult to exclude and for this reason a CT is recommended to further assess. Mild pulmonary edema is new from prior exam. A tiny left effusion persists.", "output": "Persistent opacity at the right mid to lower lung status post chest tube placement. Recommend CT to further assess. Interval development of mild pulmonary edema. Stable trace left effusion." }, { "input": "Cardiomediastinal contours are stable with mild cardiomegaly. Multifocal pneumonia in the left lung has markedly improved not completely resolved. The lungs are mildly hyperinflated. There is no pneumothorax or pleural effusion. Right scoliosis is again noted.", "output": "Markedly improved multifocal pneumonia, not completely resolved" }, { "input": "There is mild cardiomegaly which stable. Mediastinal silhouette is normal. The lungs are clear without focal opacifications, pleural effusions, or pneumothorax. The hila are normal. There is moderate right scoliosis again seen which is unchanged.", "output": "Resolution of previously seen left lower lobe pneumonia." }, { "input": "There is streaky density in the left upper lobe most consistent with subsegmental atelectasis or scarring. The right lung is clear. The heart is normal size. Mediastinal structures are otherwise unremarkable. There is a moderate thoracic scoliosis convex to right. The bony thorax is grossly intact.", "output": "Left lung subsegmental atelectasis or scarring." }, { "input": "There is been short interval development of left upper lobe parenchymal opacities suspicious for a lingular/left upper lobe pneumonia. Right apical parenchymal opacity is also noted, potentially due to overlapping shadows although additional area parenchymal opacification is possible. Cardiomediastinal silhouette is within normal limits. Mid thoracic dextroscoliosis is noted.", "output": "Interval development of parenchymal opacities in the left lung suspicious for pneumonia. Followup suggested after treatment to document resolution." }, { "input": "Single portable view of the chest demonstrates normal lung volumes. There is no pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Retrocardiac opacity with rounded rounded lucencies, represents diaphragmatic hernia containing stomach and large bowel loops, better demonstrated on CT torso of ___. No pulmonary edema.", "output": "1. No evidence of acute cardiopulmonary process. 2. Large right-sided diaphragmatic hernia." }, { "input": "Heart size is normal. The aorta is diffusely calcified. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is present. Streaky atelectasis is noted in the lung bases. Mild loss of height of a low thoracic vertebral body is of indeterminate age.", "output": "No acute cardiopulmonary abnormality. Mild compression deformity of a low thoracic vertebral body, of indeterminate age." }, { "input": "There are no rib fractures visualized. There is no pneumothorax. The lungs are incompletely expanded with associated vascular crowding but otherwise clear. There is no focal consolidation, pleural effusion, or evidence of pneumothorax. The cardiomediastinal silhouette is normal. The pleural surfaces are unremarkable. There is mild degenerative changes seen along the thoracic spine.", "output": "No evidence of pneumothorax or rib fractures." }, { "input": "Streaky bibasilar opacities are seen, most suggestive of atelectasis. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits noting a slightly tortuous descending thoracic aorta.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were obtained demonstrating no focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Normal chest radiographs." }, { "input": "PA and lateral radiographs of the chest demonstrate low lung volumes from incomplete inspiratory effort. Mild cardiomegaly is stable. There is chronic scarring in the left lower lobe. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal, and there is no evidence of pulmonary edema. Surgical clips are once again seen in the upper mediastinum and the left upper quadrant of the abdomen.", "output": "No evidence of acute cariopulmonary process." }, { "input": "Portable supine chest film ___ at 17:29 is submitted.", "output": "Interval appearance of layering bilateral effusions with bibasilar airspace opacities most likely representing compressive atelectasis, although aspiration or pneumonia can not be excluded. Interval appearance of mild pulmonary edema. Heart remains stably enlarged which may reflect cardiomegaly, although pericardial effusion should also be considered. Clips in the right superior mediastinum are likely related to prior thyroid surgery. Surgical clips are also again seen in the left upper quadrant." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Lung volumes are slightly low with minimal streaky atelectasis in the right lung base. No focal consolidation, pleural effusion or pneumothorax is detected. Clips are seen projecting over the left axilla. No subdiaphragmatic free air is identified. There are no acute osseous abnormalities.", "output": "Minimal atelectasis in the right lung base. Otherwise, no acute cardiopulmonary process. No subdiaphragmatic free air." }, { "input": "The lungs are clear without focal consolidation, effusion, or pulmonary edema. Cardiac silhouette is within normal limits. Prominence of the upper mediastinum is confirmed as prominent mediastinal fat as demonstrated on prior MRI. Lower cervical anterior fixation hardware is partially visualized.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest show stable scoliosis with posterior thoracolumbar spinal fixation hardware, unchanged from the preceding radiograph. The lungs are clear without focal consolidation, pleural effusion, or pneumothorax. The pulmonary vasculature is not engorged. The cardiac silhouette is normal in size. The mediastinal and hilar contours are within normal limits and unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "Endotracheal tube terminates 3.8 cm above the carina. Right internal jugular approach central venous catheter terminates low SVC. Lung volumes are markedly low and left costophrenic angle is not visualized. Dense retrocardiac opacity suggests left lower lobe collapse. Additional opacity at the base the right is most consistent with atelectasis. No pneumothorax.", "output": "Endotracheal tube terminates 3 point cm above the carina. Marked volume loss in the bilateral lower lobes." }, { "input": "There is near complete resolution of right upper lobe opacity, with minimal linear opacities remaining, representing resolving pneumonia or atelectasis. No acute airspace or interstitial opacity. The cardiomediastinal silhouette is within normal limits. No pleural effusions or pneumothorax.", "output": "Interval near complete resolution of the right upper lobe consolidation, with minimal residual linear opacities representing resolving/residual infection or atelectasis. No chest radiographic evidence of new infection." }, { "input": "There is persistent chronic blunting of the right costophrenic angle. No new focal consolidation is seen. There is no large pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are stable and unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is a hazy opacity in the right mid zone likely corresponding in the lower portion of the right upper lobe, consistent with pneumonia. Otherwise, the right and left lungs are grossly clear, without CHF, other focal opacity, or fusion. The extreme left costophrenic angle is excluded from the film. The cardiomediastinal silhouette is within normal limits.", "output": "Relatively large hazy opacity in the right mid zone consistent with pneumonia, likely in the lower portion of the right upper lobe. The differential could include other etiologies for an alveolar opacity, but, given the history of fevers, these are considered less likely. This finding is new compared with the chest CT from ___. The lungs are otherwise grossly clear." }, { "input": "No complications.", "output": "Comparison to ___. The second of 2 images shows the feeding tube correctly positioned in the middle parts of the stomach." }, { "input": "ET tube is 3.8 cm the carina. Enteric tube courses into the stomach and beyond the field of view. Opacification at the right base with air bronchograms is worsening. Lung volumes remain low. Heart is top normal. There is mild pulmonary vascular congestion without frank pulmonary edema. The mediastinal and hilar contours are normal.", "output": "Worsening right basilar opacity is worrisome for pneumonia." }, { "input": "Since ___, small pleural effusion is unchanged. The cardiomediastinal silhouette and hilar contours are normal. A feeding tube is seen in the stomach and continues out of view. A right PICC line tip terminates in the lower SVC. No pneumothorax.", "output": "1. Unchanged small pleural effusion since ___. 2. Appropriate positioning of right PICC line and feeding tube" }, { "input": "The heart is at the upper limits of normal size. The mediastinal and hilar contours are unremarkable. There are no pleural effusions or pneumothorax. The osseous structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "AP and lateral views of the chest ___ 11:35 are submitted.", "output": "A feeding tube is seen coursing below the diaphragm with the tip projecting over the proximal stomach. Overall cardiac and mediastinal contours are stable. There are residual streaky opacities in the right lower lung likely related to resolving pneumonia. No pulmonary edema. Probable small residual right effusion or pleural thickening. Degenerative changes of the right glenohumeral joint. No pneumothorax." }, { "input": "PA and lateral chest radiographs demonstrate clear lungs. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Normal chest radiographs." }, { "input": "As compared to chest radiograph from 1 day prior, moderate pulmonary edema has improved and pulmonary vascular congestion also improved. Bilateral lower lobe opacities persist. Moderate cardiomegaly. No substantial pleural effusions. No pneumothorax.", "output": "Overall improvement of the pulmonary edema which is now mild to moderate." }, { "input": "Right mid and lower lung airspace opacification is consistent with pneumonia, new from the prior study. Moderate cardiomegaly is likely exaggerated by AP technique. There is no pneumothorax, pulmonary edema, or pleural effusion. The cardiomediastinal silhouette is stable.", "output": "Right mid and lower lung pneumonia. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 1:56 PM, 20 minutes after discovery of the findings." }, { "input": "PA and lateral views of the chest provided. The heart appears mildly enlarged. There is hilar congestion without frank pulmonary edema. No large effusion or pneumothorax is seen. No convincing signs of pneumonia. Mediastinal contour is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Cardiomegaly with hilar congestion." }, { "input": "AP upright and lateral views of the chest provided. Patient is slightly rotated to his left side somewhat limiting assessment. The lungs appear clear without focal consolidation, large effusion or pneumothorax. The heart appears mildly enlarged mediastinal contour appears normal. Bony structures are intact.", "output": "Mild cardiomegaly. No signs of pneumonia or edema." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are clear without focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "No focal opacity to suggest pneumonia is seen. No pleural effusion, pulmonary edema or pneumothorax is present. The heart, mediastinal and pleural surface contours are normal.", "output": "Normal radiographs of the chest." }, { "input": "The lungs are symmetrically well expanded and well aerated without focal airspace opacity, pleural effusion or pneumothorax. The pulmonary vasculature is not engorged, and there is no overt pulmonary edema. The cardiomediastinal and hilar contours are within normal limits. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "Endotracheal tube is in unremarkable position. Enteric tube tip passes below the diaphragm and out of view. There is no focal consolidation or pneumothorax. The cardiac silhouette is enlarged. There is pulmonary vascular congestion. There is moderate retrocardiac atelectasis and mild right basilar atelectasis.", "output": "1. Findings suggestive of CHF. 2. Enteric tube passes below the diaphragm and out of view. If tip position needs to be confirmed, abdominal radiograph could be performed." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. The bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "There is an unchanged left-sided pacemaker with leads ending in the right atrium and right ventricle. The lungs are clear, the cardiomediastinal shilouette and hila are normal. There is no pleural effusion and no pneumothorax.", "output": "No acute cardiothoracic process." }, { "input": "The heart size is mildly enlarged. There are bilateral pleural effusions left greater than right. There is bilateral lower lobe volume loss. There is vascular redistribution and patchy areas of increased alveolar infiltrate.", "output": "Compared to the prior study. The pulmonary status appears worse. this may be due to pulmonary edema and lower lobe volume loss however an underlying infectious infiltrate in the lower lobes can't be excluded." }, { "input": "The cardiomediastinal and hilar contours are normal. Again seen is a right PICC line with tip terminating at the cavoatrial junction. Cardiomediastinal and hilar contours remain stable. The left pleural effusion has resolved, but a small right pleural effusion remains, stable compared to yesterday's study. Mild pulmonary edema persists. Heterogeneous opacities in the right lung continue to improve. Retained barium in the stomach and small bowel from recent study is noted.", "output": "Continued improvement in right lung opacities." }, { "input": "Heart size is normal. Mediastinal silhouette is unremarkable. Left hilar contour is unremarkable. Right hilar contour is obscured by worsening consolidation Of most Of the right lung compatible with progressive pneumonia. Interval development Of increased interstitial lung markings and the remainder Of the right lung is worrisome for asymmetric pulmonary edema. The left lung is clear without consolidation or edema. There is no large effusion or pneumothorax.", "output": "Marked progression of right-sided pneumonia with interval development Of asymmetric right-sided edema. The etiology of this unilateral edema is unclear with possibilities including a localized reactive process, hemorrhage or pulmonary venous thrombosis. Further evaluation with a dedicated chest CT with contrast may be helpful. Results were discussed over the telephone with Dr. ___ by Dr. ___ ___ at 10:36 a.m. on ___ at time of initial review." }, { "input": "2 views were obtained of the chest. Large area of consolidation of the posterior right upper lobe and in smaller volumes of the right lower lobe is compatible with pneumonia. Small right pleural effusion is likely. Left lower lobe consolidation has largely cleared since ___. Background emphysema is also noted. There is no pneumothorax. Heart and mediastinal contours are unremarkable.", "output": "Extensive right sided pneumonia." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Comparison is made with the next preceding similar study ___ ___. Since the next preceding study, a previously present right-sided PICC line has been removed. Heart size and mediastinal structures remain unchanged. The previously persistent remnants of the more massive infiltrates in the right upper lobe and middle lobe area have further regressed and constitutes now with only some linear disease pointing towards a local pleural thickening in the lateral axillary wall of the chest. No new infiltrates are seen. The right-sided diaphragm remains mildly elevated as before, but there is no evidence of residual pleural effusion as the lateral and posterior pleural sinuses are free. No pneumothorax is identified. Comparison is extended to an upright chest examination dated ___ and obtained at___. Comparison demonstrates that the diaphragmatic contours are now slightly lower positioned after the diaphragmatic plication operation of ___. If diaphragmatic function has improved cannot be assessed on routine chest images.", "output": "Further regression of parenchymal infiltrates in right hemithorax, now barely constituting scar formations. No new abnormalities." }, { "input": "A right-sided chest tube has been removed. There are small bilateral pleural effusions which have increased in the interval since the prior day. There is at left lower lobe infiltrate/area volume loss with obscuration of the left hemidiaphragm which is also slightly worse. However the pulmonary vascular redistribution is less pronounced.", "output": "Increased bilateral effusions have increased left lower lobe volume loss/infiltrate." }, { "input": "A portable frontal expiratory chest radiograph again demonstrates a left apically directed chest tube in place. The small left apical pneumothorax is decreased in size, but persistent. Left rib fractures are unchanged. Lung volumes are lower, with increasing bibasilar opacities likely reflecting increased atelectasis. The visualized upper abdomen is unremarkable.", "output": "1. Persistent small left apical pneumothorax, decrease in size. 2. Increasing bibasilar opacities likely reflect atelectasis, given lower lung volumes and expiratory technique." }, { "input": "Unchanged position of a left-sided chest tube with tip projecting over the left apex. Improvement in left lower lobe atelectasis with some residual. Minimal right lower lobe atelectasis. Stable cardiomediastinal silhouette. Bony thorax is unchanged. Upper abdomen is unremarkable. EKG leads overlie the anterior chest wall.", "output": "Stable position of left-sided chest tube with interval mild improvement in left basilar atelectasis, consolidation or parenchymal contusions. Mild linear right lower lobe atelectasis." }, { "input": "Left chest tube is unchanged in position. Following placement of the chest tube to water seal there is a tiny left apical pneumothorax measuring 6 mm in width. The lung volumes remain low with unchanged bibasilar, likely subsegmental atelectasis. Cardiomediastinal silhouette is unchanged. Bony thorax remains unchanged. Fairly large gastric air bubble.", "output": "6 mm small left apical pneumothorax following placement of the chest tube to water seal. Low lung volumes with persistent, likely bibasilar atelectasis. A prominent gastric air bubble, partially visualized." }, { "input": "A frontal chest radiograph demonstrates interval removal of a left chest tube, now with a tiny apical pneumothorax which is new. The remainder of the exam is unchanged, including small bilateral pleural effusions and bibasilar atelectasis. There is no new focal consolidation. Left rib fractures are again noted. The visualized upper abdomen is unremarkable.", "output": "Interval removal of a left chest tube, now with a tiny apical pneumothorax which is new. NOTIFICATION: These findings were communicated via telephone by ___ ___, MD, ___, NP, at ___ on ___, during initial review." }, { "input": "No prior is available for comparison. A left chest tube is seen coursing into the medial left lung apex, mediastinal involvement not excluded. There are patchy bibasilar opacities, may be due to atelectasis, pulmonary contusion, or aspiration. Cardiac silhouette is top-normal to mildly enlarged. Mediastinal contours are unremarkable. Multiple left-sided rib fractures are seen.", "output": "No prior is available for comparison. A left chest tube is seen coursing into the medial left lung apex, mediastinal involvement not excluded. There are patchy bibasilar opacities, may be due to atelectasis, pulmonary contusion, or aspiration" }, { "input": "Indistinct airspace opacities in the right lung base may represent atelectasis or early pneumonia depending upon the clinical setting. There is no pneumothorax, pulmonary edema, or pleural effusion. The cardiomediastinal silhouette is normal.", "output": "Right lung base airspace opacities may represent atelectasis or early pneumonia, depending upon the clinical setting." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes. Linear opacity in the right lung base likely represents atelectasis. There is no focal consolidation. There is slight elevation of the right hemidiaphragm, which likely reflects eventration. There is no pneumothorax. Hilar and mediastinal silhouettes are unchanged. Heart size is top normal. There is no pulmonary edema. Partially imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Heart is top-normal in size. Mediastinal contours unremarkable. There is no pleural effusion or pneumothorax. No focal consolidation is seen. Views of the upper abdomen are unremarkable. No acute osseous abnormalities seen.", "output": "No radiographic evidence of pneumonia." }, { "input": "The heart size is mildly enlarged but unchanged. There is stable mild tortuosity of the aorta. There is unchanged lung hyperinflation with blunting of the costophrenic angles bilaterally consistent with a small pleural effusions, left greater than right. This is overall improved compared to the prior exam. There is an increased area of opacification in the retrocardiac region which could be secondary to atelectasis; however, an acute infectious process cannot be excluded. New fractures are seen along the lateral right fourth, fifth, sixth ribs, overall minimally displaced.", "output": "1. Acute fractures are seen along the lateral right fourth, fifth, sixth ribs, minimally displaced. 2. Increase in opacification in the retrocardiac region could be secondary to atelectasis; however, an acute infectious process cannot be excluded. 3. Small bilateral pleural effusions, left greater than right. 4. Diffusely osteopenic bones." }, { "input": "The lungs are hyperinflated. The cardiomediastinal silhouette and hilar contours are unremarkable. There are no pleural effusions or pneumothoraces.", "output": "Hyperinflated lungs suggests small airways obstruction; no evidence of pneumonia." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear. There is no free air.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Lungs are severely hyperexpanded, more so today than on ___. There is no consolidation, pleural effusion, or pneumothorax. Cardiomediastinal and hilar silhouettes are normal size.", "output": "No radiographic evidence of pneumonia. COPD." }, { "input": "The lungs are fully expanded and clear. The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. No intra-abdominal free air is seen. Visualized osseous structures are unremarkable.", "output": "Normal chest radiograph." }, { "input": "Heart size is upper limits of normal. The mediastinal and hilar contours are remarkable for a prominent left cardiophrenic angle fat pad. The pulmonary vasculature is normal. Lungs are clear except for unchanged calcified granuloma in the right upper lobe and localize linear scarring in the lingula and left lower lobe. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Linear opacities in the lingula likely represent prominent epicardial fat pad and adjacent atelectasis. No acute focal consolidation. Stable calcified nodule in the right upper lobe. The cardiomediastinal silhouette is unchanged. No pleural effusions or pneumothorax. VP shunt is partially imaged along the right anterolateral chest wall.", "output": "No acute cardiopulmonary process." }, { "input": "Low lung volumes are present. The heart size is mildly enlarged. Mediastinal and hilar contours are unchanged with similar fullness of the superior mediastinum attributable to mediastinal fat. There is no pulmonary vascular congestion. No focal consolidation, pleural effusion or pneumothorax is identified. There are multilevel degenerative changes in the thoracic spine.", "output": "Low lung volumes. Otherwise no acute cardiopulmonary process." }, { "input": "Single portable view of the chest. There is a new right IJ central line with tip in the mid SVC. There is no pneumothorax. The lungs remain clear. Azygous fissure again noted. Cardiomediastinal silhouette is stable noting prominence of the upper mediastinum due to fat, unchanged.", "output": "New right IJ line. No pneumothorax." }, { "input": "No focal consolidation, pleural effusion, or pneumothorax is seen. Lung volumes are slightly low. There may be an azygous lobe. Pulmonary vascular prominence is again seen with interval improvement in mild interstitial edema. Heart size is mildly enlarged.", "output": "Persistent pulmonary vascular prominence with interval improvement in mild interstitial edema." }, { "input": "There are low lung volumes without focal consolidation, effusion, or pneumothorax. The cardiac silhouette is moderately enlarged, there is stable widening of the mediastinum. Pulmonary vasculature appears normal.", "output": "Low lung volumes, without pneumonia or CHF. Moderate cardiac enlargement is stable in appearance." }, { "input": "PA and lateral views of the chest are obtained. There is no focal consolidation, effusion, or pneumothorax. Linear plate-like atelectasis in the left lower lung noted. Cardiomediastinal silhouette is normal. No signs of CHF. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest were obtained. There is right mid lung linear atelectasis/scarring. No focal consolidation is seen. There is no pleural effusion. The cardiac silhouette is top normal to mildly enlarged. The aorta is tortuous. Slight prominence of the right hilum may be due to minimal pulmonary vascular engorgement; however, there is no frank pulmonary edema. There is eventration of the right hemidiaphragm anteriorly.", "output": "No focal consolidation. Top normal to mildly enlarged cardiac silhouette without overt pulmonary edema." }, { "input": "Single AP upright portable view of the chest was obtained. The patient is rotated slightly to the right. No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. No evidence of free air is seen beneath the diaphragms.", "output": "No acute cardiopulmonary process. No evidence of free air beneath the diaphragms." }, { "input": "The lungs are fully expanded and clear. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax or pleural effusion. The pleural surfaces are normal.", "output": "Normal chest x-ray. Specifically, no evidence of TB." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Mild degenerative spurring is noted within the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "No pneumothorax or pleural effusion is detected. Compared to the prior film, the right paratracheal opacity is more readily visible. I suspect this is due to differences in technique, but slight interval enlargement cannot be entirely excluded. The trachea in this area does not appear narrowed. Otherwise, the cardiomediastinal silhouette, including the hilar adenopathy, is unchanged. No CHF or focal consolidation. Mild patchy opacity in the right cardiophrenic region is slightly improved. Platelike atelectasis in the right mid zone is new.", "output": "1. No pneumothorax detected. 2. Right paratracheal opacity is more prominent --___ due to technique or interval slight enlargement. 3. New right midzone platelike atelectasis. Slight interval improvement in right cardiophrenic opacity, likely also atelectasis ." }, { "input": "Mild to moderate enlargement of the cardiac silhouette is unchanged. The aorta remains unfolded. Previous pattern of mild pulmonary edema has essentially resolved. Lungs remain hyperinflated. Previously noted bilateral pleural effusions have also resolved. There is no focal consolidation or pneumothorax. Enlargement of the hila bilaterally appears similar, right larger than left. Cholecystectomy clips are demonstrated in the right upper quadrant of the abdomen. There are no acute osseous abnormalities.", "output": "1. Resolution of previously seen pulmonary edema and small bilateral pleural effusions. 2. Bilateral hilar enlargement concerning for underlying lymphadenopathy. Please see subsequent chest CTA report for further details." }, { "input": "Lobular enlargement of the right hilus is unchanged since ___. Chest radiograph one ___ also shows right hilar adenopathy, but probably not as large. Aside from mild right lower lobe atelectasis, lungs are clear. Heart size is stable. Other central adenopathy seen on the recent CTA is not apparent on the conventional radiograph. The peripheral pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen.", "output": "1. Right hilar adenopathy or mass is better evaluated on the CTA dated ___, stable since ___ have been present to some degree in ___. 2. Likely mild right basilar atelectasis, although developing pneumonia cannot be ruled out." }, { "input": "The heart is top-normal in size but stable from ___. There is pulmonary vascular congestion and mild to moderate edema minimally improved from ___. No focal consolidation is identified. A previously seen confluent opacity at the right base is no longer seen on the current examination. There is however a new right pleural effusion and small left pleural effusion. No pneumothorax.", "output": "Mild to moderate edema. New bilateral pleural effusions which are small (right > left)" }, { "input": "AP portable upright view of the chest. Asymmetric diffuse pulmonary opacity, right greater than left is noted. Findings are concerning for asymmetric pulmonary edema, however the possibility of superimposed pneumonia at the right lower lung is difficult to exclude in the appropriate clinical setting heart size remains mildly enlarged. Mediastinal contour grossly unremarkable. Hilar congestion noted. Bony structures are intact. No pneumothorax. No large effusion.", "output": "Findings as above." }, { "input": "Frontal and lateral chest radiographs demonstrate clear lungs, without effusion or pneumothorax. Two ECG lead markers are noted over the upper lung zones. The heart size is normal, the mediastinal contours are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. Peribronchial cuffing, cephalization of the pulmonary vascular and interstitial edema are new since ___. Small bilateral pleural effusions are also new. The mediastinum is mildly widened and the heart size is mildly enlarged.", "output": "Interval development of interstitial edema and small pleural effusions." }, { "input": "Single frontal view of the chest. A metallic stent projects over the left heart border. Heart size is stable. Slight widening of the vascular pedicle, engorgement of the pulmonary vasculature, and mild perihilar haziness are consistent with new mild pulmonary edema. Lung volumes are low but there is no focal consolidation, substantial pleural effusion, or pneumothorax. Bibasilar atelectasis is unchanged.", "output": "New mild pulmonary edema. No focal consolidation." }, { "input": "Single frontal view of the chest. Previously present mild pulmonary edema has resolved. The azygos vein is no longer distended and perihilar haze is no longer present. The lungs are now clear without focal consolidation, pleural effusion, or pneumothorax. Heart size and cardiomediastinal contours are stable.", "output": "Interval resolution of previously seen mild pulmonary edema." }, { "input": "AP and lateral chest radiograph demonstrates clear lungs bilaterally. Cardiomediastinal and hilar contours are within normal limits. There is no pleural effusion, pulmonary edema, or pneumothorax. Visualized osseous structures demonstrates no acute abnormality. Mid thoracic dextroscoliosis.", "output": "No acute intrathoracic abnormality." }, { "input": "PA and lateral views of the chest provided. Bronchovascular crowding in the lower lungs noted without convincing evidence for pneumonia. No large effusion or pneumothorax. No signs of congestion or edema. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings." }, { "input": "Triangular opacification of the left lower lobe is increased since the prior exam with new slight blunting of the adjacent left hemidiaphragm on the PA view and opacification of the retrocardiac space on the lateral view. No pleural effusion, pneumothorax, or pulmonary edema. Cardiomegaly persists and is overall unchanged - previously had normal echocardiogram. Mediastinal contours, hila, and pleura are stable.", "output": "1. Left lower lobe opacity is new, likely subsegmental atelectasis, but pneumonia cannot be excluded in the appropriate clinical setting. 2. Stable cardiomegaly. Correlate with clinical assessment." }, { "input": "Mild to moderate enlargement of the cardiac silhouette persists. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormality is visualized.", "output": "No acute cardiopulmonary abnormality. Unchanged mild to moderate cardiomegaly." }, { "input": "There is no consolidation, pleural effusion, or pneumothorax. Mild to moderately enlarged cardiac silhouette is unchanged since at least ___.", "output": "No radiographic evidence of pneumonia. Unchanged mild to moderate cardiomegaly. RECOMMENDATION(S): Evaluation of chronic cardiomegaly, if not already performed." }, { "input": "The heart appears mildly enlarged, which is possibly significant noting the young age of the patient. The lungs appear clear. There is no pleural effusions or pneumothorax. Bony structures are unremarkable.", "output": "Apparent cardiac enlargement. If the etiology for suspected cardiac enlargement is not known, then echocardiography should be considered in addition to correlation with other clinical factors. No evidence of acute cardiopulmonary disease." }, { "input": "Lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified. Hypertrophic changes noted in the thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal view of the chest provided. Lungs are clear. Cardiomediastinal silhouette appears stable and normal. No large effusion or pneumothorax is seen. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "The lungs are well-expanded and clear. There is no pleural effusion or pneumothorax. Heart size is normal. The mediastinal and hilar contours are normal. No displaced rib fractures detected.", "output": "No acute cardiopulmonary abnormality. No evidence of displaced rib fracture within the limitations of routine chest radiographs." }, { "input": "Lung volumes are low. There is bibasilar atelectasis. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "Low lung volumes with bibasilar atelectasis." }, { "input": "The heart size is normal. The aorta is tortuous and diffusely calcified. There is no pulmonary vascular congestion. Lungs are hyperinflated with attenuation of pulmonary vascular markings towards the apices, compatible with underlying emphysema. Calcified granuloma is noted within the right mid lung field. Linear opacities within the right lung base most likely reflect atelectatic changes. No focal consolidation, pleural effusion, or pneumothorax is clearly identified. No acute osseous abnormality is seen.", "output": "Mild bibasilar atelectasis. Otherwise, no acute cardiopulmonary abnormality. Emphysema." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes. No pleural effusion, focal consolidation, or pneumothorax is seen. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Partially imaged upper abdomen is unremarkable. A round density projecting just inferior to distal left clavicle may be artifactual or represent soft tissue calcification.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Lungs are normally expanded and clear. The heart is not enlarged. The mediastinal contours are normal. There is no pleural effusion or pneumothorax. Within the limitations of routine radiography the included osseous structures are grossly intact.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "PA and lateral views of the chest. There is no focal consolidation. The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "There is interval decrease in bilateral pleural effusions, however there is alveolar and interstitial infiltrates bilaterally likely due to the re-expansion pulmonary edema. An underlying infectious infiltrate can't be totally excluded. The heart size continues to be severely enlarged. Right-sided PICC line with tip in the right atrium is unchanged. Bilateral small bore chest tubes are again visualized.", "output": "Interstitial pulmonary edema" }, { "input": "There is a new right lower lobe infiltrate. There is also opacity in the retrocardiac region. There is a small right effusion. There is pulmonary vascular redistribution with ill-defined vasculature. The heart is mildly enlarged. The NG tube tip is in the proximal stomach", "output": "Fluid overload. An underlying infectious infiltrate, in particular in the right lower lobe cannot be excluded." }, { "input": "Since the prior CXR performed on ___, the patient has been extubated. The right sided PICC line is unchanged in position and terminates at the cavoatrial junction. The moderate bilateral pleural effusions appear to have worsened, but this may be exaggerated by post-extubation lung volume loss. Mild interstitial pulmonary edema has improved. No pneumothorax. Heart size is top-normal. Other than a possible old left 9th rib fracture, there are no acute osseous abnormalities.", "output": "1. Bilateral pleural effusions appear worse, but this may be exaggerated by post-extubation volume loss. 2. Improving mild interstitial edema." }, { "input": "An NG tube is present with tip in the proximal stomach but the distal side port likely above the GE junction. The heart is mildly enlarged. Mediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. The lungs are well-expanded without focal consolidation concerning for pneumonia. There is no pulmonary edema. The distended bowel loop is seen in the left upper quadrant.", "output": "NG tube tip within the proximal stomach and advancement would be recommended for more optimal positioning. Otherwise, no change." }, { "input": "There has been interval placement of an endotracheal tube that ends approximately 5 cm above the carinal. A right-sided PICC line ends in the lower SVC in unchanged position. There has been no significant interval change in appearance of the lungs compared with the previous exam, with a diffuse alveolar process that appears to have the same distribution observed in prior CT from ___. The more pronouced right basal opacity is likely a combination of atelectasis and a large layering pleural effusion. A small left-sided pleural effusion with probable associated atelectasis is also present.", "output": "1. Endotracheal tube ends beyond the thoracic inlet in appropriate position approximately 5 cm above the carina. 2. Persistent diffuse alveolar process better assessed in recent CT from ___ is not resolving and suggestive of multifocal pneumonia with underlying interstitial pulmonary edema. 3. Bilateral layering pleural effusions with associated atelectasis, right worse than left, are unchanged." }, { "input": "There has been interval progression of the hazy alveolar infiltrate. This is now greatest in the right lung and left upper lobe. There is dense retrocardiac opacity consistent with volume loss/ effusion/infiltrate. The pulmonary vascularity is ill-defined. The heart is moderately enlarged.", "output": "Worsened pulmonary edema. An underlying infectious infiltrate cannot be excluded." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "No acute findings in the chest." }, { "input": "No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "The tracheal tube is noted in the mid trachea. Enteric tube traverses towards the stomach. There are increased opacities overlying the left lung with the most confluent opacities at the left lung base. Additionally, there is left lower lobe atelectasis with mild leftward shift of mediastinal structures. Otherwise, cardiac and mediastinal contours are within normal limits. No acute fracture identified.", "output": "Endotracheal tube is in position. Opacities overlying the left lung with the most confluent opacities at the left lung base and likely representing an infectious or aspiration process. Additionally, there is left lower lobe atelectasis with mild leftward shift of mediastinal structures." }, { "input": "Heart size is normal. Mediastinal and hilar contours are within normal limits. Lungs are clear. Pulmonary vascularity is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are present.", "output": "Normal chest radiograph." }, { "input": "A nasogastric tube courses into the stomach, its distal course not otherwise imaged, however. A right internal jugular catheter terminates at the cavoatrial junction. The cardiac, mediastinal and hilar contours appear stable. There is no definite pleural effusion or pneumothorax. Streaky retrocardiac opacity suggests minor atelectasis. The lungs appear otherwise clear.", "output": "No evidence of acute disease." }, { "input": "AP portable upright radiograph of the chest demonstrates clear lungs and normal hilar cardiomediastinal contours. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal. There is no free air under the diaphragm.", "output": "Normal radiographs of the chest. No evidence of pneumoperitoneum." }, { "input": "Cardiomediastinal silhouette and hilar contours are unremarkable. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax. There is no evidence of pneumoperitoneum.", "output": "No acute cardiopulmonary abnormality. No evidence of pneumoperitoneum." }, { "input": "There has been interval decrease in lung volumes bilaterally with worsening left lower lung atelectasis and new opacity concerning for an infectious process. The heart is stable and top normal in size with no evidence of failure. There is no pleural effusion or pneumothorax. Right-sided Port-A-Cath and left-sided PICC catheter both appropriately positioned and terminate within the low SVC.", "output": "1) Increasing left lower lung zone opacity concerning for pneumonia. 2) Worsening low lung volumes and left basilar atelectasis." }, { "input": "Right Port-A-Cath is seen with tip in the mid SVC. The lungs are clear without focal opacity, pleural effusion or pneumothorax. Numerous bilateral old rib fractures are identified, similar in distribution from the prior study. A moderate hiatal hernia is seen slightly more distended than on the prior study. The heart is normal in size with normal cardiomediastinal silhouette. Multiple vertebral compression deformities are seen in the mid thoracic spine, similar in appearance to the most recent comparison study.", "output": "No acute intrathoracic process with multiple old rib fractures, vertebral body compression fractures and moderate hiatal hernia noted." }, { "input": "There has been interval increase in cardiomegaly, mediastinal veins, and pulmonary edema consistent with congestive heart failure. Lung volumes are lower than in prior study with increasing bilateral atelectasis. There has been increase in the amount of right pleural effusion. ET tube is unchanged in position terminating no less than 3 cm from the carina. Right Port-A-Cath terminates within the low SVC. Left-sided PICC line in unchanged position terminating within the mid SVC. Nasogastric tube courses through the esophagus, enters the stomach and out of the field of view.", "output": "Congestive heart failure." }, { "input": "PA and lateral views of the chest were obtained. A Port-A-Cath is again noted residing over the right chest wall with catheter tip located in the SVC. Subtle opacities in the lateral aspect of both lungs likely reflect overlying osseous lesions given patient's history of multiple myeloma. There are linear densities again noted in the left mid to lower lung as well as the right mid lung likely representing areas of plate-like atelectasis. There is no lobar consolidation or definite signs of pneumonia. No large pleural effusion or pneumothorax is seen. The cardiomediastinal silhouette appears grossly unremarkable. There is a retrocardiac density containing air which could represent a small hiatal hernia. The imaged osseous structures appear grossly stable with new thoracic compression fracture and numerous rib deformities likely related to patient's history of multiple myeloma. No free air below the right hemidiaphragm.", "output": "No definite signs of pneumonia." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest were obtained. The heart size and cardiomediastinal contours are normal. The lungs are clear. No focal consolidation, pleural effusion, or pneumothorax. No radiopaque foreign body.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is top normal. The aorta is tortuous and aortic knob calcifications are demonstrated. Assessment of the mediastinal contour is somewhat limited due to the presence of bilateral ___ rods extending from the cervical spine to the lumbar spine. There is no pulmonary vascular congestion. Apart from minimal atelectasis at the lung bases, the lungs are clear. No large pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest demonstrate low lung volumes. There is no pleural effusion, focal consolidation, or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Partially imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear with no evidence of consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Osseous structures are grossly normal.", "output": "Normal chest radiograph. These findings were discussed by Dr. ___ with ___ via telephone at 3:05 p.m. on ___." }, { "input": "Mild cardiomegaly is seen. There is a small retrocardiac opacity. There is no pneumothorax or pleural effusion. The visualized osseous structures are unremarkable.", "output": "Small retrocardiac opacity, which could be secondary to pneumonia." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are hyperinflated, suggesting chronic obstructive pulmonary disease.No focal consolidation is seen. Biapical scarring is noted. No pleural effusion or pneumothorax is seen. The cardiac silhouette is not enlarged. Mediastinal contours are unremarkable.", "output": "COPD. No focal consolidation to suggest pneumonia." }, { "input": "Heart size and cardiomediastinal contours are normal. Lungs are somewhat hyperinflated but are clear without focal consolidation, pleural effusion, or pneumothorax.", "output": "No focal consolidation." }, { "input": "The lungs are hyperinflated. There is no focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "Hyperinflated lungs, without acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest were obtained. There is bibasilar atelectasis. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. Degenerative change at the right acromioclavicular joint is again seen.", "output": "No acute cardiopulmonary process." }, { "input": "A subtle relatively linear bibasilar opacities likely represents atelectasis. No definite focal consolidation is seen. No pleural effusion or pneumothorax is seen. There is minimal to no pulmonary vascular congestion. The cardiac and mediastinal silhouettes are unremarkable. The bones are diffusely osteopenic.", "output": "Minimal to no pulmonary vascular congestion. Likely mild bibasilar atelectasis." }, { "input": "Frontal and lateral views of the chest. The lungs are clear of focal consolidation, effusion, or pulmonary vascular congestion. The cardiomediastinal silhouette is normal. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs are hyperinflated but clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are within normal limits. There is no pleural effusion or pneumothorax. Degenerative changes are seen at the bilateral acromioclavicular joints.", "output": "Hyperinflated lungs without acute cardiopulmonary process." }, { "input": "There is mild hyperexpansion of the lung, similar to prior to studies. There is no focal airspace opacity. Atelectasis at the lung bases is mild. The cardiomediastinal silhouette and hilar contours are normal. There is no pleural effusion or pneumothorax.", "output": "Mild atelectasis at the lung bases and stable hyperexpansion. No acute cardiopulmonary abnormality." }, { "input": "Cardiomediastinal and hilar contours remain stable. There is no pleural effusion or pneumothorax. Lungs are well expanded and clear. Pulmonary vasculature is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute findings in the chest." }, { "input": "There is minimal left lower lung atelectasis. The lungs are otherwise clear. The heart size is normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen.", "output": "No acute cardiac or pulmonary process." }, { "input": "The heart size is normal. Mediastinal and hilar contours are unremarkable. The pulmonary vascularity is not engorged. Ill-defined patchy opacity within the left lower lobe is concerning for an area of developing infection. Minimal streaky opacity in the right lung base may also reflect an infectious process or atelectasis. No pleural effusion or pneumothorax is identified. No acute osseous abnormalities are detected.", "output": "Ill-defined opacity in the left lower lobe is concerning for an area of developing infection. Streaky opacity in the right lung base is nonspecific and may reflect an area of atelectasis or additional area of infection." }, { "input": "The lungs appear slightly hyperexpanded, as before. There is no focal consolidation concerning for pneumonia, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are within normal limits. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear of focal consolidation. Cardiomediastinal silhouette is within normal limits. There is apparent enlargement of right hilum which could be due to underlying enlargement of the pulmonary artery or underlying adenopathy. No acute osseous abnormalities identified, hypertrophic changes are noted spine and degenerative changes at the acromioclavicular joints.", "output": "Apparent right hilar enlargement, potentially enlarged pulmonary artery or adenopathy. Consider CT scan to further evaluate. No acute cardiopulmonary process." }, { "input": "A large right upper lung opacity is not significantly changed in size compared to the outside hospital chest radiograph from ___, corresponding to a 6-cm right upper lobe mass on recent CT from ___. The lungs are otherwise clear. The heart size is normal. The mediastinal contours are normal. There is no pneumothorax. No pleural effusions.", "output": "No evidence of pneumothorax status post bronchoscopic biopsy of large right upper lobe mass." }, { "input": "The lungs are well-expanded and clear. There is no consolidation or vascular congestion. Cardiomediastinal silhouette is within normal limits for technique. Surgical clips seen in the left upper abdomen. Hypertrophic changes noted in the spine.", "output": "No acute cardiopulmonary process." }, { "input": "Chest radiograph demonstrates unremarkable mediastinal, hilar and cardiac contours. Lungs are clear. No pleural effusion or pneumothorax is evident.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. There is no effusion or pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. The lungs are clear and the pulmonary vascularity is within normal limits. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The patient is rotated to the right significantly limiting evaluation of the mediastinal structures. Allowing for these limitations a faint small focal opacity in the left upper lobe is not appreciably changed since ___ and may correspond to scarring. Bibasilar hazy opacities are likely due to atelectasis, however small pleural effusions cannot be excluded on this limited frontal radiograph, and there is mild blunting of the lateral costophrenic sulci. The mediastinal structures are not well evaluated, however, the heart appears mildly enlarged. There is no evidence of pulmonary edema or pneumothorax.", "output": "1. Bibasilar opacities likely a combination of atelectasis and possibly trace pleural effusions. 2. If clinically indicated a repeat frontal and lateral radiograph with normal positioning would provide a more complete evaluation." }, { "input": "The heart is mildly enlarged. Mediastinal and hilar contours are unchanged. Mild pulmonary edema appears relatively unchanged compared to the prior study. There is likely a small right pleural effusion. No pneumothorax or new areas of focal consolidation is present. No acute osseous abnormalities are detected. Degenerative changes of both acromioclavicular joints are noted.", "output": "Mild pulmonary edema and trace right pleural effusion, relatively unchanged compared to the prior exam." }, { "input": "As compared to prior chest radiograph from ___, there has been interval increase of right lower lobe opacification. There is atelectasis of the left lung base and probably a small right pleural effusion. There is no pneumothorax. The cardiac silhouette remains top normal in size. There has been interval increase of the right hilus, which is concerning for either acute exacerbation of adenopathy or acutely dilated pulmonary artery due to embolus. The mediastinal and left hilar contours are within normal limits.", "output": "1. Worsening right lower lobe pneumonia, alternatively, depending upon clinical circumstances, pulmonary hemorrhage or large infarction. 2. Interval enlargement of right hilus could be due to acute exacerbation of adenopathy or acutely dilated pulmonary artery due to embolus. These findings were discussed with Dr. ___ by Dr. ___ via telephone on ___ at 10:02 a.m., at time of discovery." }, { "input": "The cardiac silhouette size remains mildly enlarged. The mediastinal and hilar contours are unchanged with lymphadenopathy again noted. Enlargement of the pulmonary arteries likely reflects pulmonary arterial hypertension. Mild pulmonary vascular congestion persists. New patchy opacity in the right lung base could reflect an area of infection or atelectasis. Small bilateral pleural effusions may be present. There is no pneumothorax. No acute osseous abnormalities are detected.", "output": "New patchy opacity in the right lung base could reflect an area of infection or atelectasis. Mild pulmonary vascular congestion and possible small bilateral pleural effusions. Mediastinal and hilar contours are unchanged compatible with known lymphadenopathy. Enlargement of the pulmonary arteries suggestive of underlying pulmonary hypertension." }, { "input": "Portable upright chest radiograph was obtained. Increased interstitial opacity with mediastinal vascular fullness and Kerley B lines is consistent with mild to moderate pulmonary edema and likely accompanying trace pleural effusions. Bibasilar atelectasis may also be present. Mild cardiomegaly persists with otherwise normal mediastinal and hilar contours. There is no pneumothorax with apical scarring again noted.", "output": "Mild to moderate pulmonary edema with accompanying trace pleural effusions." }, { "input": "The heart size is normal. The hilar and mediastinal contours are within normal limits. There is no pneumothorax, focal consolidation, or pleural effusion.", "output": "No acute intrathoracic process." }, { "input": "AP and lateral views of the chest provided. The lungs appear clear without focal consolidation, effusion or pneumothorax. There is hyperinflation which could reflect underlying emphysema. A focal eventration of the right hemidiaphragm is stable. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Degenerative changes are seen at bilateral AC joints and glenohumeral joints. No free air below the right hemidiaphragm is seen. Tiny clips are seen in the superior mediastinum and left neck.", "output": "No acute intrathoracic process." }, { "input": "Cardiac silhouette size is normal. Mediastinal and hilar contours are unchanged. Pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is seen. Focal eventration of the right hemidiaphragm is similar. No acute osseous abnormality is visualized. Clips within the left neck are again noted.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The trachea is deviated rightward, likely secondary to an anterior mediastinal/lower cervical mass, which is most commonly an enlarged thyroid. Given the rapid enlargement, would further evaluate with thyroid ultrasound. The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Progressive rightward deviation of the trachea concerning for an anterior mediastinal/lower cervical mass, which most commonly is due to a thyroid mass. Would recommend further evaluation with thyroid ultrasound. Results were communicated with ___ at 3 p.m. on ___ via telephone by Dr. ___." }, { "input": "Cardiac silhouette size is normal. The mediastinal and hilar contours are unchanged. Pulmonary vasculature is not engorged. The lungs remain hyperinflated suggestive of COPD. No focal consolidation, pleural effusion or pneumothorax is identified. Scarring is seen within the lung apices. The osseous structures are diffusely demineralized. No acute osseous abnormalities otherwise demonstrated.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The cardiac silhouette is normal in size. The mediastinal and hilar contours are within normal limits.", "output": "No radiographic evidence of pneumonia." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No acute cardiopulmonary process. No evidence of pneumothorax." }, { "input": "Frontal and lateral radiographs of the chest demonstrate clear lungs. The cardiac and mediastinal contours are normal. No pleural effusion or pneumothorax is detected.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Mild atherosclerotic calcifications are seen at the aortic knob. Pulmonary vascularity is normal and the lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. No focal consolidation, effusion, edema, or pneumothorax. The heart size is normal. The mediastinum is not widened. Mild aortic knob calcifications are overall unchanged. Overall appearance of the thoracic spine is similar to ___. External material projects over the right shoulder.", "output": "No acute cardiopulmonary process." }, { "input": "The patient has been intubated. The endotracheal tube terminates approximately 5.5 cm above the carina. An orogastric tube terminates in the distal esophagus. The cardiac, mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax.", "output": "No evidence of acute cardiopulmonary disease. Status post endotracheal intubation. If clinically indicated, the orogastric tube could be advanced into the stomach and the endotracheal tube also advanced slightly." }, { "input": "There is widespread bilateral airspace opacity, with normal lung volumes. Small bilateral pleural effusions are present, with a probable loculated effusion resulting in well defined right lower lobe opacity. The cardiac silhouette is mildly enlarged, in this patient with changes of median sternotomy and CABG. There is no pneumothorax.", "output": "Mild pulmonary edema, with probable loculated components to pleural effusion, although infection is not excluded and followup is recommended to exclude pneumonia." }, { "input": "The heart size normal. The patient is had median sternotomy and CABG otherwise mediastinal silhouette is normal. Again seen is pleural thickening with multiple calcified pleural plaques and left apical scarring. There are no pleural effusions.", "output": "No acute cardiopulmonary findings." }, { "input": "Rotated positioning. In addition, the patient's chin overlies the upper mediastinum and left upper lung. Allowing for this, the patient is status post sternotomy. The heart is not enlarged. There is upper zone redistribution, without other evidence of CHF. There is increased opacity at the left lung base, not fully characterized. This may represent a combination of a small amount of pleural fluid and atelectasis. Possible hiatal hernia. Minimal atelectasis at the right lung base. The right costophrenic angle is excluded from the film, but no gross right effusion.", "output": "Increased opacity at left lung base, with small pleural effusion and atelectasis. The possibility of a pneumonic infiltrate in this area cannot be excluded. If clinically indicated, a lateral view may help for further assessment. Right lung grossly clear except for atelectasis at right lung base. Upper zone redistribution without other evidence of CHF. Possible hiatal hernia." }, { "input": "In comparison with study of ___, there is little overall change. Continued low lung volumes. Bilateral pleural effusions, more prominent on the right with basilar atelectasis. There is some element of elevated pulmonary venous pressure as well.", "output": "Little overall change." }, { "input": "The previously noted right upper extremity PICC line has apparently been removed and replaced with a left upper extremity approach PICC line. The distal tip of the line is projecting well within the right atrium. Retraction by at least 6 to 7 cm is advised for placement at the superior cavoatrial junction. Lung volumes are profoundly diminished with hazy opacity at the lung bases, likely reflecting atelectasis. In addition, there is likely fluid tracking within the right major fissure. There are bilateral pleural effusions. A subpulmonic component, particularly on the right cannot be excluded, resulting in the appearance of an elevated right hemidiaphragm. No pneumothorax is seen. There is no consolidation or edema. Mild aortic tortuosity is accentuated by low lung volumes. The cardiac silhouette is within normal limits for size. The osseous structures are grossly unremarkable.", "output": "PICC line as above. Consider retracting 6 to 7 cm for optimal placement. Bilateral pleural effusions with bibasilar atelectasis." }, { "input": "There are mild bibasilar atelectatic changes. No consolidation, effusion, or pneumothorax detected. Cardiomediastinal silhouette is at the upper limits of normal. The aorta is minimally unfolded. The mediastinum is otherwise within normal limits.", "output": "Minimal bibasilar atelectasis. Otherwise, no acute pulmonary process." }, { "input": "PA and lateral chest radiographs show hyperinflated lungs. When compared to most recent radiograph dated ___, there is minimal residual left lower lung linear opacity likely atelectasis or scarring. Redemonstration of left apical calcified granuloma, unchanged in appearance. No pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are unremarkable.", "output": "Improved left lower lung linear opacity, likely atelectasis or residual scarring." }, { "input": "Focal left lower lung linear atelectasis. Unchanged left apical calcified granuloma is seen again. Hyperinflated lungs. No focal consolidation, pleural effusion, pneumothorax or pulmonary edema is seen. Heart size is normal. Mediastinal contours are normal.", "output": "No evidence of pneumonia. Hyperinflated lungs, suggestive of COPD." }, { "input": "PA and lateral views of the chest. No prior. The lungs are clear. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "No significant interval change. Mild retrocardiac opacity is unchanged since ___ and likely atelectasis. The lungs are otherwise clear. No focal consolidation, pulmonary edema, pleural effusion, or pneumothorax. The heart size is normal. The hila mediastinum are within normal limits. Extensive bony demineralization is overall unchanged. Multiple levels of vertebral compression fractures in the thoracic spine are grossly unchanged and probably pathologic given provided history. Prior vertebroplasty is also noted.", "output": "No acute intrathoracic process. NOTIFICATION: Findings conveyed to ___, requesting a wet read, at 435 pm." }, { "input": "PA and lateral views of the chest. Low lung volumes. There is a compression fracture in the lower thoracic spine with previous kyphoplasty procedure. There is mild bibasilar atelectasis. There is no focal consolidation. Cardiomediastinal contours are normal.", "output": "Low lung volumes. No definite focal consolidation." }, { "input": "PA and lateral views of the chest were provided. An old right rib deformity is noted, unchanged. Please correlate with concurrently performed rib series to assess for displaced acute rib fractures. The lungs appear clear without focal consolidation or pneumothorax. Cardiomediastinal silhouette appears grossly unchanged. Compression deformities in the thoracic spine are stable, compatible with patient's myeloma.", "output": "No pneumothorax. Old right lower rib deformity. Please refer to concurrently performed rib series for evaluation of acute rib fracture." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes. Several healing minimally displaced right lower lateral rib fractures are present at least since ___. Additional known left sided fractures are not evident. There is no pneumothorax, vascular congestion, or large effusion. Patient is status post T11 vertebral kyphoplasty.", "output": "1. No definite acute cardiopulmonary process. 2. Healing multiple lateral rib fractures. 3. Interval T11 vertebroplasty since ___." }, { "input": "Frontal and lateral radiographs of the chest show persistent low inspiratory lung volumes without focal consolidation, pleural effusion or pneumothorax. The pulmonary vasculature is not engorged. The cardiomediastinal silhouette is unchanged. The hilar contours are within normal limits. Evidence of prior kyphoplasty and healing right lateral seventh and eighth as well as left posterior eighth rib fractures are unchanged. A right-sided double-lumen central venous catheter has been placed since the preceding radiographs with the tip terminating in the proximal right atrium.", "output": "No acute cardiopulmonary process. Findings were communicated by Dr. ___ to Dr. ___ by phone at 14:34 p.m. on ___." }, { "input": "PA and lateral views of the chest provided. Widened AP diameter of the chest is again noted. Lung volumes are low. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Vertebroplasty changes are not again noted in the lower T-spine. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Low lung volumes. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. There is left basilar atelectasis. Lungs are otherwise clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Note is made of multiple severe compression deformities in the mid to lower thoracic spine. Vertebroplasty changes are noted at T11.", "output": "Left basilar atelectasis. Multiple severe mid to lower thoracic vertebral body compression deformities without obvious change since prior CT from 3 days prior." }, { "input": "The lung volumes are low. Prominence of the interstitial markings is unchanged since ___. There is no pleural effusion or pneumothorax. The cardiac and mediastinal contours are stable. Evidence of prior vertebroplasty is again noted in the lower thoracic spine. Multiple vertebral body compression fractures are stable since ___ and may be related to known multiple myeloma.", "output": "No focal opacity concerning for lobar pneumonia." }, { "input": "PA and lateral chest radiographs were provided. Lung volumes are low. There is no focal consolidation, pleural effusion, or pneumothorax. Cardiomediastinal silhouette is normal. An old rib fracture is noted on the right. Multiple thoracic vertebral body compression fractures are stable.", "output": "Low lung volumes, but no acute cardiopulmonary process." }, { "input": "Lung volumes are markedly diminished, however, similar to prior exams. There is mild interstitial prominence on the current study slightly accentuated over prior studies with prominence of bilateral hila. No focal infiltrate is identified. The cardiomediastinal configuration and morphology is stable. There is subtle blunting of the right costophrenic angle, possibly indicating a small effusion. No pneumothorax is evident. Body habitus limits evaluation of the osseous structures, but they are grossly stable.", "output": "Low lung volumes. There is likely mild interstitial edema which has developed in the interval. A tiny right pleural effusion is also suspected. Given normal heart size, this is suspected non-cardiogenic pulmonary edema." }, { "input": "Endotracheal tube tip terminates approximately 5.6 cm from the carina. Heart size is normal. Mediastinal and hilar contours are unremarkable. There is no pulmonary edema. Streaky and linear opacities in the lung bases are compatible with areas of atelectasis. No large pleural effusion or pneumothorax is seen. A 6 mm nodular opacity projecting over the left mid lung field may reflect a calcified granuloma. There is no focal consolidation. There is gaseous distention of the stomach. Widening of the right acromioclavicular joint suggests prior type II AC joint separation.", "output": "1. Standard positioning of the endotracheal tube. 2. Bibasilar atelectasis. 3. Gaseous distension of the stomach. 4. Evidence of right acromioclavicular joint separation, type II, likely chronic." }, { "input": "Compared with prior radiographs on ___, cardiomegaly is unchanged.The lungs are clear without focal consolidation. There is no vascular congestion or edema. No pleural effusion or pneumothorax is seen.", "output": "No pneumonia." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality. No radiographic findings to suggest active or latent pulmonary tuberculosis." }, { "input": "There is volume loss at both bases. An underlying infectious infiltrate can't be excluded. There is mild pulmonary vascular redistribution. Loops of bowel in the left upper abdomen are dilated, likely due to a postoperative ileus", "output": "Volume loss at the bases. An underlying infectious infiltrate can't be excluded." }, { "input": "Frontal and lateral chest radiographs demonstrate unremarkable cardiomediastinal and hilar contours. Lungs are clear but sligtlty hyperexpanded possibly due to underlying emphysema. No pleural effusion or pneumothorax present.", "output": "No acute process. Expanded lungs may be due to underlying emphysema. ___ discussed possibility of emphysema with Dr ___ at 08:40 am on ___ via telephone ___ after discovery." }, { "input": "PA and lateral views of the chest. There is no focal consolidation, pneumothorax, or pleural effusion. The cardiac and mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. There is mild residual opacity in the right lower lobe which could represent residual pneumonia. Otherwise, the lungs are clear. No pleural effusion or pneumothorax is seen. Cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "Mild RLL opacity - may represent residual infection." }, { "input": "Frontal and lateral radiographs of the chest demonstrate normal heart size. The cardiomediastinal silhouette and hilar contours are normal. The lungs are clear. No pleural effusion or pneumothorax. No displaced rib fracture identified.", "output": "Normal chest radiograph." }, { "input": "Subtle peribronchical thickening at the right base is suggestive of continued resolution of the prior infection. It has improved since the prior exam. The lungs are otherwise clear without a new consolidation or edema. There is no pleural effusion or pneumothorax. The fine nodular pattern seen on the prior CT is not well evaluated on chest radiograph. The cardiomediastinal silhouette is normal.", "output": "Continued improvement of right lower lobe infectious process. No acute cardiopulmonary process." }, { "input": "On the lateral view, there is a 2.8 cm rounded opacity of unclear etiology, projecting over the posterior aspect of the cardiac silhouette. Otherwise, no definite focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "2.8 cm rounded opacity seen on the lateral view projecting over the posterior aspect of the cardiac silhouette, of unclear etiology. Suggest nonurgent chest CT for further evaluation." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is a consolidation in the anterior segment of the right upper lobe, consistent with pneumonia. Elsewhere, the lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures are unremarkable.", "output": "Findings consistent with pneumonia in the right upper lobe. Follow-up radiographs are recommended in six to eight weeks in order to ensure resolution." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well aerated lungs which are clear. There is no pleural effusion or pneumothorax.", "output": "Normal chest radiograph." }, { "input": "Frontal and lateral chest radiographs demonstrate unremarkable cardiomediastinal and hilar contours. Possibly calcified hilar nodes are identified. Lung volumes are low; however, lungs are clear. No pleural effusion or pneumothorax is present. No osseous abnormalities are identified.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral chest radiographs are provided. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Osseous structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest demonstrate normal cardiomediastinal silhouette. The lungs are clear despite slightly decreased volume. There is no pneumothorax, vascular congestion, or pleural effusion.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs are clear. There is no effusion or pneumothorax. The cardiomediastinal silhouette is normal. Osseous structures are unremarkable. Surgical clips seen in the right upper quadrant.", "output": "No acute cardiopulmonary process." }, { "input": "There is no consolidation, pleural effusion, or pneumothorax. Cardiomediastinal and hilar silhouettes are normal size.", "output": "No radiographic evidence of pneumonia." }, { "input": "Portable AP chest radiograph demonstrates an endotracheal tube, its tip appears to project into the right mainstem bronchus. An enteric tube descends these thorax an uncomplicated course, its tip below the left hemidiaphragm. Cardiomediastinal and hilar contours are within normal limits. Lung volumes are low with resultant central vascular crowding and bibasilar atelectasis. There is no right pleural effusion. Blunting of the left costophrenic angle may reflect pleural thickening. No focal opacity convincing for pneumonia is seen. There is no air under the right hemidiaphragm. There is no pneumothorax.", "output": "Endotracheal tube positioned within the right mainstem bronchus for which repositioning is advised." }, { "input": "Semi supine portable AP chest radiograph demonstrates interval retraction of an endotracheal tube which appears to terminate 3.8 cm above the level of the carina. An enteric tube descends the thorax in uncomplicated course, its tip below the level of the left hemidiaphragm incompletely imaged. Lung volumes are low with associated atelectasis. Cardiomediastinal and hilar contours are stable. Central vascular crowding is likely sequela of low lung volumes. There is no pneumothorax. There is no large pleural effusion. Blunting of the left costophrenic angle may reflect pleural thickening. There is no air under the right hemidiaphragm.", "output": "Interval retraction of endotracheal tube now appropriately positioned. Low lung volumes." }, { "input": "AP portable supine view of the chest. Tip of the endotracheal tube resides 2.7 cm above the carina. An NG tube courses into the left upper abdomen. Multiple overlying EKG loop leads and defibrillator wires are present. Lung volumes are low limiting assessment. There is probable atelectasis in the lower lungs. No large effusion or pneumothorax seen on this supine radiograph. Difficult to exclude a component of congestion.", "output": "As above." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are normal. Density at the left lung base is unchanged and likely represents pericardial fat pad. Lungs are otherwise clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "No focal consolidation is seen. There may be a few calcified granulomas in the left mid lung. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is moderate cardiomegaly which appears to have increased in size compared to the prior exam. There appears to be increased pulmonary vascular engorgement as well as diffuse bilateral mild-to-moderate pulmonary edema. There is a new small left pleural effusion. However, the small layering right pleural effusion has appeared to redistributed compared to the prior exam with interval increase in opacification over the mid right lung. There is no pneumothorax. Persistent retrocardiac opacification is identified and likely secondary to atelectasis.", "output": "1. Slight interval increase in bilateral mild pulmonary edema. 2. Redistribution of the small right and new left pleural effusion." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Comparison is made with the next preceding chest examination of ___. Heart size has increased and the configuration has been altered. Appearance of thoracic aorta is unchanged demonstrating a few calcium deposits in the wall at the level of the arch. No new contour abnormalities identified. Now evidence of bilateral pleural effusions blunting the lateral pleural sinuses and obscuring the outer thirds of the diaphragmatic contours. Although this results in a crowded appearance of the basal pulmonary vessels, exist also suspicious small patchy parenchymal densities, which clearly seen on the right base, which deserve further evaluation. On the lateral view, a mild blunting of the posterior pleural sinuses is seen and again the crowded appearance of the pulmonary vasculature makes precise evaluation of suspected small patchy densities difficult. In comparison with the previous chest examination obtained two days earlier whether findings were practically within normal limits present examination identifies the occurrence of new small amounts of bilateral pleural effusions. As the heart contours also have undergone a change in appearance with broader diameter on the bases, possibility of coinciding pericardial effusion should be considered. Comparison of the pulmonary vasculature does not indicate significant pulmonary vascular venous congestion, there is no evidence of pneumothorax in the apical area.", "output": "Rather sudden onset of bilateral pleural effusions and change of cardiac contours suspicious for coinciding development of pericardial effusion. Referring physician, ___, was paged to transmit these rather subtle sudden developing findings. ___ was paged under #___ at 4:20 p.m." }, { "input": "Bilateral pleural effusions have mildly improved, and the cardiomegaly has slightly decreased. Associated bibasilar atelectasis is seen. No focal consolidation or pulmonary edema is seen.", "output": "Mild improvement in cardiomegaly and bilateral effusions." }, { "input": "The cardiomediastinal hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax. No acute osseous abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear besides streaky right basilar atelectasis. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac silhouette and mediastinum are unremarkable. The pulmonary vasculature is normal. There is no pleural effusion or pneumothorax. In the right infrahilar region, there is progressive opacity in comparison to prior examinations, which may represent developing consolidation. More linear areas of opacity likely represent atelectasis.", "output": "1. Possible right middle lobe pneumonia. 2. Bibasilar atelectasis." }, { "input": "Interval insertion of a tracheostomy in good position. The right-sided subclavian line is good position at the cavoatrial junction. Previous mild to moderate pulmonary edema has slightly increased since the prior. Moderate right pleural effusion and some right lower lobe atelectasis are stable. Small left pleural effusion is presumed. Normal cardiomediastinal silhouette. No pneumothorax.", "output": "Interval insertion of tracheostomy in standard position; no complications. Interval worsening of the moderate pulmonary edema. Stable bilateral pleural effusions and basal opacities." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable", "output": "No acute cardiopulmonary abnormalities" }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal upright and lateral views of the chest were obtained. Low lung volumes result in bronchovascular crowding. There is no focal consolidation, pleural effusion or pneumothorax. Heart size is normal. Mediastinal silhouette and hilar contours are normal. No acute osseous abnormality is identified.", "output": "Normal mediastinal contour in the upright position." }, { "input": "Severe hyperexpansion is consistent with underlying COPD. There is moderate pulmonary vascular congestion and associated mild to moderate interstitial pulmonary edema. Bilateral pleural effusions are small. A mildly displaced anterior left eighth rib fracture is acute or subacute. Dextroscoliosis of the lower thoracic spine is severe. There is moderate to severe cardiomegaly and tortuosity of the descending aorta. There is focal eventration and elevation of the left hemidiaphragm. Demineralization is moderate to severe. Allowing for scoliosis, the cardiomediastinal silhouette is within normal limits.", "output": "1. Moderate pulmonary vascular congestion and mild to moderate interstitial pulmonary edema with moderate to severe cardiomegaly and likely small bilateral pleural effusions. 2. Severe hyperexpansion consistent with COPD. 3. Acute to subacute anterior left eighth rib fracture in its lateral aspect without significant displacement. 4. Elevation of the left hemidiaphragm, projecting over the lower thoracic ribs on the lateral view, better defined on the subsequent CT of the abdomen and pelvis. NOTIFICATION: The fact that a Chest CT is no longer recommended was paged to ___, M.D. by ___, M.D. on ___ at 10:03 AM, 8 minutes after discovery of the findings." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "AP portable upright view of the chest. Mild elevation of the left hemidiaphragm noted. There is somewhat rounded bilateral infrahilar opacity which has a somewhat unusual appearance for pneumonia or hiatal hernia. No large effusion or pneumothorax. Heart is mildly enlarged though not fully assessed. Mediastinal contour is normal. The hila appear prominent. Bony structures are intact.", "output": "Bilateral infrahilar rounded opacity, incompletely characterized; chest CT recommended to further assess." }, { "input": "The lungs are fully expanded and clear. The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax.", "output": "No evidence of pneumonia." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "ICD leads are seen with revised position of the right atrial lead noted. Moderate-to-severe cardiomegaly persists without signs of pulmonary edema. There is no focal consolidation. No pneumothorax is seen.", "output": "No acute process with findings of right atrial lead revision and moderate-to-severe cardiomegaly as before." }, { "input": "Again seen is a right pectoral pacemaker device with leads in stable position projecting over the right atrium, right ventricle, and left ventricle. The heart continues to be enlarged and there is interval improvement in the previously noted retrocardiac opacity from ___. No focal consolidation is identified. There is no pleural effusion, pneumothorax, or pulmonary edema.", "output": "1. Right pectoral pacemaker device is seen in unchanged position with leads projecting over the right atrium, right ventricle, and left ventricle. 2. Interval resolution of previously noted retrocardiac opacity from ___. 3. Stable cardiomegaly" }, { "input": "There is a right pectoral cardiac device with its leads in stable position projecting over the right atrium, right ventricle and left ventricle. The cardiac silhouette continues to be enlarged, and there is a left retrocardiac opacity, reflecting atelectasis and/or pleural effusion. Lower lobe opacities reflect worsening edema. There are surgical clips along the right neck.", "output": "1. SEVERE Cardiomegaly with a cardiac device and its leads in stable position. 2. Mild edema. NEW LEFT LOWER LOBE ATELECTASIS AND/OR PLEURAL EFFUSION." }, { "input": "A dual lead left anterior chest wall pacer is again noted and is unchanged in position. Moderate cardiomegaly is unchanged from prior study. Atherosclerotic calcifications are noted along the aortic arch. Subtle increased density is noted in the right middle lobe with questionable lateral correlate in the posterior lower lung fields. There is no pleural effusion or pneumothorax. A right humeral head replacement is incompletely imaged. The osseous structures are otherwise grossly unremarkable.", "output": "Subtle increased density in the right middle lobe with questionable lateral correlate suspicious for infection." }, { "input": "AP upright and lateral chest radiograph demonstrates a top-normal heart size. Linear opacities at the right lung base is most likely consistent with atelectasis. Probably small right sided effusion is present. No pulmonary edema. Osseous structures demonstrates degenerative changes throughout the thoracic spine. No acute osseous abnormality is identified.", "output": "Minimal right pleural effusion and atelectasis. No focal consolidation convincing for pneumonia." }, { "input": "There is no focal consolidation, pulmonary edema, or pneumothorax. The cardiomediastinal silhouette is normal. There is minimal blunting of the left costophrenic sulcus posteriorly.", "output": "No evidence of acute cardiopulmonary process. Possible trace left pleural effusion versus focal pleural thickening." }, { "input": "Bronchiectasis is noted in lower lobes. Mild opacity in the right lower lobe is likely atelectasis. There is no pleural effusion or pneumothorax. Cardiomediastinal silhouette is normal size.", "output": "Mild opacity in the right lower lobe is likely atelectasis." }, { "input": "Cardiomediastinal contours are normal. Lungs and pleural surfaces are clear.", "output": "No radiographic evidence of pneumonia" }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top normal. The mediastinal and hilar contours are stable.", "output": "No acute cardiopulmonary process." }, { "input": "AP view of the chest provided. Endotracheal tube is seen with its tip residing approximately 3.9 cm above the carina. An OG tube extends to the left upper quadrant, though the tip is not clearly visualized. Scattered pulmonary opacities raise potential concern for aspiration and atelectasis, though lung volumes are quite low. Heart size is grossly stable. Mediastinal contour is difficult to assess. The bony structures are intact.", "output": "ET and OG tubes positioned appropriately. Scattered pulmonary opacities raise potential concern for aspiration and atelectasis." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "Normal chest radiographs." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "ET tube is 5 cm from the carina. Left internal jugular central venous catheter is near the superior cavoatrial junction, unchanged. There is persistent collapse of the right middle and lower lobes. The right upper lobe is clear. Atelectasis at the left base is improved. The right heart border is obscured however the heart is likely normal in size. There is no large pneumothorax. There is a presumed small right pleural effusion. There is persistent deformity of the right clavicle.", "output": "1. Persistent collapse the right middle and lower lobes. 2. Mild atelectasis at the left base is improved." }, { "input": "Severe enlargement of the cardiac silhouette with a globular configuration is not substantially changed from the prior radiograph and likely reflects the presence of a moderate size pericardial effusion, as was previously demonstrated on the prior CT. Aortic knob calcifications are again noted. Pulmonary vascular congestion is again present. No pleural effusion or pneumothorax is seen. There is minimal streaky atelectasis at the lung bases. No acute osseous abnormality is identified.", "output": "Relatively similar appearance of enlarged globular configuration of the cardiac silhouette likely reflective of a moderate size pericardial effusion. Mild pulmonary vascular congestion." }, { "input": "Single AP portable view of the chest was obtained. The cardiac silhouette is enlarged and globular in appearance, raising concern for pericardial effusion. There is a small left pleural effusion. A trace right pleural effusion is difficult to exclude. There is no overt pulmonary edema. Aortic knob calcification is seen.", "output": "Severe enlargement of the cardiac silhouette, raising concern for underlying pericardial effusion. Small left pleural effusion with possible trace right pleural effusion. No overt pulmonary edema." }, { "input": "Frontal and lateral radiographs of the chest demonstrates slight decrease in size of the severely enlarged cardiac silhouette. Persistent small bilateral pleural effusions. Probable small hiatal hernia. There is persistent mild pulmonary vascular congestion. Clear lungs. No pneumothorax.", "output": "Decrease in severe enlargement of the cardiac silhouette likely due to decrease in pericardial effusion with persistent small effusions and pulmonary vascular congestion. No pneumonia" }, { "input": "The cardiac silhouette is severely enlarged, similar to possibly mildly increased as compared to the prior study. Findings could be due to underlying cardiomyopathy however, pericardial effusion is not excluded. There is slight blunting of the left costophrenic angle and there may be a small pleural effusion. Trace effusion is difficult to exclude on the right. Again, there is bilateral hilar prominence and vascular cephalization suggesting mild vascular congestion. Mediastinal contours are unremarkable. No pneumothorax is seen.", "output": "1. Severe enlargement of the cardiac silhouette is again seen, possibly mildly increased, may be due to underlying cardiomyopathy however underlying pericardial effusion not excluded. 2. Small bilateral pleural effusions. Mild pulmonary vascular congestion." }, { "input": "Compared to the prior study, there is slightly improved aeration of the right lower lobe with persistent collapse of the right middle lobe and atelectasis of the right lower lobe. The left lung is clear. The mediastinum remains shifted to the right. No pneumothorax. Tracheostomy tube and right PICC are in unchanged satisfactory position.", "output": "Somewhat improved aeration of the right lower lobe with persistent right middle lobe collapse and right lower lobe atelectasis." }, { "input": "Interval re-expansion of right lower and middle lobes with mild residual atelectasis and possible small effusion. Lung fields are otherwise clear without focal consolidation. The cardiac borders and mediastinal silhouette are unchanged. A left internal jugular venous catheter has been removed. Tracheostomy appears unchanged.", "output": "Re-expansion of right lower and middle lobes with mild residual atelectasis and possible small effusion." }, { "input": "New right lower lung opacities likely reflect asymmetric edema in the setting of severe cardiomegaly, although this may be emphasized by volume loss. Concurrent infection cannot be excluded in the right clinical setting. Lung volumes are decreased with moderate bibasilar atelectasis. Small bilateral pleural effusions are possible. The heart size is unchanged. A new right central line tip is seen in the right atrium. No pneumothorax.", "output": "New right lower lung opacities likely represent asymmetric pulmonary edema. However, concurrent pneumonia cannot be excluded in the right clinical setting." }, { "input": "There is bilateral diffuse interstitial edema, more pronounced in the lung bases, with associated Kerley B lines, vascular cephalization, bilateral hilar prominence and bilateral small pleural effusions. There is moderate-to-severe cardiomegaly, with a predominance of right chamber enlargement. No pneumothorax.", "output": "Findings compatible with acute on chronic congestive heart failure." }, { "input": "There is bibasilar atelectasis, left greater than right. Difficult to exclude underlying pneumonia. The cardiomediastinal silhouette and hilar contours are normal. There are likely a small left pleural effusion. No pneumothorax is identified. Visualized upper abdomen is unremarkable without pneumoperitoneum.", "output": "Bibasilar atelectasis, cannot exclude pneumonia." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. Lung volumes are slightly low with subtle bronchovascular crowding in the lower lungs. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Mild bronchovascular crowding in the setting of low lung volumes without convincing signs of pneumonia or CHF." }, { "input": "Single semi supine portable AP radiograph through the lungs demonstrates bibasilar patchy opacities. Heart size is unchanged when compared to prior study dated ___. Allowing for differences in patient position, mediastinal and hilar contours are stable in appearance. Patient is status post endotracheal tube placement its tip which appears 7 cm above the level of the carina. For more appropriate placement, endotracheal tube should be advanced 2 cm. There is no large pleural effusion. There is no pneumothorax. Mild basilar atelectasis.", "output": "Bibasilar patchy opacities are likely due to atelectasis or aspiration. Endotracheal tube should be advanced 2cm for more appropriate position." }, { "input": "Interval development of mild to moderate bilateral pulmonary edema is with a small to moderate bilateral pleural effusions and adjacent atelectasis. There is no evidence of focal consolidation suspicious for pneumonia. No pneumothorax is identified. The heart size is top normal. Redemonstrated is a left pectoral pacemaker with two continuous leads seen extending to the right atrium and right ventricle, respectively.", "output": "Mild to moderate pulmonary edema with bilateral pleural effusions and adjacent atelectasis." }, { "input": "Lungs are well expanded and clear. No lung opacities of concern. Mediastinal, hilar, and cardiac contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. There is new mild elevation of the right hemidiaphragm with streaky opacity most suggestive of minor atelectasis. On the left, there is a streaky left retrocardiac density, most suggestive of atelectasis, with a possible trace pleural effusion. The lung volumes are low. Cholecystectomy clips project over the right upper quadrant. Bony structures are unremarkable.", "output": "Findings suggestive of mild atelectasis as well as new mild relative elevation of the right hemidiaphragm; infection is difficult to exclude although doubted." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are clear. No effusion or pneumothorax is present. Heart and mediastinal contours are normal.", "output": "Normal chest radiograph." }, { "input": "Retrocardiac opacity is increasing. The left diaphragmatic contour remains blunted. Aortic arch calcifications are similar. No new consolidation or pneumothorax is present. Mild thoracolumbar scoliosis is unchanged.", "output": "Increasing retrocardiac opacity likely represents atelectasis rather than consolidation." }, { "input": "Flattening of the diaphragms is consistent with known history of emphysema. Increased vascular marking with upper redistribution and interstitial thickening is present. Ill defined opacities are noted in both lung bases. Small bilateral pleural effusions are also noted, left worse than right, with concurrent bibasilar atelectases. There is no evidence of pneumothorax. Mild cardiomegaly and severe degenerative changes of the right AC joint are again seen.", "output": "Emphysematous lungs with superimposed pulmonary edema. Superimposed bibasilar pneumonia cannot be excluded." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.A radiopaque foreign body resembling a bullet fragment is identified overlying the upper thoracic spine, just to the left of midline.", "output": "1. No acute cardiopulmonary process. 2. Likely bullet fragment in the upper posterior thorax." }, { "input": "PA and lateral radiographs of the chest demonstrate clear lungs and normal hilar and cardiomediastinal contours. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal.", "output": "Normal radiographs of the chest." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. The lungs are well expanded without focal consolidation concerning for pneumonia. Mild left basilar atelectasis is present. The upper abdomen is unremarkable. No acute osseous abnormality is present.", "output": "No acute cardiopulmonary process. Mild left basilar atelectasis." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen. Evidence of DISH is seen along the spine.", "output": "No acute cardiopulmonary process." }, { "input": "Low lung volumes accentuate the cardiomediastinal contours and result in crowding of bronchovascular structures. There are no focal areas of consolidation to suggest the presence of pneumonia. . Cardiomediastinal silhouette is stable. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary process." }, { "input": "There is an asymmetric opacity in the left lower lobe, concerning for left lower lobe pneumonia. The heart is mildly enlarged. The mediastinum and hila are unremarkable. Multiple calcified granulomas are seen bilaterally, unchanged from prior.", "output": "Asymmetric left lower lobe opacity likely pneumonia. Repeat chest radiograph in ___ weeks after antibiotic therapy is recommended. RECOMMENDATION(S): Asymmetric left lower lobe opacity likely pneumonia. Repeat chest radiograph in ___ weeks after antibiotic therapy is recommended. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the ___ ___ at 3:45 PM, 20 minutes after discovery of the findings." }, { "input": "Overall lung volumes are low. There is no focal consolidation. No pleural effusion or pneumothorax is seen. Mild cardiomegaly is significantly changed. Multiple calcified granulomas are again noted.", "output": "Overall low lung volumes. No focal consolidation." }, { "input": "The previously noted left lower lung pneumonia is resolved. Lungs are hyperinflated, suggestive of emphysema or small airways obstruction. The heart is mildly enlarged. Multiple calcified granulomas are again identified. No pulmonary edema, pleural effusion, or pneumothorax.", "output": "1. Resolution of left lower lobe pneumonia. 2. Hyperinflated lungs, compatible with COPD or small airways obstruction." }, { "input": "The patient is status post median sternotomy with multiple intact appearing sternal wires. Mediastinal surgical clips are compatible with prior CABG surgery. The cardiac silhouette is mildly enlarged, increased from the prior study of ___, which may be in part related to AP technique. The mediastinal and hilar contours are within normal limits. There is minimal calcification of the aortic knob. The inspiratory lung volumes are appropriate. Likely bibasilar atelectasis, early infection not excluded in appropriate clinical setting. No large pleural effusion or pneumothorax is appreciated. Healed right rib fractures are noted.", "output": "Cardiac silhouette increased in size compared to prior study from ___. Likely bibasilar atelectasis, early infection not excluded in appropriate clinical setting." }, { "input": "There is moderate enlargement of cardiac silhouette similar to prior. The lungs are clear without consolidation, effusion, or edema. Median sternotomy wires are intact. Mediastinal clips are again noted. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "There is interval placement of a right sided hemodialysis catheter with its tip at the caval atrial junction. The lungs are clear. Remainder of the exam is not significantly changed compared to ___.", "output": "Placement of a right-sided hemodialysis catheter in appropriate position. Reviewed with Dr. ___." }, { "input": "The heart is enlarged. Great vessels are unremarkable. No lung opacities. No significant change since ___", "output": "Mild cardiomegaly with no evidence of CHF." }, { "input": "There is no focal consolidation, effusion, or pneumothorax. Heart size is top normal. The mediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Biapical pleural thickening is noted. Degenerative changes are seen in the spine.", "output": "No acute intrathoracic process." }, { "input": "Endotracheal tube tip terminates approximately 6 cm from the carina. An enteric tube is noted with tip and side-port seen within the stomach. Patient is status post median sternotomy and CABG. The cardiac and mediastinal contours are unchanged, with the heart size remaining moderately enlarged. There is mild pulmonary vascular congestion. Small right pleural effusion is present. There are streaky opacities in the lung bases possibly reflective of atelectasis though aspiration is not excluded. Multilevel degenerative changes are seen in the thoracic spine.", "output": "1. Standard positioning of the endotracheal and enteric tubes. 2. Mild pulmonary vascular congestion, small right pleural effusion. 3. Bibasilar opacities likely reflect atelectasis but aspiration is not excluded." }, { "input": "AP portable upright view of the chest. Multiple internal intact sternal wires and numerous surgical clips are unchanged in position. Again seen is central pulmonary vascular congestion without overt edema. There is no pneumothorax, focal consolidation, or pleural effusion.", "output": "No acute intrathoracic process. This examination is unchanged since ___." }, { "input": "There is cardiomegaly with a tortuous aorta, stable from prior.The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. There is no vascular congestion.", "output": "No pneumonia or pulmonary vascular congestion. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephoneon ___ at 3:38 PM, 15 minutes after discovery of the findings." }, { "input": "The tip of the endotracheal tube projects above the level of the clavicles, approximately 8.5 cm from the carina. For more optimal positioning, could be advanced by 2 cm. Bilateral alveolar opacities and broncho-vascular congestion likely indicates pulmonary edema. There is a small to moderate right pleural effusion and a left pleural effusion is likely. Stable cardiomegaly compared to the prior study from ___. Prominence of the mediastinum is likely due to unfolding of the thoracic aorta.", "output": "1. The tip of the endotracheal tube is approximately 8.5 cm from the carina and for more optimal placement, this could be advanced by 2 cm. 2. Bilateral alveolar opacities and bronchovascular congestion consistent with severe pulmonary edema. Right pleural effusion and likely left pleural effusion." }, { "input": "Since the prior radiograph, the left lower lobe is now well aerated with stable moderate cardiomegaly. Right lower lobe atelectasis is unchanged. No pleural effusion or pneumothorax.", "output": "The left lower lobe is now well-aerated with stable right lower lobe atelectasis." }, { "input": "Lung volumes are low. Heart size is exaggerated due to low lung volumes but is appears moderately enlarged. Widening of the mediastinum is likely due to low lung volumes. There is crowding of the bronchovascular structures without overt pulmonary edema. Patchy opacities in the lung bases likely reflect atelectasis. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Low lung volumes with probable bibasilar atelectasis." }, { "input": "Interval placement of a Dobhoff tube, with weighted tip just straddling the gastroesophageal junction. Lung volumes remain low, with bibasilar opacifications, likely a combination of atelectasis and pleural fluid, right greater than left. Several old right rib fractures are again seen. Partially visualized cervical spinal hardware.", "output": "1. Dobhoff tube tip is just reaches the region of the gastroesophageal junction, and should be advanced several cm for more optimal positioning. 2. Unchanged low lung volumes with bibasilar opacifications, likely a combination of atelectasis and pleural fluid. NOTIFICATION: The above findings and recommendation regarding the Dobhoff tube were communicated via telephone by Dr. ___ to ___ RN on Farr ___ taking care of the patient at 17:10 on ___, ___ min after discovery." }, { "input": "There are low lung volumes. Right basilar atelectasis is re- demonstrated. Dobhoff tube projects over the left upper quadrant in the expected location of the stomach. No large pleural effusion is seen although trace right pleural effusion be difficult to exclude. There is no pneumothorax. The cardiac and mediastinal silhouettes are stable. Cervical surgical hardware is noted.", "output": "Dobhoff tube projects over the left upper quadrant in the expected location of the stomach. Persistent low lung volumes and right base atelectasis." }, { "input": "Frontal and lateral views of the chest were obtained. Dual-lead left-sided AICD is again seen with leads unchanged in position, currently in expected positions of the right atrium and ventricle. Cardiac and mediastinal silhouettes are unchanged, with the cardiac silhouette mildly enlarged. There is persistent blunting of the left costophrenic angle likely due to pleural effusion with overlying atelectasis. Evidence of bilateral calcified pleural plaques is again seen. Degenerative changes are seen along the spine. No evidence of pneumothorax is seen.", "output": "No significant interval change." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___ and CTA from ___. Again seen are bilateral calcified pleural plaques. There is engorgement of the central pulmonary vasculature with mild indistinctness of the vessels. There is a left-sided pleural effusion which is small but slightly larger compared to previous exam. There is no significant right pleural effusion. Increased density projecting over the posterior aspect of the heart on the lateral is view at least in part due to calcified pleural plaques seen on prior CT of the chest from ___. Cardiac silhouette is enlarged, mildly increased compared to most recent prior. Dual-lead pacing device is in stable position. Osseous and soft tissue structures are unchanged.", "output": "1. Findings suggestive of mild failure. Slightly increased left-sided pleural effusion and cardiomegaly. 2. Bilateral calcified pleural plaques." }, { "input": "Single portable AP chest radiograph was provided. The right pleural effusion is unchanged in size since the prior radiograph. Overlying opacity has slightly increased since the prior exam but most likely represents atelectasis. The left lung is clear. Cardiomediastinal silhouette is unchanged. Bony structures are intact.", "output": "Stable moderate right pleural effusion with opacity at the right base, which is likely overlying atelectasis." }, { "input": "Frontal and lateral views of the chest are compared to prior CT scan from ___. Small-to-moderate right-sided pleural effusion is again noted with probable underlying atelectasis, possible consolidation. The left lung is clear. Cardiomediastinal silhouette is stable as are the osseous and soft tissue structures. Partially visualized filter identified in the mid abdomen as well as surgical clips in the right upper quadrant suggesting prior cholecystectomy.", "output": "No change from recent CT scan which demonstrates small to moderate sized right-sided pleural effusion with underlying parenchymal opacity, potentially atelectasis or consolidation." }, { "input": "Cardiomediastinal contours are normal. Lungs and pleural surfaces are clear.", "output": "Stable radiographic appearance of the chest, with no findings to suggest the presence of primary lung cancer." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Lung volumes are within normal limits however there is mild flattening of the hemidiaphragms within increased AP diameter of the thorax which may reflect COPD. No consolidation, pneumothorax or pleural effusion seen. The heart is not enlarged. Scarring versus atelectasis of the bilateral lung bases. Focal eventration of the right hemidiaphragm unchanged compared to the prior CT.", "output": "No acute cardiopulmonary process seen. Findings suggestive of COPD." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "The right PICC line still heads high into the right neck and continues out of view. The feeding tube is seen in the mid-esophagus. Lung volumes remain low. The heart size is normal. Subsegmental atelectasis persists in the right lower lung. No pulmonary edema, pleural effusion, or pneumothorax.", "output": "1. Right PICC line is seen in the right neck and continues out of view. 2. The feeding tube is in the midesophagus. NOTIFICATION: The findings were discussed by Dr. ___ with RN ___ on the telephoneon ___ at 12:32 PM, 2 minutes after discovery of the findings." }, { "input": "Lung volumes are low and there is increased volume loss/collapse of both lower lobes there bilateral effusions left greater than right the ET tube, NG tube, and right-sided PICC line are unchanged", "output": "Increased volume loss/ infiltrate in both lower lobes." }, { "input": "Portable AP semi-erect chest radiograph ___ at 16:19 is submitted.", "output": "Right subclavian PICC line now has its tip in the distal SVC. Nasogastric tube is difficult to visualize but is felt to be coursing below the diaphragm with the tip not identified. The left lung is grossly clear. There is volume loss in the right upper lung. No pulmonary edema. No pneumothorax. Overall cardiac and mediastinal contours are stable." }, { "input": "There is mild cardiomegaly and right infrahilar vascular crowding, but no pulmonary edema. The mediastinum and hila are normal. There is no pleural effusion and no pneumothorax. No pneumonia.", "output": "No evidence of pneumonia." }, { "input": "Portable upright chest radiograph ___ at 06:22 is submitted.", "output": "Left PICC line, tracheostomy tube and nasogastric tube are unchanged in position. Retrocardiac consolidation remains and may reflect atelectasis, although pneumonia cannot be entirely excluded. The lungs are otherwise grossly clear. No pulmonary edema, obvious pneumothorax or pleural effusions. Cardiac and mediastinal contours are unchanged." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. The aorta is tortuous and calcified. There is no pleural effusion or pneumothorax. A lucency projecting over the lateral mid to lower right chest suggests a skinfold or object lying outside of the patient. The lungs appear clear.", "output": "No evidence of acute disease." }, { "input": "Frontal and lateral radiographs of the chest demonstrate hyperinflated, clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "Since the most recent exam yesterday evening, the left lower lobe atelectasis has increased, returning to its previous appearance on the exam yesterday morning. The right lower lobe atelectasis and new right upper lobe linear atelectasis are essentially unchanged from the most recent exam. Otherwise, no significant change in the mediastinal contour, elevation of left hemidiaphragm, and right chest wall subcutaneous emphysema. No pneumothorax. Small bilateral pleural effusions.", "output": "Interval worsening of left lower lobe atelectasis. Small bilateral pleural effusions." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pneumothorax. Small bilateral pleural effusions are noted. Bibasilar atelectasis is present. There is no focal consolidation concerning for pneumonia. Several air-fluid levels are noted in the imaged portion of the upper abdomen.", "output": "1. Bibasilar atelectasis and small bilateral pleural effusions. 2. Multiple air-fluid levels within bowel in the imaged upper abdomen, incompletely evaluated on this chest radiograph. Dedicated abdominal imaging may be considered for further evaluation of the bowel gas pattern." }, { "input": "Interval removal of the right chest tube with associated atelectasis in the region surrounding the prior chest tube site in the right upper thorax. No pneumothorax. Slight interval improvement in the left and right lower lobe atelectasis. No pleural effusion. Stable mediastinal contours. Stable elevation of the left hemidiaphragm. No free sub-diaphragmatic intra-abdominal free air. Stable, small amount of subcutaneous emphysema at the prior chest tube insertion site in the right lower lateral chest wall.", "output": "1. No pneumothorax status-post right chest tube removal. 2. Interval improvement in bibasilar atelectasis." }, { "input": "Interval development of a small right pleural effusion as well as interval increase in the right basilar atelectasis since ___, after the right-sided VATS procedure. The left basilar atelectasis has since improved, although the left hemidiaphragm remains elevated. The lung volumes remain low. The cardiomediastinal silhouette is unchanged. The mildly tortuous or dilated descending aorta is also unchanged. No pneumothorax or pulmonary edema.", "output": "1. Increased right basilar atelectasis and new small right pleural effusion since ___, 2 days after VATS procedure, which may represent developing pulmonary hemorrhage or infection. 2. Improving left basilar atelectasis since ___. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ ___, the referring provider, on the telephone on ___ at 11:27 AM, 2 minutes after discovery of the findings." }, { "input": "There is patchy retrocardiac opacity and streaky right basilar opacity. Superiorly, lungs are clear. The cardiomediastinal silhouette is within normal limits. Tortuosity of the thoracic aorta is noted. No acute osseous abnormalities.", "output": "Bibasilar opacities, left greater than right which could represent atelectasis though infection would certainly be possible in the proper clinical setting." }, { "input": "AP and lateral views of the chest demonstrates a tortuous aorta with calcified aortic knob, as well as dilatation of the ascending aorta. Bibasilar atelectasis is present. Multiple tiny nodules verses vessels on end appear to be present in the lungs all sub 3 mm and benign appearing on this radiograph. Cardiac size is normal. No pleural effusion or pneumothorax. A veterbra plana deformity of the mid thoracic veterbral body is noted, age indeterminate.", "output": "1. Ascending aortic aneurysm. 2. No evidence of acute pulmonary process. 3. Veterbra plana deformity of T8, better seen on the MR from the same day." }, { "input": "Lung volumes is slightly low. The lungs are clear. No focal consolidation, edema, effusion, or pneumothorax. The heart size is normal. The mediastinum is not widened. The trachea and bilateral mainstem bronchi appear normal in caliber. Levoconvex scoliosis of the thoracic spine is mild. No acute osseous abnormality. No evidence of a radiopaque foreign body.", "output": "No evidence of radio-opaque foreign body in the airways. The lungs are clear." }, { "input": "PA and lateral radiographs of the chest demonstrate a wedge-shaped opacity in the periphery of the left upper lobe, similar in appearance to ___ but more conspicuous on today's examination. This may represent an area of infarction or recurrent pneumonia. The lungs are otherwise clear without pleural effusion or pneumothorax. No pulmonary vascular congestion is detected. The cardiomediastinal silhouette is within normal limits.", "output": "Left upper lobe peripheral opacity possibly representing recurrent infection or infarction, more conspicuous but similar in appearance to ___." }, { "input": "The lungs are clear, the cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax. Congenital rib anomaly or postsurgical change at the first rib, stable, is noted.", "output": "No acute cardiothoracic process including no evidence of pneumonia." }, { "input": "Portable upright chest radiograph was obtained. Medial right upper lobe juxta-mediastinal consolidation/mass persists with extensive reticular interstitial abnormality, relatively isolated to the right upper lobe. No pneumothorax is seen. There are no pleural effusions. The heart is normal in size with tortuous thoracic aortic contour.", "output": "No evidence of pneumothorax with unchanged right upper lobe mass and surrounding interstitial abnormality." }, { "input": "PA and lateral views of the chest. There is new consolidation and interstitial abnormality identified within the right upper and middle lobes not present on prior exam. The left lung is clear. There is a small right-sided pleural effusion. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "Findings suggestive of right upper and middle lobe pneumonia. Recommend repeat with PA and lateral after treatment to document resolution." }, { "input": "Normal heart size, mediastinal and hilar contours. No focal consolidation, pleural effusion or pneumothorax. Chronic hyperinflation of the lungs is unchanged. Old right healed rib fractures are again seen.", "output": "No acute process" }, { "input": "Frontal and lateral views of the chest were obtained. The lungs remain hyperinflated, flattening of the diaphragms, suggesting chronic obstructive pulmonary disease. Prominence of interstitial markings is seen in the right perihilar region, similar to prior, most likely relates to underlying pulmonary emphysema. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable. Hilar contours are also stable.", "output": "COPD. No acute cardiopulmonary process." }, { "input": "The lungs are well-expanded and clear. Lingular atelectasis has improved. The cardiac silhouette remains top-normal in size. No pneumothorax, pleural effusion, or consolidation. No obvious evidence of intrathoracic malignancy.", "output": "No lung nodules or masses suspicious for metastatic disease, however conventional radiography is limited for this assessment. If concern remains for intrathoracic metastatic disease, CT of the chest with contrast is recommended for further evaluation. RECOMMENDATION(S): No lung nodules or masses suspicious for metastatic disease, however conventional radiography is limited for this assessment. If concern remains for intrathoracic metastatic disease, CT of the chest with contrast is recommended for further evaluation." }, { "input": "Lungs are fully expanded and clear. Heart size is normal. Cardiomediastinal and hilar silhouettes and pleural surfaces are normal. No evidence of intrathoracic malignancy.", "output": "No radiographic evidence intrathoracic metastatic disease or other significant cardiopulmonary abnormality is." }, { "input": "Linear lateral left base atelectasis/scarring is seen. No definite focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal. Mediastinal contours are unremarkable. The aorta appears tortuous. No pulmonary edema is seen.", "output": "Top-normal cardiac silhouette size. Mild left basilar linear atelectasis/ scarring. No pulmonary edema." }, { "input": "Hazy opacification in the superior segment of the right lower lobe is new since the prior study, concerning for pneumonia. There is no pleural effusion, pneumothorax, or overt pulmonary edema. The left lung is grossly clear. The cardiomediastinal silhouette is unremarkable.", "output": "Pneumonia within the superior segment of the right lower lobe. Followup radiographs after treatment are recommended to ensure resolution." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. The heart size is normal. Mediastinal contours are normal. No bony abnormality is detected.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest were obtained. Minimal left base atelectasis is seen. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Surgical hardware is seen in the cervical spine. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. Fusion hardware is partially imaged in the lower C-spine. The lungs appear clear without focal consolidation, effusion, or pneumothorax. The lungs appear hyperinflated which likely reflects underlying COPD. No effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "Chronic stable blunting of left costophrenic angle only seen on lateral is likely from scarring. Linear opacity in the left lower lobe is likely atelectasis or scar and is unchanged. No new focal opacity, pleural effusion, pneumothorax or pulmonary edema. Heart size, mediastinal contour and hila are normal. Anterior cervical fusion is again noted without additional bony abnormality.", "output": "1. Chronic stable scarring of the left costophrenic angle. 2. Stable left lower lobe opacity which is either atelectasis or scar." }, { "input": "PA and lateral views of chest Chronic scarring at the left lower lobe is again noted. There is also chronic blunting of the left costophrenic angle seen on the lateral view. Otherwise, the lungs are clear. Heart size is normal. No pleural effusion, pneumonia, pneumothorax is identified. Patient status post spinal surgery with hardware.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Portable semi-erect AP chest radiograph demonstrates low lung volumes and minimal bibasilar atelectasis. The lungs are otherwise clear. There is no pneumothorax. The heart size is normal. The cardiomediastinal silhouette is unremarkable. Anterior cervical fusion hardware is partially visualized.", "output": "No acute cardiopulmonary process." }, { "input": "Single supine portable AP radiograph through the chest demonstrate an orogastric tube which appears to traverse along the expected course of the esophagus with terminal and within the stomach. An endotracheal tube is identified 5.7 cm from the level of the trachea in appropriate position. Low lung volumes and patient rotation. Limited assessment of cardiomediastinal contours. Additionally, low lung volumes resulting crowding of bronchovascular structures. Osseous structures are unremarkable.", "output": "Endotracheal tube and orogastric tube appear in appropriate position. Limited assessment of cardiomediastinal contours and the lungs due to low lung volumes and patient rotation. Attention on follow up radiographs recommended." }, { "input": "Under esophageal probe terminates in mid esophagus. A transesophageal tube can be traced to the level of distal esophagus but is not visualized below. ET tube terminates 7.6 cm above the carina. Lung volume is low. There is no consolidation, pneumothorax, or large pleural effusion. Cardiomediastinal silhouette is exaggerated by low lung volumes.", "output": "1. No radiographic evidence pneumonia or pneumothorax. 2. Transesophageal tube is not visualized below the distal esophagus." }, { "input": "A portable semi upright frontal chest radiograph again demonstrates an endotracheal tube terminating in mid thoracic trachea and an enteric tube terminating within the stomach. Bilateral pulmonary opacities continue to increase. There is a new small to moderate right pleural effusion and possible trace left pleural effusion. There is no pneumothorax. The visualized upper abdomen is unremarkable.", "output": "1. Continued increase in bilateral pulmonary opacities, possibly/pulmonary edema or ARDS, although multifocal pneumonia is also a consideration in the right clinical setting. 2. New small to moderate right pleural effusion. Of note, pleural effusions are less commonly seen in ARDS." }, { "input": "A semi upright portable frontal chest radiograph demonstrates a endotracheal tube terminating in the mid thoracic trachea and an enteric tube which terminates just distal to the GE junction. There are low lung volumes, as before. The heart is likely normal in size, allowing for exaggeration due to low lung volumes. Bilateral pulmonary opacities are increased compared to the most recent chest radiograph. The visualized upper abdomen is unremarkable.", "output": "1. Increased bilateral pulmonary opacities, possibly flash pulmonary edema. However, in the right clinical setting, ARDS or multifocal pneumonia can also be a consideration. 2. Endotracheal tube in appropriate position. Enteric tube terminating just distal to the GE junction. On subsequent chest radiograph, this tube is advanced." }, { "input": "Endotracheal tube terminates approximately 4.5 cm above the carina. Enteric tube courses below the diaphragm but terminates at the GE junction. Recommend advancement so that it is well within the stomach. Lung volumes remain low. Patchy bibasilar opacities most likely represent atelectasis versus aspiration. No large pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are stable.", "output": "Endotracheal tube terminates 4.5 cm above the carina. Enteric tube courses below the diaphragm, but terminates at the GE junction. Recommend advancement so that it is well within the stomach. Low lung volumes. Patchy bibasilar opacities most likely present at atelectasis versus aspiration." }, { "input": "Previously seen in fluid in the right minor fissure has resolved in the interval. There is persistent blunting of the right costophrenic angle with re- demonstrated right pleural thickening. Re- demonstrated bilateral pleural plaques, again suggestive of history of prior asbestos exposure. Bibasilar atelectasis is seen. Patient is status post median sternotomy and CABG. Cardiac and mediastinal silhouettes are stable. No pulmonary edema is seen.", "output": "No definite new focal consolidation to suggest pneumonia. No pulmonary edema. Previously seen fluid in the right minor fissure has resolved in the interval. Re- demonstrated right pleural thickening and bilateral calcified pleural plaques, along with bibasilar atelectasis/scarring." }, { "input": "Patient is status post median sternotomy and CABG. The cardiac silhouette remains moderately enlarged. Interval aortic valve replacement. Mediastinal contours are stable. Re- demonstrated bilateral, right greater than left pleural thickening. Ovoid opacity along the right major fissure may be due to fluid in the fissure. Calcified pleural plaques re- demonstrated, particularly on the left.", "output": "Again seen bilateral pleural thickening, right greater than left. Ovoid opacity projecting over the right major fissure may be due to fluid in the fissure. Cardiomegaly." }, { "input": "Linear opacities at the lung bases likely represent atelectasis. There is no focal consolidation to suggest pneumonia. Cardiomediastinal and hilar contours are unchanged. ___ paralleling the thoracic vertebral bodies are again noted. There is no pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. Lung volumes are again low, with continued obscuration of the left heart border. These are most likely atelectatic changes in the left lung base. Pulmonary vasculature is normal without pleural effusion. Osseous structures are unremarkable.", "output": "1. Continued obscuration of the left heart border favors left lower lung atelectatic changes over pneumonia. Otherwise, stable chest x-ray." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Analysis is performed in direct comparison with the next preceding similar study of ___. The heart remains normal in size. No configurational abnormality is seen. Thoracic aorta unremarkable. No mediastinal abnormalities are present. The pulmonary vasculature is normal. No signs of acute or chronic parenchymal infiltrates are present and the lateral and posterior pleural sinuses are free. No evidence of pneumothorax in the apical area. Skeletal structures of the thorax remain grossly unremarkable.", "output": "Stable normal chest findings, thus no evidence for acute pulmonary parenchymal infiltrates or chronic scar formations." }, { "input": "PA and lateral views of the chest were obtained demonstrating no focal consolidation, effusion, or pneumothorax. Heart size is normal. Mediastinal contour is unremarkable. Bony structures are intact. No free air is seen below the right hemidiaphragm.", "output": "No signs of pneumonia." }, { "input": "Frontal and lateral views of the chest demonstrate clear lungs without effusion or pneumothorax. The heart size is normal, the mediastinal contours are normal.", "output": "Normal chest." }, { "input": "PA and lateral chest radiographs were obtained. A large right upper lobe opacity is new since ___. No additional foci of consolidation, effusion, pneumothorax are present. Cardiac and mediastinal contours are normal. No displaced rib fracture or osseous lesion is identified.", "output": "Large right upper lobe opacity correlates with known focus of non-small cell lung cancer. No abnormalities detected on the right seventh rib. Direct correlation with the recent PET-CT is suggested. Findings was discussed with Dr. ___ ___ telephone at noon on ___." }, { "input": "No previous images. The heart is normal in size, and the lungs are clear without vascular congestion or pleural effusion.", "output": "No evidence of acute cardiopulmonary disease or old tuberculous disease." }, { "input": "Aside from mild atelectasis of the lung bases the lungs are well expanded and clear. Heart size is normal. There is no pulmonary edema. Mediastinal and hilar contours are unremarkable. There is no large pleural effusion or pneumothorax. Multiple surgical clips project over the mediastinum. Median sternotomy wires appear grossly intact.", "output": "No pulmonary edema. Mild bibasilar atelectasis similar to the prior study." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded, clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. There are slightly low lung volumes, which accentuate the bronchovascular markings. However, no focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. No overt pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. Patchy calcification is noted along the aortic arch and there is similar mild aortic unfolding. The mediastinal and hilar contours appear unchanged. There is no pleural effusion or pneumothorax. Surgical clips project along the base of the left neck. The lungs appear clear. Mild degenerative changes are similar along the thoracic spine. A few surgical clips are also seen on the right side. There has been no significant change.", "output": "No evidence of acute disease." }, { "input": "Frontal and lateral chest radiographs demonstrate clear lungs without effusion or pneumothorax. The heart size is normal, the mediastinal contours are normal.", "output": "No acute chest pathology." }, { "input": "PA and lateral chest radiographs were obtained. Bilateral pleural effusions are small. There is no consolidation, pneumothorax or consolidation. The cardiac and mediastinal contours are normal. Mild apical fibrotic changes are stable.", "output": "Small bibasilar pleural effusions are better seen on subsequent chest CT." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are normal. Lungs remain hyperinflated. Biapical scarring is unchanged. Lungs are otherwise clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality. Stable hyperexpansion of the lungs of though no emphysema was noted on the prior CT." }, { "input": "PA and lateral views of the chest. No prior. The lungs are clear. There is no effusion or pneumothorax. The cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. The left lung is clear. Right hemithorax shows extensive subpleural thickening and opacification particularly at the right lung apex without change. There is no definite pleural effusion or pneumothorax. Chest is hyperinflated. Calcified pleural plaques are present.", "output": "Stable chronic-appearing volume loss and subpleural thickening and scarring in the right hemithorax, but no definite evidence of acute superimposed disease." }, { "input": "Since the CT examination, a left-sided chest tube has been placed. There is no evidence of pneumothorax. There is persistent consolidation involving the right upper lobe. Air densities demonstrated in the region of the right upper lobe can be attributed to air within a dilated esophagus. There is persistent interstitial abnormality with a lower lobe predominance as better demonstrated on prior CT from ___. There are no new focal areas of opacification. There are no pleural effusions. The cardiomediastinal and hilar contours are stable. Heart size is normal.", "output": "Stable parenchymal changes since CT from ___. No evidence of pneumothorax status post left-sided VATS wedge resections with chest tube in place." }, { "input": "Lung volumes are low. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. The imaged upper abdomen is unremarkable. The bones are intact.", "output": "Low lung volumes but no acute cardiopulmonary process." }, { "input": "No consolidation, pleural effusion or pulmonary edema is seen, and the cardiac mediastinal contours are normal.", "output": "No acute cardiopulmonary disease including pneumonia. Findings were conveyed to Dr. ___ ___ following review on ___ at approximately 15:45 by Dr. ___." }, { "input": "Lung volumes are low. Cardiomediastinal and hilar contours are normal. Opacity in the left lung base is concerning for pneumonia, particularly given the clinical history. Scarring within the right upper lobe laterally is unchanged. No pleural effusions or pneumothorax.", "output": "New left basilar opacity is concerning for pneumonia." }, { "input": "Known right hilar mass is not clearly delineated on today's exam. Scarring seen in the right upper lung. Peripherally seen opacity in the left lower lung is no longer visualized. There is no new consolidation or effusion. The cardiomediastinal silhouette is stable. Healing posterior left fourth rib fracture is noted.", "output": "No definite acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinum and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "PA and lateral views of the chest were compared to previous exam from ___. The lungs are clear without consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. There is no pneumothorax. The heart and mediastinum are within normal limits. Regional bones and soft tissues are unremarkable.", "output": "Clear lungs." }, { "input": "PA and lateral views of the chest demonstrate the lungs are well expanded with no evidence of focal consolidation, pneumothorax or pleural effusion. Cardiomediastinal silhouette is stable. No rib fractures are identified on this study. An 8mm right upper lobe nodule is redemonstrated, unchanged since prior CT from ___.", "output": "No acute cardiopulmonary process. No rib fractures are identified." }, { "input": "Frontal and lateral chest radiographs demonstrate interval repositioning of a right PICC, which now terminates in the mid SVC. The remainder of the exam is largely unchanged, with sternal wires and mediastinal clips again seen. The cardiomediastinal silhouette is normal in size with a tortuous aorta. The lungs are clear, without pleural effusion, pneumothorax, or focal consolidation. The visualized upper abdomen is unremarkable.", "output": "Interval repositioning of a right PICC, which now terminates in the mid SVC. NOTIFICATION: Discussed by Dr. ___ with ___, ___ nurse, at ___ on ___." }, { "input": "PA and lateral views of the chest. The lungs are clear without consolidation or pneumothorax. The cardiomediastinal silhouette is normal. Osseous structures demonstrate no acute osseous abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "There are low lung volumes. Left basilar atelectasis is noted. Chronic appearing left-sided rib deformities are noted. Mid lung atelectasis is noted. No large pleural effusion or pneumothorax is seen. The aortic knob is calcified. The cardiac silhouette is top-normal to mildly enlarged. There is no overt pulmonary edema. Partially imaged right humeral prosthesis is not well evaluated. .", "output": "Low lung volumes and atelectasis without focal consolidation seen." }, { "input": "There are relatively low lung volumes. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. No displaced fracture is seen.", "output": "Relatively low lung volumes without acute cardiopulmonary process seen." }, { "input": "An NG tube ends in the stomach and should be advanced 5 cm for appropriate placement. Heart size is top normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "1. NG tube should be advanced 5 cm for appropriate placement. No acute cardiopulmonary process." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. The heart size has decreased since the prior radiograph. No free air is identified below the hemidiaphragms.", "output": "1. No acute cardiopulmonary process. 2. No evidence of free air." }, { "input": "PA and lateral views of the chest. The lungs are clear. There is no effusion or pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Cholecystectomy clips project over the right upper quadrant. The stomach does not appear distended. The colon is aerated and an aerated viscus in the left upper quadrant suggesting redundancy of the sigmoid. Persistent enteric contrast from the prior CT performed on ___ is noted. There is no free air.", "output": "No free air. Persistent retained enteric contrast in the colon." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No overt pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Surgical clips are seen over right upper abdomen.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Frontal view of the chest was obtained. The heart is of normal size with normal cardiomediastinal contours. Linear atelectasis is present in left lower lung. No focal consolidation, pleural effusion, or pneumothorax. Surgical clips overlie the right upper quadrant.", "output": "Left lung base linear atelectasis. No focal consolidation." }, { "input": "Lungs are clear of focal consolidation, effusion, or vascular congestion. No acute osseous abnormalities identified. Surgical clips in the right upper quadrant suggest prior cholecystectomy. There is no free intraperitoneal air.", "output": "No acute cardiopulmonary process. No free intraperitoneal air." }, { "input": "There is mild central pulmonary vascular congestion. Patchy right base opacity could be due to atelectasis and vascular congestion although consolidation due to pneumonia or aspiration is not excluded. No pleural effusion or pneumothorax is seen. The cardiac mediastinal silhouettes are stable.", "output": "Mild central pulmonary vascular congestion. Patchy right base opacity could be due to atelectasis and vascular congestion, although consolidation due to pneumonia or aspiration is not excluded." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is detected. Multiple clips are noted in the region of the gastroesophageal junction.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest. The lungs are clear without focal consolidation, effusion or pulmonary vascular congestion. The cardiomediastinal silhouette is normal. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear and well inflated. There is no pleural effusion, pneumothorax or focal airspace consolidation. There is slight prominence and angulation along the right heart border which is stable compared with ___. The cardiomediastinal contours are otherwise unremarkable. The hilar structures are unremarkable. The pulmonary vascularity is normal.", "output": "No acute pulmonary process." }, { "input": "PA and lateral views of the chest. The lungs are clear of consolidation, effusion, or pulmonary vascular congestion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "Normal heart size, pulmonary vascularity. Trace bilateral pleural effusions, more apparent. Thoracic curve convex to the right. No pneumothorax. Minimal left basilar opacity, likely atelectasis. Right lung is clear.", "output": "Trace pleural effusions." }, { "input": "Portable semi-upright radiograph of the chest demonstrates an unremarkable cardiomediastinal silhouette. No definite focal consolidation is identified. Subcentimeter dense round opacity overlying medial aspect of right clavicle corresponds to a calcified lymph node on separately dictated CT of the cervical spine from the same date. There is no pleural effusion or pneumothorax. There is dextroscoliosis of the thoracic spine.", "output": "No definite evidence of pneumonia." }, { "input": "The patient is status post median sternotomy and CABG. There has been interval increase in size of the left pleural effusion which is now large, and obscures assessment of the cardiac silhouette size. No pulmonary vascular congestion is identified, and there is mild rightward shift of mediastinal structures. The mediastinum is not widened. Left basilar compressive atelectasis is demonstrated. Right lung is clear. Trace right pleural effusion is slightly smaller compared to the prior study. No pneumothorax is identified. No acute osseous abnormalities are seen.", "output": "Increased size of left pleural effusion which is now large with associated left basilar atelectasis. Trace right pleural effusion." }, { "input": "Frontal and lateral views of the chest were obtained. There is persistent large left pleural effusion with associated atelectasis, stable in appearance as compared to the prior study. There is very slight rightward shift of the cardiac silhouette, stable. There is slight blunting of the posterior right costophrenic angle which may be due to a trace right pleural effusion. No focal consolidation is seen in the right lung. There is no pneumothorax. The cardiac and mediastinal contours are stable, although not well evaluated given the large left pleural effusion.", "output": "Stable large left pleural effusion with overlying atelectasis. Possible trace right pleural effusion." }, { "input": "PA and lateral views of the chest were provided. There is subtle opacity in the medial right and left lung base which is similar to prior and may represent crowding of bronchovascular markings though the possibility of a subtle pneumonia is difficult to exclude in the correct clinical setting. No large effusion or pneumothorax. No signs of edema. Cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "Prominent bronchovascular markings versus early pneumonia at the medial lung bases." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette. Opacity at the right lung base is consistent with the clinical diagnosis of right lower lobe pneumonia. There is no definite correlate on lateral view. No pleural effusion or pneumothorax is appreciated. The visualized upper abdomen is unremarkable.", "output": "Opacity at the right lung base is consistent with right lower lobe pneumonia." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Mild atelectasis at the lung bases. The lungs are otherwise clear. There is no pneumothorax, fracture or dislocation.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal contours are unchanged with mild cardiomegaly, calcification of the mitral annulus and a elongated aorta. Aside from minimal bibasilar atelectasis, the lungs are clear. There is no pneumothorax or pleural effusion. There are moderate degenerative changes in the thoracic spine", "output": "No acute cardiopulmonary abnormalities" }, { "input": "Heart size is top normal. There is no large pleural effusion or pneumothorax. There are low lung volumes. Linear opacities in the left mid lung and left base are consistent with atelectasis. There is calcification of the mitral annulus.", "output": "Opacities in the left base are likely atelectasis. If clinically indicated repeat radiographs with better inspiration is recommended." }, { "input": "AP view of the chest. Mitral annular calcifications are again seen. Heart size is normal. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest show radiopacity in the left lung base that most likely represents atelectasis. Otherwise, lungs are clear, without focal opacity, pleural effusion or pneumothorax. The heart size is normal. Mitral annular calcifications again noted. The aorta is ectatic but relatively unchanged since ___. There is no free air beneath the hemidiaphragms. There are degenerative changes in the thoracic spine including anterior osteophytes.", "output": "No acute cardiopulmonary process." }, { "input": "The inspiratory lung volumes are slightly decreased. Streaky opacities in the right lung base greater than the left are compatible with atelectasis. There is no focal consolidation concerning for pneumonia, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are within normal limits allowing for low lung volumes. No acute osseous abnormality is detected.", "output": "Decreased lung volumes with bibasilar atelectasis." }, { "input": "Cardiac, mediastinal and hilar contours are within normal limits. Pulmonary vasculature is normal. Minimal patchy opacities are seen in the lung bases, more so on the left. No focal consolidation, pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Minimal patchy opacities in the lung bases, likely atelectasis, however infection within the left lung base is not completely excluded in the correct clinical setting." }, { "input": "Cardiac silhouette is prominent, but not frankly enlarged and use overall similar to the prior study. Again seen is slight unfolding of the aorta, unchanged compared with ___. A prominent focus of platelike atelectasis is seen over the right lung base, also similar to the prior study. Possible minimal atelectasis at the left lung base. No frank consolidation is identified. No CHF. The lateral view suggests a normal variant pectus carinatum configuration, unchanged.", "output": "Platelike atelectasis at the right lung base. No focal consolidation or evidence of pulmonary edema is identified." }, { "input": "Previously seen right lower lobe pneumonia has essentially resolved in the interval. No focal consolidation is seen currently. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiograph demonstrates right lower lobe opacity obscuring the right hemidiaphragm.No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable. Limited assessment of the upper abdomen is within normal limits.", "output": "Right lower lobe pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 11:14 AM, 5 minutes after discovery of the findings." }, { "input": "Cardiac silhouette size is normal. Mediastinal and hilar contours are within normal limits. Pulmonary vasculature is not engorged. Minimal atelectasis is noted in the lung bases without focal consolidation. No pleural effusion or pneumothorax is present. No acute osseous abnormality is visualized.", "output": "Minimal atelectasis in the lung bases. No focal consolidation to suggest pneumonia." }, { "input": "PA and lateral views of the chest provided. Volumes are somewhat low. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest are obtained. Mild right base atelectasis is seen without discrete focal consolidation. The left lung is clear. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Right base opacity likely represents atelectasis. No focal consolidation." }, { "input": "A right power injectable a chest wall Port-A-Cath is present, the tip projecting over the right atria. No focal consolidation, pleural effusion or pneumothorax identified. Platelike atelectasis is present in the right midlung zone and mild left basilar atelectasis is noted. The size of the cardiac silhouette is within normal limits.", "output": "Minimal left basilar atelectasis and linear atelectasis in the right mid lung zone." }, { "input": "NG tube courses below the diaphragm and out of the field of view of the image. Endotracheal tube terminates 6.7 cm above the carina. Recommend inserting the endotracheal tube farther by several cm for more optimal positioning. Right IJ catheter is in unchanged position. Stable, borderline cardiomegaly. Normal mediastinal and hilar contours. Stable, mild pulmonary edema. Interval improvement in left lower lobe atelectasis. Possible, small left pleural effusion.", "output": "1. Interval improvement in left lower lobe atelectasis. 2. Endotracheal tube terminates 6.7 cm above the carina. Recommend inserting the endotracheal tube farther by several cm for more optimal positioning. RECOMMENDATION(S): Insert endotracheal tube farther in by several cm. NOTIFICATION: The findings and recommendations were commuincated to Dr. ___ by Dr. ___ ___ text ___ on ___ at 11:04 AM, 5 minutes after discovery of the findings." }, { "input": "Frontal and lateral radiographs of the chest demonstrate clear lungs with no increased interstitial markings to suggest pulmonary edema. The hila are abnormal and do not suggest lymph node enlargement. The cardiac and mediastinal contours are normal. Again noted is a rounded density at the left lateral aspect of the diaphragm which may be in the breast tissue. Correlation with physical exam is recommended. No pleural effusion or pneumothorax seen.", "output": "1. No evidence of pneumonia, COPD, sarcoid, or volume overload. 2. Incidentally noted focal rounded density in the area of the left lateral hemidiaphragm, which may be in the breast tissue. Correlation with clinical exam is recommended." }, { "input": "Moderate cardiomegaly is re- demonstrated. Mediastinal and hilar contours are unchanged. There is mild pulmonary vascular congestion without overt pulmonary edema. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormality is visualized.", "output": "Moderate cardiomegaly with mild pulmonary vascular congestion." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is mildly enlarged. . Mediastinal contours are unremarkable. Hilar contours are stable and unremarkable.", "output": "Persistent mild cardiomegaly. No focal consolidation to suggest pneumonia." }, { "input": "The cardiac, mediastinal and hilar contours are probably unchanged, allowing for differences in technique. The heart is borderline in size. There is no pleural effusion or pneumothorax. The lungs appear clear. Mid to lower thoracic interspaces appear moderately narrowed.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Heart size is mildly enlarged but unchanged. Mediastinal and hilar contours are unremarkable. Lungs are hyperinflated as seen previously with flattening of the diaphragms, but clear without focal consolidation. No pleural effusion or pneumothorax is visualized. There are mild degenerative changes noted in the mid thoracic spine. .", "output": "No acute cardiopulmonary abnormality. COPD." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. Biapical pleural parenchymal scarring is unchanged from ___. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable", "output": "No acute cardiopulmonary abnormalities" }, { "input": "The lungs are clear without focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest demonstrate the lungs are well expanded, with a hazy opacity in the right lung base with mild peribronchial cuffing. The heart is top normal in size. No focal consolidation is identified. There is no effusion and no pneumothorax.", "output": "Findings compatible with mild pulmonary edema. However, please note that the differential could include other causes of increased interstial markings, including infectious infiltrates." }, { "input": "The lungs are now clear. There is no effusion or pulmonary edema. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are normally expanded and clear. The cardiomediastinal silhouette, hilar contours and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There are low lung volumes which likely in part accentuate the cardiomediastinal silhouette. There is mild prominence of the superior mediastinum, most likely related to low lung volumes, and AP, portable view. However, if there is clinical concern for acute mediastinal injury, chest CT is more sensitive. The lungs are grossly clear. No focal consolidation is seen. There is no pleural effusion or pneumothorax. No displaced fracture is identified.", "output": "Low lung volumes. Mild prominence of the superior mediastinum most likely related to low lung volumes, and AP, portable view. However, there is high clinical concern for acute mediastinal injury, chest CT is more sensitive. No focal consolidation. No pneumothorax seen." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The heart is normal in size with normal cardiomediastinal contours. No displaced rib fractures are identified.", "output": "No acute intrathoracic process." }, { "input": "There is dense opacification of the left lung base with patchy areas of opacification within the right lung. Know interstitial opacities demonstrated opn the previous chest CT are less visible now. Left-sided opacity obscures the cardiac border. There is no pneumothorax. There is likely a left-sided pleural effusion.", "output": "Dense opacity at the left lung base with patchy areas of opacity at the right lung, findings concerning for multifocal infectious process with pulmonary edema being less likely. Underlying interstitial lung disease." }, { "input": "Single AP view of the chest provided. Patient is status post left lower lobectomy with unchanged elevation of left hemidiaphragm. Bilateral, diffuse consolidations appear grossly unchanged from ___. No pleural effusion or pneumothorax. The cardiomediastinal contour is not enlarged.", "output": "1. Bilateral, diffuse consolidations appear grossly unchanged from ___. 2. Patient is status post left lower lobectomy with unchanged elevation of left hemidiaphragm." }, { "input": "Cardiac, mediastinal and hilar contours are unremarkable. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. Multilevel degenerative changes are again noted in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "No radiopaque foreign body is identified in the imaged portion of the chest or upper abdomen to suggest an ingestion of swallowed dentures. However, only the uppermost portion of the abdomen was included on the study, and dedicated abdominal radiograph may be helpful if there is concern for foreign body in the large or small bowel. In the imaged portion of the neck, two partially imaged cylindrical radiodense foreign bodies are evident, overlying the inferior aspect of the mandible, and may potentially be related to dental hardware, cervical spine hardware, or a structure external to the patient. Dedicated neck imaging could clarify the location if it remains unknown clinically. Within the imaged portion of the chest, an asymmetrical 1.6 cm diameter opacity is seen at the right apex above the level of the right clavicle overlying the fourth posterior rib level. On the single view, it is uncertain whether this is a lung nodule or an abnormality of the rib. Moderate cardiomegaly is accompanied by mild pulmonary vascular congestion and minimal interstitial edema.", "output": "1. Right apical nodular opacity which may be related to a rib or lung abnormality. Further evaluation could be performed either with an apical lordotic chest radiograph or CT scan, as communicated to Dr. ___ by telephone at 8:05 a.m. on ___ at the time of discovery. 2. Cardiomegaly and mild interstitial edema. 3. No evidence of ingested foreign body in the thoracic esophagus or stomach. Please see comments above regarding the upper cervical region." }, { "input": "There has been interval placement of an ET tube in satisfactory position. A right PICC line is present with the tip in the mid SVC. There is new left lower lobe consolidation which is consistent with collapse. There is no leftward shift of mediastinal structures, indicating hyperinflation of the left upper lobe. There is a small left-sided pleural effusion. Right-sided atelectasis has improved. Heart size is top normal.", "output": "1. Left lower lobe collapse with consequent hyperinflation of left upper lobe. 2. Satisfactory placement of ET tube." }, { "input": "The right lower lung zone atelectasis and pleural effusion are improved today; however, the right lower lobe is still not fully re-expanded. In addition, the appearance of the left lower lobe consolidation and pleural effusion is also improved. There is a new focal bulge below the level of the aortic knob, which may represent atelectatic lung compressed against the hilum. There is no pneumothorax. Support devices remain in good position.", "output": "1. Improved appearance of right and left lower lobe consolidation and pleural effusions. 2. Slight change in mediastinal contour of unclear significance. Conventional PA and lateral chest radiograph to be obtained when the patient is stable to better evaluate this finding." }, { "input": "There are new dense areas of volume loss most marked in the right mid to upper lung and left lower lung. There is also right lower lobe alveolar infiltrate. ET tube and right-sided PICC line and cervical spine fixation devices are unchanged. OG tube tip is off the film.", "output": "Worsened pulmonary status with areas of volume loss/infiltrate." }, { "input": "There is a non-characteristic opacity in the left retrocardiac and left base area. The right basilar atelectasis and pleural effusion continue to improve. The remainder of the exam is stable including stable position of support and monitoring devices.", "output": "1. Non-characteristic left retrocardiac opacity likely representing atelectasis. 2. Improvement of right-sided pleural effusion and atelectasis." }, { "input": "The cardiac, mediastinal and hilar contours are stable. ET tube and PICC line are noted in good position. There is partial right upper lobe collapse with displacement of the minor fissure. The lungs are otherwise clear. There is no pleural effusion or pneumothorax.", "output": "1. Partial right upper lobe collapse. 2. No focal consolidation to suggest pneumonia." }, { "input": "Frontal semi-erect view of the chest was obtained. The heart is of top normal size with normal cardiomediastinal contours. Pleural fluid is again seen within the right minor fissure. Indistinct costophrenic angles are compatible with small bilateral effusions. Bibasilar atelectasis is present. No focal consolidation or pneumothorax. Tracheostomy tube and PEG are in similar position to prior. Anterior cervical fusion device is similar to prior and incompletely imaged. A right PICC terminates in the lower SVC.", "output": "Small bilateral pleural effusions, similar to prior, with bibasilar atelectasis. No new consolidation." }, { "input": "Moderate hiatal hernia, which exaggerates heart size, borderline in size. No pleural effusion. No pneumothorax or focal consolidation.", "output": "No acute cardiopulmonary process. Moderate hiatal hernia." }, { "input": "Note is made of a moderate hiatal hernia, overall similar to the prior exam. The hilar mediastinal contours are otherwise unremarkable. No focal consolidations concerning for pneumonia are identified. Eventration of the right hemidiaphragm is stable. There is no pleural effusion or pneumothorax.", "output": "1. No acute intrathoracic abnormalities identified. 2. Stable moderate hiatal hernia." }, { "input": "The cardiac silhouette is enlarged. Again noted are widespread, primarily reticular opacities with basal predominance, not significantly changed since the prior examination. No definite consolidation, large pleural effusion, or pneumothorax is identified.", "output": "No acute intrathoracic abnormality. Radiographically stable interstitial lung disease." }, { "input": "In comparison with prior imaging study performed earlier today, there has been no significant interval change. Subpleural reticular opacity is again noted most compatible with interstitial lung disease. No large effusion or pneumothorax. No convincing signs of edema or pneumonia. Cardiomediastinal silhouette appears stable. Bony structures are intact.", "output": "Interstitial lung disease." }, { "input": "Right internal jugular central venous catheter tip terminates at the junction of the SVC with the right atrium. No pneumothorax is identified. Remainder of the chest is unchanged with continued diffuse bilateral alveolar opacities. No pleural effusion is identified, though the left costophrenic angle is excluded from the field of view.", "output": "Right internal jugular central venous catheter tip at the junction of the SVC and right atrium. No pneumothorax." }, { "input": "There has been interval removal of the endotracheal and esophageal tubes since the prior study. Left internal jugular approach central venous catheter is unchanged in position. The lung volumes are slightly low, as before, but remain clear. The cardiomediastinal silhouette is unremarkable. There is no pleural effusion or pneumothorax.", "output": "Interval removal of endotracheal and esophageal tubes, with no other significant change since the prior study." }, { "input": "Heart size is mildly enlarged. There are diffuse bilateral alveolar opacities. No pneumothorax or pleural effusion is identified. The mediastinal contours are unremarkable. Cholecystectomy clips are demonstrated in the right upper quadrant the abdomen. No acute osseous abnormalities seen.", "output": "Diffuse bilateral alveolar opacities could reflect moderate non-cardiogenic pulmonary edema, though an underlying multifocal pneumonia is not excluded. Continued followup radiographs are recommended." }, { "input": "The previously described ihilar opacity is no longer apparent. The lungs are clear. Cardiopericardial silhouette is not enlarged. No pleural effusions or pneumothorax.", "output": "No significant interval change, no hilar infiltrate." }, { "input": "AP portable upright view of the chest. The endotracheal tube tip extends into the prox right mainstem bronchus. Retraction by at least 3-4 cm is advised. Nasogastric tube extends into the left upper quadrant. Retrocardiac opacity is concerning for aspiration or pneumonia. Right lung is clear. Cardiomediastinal silhouette is unremarkable. No bony injuries. Clips in the right upper quadrant noted.", "output": "1. Endotracheal tube tip extends into the proximal right mainstem bronchus. Retraction by at least 3-4 cm is advised. 2. NG tube appropriately positioned. 3. Retrocardiac opacity concerning for aspiration or pneumonia." }, { "input": "There has been interval retraction of endotracheal tube, with distal tip now positioned approximately 4 cm above the carina. There has been interval placement of a left IJ central line, whose distal tip projects over the mid SVC. An NG tube is again seen coursing inferiorly with distal tip and side port projecting over the left upper quadrant. Lower lung opacities are concerning for aspiration/ pneumonia.", "output": "Lines and tubes positioned appropriately. Lower lung opacities concerning for aspiration/ pneumonia." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax. Small left pleural effusion is new. . The osseous structures are unremarkable", "output": "New small left pleural effusion" }, { "input": "Cardiac and mediastinal contours are within normal limits. Apparent enlargement of the left hilum is likely due to mild enlargement of the left lower lobe pulmonary artery due to pulmonary embolism as demonstrated on CT. Focal opacity within the left lower lobe is compatible with infarction. Streaky opacity in the right lower lobe may reflect an additional site of developing infarction or atelectasis. Small left pleural effusion is noted. No pneumothorax is identified. Mild degenerative changes are present in the thoracic spine.", "output": "1. Apparent left hilar enlargement likely reflects mild enlargement of the left lower lobes pulmonary artery due to known embolism. 2. Left lower lobe opacity compatible with infarction. Small left pleural effusion. 3. Streaky right lower lobe opacity may reflect atelectasis or additional site of developing infarction." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. Mild blunting of the left posterior costophrenic sulcus makes it difficult to exclude a trace effusion, but a pleural effusion is doubtful. There is no pneumothorax. The lungs appear clear. Bony structures are unremarkable.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Partially imaged upper abdomen is unremarkable. Multiple surgical clips project over right upper abdomen.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. There is mild unchanged unfolding of the thoracic aorta, but the mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "", "output": "Stable right apical hydropneumothorax and expected post-lobectomy changes. ______________________________________________________________________________ FINAL REPORT HISTORY: ___-year-old male with right upper lobe and right middle lobe resections with right apical fluid collection. STUDY: PA and lateral chest radiograph. COMPARISON: ___. FINDINGS: Clips in the right hilum and the right costophrenic angle represent post-surgical changes from prior upper and middle lobe resections. The remaining right lower lobe is well aerated. There is a small amount of pleural fluid with a locule of gas in the right apex representing a stable hydropneumothorax. There is no mediastinal shift or diaphragmatic flattening to suggest tension. Subcutaneous gas is seen along the right chest wall. The left lung appears unremarkable. IMPRESSION: Stable right apical hydropneumothorax and expected post-lobectomy changes." }, { "input": "Clips in the right hilus and right costophrenic angle compatible with the known history of lobectomy. There has been interval removal of a right apical pleural drainage catheter. A small amount of apical pleural fluid persists as well as a small right basal pleural effusion. There is no large pneumothorax. There is no mediastinal shift or diaphragmatic flattening. The cardiomediastinal contours are minimally shifted to the right, likely the expected result of lobectomy. The left lung is clear. Subcutaneous emphysema persists in the right chest wall.", "output": "Expected right lobectomy postoperative changes." }, { "input": "Moderate amount of right apical pneumothorax is unchanged since ___ inspite of right apical and right basal chest tubes, unchanged in position. Right-sided shift of the cardiomediastinal silhouette is stable. The extent of opacification in the right lung, predominantly in the mid portion, is unchanged in severity since ___, and differential diagnosis includes atelectasis or pneumonia or hemorrhage. There is at least mild-to-moderate pleural effusion on the right side, stable since ___. Mild-to-moderate amount of left pleural effusion and left lung base atelectasis are similar. No opacities on the left side do suggest pneumonia.", "output": "Moderate right apical pneumothorax and right mid lung opacity likely atelectasis or pneumonia or hemorrhage, mild-to-moderate bilateral pleural effusions, and left lung atelectasis are unchanged since ___." }, { "input": "Patient is status post right-sided surgery with several discontinuous ribs. There is also associated volume loss of the right upper lobe as well as right apical pleural thickening and likely loculated fluid. The left lung is essentially clear. There may be small right-sided pleural effusion. No focal opacities are noted.", "output": "No acute cardiopulmonary process. Post-surgical changes in the right hemithorax are unchanged." }, { "input": "Resolution of the hydropneumothorax in the right apex which is now replaced with pleural effusion. A small right basilar pleural effusion is also noted. There has been interval expansion of the right lung with decrease in observed right lower zone atelectasis. There has been a stable shift in the mediastinum and heart to the right. Left lung is emphysematous but otherwise unremarkable. There are post-surgical changes seen in the right lateral ribs with interval increase in rib retraction likely secondary to volume loss.", "output": "Improved aeration and expansion of right lung. Right apical and small basilar pleural effusions. No evidence of infection or malignancy." }, { "input": "PA and lateral views of the chest. Clips in the right hilum and right costophrenic angle represent post-right upper and middle lobectomy. Right apical pleural drain has been placed. The air has decreased in right apical hydropneumothorax and has now filled with fluid. The remaining right lung is unchanged. The left lung is clear. No left pleural effusion or pneumothorax. No evidence of pneumonia. Right-sided subcutaneous air has decreased.", "output": "Right apical pleural drain placed with less air in the pleural space and now more fluid filled. Decrease in subcutaneous air. Otherwise unchanged." }, { "input": "Frontal and lateral views of the chest redemonstrate marked asymmetric aeration of the right lung and architectural distortion related to prior right upper lobectomy, with posterior surgical rib defects. There is new hazy opacity involving the right lower lung with extension superiorly. Multiple air-fluid levels are present in the right upper lung in the resection bed, suggestive of complex loculated fluid, raising question of empyema. The left lung remains clear. The visualized portion of the cardiomediastinal silhouette is within normal limits. Trace subcutaneous emphysema is persistent, likely postoperative residual.", "output": "1. New hazy opacity involving the right lung with numerous air-fluid levels superiorly in the region of recent right upper lobectomy. This could represent infection with associated loculated fluid, however CT would be prudent to exclude empyema. 2. No radiographic evidence of pneumothorax. 3. Diminishing subcutaneous emphysema." }, { "input": "A single AP radiograph of the chest was acquired. As before, the patient is status post right upper lobectomy for prior lung carcinoma. Right apical pleural thickening and loculated pleural effusion has decreased compared to ___. There is minimal bibasilar atelectasis. No focal consolidations are noted. The heart size is normal. The mediastinal contours are unchanged. There is no pneumothorax. There is evidence of prior right thoracotomy, as before.", "output": "1. No acute cardiac or pulmonary process. 2. Post-surgical changes in the right hemithorax, consistent with prior right upper lobectomy. The degree of pleural thickening and/or loculated pleural effusion at the right apex is decreased." }, { "input": "Since ___, there are no relevant changes in the lungs. Two right chest tubes are seen ending at right lung apex and the third one at the right lung base. Minimal right apical hydropneumothorax with partial collapse of underlying lung is similar in appearance. There are no other relevant findings in the bilateral lungs. Volume loss in the right lung and right mid-lower lung opacities are similar in appearance. Cardiomediastinal silhouette is stable.", "output": "Unchanged appearance of the mild right apical hydropneumothorax." }, { "input": "There is an unchanged appearance to clips in the right hilum and right lower chest. The heart size is within normal limits. The mediastinal contours are stable, showing expected post-surgical change. The remaining right lower lobe appears as well inflated. Persistent area of hydropneumothorax is seen in the right apical region of the chest. The left lung is clear. Post-surgical changes seen in the right rib cage.", "output": "Stable appearance of right apical hydropneumothorax, but otherwise expected post-surgical change." }, { "input": "The patient is status post right upper and right middle lobe resection with expected postoperative volume loss in the right hemithorax. An area of loculated fluid persists at the right apex, and there is stable postoperative appearance of the right hilar regions. Improving aeration is present at the right lung base with some residual minimal linear atelectasis or scar remaining as well as a persistent small right pleural effusion. Left lung is slightly overexpanded but grossly clear. As compared to the prior study, subcutaneous emphysema in the right chest wall has resolved.", "output": "Postoperative changes in the right hemithorax as described." }, { "input": "Rotated positioning. ET tube tip approximately 5.7 cm above the carina at the level of the lower clavicular heads. NG tube extends beneath the diaphragm, off the film. A right subclavian PICC line tip most likely overlies proximal SVC, allowing for rotation. Additional tubing with pigtail tip over the lower left chest or upper left abdomen is again noted. Again seen is marked cardiomegaly. On today's exam, the focal opacities in the left lung apex appear slightly improved. Left lower lobe collapse and/or consolidation with air bronchograms remains present, similar to the prior film. Vascular plethora in the right lung is consistent with ongoing CHF. Probable small right of fusion, with right base atelectasis, similar to the prior film.", "output": "1. Partial interval improvement of opacity in the left lung apex compared with the most recent prior film. Compared with ___ at 08:35 a.m., aeration at the left lung apex has clearly improved. 2. Continuing left lower lobe collapse and/or consolidation. Mediastinal shift difficult in light of the patient rotation, but may very well be similar to the prior film. 3. CHF, with suspected small right effusion as well is right base atelectasis." }, { "input": "A small amount of aerated lung is seen in the left chest laterally. A few air bronchograms are visualize. Otherwise, the left chest is opacified. There continues to be mediastinal shift to the left indicating that the left lung is at least partially collapsed. The more distal trachea and proximal left mainstem bronchus are now aerated, which is improved compared to the prior study however, the right mainstem bronchus is poorly visualized as are the more distal left-sided airways. There continues to be hazy opacity projecting over the right lung. Is unclear how much of this is due to patient's soft tissue or if there is an effusion layering posteriorly or and alveolar infiltrate on the right.", "output": "A small amount of improved aeration on the left with continued near complete opacification of the left hemi thorax" }, { "input": "As on the prior outside study there is near complete opacification of the left hemi thorax with mediastinal shift to the left did trachea is deviated to the left and the endotracheal tube tip is seen at the thoracic inlet with the carina not adequately visualized and NG tube tip is off the film, at least in the stomach. Right-sided PICC line tip is in the expected location of the cavoatrial junction the right lung has a hazy appearance with ill-defined vasculature. Some of this could be due to overlying soft tissues but pulmonary edema is likely also present. There is probably right pleural effusion.", "output": "Near complete opacification of the left hemi thorax. At the time of this dictation the patient had already undergone a bronchoscopy. Please see that report" }, { "input": "Overall no significant interval change from the prior exam. The patient is rotated. The ETT tip ends approximately 5 cm from the carina. The right subclavian PICC line ends in the mid SVC. The left pigtail drain projects over the lower left hemithorax. Bilateral left greater right pleural effusions are unchanged. Lung volumes remain low. Opacification of the left lower hemithorax with slight leftward shift despite coexisting pleural effusion suggests substantial atelectasis, overall similar. Moderate cardiomegaly persists. No pneumothorax. Opacities in the right hemithorax suggest pulmonary vascular congestion. Right pulmonary edema has since decreased.", "output": "Minimal interval decrease since ___ in mild right pulmonary edema. Otherwise, no significant interval change." }, { "input": "The patient is rotated. ETT tip is in standard position. The right subclavian PICC ends in the mid SVC. The left PICC catheter is incompletely visualized and its tip is not seen. An enteric tube traverses the diaphragm. Lung volumes remain very low. Moderate right pulmonary edema and dependent pleural effusion. Evaluation of the left lung is limited as the moderately enlarged heart and mediastinum obscures most of the left lung. Left pleural effusion and atelectasis is likely. Underlying pneumonia cannot be excluded. Of note, the patient has severe bronchomalacia on CT from ___.", "output": "1. Moderate right pulmonary edema and effusion. Limited evaluation of the left lung. 2. Pneumonia cannot be excluded and dedicated Chest CT would be required." }, { "input": "There has been some partial interval re-expansion of the left lung with some aerated lung seen laterally and superiorly. However there still large areas of consolidation in the left upper and lower lobes. Air bronchograms are visualized. There is small amount of decrease in the mediastinal shift again compatible with some interval re-expansion of the left lung the ET tube, NG tube and right-sided PICC line are unchanged. There is a new left-sided pigtail catheter projecting over the left lower lung There continues to be volume loss in the right lower lobe. There is new/ increased pulmonary vascular redistribution on the right suggesting increased pulmonary edema", "output": "Partial re-expansion of the left lung with worsening pulmonary edema" }, { "input": "Frontal and lateral views of the chest demonstrate normal cardiomediastinal silhouette. The lungs are clear. There is no pneumothorax or pleural effusion. No displaced osseous injury is evident.", "output": "No evidence of fracture or dislocation. No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Partially imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "A single portable upright radiograph of the chest demonstrates a right chest port with catheter terminating at the cavoatrial junction. There is a nasoenteric tube passing through the esophagus, through the stomach, and terminating inferiorly out of the field of view, possibly within the jejunum. The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal.", "output": "1. Nasojejunal tube, although terminating inferiorly out of field of view, is likely within the jejunum. 2. No acute cardiopulmonary process." }, { "input": "A right-sided indwelling catheter is present, with tip at cavoatrial junction. There is a small to moderate left pleural effusion, with underlying collapse and/or consolidation. No right-sided effusion is identified. No CHF, focal infiltrate, or pneumothorax is detected. Heart size is at the upper limits of normal. The aorta is minimally unfolded. The subpleural and perifissural pulmonary nodules described on the report of the ___ chest CT are not appreciated radiographically. Multiple drains/stents are seen in the right upper quadrant and upper mid abdomen.", "output": "1. Small to moderate left effusion with underlying collapse and/or consolidation. This has increased in size compared with ___. 2. No right-sided effusion (note is made that this was the side of clinical concern). 3. Tiny nodules seen on ___ chest CT are not appreciated radiographically." }, { "input": "Frontal and lateral views of the chest demonstrate a right port ending at the cavoatrial junction without evidence of disruption. The lungs are grossly clear. The cardiomediastinal and hilar contours are unchanged. There is no pneumothorax or pleural effusion.", "output": "Right Port ends at the cavoatrial junction. NOTIFICATION: Findings were paged to Dr. ___ by Dr. ___ on ___ at 14:45, 1 minutes after they were made." }, { "input": "A right-sided Port-A-Cath is in unchanged position with the tip at the cavoatrial junction. A nasogastric tube is present coursing below the diaphragm with the tip out of the field of view. Since the prior exam, there is a new large left pleural effusion with associated atelectasis. There is no right pleural effusion. There is no pulmonary edema or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "1. New large left pleural effusion. 2. Satisfactory position of the right Port-A-Cath with the tip at the cavoatrial junction." }, { "input": "An endotracheal tube is in place with the tip terminating approximately 3 cm above the carina. An enteric tube is seen coursing below the diaphragm and extending to the right and coiling back to the left of the spine, likely in post-pyloric position. An epidural catheter is in place. The lung volumes are low. There is mild bibasilar atelectasis. No focal consolidation, significant pleural effusion or pneumothorax is present. The pulmonary vasculature is mildly engorged without overt pulmonary edema. The mediastinal contours are prominent in the setting of low lung volumes but likely within normal limits.", "output": "1. Endotracheal tube tip 3 cm above the carina. 2. Low lung volumes and bibasilar atelectasis. 3. Mild pulmonary vascular congestion." }, { "input": "PA and lateral images of the chest demonstrate well expanded lungs which are clear. There is no pneumothorax or pleural effusion. Cardiomediastinal silhouette is unremarkable. A cervical fusion plate is visualized. Other visualized osseous structures are unremarkable.", "output": "Normal chest radiograph with no evidence of pleural disease on this exam." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. Compared to prior, there has been no significant interval change. There is no evidence of focal consolidation. Increased interstitial markings on one of the lateral views resolves on the second lateral view, likely due to improved inspiratory effort. Cardiomediastinal silhouette is unchanged, as are the osseous and soft tissue structures. Calcific densities projecting over the neck and left upper quadrant are unchanged, as are the vascular stents.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Sclerotic bones, splenic granulomas, vascular stents, and moderate cardiomegaly are again visualized. There is dense retrocardiac opacification compatible with volume loss/ infiltrate/effusion. There is also an infiltrate of right lower lobe partially obscuring the right hemidiaphragm. Other patchy alveolar infiltrates are seen in the right upper lobe and left mid lung. Overall the appearance is worsened compared to prior", "output": "New bilateral lower lobe volume loss./infiltrate. Infection is of concern" }, { "input": "There are diffusely increased interstitial markings throughout the lungs which are hyperinflated. There is no effusion or pneumothorax. Cardiac silhouette is enlarged but unchanged. Multiple vascular stents are again identified. Numerous punctate calcifications in the left upper quadrant are compatible with splenic granulomas. No acute osseous abnormalities identified.", "output": "Increased interstitial markings throughout the lungs bilaterally which can be seen in the setting of atypical infection or interstitial edema, likely superimposed on underlying emphysema." }, { "input": "The patient is rotated with his neck turned to the right. The tip of the tracheostomy tube appears appropriately positioned and unchanged. The configuration of the right subclavian vein and brachiocephalic vein stent appears similar to the prior chest CT with kinking of the stent at the level of the clavicle. The configuration of the left brachiocephalic vein stent is also similar to the prior CT. Bilateral right worse than left parenchymal opacities have progressed from the prior radiograph as well as CT, again concerning for multifocal infection and/or metastases. A right pleural effusion may be trace. The left pleural effusion may have resolved in the interim. No pneumothorax. The heart is normal in size. Mild prominence of the right mediastinum may correspond to the known mild ascending thoracic aortic aneurysm on prior CT. The size of the mediastinum is similar to the prior exam. Calcified right mediastinal lymph node is unchanged. Catheter projecting over the lower portion of the SVC is unchanged. Coils projecting over the left upper abdomen are also unchanged. Coarse calcifications projecting over the left upper abdomen are unchanged from the prior radiograph in correspond to splenic calcifications on the prior CT. Coarse calcifications in the soft tissue of the neck are unchanged from prior CT neck.", "output": "1. Interval progression of bilateral, right worse than left parenchymal opacities again concerning for multifocal infection and/or metastases. 2. Similar appearance of the mediastinum. 3. Probable small right pleural effusion, new from the prior exam. 4. Position of vascular stents with kinking of the right brachiocephalic/axillary vein stent is similar to the prior chest CT." }, { "input": "Single frontal view of the chest is obtained. Large area of consolidation in the right lung base is highly worrisome for pneumonia. The left lung is clear. Bilateral brachiocephalic stents are stable in position. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are stable. Innumerable rounded calcifications projecting over the spleen are again seen in this patient with history of prior granulomatous disease.", "output": "Right lower lung consolidation worrisome for infection/pneumonia. Recommend followup to resolution to exclude underlying mass." }, { "input": "Again, the bones are diffusely sclerotic. The somewhat limits assessment for underlying focal consolidation, however, previously seen multifocal consolidations bilaterally on ___ have significantly decreased in the interval. No definite new focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac silhouette is moderately enlarged. Mediastinal contours are stable. Several vascular stents are re- demonstrated.", "output": "Osseous sclerosis limits assessment for underlying focal consolidation. Interval decrease in pulmonary consolidations compared to ___. No definite new focal consolidation. Moderate cardiomegaly." }, { "input": "AP upright and lateral views of the chest provided. Vascular stents are noted in the left and right brachiocephalic vein. Calcifications in the left upper quadrant correspond with the spleen. Cardiomegaly is stable with interval increase in bilateral ground-glass opacity consistent with pulmonary edema. Subtle nodularity in the right lower lung raises potential concern for a superimposed pneumonia. No large effusion or pneumothorax is seen. The mediastinal contour is stable. Mild hilar engorgement is noted. Hyperdense appearance of the osseous structures are is consistent with renal osteodystrophy. No free air below the right hemidiaphragm is seen.", "output": "Cardiomegaly, mild edema, with possible superimposed pneumonia." }, { "input": "Vascular stents are again seen and stable from ___. There is no focal opacity, pleural effusions or overt signs of pulmonary edema. The cardiac and mediastinal contours are stable. The bones are diffusely sclerotic, likely secondary to renal osteodystrophy.", "output": "No acute cardiopulmonary process." }, { "input": "Vascular stents are unchanged in position. No focal consolidation is seen. There is no large pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "CHEST, SINGLE AP PORTABLE VIEW The carina is not well delineated. Allowing for this, the ET tube lies approximately 4.6-5.3 cm above the carina. An NG tube is present -- the tip extends beneath diaphragm, off film. Additional tubing is looped over the upper abdomen in the midline. A right IJ sheath is present, tip over distal IJ, proximal to its point of confluence with the subclavian vessel. Of note, a stent is present in this location. An additional stent is seen along the expected course of the left innominate vein. The lungs are hyperinflated. The heart lies to the left of midline, raising the question of some volume loss on the left side. There is increased retrocardiac density. There are prominent interstitial markings in both lungs, of uncertain etiology or significance. The hila are obscured by the interstitial markings. No gross effusion. Innumerable calcific densities in the spleen suggest prior granulomatous disease. Two calcified nodes are also seen along the expected course of the splenic artery. Question also a calcified node in the neck. The bones appear diffusely dense. Compared to ___, no definite change is detected. Increased retrocardiac density consistent with left lower lobe collapse and/or consolidation is again seen.", "output": "1. Right IJ sheath position appears slightly proximal to the right subclavian vein at the site where a stent is seen. There is also kinking of the sheath at the skin. Correlation with specifics of clinical presentation is requested.Targeted review of the report from a ___ chest CT refers to occlusion of the left subclavian vein stent. 2. Left lower lobe collapse and/or consolidation and minimal patchy opacity at the right base, unchanged. 3. Extensive calcified granulomas, similar to prior. 4. Diffusely increased osseous density. There is an extensive differential, which should be correlated with the clinical presentation. The differential includes changes due to osteodystrophy. In the appropriate clinical setting, osteosclerosis could have a similar appearance." }, { "input": "The tracheostomy tube midline and unchanged. The right subclavian and brachiocephalic vein stent appears similar to prior. The left brachiocephalic stent is unchanged. The vascular catheter coursing through the IVC terminates in SVC. The diffuse bilateral lung opacities have increased slightly. This is concerning for multifocal pneumonia. The opacities in the left lung appears or nodule and discrete. With known history of squamous cell carcinoma of the tongue, nodular metastases is on the differential. Bilateral lower lobe atelectasis is stable. The mild to moderate right pleural effusion is stable. Minimal pleural effusion in the left lung. No pneumothorax. Mediastinal silhouette is unchanged. Splenic ossification is again seen and unchanged. The visualized vertebrae appear more sclerotic which could represent osseous metastases.", "output": "1. Increased diffuse opacification is concerning for multifocal pneumonia. 2. The left lung discrete nodular opacities are also worrisome for nodular metastases. 3. The sclerotic vertebrae are concerning for osseous metastases." }, { "input": "There bilateral regions of consolidation, at the right lung and left mid to lower lung. Findings are most concerning for bilateral infection. Moderate enlargement of the cardiac silhouette is unchanged. Multiple vascular stents are also noted. No acute osseous abnormalities. Splenic calcifications are again noted.", "output": "Bilateral parenchymal opacities, right greater than left compatible with pneumonia in the proper clinical setting. RECOMMENDATIONS: Repeat after treatment will be necessary to document resolution." }, { "input": "A focal consolidation is noted within the right upper lobe. There is no evidence of pleural effusion, pneumothorax, or pulmonary edema. Mild cardiomegaly is stable. Redemonstrated are right subclavian and left brachiocephalic vascular stents, unchanged in position from prior examination.", "output": "New right upper lobe consolidation compatible with pneumonia." }, { "input": "There is prominence of interstitial markings and perihilar engorgement consistent with mild pulmonary edema. The heart size is normal and there is no pleural effusion, pneumothorax or focal consolidation. Osseous structures are unremarkable.", "output": "Findings consistent with mild pulmonary edema." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. There is mild atelectasis in the right middle and right lower lobes. There is no pneumothorax, pleural effusion or focal consolidation. No definite displaced rib fracture identified.", "output": "1. Mild atelectasis in the right middle and right lower lobes. 2. No definite displaced rib fracture identified." }, { "input": "PA and lateral views of the chest. The lungs, mediastinum, hilar and pleural sinuses are normal. No evidence of pneumonia. No pleural effusion or pneumothorax. No pulmonary edema.", "output": "No radiographic evidence of acute cardiopulmonary process." }, { "input": "Mild elevation of the right hemidiaphragm is stable.The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. There is no evidence of free air beneath the diaphragms.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation, effusion or vascular congestion. Cardiac silhouette is top normal, similar to prior. There is tortuosity of the descending thoracic aorta. Hypertrophic changes are noted in the spine.", "output": "No acute cardiopulmonary process." }, { "input": "Again seen is mild lower thoracic spine levoscoliosis. The cardiomediastinal silhouettes are unchanged, and within normal limits. The hila are unremarkable. Aortic arch calcifications are again seen. Mild diffuse interstitial prominence may relate to chronic age-related changes, unchanged in comparison to prior radiographs. There may be mild diffuse peribronchial wall thickening, suggestive of small airways inflammation. No focal lung consolidations are seen. The lungs are hyperinflated. There is no evidence of pulmonary vascular congestion. There is no pneumothorax or pleural effusion.", "output": "Mild peribronchial cuffing may represent small airways inflammation in the appropriate clinical setting. Hyperinflated lungs, as on prior. No focal lung consolidations." }, { "input": "Normal cardiomediastinal and hilar contours. Hyperinflated lungs reflect underlying COPD. New bronchial cuffing and fine linear opacities at the left base may reflect aspiration or asymmetric pulmonary edema. Similar opacities were seen at the right base on ___ with subsequent resolution on later radiographs and this pattern of rapidly emerging and resolving basilar opacities suggests recurrent aspiration. Normal pleural surfaces.", "output": "New bronchial cuffing and recurrent linear opacities at the left base likely reflect repeat aspiration or asymmetric pulmonary edema. Suggest close follow-up to evaluate possible early broncho pneumonia RECOMMENDATION(S): Suggest close follow-up to evaluate possible early broncho pneumonia NOTIFICATION: Findings were communicated to Dr. ___ at 16:20." }, { "input": "Left lower lobe consolidation has mildly worsened. Improved left perihilar infiltrate. Tiny left pleural effusion has improved. Thoracolumbar curve. Postoperative changes upper abdomen. Mild volume loss in the left chest stable. Right lung is clear. Normal pulmonary vascularity and heart size.", "output": "Increase consolidation left lung base, with stable mild volume loss, possibly all from atelectasis, component of pneumonitis cannot be excluded. Improved now tiny left pleural effusion." }, { "input": "PA and lateral views of the chest provided. The lungs are hyperinflated and clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Mesh projects over the anterior upper abdomen.", "output": "Hyperinflated lungs without superimposed pneumonia." }, { "input": "Persisting retrocardiac opacity, consistent with pneumonia. No pleural effusion or pneumothorax identified in either lung. The size of the cardiac silhouette is enlarged but unchanged.", "output": "No significant interval change since the prior examination with a persisting retrocardiac consolidation concerning for pneumonia." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Moderate bilateral pleural effusions and interstitial edema is unchanged. Left lower lobe atelectasis is also again seen. Left PICC ends in the low SVC. The endotracheal tube ends 4.6 cm from the carina. Mediastinal clips are seen. Cervical fusion hardware is seen.", "output": "Unchanged moderate bilateral pleural effusions and interstitial pulmonary edema with left lower lobe atelectasis." }, { "input": "The lungs are well expanded. There is increasing opacity in the right lateral mid lung field at the site of the prior chest tube, which likely represents fluid loculated within the major fissure. Cardiomediastinal silhouette is unremarkable. There is no pneumothorax or pleural effusion. Patient is status post gastric pull through with clips noted in the mediastinum.", "output": "Increasing focal opacity in the right lateral mid lung field at the site of the prior chest tube, which likely represents loculated fluid within the fissure." }, { "input": "Heart size remains mildly enlarged. Mediastinal and hilar contours are unchanged, with multiple clips noted in the left posterior mediastinum. Aortic knob is calcified. Hilar contours are unremarkable. There is no pulmonary edema. Small bilateral pleural effusions are again demonstrated with associated bibasilar opacities possibly reflecting atelectasis. Left PICC tip remains in unchanged position, terminating in the left brachiocephalic vein. There is no pneumothorax. Cervical spinal fusion hardware is partially imaged.", "output": "1. Small bilateral pleural effusions with probable bibasilar atelectasis. 2. Left PICC tip terminates in the left brachiocephalic vein." }, { "input": "No interval change in mild left lower lobe plate-like atelectasis. Lungs are otherwise clear and pleural surfaces are normal. Heart size, mediastinal contour and hila are normal. Mild aortic arch calcifications with tortuous aorta noted. No displaced rib fracture and cervical spine stabilization device is noted. Sclerotic appearance to right lateral ribs is worrisome for metastatic disease.", "output": "1. No radiographic evidence of displaced rib fracture. If clinical concern, consider dedicated rib series for further evaluation. 2. Sclerotic appearance to right lateral ribs is worrisome for possible metastatic disease. Preliminary results were conveyed via telephone to Dr. ___ by Dr. ___ on ___ at 1:10 p.m. within 5 minutes of observation of findings. Results were entered into critical results by Dr.___ on ___ to be conveyed to the referring physcian." }, { "input": "The patient is intubated. The endotracheal tube terminates approximately 4 cm above the carina. An orogastric tube terminates near the inlet of the diaphragm. A right internal jugular venous catheter terminates in the superior vena cava. There is again moderate unfolding of the thoracic aorta. Surgical clips also project over the lower-to-mid mediastinum. Mediastinal widening is consistent with post-operative change. There is new confluent left basilar opacification suggesting atelectasis in the left lower lobe of substantial extent with a pleural effusion, probably small to moderate in size. A small subpulmonic right-sided pleural effusion is difficult to exclude. There is also subcutaneous emphysema, small in amount, along the right lateral chest wall, as well as a right-sided chest tube. The patient is status post incompletely characterized lower cervical fusion. Moderate degenerative change involves the right shoulder.", "output": "Lines, tubes and drains as described above with post-operative changes, including post-operative mediastinal widening and left lower lobe opacification with a pleural effusion." }, { "input": "AP upright and lateral views of the chest were provided. A PICC line is unchanged, again seen terminating in the low SVC. Mediastinal clips are again noted as well as hardware in the cervical spine. There is pulmonary edema which is worsened in the interval with small bilateral pleural effusions. The heart size cannot be assessed. There is no pneumothorax. Degenerative changes at the left shoulder with high-riding left humeral head is again noted.", "output": "Worsening pulmonary edema." }, { "input": "Large bilateral pleural effusions have slightly decreased in size since ___. The left lower lobe remains collapsed. A left-sided PICC line terminates in the low SVC. No new airspace opacities are detected. There is mild central pulmonary vascular congestion, but no frank pulmonary edema. The heart is top normal in size. There is no pneumothorax.", "output": "1. Slight decrease or redistribution of large bilateral pleural effusions. 2. Persistent atelectasis of the left lower lobe. 3. No new airspace opacity to suggest infection, although lung bases are obscured, and no pulmonary edema." }, { "input": "A nodular opacity in the interspace between the anterior first and second right ribs is ill-defined. There is no pleural effusion or pneumothorax. The heart size is normal. The aortic knob is calcified.", "output": "A nodular opacity in the interspace between the anterior first and second right ribs is ill-defined. Shallow obliques are recommended. NOTIFICATION: ___ discussed with ___ ___." }, { "input": "Portable upright chest radiograph ___ at 10:45 is submitted.", "output": "Right chest tube remains in place. There is a stable small right apical pneumothorax. Stable right postsurgical changes status post right lower lobectomy. Residual subcutaneous emphysema in the right lateral chest wall. No pulmonary edema or focal airspace consolidation. Blunting of the right costophrenic angle may reflect residual small effusion or pleural thickening." }, { "input": "Right-sided chest tube has been removed and subcutaneous emphysema in the right chest has decreased. Small right apical pneumothorax is unchanged. Significant interval increase in the volume of a right paraspinal loculation of hydro pneumothorax, measuring 5.5 x 7.5 cm. A smaller, right lower lateral component of the air and pleural fluid is not appreciably changed since ___. The left lung is clear. The cardiomediastinal contours are unremarkable.", "output": "Small persistent left apical pneumothorax unchanged post right chest tube removal. Enlarged or new right paraspinal pleural air and fluid loculation, following removal of the right pleural drain, suggests small bronchopulmonary leak and possible superinfection. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the ___ ___ at 2:00 PM, 45 minutes after discovery of the findings." }, { "input": "PA and lateral views of the chest provided. Right lung volume loss reflects recent right lower lobectomy. There is persistent right pleural effusion not significantly changed from prior. Left lung remains clear. The cardiomediastinal silhouette is unchanged from prior. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "As above." }, { "input": "Portable upright chest radiograph ___ at 09:47 is submitted.", "output": "Interval decrease in size but persistent small right apical pneumothorax. Right chest tube remains in place. Overall the lungs are grossly clear. Surgical chain sutures in the right lower hemithorax consistent with known right lower lobectomy. No pulmonary edema. Cardiac mediastinal contours are within normal limits. Subcutaneous emphysema air within the right lateral chest wall. No large effusions." }, { "input": "Cardiac size is normal. There is moderate right pneumothorax. A right chest tube is in place. There are no large pleural effusions. Surgical chain projects in the right lower hemi thorax. There is mild right chest wall subcutaneous emphysema", "output": "Moderate right pneumothorax" }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. The left hemidiaphragm is slightly higher than the right, possibly due to a diaphragmatic eventration. This is unchanged from the prior exam.", "output": "No acute cardiopulmonary process." }, { "input": "Underpenetration of the radiograph secondary to overlying soft tissues. Low bilateral lung volumes. No focal consolidation, pleural effusion or pneumothorax identified. The size the cardiac silhouette is enlarged but unchanged. The tip of the right PICC line extends into the superior cavoatrial junction.", "output": "Low bilateral lung volumes. No focal consolidation identified." }, { "input": "There are low inspiratory volumes and underpenetration due to overlying soft tissues. Allowing for this, there is moderate to moderately severe cardiomegaly, straightening of left heart border trauma and effacement of the AP window. Mild prominence the right hilum is noted, but is likely accentuated by low inspiratory volumes. There is upper zone redistribution. There may be mild vascular plethora, but this is likely accentuated by low inspiratory volumes and underpenetration. No gross s right-sided effusion. The left costophrenic sulcus is clear. Minimal bibasilar atelectasis No calcified lymph nodes, apical scarring, hilar retraction and/or obvious calcified granuloma identified.", "output": "Limited evaluation due to low inspiratory volumes, underpenetration and absence of lateral view. Moderate to moderately severe cardiomegaly. Mild vascular plethora, without other evidence of CHF. No definite infiltrate. No gross effusion. If there is clinical concern for detailed evaluation of the mediastinum and hila, then cross-sectional imaging would help for further assessment." }, { "input": "There is no focal consolidation, effusion, or pneumothorax. Mild cardiomegaly is similar to prior. The cardiomediastinal silhouette is otherwise normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Left chest cardiac device and 2 lead tips appear in similar position compared to prior.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest. Left-sided pacemaker with the wires in appropriate position. There is no focal consolidation, pleural effusion, or pneumothorax. There is mild cardiomegaly. The mediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process. Mild cardiomegaly." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac, mediastinal and hilar contours are within normal limits. The pulmonary vascularity is normal. Lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are detected.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is status post median sternotomy and CABG. Mild cardiomegaly is re- demonstrated. Mediastinal and hilar contours are within normal limits. Mild upper zone vascular redistribution is again seen, but there is no pulmonary edema. No focal consolidation, pleural effusion or pneumothorax is identified. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Endotracheal tube tip is 2.8 cm from the carina. Enteric tube passes off the inferior field of view. There has been no change in the degree of pulmonary edema and bilateral opacities which may be due to layering effusions and atelectasis. The cardiomediastinal silhouette is unchanged. Median sternotomy wires are intact.", "output": "No significant interval change." }, { "input": "There is possible hyperinflation, which could reflect COPD. The patient is at status post sternotomy, with multiple mediastinal clips. There is moderate to moderately severe cardiomegaly, which appears stable compared with the chest x-ray dated ___. There is upper zone redistribution, without other evidence of CHF. No focal infiltrate or effusion is detected. Possible minimal pleural thickening at the base of the left lateral ribcage, unchanged . Degenerative changes noted in the thoracic spine.", "output": "1. Stable cardiomegaly, with sternotomy wires present. 2. Upper zone redistribution, without other evidence of CHF, unchanged. 3. No focal infiltrate or effusion. No free air seen beneath the diaphragm." }, { "input": "Endotracheal tube tip is approximately 1.5 cm above carina. Enteric tube tip is below diaphragm, not included on the radiograph. Sternotomy. There is increasing left basilar opacification, with associated volume loss, consistent with atelectasis, with probable component of mildly increasing effusion. Stable right basilar opacification, likely edema. There is stable probably mild right pleural effusion. It is difficult to estimate cardiac size cava left basilar opacification. No pneumothorax.", "output": "Significantly increased left lung opacification, with associated mild volume loss, likely at least in part from atelectasis, with probable component of worsening left pleural effusion. Stable right basilar opacity, likely edema." }, { "input": "The tip of the enteric tube is not seen, but the course is unremarkable as it passes under the diaphragm and out of view. There is no other significant change since 1 hr prior.", "output": "The tip of the enteric tube is not seen, but the course is unremarkable as it passes under the diaphragm and out of view." }, { "input": "There may be a very trace right pleural effusion. No large pleural effusion is seen. The patient is status post median sternotomy and CABG. The cardiac and mediastinal silhouettes are stable with the cardiac silhouette moderately enlarged. No pulmonary edema is seen. No pneumothorax is seen. On the lateral view, projecting over the posterior aspect of ___ mid thoracic vertebral bodies, there is a somewhat rounded opacity measuring 2 cm. While findings may be osseous in nature, it is more conspicuous as compared to the prior study, and underlying pulmonary lesion is not excluded. Recommend chest CT for further assessment.", "output": "On the lateral view, projecting over the posterior aspect of ___ mid thoracic vertebral bodies, there is a somewhat rounded opacity measuring 2 cm. While findings may be osseous in nature, it is more conspicuous as compared to the prior study, and underlying pulmonary lesion is not excluded. Recommend chest CT for further assessment. Possible very trace pleural effusion. Persistent cardiomegaly without pulmonary edema." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes, accentuating enlarged cardiac silhouette. The mediastinal and hilar contours are within normal limits. The lungs are clear. There is no pneumothorax, pulmonary edema, or large effusion. Median sternotomy wires are in place and post-CABG changes are noted. There is spondylosis in the mid thoracic spine.", "output": "No evidence of pneumonia. Stable cardiomegaly." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities are identified.", "output": "1. No acute cardiopulmonary process. 2. No evidence of a rib fracture. However, please note that a chest radiograph is suboptimal for evaluation of subtle rib fractures. If there is persistent clinical concern, recommend further evaluation with dedicated rib series." }, { "input": "2 new fiducial seen in the left left lower lung. Left lower lung opacity largely unchanged from ___ is presumably slowly resolving or recurrent pulmonary hemorrhage after lung biopsy. No definite pneumothorax is seen. Cardiomediastinal silhouette is largely unchanged. Cardiomediastinal silhouette is largely unchanged.", "output": "Post left CT guided left lung biopsy, no definite pneumothorax is seen." }, { "input": "New left small pneumothorax is seen. Left lower lung opacity largely unchanged from 2 hrs previously. ___ fiducial markers are seen in the area of left lower lung biopsy. Cardiomediastinal silhouette is unchanged.", "output": "New small left pneumothorax. NOTIFICATION: The finding was communicated to ___, MD." }, { "input": "Portable semi-upright radiograph of the chest demonstrates a normal cardiomediastinal silhouette and pulmonary vasculature. There is no pleural effusion or pneumothorax. No definite consolidation is identified.", "output": "No acute intrathoracic abnormality." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There are no pleural effusions or pneumothorax. Streaky opacities at the lung bases suggest minor atelectasis. Otherwise, the lungs appear clear. Pulmonary nodules mentioned in the recent CT report are not apparent on radiography. Bony structures appear similar. A sclerotic upper vertebral body, namely T3, appears likely unchanged, but not well visualized.", "output": "No evidence of acute disease. Known metastatic disease not well assessed on radiography." }, { "input": "Heart size is normal. The aorta is mildly tortuous. Mediastinal and hilar contours are otherwise unremarkable. Subsegmental atelectasis is noted in the left lung base. No focal consolidation, pleural effusion or pneumothorax is identified. Known pulmonary nodules are better assessed on the previous CT. No acute osseous abnormalities detected. Sclerotic metastases are also visualized better on the prior CT.", "output": "No acute cardiopulmonary abnormality. Known pulmonary nodules and osseous metastases are better assessed on the prior CT." }, { "input": "Lung volumes are mildly decreased with bibasilar atelectasis, more prominent on the left, overall similar from the prior examination. There is no lobar consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is unchanged in appearance. No displaced rib fracture is identified. Known mixed sclerotic and lytic lesions within the right coronoid process, right scapula, left anterior second rib, manubrium, and sternum are better visualized on the patient's previous CT chest examination.", "output": "Bibasilar linear atelectasis, left greater than right, without evidence of acute cardiopulmonary process." }, { "input": "Surgical clips are seen projecting over the left mediastinal region. Mild cardiomegaly and mild vascular congestion, but no pulmonary edema. No pleural effusion and no pneumothorax. No evidence of pneumoperitoneum.", "output": "1. Mild cardiomegaly and mild vascular congestion, but no pulmonary edema. No acute cardiothoracic process. 2. No pneumoperitoneum." }, { "input": "PA and lateral views of the chest were provided. Since the prior CT torso, there has been no significant change with innumerable bilateral pulmonary metastatic lesions again seen. Evaluation for superimposed pneumonia limited given the extensive metastatic burden, though no clear sign of superimposed pneumonia, effusion, or pneumothorax. Overall, cardiomediastinal silhouette is unchanged. Bony structures appear intact.", "output": "Innumerable pulmonary metastatic disease with no gross signs of superimposed acute process. Please refer to subsequent CT for further details." }, { "input": "Widespread pulmonary nodules consistent with diffuse metastatic disease appear unchanged. However, an area of coalescent opacification partially obscuring known mass is demonstrated within the left retrocardiac region, and could potentially be due to a developing area of infection given the clinical suspicion for this entity. Heart size remains normal. Enlargement of both hila consistent with known lymphadenopathy, and mediastinal lymph node enlargement is also present. Bilateral small pleural effusions are apparently new.", "output": "1. Possible developing pneumonia within the left lower lobe. Consider standard PA and lateral chest radiographs for more complete evaluation when the patient's condition permits. 2. Widespread pulmonary nodules and lymphadenopathy consistent with metastatic disease. 3. Small bilateral pleural effusions." }, { "input": "Frontal and lateral views of the chest are compared to CT torso from ___. Diffuse bilateral pulmonary nodules are seen scattered throughout the lungs bilaterally. There is no definite superimposed large confluent consolidation or effusion. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are grossly unremarkable. Surgical clips noted in the upper abdomen in the right upper quadrant compatible with prior right nephrectomy.", "output": "Significant burden of metastatic disease with innumerable bilateral pulmonary nodules. Although no definite superimposed consolidation is identified, small area of infection would be difficult to exclude given burden of disease." }, { "input": "AP and lateral views of the chest were performed, patient was positioned upright. There are innumerable round metastatic lesions within both lungs which appear essentially stable from the prior CT torso, though mild progression cannot be assessed. There is no clear evidence of a superimposed pneumonia. Please note, given the underlying metastatic disease, a subtle consolidative process is impossible to exclude. No effusion or pneumothorax. Cardiomediastinal silhouette is stable. Bony structures appear intact.", "output": "Innumerable pulmonary metastatic lesions, grossly stable. No clear sign of superimposed pneumonia, though evaluation limited given the extensive metastatic burden." }, { "input": "Portable upright chest radiograph is obtained. In comparison to the prior study, the lungs are better expanded and numerous bilateral metastases are better demarcated. The diffuse pattern of opacification caused by extensive metastatic disease makes it very difficult to appreciate any overlying consolidation; therefore pneumonia should be diagnosed clinically. Cardiomediastinal silhouette is unchanged. No pleural effusions and no pneumothorax.", "output": "No significant changes compared to the prior study." }, { "input": "The lungs are symmetrically expanded and aerated with no focal consolidation, pleural effusion or pneumothorax. The pulmonary vasculature is not engorged. The cardiac silhouette is normal in size. The cardiomediastinal and hilar contours are within normal limits. The visualized upper abdomen is unremarkable. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "A left pectoral pacemaker is unchanged with dual leads terminating in the right atrium and right ventricle. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The pulmonary vasculature is not engorged and there is no overt pulmonary edema. The cardiomediastinal and hilar contours are within normal limits with mild tortuosity of the thoracic aorta. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "There is mild prominence of the pulmonary vasculature without edema, likely due to fluid resuscitation. Minimally increase opacification of bilateral bases is likely due to overlying prominent pulmonary vasculature. The lungs are without focal consolidation, effusion, or pneumothorax. Cardiac and mediastinal silhouettes are normal. Two lead pacemaker appears in place. No acute fractures are identified.", "output": "No acute cardiopulmonary process." }, { "input": "Left pectoral pacemaker has leads terminating in the right atrium and right ventricle. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The heart is not enlarged. The mediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. Lungs are well expanded. There is no focal consolidation. There is no pleural effusion or pneumothorax. The right PICC line tip is seen at the confluence of the brachiocephalic veins. The left-sided pacemaker leads terminate in the right atrium and right ventricle, expected locations. There is moderate amount of free air within the abdomen. Visualized osseous structures are grossly unremarkable.", "output": "1. No radiographic evidence of acute cardiopulmonary process. 2. Moderate amount of free air within the abdomen, likely related to recent PEG tube placement. These findings were discussed with ___ by Dr. ___ on ___ at 12:00 PM, time of discovery." }, { "input": "AP and lateral views of the chest. A pacer is seen overlying the left anterior chest with intact leads in appropriate position. The lungs well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is a right-sided PIC line which terminates proximal to the origin of the SVC. The enteric tube coils in the lower esophagus, with the tip at the mid esophagus. There is a left-sided pacemaker with the leads terminating in the right atrium and right ventricle respectively. The heart size is normal. The hilar and mediastinal contours are normal. There is no focal consolidation. There is no pleural effusion or pneumothorax.", "output": "Enteric tube coils in the lower esophagus, with the tip extending superiorly to the mid esophagus. These findings were discussed with Dr. ___ by Dr. ___ by telephone at 10:08 am on the day of the exam, who indicated that they were aware of the findings and that the tube already had been pulled out." }, { "input": "Frontal and lateral views of the chest were obtained. The left-sided pacemaker is seen with leads extending to the expected position of the right atrium and ventricle. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable with the cardiac silhouette top normal.", "output": "No acute cardiopulmonary process." }, { "input": "There is a right-sided PIC line which terminates proximal to the origin of the SVC. There is an enteric tube which courses below the diaphragm with the tip in the fundus of the stomach. There is a left-sided pacemaker with the leads terminating in the right atrium and right ventricle respectively. The heart size is normal. The hilar and mediastinal contours are normal. There is no focal consolidation. There is no pleural effusion or pneumothorax.", "output": "Enteric tube ends in the gastric fundus." }, { "input": "A left-sided pacemaker with right atrial and right ventricular leads not significantly changed in position. A right PICC ends in the mid SVC, as before. A new Dobbhoff tube ends within the uppermost portion of the stomach, although a large component of the floppy distal end of the catheter is positioned within the distal esophagus. The lungs are clear. The heart size is normal. Mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen.", "output": "1. Newly placed Dobbhoff tube ends in the uppermost portion of the stomach. Recommend advancement. 2. No acute cardiac or pulmonary process. Findings were discussed with by Dr. ___ by Dr. ___ at 4:08 p.m. via telephone on the day of the study." }, { "input": "Single frontal radiograph of the chest. Left-sided pacemaker leads terminating in the right atrium and right ventricle in unchanged position. Normal heart size. Stable mediastinal and hilar contours. Clear lungs. No pleural effusion or pneumothorax. No displaced rib fracture.", "output": "No pneumonia." }, { "input": "The lungs are well expanded and clear. There is no pneumothorax, pleural effusion, pulmonary edema, or focal airspace consolidation. Minimal linear atelectasis is present in the left lung base. The cardiomediastinal silhouette is unremarkable. No displaced rib fractures are identified.", "output": "No radiographic evidence of displaced rib fracture. If clinical concern remains for radiographically occult fracture, dedicated rib series radiographs or CT of the chest is recommended. No acute cardiopulmonary process." }, { "input": "Compared to chest radiographs from ___, large left pleural effusion has significantly improved with re-expansion of the left lung. Left chest tube remains in place. The right lung is clear. No appreciable effusion on the right. No pneumothorax. No focal consolidation. No pulmonary edema. Cardiomediastinal silhouette is normal.", "output": "Significantly improved loculated left pleural effusion, now small, with re-expansion of the left lung. No pneumothorax." }, { "input": "A left-sided chest tube is in place within a large left-sided probable loculated effusion, better assessed on prior CT from ___, with compressive atelectasis of the left lower and upper lobes. No pneumothorax. The right lung is unremarkable without focal consolidation, effusion or pneumothorax. No central vascular congestion or overt pulmonary edema in the aerated portions of lung. Cardiac size is difficult to assess in the presence of a large effusion, though appears within normal limits.", "output": "Left-sided chest tube present within a large, likely loculated left effusion with compressive atelectasis of the left lung. No pneumothorax." }, { "input": "The patient remains intubated with the endotracheal tube terminating at the thoracic inlet. An orogastric tube terminates in the lower esophagus. A dual-lead pacemaker/ICD device appears unchanged. What is new, however, is a right internal central jugular venous catheter that terminates in the upper superior vena cava. The cardiac, mediastinal and hilar contours appear stable. There is similar opacification of the left lung base obscuring cardiac borders as well as the left hemidiaphragm, suggesting potential combination of consolidation or atelectasis, probably with some degree of pleural effusion. Hazy indistinct bronchovascular structures suggest mild fluid overload, but not increased. There is no pneumothorax.", "output": "New right internal jugular catheter terminating in the superior vena cava; no pneumothorax identified. Persistent left basilar opacification. Suspected mild fluid overload." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. The imaged upper abdomen is unremarkable. The bones are intact.", "output": "No acute cardiopulmonary process." }, { "input": "Right-sided Port-A-Cath terminates in the low SVC without evidence of pneumothorax. Cardiac and mediastinal silhouettes are stable. There is blunting of the left costophrenic angle most likely due to a small pleural effusion/pleural thickening. No definite focal consolidation is seen. Degenerative changes are seen along the spine. The partially imaged right humeral prosthesis. No pulmonary edema is seen.", "output": "Blunting of the right costophrenic angle may be due to pleural thickening versus trace pleural effusion. No focal consolidation." }, { "input": "Patient is status post median sternotomy and aortic valve replacement. Heart size is normal. The aorta is mildly tortuous and the known aneurysmal dilatation of the ascending aorta is better appreciated on the prior CT. Hilar contours are unremarkable. Pulmonary vasculature is normal. Lungs are hyperinflated with atelectasis noted at the lung bases. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. A VP shunt catheter is seen coursing along the right lateral neck, right anterior chest wall, and into the right upper quadrant of the abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "ET tube is in appropriate position 4.4 cm above the carina. There is no pneumothorax or other complication seen. There has been interval improvement in the right lower lobe consolidation. There is decreased vascular congestion compared to previous exam. There are small bilateral pleural effusions. Cardiomediastinal silhouette is unchanged. The right internal jugular central line has been removed since prior exam.", "output": "ET tube in appropriate position. Interval improvement of vascular congestion and right lower lobe opacity. Small bilateral pleural effusions." }, { "input": "Frontal and lateral radiographs of the chest demonstrate mildly hyperexpanded, clear lungs. The cardiomediastinal and hilar contours are unchanged. The heart remains mildly enlarged. The hila are persistently prominent, likely due to hyperinflation. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "Portable AP upright chest radiograph obtained. The lungs are clear without focal consolidation, effusion, pneumothorax. The heart is mildly enlarged with a left ventricular configuration. Mitral annular calcifications are seen. There is no pneumothorax or pleural effusion. No gross osseous abnormality is seen.", "output": "Mild cardiomegaly, otherwise unremarkable." }, { "input": "PA and lateral views of the chest were provided. Patient is slightly rotated to the left. No signs of pneumonia or CHF. No pleural effusion or pneumothorax. Cardiomediastinal silhouette appears normal. Bony structures are intact. DISH related changes of the T-spine noted.", "output": "No signs of pneumonia or other acute intrathoracic process." }, { "input": "Low lung volumes are present. The heart is mildly enlarged. Superior mediastinum is widened, though this partially may be due to supine positioning and low inspiratory volumes. Crowding of the bronchovascular structures is noted, but no pulmonary edema is seen. Hazy rounded opacity is seen within the left mid lung field, which is nonspecific but could reflect an area of contusion. No focal consolidation, pleural effusion or pneumothorax is present. No displaced fractures are visualized.", "output": "1. Widening of the superior mediastinum may be due to low lung volumes and supine positioning. However, if there is continued clinical concern for mediastinal injury, then a dedicated chest CTA is suggested. 2. Nonspecific ill-defined opacity within the left mid lung field. This could reflect an area of contusion. 3. No displaced rib fractures are identified." }, { "input": "No focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "There are low lung volumes. Subtle right basilar opacity is most likely due to overlying vascular structures without definite focal consolidation seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No definite focal consolidation." }, { "input": "There has been no significant interval change since the radiograph from 13:20 from the same day. Lung volumes are somewhat low. There is a left pectoral cardiac pacing device with its leads projecting over the region of the right atrium and right ventricle. The cardiac silhouette is mildly prominent. Calcifications are again noted along the aortic arch. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. There is no pulmonary edema. Bony structures appear intact.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal contours are stable with a severe cardiomegaly. Right lower lobe consolidation has minimally improved. Continued followup is recommended to assess complete resolution. Left retrocardiac opacities are grossly unchanged. The upper lungs are grossly clear. . There is no pneumothorax or pleural effusion. Moderate degenerative changes through the thoracic spine are again noted", "output": "Right lower lobe consolidation has mildly improved continue followup is recommended to assess complete resolution CXR in 4 - 6 weeeks. Retrocardiac opacities are grossly unchanged. NOTIFICATION: The impression and recommendation above was entered by Dr. ___ on ___ at 11:53 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "The heart size top normal. Mediastinal contours are unremarkable. Mild prominence of the left hilum is present. New consolidation in the right middle and right lower lobe is consistent with pneumonia in the correct clinical setting. In addition there is left perihilar consolidation as well as left lower lobe opacity, also concerning for infectious process as well. There is no large pleural effusion or pneumothorax.", "output": "1. New multifocal consolidations concerning for multifocal pneumonia. 2. New mildly prominent left hilus may represent reactive lymphadenopathy. Attention on follow-up is recommended." }, { "input": "AP upright and lateral views of the chest provided. Cardiomegaly is noted with pulmonary vascular congestion and mild pulmonary edema. Lung volumes are somewhat low. There are small bilateral pleural effusions. No pneumothorax. Mediastinal contour is stable. Previously noted lines and tubes have been removed.", "output": "Mild pulmonary edema, persisting cardiomegaly, small bilateral pleural effusions." }, { "input": "The bilateral lower lobe opacification has slightly improved. Otherwise there is no consolidation. The hila and pulmonary vasculatures are normal. The bilateral pleural effusion has improved. No pneumothorax. The cardiomegaly is unchanged. The mediastinum is normal. No fractures.", "output": "1. Improved bilateral lower lobe opacities and bilateral pleural effusion. 2. No new cardiopulmonary process." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs demonstrate mild bibasilar atelectatic changes, although are without focal consolidation, pleural effusion, or pneumothorax. Degenerative changes of the thoracic spine are seen.", "output": "Mild bibasilar atelectatic changes without focal consolidation, pleural effusion, or pneumothorax." }, { "input": "Lungs are fully expanded and clear. There is no focal consolidation, effusion, or pneumothorax. Hilar structures are symmetric with diameter at the upper limit of normal. Mediastinal contours are normal. Moderate cardiomegaly is unchanged. Prosthetic mitral and tricuspid valves are in place.", "output": "No pulmonary edema or evidence of cardiac decompensation." }, { "input": "PA and lateral views of the chest provided. Previously noted PICC line has been removed. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process. Intervally resolved pleural effusions." }, { "input": "PA and lateral views of the chest provided. Moderate, bilateral pleural effusions are seen. Bilateral, lower lung opacities likely represent moderate bibasilar atelectasis more likely than pneumonia. Imaged osseous structures are intact.", "output": "Moderate, bilateral pleural effusions and associated moderate bibasilar atelectasis are noted." }, { "input": "2 views of the chest. The lungs are well expanded. Peribronchial cuffing is present in the perihilar region and a confluent opacity is seen in the right lower lobe in the infrahilar area. There is no pleural effusion or pneumothorax. The heart and mediastinal contours are unremarkable.", "output": "Peribronchial cuffing suggetsing bronchitis with possible early focus of pneumonia in the right lower lobe. Findings discussed with Dr. ___ by Dr. ___ by phone at ___, the time of discovery, on ___." }, { "input": "The heart is at the upper limits of normal size. There is mild unfolding of the thoracic aorta. The lungs appear clear. There are no pleural effusions or pneumothorax. Small osteophytes are noted along the thoracic spine.", "output": "No evidence of acute disease." }, { "input": "No displaced rib fracture is detected on these lung technique films. Linear atelectasis is seen at the lung bases. There is a tortuous descending aorta. Cardiac and mediastinal contours are otherwise within normal limits. There is no pleural effusion or pneumothorax. The pulmonary vascularity is normal. The right hemidiaphgram is elevated. Clips are seen in the upper abdomen posteriorly.", "output": "1) Minimal atelectasis. Otherwise, no acute pulmonary process. 2) No displaced rib fracture detected on these lung-technique films." }, { "input": "The heart is mildly enlarged and there is mild interstitial edema. Fluid is noted within a fissure on the lateral projection. There is a nonspecific patchy infrahilar opacity in the right lung. There is no pneumothorax. The imaged upper abdomen is unremarkable tear.", "output": "1. Mild pulmonary edema and small bilateral pleural effusions. 2. Patchy right infrahilar opacity. Recommend repeat radiograph after diuresis to exclude infection or aspiration pneumonia." }, { "input": "No focal consolidation is seen. There is no pleural effusion or pneumothorax. Costochondral calcification is seen bilaterally, most notably on the right. . The cardiac silhouette remains enlarged. The aorta is tortuous. Surgical clips were again noted in the epigastric region, at the level of the gastroesophageal junction.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac and mediastinal silhouettes are stable. Prominent anterior costochondral calcification is seen. Surgical clips are noted again projecting over the epigastrium. The lungs remain relatively hyperinflated. There is minimal atelectasis without focal consolidation. No large pleural effusion or pneumothorax is seen.", "output": "No significant interval change." }, { "input": "PA and lateral chest radiographs demonstrate no focal consolidation, pleural effusion, or pneumothorax. A nodular opacity identified in ___ is no longer seen. The cardiomediastinal silhouette is within normal limits.", "output": "No acute cardiopulmonary abnormality. Findings were relayed to Dr. ___." }, { "input": "There is moderate amount of free air below the right hemidiaphragm, new since ___. The cardiomediastinal silhouette and hila are normal. There is a small left pleural effusion and associated basilar atelectasis. There is moderate osteopenia and kyphosis.", "output": "Moderate amount of pneumonperitoneum. Discussed with Dr. ___ by phone at 3.___ pm, ___ by Dr. ___." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest. The lungs are clear of consolidation, effusion, or pulmonary vascular congestion. Note is made of an azygos lobe. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "Four frontal images of the chest were obtained. One pair of images demonstrates an NG tube overlying the right chest. Due to patient positioning, it is unclear exactly where this tube is located, particularly since there is no lateral view. The other pair of images demonstrates an NG tube with the tip in the stomach. After discussing with the medical team, it appears that this is the latter pair of images. Again seen is a left lower lobe parenchymal density and pleural effusion, unchanged from previous imaging. The right lung is clear. There is no evidence of flash pulmonary edema and, given that the opacity seems localized to the left lower lobe, a pneumonic or pleuritic etiology is more likely. This could include a possible infectious etiology in the left lower lobe. The cardiomediastinal silhouette cannot be fully assessed due to bordering left lung opacities, but the heart appears normal in size. Gaseous distention of the large and small bowel is again seen.", "output": "Nasogastric tube is seen on the second pair of images to be in place with the tip in the stomach. Left lower lobe opacity and left pleural effusion suggestive of a left lower lobe pneumonia or focal process rather than a generalized flash pulmonary edema. These findings were communicated by phone to Dr. ___ at 2:44 p.m." }, { "input": "Single portable view of the chest. No prior. Endotracheal tube is seen with tip approximately 4 cm from the carina. Nasogastric tube seen off the inferior field of view, side port just past the GE junction. Lungs are clear of focal consolidation. Small calcific density projecting over the anterior left first rib could be calcified granuloma or potentially a bone island. Cardiomediastinal silhouette is within normal limits noting a slightly tortuous aorta with some atherosclerotic calcifications. Osseous and soft tissue structures are unremarkable.", "output": "Endotracheal tube tip 4 cm from the carina. No definite acute cardiopulmonary process." }, { "input": "Compared to chest radiographs from ___, right infrahilar, right basilar, retrocardiac and left basilar opacities have increased, concerning for worsening atelectasis or aspiration. There is increasing central vascular congestion and new moderate pulmonary edema. Small right pleural effusion has worsened. No appreciable effusion on the left. No pneumothorax. Mildly tortuous and calcified thoracic aorta is stable. ETT in standard placement, unchanged. Left subclavian central line terminates in the upper right atrium. Enteric tube descends below the diaphragm and out of the field-of-view.", "output": "1. Increased central vascular congestion with new moderate pulmonary edema. 2. Worsening small right pleural effusion. 3. Increased right infrahilar, right basilar, retrocardiac and left basilar opacities, suggestive of worsening atelectasis or aspiration." }, { "input": "Lungs are grossly clear given patient's positioning. Relative elevation of the right hemidiaphragm is noted. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Prior right IJ central venous line is no longer seen. The lungs are clear of consolidation. The cardiomediastinal silhouette is stable. No acute osseous abnormalities identified. Healed posterior right seventh rib fracture is again noted.", "output": "No acute cardiopulmonary process." }, { "input": "The ETT terminates 3.7 cm above the carina. A feeding tube terminates in the stomach with the side hole at the level of the diaphragm. Diffuse hazy opacities are seen throughout the lungs bilaterally. More focal consolidative opacities are seen adjacent to the right hilum and in the left upper lung laterally. Findings may represent moderate to severe pulmonary edema, but cannot exclude an underlying pneumonia or aspiration in the right clinical setting. No pneumothorax is seen. The cardiomediastinal silhouette is partially obscured by the adjacent opacities but may be slightly enlarged.", "output": "1. ET tube terminates 3.7 cm above the carinal. 2. Bilateral parenchymal opacities, potentially moderate to severe pulmonary edema, ARDS or diffuse infection." }, { "input": "The lungs are essentially clear. There is no effusion or edema. The cardiomediastinal silhouette is within normal limits. Prominent extrapleural fat seen laterally on both sides. No acute osseous abnormalities. Old anterior right sixth and seventh rib fractures are noted.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is borderline in size. The aorta is mildly tortuous with calcification along the arch. There is no pleural effusion or pneumothorax. In addition to a very mild diffuse interstitial process, probably vascular congestion, there is a focal opacity that includes some tethering to the right apical pleural surface with streaky opacities and volume loss, somewhat suggestive of chronic scarring. Right suprahilar opacity appears irregular but not very dense, possibly an additional area of scarring, less likely pneumonia; however primary neoplasm is also a differential diagnosis.", "output": "1. Mild interstitial abnormality as the suggestive of vascular congestion. Differential considerations may also include atypical pneumonia in the appropriate setting. 2. Focal right suprahilar and right apical peripheral opacities. These may be due to chronic scarring but other etiologies including acute infection or even primary neoplasm are not excluded by this study. Comparison with any prior studies is recommended, if available; otherwise short-term follow-up evaluation with chest CT is recommended to reassess." }, { "input": "Portable frontal radiograph of the upper abdomen and chest demonstrates an enteric tube with tip within the stomach. An electronic device projecting over the right hemithorax obscures the underlying lung parenchyma. Stable heart and mediastinal contours. No large pleural effusion. The lung apices are is not included on this image.", "output": "Weighted feeding tube in the stomach." }, { "input": "A portable view of the chest shows a Dobbhoff tube ending in the proximal stomach. Electronic pack projects over the right upper chest with leads coursing upward. Minimal atelectasis is noted at the lung bases. The lungs are otherwise clear. Cardiomediastinal contour is unchanged. There is no pneumothorax.", "output": "Dobbhoff ends in the proximal stomach." }, { "input": "PA and lateral views of the chest provided. There is an electronic device projecting over the right chest wall with leads extending to the right neck. Lung volumes are low. No definite consolidation, effusion or pneumothorax is seen. The heart and mediastinal contours are normal. No definite osseous abnormality is seen.", "output": "No acute findings in the chest." }, { "input": "Single portable semi-upright chest radiograph demonstrates a Dobbhoff catheter with tip in the fundus of the stomach just beyond the GE junction. A wire is still in place. Recommend advancing several centimeters to secure access. No other enteric catheter or central venous line identified. Electronic pack projects over the right upper chest with leads coursing upward, possibly a deep brain stimulator. Minimal atelectatic changes are noted in the lung bases, left greater than right. No pneumothorax or pleural effusion identified.", "output": "Dobbhoff enteric catheter with tip in the fundus close to the gastroesophageal junction. Recommend advancing several centimeters." }, { "input": "Redemonstrated is an electrical device overlying the right anterior chest with intact leads extending to the right neck, compatible with a deep brain stimulator. No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. The cardiomediastinal silhouette is stable. No acute bony abnormality is detected.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "The lungs are clear without focal opacity, pulmonary edema, pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal. The osseous structures are without gross abnormality.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cephalization of the pulmonary vasculature is unchanged with mild interstitial opacification compatible with pulmonary vascular congestion and mild pulmonary edema, which is not significantly changed from ___. Small bilateral pleural effusions are unchanged. No focal consolidation or pneumothorax is present. The cardiac silhouette remains enlarged but stable. The mediastinal and hilar contours are within normal limits and unchanged. Compression fracture deformities in the lower thoracic spine are unchanged.", "output": "Minimal change in pulmonary vascular congestion and mild pulmonary edema with small bilateral pleural effusions from ___." }, { "input": "2 views of the chest. The lungs are well expanded and show cephalization of the pulmonary vasculature with mild interstitial opacities and new small bilateral pleural effusions. The heart is enlarged. The mediastinal silhouette and hilar contours are normal. No pneumothorax present.", "output": "Pulmonary vascular congestion with pulmonary edema and small bilateral effusions." }, { "input": "There are low lung volumes. There is a hazy opacity at the right lung base which may represent atelectasis but an infectious process cannot be excluded. Cardiomediastinal silhouette is slightly enlarged, similar to prior exam. There is no pneumothorax or pleural effusion.", "output": "Hazy opacity at the right lung base which may represent atelectasis but an infectious process is not excluded." }, { "input": "Portable AP upright chest radiograph obtained. Lung volumes are low, though lungs appear clear. No large effusion or pneumothorax. Cardiomediastinal silhouette appears normal. Imaged osseous structures are intact.", "output": "Low lung volumes, without acute intrathoracic process." }, { "input": "In comparison with the study of ___, there is little interval change. Continued enlargement of the cardiac silhouette with tortuosity of a diffusely calcified aorta. However, no evidence of acute focal pneumonia or pulmonary edema. Chronic interstitial changes are seen at the bases.", "output": "Little change." }, { "input": "The heart size remains mildly enlarged. The aorta is diffusely calcified and mildly tortuous. The hilar contours are unchanged. The pulmonary vascularity is normal. No focal consolidation, pleural effusion or pneumothorax is identified. Minimal interstitial opacity within the lung bases likely reflect chronic changes. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. There is no pulmonary edema. The heart is normal in size, and the mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Subtle bibasilar opacities seen on the frontal view, not substantiated on the lateral view, may be due to atelectasis and overlying vascular structures although a residual pneumonia is not excluded in the appropriate clinical setting. Comparison with prior would be helpful for further evaluation in this patient reportedly being diagnosed with pneumonia at an outside facility. No pleural effusion or pneumothorax is seen. There is no pulmonary edema. Aortic knob calcification is seen. The cardiac silhouette is not enlarged. There is moderate to severe compression deformity of a mid thoracic vertebral body of indeterminate age. Correlate clinically and for acuity.", "output": "Subtle bibasilar including left base retrocardiac opacity on the frontal view, not substantiated on the lateral view, may be due to atelectasis and overlying vascular structures, although residual pneumonia is not excluded in the appropriate clinical setting in this patient is recently diagnosed with pneumonia. Comparison with prior radiographs would be helpful. Moderate to severe compression of a mid thoracic vertebral body of indeterminate age. Correlate clinically for acuity." }, { "input": "AP upright and lateral views of the chest provided. Midline sternotomy wires noted. Right chest wall AICD is again noted with leads extending into the region of the right atrium and right ventricle. Abandoned left-sided leads are noted. There is opacity at the left mid and lower lung, slightly improved from prior though likely reflects persistent left effusion and basal atelectasis. Right lung is partially obscured by pacer device. Right lung appears grossly clear. Heart size cannot be assessed. Mediastinal contour is unchanged. Bony structures are intact. Degenerative changes partially imaged at the shoulders.", "output": "Persistent left mid and lower lung opacity which is concerning for atelectasis and pleural effusion. Minimal improvement compared with prior. No fracture." }, { "input": "Chest PA and lateral radiograph demonstrates unchanged mediastinal, hilar, and cardiac contours. Bibasilar opacifications are again evident with minimally improved aeration on the left. Overall, radiograph is relatively unchanged compared to scout image obtained as part of a ___ chest CT, at which time, the opacifications were most consistent with atelectasis. No new opacifications evident. A right-sided pacemaker has leads terminating in the right atrium and right ventricle. Abandoned pacer leads are also identified in the left chest. Sternotomy sutures are midline and intact.", "output": "Bibasilar opacifications, left greater than right. Findings similar to ___ CT, at which point, opacities corresponded with atelectasis." }, { "input": "PA and lateral views of the chest provided. There is left lower lobe consolidation, concerning for pneumonia. Chronic moderate cardiomegaly is again seen. Right-sided transvenous are in appropriate positions coursing toward the right atrium and right ventricle. Left-sided leads are in unchanged positions, terminating in the upper SVC and right ventricle.", "output": "Left lower lobe pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 4:11 PM, minutes after discovery of the findings." }, { "input": "Overall, lung volumes are slightly increased compared to the prior study, with associated improved aeration at both lung bases. Residual patchy opacities are present in the left retrocardiac region. Focal linear scar versus atelectasis within the lingula appears unchanged. Heart is upper limits of normal in size, and ICD pacing leads are unchanged in position, a right-sided pacer as well as abandoned leads from previous left-sided device. There are no pleural effusions or acute skeletal findings. Curvilinear calcifications along the anterior cardiac border on lateral view correspond to a known calcified left ventricular aneurysm.", "output": "1. Improved aeration at lung bases with residual patchy left lower lobe opacity remaining. 2. Calcified left ventricular aneurysm." }, { "input": "The patient is status post median sternotomy and coronary bypass surgery. ICD pacing leads are unchanged in position including abandoned leads. Stable mild cardiomegaly without evidence of congestive heart failure. Lung volumes remain low. Pleural and parenchymal scarring in the left mid and lower lung are unchanged since ___, but a new patchy left retrocardiac opacity is noted .", "output": "New patchy left retrocardiac opacity which may reflect patchy atelectasis, aspiration, or a developing pneumonia. Short-term followup radiographs may be helpful in this regard." }, { "input": "There is moderate cardiomegaly. The small left pleural effusion is unchanged compared to the prior exam. There appears to be mild interstitial edema. No new focal consolidations are identified. There is no pneumothorax. The transvenous right atrial and left ventricular pacer leads and right ventricular pacer defibrillator leads are unchanged in position compared to the prior exam.", "output": "No acute abnormalities identified to explain patients abnormal left base breath sounds." }, { "input": "Overall, appearances are very similar when compared to the prior study. Lung volumes remain low with a moderate left pleural effusion and left basal airspace opacity. This is likely due to atelectasis but infection cannot be excluded. The right lung appears grossly clear. A right chest wall pacemaker is unchanged in appearance. Leads from a previously removed pacemaker also seen. No pneumothorax seen. Mild prominence of the bilateral hila and pulmonary vasculature is similar in degree when compared to the prior study and consistent with a degree of congestive heart failure. Moderate cardiomegaly.", "output": "No significant interval change when compared to the prior study." }, { "input": "The lungs are moderately well expanded. Hazy opacity in the left lung base is similar to prior and likely represents known chronic atelectasis. The lungs are otherwise clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is enlarged. A pacer is seen overlying the right anterior chest with intact leads in appropriate position.", "output": "No acute cardiopulmonary process. Little change from prior." }, { "input": "No significant change from ___. Unchanged moderate cardiomegaly and unchanged pulmonary central vascular congestion. Unchanged moderate left pleural effusion. Left retrocardiac opacity has persisted and likely represents atelectasis although infection cannot be ruled out. Right-sided AICD is seen with the leads projecting over the right atrium and right ventricle. Abandoned left sided leads are also seen. There is no pneumothorax. Mediastinal wires are normal.", "output": "Moderate cardiomegaly and mild pulmonary central vascular congestion without evidence of pulmonary edema. Unchanged moderate left pleural effusion and left retrocardiac opacity likely representing atelectasis." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Incidental note is made of right AC joint arthropathy with bony hypertrophy and loss of joint space. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest. No prior. The lungs are clear of focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. No displaced fracture is identified.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is status post prior median sternotomy and CABG. A left chest wall dual lead pacemaker is present. A right central venous catheter is unchanged, the tip extending to the superior cavoatrial junction. No focal consolidation, pleural effusion or pneumothorax identified. Mild unchanged central pulmonary vascular congestion. The size and appearance of the cardiomediastinal silhouette is unchanged. Partially evaluated bilateral shoulder prostheses.", "output": "Unchanged central pulmonary vascular congestion without evidence for pulmonary edema." }, { "input": "The lungs are moderately well inflated. There is unchanged mild prominence of lung vasculature without frank pulmonary edema. Mild cardiomegaly. No pleural effusions. Left upper chest wall pacemaker and pacer wires, right-sided central venous catheter terminating at the cavoatrial junction, sternotomy sutures, bilateral humeral prosthesis, all remain unchanged compared to the prior radiograph.", "output": "1. Mild prominence of lung vasculature without pulmonary edema. 2. No pleural effusion or pneumothorax." }, { "input": "All the monitoring and support devices are unchanged within standard position. Patient is after sternotomy for cardiac surgery. Lung volume is still low but the left upper lobe opacification is reduced, likely for reabsorption of edema component. Also, the left base pleural effusion is reduced. The right basilar opacification is slightly increased for increased pleural effusion. Heart is still mildly enlarged. There is no pneumothorax.", "output": "Reduced left upper lobe opacification likely for reduced edema component. Reduced left base pleural effusion, but increase in the right base." }, { "input": "Left-sided pacer is re- demonstrated with leads terminating in the right atrium and right ventricle. The patient is status post median sternotomy, aortic valve replacement, and CABG. Heart size is mildly enlarged, unchanged. Mediastinal and hilar contours are similar. Mild upper zone pulmonary vascular redistribution is likely chronic without overt pulmonary edema. Lung volumes remain low with streaky opacities in the lung bases suggestive of atelectasis. No large pleural effusion or pneumothorax is present. Fusion hardware within the lumbar spine is partially imaged as well as hardware within the right humeral head.", "output": "Chronic mild pulmonary vascular congestion without overt pulmonary edema. Bibasilar atelectasis." }, { "input": "Right central venous catheter terminates in the right atrium. Left pectoral pacemaker and its leads are in unchanged position. Sternotomy wires are intact. Mild bibasilar opacities are likely atelectasis in setting of low lung volumes. Enlarged pulmonary vessels are slightly larger compared to ___. Mildly enlarged cardiac silhouette is similar to before. Trachea is mildly deviated to the left with luminal narrowing, similar to ___.", "output": "1. Slightly increased pulmonary vascular congestion compared to ___. 2. Trachea is mildly deviated to the left with luminal narrowing, similar to ___ but increased compared to ___. Possible etiologies may include enlarged thyroid or other mass. NOTIFICATION: The impression 2. was Discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 3:44 PM, 5 minutes after discovery of the findings." }, { "input": "Compared with the prior film, inspiratory volumes are lower. A right IJ line is present, tip overlying distal SVC, new compared with the prior film. Left-sided pacemaker is present, with lead tips over the right atrium and right ventricle. Prosthetic aortic valve again noted. The cardio mediastinal silhouette, including mild cardiomegaly, is unchanged. There is possible minimal upper zone redistribution. There is bibasilar atelectasis. No frank consolidation or gross effusion identified. Incidental note made of partially imaged bilateral shoulder prostheses.", "output": "As above." }, { "input": "The left-sided chest tube has been removed. No pneumothorax is visualized. Lung volumes are low and there is continued/increased infiltrate in the left upper lung. There continues to be retrocardiac opacity and a layering left effusion. Vascular plethora and patchy areas of alveolar edema are also seen on the right. The ET tube is 4.3 cm above the carina. The NG tube is in the stomach.", "output": "Markedly worsened appearance of the left upper lung." }, { "input": "PA and lateral views of the chest. The dual-chamber transvenous pacemaker leads are in the appropriate position in the right atrium and right ventricle. No pneumothorax, mediastinal widening or evidence of hemothorax. No pleural effusion. Mild cardiomegaly stable. Left mild basilar atelectasis. No evidence of pneumonia.", "output": "Dual-chamber transvenous pacemaker leads are in appropriate positions. No evidence of pneumothorax, mediastinal widening, or evidence of hemothorax." }, { "input": "Lung volumes are relatively low with bibasilar atelectasis. Superiorly, lungs are clear. There is no overt edema nor effusion. The cardiomediastinal silhouette is stable. Prosthetic aortic valve and left chest wall dual lead pacing device are unchanged. There is a new dual lumen right-sided central venous catheter with distal tip in the right atrium. Bilateral shoulder arthroplasties are noted as well as lumbar fixation hardware. .", "output": "Low lung volumes without definite acute cardiopulmonary process." }, { "input": "Sternotomy with valve prosthesis. Endotracheal tube tip is 4 cm above carina. Right IJ central line tip is near cavoatrial junction. Cardiac pacemaker. There is worsening of left basilar opacity. Left costophrenic angle is not fully seen. No pneumothorax. Shallow inspiration accentuates heart size, pulmonary vascularity. Pulmonary vascularity has mildly improved. Improved right basilar, perihilar opacities. Right shoulder arthroplasty.", "output": "Worsened left basilar opacity, may represent atelectasis, consider pneumonitis in the appropriate clinical setting. Pulmonary vascularity has mildly improved." }, { "input": "Enteric tube tip is in the mid stomach, new since prior. Improved bilateral perihilar, bibasilar opacities. Sternotomy, valve replacement. Bilateral shoulder arthroplasties. Cardiac pacemaker. Right IJ central line tip near cavoatrial junction. Postoperative changes in the spine, with hardware in place. Degenerative changes spine.", "output": "Enteric tube tip in the mid stomach. Improved pulmonary opacities." }, { "input": "There has been interval development of diffuse, mild to moderate interstitial pulmonary edema. A focal opacity seen in the right middle lobe may represent an early pnemonia in the appropriate clinical setting. Redemonstrated is stable moderate cardiomegaly with small bilateral pleural effusions. Mediastinal and hilar contours are stable. The patient is status post CABG with median sternotomy wires aligned and intact. A transvenous pacemaker is seen with leads terminating in right atrium and right ventricle.", "output": "1. Probable right middle lobe pneumonia. Recommend PA/lateral chest radiographs to confirm and further characterize the opacity. 2. Mild to moderate, diffuse interstitial pulmonary edema. 3. Stable moderate cardiomegaly with small bilateral pleural effusions." }, { "input": "Dual lead left-sided pacemaker is again seen extending to the expected positions of the right atrium and right ventricle. No focal consolidation is seen. There is slight blunting of the posterior costophrenic angles which may be due to very trace pleural effusions. There is slight prominence of the interstitium which may be due to minimal interstitial edema. The cardiac and mediastinal silhouettes are stable. Right proximal humerus hardware is seen but not well evaluated.", "output": "Possible trace pleural effusions and minimal interstitial edema." }, { "input": "No focal consolidation, pleural effusion, or pneumothorax is seen. Heart and mediastinal contours are within normal limits.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "There is a rounded opacity in the left lower lobe, with possible cavitation. Minimal ill-defined nodular opacities are also noted in the right upper and mid lung fields, suggestive of additional sites of infection. There is no evidence of pulmonary edema, pleural effusions, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Multifocal pneumonia, with predominant abnormality in the left lower lobe, where there is a rounded opacity with a suggestion of cavitation. A CT of chest should be consider for further assessment." }, { "input": "The lungs are hyperinflated with bullous emphysematous disease, again most pronounced in the lung apices. The heart size is normal. The mediastinal and hilar contours are unremarkable. No focal consolidation, pleural effusion or pneumothorax is present. Prominent interstitial markings within the lung bases are similar compared to the prior study, and may reflect a chronic interstitial lung disease. There are mild degenerative changes of the thoracic spine.", "output": "No acute cardiopulmonary abnormality. Severe bullous emphysema." }, { "input": "Cardiomediastinal and hilar silhouettes are normal size. There is no consolidation, pneumothorax, or pleural effusion. Screws are noted in the left proximal humerus. Anterior wedge compression fracture of T___ vertebral body is new compared to ___.", "output": "1. Cardiomediastinal silhouette is normal size. 2. Anterior wedge compression fracture of T___ vertebral body is new since ___. NOTIFICATION: The impression 2. Discussed with Dr. ___, ___D. by ___, ___D. on the telephone on ___ at 9:___ AM, ___ minutes after discovery of the findings." }, { "input": "Low lung volumes bilaterally. Probable mild left basilar atelectasis. There is blunting of the left costophrenic angle. Cardiomediastinal silhouette is unchanged. There is no pneumothorax.", "output": "No evidence of pneumonia. Probable mild left basilar atelectasis with blunting of the left costophrenic angle." }, { "input": "Lung volumes are low. There is a retrocardiac opacity, likely reflecting atelectasis. No right pleural effusion. There is mild cardiomegaly. An ET tube terminates approximately 4 cm above the carina. An enteric tube terminates in the stomach.", "output": "1. A enteric tube terminates in the stomach. 2. Low lung volumes, with atelectasis at the left lung base" }, { "input": "Bilateral low lung volumes. Elevated left diaphragm. Otherwise, the lungs are clear. There is no pneumothorax or pleural effusion. Cardiac size is unchanged.", "output": "No acute cardiopulmonary abnormality. Elevated left diaphragm." }, { "input": "Frontal and lateral views of the chest were obtained. The heart size and cardiomediastinal contours are normal. The lungs are hyperinflated, similar to prior, suggestive of COPD. No focal consolidation, pleural effusion, or pneumothorax. Wedging of three mid-thoracic vertebral bodies are new since ___.", "output": "Anterior wedging and compression deformity of three midthoracic vertebral bodies, new since ___. Please refer to subsequent T-spine CT for further details." }, { "input": "Supine frontal, upright AP, and upright lateral images of the chest were acquired. Exam is very limited due to portable technique and patient body habitus. The lung volumes are very low. With associated bronchovascular crowding. Supine positioning is responsible for substantial amount of vascular engorgement compared to prior exam in ___ when vessels were normal. This engorgement, along with patient body habitus, makes it difficult to tell if there is heart failure or not. No large pleural effusion is seen. The cardiac silhouette is enlarged.", "output": "Limited exam due to patient body habitus and portable technique. Supine positioning is responsible for substantial amount of vascular engorgement compared to prior exam in ___ when vessels were normal. This engorgement, along with patient body habitus, makes it difficult to tell if there is heart failure or not. No definite acute cardiopulmonary process." }, { "input": "There is ill-defined opacity overlying the left lower lobe which likely represents pneumonia. The right lung is clear. Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. Osseous structures are normal.", "output": "Ill-defined opacity overlying the left lower lobe compatible with pneumonia. RECOMMENDATION(S): Followup after treatment suggested to document resolution." }, { "input": "There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits. The aorta is partially calcified.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "There are some faint opacities in the right lower lobe. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits.", "output": "Right lower lobe opacities would be consistent with pneumonia in the proper clinical setting. Findings were discussed by Dr. ___ with Dr. ___ by phone at 3:10 p.m. on ___." }, { "input": "Lung volumes are slightly low. The cardiomediastinal silhouette is unremarkable. The central pulmonary vasculature appears mildly engorged. There is left basilar atelectasis. Minimal opacity is seen in the right infrahilar region and at the left base. No definite correlate is seen on the lateral view, however, in the appropriate clinical context, this may represent focal pneumonia. There is no pleural effusion or pneumothorax.", "output": "Right infrahilar and left basilar opacity, in the appropriate clinical context, may represent pneumonia." }, { "input": "Compared to exam on ___, there is no significant change. Lung volumes are low, with persistent pleural effusions and bibasilar atelectasis, though left lower lobe atelectasis appears improved. Upper lungs are clear. Heart size is top normal. Mild mediastinal venous engorgement is again seen. There is no pneumothorax. Enteric tube is seen traversing the mid thorax, below the diaphragm in terminating in the stomach, unchanged from prior.", "output": "1. Persistent small pleural effusions. Slightly improved left lower lobe atelectasis. 2. Unchanged coarse of enteric tube, terminating in the stomach." }, { "input": "Portable upright chest radiograph ___ at 18:10 is submitted", "output": "Nasogastric tube has its tip projecting over the stomach in satisfactory position. Lung volumes remain low with patchy bibasilar opacities which could reflect atelectasis and at least a small right layering effusion. A superimposed infectious process cannot be entirely excluded. No pulmonary edema. Cardiac and mediastinal contours are unchanged. No pneumothorax." }, { "input": "Opacity projects over the bilateral costophrenic angles due to overlying soft tissue. No definite focal consolidation is seen. There is no large pleural effusion or pneumothorax. The cardiac silhouette is mild to moderately enlarged. Mediastinal contours are unremarkable. While there may be some mild central pulmonary vascular engorgement no overt pulmonary edema is seen.", "output": "Cardiomegaly ; underlying pericardial effusion not excluded. Possible mild central pulmonary vascular engorgement without overt pulmonary edema." }, { "input": "PA and lateral views of the chest provided. The heart is mildly enlarged as on prior. The hila appear slightly congested. There is no convincing evidence for edema. No large effusion or pneumothorax. No focal consolidation to suggest pneumonia. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Stable mild cardiomegaly with hilar congestion." }, { "input": "PA and lateral views of the chest were obtained. Again noted is stable position of a pacemaker overlying the left chest with leads in the right atrium and ventricle. Cardiomediastinal silhouette including cardiomegaly and tortuosity of the thoracic aorta is unchanged. There is no focal consolidation. There is no pleural effusion or pneumothorax.", "output": "No evidence of pneumonia." }, { "input": "AP upright and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. Pulmonary vascular congestion is mild. Mild cardiomegaly is similar to prior. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Left chest cardiac device and leads are in similar position compared to prior.", "output": "No acute intrathoracic process." }, { "input": "No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. 3 mm rounded nodular opacity in the right mid lung medially most likely represents a vessel on end or possibly a granuloma.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is detected. Heart and mediastinal contours are within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Lung volumes are low with bibasilar atelectasis noted. No convincing sign of pneumonia edema effusion or pneumothorax. Heart size is difficult to assess. Mediastinal contour is normal. No acute bony abnormalities.", "output": "Bibasilar atelectasis. Please refer to subsequent CT of the chest for further details." }, { "input": "Lung volumes of slightly increased in their slightly less atelectasis at the lung bases, particularly in the right medial lower lobe. There tiny pleural effusions. There is no convincing pneumonia. Heart size remains top-normal in rib. As before, there is degenerative change in the right glenohumeral joint and disc degeneration to a mild degree in the thoracic and upper lumbar spine. Air-filled loops of bowel in the upper abdomen appear to be the colon and are not dilated", "output": "Bibasilar atelectasis unlikely very small pleural effusions without convincing evidence of pneumonia." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac silhouette size is top normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Minimal patchy opacity within the right lower lobe appears new in the interval, concerning for infection. Left lung is clear without focal consolidation. No pleural effusion or pneumothorax is present. No acute osseous abnormality is visualized.", "output": "Patchy opacity in the right lower lobe is concerning for pneumonia. RECOMMENDATION(S): Followup radiographs after treatment are recommended to ensure resolution of this finding." }, { "input": "Frontal and lateral radiographs of the chest demonstrate normal heart size. The cardiomediastinal silhouette and hilar contours are normal. The lungs are clear. No pleural effusion or pneumothorax. No displaced rib fracture identified.", "output": "No pneumonia." }, { "input": "AP upright and lateral views of the chest were provided demonstrating no focal consolidation, effusion, pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "Comparison is made to prior study from ___. Endotracheal tube and feeding tube have been removed. The heart size is within normal limits. There are clear lungs. Bony structures are intact.", "output": "No signs for acute cardiopulmonary process." }, { "input": "The endotracheal tube terminates 4.6 cm above the carinal. NG tube is within the stomach. Heart is normal size and cardiomediastinal silhouette is stable. There is increased opacification at the right the right base with partial obscuration of the right hemidiaphragm with suggestion of a depressed major fissure. Findings can't be entirely explained by volume loss in the right lower lobe; however superimposed pneumonia cannot be excluded. The left lung is clear. There is no pleural effusion or pneumothorax.", "output": "Increased opacification at the right base is entirely explained by volume loss in the right lower lobe; however superimposed pneumonia cannot be excluded." }, { "input": "PA and lateral views of the chest were obtained. There is no definite sign of pneumonia or CHF. Along the left heart border is subtle density which is most compatible with slightly prominent bronchovasculature, though the possibility of a very early or partially resolving pneumonia is impossible to exclude. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No definite signs of pneumonia, though very subtle opacity in the left lower lung could represent a minimal consolidation in the correct clinical setting." }, { "input": "There is mild cardiomegaly. There is mild vascular congestion. If any there is a small left effusion. There is no pneumothorax. The aorta is tortuous", "output": "Mild vascular congestion." }, { "input": "Cardiomediastinal silhouette is normal. There is no focal consolidation. There is no pleural effusion or pneumothorax. No displaced rib fracture is seen. There are surgical clips in the region of the thyroid bed.", "output": "No radiographic explanation for chest pain." }, { "input": "Heart size, mediastinal and hilar contours are normal. Lungs and pleural surfaces are clear. No pneumothorax or acute skeletal finding. Surgical clips in the region of the thyroid bed are again demonstrated.", "output": "No findings to account for chest pain." }, { "input": "The lungs are well-expanded and clear. Cardiomediastinal and hilar contours are unremarkable. No pneumothorax, pleural effusion, or consolidation.", "output": "No pneumothorax." }, { "input": "The lungs are clear without focal opacity, pleural effusion or pneumothorax. The heart is possibly enlarged. The mediastinal contours are normal.", "output": "Possible cardiomegaly. Repeat radiographs in deep inspiration are recommended. COMMENT: Findings placed on the critical results dashboard by ___ at 9:36 AM." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for pneumonia. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No acute intrathoracic abnormalities identified." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is identified. There are mild to moderate multilevel degenerative changes seen in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest. Linear left base and right perihilar opacities may be due to atelectasis given lower lung volumes. Elsewhere, the lungs are clear. There is no effusion or pulmonary vascular congestion. Surgical clips project over the right lung apex as on prior. The cardiomediastinal silhouette is within normal limits. Posterior fixation hardware is seen at the lower thoracic, upper lumbar region as on prior. No acute osseous abnormality is detected.", "output": "No definite acute cardiopulmonary process." }, { "input": "Moderate to severe cardiomegaly is stable. Widening of the mediastinum is unchanged, probably due to enlargement of the main pulmonary arteries. Left PICC tip is in the lower SVC. There is no pneumothorax. . If any there is a small left effusion. Retrocardiac atelectasis are unchanged. There is no pulmonary edema.", "output": "Retrocardiac opacities are a combination of atelectasis and small effusion Probably enlargement of the main pulmonary arteries" }, { "input": "Lung volumes are unchanged compared to the prior study. There is persistent moderate cardiomegaly. The right upper lobe airspace opacity now appears more confluent with air bronchograms. This could reflect asymmetric pulmonary edema but infection cannot be excluded. No pneumothorax or pleural effusion seen. The visualized bony structures are unremarkable in appearance.", "output": "Airspace opacity in the right upper lobe may reflect asymmetric pulmonary edema versus infection." }, { "input": "Lung volumes continue to be low. The cardiac silhouette continues to be enlarged, accentuated by the low lung volumes, and there is crowding of the central bronchovascular structures due to the low lung volumes. There is bilaterally predominately upper lobe airspace opacity, likely reflecting pulmonary edema but infection cannot be excluded.", "output": "Low lung volumes. Bilateral upper lobe airspace opacities likely reflect pulmonary edema but infection cannot be excluded." }, { "input": "Lung volumes are low. The cardiac silhouette is borderline enlarged. No definite pleural effusion or pneumothorax is identified. No consolidations are noted.", "output": "Stable examination of the chest." }, { "input": "Even allowing for the projection, the cardiac silhouette is enlarged. There is persistent airspace opacity in the right upper lobe which may reflect asymmetric pulmonary edema versus infection. There is new partial silhouetting of the left hemidiaphragm which may be due to left lower lobe atelectasis or a layering pleural effusion. Mild pulmonary vascular congestion is similar in degree when compared to the prior study.", "output": "Increased opacity at the left lung base may reflect atelectasis or a layering pleural effusion. Unchanged right upper lobe consolidation." }, { "input": "Portable semi-erect chest radiograph ___ at 15:41 is submitted.", "output": "Left subclavian PICC line unchanged in position. Stable cardiac enlargement. Stable appearance to mediastinal contours. Lung volumes remain low but no focal airspace consolidation is seen to suggest pneumonia. No pulmonary edema, pleural effusions or pneumothorax." }, { "input": "Portable semi-erect chest radiograph ___ at 09:23 is submitted.", "output": "Left subclavian PICC line unchanged in position. Overall cardiac and mediastinal contours are likely stable given patient rotation on the current study. Lungs appear well inflated without evidence of focal airspace consolidation to suggest pneumonia. No pleural effusions or pneumothorax. No pulmonary edema. Nodular opacity in the right apex is felt to correspond to the first costochondral junction." }, { "input": "Lung volumes remain low with persistent left basilar opacity likely reflecting a combination of pleural fluid and atelectasis. Airspace opacity in the right upper lobe is also unchanged. No pneumothorax seen. No definite right-sided pleural effusion.", "output": "No significant interval change when compared to the prior study." }, { "input": "Overall, appearances are very similar when compared to the prior study. Even allowing for the projection, the heart is enlarged. There is persistent opacity at the left lung base likely reflecting a combination of pleural effusion and atelectasis, superimposed infection cannot be excluded. The right upper lobe consolidation is not as clearly seen as on the prior study. No pneumothorax seen.", "output": "No significant interval change when compared to the prior study." }, { "input": "Chest, PA and lateral. Findings the lungs are clear. The hilar and mediastinal contours are normal. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal. Median sternotomy cerclage wires intact.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. There is no consolidation or effusion. The cardiomediastinal silhouette is within normal limits. Median sternotomy wires and mediastinal clips are again noted. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Patient is status post CABG with sternotomy wires and clips noted. Heart is normal size and unchanged. Mediastinal and hilar contours are normal. Lungs are clear and lung volumes are normal. No pleural effusion, pneumothorax or focal airspace consolidation. The right costophrenic angle was not completely visualized on the frontal view.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac size is normal. The mediastinal and hilar silhouettes are unremarkable. The sternotomy wires are aligned, and surgical clips are again noted. There is no pleural effusion or pneumothorax. The lungs are clear with no pneumonia or atelectasis.", "output": "No pneumonia." }, { "input": "There is no focal opacity, pleural effusion, pneumothorax, or pulmonary edema identified. The heart size is normal. Mediastinal and hilar contours are normal.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "Shallow inspiration. Left perihilar, basilar opacity, consistent with mass seen on chest CT. Multiple tiny lung nodules, probably similar. Shallow inspiration accentuates heart size, pulmonary vascularity. Mild interstitial prominence, may be inflammatory or edema. Heart size is normal. Bilateral hilar fullness, suggests adenopathy. Small pleural effusions.", "output": "Left perihilar, basilar opacity, corresponds to known malignancy. Small pulmonary nodules. Hilar fullness, suggest adenopathy. Small pleural effusions. Mild interstitial prominence, may be inflammatory or edema." }, { "input": "PA and lateral views of the chest. The lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded, clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pneumomediastinum, pleural effusion, or consolidation. Note is made of mild leftward deviation of the trachea.", "output": "1. No acute cardiopulmonary process. 2. Mild leftward deviation of the trachea. Recommend nonemergent thyroid ultrasound for further evaluation. RECOMMENDATION(S): Mild leftward deviation of the trachea. Recommend nonemergent thyroid ultrasound for further evaluation. NOTIFICATION: Updated findings and recommendations were emailed to the ED QA nurse by ___ at approximately 08:15 on ___." }, { "input": "Lung volumes are low with secondary bronchovascular crowding. There is superimposed vascular congestion likely mild edema. There is no effusion. Left greater than right basilar opacities are also noted. Moderate enlargement of the cardiac silhouette is seen. No acute osseous abnormalities. Cervical fixation hardware noted anteriorly and posteriorly.", "output": "Cardiomegaly with findings suggestive of mild pulmonary edema. Bibasilar opacities potentially atelectasis, infection cannot be excluded." }, { "input": "Portable supine chest film of ___ at 04:14 is submitted.", "output": "Patient is status post median sternotomy with postoperative cardiac and mediastinal contours. The aorta is somewhat unfolded and tortuous. Lung volumes are low with faint opacities at both bases most likely representing patchy atelectasis in this setting of low lung volumes. No evidence of pulmonary edema, pleural effusions or pneumothorax." }, { "input": "A right-sided central venous catheter terminates in the upper to mid SVC. The cardiomediastinal and hilar contours are normal. The lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "Right-sided central venous catheter terminates in the upper to mid SVC. No pneumothorax." }, { "input": "Heart size is normal. The aorta is unfolded. Hilar contours are unremarkable. Pulmonary vasculature is not engorged. Streaky opacities seen within the right upper lobe as well as within the retrocardiac region. No focal consolidation, pleural effusion or pneumothorax is seen. No acute osseous abnormality is detected.", "output": "Streaky opacities in the right upper lobe and retrocardiac region may reflect areas of atelectasis. Early infection in the right upper lobe however is not completely excluded in the correct clinical setting." }, { "input": "The patient is status post median sternotomy and CABG. The heart size is mildly enlarged. The aorta is mildly tortuous. Mediastinal and hilar contours are otherwise unremarkable. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormality is detected. Remote fracture of the left seventh rib is noted.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest. No focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac silhouette size is top normal. The aorta remains mildly tortuous with atherosclerotic calcifications again noted at the aortic knob. The mediastinal hilar contours are otherwise unremarkable. Pulmonary vasculature is not engorged. Subsegmental atelectasis is noted in the right lung base. No focal consolidation, pleural effusion or pneumothorax is detected. No acute osseous abnormalities present. .", "output": "No acute cardiopulmonary abnormality. ___, MD CC: DR. ___" }, { "input": "PA and lateral views of the chest were obtained. Midline sternotomy wires, aortic valve replacement and upper to mid thoracic spinal hardware is again noted. The lungs are clear bilaterally without focal consolidation, effusion, or signs of CHF. Cardiomediastinal silhouette is stable. Bony structures appear intact.", "output": "No acute intrathoracic process." }, { "input": "Frontal lateral chest radiographs demonstrate low lung volumes. Cardiomediastinal silhouette is normal. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "A new right internal jugular central line courses into the right atrium. If desired, the line could be withdrawn 4-5 cm for positioning within the low SVC. There is no pneumothorax or new pleural effusion. Bilateral diffuse parenchymal opacities, worse in the right lung, are unchanged.", "output": "1. Right intrajugular line courses into the right atrium. If desired, the line could be withdrawn 4-5 cm for positioning within the low SVC. No pneumothorax. 2. Unchanged, diffuse bilateral parenchymal opacities from 2.5 hr earlier." }, { "input": "Severe infiltrative pulmonary opacities, right worse than left. Heart size is difficult to assess given the diffuse parenchymal abnormality. The mediastinal and hilar contours are obscured by the diffuse interstitial opacities bilaterally. The pulmonary vasculature is congested. No pleural effusion or pneumothorax. Aortic arch calcifications are again seen. Lines and tubes: Allowing for differences in patient positioning, ET tube tip is approximately 1.2 cm above the carina and the right IJ venous line is approximately at the CA junction.", "output": "1. Probable pneumonia and concern for ARDS. 2. Pulmonary edema." }, { "input": "Low lung volumes cause crowding of the central bronchovascular structures and accentuation of the heart size. No focal consolidation, pleural effusion or pneumothorax is seen.", "output": "Low lung volumes." }, { "input": "Heart size is normal with mild unfolding of the thoracic aortic arch. Subtle retrocardiac opacity corresponds to density at the posterior base on lateral view. Pleural surfaces are clear without effusion pneumothorax.", "output": "Subtle left lower lobe opacity which may represent pneumonia." }, { "input": "Two supine portable views of the chest. Endotracheal tube tip is approximately 5 cm from the carina. Enteric tube passes below the field of view, side port past the GE junction. On one view, there are low lung volumes with crowding of the bronchovascular markings with improvement on the second acquisition. There is mild cardiomegaly potentially accentuated due to supine technique. Prominence of the upper mediastinum does improve between the two views and is thought to be in part due to portable technique. Calcification projecting over the right lung apex may be a calcified granuloma. There is no confluent consolidation. Hyperdensity of the renal shadows seen bilaterally presumed from recent intravenous contrast administration can be seen in the setting of acute tubular necrosis if no recent CT scan has been performed.", "output": "1. Endotracheal and enteric tubes in place. 2. Hyperdensity of the renal shadows bilaterally. Assuming no recent CT scan has been performed in the past few hours, this persistent hyperdensity can be seen in the setting of acute tubular necrosis and correlation with serial creatinines is suggested." }, { "input": "A portable frontal chest radiograph demonstrate the nasogastric tube extending at least into the stomach. Low lung volumes emphasize the cardiac silhouette, with the heart likely top normal in size. There is bibasilar linear atelectasis, right greater than left. There is no large pleural effusion, and no pneumothorax. A skin fold overlying the right upper lung should not be confused for a pneumothorax.", "output": "1. Nasogastric tube extending into the stomach. 2. Bibasilar linear atelectasis, right greater than left." }, { "input": "The lungs are normally expanded and clear. The cardiomediastinal silhouette, hilar contours and pleural surfaces are normal. There is no pleural effusion or pneumothorax. There is no pulmonary edema.", "output": "No evidence of acute cardiopulmonary abnormality." }, { "input": "The ET tube is 3.7 cm above the carina. PICC line catheter tip is in the mid axillary vein and is not seen extending beyond this point. Left subclavian line tip is in the SVC. There is increased pulmonary vascular congestion with moderate cardiomegaly, bilateral pleural effusions, right greater than left pulmonary vascular redistribution and alveolar edema.", "output": "Increased CHF." }, { "input": "Right-sided pleural effusion is decreased after placement of right pleural catheter, which may have been withdrawn slightly as pigtail is partially external to the chest and not formed. Pulmonary opacities are slightly increased, particularly in the bilateral apices, compatible with superimposed pulmonary edema with unchanged dense left basal opacity at least in part reflecting atelectasis. Right PICC is in stable position. No appreciable pneumothorax is seen. The left costophrenic angle is excluded from view.", "output": "Increased parenchymal opacities compatible with superimposed pulmonary edema. Improved right-sided pleural effusion with pigtail catheter not clearly formed and partially withdrawn from the chest. These findings regarding the pigtail catheter were discussed with Dr. ___ by Dr. ___ by phone at ___ on ___." }, { "input": "An endotracheal tube is in place, positioned 3.5 cm from the level of the carina. A right upper extremity PICC tip is seen in the lower SVC. A nasogastric tube tip and sidehole project over the expected location of the stomach. There is moderate-to-severe pulmonary edema, which is not significantly changed, and are small bilateral pleural effusions. The cardiac silhouette remains moderately enlarged. No pneumothorax.", "output": "Unchanged moderate-to-severe pulmonary edema, with small bilateral pleural effusions and moderate cardiomegaly." }, { "input": "Single portable view of the chest was compared to previous exam from earlier the same day at 10:27 a.m. Endotracheal tube is now seen with tip approximately 5 cm from the carina. Enteric tube is seen passing below the diaphragm with tip in the gastric body. Again, low lung volumes are seen. The lungs are clear of large confluent consolidation. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "Interval placement of ET and enteric tubes as above. No other change." }, { "input": "Comparison is made to previous study from ___. There is a left central venous line with distal lead tip in the proximal SVC. There are areas of consolidation at both lung bases and bilateral pleural effusions, right side worse than left. There are no pneumothoraces.", "output": "Interval worsening of the airspace opacities at the lung bases as well as bilateral pleural effusions, right side worse than left." }, { "input": "Aeration of both lungs has significantly improved in the preceding 17 hours due to resolution of moderately severe pulmonary edema. Moderate right and smaller left pleural effusions are present. No pneumothorax is present. Mild cardiomegaly is unchanged. A left subclavian catheter tip terminates in the upper SVC.", "output": "Significant improvement in previously severe pulmonary edema. Moderate right and small left pleural effusions." }, { "input": "Single portable view of the chest. No prior. Low lung volumes are seen. The lungs are clear of large confluent consolidation noting some right basilar probable atelectasis. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The ET tube is 3.8 cm above the carina. Left subclavian line tip is in the SVC. There is moderate cardiomegaly, bilateral pleural effusions, pulmonary vascular re-distribution, and bilateral hazy alveolar infiltrates. Compared to the study from the prior day, the alveolar infiltrates are worse.", "output": "Fluid overload. An underlying infectious infiltrate cannot be excluded." }, { "input": "A Dobbhoff tube has been inserted below the diaphragm projecting over the left upper quadrant. Endotracheal tube, left subclavian central catheter are unchanged. Bilateral pleural effusions and right greater than left parenchymal opacities are unchanged.", "output": "Dobbhoff tube in the stomach." }, { "input": "A left IJ catheter and NG tube are in place, and in standard position. Lung volumes are unchanged, though there has been interval increase in bilateral airspace consolidation and small bilateral pleural effusions. The cardiac silhouette remains moderately enlarged. A right upper extremity PICC tip is unchanged in position at the cavoatrial junction.", "output": "1. Interval placement of NG tube, the tip of which is seen within the stomach. 2. Increase in moderate-to-severe pulmonary edema. Though this exam was performed on ___, it is being dictated on ___ due to a delay within PACS." }, { "input": "Upright portable chest radiograph demonstrates increasing bibasilar opacities, with likely small bilateral pleural effusions, and an interval increase in pulmonary edema, now moderate in degree. Airspace opacity in the right upper lobe may reflect asymmetric edema or developing infection. The cardiac silhouette remains enlarged, and is slightly increased in size compared with prior. The mediastinal contours are unchanged.", "output": "Interval increase in heart size, and in pulmonary edema which is now moderate. There are small bilateral pleural effusions. Airspace opacity in the right upper lobe is new and may represent asymmetric edema or developing infection." }, { "input": "Semi-upright bedside AP radiograph of the chest demonstrates diffuse bilateral heterogeneous opacities representing moderate-to-severe pulmonary edema, which has worsened from two days ago. Asymmetric prominence of the right upper lung opacity is also noted when compared to the two prior studies from ___ and ___. There continues to be moderate cardiomegaly and pulmonary and mediastinal vascular engorgement. There are probable persistent bilateral pleural effusions, better appreciated on the CT from ___. There is no pneumothorax.", "output": "1. Worsening biventricular congestive heart failure. 2. Asymmetric right upper lobe pulmonary edema or worsening edema and right upper lobe pneumonia in the appropriate clinical context." }, { "input": "The right IJ central line is again seen terminating in the right atrium. The lungs are well expanded. Vascular engorgement has resolved from the prior exam. The lungs are clear. There is no pleural effusion or pneumothorax. Moderate cardiomegaly is again seen.", "output": "Right IJ central line terminates in the right atrium. No evidence of pneumothorax. No pulmonary edema." }, { "input": "There is minimal bilateral atelectasis but the lungs are otherwise clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal. No displaced rib fractures are seen.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs which are clear. There is no focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear of focal consolidation, pleural effusion or pneumothorax. The heart size is normal. The mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax or pleural effusion. There are mild degenerative changes in the thoracic spine", "output": "No acute cardiopulmonary abnormalities" }, { "input": "There are streaky bibasilar opacities, likely atelectasis. Additional linear opacity in the right mid lung sulcal atelectasis versus scarring. The lungs are otherwise clear. Cardiac silhouette is mildly enlarged as on prior. Median sternotomy wires and mediastinal clips are again noted. Tortuosity of the descending thoracic aorta is noted. There are hypertrophic changes in the spine.", "output": "Cardiomegaly without acute cardiopulmonary process." }, { "input": "Lung volumes are low. However there is clear increased alveolar opacity involving the left lower lobe. The right lung is relatively clear. The heart size is unchanged in continues to be mildly enlarged", "output": "Increased left lower lobe infiltrate" }, { "input": "The cardiac, mediastinal and hilar contours are normal. The pulmonary vascularity is normal. The lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormality is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "AP upright and lateral views of the chest provided. Slightly rotated positioning somewhat limits assessment. Focal tenting of the right hemidiaphragm is unchanged which may reflect the presence of an accessory fissure. Lungs are clear without focal consolidation, large effusion or pneumothorax. No signs of edema or congestion. Cardiomediastinal silhouette appears normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings." }, { "input": "Portable frontal chest radiograph demonstrate diffuse mild interstitial pulmonary edema. There is no new focal consolidation. Lung volumes are mildly improved. An enteric tube is seen with its terminal tip in a nondistended stomach. The cardiomediastinal and hilar contours are stable.", "output": "Mild increased interstitial pulmonary edema." }, { "input": "No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. There is minimal left base atelectasis. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable. No significant change.", "output": "No evidence of acute disease." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable A punctate density projecting over the right mid lung is again noted, unchanged since ___, located in the subcutaneous tissues", "output": "No acute cardiopulmonary abnormalities" }, { "input": "Heart size within normal. No pleural effusions. A linear density is again noted in the anterior right chest. Narrowing of the transverse tracheal diameter. No focal consolidation or pneumothorax. No apparent chest wall abnormality.", "output": "Although no acute fracture or other chest wall lesion is seen, conventional chest radiographs are not sufficient for detection or characterization of such abnormalities. If the demonstration of such a chest cage abnormality is clinically warranted, the location of any referrable focal findings should be clearly marked and imaged with either bone detail views or CT scanning. No acute cardiopulmonary process. Narrowing of the transverse tracheal diameter, probable saber sheath trachea, which is associated with chronic lung disease." }, { "input": "Mild enlargement of the cardiac silhouette is unchanged. The aorta remains tortuous with diffuse atherosclerotic calcifications. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is normal. Punctate granulomas are again seen in the lungs. No focal consolidation, pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is mildly enlarged but unchanged. The aorta remains diffusely calcified and tortuous. Pulmonary vasculature is not engorged. Hilar contours are similar. No focal consolidation, pleural effusion or pneumothorax is seen. Chronic fracture deformities of the left proximal humerus and distal left clavicle are re- demonstrated.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Again seen is mild hyperinflation a mild cardiomegaly. There patchy areas of increased opacity at the bases that could represent volume loss or early infiltrate. There is a lucency below the right hemidiaphragm, and free air can't be totally excluded. Recommend clinical correlation and followup.", "output": "Question small amount of free air. Recommend clinical correlation and followup when the patient is able. NOTIFICATION: These findings were called to ___, the nurse in the PACU at the time of interpretation of the film by Dr. ___ at 09:15 on ___" }, { "input": "PA and lateral views of the chest provided. Lung volumes are somewhat low with streaky lower lobe opacities which could represent an atelectasis versus early pneumonia. No convincing signs of edema, effusion or pneumothorax. The heart size is top-normal. The mediastinal contours unremarkable. No free air below the right hemidiaphragm. Bony structures are intact.", "output": "Top normal heart size with streaky opacities in the lower lungs likely atelectasis less likely pneumonia." }, { "input": "The lungs are clear. There is no focal consolidation, edema, or effusion. Cardiomediastinal silhouette is stable. No acute osseous abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral images of the chest. The lungs are well expanded and clear. Mild prominence of the pulmonary vasculature is noted. No mass or consolidation is seen. There is no pleural effusion or pneumothorax. Cardiomediastinal silhouette is mildly enlarged, stable from prior exam. Possible mitral annulus calcification is seen.", "output": "Mild prominence of the pulmonary vasculature." }, { "input": "Frontal and lateral radiographs of the chest show appropriate inspiratory lung volumes. The lungs are clear without focal consolidation, pleural effusion, or pneumothorax. The pulmonary vasculature is not engorged. The cardiac silhouette is normal in size. The mediastinal and hilar contours are within normal limits.", "output": "No acute cardiopulmonary process. Findings were communicated by Dr. ___ to Dr. ___ by page at 09:41 a.m. on ___." }, { "input": "The lungs are hyperinflated but clear with no evidence of a consolidation, effusion, or pneumothorax. Cardiac and mediastinal silhouettes are normal. No acute fractures are identified.", "output": "No acute cardiopulmonary process." }, { "input": "One portable AP view of the chest. The patient is status post median sternotomy and CABG. The enlarged cardiac silhouette is stable. Right perihilar/hilar opacity is unchanged since ___. Moderate pulmonary vascular congestion is unchanged. No large pleural effusion. No pneumothorax. The right internal jugular central venous line ends in the distal SVC.", "output": "New right IJ line placement ends in the distal SVC without evidence of pneumothorax. Otherwise unchanged moderate pulmonary vascular congestion and cardiomegaly." }, { "input": "The patient is status post median sternotomy and CABG. The cardiac silhouette remains enlarged. The aorta is tortuous. Right hilar/perihilar opacity is grossly stable since at least ___. There is moderate pulmonary vascular congestion. No large pleural effusion is seen. There is no evidence of pneumothorax.", "output": "Pulmonary vascular congestion. Persistent enlargement of the cardiac silhouette." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___ and older previous exam dating back to ___. Indistinct pulmonary vascular markings are seen throughout with increased interstitial markings without confluent consolidation. Region of scarring is seen in the left upper lung stable dating back to ___. There is increased opacity projecting over the right hilum, which appears distinct from the pulmonary artery, however, remains stable in configuration dating back to ___. There is no pleural effusion. Cardiomediastinal silhouette is enlarged but stable. Median sternotomy wires and mediastinal clips again noted. Osseous and soft tissue structures are unremarkable.", "output": "Increased interstitial markings throughout the lungs which may be from mild failure. No confluent consolidation. Stable opacity projecting over the right hilum dating back to ___." }, { "input": "Frontal and lateral chest radiographs were performed. There is no pleural effusion or pneumothorax. Left base opacity is is best appreciated on the frontal view. The mediastinum is unremarkable. The cardiac silhouette is top normal.", "output": "Possible left lower lobe pneumonia. Follow up after treatment is recommended to evaluate resolution." }, { "input": "Heart is normal in size. Mediastinal structures are remarkable for air-filled distention of the upper thoracic esophagus lateral to the trachea. Within the lungs, coarse bilateral lower lobe reticular opacities are present with mildly dilated bronchi. Although these findings are present on the prior study, newly developed patchy opacities have developed in both lung bases with associated partial obscuration of both hemidiaphragms. Bi-apical pleural and parenchymal scarring appears unchanged. No pleural effusion.", "output": "1. New patchy bibasilar lung opacities which may reflect recurrent aspiration pneumonia given clinical suspicion for this entity. 2. These findings are superimposed on bibasilar interstitial lung disease, which could be due to a variety of etiologies including chronic aspiration, IPF and NSIP. If warranted clinically, dedicated chest CT with high-resolution technique may be considered following resolution of the acute basilar opacity." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures are unremarkable.", "output": "No enlargement of the cardiac silhouette. No evidence of acute cardiopulmonary disease." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "Normal chest radiographic examination." }, { "input": "AP single view of the chest has been obtained with patient in sitting semi-upright position. Analysis is performed in direct comparison with the next preceding portable chest examination of ___. During the latest examination interval, the patient has been extubated and the NG tube has been removed. A right-sided internal jugular approach central venous line remains. The heart size is unchanged. No pulmonary vascular congestion is observed. No pneumothorax can be identified. No new infiltrates.", "output": "Satisfactory followup chest findings, no pneumothorax." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes. There is no pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Partially imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are well expanded and clear. There is no focal consolidation, effusion or pneumothorax. Cardiac and mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were obtained. The heart size is normal. The mediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. There is no focal consolidation concerning for pneumonia.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Fusion hardware noted in the low cervical spine.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are clear without focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Stable, moderate cardiomegaly. Mediastinal and hilar contours are unchanged. Interval increase in bilateral interstitial markings and central ill-defined opacities, more pronounced on the right, suggests worsening, moderate to severe pulmonary edema. Increased, focal opacity in the right apex with silhouetting of the right paratracheal stripe may represent pneumonia or alveolar edema in the right upper lobe. Right upper lobe alveolar edema can be seen in severe mitral regurgitation. Consider echocardiographic evaluation if clinically indicated. New, small, bilateral pleural effusions with increasing atelectasis at the left base.", "output": "Worsening, moderate to severe pulmonary edema with new, small bilateral pleural effusions and new consolidation in the right upper lobe which may reflect infection or alveolar edema. Right upper lobe alveolar edema can be seen in severe mitral regurgitation. Consider echocardiographic evaluation if clinically indicated. RECOMMENDATION(S): Consider echocardiogram to evaluate for mitral regurgitation if clinically indicated." }, { "input": "The lungs are hyperinflated which could suggest chronic pulmonary disease. Right greater than left increased interstitial markings are nonspecific but could reflect edema, less likely infection depending on the clinical situation. Nonetheless bilateral central airspace opacities and mild to moderate cardiomegaly suggests a component of volume overload. Aortic knob calcifications are moderate. No pneumothorax or pleural effusion.", "output": "Findings most suggestive of volume overload and/or heart failure, although of the patient has fever, infection is possible." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs which are clear. There is no pleural effusion or pneumothorax.", "output": "Normal chest radiograph without evidence of active or latent tuberculosis." }, { "input": "Low lung volumes accentuate the cardiomediastinal contours. Bibasilar atelectasis is present. There is no focal consolidation concerning for pneumonia. A right internal jugular approach central venous catheter is present with tip terminating in the low SVC. Crowding of the pulmonary vasculature.", "output": "Low lung volumes with bibasilar atelectasis. No focal consolidation concerning for pneumonia." }, { "input": "Lung volumes have slightly improved compared to the prior study performed several hours earlier. There is mild pulmonary vascular congestion without overt pulmonary edema. Bibasilar opacities most likely represent atelectasis. No pleural effusion or pneumothorax. Mild cardiomegaly. Multiple old left-sided rib fractures. Tip of the right IJ terminates in the mid SVC.", "output": "Mild pulmonary vascular congestion, without overt pulmonary edema." }, { "input": "Heart size is within normal limits. Mediastinal and hilar contours are unremarkable. There is no evidence for pulmonary edema, pulmonary consolidation, pleural effusion, or pneumothorax.", "output": "No evidence for active cardiopulmonary disease." }, { "input": "Single AP upright portable view of the chest was obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top normal. Mediastinal contours are unremarkable. There is slight prominence of the left hilum, and underlying prominent lymph nodes or small consolidation is not excluded. Dedicated PA and lateral views would be helpful for further evaluation.", "output": "Mild prominence of the left hilum is non-specific, underlying prominent lymph node or small consolidation not excluded. Dedicated PA and lateral views would be helpful for further evaluation." }, { "input": "An accessed right chest wall Port-A-Cath is in place, terminating in the upper right atrium. There is no pleural effusion, pulmonary edema, or pneumothorax. Retrocardiac opacity in the left lung base could reflect pneumonia. No focal consolidation concerning for pneumonia is seen.", "output": "Left lower lobe consolidation concerning for pneumonia. A lateral view would be helpful for confirmation." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. Heart size is normal. Mediastinal silhouette and hilar contours are normal. Elevation of the left hemidiaphragm is probably from eventration.", "output": "No pneumonia, edema, or effusion." }, { "input": "The small left pleural effusion is new from the prior study. There is no focal consolidation, pulmonary edema, or pneumothorax. The right IJ central venous catheter has been withdrawn compared with the prior study. Mediastinal clips and median sternotomy wires are unchanged.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Compared with ___ at 22:22 , subcutaneous emphysema in the right supraclavicular of the region may be more pronounced. Again seen is a right IJ sheath, with tip over proximal SVC. Note is made of a gap in tubing at the proximal edge of the sheath measuring 6.7 mm. On today's examination 2 small clips are seen in the right neck, away from the sheath and subcutaneous emphysema. In retrospect Beaver present at the edge of the prior film. Otherwise, I doubt significant interval change. Cardiomediastinal silhouette and vascular plethora, with bibasilar atelectasis, is similar to the prior study. Cardiomediastinal silhouette I doubt significant interval change. No pleural effusion seen on either side. No obvious pneumothorax detected.", "output": "Subcutaneous emphysema in the right supraclavicular region may be slightly more pronounced. As noted, there is a possible interruption in the right IJ sheath tubing versus two adjoining pieces of tubing, though this appearance is similar to the prior film. Clinical correlation is requested for further assessment. Otherwise, I doubt significant interval change. NOTIFICATION: The appearance of the right IJ sheath and right supraclavicular subcutaneous emphysema was discussed by Dr. ___ with the covering PA by phone ___ min after discovery at 18:53 on ___." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is visualized. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart is at the upper limits of normal size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute disease." }, { "input": "Frontal and lateral views of the chest were obtained. There is minimal left basilar atelectasis. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. There may be minimal central pulmonary vascular engorgement; however, no overt pulmonary edema is seen.", "output": "Possible minimal central pulmonary vascular engorgement without overt pulmonary edema. No focal consolidation to suggest pneumonia." }, { "input": "PA and lateral images of the chest demonstrate well-expanded lungs which are clear. There is no pleural effusion or pneumothorax. Cardiomediastinal silhouette is unremarkable. Visualized osseous structures are unremarkable.", "output": "Normal chest radiograph." }, { "input": "There is increased prominence of the mediastinum which could be due to differences in patient position and AP technique, underlying lymphadenopathy not excluded. Patchy left base opacity is worrisome for pneumonia versus atelectasis. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal.", "output": "Patchy left base opacity could be due to pneumonia or atelectasis. There is increased prominence of the mediastinum which could relate to patient positioning however underlying mediastinal lymphadenopathy is not excluded. Dedicated PA and lateral views with better patient positioning may be helpful for further evaluation." }, { "input": "Lung volumes are low. The heart size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is identified. No acute osseous abnormality is present.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lung volumes are decreased. There is mild bibasilar atelectasis. Otherwise, the lung fields are clear. The heart size is normal. There is no fracture. There is no pleural effusion pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest. There is mild pulmonary vascular congestion. There is no focal consolidation. There is no pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "Mild pulmonary vascular congestion." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear unremarkable. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable. There has been no significant change.", "output": "No evidence of acute disease." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lower lung volumes are seen on the current exam. The lungs remain clear. There is no consolidation, effusion, or edema. Relative elevation of the left hemi diaphragm is unchanged from prior. There is no pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "A subtle opacity in the left mid lung zone is likely due to superimposed chest wall structures and normal vessels. The lungs are otherwise clear. There is no pulmonary edema, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal. The previously identified right rib fractures are not well visualized on today's exam.", "output": "No acute cardiopulmonary process. NOTIFICATION: The inital wet read \"possible developing left mid lung zone pneumonia\" was discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 4:25 AM, 2 minutes after discovery of the findings. Changes to the wet read were emailed to the ___ nurses on ___." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with ___ on the telephoneon ___ at 1:00 PM, 5 minutes after discovery of the findings." }, { "input": "PA and lateral views of the chest. The lungs are clear of consolidation or effusion. Cardiomediastinal silhouette is within normal limits. No free air seen below the diaphragm.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The chest is hyperinflated. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unchanged.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The lungs are clear without focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear. The distal left clavicle is attenuated, possibly post-traumatic with widening of the acromioclavicular interval, but unchanged.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The cardiac silhouette size is top normal. The mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest. The lungs are clear without consolidation or pulmonary vascular congestion. Mild biapical scarring is again noted. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest demonstrate normal cardiomediastinal silhouette. The lungs are clear. There is no pneumothorax, vascular congestion, or pleural effusion. No obvious displaced osseous injury.", "output": "No acute cardiopulmonary process. No displaced osseous injury. Current study is not tailored for assessment of rib fractures, which could be correlated with focal tenderness." }, { "input": "Mild to moderate atelectasis, left lower lobe, is stable since ___, improved substantially since ___. Cardiomediastinal silhouette is normal. Pleural effusion is small if any. Esophageal drainage tube ending at or just past pylorus and a feeding tube ending in the upper jejunum are unchanged in their respective positions.", "output": "Stable placement of drainage tube at or just distal to the pylorus and feeding tube terminating in the jejunum. Stable residual left lower lobe atelectasis." }, { "input": "In comparison ___ study the cardiomediastinal silhouette is stable. Left retrocardiac atelectasis is unchanged. Previously seen right basilar opacity likely represents vascular crowding secondary to low lung volume though superimposed pneumonia cannot be excluded in the appropriate clinical setting. The upper lungs are clear. No pleural effusions or pneumothorax are seen. Again seen is a right PICC line with the catheter tip terminating at the distal SVC.", "output": "Stable left retrocardiac atelectasis and no evidence of pulmonary edema. A superimposed pneumonia cannot be excluded, in the right clinical setting, given the above findings." }, { "input": "Enteric tube tip projected over mid stomach. Tip of endotracheal tube is difficult to see, is probably 2.3 cm above carina. Left subclavian central line tip in the low SVC. Stable bilateral perihilar opacities, and medial left lower lobe opacity. Stable elevation of the right hemidiaphragm. Postoperative changes in the abdomen. Prominent central pulmonary artery, suggests pulmonary artery hypertension. Stable appearance of the right AC joint.", "output": "Enteric tube tip projected over mid stomach." }, { "input": "Again seen is right hemidiaphragm elevation which is chronic and stable. There is a small right pleural effusion which is unchanged from prior studies. Otherwise the lungs appear clear. There is a right-sided PICC line that terminates in the SVC. There is interval placement of a dobhoff tube which terminates within the stomach and is adjacent to an intragastric opacity with contours that consistent with a tooth.", "output": "Interval placement of dobhoff tube that terminates within the stomach. Incidental finding of a intragastric tooth. Stable cardiopulmonary findings when compared to the earlier study on ___." }, { "input": "Patient is status post left upper lobectomy, with surgical clips noted near the left hilus. This results in volume loss of the left hemithorax. Streaky bibasilar opacities may represent atelectasis or scarring. No other consolidation, sizable pleural effusion or pneumothorax. Heart size is normal. No acute osseous abnormalities are identified.", "output": "No acute cardiopulmonary process." }, { "input": "Retrocardiac opacity obscuring medial left hemidiaphragm is potentially atelectasis however infectious process cannot be excluded. Patient is status post left upper lobectomy with volume loss of the left hemithorax and post surgical changes at the left hilum. Chronic blunting of left costophrenic angle noted. There is no effusion or pneumothorax. The cardiomediastinal silhouette is normal. Left posterior rib changes likely postsurgical. No evidence of free air below the diaphragm.", "output": "Retrocardiac opacity obscuring medial left hemidiaphragm potentially atelectasis however infectious process cannot be excluded. Consider PA and lateral chest radiograph if patient amenable. RECOMMENDATION(S): Consider PA and lateral chest radiograph if patient amenable." }, { "input": "There is no consolidation, pleural effusion, or pneumothorax. Cardiomediastinal and hilar silhouettes are normal size. Tortuous aortic contour is noted. There is eventration of right hemidiaphragm.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is mildly enlarged. The mediastinal and hilar contours are unremarkable. There is no pulmonary edema. Bibasilar opacities are noted obscuring the hemidiaphragms bilaterally. There appears to be a small right pleural effusion. Assessment for a left pleural effusion is limited as the left costophrenic angle is excluded from the field of view. No large left pleural effusion is demonstrated. There is no pneumothorax. No acute osseous abnormalities identified.", "output": "Bibasilar airspace opacities, possibly atelectasis but aspiration or infection cannot be excluded. Probable small right pleural effusion. Exclusion of the left costophrenic angle." }, { "input": "Right internal jugular central venous catheter tip terminates in the region of the low SVC. No pneumothorax is identified. There has been interval improvement in aeration of the lung bases with residual patchy bibasilar opacities, likely atelectasis. No large left pleural effusion is present. The right costophrenic angle is excluded from the field of view. Cardiac and mediastinal contours are unchanged.", "output": "Right internal jugular central venous catheter tip terminates in the region of the low SVC. No pneumothorax." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures appear within normal limits.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The cardiac silhouette is not enlarged. The lungs are clear without evidence of effusion. Soft tissues and osseous structures are normal. There is mild dextroscoliosis of the thoracic spine.", "output": "Normal examination of the chest." }, { "input": "Basilar atelectasis without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture identified.", "output": "No displaced rib fracture seen. No large pleural effusion or evidence of pneumothorax." }, { "input": "As compared to the prior examination dated ___, there has been minimal interval change. The lungs are essentially clear without focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The heart size is normal. Mediastinal and hilar contours are stable.", "output": "No radiographic evidence for acute cardiopulmonary process. Findings were conveyed by Dr. ___ to Dr. ___ ___ telephone at 3:10pm on ___. ___ min after discovery." }, { "input": "AP upright and lateral views of the chest provided. Left lower lobe opacity is severe. There is mild-to-moderate right fissural fluid. There is mild pulmonary vascular congestion and trace interstitial edema. Hazy opacity in the right lower lobe is likely due to a combination of edema and atelectasis. There is no pneumothorax. The cardiomediastinal silhouette is similar to prior. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Right arm stent and IVC stent are partially evaluated. Bilateral pleural effusion is most likely moderate.", "output": "1. Severe left lower lobe opacity could be due to atelectasis and/or pneumonia. 2. Right lower lobe hazy opacity is likely due to a combination of edema and atelectasis, but superimposed infection could be present. 3. Trace interstitial edema. 4. Bilateral pleural effusions, most likely moderate." }, { "input": "Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. A right femoral approach dialysis catheter is at similar position, terminating at the cavoatrial junction.", "output": "No acute cardiopulmonary process. No significant interval change." }, { "input": "Two views of the chest demonstrate a right chest hemodialysis catheter with its tip located at the expected position of the right atrium. Low lung volumes are present. The pulmonary vasculature is mildly engorged. There is no pleural effusion or pneumothorax. The cardiac silhouette is top normal, the mediastinal contours are normal. Incidental note is made of a stent graft within the right arm.", "output": "Mild engorgement of the pulmonary vasculature in the setting of low lung volumes, without focal consolidation to suggest pneumonia." }, { "input": "A central venous catheter entering via an inferior approach terminates within the right atrium, unchanged. Cardiac, mediastinal and hilar contours are normal. Apart from minimal atelectasis in the lung bases likely due to low lung volumes, the lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. There is no pulmonary vascular congestion. Vascular stent is re- demonstrated within the right upper extremity. No acute osseous abnormalities are present.", "output": "No definite radiographic evidence for pneumonia. Low lung volumes with mild bibasilar atelectasis." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vascularity within the right lung is a more pronounced compared to the left, findings which could suggest mild asymmetric pulmonary edema. Patchy opacity in the right lung base may reflect atelectasis. Minimal blunting of the right costophrenic angle suggests a trace pleural effusion, and there is minimal fluid seen in the right minor fissure. No large left pleural effusion is seen, but the left costophrenic angle is excluded from the field of view. There is no pneumothorax. Vascular stent is noted in the right the brachial/axillary region.", "output": "Trace right pleural effusion and possible asymmetric mild pulmonary edema. Patchy right basilar opacity, potentially atelectasis. Infection is not excluded in the correct clinical setting." }, { "input": "Portable frontal chest radiographs demonstrate a normal cardiomediastinal silhouette and a slightly hypoinflated lungs. There is persistent opacity in the right lower lung, which may correlate with the right pleural fluid seen on the CTA chest from the same day there is no pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No pneumothorax. Persistent right lower lobe lung opacity may correspond to right pleural fluid seen on CTA chest from the same day." }, { "input": "Cardiomediastinal silhouette and hilar contours are unremarkable. Lungs are clear. There is no pleural effusion or pneumothorax. A right femoral approach dialysis catheter is unchanged in position with the tip terminating at the cavoatrial junction.", "output": "No acute intrathoracic process, specifically no evidence of pneumothorax or focal consolidation. The results were discussed over the telephone with Dr. ___ by Dr. ___ ___ at 12:07 p.m. on ___ at the time of initial review." }, { "input": "AP and lateral views of the chest are compared to previous exam from ___. The lungs are clear. Cardiomediastinal silhouette is within normal limits. Right-sided hemodialysis central catheter is seen, slightly retracted when compared to prior with distal tip within the right atrium but slightly more proximal when compared to prior. Right upper extremity vascular stent is partially visualized. Osseous and soft tissue structures are otherwise unremarkable.", "output": "Right-sided central line seen with distal tip in the right atrium but slightly more proximal in location when compared to prior exam." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded, clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "There is a right chest Port-A-Cath which terminates in the mid SVC. The lungs are overall clear without focal consolidation. The cardiomediastinal silhouette and hilar contours are stable. There is no pleural effusion or pneumothorax. There is no free air under the diaphragm.", "output": "No acute cardiopulmonary process. No free air under the diaphragm." }, { "input": "The lungs are clear. There is no pneumothorax. The heart and mediastinum are within normal limits. Regional bones and soft tissues are unremarkable.", "output": "Clear lungs." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The mediastinal contours are normal. Apparent mild enlargement of the cardiac silhouette may be due to the low lung volumes. No fracture is identified.", "output": "1. Clear lungs. 2. No evidence of fracture. 3. Apparent mild enlargement of the cardiac silhouette may be related to low lung volumes. If there is clinical concern for cardiomegaly, a repeat radiograph could be obtained at full inspiration." }, { "input": "The lungs are clear. There is no evidence of pneumonia, pneumothorax, or pleural effusion. Cardiac silhouette is normal in size.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well-expanded and clear. The cardiomediastinal silhouette is unremarkable. There is no pleural effusion, pneumothorax, pulmonary edema, or focal airspace consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. The lungs are clear. No pleural effusion or pneumothorax is present. The pulmonary vascularity is normal. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "2 views of the chest show a left lower lobe opacity with a possible associated effusion. The left mediastinal silhouette appears prominent. The cardiac silhouette is normal. No pneumothorax is present.", "output": "Left lower lobe opacity with possible associated effusion in the setting of trauma. A chest CT is recommended for further evaluation. These findings were communicated to Dr. ___ ___ telephone at 21:10 on ___" }, { "input": "The lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified. Surgical clips seen in in the upper abdomen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Heart size remains mildly enlarged but unchanged. The aorta slightly tortuous but similar. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart size is top normal. No focal consolidations concerning for pneumonia are identified. There is no pleural effusion, or pneumothorax.", "output": "No acute intrathoracic abnormalities identified." }, { "input": "PA and lateral views of the chest demonstrates lungs are well-expanded and clear. The cardiomediastinal silhouette is unremarkable. There is no evidence of pleural effusion, pneumothorax or focal consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "Mild enlargement of the cardiac silhouette is unchanged. The mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Linear right basilar opacities are unchanged, potentially reflecting atelectasis and/ or scarring. Blunting of the right costophrenic angle is similar, compatible with a small effusion. Previously noted nodular opacity projecting over the right lung base is not well seen on the current exam. Left lung is clear. No pneumothorax. No acute osseous abnormality is present.", "output": "Right basilar linear opacities are unchanged, likely scarring and/ or atelectasis with unchanged small right pleural effusion. No new focal consolidation." }, { "input": "A right-sided internal jugular catheter terminates in the proximal SVC. Median sternotomy sutures are unchanged in appearance compared to the prior postoperative radiographs. There is a small left pleural effusion. There is left lower lobe atelectasis. Probable a atelectasis at the right lung base also, following the curve the diaphragm. No consolidation or pneumothorax seen.", "output": "Small left pleural effusion. Bibasilar atelectasis." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Since the prior radiograph, there has been significant improvement in the right-sided pleural effusion, the fluid currently seen along the lateral pleural surface of the right lung, in the region of the pleural catheter. Right lung volume has reduced since the prior study with lower position of the fissure, indicative of right middle and lower lobe atelectasis. The left lung is clear. Heart size is top-normal. No pneumothorax.", "output": "1. Significant interval improvement in right-sided pleural effusion. 2. Partial collapse of the right middle and lower lobes." }, { "input": "The patient has been extubated and a left basal chest drain has been removed. Lung volumes are slightly low with bilateral lower lobe atelectasis. No pneumothorax seen. A right-sided internal jugular catheter is in-situ, the tip is in the mid svc. Mild cardiomegaly may in part be due to the projection and in part due to low lung volumes. Similarly widening of the mediastinum may in part be due to the projection. No frank pulmonary edema seen. Interval improvement in the streaky left mid lung opacities, presumed atelectasis. Median sternotomy sutures are unchanged in appearance. Coronary artery bypass clips seen.", "output": "Bibasilar atelectasis. No pneumothorax seen." }, { "input": "The right-sided subclavian line has been removed. No pneumothorax. The appearance of the lungs are unchanged with a 7mm nodule in the right lower lobe and surrounding linear opacities. There is a trace right-sided effusion. The left lung remains clear. The cardiomediastinal silhouette is unremarkable.", "output": "No pneumothorax post subclavian line removal. The lungs are unchanged. 7 mm pulmonary nodule in the right lower lobe was not seen on prior CT due to consolidation. This could represent nipple shadow versus lung nodule. RECOMMENDATION(S): Repeat radiograph with nipple markers for right lower lobe nodule. NOTIFICATION: The findings were sent by Dr. ___ ___ info radiology to Dr. ___ on ___ at 2:10 PM." }, { "input": "2 pleural catheters overlie the right lung, in similar position to the prior radiograph. Small right pleural effusion persists, predominantly laterally. Right basilar atelectasis versus, to a similar degree as on ___. Left lung is clear. Left-sided PICC line terminates in the upper SVC.", "output": "No significant interval change in appearance of the right lung." }, { "input": "Two frontal views of the chest was obtained portably. A left port-A-Cath ends in the upper SVC. Since ___, there is improved aeration of the bilateral lung fields. Bibasilar opacities may represent atelectasis, scarring or residual consolidation, right worse than left, similar to the prior study. Small pleural effusions are better seen on concurrent CT. Heart size is normal. There is mild aortic tortuosity. The nipple projecting over the right lower lung should not be mistaken for a lung nodule.", "output": "Improved aeration since ___. Bibasilar opacities, right more than left, may be atelectasis or residual consolidation." }, { "input": "PA and lateral views of the chest were obtained. Midline sternotomy wires are noted. There is an eventration of the right hemidiaphragm. There is no definite sign of pneumonia or CHF. Minimally prominent lung markings at the right lung base likely reflect crowding of bronchovasculature with a possibility of an early pneumonia considered is thought unlikely. No pleural effusion or pneumothorax. Heart size is normal. Mediastinal contour unremarkable. Bony structures intact.", "output": "No signs of pneumonia." }, { "input": "The patient is status post sternotomy. A PICC line has been removed. The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. A similar eventration of the right hemidiaphragm is present. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "No focal consolidation, pleural effusion or pneumothorax identified. In the size the cardiomediastinal silhouette is within normal limits. Interval removal of the left PICC line.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Cardiomediastinal contours are normal. Opacities in the left base have resolved. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable. Right PICC tip remains in standard position.", "output": "No acute cardiopulmonary abnormalities" }, { "input": "The lungs are hyperinflated, similar when compared to the prior study. An endotracheal tube is in-situ, the tip terminates 6.5 cm above the level the carina, the nasogastric tube terminates in the stomach, a side hole is at the level the gastroesophageal junction, this is withdrawn slightly when compared to the prior study. No consolidation, pneumothorax or pleural effusion seen. A atelectasis at the left lung base.", "output": "Hyperinflation consistent with the patient's known emphysema. The nasogastric tube has withdrawn slightly, the tip distal stomach however a side hole is now positioned at the level the gastroesophageal junction." }, { "input": "The lungs are hyperinflated. Increased right infrahilar opacity could reflect aspiration and pneumonia. There appears to be mild peribronchiolar thickening. The minor fissure with is depressed, suggesting some degree of atelectasis in the right lung. Streaky opacities in the left lower lung may reflect atelectasis. No pleural effusion or pneumothorax. Background hyperlucency of the lungs suggests emphysema. An approximately 5 mm the opacity in this periphery of the right midlung could be a vessel on and, however pulmonary nodule cannot be excluded. Probable 4-mm calcified granuloma in the left periphery of the lung.", "output": "1. Right lower lobe opacity could reflect pneumonia in the appropriate clinical situation. Close interval follow-up after treatment is recommended. This patient could benefit from a non-emergent Chest CT if he has not had any before. 2. Background emphysema. 3. Possible 5 mm right peripheral mid lung nodule versus a vascular marking. Correlate with any prior imaging." }, { "input": "The lungs remain significantly hyperinflated in keeping with known COPD. Bilateral lower lobe opacity is have not substantially changed. Bilateral lower reticular opacities in the lower lobes also suggests bronchiectasis. No pulmonary edema, no pleural effusions or pneumothorax. Cardiac silhouette is not enlarged.", "output": "No substantial change, severe hyperinflation and bilateral lower lobe peribronchial opacities." }, { "input": "The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. Streaky opacity in the retrocardiac region overlying the spine on lateral view, most likely represents pulmonary vessels.", "output": "No evidence of pneumonia." }, { "input": "Lungs are well-expanded and clear. Unchanged 8 mm nodule in the left midlung. Cardiomediastinal and hilar contours are unchanged. No pneumothorax, pleural effusion, or consolidation.", "output": "No pneumonia." }, { "input": "There is a small right pleural effusion with associated atelectasis. There is no pulmonary vascular congestion or pneumothorax. The heart size is normal. The mediastinal and hilar contours are within normal limits.", "output": "Small right pleural effusion with associated atelectasis. An underlying pneumonia is possible in the proper clinical setting." }, { "input": "Small right pleural effusion is stable from prior study. The heart size is increased and pulmonary vascular congestion is present without overt pulmonary edema. There is no focal consolidation or pneumothorax.", "output": "1. Volume overload without frank pulmonary edema. 2. Unchanged small right pleural effusion." }, { "input": "Cardiac silhouette size remains mildly enlarged. The mediastinal and hilar contours are unchanged. Pulmonary vasculature is normal. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is identified. Degenerative changes are seen in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "AP and lateral chest radiograph demonstrates low lung volumes. Resultant bronchovascular crowding is noted. There is no pleural effusion identified. No focal consolidation concerning for pneumonia is identified. Heart is enlarged, partially sequelae of low lung volumes.", "output": "Allowing for difference in patient positioning and low lung volumes, there is no interval change when compared to most recent chest radiograph obtained 9 hours previously." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. Old healed right lateral rib fractures are noted.", "output": "No acute cardiopulmonary process." }, { "input": "There is mild left base atelectasis. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No overt pulmonary edema is seen. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac, mediastinal and hilar contours are unchanged with the heart size within normal limits. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities detected. Dextroscoliosis of the thoracic spine is again. Patient is status post right mastectomy.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Patient is status post CABG with median sternotomy wires in place. Lung volumes are normal. Minimal bibasilar streaky opacities, slightly improved from prior study, are consistent with atelectasis. There is no focal consolidation, effusion, or pneumothorax. Incidentally noted is an azygos fissure. There is mild unfolding of the descending thoracic aorta. Otherwise, mediastinal and hilar contours are normal. Heart size is normal.", "output": "No acute intrathoracic process." }, { "input": "A right pectoral pacemaker is in place with two leads terminating in the right atrium and right ventricle. The cardiac silhouette is mildly enlarged. The mediastinal contours are prominent, with unfolding of the thoracic aorta but the aortic knob remains distinct. The lungs are hyperinflated with flattening of the diaphragms and lucency at the lung apices, compatible with COPD. Small bilateral pleural effusions are present. There is improved pulmonary vascular congestion from the outside radiograph of ___. No focal consolidation or pneumothorax is detected.", "output": "1. No mediastinal widening. 2. Mild cardiomegaly. 3. Small bilateral pleural effusions. Improved mild pulmonary vascular congestion from the outside radiograph of ___." }, { "input": "PA and lateral views of the chest. The lungs are essentially clear noting minimal left basilar atelectasis. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "There is new substantial moderate elevation of the left hemidiaphragm. Elevation of the left hemidiaphragm is new. There is no pleural effusion or pneumothorax. The cardiac, mediastinal and hilar contours appear stable. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease. Moderate new elevation of the left hemidiaphragm." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiac, mediastinal and hilar contours are normal. There is a right middle lobe opacity. Otherwise, the lungs are clear. There is no associated finding of lymphadenopathy or pleural effusion.", "output": "Right middle lobe opacity. In the appropriate clinical setting, this is compatible with pneumonia. Repeat chest X-___ several weeks after treatment to document resolution is recommended. Wet read was called to Dr. ___ at 10:31 a.m. at the time of discovery by Dr. ___ ___ telephone." }, { "input": "Single supine view of the chest. Endotracheal tube is seen with tip approximately 7 mm from the carina which is difficult to clearly see. Left-sided central venous catheter tip projects over the distal brachiocephalic/upper SVC, although its tip is not well seen. Relatively low lung volumes are seen without focal consolidation or large effusion. Cardiomediastinal silhouette is within normal limits. Median sternotomy wires and mediastinal clips are identified. Atherosclerotic calcifications seen at the aortic arch. Surgical clips project over the right lateral chest wall. Surgical clips are also seen in the right upper quadrant.", "output": "Endotracheal tube seen with tip likely under 1 cm from the carina and should be withdrawn for optimal positioning. Left-sided central venous catheter tip not clearly delineated, but likely in the region of the distal brachiocephalic/upper SVC." }, { "input": "An endotracheal tube is in satisfactory position 2.8 cm from the carina. A left internal jugular central venous catheter is present with the tip in the upper SVC, likely against the lateral wall. An enteric tube is coiled in the oropharynx. The lungs are clear, without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. Post-operative changes are noted from prior CABG.", "output": "1. Enteric tube is coiled in the oropharynx. 2. No acute cardiopulmonary process. Results were discussed with Dr. ___ at 9:45 AM on ___ via telephone by Dr. ___ at the time the findings were discovered." }, { "input": "Low lung volumes and body habitus obscure the lung bases bilaterally. Heart size appears enlarged, which is likely in part a function of portable technique and low lung volumes. There is no focal consolidation or pleural effusion. No pneumothorax. Osseous structures are intact.", "output": "Low lung volumes, but no evidence of consolidation or pleural effusion." }, { "input": "Heart size is mild to moderately enlarged but unchanged. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is not engorged. Lung volumes are low without focal consolidation. No pleural effusion or are pneumothorax is present. There is minimal atelectasis in the lung bases. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cardiac silhouette size is top normal. Mediastinal and hilar contours are unremarkable. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The patient is status post median sternotomy and CABG. The heart size remains moderately enlarged. The aorta is tortuous, with the mediastinal contours appearing unchanged. There is no pulmonary vascular congestion. Small bilateral pleural effusions are visualized, possibly slightly increased on the left compared to the prior exam. Bibasilar atelectasis is also re- demonstrated. There is no pneumothorax. No acute osseous abnormalities are visualized though there are multilevel degenerative changes in the thoracic spine.", "output": "Small bilateral pleural effusions with bibasilar atelectasis. The size of the pleural effusion on the left may be slightly increased compared to the prior exam." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lung volumes are normal. Normal size of the cardiac silhouette. Normal hilar and mediastinal structures. No pneumonia, no pulmonary edema. No pleural effusions.", "output": "Normal chest radiograph without evidence of pneumonia." }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Portable semi-erect chest film ___ at 00:17 is submitted.", "output": "There has been some interval improvement but persistent mild pulmonary and perihilar edema. In addition, there is more focal consolidation in the retrocardiac area with the suggestion of air bronchograms. These findings may reflect pneumonia or aspiration rather than partial lower lobe atelectasis. Clinical correlation is advised. There are likely small layering pleural effusions, left greater than right. No pneumothorax. Heart remains stably enlarged." }, { "input": "There is new opacity in the right lower lobe obscuring the right heart border and right hemidiaphragm the upper lungs are clear", "output": "New right lower lobe volume loss/infiltrate" }, { "input": "Since ___, mild pulmonary vascular congestion is new and moderate retrocardiac and left basilar atelectasis is increased. In addition, the left heart border is not well seen due to mild opacities, which may represent lingular pneumonia. The lung volumes remain low. Moderate to severe cardiomegaly is stable. No pneumothorax. Median sternotomy wires are intact and aligned.", "output": "1. Mild opacities obscure the left heart border, which may indicate a lingular pneumonia. 2. Mild pulmonary congestion and moderate retrocardiac and left basilar atelectasis are increased since ___. NOTIFICATION: The findings were discussed by Dr. ___ with NP. ___ ___ on the telephoneon ___ at 5:30 PM, 30 minutes after discovery of the findings." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. The imaged upper abdomen is unremarkable. The bones are intact.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is mildly enlarged, and a left cardiac pacer device is seen with its leads in the appropriate position in the right atrium and ventricle. The patient is status post median sternotomy and aortic valve replacement. Lungs are clear of focal consolidations, pleural effusions or overt pulmonary edema.", "output": "Mild cardiomegaly without pulmonary edema." }, { "input": "Compared to prior, lung volumes are lower. Diffuse right lung opacification has increased. Vascular congestion is also increased. There is no pneumothorax. Pleural effusions are small, if any.", "output": "Worsening diffuse right lung opacity, unclear if related to worsening parenchymal process versus concurrent vascular congestion." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes. No pleural effusion, focal consolidation or pneumothorax. Borderline cardiomegaly is exaggerated by low lung volume. There is no pulmonary edema. Imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "In comparison to the chest radiograph from ___, there is re- demonstrated diffuse opacity throughout the right lung, concerning for pneumonia. The cardiomediastinal silhouette is unremarkable.", "output": "Airspace opacities throughout the right lung, are not significantly changed from ___ and are concerning for pneumonia." }, { "input": "Frontal and lateral chest radiographdemonstrates well expanded and clear lungs.No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable.", "output": "Normal chest radiograph. No focal opacity suggest pneumonia." }, { "input": "AP upright portable chest radiograph obtained. Lung volumes are low. Fusion hardware is noted in the lower cervical spine. The heart is mildly enlarged. The mediastinal contour appears somewhat prominent, though borders appear sharp. No large effusion or pneumothorax seen. Retrocardiac space is poorly assessed. Bony structures are intact.", "output": "Limited exam with cardiomegaly and mediastinal prominence, which in part could reflect technique. Recommend repeat with dedicated PA and laterals with improved/optimized inspiratory effort." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. No subdiaphragmatic free air is noted.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear without consolidation or effusion. The cardiac silhouette is mildly enlarged as on prior. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Lung volumes are low. Allowing for this, there is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "There is no focal consolidation, effusion, or pneumothorax. Heart size is normal. Mediastinal and hilar contours are normal. No pulmonary edema.", "output": "No acute intrathoracic process." }, { "input": "The lung volumes are low. The cardiac, mediastinal and hilar contours appear unchanged including moderate tortuosity along the descending thoracic aorta. The streaky opacity in the left lower lung is most consistent with minor unchanged scarring. Otherwise, the lungs appear clear. There no pleural effusions or pneumothorax. The patient is status post left shoulder replacement.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The temporary pacemaker wire has been removed. There is no pneumothorax. A right apical density could be an elongated calcified right brachiocephalic trunk, more prominently seen due to positioning. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits. The aorta is tortuous. There has been a total shoulder arthroplasty of the left, and severe degenerative changes are noted at the right glenohumeral joint.", "output": "1. No pneumothorax. 2. No evidence of acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The chest is hyperinflated. Slight blunting along the left costophrenic angle suggests a trace effusion or perhaps minor scarring. There is no evidence for pleural effusion on the right. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The lungs remain hyperinflated. Rounded opacity projecting over the posterior right lower hemithorax, may be pleural-based. Further evaluation with chest CT is advised. Blunting of the right costophrenic angle which may be due to chronic changes, although trace right pleural effusion is not excluded. No left pleural effusion is seen. There is no focal consolidation in the left lung. Mildly increased interstitial markings bilaterally are stable. The prominence of the right hilum is again seen. Patient has known bilateral pleural plaques.", "output": "1. Hyperinflated lungs. 2. Rounded opacity projecting over the right lower hemithorax posteriorly is likely pleural-based and new since the prior study. Chest CT is recommended for further evaluation." }, { "input": "There is no pneumothorax or pneumomediastinum. A 3.9 cm rounded opacity again projects over the right lung base and is unchanged from ___. There are new patchy bibasilar opacities, worse at the left lung base, and a more vague opacity in the left upper lung which may represent pneumonia in appropriate clinical setting. There is engorgement of the central vasculature without strong evidence for pulmonary edema. No pleural effusion.", "output": "1. No evidence for esophageal rupture. 2. 3.9 cm rounded opacity projecting over the right lung base is unchanged from ___. Again, chest CT is recommended for full evaluation. 3. New patchy opacities at the left lung base and a vague opacity in the left upper lung are non-specific, especially in the setting of suspected underlying mass, and may reflect pneumonia or aspiration with supporting clinical evidence. These could further assessed at the time of cross-sectional imaging." }, { "input": "Portable AP upright chest radiograph is obtained. A right chest wall Port-A-Cath is new with catheter tip extending to the region of the SVC. Lungs are clear bilaterally. Tiny clips in the left axilla and left breast. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "No acute intrathoracic process. Port-A-Cath positioned appropriately." }, { "input": "A 2 lead pacemaker is in-situ, unchanged in appearance compared to the prior study. Left upper abdominal surgical clips are unchanged. The trachea is central. The cardiomediastinal contour is unchanged compared to the prior study. Specifically, no widening of the mediastinum seen. No lobar consolidation or pneumothorax seen. No pleural effusions seen. Degenerative changes are seen throughout the thoracic spine.", "output": "No acute cardiopulmonary process seen." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of normal size with normal cardiomediastinal contours. Atriobiventricular leads of a left chest wall pacer terminate in similar position to ___. Sternotomy wires are intact. Multiple mediastinal clips are similar to prior. Lung volumes are low. Lungs are otherwise clear without focal or diffuse abnormality. No pleural effusion or pneumothorax. Chronic right rib deformities are similar to prior. Acromioclavicular joint arthropathy is present bilaterally.", "output": "No acute cardiopulmonary process." }, { "input": "Patient is status post median sternotomy and CABG. A left-sided AICD/ pacemaker device is noted with leads in unchanged positions. Cardiac silhouette size is unchanged, appearing borderline enlarged. Mediastinal and hilar contours are stable. Pulmonary vasculature is not engorged. There is minimal atelectasis at the lung bases, but the lungs are otherwise clear without focal consolidation. No pleural effusion or pneumothorax is demonstrated. Remote right-sided rib fractures are present. An electronic device also projects over the lower chest, just to the left of midline.", "output": "No acute cardiopulmonary abnormality." }, { "input": "AP semi upright and lateral views of the chest provided. Left chest wall AICD is again seen with leads extending to the region of the right atrium, Coronary sinus, and right ventricle as on prior. Midline sternotomy wires and mediastinal clips again noted. Lung volumes are low limiting assessment. There is subtle retrocardiac opacity which could represent a developing pneumonia or aspiration. There is mild right basal atelectasis with mildly elevated right hemidiaphragm. No overt edema. No pneumothorax or definite signs of effusion. Cardiomediastinal silhouette is stable. Chronic right rib cage deformities again noted. No acute fracture is seen.", "output": "Retrocardiac opacity, question pneumonia versus aspiration. No overt edema." }, { "input": "Cardiac silhouette is top-normal to mildly enlarged. Mediastinal contours remarkable. No pleural effusion or pneumothorax is seen. No definite focal consolidation is seen on the frontal view, although on the lateral view, there is a somewhat rounded opacity projecting over the lower lobe posteriorly, overlying the anterior aspect of 2 lower thoracic vertebral bodies. While findings could relate to osseous degenerative change, underlying pulmonary lesion not excluded. Recommend follow-up chest CT for further assessment.", "output": "No definite focal consolidation is seen on the frontal view, although on the lateral view, there is a somewhat rounded opacity projecting over a lower lobe posteriorly, overlying the anterior aspect of 2 lower thoracic vertebral bodies. While findings could relate to osseous degenerative change, underlying pulmonary lesion not excluded. Recommend follow-up chest CT for further assessment. RECOMMENDATION(S): Chest CT." }, { "input": "Cardiac, mediastinal, and hilar contours are within normal limits. There is no evidence for pulmonary consolidation, pulmonary edema, pleural effusion, or pneumothorax. No displaced left rib fracture is seen, but the ribs are not adequately penetrated on chest radiography.", "output": "No evidence for acute cardiopulmonary abnormalities. If clinically warranted, dedicated left rib radiographs could be pursued for better assessment of the left ribs." }, { "input": "The lung volumes are somewhat low. However, the lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. The heart and mediastinal contours appear normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "Right carotid calcifications are seen. There is mild cardiomegaly and mild vascular congestion. There is a small left pleural effusion. There is no pneumothorax and no focal lung consolidation. Hardware is seen in the lower thoracic and upper lumbar spine.", "output": "Mild vascular congestion and small left pleural effusion." }, { "input": "A Port-A-Cath terminates in the superior vena cava. The cardiac, mediastinal and hilar contours appear stable. There is vague persistent opacity in the left lower lobe which is apparently a background finding, likely due to atelectasis. Otherwise the lungs appear clear. There are no pleural effusions or pneumothorax. There is no free air.", "output": "Persistent vague left base opacity, probably atelectasis." }, { "input": "Right chest wall port is again noted. Given differences in technique, there has been no significant interval change in the appearance of the right basilar pulmonary nodule projecting over the anterior right fifth rib. Other smaller pulmonary nodules on prior chest CT are not clearly delineated by x-ray. The lungs are clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is stable. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest provided. Right chest wall Port-A-Cath is again seen with its tip extending to the low SVC. Lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "There is consolidation of the right lung base, likely due to collapse of the right lower lobe and partial collapse of the right middle lobe with an associated large pleural effusion. The minor fissure is still visible, denoting that there is at least some portion of the right middle lobe still aerated. This consolidation is essentially unchanged compared with prior exam. The remaining right lung and the left lung field demonstrate prominent vascular markings, likely secondary to pulmonary vascular congestion. There is mild-to-moderate cardiomegaly, unchanged compared with prior exam. A small pleural effusion is present on the left. There is no pneumothorax. A tunneled dialysis catheter is noted ending in the right atrium. The right humeral head shows two anchors.", "output": "1. Right lower lobe and partial right middle lobe collapse associated with large pleural effusion are unchanged compared with prior exam. 2. Cardiomegaly with new small pleural effusion in the left along with pulmonary vascular congestion. 3. Dialysis catheter ending in the right atrium, unchanged from prior exam." }, { "input": "Interval placement of right-sided basilar pigtail catheter with interval decrease in size of the right pleural effusion and increased aeration overall in the right lung. There is persistent airspace consolidation in the right lower lung likely representing residual partial lower lobe collapse. No pneumothorax is appreciated. Cardiac mediastinal contours are difficult to assess due to marked patient rotation on the current study, although the heart remains enlarged. Overall, the left lung remains grossly clear. No pulmonary edema.", "output": "Interval placement of right-sided pigtail pleural drain with interval decrease in size of right-sided pleural effusion and improved aeration of the right lung. No pneumothorax is identified." }, { "input": "Compared to ___, there is an unchanged moderate right pleural effusion and partial collapse of the right middle and lower lobes, moderate cardiomegaly, and mild vascular congestion. There is no pneumothorax. A hemodialysis catheter is again seen ending in the proximal right atrium.", "output": "No change from ___ with cardiomegaly, mild vascular congestion, moderate right effusion and atelectasis." }, { "input": "Frontal and lateral views of the chest were obtained. Right-sided catheter is seen, again terminating in the right atrium. The cardiac silhouette is mildly enlarged. There are trace bilateral pleural effusions, significantly decreased on the right. No focal consolidation or pneumothorax is seen. The mediastinal and hilar contours are unremarkable. No overt pulmonary edema is seen.", "output": "Mild cardiomegaly and trace bilateral pleural effusions." }, { "input": "Severe cardiomegaly is re- demonstrated with similar mediastinal contours. Mild pulmonary vascular congestion is slightly improved compared to the previous study. Moderate to large right pleural effusion which is loculated partially laterally appears increased from the previous study. Worsening opacification of right lung base may reflect atelectasis, however infection is not excluded. There is a small left pleural effusion with left basilar atelectasis. No pneumothorax is identified.", "output": "Worsening opacification in the right lung base may reflect increased atelectasis though infection is not excluded. Increased size of large right partially loculated pleural effusion and trace left pleural effusion. Mild pulmonary vascular congestion, slightly improved in the interval." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes. Dual-lumen dialysis catheter projects over right atrium. Right lung base consolidation obscures right cardiac border. Moderate right pleural effusion is unchanged. Small left pleural effusion is present. Moderate cardiomegaly persists. Hilar and mediastinal silhouettes are unchanged. Pulmonary vascular congestion is noted. No pneumothorax.", "output": "Right lung base opacity has progressed since ___ exam, and may represent atelectasis or infection. Bilateral pleural effusions and moderate cardiomegaly are essentially unchanged with slight worsening of mild pulmonary vascular congestion." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged including cardiac enlargement. There has been marked increase in a right-sided pleural effusion, which is now very large. Although there is probably coinciding atelectasis of much or all of the right lower lobe, as well as the right middle lobe, there is also leftward shift of mediastinal structures that has increased. There is no pleural effusion on the left.", "output": "Large right-sided pleural effusion, substantially increased." }, { "input": "AP and lateral views of the chest are compared to previous exam from ___. When compared to prior, there has been interval development of more confluent consolidation identified in the right lower lobe. Indistinctness of the pulmonary vasculature is again seen throughout both lungs. Obscuration of the left lateral costophrenic angle could be due to fat pad or atelectasis. Cardiac silhouette is enlarged but stable. Osseous and soft tissue structures are unchanged.", "output": "New right base region of consolidation which could represent pneumonia in the appropriate clinical setting. Otherwise, no significant interval change in findings suggestive of pulmonary vascular congestion." }, { "input": "ET tube is 5.1 cm show the carina. Enteric tube courses into the stomach and beyond the field of view. Loculated right pleural effusion is overall unchanged. There may be slightly improved aeration of the right mid and lower lung.Small left pleural effusion is unchanged. The left lung is otherwise clear. The overall contour of the heart is unchanged with known mild cardiomegaly and moderate pericardial effusion.", "output": "1. Unchanged loculated right pleural effusion and small left pleural effusion. 2. Stable enlargement of the cardiac silhouette reflecting mild cardiomegaly and moderate pleural effusion better seen on recent chest CT." }, { "input": "PA and lateral image of the chest demonstrates significantly improved right pleural effusion suggests a repeat successful thoracocentesis. The lungs are well expanded and clear. There is no pneumothorax or other complication seen. Otherwise, there is no change in the chest radiograph from previous imaging. The appearance of the left lung is unchanged.", "output": "Significant improvement in the right pleural effusion suggestive of repeat successful thoracocentesis. Otherwise, unchanged chest radiograph." }, { "input": "The right pigtail catheter has been removed in the interim. Complete opacification of the right lower and mid hemithorax with silhouetting of the right heart border and right hemidiaphragm is new. There is associated rightward shift of the cardiomediastinal silhouette. These findings suggest volume loss. However, superimposed pneumonia cannot be excluded given the clinical history. The heart appears enlarged, overall similar to the prior exam. Streaky retrocardiac opacities are most likely reflective of atelectasis. No pneumothorax. There is a small effusion extending in the minor fissure seen on both the frontal and lateral views.", "output": "1. Right mid-lower hemithorax opacification has increased since ___ after the removal of the pigtail catheter and may reflect a combination of moderate effusion and atelectasis, but cannot exclude superimposed consolidation/pneumonia. 2. Mild edema." }, { "input": "The heart is mildly enlarged. The mediastinal and hilar contours appear unchanged. There is mild perihilar fullness and hazy predominantly perihilar opacification, including upper zone redistribution of the pulmonary vascularity, suggesting mild pulmonary vascular congestion. In addition, a focal opacity in the right lower lobe suggests pneumonia, probably also involving the right middle lobe, not significantly changed. There is a suspected small pleural effusion on the left. Mild-to-moderate rightward convex curvature is centered along the mid thoracic spine.", "output": "1. Persistent focal opacities in the right lower lung suggesting pneumonia. 2. Findings suggesting mild vascular congestion." }, { "input": "Moderate right pleural effusion, reaccumulated since ___ accounts for increased right basal atelectasis. A small left pleural effusion is unchanged since prior imaging. Mild cardiogenic pulmonary edema is increasing since ___. There is no pneumothorax. Moderate cardiomegaly is stable. Central hemodialysis catheter set is in standard location.", "output": "Moderate right pleural effusion reaccumulation and associated right basilar atelectasis. Small left pleural effusion and mild cardiomegaly, unchanged. Mild pulmonary edema increasing." }, { "input": "PA and lateral chest radiographs are obtained. Right large pleural effusion seen previously extending to the level of mid thorax appears slightly worse. Cardiomediastinal contours are stable. Dialysis catheter is unchanged. Left lung and visualized portion of the right lung are clear. No pneumothorax.", "output": "Slight increase in the size of the large right pleural effusion." }, { "input": "PA and lateral views of the chest were obtained. Moderate cardiomegaly is again seen. The mediastinal and hilar contours are stable. There is a small right pleural effusion. There is no pneumothorax. Lungs are clear. Cephalization of vessels is compatible with mild fluid overload, similar compared to the prior study. Again noted are tenodesis screws in the right humeral head.", "output": "Mild vascular congestion with small right pleural effusion and persistent enlargement of the cardiac silhouette." }, { "input": "Moderate cardiomegaly is unchanged since at least ___. Mediastinal silhouette and hilar contours are unremarkable. Lungs are clear. Trace fluid tracks along the major and minor fissure on the right side though there is no notable pleural effusion. Cephalization of vasculature is compatible with mild fluid overload. Pleural surfaces are otherwise clear without pneumothorax. Tenodesis screws are noted in the right humeral head from prior biceps tendon repair.", "output": "Stable cardiomegaly with trace fluid tracking along the major and minor fissures on the right and mild vascular congestion." }, { "input": "Persistent, stable cardiomegaly with mild pulmonary vascular engorgement. Moderate right-sided pleural effusion has increased from the prior examination. There is right lower lobe volume loss/infiltrate The left lung appears clear", "output": "Increased size of moderate right effusion." }, { "input": "Heart size is normal. Mediastinal and hilar contours are normal. Pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Patient is status post left shoulder arthroplasty, incompletely imaged.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Left-sided dual-chamber pacemaker appear unchanged with the leads in right atrium and right ventricle. The lungs are well expanded and clear. No pleural abnormality is seen. The hilar and mediastinal contours are normal. The heart size is top normal.", "output": "Left-sided dual-chamber pacemaker with leads in standard position." }, { "input": "The left subclavian pacemaker seen with leads terminating within the right atrium and right ventricle. Unchanged mild cardiomegaly. Normal lung volumes. No pneumothorax, no pleural effusion, no pulmonary edema. Mediastinal borders and hilar structures are normal.", "output": "Pacemaker leads in appropriate position." }, { "input": "The heart is top-normal in size. There is a small left pleural effusion. The lungs do not have any focal consolidation or pneumothorax. Opacity projecting over the right heart border likely represents bronchovascular crowding.", "output": "Small left pleural effusion. No convincing evidence of pneumonia." }, { "input": "Left-sided pacer device is stable in position.No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal to mildly enlarged. Mediastinal contours are stable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. The bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "Frontal and lateral radiographs of the chest demonstrate normal heart size. The left costophrenic angle is excluded on the frontal view. There are low lung volumes. There is persistent elevation of the right hemidiaphragm. The cardiomediastinal silhouette and hilar contours are normal. The lungs are clear. No pleural effusion or pneumothorax. No displaced rib fracture identified. No subdiaphragmatic free air.", "output": "No evidence of pneumonia." }, { "input": "The cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax. The lung volumes are low; particularly in that context, faint basilar opacities are likely due to minor atelectasis.", "output": "No definite evidence of acute cardiothoracic process. Patchy opacities likely attributable to minor atelectasis." }, { "input": "The lungs are clear. No focal consolidation, pulmonary edema, or pneumothorax. The heart is mildly enlarged. There is a small right anterior pleural effusion best seen on the lateral view. No left pleural effusion. The descending aorta slightly tortuous. Multilevel degenerative changes are noted in the thoracic spine.", "output": "Mild cardiomegaly and small anterior right pleural effusion. No edema." }, { "input": "The lungs are clear without focal opacity, pulmonary edema, pleural effusion or pneumothorax. Mild bronchial wall thickening. The cardiac and mediastinal contours are normal.", "output": "No pneumonia. Mild bronchial wall thickening could reflect chronic airway inflammation or acute bronchitis in the appropriate clinical setting." }, { "input": "The patient is status post median sternotomy. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. There is relative osteopenia.", "output": "No acute cardiopulmonary process." }, { "input": "Scarring is again noted in the left suprahilar region. Calcific density compatible previous granulomatous disease projecting over the left lung apex. Additional calcified granuloma seen in the left mid to lower lung laterally. Lungs are otherwise clear. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well inflated and clear. Heart size is normal. There is prominence of the ascending aorta, which may related to an unfolded aorta or enlarged ascending aorta. There is no pleural effusion or pneumothorax.", "output": "1. No acute cardiopulmonary process. 2. Prominent ascending aorta may relate to dilatation of the ascending aorta or unfolded aorta. Non emergent chest CT or follow up echocardiogram may better assess this." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear unchanged. There are no pleural effusions or pneumothorax. Band-like opacity projecting over the cardiac border on the lateral view suggests minor atelectasis in the right middle lobe. Otherwise, the lungs appear clear. Slight rightward convex curvature of the mid thoracic spine is similar.", "output": "Findings suggesting minor atelectasis in the right middle lobe without findings suggestive of pneumonia." }, { "input": "Single AP portable view of the chest was obtained. No focal consolidation, pleural effusion or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. No evidence of right lower lobe collapse seen in the current study. Upon further review of the scout radiograph from cervical spine CT, the opacity projecting over the right lower hemithorax likely represents the patient's overlying hand.", "output": "No acute cardiopulmonary process." }, { "input": "Right lower lobe opacity is worrisome for pneumonia. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Right lower lobe opacity worrisome for pneumonia." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. No pulmonary edema. Heart size is top-normal. Median sternotomy wires are intact. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "There is no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No pneumonia." }, { "input": "There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is unremarkable. There are no acute skeletal abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "No pneumothorax is identified. The cardiac and mediastinal silhouettes are normal.", "output": "No pneumothorax seen." }, { "input": "The left posterior 9th rib fracture is minimally displaced. There is obscuration of the left hemidiaphragm laterally. This is likely due to a combination of volume loss and small effusion. No pneumothorax is identified.", "output": "Compared to the prior study, appearance of the left lower lobe is worse." }, { "input": "PA and lateral views of the chest were obtained demonstrating clear well-expanded lungs without focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. There is no free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral chest radiographdemonstrates well expanded and clear lungs.No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable. Calcifications along the aortic arch are unchanged in appearance.", "output": "Normal chest radiograph." }, { "input": "The cardiomediastinal silhouette is top normal in size. There pulmonary vasculature are stable and shows no significant abnormalities. Calcifications along the aortic arch are unchanged. The lungs are clear aside from bibasilar atelectasis. There is no pleural effusion or pneumothorax. There may be left thyroid lobe enlargement, given mild mass effect on the trachea.", "output": "1. No acute intrathoracic abnormality. 2. Possible left thyroid lobe enlargement. Further evaluation by physical examination or with ultrasound can be considered if clinically warranted. RECOMMENDATION(S): Possible left thyroid lobe enlargement. Further evaluation with ultrasound can be considered if clinically warranted." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes. There is no focal consolidation, pleural effusion or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Surgical clips project over right upper abdomen. Partially imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are normally expanded and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lungs are well-expanded without focal consolidation, pleural effusion or pneumothorax. The cardiac size is normal. The mediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lung volumes are normal. Normal size of the cardiac silhouette. Normal hilar and mediastinal structures.No pneumonia, no pulmonary edema. No pleural effusions.", "output": "Normal chest radiograph without evidence of pneumonia. RECOMMENDATION(S): The findings were discussed by Dr. ___ ___ ___ on the telephone on ___ at 4:29 PM, 120 minutes after discovery of the findings." }, { "input": "There is increased retrocardiac density and subtle increased opacity of the right lower lung. No pleural effusion, pneumothorax, or pulmonary edema is detected. Evidence of emphysema corresponds with recent chest CT findings. Cardiomegaly persists. Calcified tortuous aorta is again noted.", "output": "Increased bibasilar opacities, which likely reflect aspiration; atelectasis and early infection are also possibilities." }, { "input": "Single portable view of the chest. No prior. Endotracheal tube is seen with tip approximately 2.5 cm from the carina. The lungs are hyperinflated. Linear parenchymal opacities seen in the right upper lung and could potentially be chronic in nature. There is no large confluent consolidation identified. Cardiac silhouette is at upper limits of normal for technique and given hyperinflation. Atherosclerotic calcifications noted at the arch. Osseous and soft tissue structures are unremarkable.", "output": "Endotracheal tube 2.5 cm from the carina. Linear parenchymal opacities in the right upper lung, potentially chronic; however, followup of this region recommended on future exams." }, { "input": "No significant interval change. Lungs are clear. No focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. Heart is normal in size. The mediastinum is not widened. The descending thoracic aorta slightly tortuous or ectatic, unchanged. The hila are within normal limits.", "output": "No pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with ___ from the office of Dr. ___, ___ referring provider requesting ___ wet read, on the telephone on ___ at 3:36 PM, after discovery of the findings." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion, pneumothorax. The heart and mediastinal contours are normal. The imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute findings in the chest." }, { "input": "Left anterior chest wall ICD leads project over the right atrium and right ventricle. Low lung volumes accentuate the cardiac silhouette and pulmonary vasculature. Heart size is moderately enlarged. Cardiomediastinal silhouette and hilar contours are otherwise normal. Lungs are clear. No evidence of fluid overload. Pleural surfaces are clear without effusion or pneumothorax.", "output": "Moderate cardiomegaly without evidence of fluid overload. No pneumonia nor pneumothorax." }, { "input": "The patient is status post interval right internal jugular central venous line placement, with the tip terminating in the proximal right atrium. There is no evidence of consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is unchanged in appearance.", "output": "Right IJ CVL in appropriate position. No pneumothorax." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear. Known mid thoracic vertebral body lesion is not well visualized on radiography.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "There is a subtle rounded opacity in the right apex and nodular opacities in the left upper lung zone. No pleural effusions or pneumothorax. The cardiomediastinal silhouette is normal. Wedge deformities in the thoracic spine from prior fractures are better characterized on concurrent CT of the chest.", "output": "Right upper lobe opacity and nodular opacities in the left upper lung for which further evaluation with CT is recommended." }, { "input": "Single frontal view of of the chest. A right chest tube terminates in the right upper lung. Small right lateral chest wall subcutaneous emphysema. Heart size and mediastinal contours are normal. Lung volumes are very low, crowding bronchovascular markings. The patient is status post right upper lobectomy and small right apical pneumothorax is expected postoperatively. Small right juxtamediastinal hematoma is also within expected post-operative limits. No significant pleural effusion.", "output": "Status post right upper lobe lobectomy with small postoperative right pneumothorax and hematoma." }, { "input": "PA and lateral views of the chest. The right chest tube has been removed. There is small right apical pneumothorax. There is clip seen in the right hilum. There is possible tiny left pleural effusion. The cardiomediastinal and hilar contours are normal. Decrease in subcutaneous emphysema on the left.", "output": "Small right apical pneumothorax. Small left pleural effusion." }, { "input": "Heart size is normal. Mediastinal and hilar contours are normal. Lungs are clear and the pulmonary vascularity is normal. Previously noted linear left lower lobe is no longer seen. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "A drain or other to overlies left upper quadrant. Surgical clips are noted near its tip. No free air seen beneath the diaphragm. Lordotic positioning with low inspiratory volumes. No CHF identified. There is patchy retrocardiac opacity consistent with left lower lobe collapse and/or consolidation. Lungs are otherwise grossly clear. No effusion identified. No pneumothorax detected.", "output": "Patchy opacity at left lung base, compatible with left lower lobe collapse and/or consolidation." }, { "input": "Frontal and lateral views of the chest were obtained. Minimal left base atelectasis is seen. There is no focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well expanded. There is linear scarring at the left base. Otherwise the lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The size of the heart is top normal. There are no abnormal cardiac or mediastinal contours. Osseous structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "New right-sided PICC is not in appropriate position, it coils back on itself in the right upper hemi thorax, to terminate in the right axilla. Recommend withdrawal and replacement/repositioning. There are low lung volumes. No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac silhouette is top-normal. Mediastinal contours unremarkable. No pulmonary edema is seen.", "output": "New right sided PICC not in appropriate position, it coils back on itself in the right upper hemi thorax to terminate in the right axilla. Recommend withdrawal and replacement/repositioning. No pneumothorax seen." }, { "input": "New right-sided PICC terminates in the mid SVC. Normal cardiomediastinal and hilar contours. Clear lungs. No pneumothorax or pleural effusion.", "output": "Right-sided PICC terminates in the mid SVC. No pneumothorax." }, { "input": "PA and lateral views of the chest provided. There has been interval removal of the left upper extremity access PICC line. No radiopaque foreign body is seen. Lung volumes are low. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process. PICC line intervally removed. No foreign body seen." }, { "input": "PA and lateral images of the chest. The lungs are well expanded. There is a focal patchy opacity in the right infrahilar area, which could represent atelectasis, aspiration, or early pneumonia. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "Focal opacity in the right infrahilar area, which could represent atelectasis, aspiration, or early pneumonia. Short term follow up radiographs are recommended." }, { "input": "The 1.3 cm nodule in the right perihilar region was better assessed in prior CT scan was characterized as a hamartoma. No other focal opacities are identified. A hyperdense nodule at the posterior costophrenic angles seen in the lateral view is compatible with a left-sided calcified retrocrural lymph node seen in prior chest CT. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion pneumothorax.", "output": "1. No evidence of acute cardiopulmonary process. 2. 1.3 cm nodule in the right perihilar region was characterized as a hamartoma in a prior CT. A ___ year followup examination was recommended more than one year ago which the patient has not undergone at least at this institution and should be performed on a nonemergent basis." }, { "input": "PA and lateral views of the chest provided. Lung volumes are markedly low limiting assessment. The cardiac silhouette appears enlarged which could reflect known prominent epicardial fat pads. In this patient with known interstitial lung disease, there are prominent reticular markings in the periphery of both lungs likely reflecting interval progression in fibrosis. Difficult to exclude a superimposed pneumonia. No large effusion or pneumothorax. No overt edema or congestion. Mediastinal contour is normal. Bony structures appear intact.", "output": "Pulmonary fibrosis, likely progressed in the interval. Difficult to exclude a superimposed pneumonia." }, { "input": "PA and lateral views of the chest. The lungs are clear. There is no effusion, pulmonary vascular congestion nor pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "There are bilateral, right greater than left, heterogeneous lower lobe opacities with a small right pleural effusion. No left pleural effusion. Again seen is a 3.2 x 3.3 cm rounded opacity within the right upper lobe with a radiopaque clip which is unchanged since prior examination. Mild cephalization of vasculature is noted. Stable mild cardiomegaly which is obscured due to overlying parenchymal abnormality. Small right pneumothorax. No left pneumothorax. Mediastinal contour and hila are otherwise unremarkable.", "output": "1. Small right pneumothorax. 2. Stable small right pleural effusion. 3. Heterogeneous right lower lobe opacity may represent atelectasis, pneumonia, aspiration in the appropriate clinical setting. 4. 3.3 cm rounded right upper lobe opacity is consistent with known right upper lobe adenocarcinoma with CyberKnife clip. 5. Stable mild cardiomegaly with mild vascular congestion." }, { "input": "The lung volumes are low. A small pleural effusion, best seen on lateral views, is of indeterminate laterality. Stable right atelectasis. The right upper lobe lesion consistent with history of adenocarcinoma is of similar size when compared to study from yesterday. Stable mild cardiomegaly. The mediastinal and hilar contours are stable. Interval resolution of small right apical pneumothorax.", "output": "1. Interval resolution of small right apical pneumothorax. 2. Stable right upper lobe mass. 3. Small pleural effusion of indeterminate laterally." }, { "input": "The aortic arch shows calcification. The heart is borderline in size. Hilar contours are unremarkable. There is no pleural effusion or pneumothorax. The lungs appear clear. The thoracic spine curves slightly to the right.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "PA and lateral views of the chest provided. Calcified granuloma projects over the right mid lung. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear of airspace or interstitial opacity. The cardiomediastinal silhouette is unchanged with unfolding of the thoracic aorta and moderate calcifications of the aortic arch. No pleural effusions or pneumothorax.", "output": "No acute radiographic intrathoracic pulmonary disease" }, { "input": "The lungs are clear. Heart size is normal. The hilar contours are normal. The pleural surfaces are normal without effusion or pneumothorax.", "output": "No evidence of mediastinal lymphadenopathy." }, { "input": "The lungs are clear with no pleural effusion identified. Cardiomediastinal contour appears stable when compared to prior study dated ___. Intact median sternotomy wires are identified. Calcifications are noted within the aortic arch. No acute osseous abnormality is identified.", "output": "No opacity convincing for pneumonia is identified." }, { "input": "The heart size is mild to moderately enlarged. The aortic knob is calcified. There is mild pulmonary edema with perihilar haziness and vascular indistinctness. Small bilateral pleural effusions are noted. Bibasilar airspace opacities likely reflect atelectasis. No pneumothorax is identified, although the extreme lung apices are somewhat obscured by the patient's chin projecting over this region. Diffuse demineralization of the osseous structures with multilevel degenerative changes are noted in the thoracic spine. Partially imaged is fusion hardware at the thoracolumbar junction.", "output": "Mild congestive heart failure with small bilateral pleural effusions and probable bibasilar atelectasis." }, { "input": "ET tube, NG tube, and left chest tube have been removed. Cardiomediastinal silhouette is slightly enlarged compared to ___. There is increased left lung base opacities suggestive of pleural fluid. There is no pneumothorax. 5 mm calcified granuloma at the right lung base is again noted. Right internal jugular Swan-Ganz catheter terminates at the proximal right pulmonary artery.", "output": "No pneumothorax. New small left pleural effusion." }, { "input": "A pulmonary arterial catheter, as well as its introducer, have been removed. Pulmonary edema has resolved. There is persistent retrocardiac opacification which probably reflects a combination of pleural effusion and atelectasis, perhaps somewhat decreased, however. A Calcified granuloma projects over the right lower lung versus nipple shadow. There is a small pleural effusion on the right.", "output": "Resolution of pulmonary edema. Persistent left base opacification, probably due to atelectasis and some degree pleural effusion. Removal of pulmonary artery catheter." }, { "input": "PA and lateral views of the chest provided. Lungs are clear. Pulmonary hilar vascular markings appear prominent. No pleural effusion or pneumothorax. No convincing evidence for pneumonia or edema. Cardiomediastinal silhouette appears within normal limits. Bony structures are intact.", "output": "Hilar vascular prominence. Please correlate with subsequent CT chest for further details." }, { "input": "Cardiac silhouette size is normal. The aorta is mildly unfolded. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is detected. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal contours are stable. Previously noted hilar prominence is improved on the current study. There is no pleural effusion or pneumothorax. Lungs are well-expanded without new focal consolidation concerning for pneumonia.", "output": "1. No new pulmonary parenchymal opacity. No pleural effusion. 2. Improvement hilar vascular prominence compared to the most recent prior study." }, { "input": "Frontal and lateral views of the chest were obtained. There is minimal bibasilar atelectasis. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac silhouette is top normal. The aortic knob remains calcified. There is slight prominence of the interstitium which may be due to minimal interstitial edema.", "output": "Bibasilar atelectasis and possible minimal interstitial edema. No focal consolidation seen." }, { "input": "AP upright portable chest radiograph is obtained. A right arm PICC line is again seen with its tip in the region of the cavoatrial junction with its tip obscured due to overlying EKG leads. The patient is rotated to her left, which limits evaluation. The right lung appears clear. There is left basal opacity which obscures the left hemidiaphragm, which could represent a combination of aspiration/pneumonia and effusion. The left upper lung appears reasonably aerated. The left-sided rib fractures are again noted. There is no pneumothorax. The ET and NG tubes have been removed. Overall, since the prior exam, there has been little change.", "output": "Status post removal of the ET and NG tubes with persistent left mid and lower lung opacity concerning for consolidation and effusion." }, { "input": "Endotracheal tube and nasogastric tube remain in standard position. Persistent cardiomegaly and bilateral pleural effusions. The moderate-to-large left pleural effusion is unchanged, moderate right pleural effusion has increased in size. Bibasilar lung opacities are likely due to atelectasis. Multiple acute left rib fractures are again demonstrated.", "output": "Persistent left and enlarging right pleural effusions." }, { "input": "Assessment is slightly limited due to patient rotation. Heart size appears mildly enlarged but unchanged. The mediastinal and hilar contours are similar with tortuosity of the thoracic aorta again noted. Pulmonary vasculature is not engorged. Streaky opacity is seen in the retrocardiac region, possibly atelectasis though infection is not excluded. No pleural effusion or pneumothorax is demonstrated. Scarring within the lung apices is again noted with curvilinear calcification in the region of the subclavian arteries again visualized bilaterally. Assessment of the lung apices is somewhat obscured by the patient's neck and chin projecting over this area. Multilevel degenerative changes are noted in the thoracic spine which demonstrates a leftward curvature. Remote left-sided rib fracture is noted.", "output": "Slightly limited assessment due to patient rotation. Streaky retrocardiac opacity, possibly atelectasis though infection cannot be excluded." }, { "input": "Lung volumes are low with secondary crowding of the bronchovascular markings. There is no consolidation or large effusion. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No definite acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is bilateral hilar fullness, concerning for adenopathy. Heart size is normal. The lungs are otherwise clear, without consolidation, pulmonary edema, or no pleural effusion.", "output": "Bilateral hilar adenopathy, concerning for sarcoidosis. Lymphoma would be less likely. CT could be helpful for further evaluation. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ On the telephone on ___ at 3:38 PM, 40 minutes after discovery of the findings." }, { "input": "Heart size is normal. Mediastinal contour is unchanged with similar enlargement of the hila compatible with known lymphadenopathy. Pulmonary vasculature is not engorged. Right perihilar opacity is re- demonstrated, perhaps minimally improved in the interval, with minimal patchy left perihilar ill-defined nodular opacities also appearing unchanged. No new focal consolidation, pleural effusion or pneumothorax is present. Streaky atelectasis is noted in the left lung base. No acute osseous abnormality is visualized.", "output": "Unchanged bilateral hilar and mediastinal lymphadenopathy. Hazy opacity in the right perihilar region persists, but is perhaps minimally improved from the previous radiograph, with ill-defined nodular opacities in the left perihilar region appearing unchanged. No new focal opacity demonstrated. Constellation of findings again may reflect active tuberculosis or sarcoidosis." }, { "input": "There is a large hiatal hernia with adjacent atelectasis. Bibasilar opacities likely represent combination of the above, without clear focal consolidation. No large pleural effusion or pneumothorax is seen. The aorta is calcified and tortuous. Cardiac silhouette size is mildly enlarged. No overt pulmonary edema is seen.", "output": "Cardiomegaly without overt pulmonary edema. Large hiatal hernia with adjacent basilar atelectasis." }, { "input": "Mild bibasilar atelectasis. The lung volumes are normal. Normal size of the cardiac silhouette. Normal hilar and mediastinal structures. no pulmonary edema. No pleural effusions. cardiomediastinal borders and hilar structures are normal.", "output": "Mild bibasilar atelectasis." }, { "input": "PA and lateral views of the chest show normal lung volumes without consolidation or nodules. Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax.", "output": "Normal chest x-ray." }, { "input": "Lung volumes are low. Heart size is difficult to assess but may be mild to moderately enlarged. There is mild pulmonary edema with perihilar haziness and vascular indistinctness. Small bilateral pleural effusions, left greater than right, are noted. Bibasilar airspace opacities may reflect atelectasis but infection or aspiration cannot be excluded. There is no pneumothorax. Mild gaseous distention of the colonic loops of bowel is present. There are diffuse atherosclerotic calcifications. There is diffuse demineralization of the osseous structures.", "output": "Mild pulmonary edema with small bilateral pleural effusions. Bibasilar airspace opacities may reflect atelectasis but infection or aspiration cannot be excluded." }, { "input": "Lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lung volumes are normal. Normal size of cardiac silhouette. No pleural effusions. No focal parenchymal opacity suggesting pneumonia. No pulmonary edema. No pneumothorax. Normal hilar and mediastinal contours. The osseous structures are stable.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal silhouette is normal. There is bronchovascular crowding in the left lower lobe consistent with atelectasis. Otherwise the lungs are clear. No pleural abnormalities. No pneumothorax. The visualized bones and soft tissues are normal. The new right port tip is in the right atrium.", "output": "1. No pneumonia. 2. Atelectasis in the left lower lobe." }, { "input": "The lungs are clear. There is no consolidation, effusion or edema. Cardiac silhouette is within normal limits. There is somewhat increased density of the aortic arch which may be technical however repeat with PA technique is suggested to further evaluate. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process. Apparent increased density projecting over the aortic arch, potentially technical however further clarification with PA film is suggested to confirm." }, { "input": "Frontal upright views of the chest were obtained. Tracheostomy tube is in stable position. Right subclavian central catheter terminates in the lower SVC. Leads of a left chest wall pacer terminate over the right atrium and right ventricle. Moderate cardiomegaly is similar to prior, allowing for difference in patient position. Retrocardiac opacity is stable and compatible with atelectasis, although infection may have a similar appearance. Left lung volume loss is similar to prior. No pneumothorax is visualized, though the patient's chin obscures the left apex.", "output": "Moderate cardiomegaly with stable left lung volume loss. Stable retrocardiac opacity is compatible with atelectasis but may represent pneumonia in the correct clinical setting." }, { "input": "Frontal view of the chest was obtained. The heart is mildly enlarged, similar to prior. Cardiomediastinal contours are stable. Left pleural effusion is similar to prior. Bibasilar opacities likely represent collapse of both lower lobes. Consolidation of left upper lobe is unchanged. Right subclavian central venous catheter terminates in the lower SVC. Tracheostomy tube, OG tube, and wires of the left chest wall pacer are in stable position.", "output": "Left upper lobe consolidation with left pleural effusion is unchanged. Bibasilar opacities are compatible with collapse of both lower lobes, similar to prior." }, { "input": "Tracheostomy tube is again seen. There has been interval placement of a right-sided subclavian central venous catheter, with the tip in the region of the cavoatrial junction. There is a dual chamber cardiac pacemaker present, with leads as expected in position. Allowing for the lung volumes, the cardiac and mediastinal silhouettes are probably within normal limits. The left hemithorax appears unchanged since the prior examination, with disproportionate of volume loss of the left hemithorax compared with right, as well as retrocardiac opacity. No osseous abnormalities are appreciated on this limited radiograph.", "output": "1. Right central venous catheter tip is in the region of the cavoatrial junction. 2. Persistent volume loss of the left hemithorax and retrocardiac opacity." }, { "input": "Single portable view of the chest is compared to previous exam from ___. Compared with prior, there has been interval improvement in aeration at the right lung base with more clear delineation of the right hemidiaphragm. There is persistent increased opacity in the left hemithorax with associated volume loss on this side, similar to CT scan from ___. There is persistent obscuration of the left hemidiaphragm. Cardiomediastinal silhouette has not changed. Dual-lead pacing device is again noted as is a tracheostomy tube. Subluxation of the glenohumeral joints is again noted.", "output": "Interval improved aeration at the right lung base. Persistent increased opacity involving majority of the left hemithorax silhouetting the left hemidiaphragm with likely volume loss. Overall, the findings have not significantly changed on the left since prior noting that infection cannot be excluded. Please clinically correlate regarding the need for additional imaging." }, { "input": "Lungs are mildly hypoinflated with crowding of vasculature. Bibasilar opacities are only seen on frontal projection. No pleural effusion or pneumothorax. Mediastinal contour and hila are unremarkable. The trachea is slightly deviated rightward suggesting an enlarged left thyroid lobe.", "output": "1. Bibasilar opacities are most consistent with atelectasis, however pneumonia cannot be excluded in the appropriate clinical setting. 2. Mild rightwards tracheal deviation suggests an enlarged left thyroid lobe. Recommend non urgent thyroid ultrasound for further evaluation. RECOMMENDATION(S): Recommend non urgent thyroid ultrasound for further evaluation. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 9:00 AM, 15 minutes after discovery of the findings." }, { "input": "PA and lateral chest radiographs demonstrate consolidation in the left upper lobe and air bronchograms. There is no pleural effusion or pneumothorax. The heart size is normal The cardiac, hilar and mediastinal contours are normal.", "output": "Left upper lobe pneumonia. Recommend follow-up chest radiograph in four weeks to visualize resolution." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. The lungs appear clear. A consolidation in the left upper lobe, seen on the prior study, has fully resolved. There is a trace pleural effusion on the right, but no clearly convincing one on the left. There is no pneumothorax.", "output": "Trace suspected left-sided pleural effusion, or possibly atelectasis in the posterior costophrenic angle; otherwise unremarkable study." }, { "input": "No focal consolidation, pleural effusion, or pneumothorax is seen. Heart and mediastinal contours are within normal limits. Lung volumes are slightly low. There is a right anterolateral seventh rib healing fracture.", "output": "No radiographic evidence for aspiration." }, { "input": "Frontal and lateral views of the chest. There is a large hiatal hernia and the intrathoracic stomach may contain a large bezoar. A dual chamber cardiac pacer is seen. The heart is mildly enlarged. There are median sternotomy wires and clips, presumably from a prior CABG procedure. The aortic valve is calcified which suggests aortic stenosis. The lungs are clear without focal opacities, pulmonary edema, pleural effusion or pneumothorax. There is no free air beneath the hemidiaphragms.", "output": "Very large hiatal hernia may contain a large bezoar. No pneumonia, edema or pleural effusion." }, { "input": "The cardiomediastinal and hilar contours remain stable. There is no pleural effusion or pneumothorax. ET tube and enteric tube remain in unchanged positions with low position of the ET tube and proximal positioning of the enteric tube. Mild pulmonary edema has improved on the current study. There is no new focal consolidation concerning for pneumonia.", "output": "1. ET tube approximately 3 cm from the carina. Enteric tube in the proximal stomach, but tube should be advanced to ensure location of proximal side holes in the stomach. 2. Improvement in interstitial edema." }, { "input": "PA and lateral views of the chest demonstrate low lung volumes. Bibasilar consolidations are present, likely atelectasis, however an underlying infectious process or aspiration cannot be completely excluded. There is no evidence of pneumothorax. Mild pulmonary vascular congestion is present. No pleural effusion is identified.", "output": "1. Low lung volumes with bibasilar consolidations, likely atelectasis, however an underlying infectious process or aspiration cannot be completely excluded. 2. Mild pulmonary vascular congestion" }, { "input": "ET tube is present with tip less than 3 cm from the carina. Additionally, the ET tube cuff appears to be overinflated. An NG tube is present with tip in the stomach but side holes near the GE junction. There is no pleural effusion or pneumothorax. The heart size is stable. The lungs are well expanded. A stable opacity obscuring the left hilus and causing tracheal deviation to the right is concerning for a mass and/or lymphadenopathy. There is also mild interstitial pulmonary edema.", "output": "1. NG tube with tip in the proximal stomach, but side holes near the GE junction. Advancement is recommended. 2. Overinflation of the ET tube cuff. Additionally, ET tube should be withdrawn by several centimeters for more standard positioning. 3. Left hilar fullness concerning for lung malignancy. Chest CT is recommended for further evaluation. 4. New mild interstitial pulmonary edema." }, { "input": "Heart size is normal. Left suprahilar mass compatible with known malignancy is re- demonstrated. Mediastinal and hilar contours are unchanged with widened right paratracheal stripe compatible with mediastinal lymphadenopathy. Low lung volumes are noted with bibasilar atelectasis. No pulmonary edema, pleural effusion or pneumothorax is identified. No acute osseous abnormalities present.", "output": "Low lung volumes with bibasilar atelectasis. Persistent left suprahilar opacity compatible with known malignancy. Widened right paratracheal stripe is unchanged and reflects known mediastinal lymphadenopathy." }, { "input": "A new nasogastric tube is visualized with the tip terminating in the stomach. Bibasilar opacities are again noted and likely representative of atelectasis. Lucency is again noted overlying the right hemidiaphragm is likely technical. Cardiac silhouette appears top normal but stable. There is no overt pulmonary edema. Atherosclerotic calcifications again noted at the aortic arch. An old right posterior 6th rib fracture is again noted.", "output": "1. Nasogastric tube appears in the stomach. 2. Bibasal opacities are again noted and likely representative of atelectasis." }, { "input": "The exam is technically limited. The lung volumes are very low. There is mild obscuration of the bilateral hemidiaphragms, which could be due to atelectasis, although a developing consolidation cannot be excluded. There is mild lucency overlying the upper hemidiaphragms. There is no overt pulmonary edema. There is no pneumothorax. The mediastinal contours are normal. Atherosclerotic calcifications are noted in the aortic arch. The heart size is difficult to evaluate given the low lung volumes, although may be mildly enlarged.", "output": "1. Very technically limited exam. Obscuration of the bilateral hemidiaphragms is likely related to atelectasis and low lung volumes, although developing consolidation cannot be completely excluded. 2. Lucency overlying the hemidiaphragms, which is likely due to positioning, although cannot pneumoperitoneum cannot be completely excluded. Recommend repeat upright radiographs, possibly with a lateral view, if clinically indicated. Results were discussed with Dr. ___ at 8 AM on ___ via telephone by Dr. ___." }, { "input": "2 views of the chest demonstrate clear lungs. The cardiac, hilar, and mediastinal contours are normal. No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is mildly enlarged with a left ventricular predominance. The aorta is mildly tortuous. Mediastinal and hilar contours are otherwise unremarkable. There is crowding of bronchovascular structures in the setting of low lung volumes. No overt pulmonary edema is present. There is minimal atelectasis in the lung bases without focal consolidation. No pleural effusion or pneumothorax is detected. There are no acute osseous abnormalities.", "output": "Low lung volumes with mild atelectasis in the lung bases." }, { "input": "Median sternotomy wires and evidence of CABG and aortic valve replacement are noted. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "A portable semi upright radiograph of the chest demonstrates a large left-sided pneumothorax and substantial left lower lung collapse with mediastinal shift to the left. The bilateral chest tubes remain in place. There is a stable appearing small right-sided pneumothorax. The endotracheal tube terminates at the thoracic inlet level, with persistent apparent overdistention of the endotracheal tube cuff.", "output": "1. Interval re-accumulation of large left-sided pneumothorax and substantial left lower lung collapse. 2. Endotracheal tube tip terminates at the thoracic inlet level with persistent apparent overdistention of the endotracheal tube cuff. COMMENTS: These findings were discussed with ___ (NP) by Dr. ___ ___ telephone at 2:25pm on ___, 15 minutes after their discovery." }, { "input": "Portable semi-upright radiograph of the chest demonstrates persistent small left-sided apical pneumothorax, which is not significantly changed from the prior study. Again seen is mild left-sided atelectasis, also unchanged. A chest tube projects over the left hemithorax. The right lung is clear. The cardiomediastinal and hilar contours are unchanged. A left-sided PICC ends at the cavoatrial junction.", "output": "Stable appearance of small left-sided apical pneumothorax." }, { "input": "Frontal and lateral chest radiographs demonstrate substantial increase in rightward tracheal deviation and mediastinal widening since ___, concerning for enlarged aorta with or without hematoma or dissection. Patient has a history of aortic graft placement as demonstrated on the CT Torso dated ___. With this information, the aforementioned findings raises the concern for possible endograft leak, dissection, or aneurysm. Moderate bilateral pleural effusion and severe, basal atelectasis, new since ___ are worse since earlier in the day. There is no focal consolidation or pulmonary edema, and no pneumothorax.", "output": "Severe enlargement of thoracic aorta could be due to aneurysm, contained perforation, and/or dissection. A chest CT with contrast enhancement is recommended, asdiscussed with Dr. ___ by Dr. ___ ___ telephone at 13:45 on ___ immediately upon review of the radiographs." }, { "input": "Frontal view of the chest was obtained. NG tube terminates below the diaphragm in proper position. Right PICC terminates in the mid SVC. Sternotomy wires are intact. Aortic valve replacement in its stable position. Mild-to-moderate cardiomegaly is stable. Pulmonary vascular congestion is similar to the prior study. Bibasilar opacities are compatible with atelectasis. No substantial pleural effusion or pneumothorax.", "output": "NG tube terminates below the diaphragm. Stable pulmonary vascular congestion and adjacent atelectasis." }, { "input": "AP single view of the chest has been obtained with patient in semi-upright position. Comparison is made with the next preceding similar study obtained two hours earlier during the same day. Chest findings are unaltered. In the interval the NG tube has been advanced and reaches now below the diaphragm including the lines and side port.", "output": "Successful adjustment of line position." }, { "input": "There is tortuosity of the aorta. There is no pleural effusion and no pneumothorax. The cardiomediastinal silhouette and hila are normal. Patient is status post median sternotomy. There is no evidence of pneumonia.", "output": "No acute cardiothoracic process." }, { "input": "Portable semi-upright radiograph of the chest demonstrates persistent, although stable, widening of the mediastinum. There is a small left-sided pleural effusion with adjacent atelectasis which is unchanged from the prior study. Right lung is clear. There is no pneumothorax. Enteric feeding tube is seen coiled in the stomach. Left-sided internal jugular central venous line ends at the upper SVC. The ET tube is above the upper margin of the clavicles, measuring 6 cm from the carina. Bilateral thoracostomy tubes are in unchanged position.", "output": "1. Stable-appearing wide mediastinum. 2. Small left-sided pleural effusion with adjacent atelectasis, unchanged from the prior study. 3. Endotracheal tube is above the upper margin of the clavicles, measuring 6 cm from the carina, and should be advanced 2 cm for more secure seating." }, { "input": "PA and lateral views of the chest were obtained demonstrating clear well expanded lungs without focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well expanded. There is no focal consolidation, effusion, or pneumothorax. A right upper lobe granuloma is stable. Mild cardiomegaly is similar. Dual-chamber pacing leads are in unchanged positions. Multi level thoracic spine osteophytes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "AP and lateral images of the chest. The lungs are well expanded. There is pulmonary vascular engorgement and increased interstitial markings, consistent with mild pulmonary edema. There are tiny bilateral pleural effusions. There is no pneumothorax. The cardiomediastinal silhouette is enlarged.", "output": "1. Mild pulmonary edema. Recommend repeat chest radiograph after treatement for edema to rule out underlying infection or other process. 2. Cardiomegaly." }, { "input": "A dual-lead pacemaker/ICD device appears unchanged with leads again terminating in the right atrium and ventricle, respectively. The heart is mildly enlarged. The mediastinal and hilar contours appear unchanged. A calcified nodule in the right upper lobe suggesting a granuloma appears unchanged. Otherwise, the lungs remain clear. There is no pleural effusion or pneumothorax. Small osteophytes are noted along the mid-to-lower thoracic spine.", "output": "No evidence of acute disease." }, { "input": "There is a dual-lead pacemaker/ICD device in place, as before. The cardiac, mediastinal and hilar contours appear stable including mild cardiomegaly. Flattening of hemidiaphragms suggest hyperinflation. There is no pleural effusion or pneumothorax. A small calcification projecting over the right upper lobe suggests a parenchymal granuloma, not significantly changed. Otherwise, the lungs appear clear. Moderate anterior osteophytes are noted along several lower thoracic levels, as before.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Mild pulmonary vascular congestion with slight thickening of the fissures is new from the prior exam. No focal consolidation, pleural effusion, or pneumothorax. Stable mild cardiomegaly. Stable flattening of the diaphragms, suggestive of hyperinflation. No change in the probable calcified granuloma projecting over the right upper lung. The dual-lead left-sided cardiac device appears intact and unchanged in position. Prominent anterior osteophytes are again noted in the visualized thoracic spine.", "output": "Mild pulmonary vascular congestion. Otherwise, no significant interval change." }, { "input": "Left-sided AICD device is noted with leads terminating in the right atrium and right ventricle. The heart remains mildly to moderately enlarged. Aorta is tortuous and calcified, similar to the prior study. There is crowding of the bronchovascular structures due to low lung volumes. No pulmonary edema is present. Patchy opacities in both lung bases may reflect atelectasis. Calcified granuloma in the right upper lung field is unchanged. Anterior osteophytes are seen within the thoracic spine spine. No acute osseous abnormalities are detected.", "output": "Low lung volumes with bibasilar patchy opacities possibly reflecting atelectasis. Infection cannot be excluded." }, { "input": "2 views were obtained of the chest. The lungs are low in volume but clear. There is no pleural effusion or pneumothorax. The heart is normal in size with normal cardiomediastinal contours.", "output": "No acute intrathoracic process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Moderate multilevel degenerative changes are noted in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of normal size with normal cardiomediastinal contours. There is calcification of the aortic knob. Lungs are clear without focal or diffuse abnormality. No pleural effusion or pneumothorax. There is extensive thoracic dextroscoliosis, similar to prior. No radiopaque foreign body.", "output": "No acute cardiopulmonary process." }, { "input": "Portable semi-erect chest radiograph ___ at 17:45 is submitted.", "output": "The right internal jugular Swan-Ganz catheter and nasogastric tube are unchanged in position. Endotracheal tube has its tip approximately 5 cm above the carina. The heart remains stably enlarged. Overall, there is improving aeration in both lungs suggestive of resolving moderate pulmonary edema. Retrocardiac consolidation persists likely reflecting lobar collapse in the setting of a pleural effusion. Pneumonia in the retrocardiac area cannot be excluded. The and right pleural effusion. Patient is status post median sternotomy for CABG. No pneumothorax." }, { "input": "Portable semi-erect chest radiograph ___ at 12:19 is submitted.", "output": "Interval intubation with the endotracheal tube having its tip approximately 3.5 cm above the carina. The feeding tube courses below the diaphragm with the tip not identified. The right internal jugular Swan-___ catheter continues to have its tip in the right pulmonary outflow tract. There are layering effusions, right greater than left, with associated bibasilar opacities suggestive of atelectasis. Increasing retrocardiac consolidation likely reflects left lower lobe collapse. There is stable bilateral diffuse airspace process suggestive of moderate pulmonary edema. No pneumothorax. Status post median sternotomy with stable cardiac enlargement." }, { "input": "Portable semi-erect chest radiograph ___ at 07:33 is submitted.", "output": "Right internal jugular Swan-Ganz catheter, endotracheal tube and nasogastric tube are unchanged in position. Status post median sternotomy with stable postoperative cardiac and mediastinal enlargement. Layering bilateral effusions with bibasilar patchy opacities likely representing lower lobe atelectasis. Prominent perihilar vasculature likely reflects combination of low lung volumes and residual perihilar edema. No pneumothorax." }, { "input": "There are bibasilar opacities which are most likely due to atelectasis in the setting of relatively low lung volumes. The lungs are otherwise clear. There is no pneumothorax. The cardiomediastinal silhouette is within normal limits. No visualized acute osseous abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "Portable semi-erect chest film ___ at 05:49", "output": "Feeding tube courses below the diaphragm with tip not identified. Right internal jugular Swan-Ganz catheter has its tip in the right pulmonary outflow tract. Status post median sternotomy with expected stable postoperative cardiac and mediastinal contours. Interval worsening of moderate pulmonary edema; an infectious process would be less likely. Probable layering effusions, left greater than right. No pneumothorax." }, { "input": "Portable semi-erect chest radiograph ___ at 14:12 is submitted.", "output": "There has been interval removal of the right internal jugular Swan-Ganz catheter with the introducer sheath remaining in place. Interval placement of a left internal jugular Swan-Ganz catheter which has its tip in the right pulmonary artery. A nasogastric tube is seen coursing below the diaphragm with the tip not identified. No pneumothorax is seen. There continues to be perihilar fullness and pulmonary vascular indistinctness consistent with mild pulmonary edema. Overall, aeration has improved at the right base but the left basilar opacity is unchanged and likely reflects lower lobe atelectasis in the setting of a layering effusion. Status post median sternotomy with stable postoperative cardiac and mediastinal contours." }, { "input": "The heart size is normal. The hilar and mediastinal contours are unremarkable. The left pectoral pacemaker leads end in the right atrium and right ventricle, in appropriate position. The sternal wires are intact and clips from prior CABG are noted. There is no pulmonary vascular congestion. No focal consolidations concerning for infection, pleural effusions or pneumothoraces are identified. There is mild bibasilar atelectasis. Visualized osseous structures are unremarkable.", "output": "No focal consolidations concerning for pneumonia identified." }, { "input": "Indistinctness of the pulmonary vasculature with increased bibasilar opacities is likely due to pulmonary vascular congestion. There is no focal consolidation, pleural effusion or pneumothorax. Heart size is normal. Mediastinal silhouette is stable. Mediastinal wires are intact. The left pectoral pacemaker leads end in the right atrium and right ventricle.", "output": "Pulmonary vascular congestion. No pneumonia." }, { "input": "Frontal and lateral chest radiographs were obtained. A right upper lobe nodule and fiducial seed from prior CyberKnife procedure are unchanged from CT on ___. No consolidation, pleural effusion, pneumothorax or pulmonary edema is seen. Heart size is normal. Mediastinal contours are normal. There are multiple bilateral healed rib fractures.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "A severe new interstitial lung abnormality is found mostly in the left upper lobe. There is a growing opacification in the right upper paramediastinal lung where a fiducial marks the focused radiation treatment of a non-small cell lung cancer. Callus formation marks healed rib fractures. Small bilateral pleural effusions are new. Cardiomediastinal and hilar contours are unremarkable.", "output": "New interstitial abnormality, more likely infection or drug reaction than cardiogenic edema. Probable local recurrence, radiated right upper lobe lung cancer." }, { "input": "PA and lateral views of the chest. The lungs are clear without focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "The patient has an unchanged tracheostomy. The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear. There is similar mild to moderate rightward convex curvature centered along the mid thoracic spine.", "output": "No evidence of acute disease." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear and well expanded without pleural effusion, focal consolidation, or pneumothorax. Tracheostomy tube is angled towards the left wall of the trachea, with its termination approximately 6-7 cm above the carina.", "output": "No acute cardiopulmonary process. No evidence of pneumonia. Tracheostomy tube is angled towards the left wall of the trachea." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. The lungs are hyperinflated but the lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are moderately well inflated with subtle retrocardiac opacity. No pulmonary edema. No pleural effusion or pneumothorax. The heart is top-normal in size. Mediastinal contour and hila are unremarkable.", "output": "Subtle left base opacity most likely represents atelectasis however early pneumonia cannot be excluded in the appropriate clinical setting." }, { "input": "The cardiomediastinal silhouette is normal. The lungs are clear without focal consolidations. The pleura and hila are normal. Previously seen left lower lobe atelectasis no longer visualized with pulmonary vasculature now within normal limits.", "output": "Normal chest x-ray." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unremarkable. Lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Moderate degenerative changes with anterior osteophyte formation is seen throughout the thoracic spine. Clips from prior thyroidectomy are seen about the lower neck.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart is of normal size with normal cardiomediastinal contours. The lungs are clear. No focal consolidation, pleural effusion, or pneumothorax. No radiopaque foreign body.", "output": "No evidence for acute cardiopulmonary process." }, { "input": "Heart size, mediastinal and hilar contours are normal. A left PICC remains in place, and terminates in the mid to lower superior vena cava. Lungs are clear, and there are no pleural effusions or acute skeletal findings.", "output": "No radiographic evidence of pneumonia." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unchanged and within normal limits. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is demonstrated. Elevation of the right hemidiaphragm is unchanged. No acute osseous abnormalities seen. A clip is noted within the right lower lobe.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Analysis is performed in direct comparison with the next preceding similar study of ___. The heart size is unchanged and remains normal. No typical configurational abnormality is present. Thoracic aorta of ordinary dimension but some small calcium deposits are seen in the wall at the level of the arch. No local contour abnormalities are identified. The pulmonary vasculature is not congested. No signs of acute or chronic parenchymal infiltrates are present and the lateral and posterior pleural sinuses are free. Skeletal structures of the thorax are grossly within normal limits.", "output": "Persistent normal chest findings in this patient with a history of an acute zoster infection." }, { "input": "The lungs are clear with no evidence of consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Multiple previously visualized sub-4-mm nodules in the left lung are better delineated on prior CT.", "output": "There is no evidence of an acute cardiopulmonary process. However, given the patient's history of AML, if clinical symptoms for a thoracic process are high, a dedicated Chest CT is recommended." }, { "input": "PA and lateral views of the chest demonstrate unchanged elevation of the right hemidiaphragm. There is no evidence of pneumothorax, pleural effusion, pulmonary edema, or pneumonia. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well expanded and clear. The mediastinum is unremarkable. The cardiac silhouette is within normal limits for size and stable. No effusion or pneumothorax is noted. The osseous structures are unremarkable.", "output": "No acute pulmonary process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Moderate pulmonary vascular congestion is seen. No large pleural effusion is appreciated on this single AP view although 1 was present on CT from ___. Cardiac silhouette remains mildly enlarged. There is left mid lung and right base atelectasis. No pneumothorax is seen.", "output": "Moderate pulmonary vascular congestion and cardiomegaly." }, { "input": "The lungs remain clear. There is no focal consolidation, effusion, or edema. Cardiomegaly is stable. No acute osseous abnormalities. Surgical clips in the right upper quadrant suggest prior cholecystectomy.", "output": "Cardiomegaly without superimposed acute cardiopulmonary process." }, { "input": "Since the prior radiograph, a dual lead permanent pacemaker is been placed with leads overlying the expected locations of the right atrium and right ventricle, with no evidence of pneumothorax. Stable cardiomegaly and tortuosity of the thoracic aorta. Lungs are clear.", "output": "Pacing leads in standard position with no visible pneumothorax." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. Mild cardiac enlargement is noted. Tortuosity of descending thoracic aorta is noted. No acute osseous abnormalities.", "output": "Mild cardiomegaly without acute cardiopulmonary process." }, { "input": "AP portable chest x-ray shows moderate hyperinflation and upper lung hyperlucency related to COPD. There are no consolidations suspicious for pneumonia. Band-like opacity in the left retrocardiac region is likely atelectasis. There is no pleural effusion or pneumothorax. Heart size is still top normal.", "output": "No sign of acute cardiopulmonary process. Small atelectasis in the left lung base in COPD patient." }, { "input": "There is mild-to-moderate cardiomegaly and an unfolded aorta. Engorgement of the vasculature is consistent with fluid overload. Left lower lobe opacities are consistent with a prominent fat pad as well as atelectasis. No focal consolidations are present that are concerning for pneumonia. No pleural effusion. On the lateral view, projecting over the spine and under the left diaphragam, is a 2.5 cm oblong density which has no clear correlate on the frontal views.", "output": "1) Cardiomegaly and engorgement of the vasculature consistent with fluid overload. 2) 2.5 cm density projecting over the spine. Recommend repeat PA and lateral views after diuresis to reevaluate. Findings discussed with ___, ___ ___ ___ 7:55 AM via telephone - ___" }, { "input": "As compared to prior chest radiograph from earlier today, pulmonary vascular congestion has improved. The cardiac silhouette is mildly enlarged. There is no focal consolidation or pneumothorax. Previously identified density projecting over the spine beneath the left hemidiaphragm, is not seen on current examination. Trace effusions are seen bilaterally.", "output": "Interval improvement of pulmonary vasculature congestion. Previously identified density projecting over the spine beneath the left hemidiaphragm is not visualized." }, { "input": "PA and lateral views of the chest were obtained. View is an apical lordotic view which somewhat limits the evaluation, though allowing for this, the lungs are clear without focal consolidation, effusion, or pneumothorax. Heart and mediastinal contours appear normal. Bony structures are intact.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral chest radiographs demonstrate clear lungs without effusion or pneumothorax. Note is made of small amount of eventration of the right hemidiaphragm. The heart size is normal, the mediastinal contours are unremarkable.", "output": "No acute chest pathology." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Relative elevation of the right hemithorax may be related to respiration.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and fairly well-aerated lungs. There are patchy bibasilar opacities. There is no pleural effusion or pneumothorax. There is no radiographic evidence for mass. Left clavicle fixation hardware is noted.", "output": "Patchy bibasilar opacities could represent atelectasis, sequela of aspiration, or early developing pneumonia. Short-term follow-up chest radiographs are recommended. NOTIFICATION: Updated findings and recommendation were communicated via telephone by Dr. ___ to Dr. ___ at 08:16 on ___, upon attending review." }, { "input": "Stable retrocardiac opacity is most consistent with atelectasis. The lungs are otherwise clear. There is a stable trace left pleural effusion. No right pleural effusion. No pneumothorax. Heart size, mediastinal contour, and hila are unremarkable. Limited assessment of the upper abdomen is unremarkable. Visualized osseous structures are notable for left clavicle fixation hardware.", "output": "1. Stable retrocardiac opacity is most consistent atelectasis. 2. Stable trace left pleural effusion. 3. No pneumothorax." }, { "input": "Both lungs are well expanded and clear. No opacities concerning for pneumonia. Heart size, mediastinal and hilar contours are normal. There is no pleural abnormality.", "output": "No pneumonia or any other acute intrathoracic process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs remain clear of focal consolidation, effusion, or pulmonary vascular congestion. The cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. Lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No acute abnormalities identified to explain patient's cough." }, { "input": "The lungs are well inflated and clear. No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable.", "output": "No acute cardiopulmonary process. Specifically, no pneumonia." }, { "input": "There is re-demonstration of a left-sided pacemaker with right atrial and right ventricular leads, not significantly changed. The heart size is normal. The mediastinal contours are normal. There is no pneumothorax. A small to moderate quantity of fluid is seen layering within one or both of the pleural spaces posteriorly on the lateral projection, new compared to the prior radiograph from ___. Multilevel degenerative changes of the thoracic spine are noted.", "output": "New small-to-moderate possibly bilateral pleural effusions. Otherwise, no acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest were obtained. Left chest wall pacemaker leads are unchanged in position ending in the right atrium and right ventricle. Heart size is top normal and unchanged. There is no focal consolidation. A right pleural effusion could be moderate in size if there is a subpulmonic component, which is suggested by the diaphragmatic contour. No left pleural effusion and no pneumothorax. Pulmonary vasculature is normal. A 1.0cm nodule projecting over the anterior second rib is unchanged from ___ but not clearly seen on ___. Degenerative change is noted in the spine.", "output": "1. Right pleural effusion with suggestion of subpulmonic component. A lateral decubitus film could be performed to better quantify the amount of fluid. No pulmonary edema or pneumonia. 2. 1.0 cm nodular opacity projecting over the right anterior second rib. ___ degree shallow oblique radiographs are recommended to distinguish a bone island in the rib from a lung nodule. Findings entered into the radiology critical results dashboard for communication to the ordering provider ___ ___:32am on ___." }, { "input": "The heart is normal in size. There is heterogeneous opacification in each mid to lower lung and each hilum is mildly enlarged. This is probably due to enlargement of pulmonary vessels in association with mild vascular congestion. Confluent opacification obscuring the left cardiac border suggests pneumonia in the lingula, although pneumonia might not be confined to this area.", "output": "Findings suggest pneumonia in the appropriate, most well defined in the lingular region, with coinciding suspicion for mild vascular congestion." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs without pleural effusion or pneumothorax. There is left base atelectasis.", "output": "No acute cardiopulmonary process. Left base atelectasis." }, { "input": "Frontal and lateral views of the chest are obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac silhouette is top normal. The mediastinal and hilar contours are unremarkable.", "output": "Top normal cardiac silhouette. No definite focal consolidation." }, { "input": "PA and lateral views of the chest demonstrate there is slight elevation of the right hemidiaphragm and relatively low lung volumes. No focal consolidation is identified. There is no pleural effusion, pulmonary edema or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. A faint ___-mm nodular opacity projecting within the left lower lobe and left anterior 7th rib is noted. Remainder of the lungs are clear. No pleural effusion, pneumothorax, or pulmonary edema. No acute osseous abnormalities are seen.", "output": "___-mm nodular left lower lobe opacity, for which further assessment with chest CT is recommended. No acute cardiopulmonary abnormality otherwise identified." }, { "input": "Relatively low lung volumes noted with crowding of the bronchovascular markings. There is no confluent consolidation or large effusion. Median sternotomy wires are noted with fractures through the second and fourth wires. Prosthetic mitral valve is noted. Cardiomediastinal silhouette is within normal limits for technique.", "output": "No definite acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal. No old pulmonary edema seen.", "output": "No acute cardiopulmonary process." }, { "input": "Postoperative appearance of the mediastinum is unchanged. Bibasilar streaks of atelectasis are noted. Lungs are otherwise clear. There has been interval placement of a Dobbhoff tube which terminates in the mid gastric body although the tip of the tube is excluded on imaging. A right internal jugular catheter is unchanged in position with the tip projecting over the cavoatrial junction.", "output": "Little change compared to ___ with interval placement of a Dobbhoff which terminates in the mid gastric body." }, { "input": "Axial. History hypoxia.", "output": "AP chest at 2:22 compared to ___: Left lower lobe consolidation, probably atelectasis, has worsened, and moderate right basal atelectasis though less severe than the left has also increased. Pulmonary vasculature is now engorged, although the cardiomediastinal silhouette has a normal postoperative appearance. No pneumothorax. ET tube, right internal jugular line, and upper enteric drainage tube are all in standard positions, respectively. The patient probably has a small hiatus hernia." }, { "input": "The heart is mildly enlarged with a left ventricular configuration. The mediastinal and hilar contours appear within normal limits without change. Streaky left basilar opacity suggests minor atelectasis or scarring, but otherwise, the lung fields appear clear. There is no definite pleural effusion or pneumothorax. An old healed right posterior ninth rib fracture appears unchanged.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Cardiac size is normal. The lungs are clear. There is no pneumothorax or pleural effusion. Left subclavian catheter tip is in the mid SVC", "output": "No acute cardiopulmonary abnormality" }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lung fields are clear. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Right PICC line tip in the low SVC, near cavoatrial junction. Heart size at the upper limits of normal. Normal pulmonary vascularity. No pulmonary edema. Lungs are clear. No effusion. No pneumothorax.", "output": "Lungs are clear." }, { "input": "No focal consolidation, pleural effusion or pneumothorax identified. The size the cardiomediastinal silhouette is within normal limits.", "output": "No radiographic evidence of acute cardiopulmonary disease." }, { "input": "The heart size at the upper limits of normal. There is mild interval increase in the size of the azygos vein, vascular pedicle and mild increase in size of the upper lobe blood vessels. No overt pulmonary edema. No large pleural effusion. No airspace consolidation to suggest pneumonia. No pneumothorax.", "output": "Mild interval distention of the upper lobe blood vessels and widening of the vascular pedicle suggesting progression in the cardiac decompensation, but no overt pulmonary edema." }, { "input": "The lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax. The heart is normal in size with normal cardiomediastinal contours.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest were provided, demonstrating no focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette appears normal. Tiny clips are noted in the right breast and axilla. Bony structures appear intact.", "output": "No acute findings in the chest. Please refer to subsequently performed CTA chest for further details." }, { "input": "Upright PA and lateral radiograph of the chest. Lung volumes are slightly low, but there is no focal airspace consolidation. There is mild atelectasis at the left base and right infrahilar region. The cardiomediastinal silhouette and hilar contours are normal. There is no pleural effusion or pneumothorax. Surgical clips again project over the right breast and axilla.", "output": "No acute cardiopulmonary abnormality detected." }, { "input": "PA and lateral views of the chest provided. Platelike left lower lung atelectasis. Tiny clips noted in the right breast and right axilla. No evidence of pneumonia, edema, pleural effusion or pneumothorax. Cardiomediastinal silhouette appears normal. Bony structures appear intact.", "output": "Mild left basal platelike atelectasis, otherwise unremarkable." }, { "input": "The patient is status post coronary artery bypass graft surgery and mitral valve repair. There is still marked enlargement of the right hemidiaphragm but atelectasis at the right lung base has decreased and appears minimal. The left lung appears clear. There is no pleural effusion or pneumothorax.", "output": "Elevation of the right hemidiaphragm. No evidence of acute disease." }, { "input": "Cardiac stents appear unchanged. The heart is at the upper limits of normal size. The aortic arch is calcified. Background coarsening of lung markings at the each lung apex suggests minor unchanged subpleural scarring. Patchy opacity in the right costophrenic angle suggests minor unchanged scarring. The lungs are hyperinflated. There is no pleural effusion or pneumothorax. Bony structures are unremarkable.", "output": "Hyperinflation. No evidence of acute disease." }, { "input": "A right-sided Port-A-Cath terminates at the cavoatrial junction. Surgical fixation hardware projects over the cervicothoracic spine. Surgical clips project over the left chest wall and axilla. The heart is normal in size. Multiple soft tissue density masses and nodules are seen throughout both lungs suggestive of metastatic lung disease, however no priors are available for comparison. The lungs are otherwise clear with no focal consolidation, pleural effusion or pneumothorax.", "output": "Right Port-A-Cath terminates at the cavoatrial junction. Multiple soft tissue density nodules are seen throughout both lungs and are suggestive of metastatic disease." }, { "input": "A left-sided chest tube is visualized within the left lower chest. There is also a left-sided PICC line with the tip position unchanged from the previous study. An opacity projecting over the left lower chest persists and is not significantly changed. Right lung appears to be clear. No pneumothorax is identified.", "output": "No acute changes compared to the prior study." }, { "input": "Frontal and lateral views of chest. When compared with prior, there has been continued interval decrease in the opacity blunting the left lateral costophrenic angle which may be due to resolving loculated effusion. This may also be due to pleural thickening or scar given overlying rib deformities suggesting prior trauma/surgery. The lungs are otherwise are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormalities are noted with folds right ___ lateral rib fracture and deformities of the left ribs.", "output": "Continued interval resolution of the opacity at the left lateral costophrenic sulcus. No acute cardiopulmonary process." }, { "input": "PA and lateral images of the chest demonstrate well-expanded lungs. There is a persistent left-sided pleural effusion/empyema, which appears unchanged in size from most recent imaging, accounting for slightly different patient positioning. Some left basilar plate atelectasis is seen. Slight elevation of the left hemidiaphragm is also again seen. The right lung is clear with no pleural effusion. There is no pneumothorax. Cardiomediastinal silhouette is unremarkable.", "output": "Essentially unchanged chest radiograph." }, { "input": "Frontal view of the chest was obtained. There is near-complete opacification of left hemithorax with slight rightward shift of the mediastinal structures. This is most compatible with a large amount of left pleural fluid. The right lung is clear. Right heart border is unremarkable. Osseous structures are unremarkable. No radiopaque foreign bodies.", "output": "Opacified left hemithorax with slight rightward shift of mediastinal structures, compatible with large left pleural effusion. Findings were discussed with Dr. ___ ___ phone at 3:50 pm on ___ at time of discovery." }, { "input": "AP single view of the chest has been obtained with patient in sitting semi-upright position. Comparison is made with the next preceding similar portable examination of ___. The previously existing small caliber pigtail catheter draining the left pleural base has been exchanged with a large caliber chest tube now seen to terminate in the left apical area. The amount of pleural effusion has decreased. There exist now a loculated pneumothorax on the left base at the site of the tube entrance but otherwise the lung remains aerated with no extension of the pneumothorax in the apical area. The previously described left-sided PICC line remains in unchanged position.", "output": "Successful exchange to large caliber chest tube with loculated small left basal pneumothorax but no other complications." }, { "input": "There has been interval placement of a left chest tube with tip projecting towards the left apex. Subcutaneous emphysema within the left chest wall is new. There has been slight interval improvement in aeration of the left upper lung field with persistently large left pleural effusion. Left basilar opacification is compatible with atelectasis. The right lung is grossly clear though the right costophrenic angle is excluded from the field of view. Deformity within the ribs bilaterally is compatible old fractures. The cardiac, mediastinal and hilar contours are relatively unchanged.", "output": "Interval improvement in aeration of the left upper lung field status post placement of a left sided chest tube. Large left pleural effusion, slightly improved in the interval." }, { "input": "A PICC line has been removed. A chest tube again projects over the left lower chest wall, although its sidehold again lies outside the left hemithorax. There is persistent volume loss with mild leftward mediastinal shift and a moderate suspected pleural effusion in the left lower hemithorax. A focus of band-like atelectasis in the left mid lung has partly resolved. The lateral view suggests persistent consolidation with air bronchograms in the left lower lobe, again without clear change.", "output": "Similar persistent loculated left-sided pleural effusion and consolidation. Chest tube terminating in the left lower hemithorax, although the sidehole again lies outside the pleural cavity." }, { "input": "Frontal and lateral views of the chest were obtained. Previously seen bilateral pleural effusions have resolved in the interval. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. Degenerative changes are seen along the spine including marked compression of the lower thoracic vertebral body which is stable.", "output": "No acute cardiopulmonary process. Interval resolution of previously seen bilateral pleural effusions." }, { "input": "The lungs are clear, the cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax.", "output": "No acute cardiothoracic process." }, { "input": "AP and lateral views of the chest are compared to previous exam from ___. The lungs are clear. Cardiomediastinal silhouette is unchanged. Osseous and soft tissue structures are again notable for lower thoracic/upper lumbar vertebral body height loss.", "output": "No acute cardiopulmonary process." }, { "input": "Since prior radiograph, the left hemidiaphragm has become elevated by a dilated colon. Plate-like atelectasis is seen at the left lower base; however, no areas of focal consolidation are noted. Aorta is somewhat tortuous. No pleural effusions or pneumothoraces. A compression fracture/deformity of the approximatley T10 vetebral body is new since ___.", "output": "No evidence of pneumonia. A compression fracture/deformity of the approximatley T10 vetebral body is new since ___. These findings were communicated by Dr. ___ with Dr. ___ via telephone at 10:23 a.m. on the day of the study." }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. There is slight prominence of the bilateral hila and pulmonary arteries. The cardiomediastinal silhouette is otherwise within normal limits. Aortic knob calcifications are noted.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No evidence of active or latent TB. No acute cardiopulmonary process." }, { "input": "The lungs are clear. Heart size is at the upper limits of normal, with a markedly tortuous aorta. No pleural effusions or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "AP supine portable view of the chest was obtained. The endotracheal tube is low in position, terminating approximately 1 cm above the level of the carina and should be withdrawn by at least 2 cm. The endotracheal tube balloon appears overinflated. Nasogastric tube is seen coursing below the level of the diaphragm, extending to the expected position of the stomach. There are right greater than left pulmonary opacities. There may be a small left pleural effusion. The cardiac silhouette is not enlarged. The aorta is calcified and tortuous. Prominence of the central vasculature suggests a component of pulmonary edema. Lucency projecting over the left lower hemithorax is seen to represent a likely loculated pneumothorax vs less likely bulla on subsequent chest CT.", "output": "1. Low-lying endotracheal tube terminates just above the carina. Recommend withdrawal by approximately 3 cm. Above findings were discussed with Dr. ___ at approximately 8:20 p.m. on ___ via telephone. 2. Lucency projecting over the left lower hemithorax represents likely loculated pneumothorax, less likely bulla on subsequent chest CT. 3. Bilateral pulmonary opacities may be due to aspiration and edema, although underlying contusion cannot be excluded." }, { "input": "Exam is limited due to portable technique and patient body habitus. Increased interstitial markings are likely due to these factors. There is no obvious edema. Opacity at the left cardiophrenic angle is compatible with prominent fat pad seen on prior CT. Retrocardiac region is poorly assessed. Right chest wall dual lead pacing device is again noted as well as a left sided port.", "output": "No definite acute cardiopulmonary process." }, { "input": "Status post placement of permanent pacemarker with both pacing leads terminate to the left of midline, with the more distal lead in the expected location of the right ventricle. The prior CTA of the chest demonstrates baseline rotation and shift of the heart towards the left, causing the right atrium to project slightly to the left of midline, likely accounting for the location of the proximal lead on today's chest radiograph. Cardiac silhouette remains enlarged, and the left hemidiaphragm is chronically mildly elevated. Blunting of left costophrenic sulcus appears to be due to a combination of cardiac enlargement and pericardial fat in this region as based on prior CTA of the chest. Exam is otherwise remarkable for 1.2 cm diameter opacity overlying the left third anterior rib level.", "output": "1. Pacing leads probably terminate in right atrium and right ventricle based on correlation with chest CTA of ___, but confirmatory lateral radiograph would be helpful in this regard when the patient's condition allows. There is no evidence of pneumothorax. 2. 1.2 cm diameter opacity at left third rib level, possibly a healed rib fracture, but attention to this finding on a followup PA and lateral radiograph would be helpful to exclude a discrete lung nodule. Dr. ___ has been notified of this finding by telephone at 8:30 a.m. on ___ at the time of discovery." }, { "input": "Single portable view of the chest is compared to previous CT angiogram of the chest from ___. Increased density at the left lung base which silhouettes the left hemidiaphragm laterally is compatible with patient's known biventricular cardiomegaly and configuration of the heart. Lungs are clear of focal consolidation or evidence of pulmonary vascular congestion. Cardiomediastinal silhouette is unchanged compared to prior CT scan scout film. Osseous and soft tissue structures are grossly unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. No prior. The lungs are hyperinflated but clear of confluent consolidation or pulmonary vascular congestion. The cardiac silhouette is enlarged. Multiple old left-sided rib fractures are identified. Osseous structures are otherwise notable for osteopenia.", "output": "Hyperinflation and moderate cardiomegaly without definite acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No displaced rib fracture is seen. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Lungs are fully expanded and clear without consolidations or effusions. Heart size is normal. There is abnormal prominence of the left hilum. Cardiomediastinal and hilar silhouettes are otherwise normal. Pleural surfaces are normal.", "output": "No radiographic evidence of pneumonia. Prominence of the left hilum may reflect an asymmetrically large left pulmonary artery and underlying pulmonic stenosis or hilar lymphadenopathy. Recommend correlation with outside hospital imaging if available to establish chronicity. RECOMMENDATION(S): Recommend correlation with outside hospital images further evaluation of prominent left hilum. If no prior imaging is available or if new, recommend CT chest for further evaluation." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. A very subtle opacity the base of the left lung appears less conspicuous on the current examination and may reflect a resolving focus of infection. No pleural effusion or pneumothorax.", "output": "Very subtle opacity seen at the left base on the frontal view appears less conspicuous on the current exam and may reflect an area of persistent or resolving infection in the appropriate clinical setting." }, { "input": "The lungs are clear. Cardiac silhouette is top normal. There is no pleural effusion or pneumothorax. There is no pulmonary edema.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The cardiac silhouette is moderately to severely enlarged. Mediastinal contours are stable. There is no pulmonary edema. No definite focal consolidation is seen. There is no large pleural effusion although left pleural effusion be difficult to exclude.", "output": "Moderate to severe enlargement of the cardiac silhouette without pulmonary edema. Findings may be due to underlying cardiomyopathy and/or pericardial effusion. No definite focal consolidation." }, { "input": "The lungs are clear of focal consolidation or edema. Degree of cardiomegaly is similar. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Left basal atelectasis noted. Lung volumes are low. No convincing sign of pneumonia or edema. No large effusion or pneumothorax. Cardiomediastinal silhouette appears normal. The imaged bony structures are intact.", "output": "Left basal atelectasis." }, { "input": "Cardiac, mediastinal and hilar contours are within normal limits. The pulmonary vasculature is normal. There is mild elevation of the left hemidiaphragm. Minimal atelectasis is seen in the left lung base. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Minimal left basilar atelectasis with slight elevation of the left hemidiaphragm. Otherwise, no acute cardiopulmonary abnormality." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Pulmonary vascularity is normal. Lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are detected.", "output": "Normal chest radiograph." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. Chronic mid right clavicular fracture is noted. Mild height loss of lower thoracic vertebral body is also noted.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours are unremarkable aside from patchy atherosclerotic calcification along the aortic arch. There is no pleural effusion or pneumothorax. The lungs appear clear. Moderate anterior osteophytes are noted along the mid thoracic spine, with smaller ones along the thoracolumbar junction.", "output": "No evidence of acute disease. Normal cardiac size." }, { "input": "Single supine AP portable view of the chest was obtained. Underlying trauma board and other external artifact partially obscures the view. No focal consolidation is seen. There is no pleural effusion or evidence of pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. No evidence of a displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral images of the chest. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Patient is intubated. Endotracheal tube terminates about 5 cm above the carina. An orogastric tube terminates in the stomach where it makes a single coil. Aorta is moderately tortuous and mildly calcified. Heart is normal in size. There is no pleural or pericardial effusion. I density at the medial right lung apex, also medial to the anterior right first rib is indeterminate. Elsewhere the lungs appear clear.", "output": "Indeterminate small opacity at the right lung apex, possibly scarring or atelectasis, but a nodule is not excluded. No definite evidence of acute disease. Repeat radiographs are recommended when clinically appropriate in order to ascertain whether a possible right upper lobe opacity may persistent investigate further if warranted." }, { "input": "There is interval placement of a single lead pacemaker with its distal tip in appropriate position in the right ventricle. The cardiopericardial silhouette is enlarged and there is vascular redistribution. There is no evidence of consolidation or pneumothorax. Chronic left rib fracture.", "output": "Interval placement of pacemaker with tip in appropriate position. Reviewed with Dr. ___." }, { "input": "A left PICC terminates at the cavoatrial junction. Right-sided central venous catheter terminates deep within the right atrium. Borderline enlargement of the cardiac silhouette has increased since ___. Bilateral pulmonary opacification looks more like edema in the right lung and concurrent consolidation on the left, perhaps pneumonia or pulmonary hemorrhage. There is no pneumothorax or effusion.", "output": "New moderately severe pulmonary edema. Possible pneumonia and/or pulmonary hemorrhage, left lung. NOTIFICATION: Dr. ___ reported the findings to Dr ___ by telephone on ___ at 2:36 PM, 2 minutes after discovery of the findings." }, { "input": "The ET tube terminates at the level of the thoracic inlet. The nasogastric tube enters the stomach. A right IJ central venous catheter terminates in the low SVC. There is no pneumothorax. A new rounded airspace opacity at the right base may be due to aspiration or infection. The heart and mediastinum are within normal limits.", "output": "New right basilar aspiration or infection. NOTIFICATION: The impression and recommendation above was entered by Dr. ___ on ___ at 09:08 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "An endotracheal tube terminates 6.4 cm above the carina. A right internal jugular sheath terminates in the mid SVC. A left internal jugular catheter terminates in the mid SVC. The heart is normal in size. There is no pneumothorax. Clear lungs with no pleural effusions or pulmonary edema.", "output": "Endotracheal tube measures 6.4 cm above the carina. No pneumothorax or focal consolidation." }, { "input": "The initial radiograph from ___ hr shows acute worsening of extensive bilateral airspace opacities. The left subclavian central venous catheter terminates at the superior cavoatrial junction. There is no pneumothorax. Mild cardiac enlargement is unchanged. The followup radiograph from ___ hr shows improved airspace opacities following intubation. The new ET tube is slightly high-riding. Advancement by 2-3 cm is suggested for more optimal ventilation. In addition, a new nasogastric tube enters the stomach, but its side port is at the GE junction. Advancement by 5 cm is advised.", "output": "Initially worsening bilateral airspace opacities have improved following intubation. The rapid change may be due to severe pulmonary edema, pulmonary hemorrhage, or drug reaction. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 12:28 PM, 5 minutes after discovery of the findings." }, { "input": "The initial radiograph from ___ hr shows acute worsening of extensive bilateral airspace opacities. The left subclavian central venous catheter terminates at the superior cavoatrial junction. There is no pneumothorax. Mild cardiac enlargement is unchanged. The followup radiograph from ___ hr shows improved airspace opacities following intubation. The new ET tube is slightly high-riding. Advancement by 2-3 cm is suggested for more optimal ventilation. In addition, a new nasogastric tube enters the stomach, but its side port is at the GE junction. Advancement by 5 cm is advised.", "output": "Initially worsening bilateral airspace opacities have improved following intubation. The rapid change may be due to severe pulmonary edema, pulmonary hemorrhage, or drug reaction. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 12:28 PM, 5 minutes after discovery of the findings." }, { "input": "Compared to ___ at 15 31 the left subclavian PICC line has retracted, and now overlies the upper SVC proximal SVC, with and curves at its extreme distal tip Again seen are in the opacities in the most pronounced in the upper zones bilaterally and in the left> right mid-zones, very similar to the prior film. No new area of consolidation and no effusion is identified. Cardiomediastinal silhouette is unchanged.", "output": "1. Interval retraction of PICC line, which now overlies the proximal SVC, with focal curving of the distal segment of the line. 2. Upper zone predominant thigh lateral alveolar opacities are similar to the prior film. No new opacity identified. NOTIFICATION: Page sent to covering physician Dr ___ at 5:20 pm on ___, at the time of discovery, and discussed with or shortly thereafter (___, phone) ." }, { "input": "The left-sided PICC line is unchanged. The heart size is mildly enlarged but is less prominent than on the prior study. Again seen is the diffuse hazy alveolar infiltrate although this has also improved slightly", "output": "Slight improvement in alveolar infiltrate" }, { "input": "Portable semi-erect chest film ___ at 04:43 is submitted.", "output": "Dual lumen right internal jugular central line, left internal jugular central line, and nasogastric tube are unchanged in position. Interval extubation. Overall cardiac CAD mediastinal contours are stable. No focal airspace consolidation to suggest pneumonia. No pulmonary edema or pneumothorax is appreciated. No acute bony abnormality is appreciated." }, { "input": "The patient is now extubated. Enteric tube has been removed. Allowing for differences in projection small bilateral pleural effusions are likely slightly larger. Streaky opacity in the right upper lobe is resolved. There may be increased pulmonary vascular congestion and mild interstitial pulmonary edema. The heart is slightly larger. The mediastinal contours are normal.", "output": "1. Increased heart size, now with moderate cardiomegaly and worsening mild to moderate pulmonary edema. 2. Small bilateral pleural effusions are also likely larger." }, { "input": "AP upright frontal and lateral chest radiograph demonstrates opacification of the left lung base concerning for atelectasis or aspiration. Within the right upper lobe, there is a subtle opacity which is concerning for pneumonia. There are mildly increased bronchovascular markings within the upper lobes bilaterally. The cardiomediastinal and hilar contours are unchanged since ___ examination with a heart size which is top normal. There is no pleural effusion or pneumothorax.", "output": "Bilateral scattered opacities in the lungs, most notable in the left lung base and right upper lobe concerning for pneumonia." }, { "input": "Frontal and lateral chest radiographs demonstrate interval removal of a right upper extremity PICC. Small-to-moderate, right greater than left, pleural effusions are unchanged to slightly improved. There is unchanged bibasilar atelectasis. The cardiac silhouette remains mildly enlarged, the mediastinal contours are notable only for tortuosity of the aorta with calcification of the aortic knob. Pulmonary vasculature is normal.", "output": "No significant pulmonary edema, with residual right greater than left small-to-moderate pleural effusions and mild cardiac enlargement." }, { "input": "Portable semi-upright radiograph of the chest demonstrates low lung volumes results in bronchovascular crowding. There are moderate size bilateral pleural effusions with adjacent atelectasis. Soft tissues of the head and neck overly the lung apices. The cardiomediastinal and hilar contours are unchanged. There is no pneumothorax. A right-sided PICC line is in unchanged position. There has been interval removal of the endotracheal tube.", "output": "Moderate bilateral pleural effusions with adjacent atelectasis." }, { "input": "There has been interval placement of an endotracheal tube and nasogastric tube. The endotracheal tube appears to be in appropriate position terminating 4.5 cm above the carina. The nasogastric tube is seen passing below the diaphragm. There continues to be a right upper and lower lobe opacification and a possible retrocardiac opacity.", "output": "Appropriate position of ET tube and nasogastric tube. No significant change in pulmonary opacities." }, { "input": "Single portable view of the chest compared to previous exam from ___ and ___. Hazy opacities at the lung bases, silhouetting the left hemidiaphragm likely due to effusions and potentially also in part due to patient positioning. There is pulmonary vascular congestion, mildly indistinct markings. Cardiac silhouette is enlarged but stable in configuration. Previously identified right-sided PICC is no longer visualized. Osseous and soft tissue structures are unremarkable.", "output": "Probable left greater than right pleural effusions and mild pulmonary edema." }, { "input": "Frontal and lateral views of the chest were obtained. Relative opacity projecting over the right lung apex at the level of the anterior right first rib likely relates to the first rib. However, AP lordotic views would help in confirmation. The lungs are relatively hyperinflated with flattening of the diaphragms, suggesting chronic obstructive pulmonary disease. There is mid-to-lower lung atelectasis bilaterally. Mild pulmonary vascular congestion is seen. Minimal to mild interstitial edema is again seen. Cardiac and mediastinal silhouettes are stable.", "output": "1. Hyperinflated lungs consistent with COPD. Minimal interstitial edema, improved since prior. 2. Bibasilar atelectasis. 3. Opacity projecting over the right lung apex at the level of the anterior right first rib may relate to the rib; however, suggest further evaluation/confirmation on AP lordotic view." }, { "input": "AP upright and lateral views of the chest provided. Low lung volumes limits assessment. No focal consolidation, large effusion or pneumothorax is seen. There is mild interstitial pulmonary edema, less severe than on prior exam. Cardiomediastinal silhouette is stable. Bony structures are intact.", "output": "Mild interstitial pulmonary edema." }, { "input": "The heart is mildly enlarged. The mediastinal and hilar contours appearing unremarkable. The chest appears hyperinflated. The lungs appear clear. There are no pleural effusions or pneumothorax. The bones appear demineralized. There is mild-to-moderate rightward convex curvature centered along the lower thoracic spine. There is minimal loss in vertebral body height along the mid thoracic vertebral body and immediately above that level there is a very minimal biconcave compression deformity which appears chronic. The left acromioclavicular joint is narrowed.", "output": "No evidence of acute disease." }, { "input": "There bilateral increased interstitial opacities suggestive of moderate pulmonary edema. Bilateral small pleural effusions likely exists. Lungs are without a focal opacity otherwise. Cardiac mediastinal silhouettes are stable with a trotuous arota. There is kyphotic angulation of the thoracic spine. No acute fractures are identified.", "output": "Moderate pulmonary edema with bilateral small pleural effusions, suggesting heart failure." }, { "input": "The cardiomediastinal silhouette and hila are normal. There is a moderate right pleural effusion, similar compared to ___, but new compared to ___. A pacemaker device is seen with leads ending in the right atrium and right ventricle. No pneumothorax.", "output": "Moderate right pleural effusion, unchanged from ___." }, { "input": "Patient is somewhat rotated to the right. Patient is status post median sternotomy and CABG. Triple lead left-sided pacer device is stable in position. Bilateral perihilar and basilar opacities persist, possibly slightly increased, most worrisome for pulmonary edema, superimposed infection is not excluded. Obscuration of the left greater than right diaphragms could be due to small pleural effusion or related to atelectasis. No pneumothorax is seen. Cardiac and mediastinal silhouettes are stable.", "output": "Extensive bilateral perihilar and basilar opacities which appear slightly increased are most worrisome for worsening pulmonary edema, superimposed infection not excluded. Obscuration of the left greater than right diaphragms could be due to small pleural effusion or related to atelectasis." }, { "input": "A left axillary pacemaker is present with the wires in standard position in the right atrium and right ventricle. Sternal wires are intact. Slight rightward deviation of the trachea is stable due to known thyroid nodule. New bibasilar hazy opacification, greater on the left than on the right, most likely represents new mild pulmonary edema, although an underlying infectious process cannot be excluded. Small bilateral pleural effusions are new. There is no pneumothorax. The cardiomediastinal silhouette is normal.", "output": "1. Probable mild pulmonary edema, although underlying pneumonia, specifically at the left base, cannot be excluded. 2. New small bilateral pleural effusions. Results were discussed with Dr. ___ at 12:15 p.m. on ___ via telephone by Dr. ___." }, { "input": "Sternotomy. Cardiac pacemaker. Heart is enlarged, similar. Improved bibasilar opacities. Improved right perihilar opacity. Right hilar fullness, stable, consider mass or adenopathy. Increased pulmonary vascularity, stable. Mild interstitial prominence, suggest edema, improved. No pneumothorax. Improved pleural effusions.", "output": "Right hilar fullness, suggest mass or adenopathy, similar. Mildly improved Cardiopulmonary findings." }, { "input": "Compared to most recent chest radiograph, there is little change. Unchanged small to moderate right pleural effusion. Unchanged small to moderate left pleural effusion. Unchanged bibasilar atelectasis and right hemidiaphragm elevation. Unchanged cardiomegaly and pulmonary vascular congestion. Median sternotomy wires are intact. Left pacemaker is intact with leads terminating in the right atrium, right ventricle and coronary sinus. No pneumothoraces.", "output": "Unchanged interstitial edema and bilateral pleural effusions, right worse than left. Unchanged basilar atelectasis." }, { "input": "In comparison to the prior study, there has been insertion of an endotracheal tube with tip projecting 4.5 cm above the carina in the mid thoracic trachea. An enteric tube is also new with distal tip projecting below the low lower limit of the radiograph. The left chest cardiac device is an unchanged orientation, as are multiple EKG leads, median sternotomy wires, and mediastinal surgical clips. Re-demonstrated is a large right pleural effusion with adjacent atelectasis. Known right perihilar mass and mediastinal lymphadenopathy was better assessed on prior cross-sectional imaging. The left lung is unchanged in appearance, with a persistent left perihilar opacity. There is no left pleural effusion. There is no pneumothorax.", "output": "New endotracheal tube with tip in the mid thoracic trachea. New enteric tube. Otherwise, stable chest radiograph." }, { "input": "In comparison to earlier same-day chest radiograph, the left IJ central venous catheter has been repositioned. The tip now projects over the expected location of the left brachiocephalic vein, no longer coiled into the left subclavian. Other lines and support devices are stable, including endotracheal tube, enteric catheter, left chest cardiac device with associated leads, and EKG leads overlying the chest. The there are unchanged extensive bilateral parenchymal opacities, right worse than left. There is an unchanged appearance of a likely large right pleural effusion. Difficult to exclude a small left pleural effusion given appearance. No pneumothorax.", "output": "Interval repositioning of left IJ central venous catheter, tip now projecting over the left brachiocephalic vein, no longer coiled into the left subclavian vein. Otherwise, stable chest radiograph." }, { "input": "PA and lateral views of the chest. The pacemaker with transvenous leads end in the appropriate positions in the right atrium and right ventricle. Sternotomy wires and mediastinal clips are stable. The cardiac, mediastinal, and hilar contours are normal. The lungs are clear. No pleural effusion or pneumothorax.", "output": "Transvenous pacemaker leads in appropriate position. No pneumothorax, mediastinal widening, or evidence of hemothorax." }, { "input": "Sternotomy. Cardiac pacemaker. Apparent elevation of the right hemidiaphragm is new, may in part be from subpulmonic effusion and/or worsening right basilar infiltrate and/or atelectasis. There is moderate left pleural effusion, which has worsened. Left perihilar infiltrate has improved. Left lower lobe consolidation is stable. Increased heart size, pulmonary vascularity stable. No pneumothorax.", "output": "Worsened findings at the right lower lung, likely combination of pleural effusion with possible subpulmonic component, and atelectasis and/or infiltrate. Worsened left pleural effusion which now moderate." }, { "input": "PA and lateral views of the chest provided. A tripolar pacer is again seen with lead tips extending to the right atrium, right ventricle and region of the coronary sinus. Midline sternotomy wires and mediastinal clips are again noted. There are tiny bilateral pleural effusions with mild interstitial pulmonary edema noted with hilar engorgement. The cardiomediastinal silhouette is stable. Bony structures are intact.", "output": "Mild pulmonary edema with tiny pleural effusions." }, { "input": "Biventricular ICD noted over the left chest with leads properly projecting over the right ventricle, right atrium, and left ventricle. Sternotomy wires and surgical clips are unchanged. The heart is top normal in size. Opacification of the right lung seen previously, likely representing layering of pleural effusion is no longer seen in this upright radiograph. There is a small right-sided effusion seen better on the lateral radiograph. There is a new area of opacity at the right cardiophrenic angle, possibly representing an area of fluid or segmental atelectasis in the lower lobe. No pneumothorax.", "output": "1. Small right pleural effusion. 2. Focal opacity at the right cardiophrenic angle likely represents an area of fluid or atelectasis in the medial basal segment of the right lower lobe. Suggest followup chest x-ray to better evaluate this region." }, { "input": "Patient is status post median sternotomy and CABG. Left-sided pacer device is stable in position. New since the prior study is moderate to severe pulmonary edema. There is also a new right mid to lower lung opacity suggesting large pleural effusion with overlying atelectasis, underlying consolidation not excluded. Right perihilar mass with associated mediastinal lymphadenopathy was better assessed on prior CT/PET CT.", "output": "Large right pleural effusion with overlying atelectasis, underlying consolidation not excluded. Right perihilar mass and mediastinal adenopathy better assessed on prior CT. Left perihilar opacity could relate to pulmonary edema versus underlying disease spread or infection." }, { "input": "Right PICC line tip is now in the medial right brachiocephalic vein, approximately 13 cm from cavoatrial junction. No pneumothorax. Exam otherwise unchanged.", "output": "Right PICC line has changed position. Otherwise stable" }, { "input": "One frontal view of the chest. Left pacemaker is seen with transvenous leads in the right atrium and right ventricle in appropriate position. Sternotomy wires and mediastinal clips are again seen. Aortic knob calcifications are stable. Cardiomegaly is stable. No pneumothorax, pleural effusion or mediastinal widening. Lungs are clear.", "output": "Left pacemaker leads are in appropriate position. No pneumothorax or mediastinal widening, or evidence of hemothorax." }, { "input": "In comparison to the prior study, there is a new left IJ central venous catheter with tip appearing to take a sharp turn into the left subclavian vein. There is no pneumothorax. Stable parenchymal opacities in the right greater than left lungs. Unchanged pulmonary edema. Unchanged appearance of a large right pleural effusion. Difficult to exclude a trace left pleural effusion given appearance.", "output": "New left IJ central venous catheter with tip entering the left subclavian vein. Otherwise, stable chest radiograph. NOTIFICATION: The findings above were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 1:___ AM, 5 minutes after discovery of the findings." }, { "input": "There is a left pectoral pacemaker with 3 leads, which appear intact and appropriately positioned. Sternotomy wires are intact and appropriately aligned. A right perihilar opacity is concerning for pneumonia. Additional ground-glass opacities throughout the lungs bilaterally may reflect pulmonary edema, or additional foci of infection. There are bilateral pleural effusions, right greater than left. Stable enlargement of the cardiac and mediastinal silhouette. No pneumothorax.", "output": "1. Right perihilar opacity, concerning for pneumonia. 2. Additional ground-glass opacities throughout the lungs bilaterally, which may reflect pulmonary edema, or additional foci of infection. 3. Bilateral pleural effusions, right greater than left. s" }, { "input": "There is a persistent moderate right pleural effusion as well as likely a small left pleural effusion. The pulmonary vasculature is minimally changed from ___. The cardiomediastinal silhouette is stable. The left pacer leads terminate in the right atrium and ventricle. There is no focal consolidation or pneumothorax.", "output": "Minimal, if any improvement in pulmonary edema." }, { "input": "The lungs are well inflated and clear. There is no pleural effusion, pneumothorax or focal airspace consolidation worrisome for pneumonia. Heart is normal size. The mediastinal hilar structures are unremarkable. The stomach is mildly distended with air. Clips are noted within the neck.", "output": "No acute cardiopulmonary process 3 NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ ___ telephone on ___ at 3:49 PM, 2 minutes after discovery of the findings." }, { "input": "AP and lateral views of the chest. Linear opacities in the right mid lung laterally suggestive of scarring. Low lung volumes likely account for bibasilar opacities suggestive of atelectasis. There is no pneumothorax or large effusion. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities detected.", "output": "Relatively low lung volumes without definite acute cardiopulmonary process." }, { "input": "Lung volumes are slightly low. Mid thoracic dextroscoliosis is also seen. The lungs are grossly clear without consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is no focal consolidation. There is no evidence of free air.", "output": "No evidence of free air." }, { "input": "A Port-A-Cath terminates in the mid to lower superior vena cava. The cardiac, mediastinal and hilar contours appear changed. Streaky opacities at the lung bases are more coalescent, corresponding to decreased lung volumes, suggesting waxing and waning atelectasis rather than pneumonia. The pulmonary vasculature appears within normal limits. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute disease." }, { "input": "The cardiac silhouette size is normal. Mediastinal and hilar contours are unremarkable. Right-sided Port-A-Cath tip terminates in the upper SVC. Subsegmental atelectasis in the left lower lobe is noted. Remainder of the lungs are clear. No pulmonary vascular congestion is seen. There is no pleural effusion or pneumothorax. No acute osseous abnormalities are demonstrated. Clips in the right upper quadrant indicate prior cholecystectomy.", "output": "Subsegmental atelectasis in the left lower lobe. No radiographic evidence for pneumonia." }, { "input": "Frontal and lateral radiographs of the chest demonstrate a right-sided port with the catheter unchanged in the low SVC. Compared to the prior radiograph, there are decreased lung volumes with bibasilar subsegmental atelectasis. The cardiac shadow is larger than the prior radiograph, possibly indicating pericarditis as a cause of the patient's pleuritic chest pain. If there is a pericardial effusion, is not hemodynamically significant.", "output": "1. Bilateral subsegmental atelectasis. 2. Enlarged cardiac shadow possibly indicating non hemodynamically significant pericardial effusion." }, { "input": "The right-sided Port-A-Cath terminates in the mid SVC, unchanged since the prior radiograph. There is persistent, unchanged bibasilar atelectasis. No focal consolidation concerning for pneumonia or pneumothorax identified.", "output": "Right-sided Port-A-Cath terminates in the mid SVC, unchanged from the prior radiograph." }, { "input": "A Port-A-Cath terminates in the superior vena cava, not significantly changed. The cardiac, mediastinal and hilar contours appear stable. There are streaky opacities at both lung bases, new on the right and improved on the left, suggesting minor atelectasis. Otherwise, the lungs appear clear. There are no pleural effusions or pneumothorax. Surgical clips project over the right upper quadrant of the abdomen. There is again very mild rightward convex curvature to the thoracic spine.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "A right-sided internal jugular Port-A-Cath is in-situ. The tip terminates in the mid SVC, unchanged compared to the prior study. Lung volumes are essentially unchanged. Minimally atelectasis at the left base is similar when compared to the prior study. No pleural effusion, pneumothorax or consolidation seen. The visualized bony structures are unremarkable in appearance.", "output": "A right-sided internal jugular catheter Port-A-Cath is unchanged in appearance when compared to the prior study. The tip terminates in the mid SVC." }, { "input": "Frontal and lateral views of the chest are obtained. There is minimal right base atelectasis. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Right-sided Port-A-Cath is seen, terminating in the proximal to mid SVC, unchanged in position since the prior study.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Right subclavian vascular catheter remains in standard position. Cardiomediastinal contours are stable in appearance. Lungs and pleural surfaces are clear.", "output": "Stable radiographic appearance of the chest, with no conventional radiographic findings to suggest metastatic disease. If there is strong clinical suspicion for intrathoracic metastatic disease, CT may be considered if warranted clinically." }, { "input": "PA and lateral views of the chest were reviewed and compared to the prior studies. A right-sided Port-A-Cath ends in the lower superior vena cava. The lungs are clear without focal consolidation, pulmonary edema, pleural effusion or pneumothorax. Cardiac, hilar, and mediastinal contours are normal.", "output": "No radiographic evidence of intrathoracic disease." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided demonstrate clear well expanded lungs without focal consolidation, large effusion or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear. No pleural effusion is seen. The heart size is top-normal. Mediastinal and hilar contours are unremarkable.", "output": "No evidence of active or latent pulmonary tuberculosis." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. There is no evidence of free air.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The Dobbhoff tube extends below the diaphragm with the tip in the body of the stomach. The lung volumes are low, with persistent mild cardiomegaly. There is bilateral perihilar vascular congestion with slight interval increase in mild-to-moderate bilateral pulmonary edema. Small bilateral pleural effusions are persistent. There is no evidence of pneumothorax. There is bibasilar atelectasis. The visualized osseous structures are unremarkable. The right IJ appears to terminate in the mid SVC.", "output": "1. Dobbhoff terminates below the diaphragm with the tip in the body of the stomach. 2. Interval increase in mild-to-moderate pulmonary edema." }, { "input": "Interval placement of an endotracheal tube terminating approximately 2.4 cm above the level of the carina. A ___ tube is noted passing through the esophagus and into the stomach, where a balloon is inflated. Lung volumes are low lead to crowding the bronchovascular structures. Interval development of dense medial right upper lobe and retrocardiac opacities. The left costophrenic angle is blunted and may reside represent focal atelectasis versus a small pleural effusion. There is no overt pneumothorax identified. The cardiac size is difficult to assess but appears mildly enlarged.", "output": "1. ETT terminating 2.4 cm above the carina. 2. Right upper lobe and retrocardiac opacities, new from the prior examination. Findings may represent atelectasis versus pneumonia. 3. ___ tube passing into the stomach." }, { "input": "Lung volumes are low. The ET tube is approximately 1 cm above the carina, with its tip pointing towards the right mainstem bronchus. Right-sided PICC line terminates in the right atrium. There is dense consolidation of left lower lobe with air bronchograms. There is small left effusion. There is pulmonary vascular redistribution.", "output": "Low position of ET tube Left lower lobe volume loss/infiltrate NOTIFICATION: These findings were communicated by Dr. ___ by Dr. ___ via telephone at 21:45, ___ min after discovery." }, { "input": "The lungs are clear without focal opacity, pulmonary edema, or pneumothorax. The cardiac and mediastinal contours are normal. There is a small left pleural effusion.", "output": "Small left pleural effusion is new since ___." }, { "input": "The lungs are clear of focal consolidation, pleural effusion or pneumothorax. The heart size is normal. The mediastinal contours are normal. A nasogastric tube terminates in the stomach.", "output": "Nasogastric tube terminates in the stomach." }, { "input": "As compared to the prior examination dated ___, there has been no significant interval change. Low lung volumes results in crowding of the bronchovascular structures. There is no lobar consolidation, pneumothorax, or overt pulmonary edema. The mediastinum is mildly widened, likely secondary to patient positioning. Allowing for differences in technique, the cardiac silhouette is stable. The cardiomediastinal silhouette is within normal limits. Significant degenerative changes are noted at the left acromioclavicular joint.", "output": "Essentially normal chest radiograph" }, { "input": "The lungs are clear without consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac silhouette size is borderline enlarged. Mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. No fractures are identified.", "output": "No acute cardiopulmonary abnormality. No fractures are identified. If there is continued concern, a dedicated rib series can be obtained." }, { "input": "The lungs are hyperinflated. Biapical scarring is noted. Left pleural effusion is moderate in size with associated compressive lower lobe atelectasis. Overall appearance is similar to prior. Mediastinal contours are unchanged. Heart size is grossly stable, however obscured by the left pleural effusion. Osseous structures are intact. No pneumothorax.", "output": "Moderate left pleural effusion, with associated compressive lower lobe atelectasis, difficult to exclude a superimposed pneumonia." }, { "input": "Cardiac silhouette size appears borderline enlarged. Tortuosity of the thoracic aorta is again noted with atherosclerotic calcifications seen at the aortic knob. Convexity at the AP window and left superior mediastinal contour likely reflects known mediastinal lymphadenopathy, better assessed on the previous CT. Lungs are hyperinflated with attenuation of pulmonary vascular markings and bullous changes in the right lung base compatible with emphysema. There has been interval development of a moderate size left pleural effusion. Left basilar opacification may reflect compressive atelectasis, but infection cannot be excluded. Known lung nodules are better assessed on previous CT. No acute osseous abnormality is demonstrated.", "output": "1. Interval development of moderate size left pleural effusion with associated left basilar opacity, likely compressive atelectasis. Infection, however, cannot be completely excluded. 2. Mediastinal lymphadenopathy, better assessed on the previous CT. 3. Emphysema." }, { "input": "A Port-A-Cath terminates at cavoatrial junction. The patient is status post sternotomy and coronary artery bypass graft surgery. The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. There is new patchy opacity in the right lower lobe, probably compatible with atelectasis; elsewhere lungs remain clear.", "output": "No pleural effusions identified. Minor right base opacity, probably atelectasis." }, { "input": "An endotracheal tube terminates about 5 cm above the carina. A nasogastric tube terminates in the stomach. A dual-lead pacemaker/ICD device has leads terminating in the right atrium and ventricle, respectively. The heart is mildly enlarged. The aorta is calcified. The chest appears hyperinflated. A small calcification projecting along the left mid lung suggests a granuloma, but otherwise the lungs appear clear. There is no definite pleural effusion or pneumothorax.", "output": "Satisfactory placement of lines, tubes and drains. No evidence of acute disease." }, { "input": "There is no marked change in the positioning of the chest wall port which terminates at the confluence of the brachiocephalic veins. The study is otherwise unchanged with moderate bilateral pleural effusions as well as obscuration of the diaphragmatic contours due to atelectasis or airspace consolidation. There is no pneumothorax.", "output": "1. No marked interval change in the chest wall port. 2. Stable moderate bilateral pleural effusions and bibasilar atelectasis. Underlying pneumonia cannot be excluded." }, { "input": "The lungs are well inflated and clear. Elevation of the right hemidiaphragm is stable. No focal consolidation, effusion, or pneumothorax is present. A left internal jugular Port-A-Cath tip remains in the upper SVC. The cardiac and mediastinal contours are normal.", "output": "No acute cardiopulmonary process. Findings were discussed with Dr. ___ ___ telephone at ___ on ___." }, { "input": "A Port-A-Cath terminates in the upper superior vena cava as before. The heart appears at the upper limits of normal size within the limitations of technique. The mediastinal and hilar contours appear unchanged. There is again moderate relative elevation of the right hemidiaphragm compared to the left. There is increased streaky opacification of the right lower lung in the neighborhood of the elevated right hemidiaphragm. Elsewhere, the lungs remain clear. Slight blunting of the right costophrenic sulcus makes it difficult to exclude a trace pleural effusion, although a pleural effusion is not definitively demonstrated.", "output": "Streaky new right basilar opacities which may be compatible with atelectasis in the setting of an elevated hemidiaphragm, but these are new and the possibility of pneumonia could be considered in the appropriate clinical setting. Short-term followup radiographs may be helpful with PA and lateral technique to evaluate further if clinically indicated." }, { "input": "PA and lateral radiographs of the chest suggest a new right apical nodule partially obscured by chest cage. The lungs are otherwise clear. The hilar and cardiomediastinal contours are normal. Chronic elevation of the right hemidiaphragm is noted. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal. A left chest-wall central venous port terminates in the mid-SVC.", "output": "Probably new infectious right apical nodule; apical lordotic views are necessary for confirmation. NOTE: Findings and recommendation for follow-up were communicated to Dr. ___ ___ by Dr. ___ ___ telephone on ___ at 11:25 am." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures appear within normal limits.", "output": "No evidence of acute disease." }, { "input": "Frontal and lateral views of the chest were obtained. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. There is subtle opacity at the right lower lobe, which most likely relates to atelectasis, however, an early infectious process cannot be excluded in the appropriate clinical setting. Bilateral spinal rods are partially imaged.", "output": "Slight increase in opacity at the right lower lobe likely represents atelectasis/overlying vascular structures. However, in the appropriate clinical setting, an early consolidation is difficult to exclude." }, { "input": "The new left-sided PICC line ends in the mid SVC. There is no pneumothorax. Slightly increased opacification at the left lung base is likely due to atelectasis, but could represent early pneumonia. Conventional PA and Lateral chest radiographs are recommended if there are any clinical findings to suggest pneumonia. There is no pleural effusion or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "1. New left PICC ends in the mid SVC. 2. PA and Lateral chest radiographs can better assess possible, new left lower lobe pneumonia." }, { "input": "Appliances in good position. Shallow inspiration accentuates heart size, pulmonary vascularity. Probable small left pleural effusion. Mildly increased bibasilar opacity, likely atelectasis.", "output": "Increased bibasilar opacities, likely atelectasis." }, { "input": "PA and lateral views of the chest provided. Left chest wall Port-A-Cath is seen with its catheter tip in the mid SVC region. No free air below the right hemidiaphragm. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Right scapula, though not fully imaged appears grossly intact.", "output": "No acute intrathoracic process." }, { "input": "left Port-A-Cath in situ with the tip in the mid to distal SVC. No airspace consolidation. No suspicious pulmonary nodules or masses. The cardiomediastinal contour is normal. No pleural effusion. No overt pulmonary hyperinflation. Insufficiency type fractures of the mid to lower thoracic vertebral bodies.", "output": "No pneumonia. No pulmonary edema." }, { "input": "Lung volumes are low. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Left chest port tip in the lower SVC. Vertebral compression fractures are stable since CT from ___ .", "output": "No acute cardiopulmonary process or pneumonia." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Left chest defibrillator with intact single lead transverses the left subclavian vein, right atrium, tricuspid valve, and terminates in the anterior inferior wall of the right ventricle. Lungs are clear. Moderate to severe cardiomegaly is accentuated by AP technique without secondary signs of cardiac decompensation. No pleural effusion or pneumothorax.", "output": "1. Left chest defibrillator with intact single lead terminates in the anterior inferior wall of the right ventricle. 2. No pneumonia." }, { "input": "There is no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. Moderate to severe cardiomegaly is similar to the prior study allowing for differences in technique. A left pectoral single-chamber pacemaker and its lead projects in unchanged location. Calcification of the aortic arch is unchanged.", "output": "No acute cardiopulmonary process. Unchanged moderate to severe cardiomegaly." }, { "input": "Frontal and lateral radiographs of the chest were acquired. The lungs are clearnoting calcified nodule at the right lung apex. The cardiac silhouette is mildly enlarged. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen. Surgical clips in the right upper abdominal quadrant suggest prior cholecystectomy.", "output": "1. No acute cardiac or pulmonary process. 2. Mild enlargement of the cardiac silhouette." }, { "input": "Focal opacity is noted at the right lung base with likely atelectasis at the left lung base. A moderate right pleural effusion is present. The cardiomediastinal silhouette and hilar contours are normal. There is no pneumothorax.", "output": "1. Focal opacity at the right lung base, which on concurrent CT chest appears to be compressive atelectasis. 2. Moderate right pleural effusion." }, { "input": "There has been interval placement of a right IJ central venous catheter which terminates in the mid SVC. There is no pneumothorax. Remainder of exam is unchanged.", "output": "Right IJ terminating in the mid SVC." }, { "input": "No consolidation, pleural effusion or pulmonary edema is seen, and the cardiac and mediastinal contours are normal. No hilar lymphadenopathy is seen, and hyperinflated lungs are again seen.", "output": "No acute cardiopulmonary disease including pneumonia or lymphadenopathy." }, { "input": "There is hyperinflation of the lungs. The cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax.", "output": "Hyperinflated lungs c/w COPD." }, { "input": "Frontal and lateral radiographs of the chest demonstrate hyperinflated lungs with flattened diaphragm, consistent with emphysema. No focal increase in opacity is seen, concerning for pneumonia. The cardiac and mediastinal contours are normal. Moderate hiatal hernia is noted in the midline. No pleural abnormality is detected.", "output": "Chronic emphysema with no acute pneumonia." }, { "input": "ET tube and enteric tube remain in standard position with tip of enteric tube off the film. Cardiomediastinal and hilar contours are normal. The left lower lobe opacity remains stable compared to the radiographs from ___ and likely represents aspiration or pneumonia. There is no pleural effusion or pneumothorax. No new focal consolidations are present. Pulmonary vasculature is within normal limits.", "output": "Persistent stable left lobe atelectasis or pneumonia, either likely due to aspiration, better characterizeb by chest CT." }, { "input": "An endotracheal tube is redemonstrated, ending 4.5 cm above the carina. NG tube has its tip and sideport within the stomach. Otherwise, the lungs are well inflated. The right lung continues to be clear, while the left lung again shows a hazy opacity throughout the entire left base, which obscures the left hemidiaphragm but not the left heart border and does not cause hilar retraction. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "1. No significant interval change in left lung base opacity. This may represent a consolidative process of the lung although other etiologies such as loculated pleural effusions cannot be excluded. Further assessment with CT could be pursued if clinically appropriate. 2. Endotracheal and NG tube in appropriate positions. Communicated to Ms ___ ___ by Dr ___ ___ phone on ___ at 4:___ pm immediately after discovery." }, { "input": "The endotracheal tube is in satisfactory position, within the mid trachea. Enteric tube courses along the esophagus and terminates at the view, likely within the stomach. A left PICC has been removed in the interim. There has been improved aeration of the left lung base, with the left apparent hemidiaphragm being more conspicuous on this exam. Multiple lucenies are also noted in this area. A right hilar opacity is likely infectious in etiology. There is no definite pleural effusion. The right lung is clear and there is no pneumothorax. The cardiomediastinal contours are normal.", "output": "Slight improvement, albeit persistent, left lower lobe pneumonia. Lucencies in this area may reflect developing cavitation versus newly aerated lung. This could be followed by radiography if the patient is clinically improving, otherwise, a chest CT would be needed for further evaluation." }, { "input": "Frontal and lateral radiographs of the chest demonstrate low lung volumes, which results in bronchovascular crowding. Atelectasis is seen at the right base. The cardiomediastinal and hilar contours are unchanged. There is persistent mild cardiomegaly and tortuosity of the aorta. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiograph demonstrate mildly hypoinflated clear lungs. No focal opacity seen. No pleural effusion or pneumothorax. Persistent mild cardiomegaly is again noted and slightly decreased from previous examination. Tortuous aorta is similar to prior. Mediastinal contour and hila are otherwise unremarkable. Limited assessment of the upper abdomen is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest demonstrate low lung volumes, which results in bronchovascular crowding. The cardiac silhouette remains enlarged. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "Moderate cardiomegaly, with enlargement of the left atrium, has been stable compared to exams dating back to ___. The aorta is mildly tortuous, otherwise the hilar and mediastinal contours are unremarkable. A confluent opacity in the retrocardiac region on the lateral view it is difficult to assess in the setting of low lung volumes.", "output": "Retrocardiac opacity on lateral view is potentially due to crowding of structures in the setting of low lung volumes, but repeat lateral radiograph with improved inspiratory level may be helpful to exclude a an early focus of pneumonia." }, { "input": "The lungs are clear of consolidation, effusion, or vascular congestion. The cardiac silhouette is enlarged but stable in configuration. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. Low lung volumes result in bronchovascular crowding. There is no focal consolidation, pleural effusion or pneumothorax. Mild to moderate cardiomegaly is unchanged with persistent left atrial enlargement. Mild aortic tortuosity is unchanged. Hilar contours are normal.", "output": "1. No pneumonia, edema, or effusion. 2. Unchanged mild to moderate cardiomegaly with left atrial enlargement." }, { "input": "There is unchanged moderate cardiomegaly, but no pulmonary edema. Mediastinum and hila are normal. There is no pleural effusion and no pneumothorax. The lungs appear clear.", "output": "No pneumomediastinum. Moderate cardiomegaly." }, { "input": "PA and lateral views of the chest were reviewed. There is moderate cardiomegaly. The thoracic aorta remains tortuous. The hila are unremarkable. There is no pleural effusion or pneumothorax. The lungs are well expanded and clear.", "output": "No acute cardiothoracic process." }, { "input": "The heart remains moderately enlarged with left atrial enlargement. Mediastinal and hilar contours are stable. Pulmonary vascularity is normal. Lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest. Moderate cardiomegaly and mediastinal contours are stable. Severe enlargement of the left atrium is unchanged. No focal consolidation, pleural effusion, or pneumothorax.", "output": "No pneumonia. Stable moderate cardiomegaly and severe left atrial enlargement." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged including moderate cardiomegaly as well as mild unfolding of the descending thoracic aorta. There is no pleural effusion or pneumothorax. The lungs appear clear. There has been no definite change.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Two views of the chest demonstrate low lung volume. There is no pleural effusion or pneumothorax. Cardiac silhouette remains mildly enlarged with an especially prominent left atrium. The pulmonary vasculature is normal.", "output": "Unchanged cardiac enlargement, especially with respect to the left atrium; there is no acute chest pathology or cardiac decompensation." }, { "input": "AP and lateral views of the chest provided. Evaluation is limited due to underpenetration and low lung volumes. Allowing for this, there is no focal consolidation, effusion, or pneumothorax. No pulmonary edema. The cardiac silhouette remains mildly enlarged. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Limited, negative." }, { "input": "The lungs are clear without focal consolidation, effusion, or pulmonary edema. The cardiac silhouette is enlarged, similar to prior. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are slightly low, causing exaggeration of the heart size and accentuation of the pulmonary vasculature. The lungs are clear. There is unchanged mild-to-moderate cardiomegaly with persistent left atrial enlargement. The descending thoracic aorta is tortuous, as before. Mediastinal contours are otherwise normal. There are no pleural effusions. No pneumothorax is seen.", "output": "1. No acute cardiac or pulmonary findings. 2. Unchanged mild-to-moderate cardiomegaly, including left atrial enlargement." }, { "input": "Lung volumes are low, accounting for some bronchovascular crowding. No focal parenchymal opacities are identified. Moderate cardiomegaly is unchanged from prior. The aorta is tortuous. Hilar contour is unremarkable. There is no pleural effusion or pneumothorax.", "output": "Stable moderate cardiomegaly. Otherwise, no acute cardiopulmonary process." }, { "input": "Heart size remains mildly enlarged. Mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is detected. No acute osseous abnormality is visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Moderate cardiomegaly and pulmonary vascular congestion, unchanged. The lungs are clear without focal consolidation or edema. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Moderate cardiomegaly and pulmonary vascular congestion without edema." }, { "input": "No focal consolidation, pleural effusion, or pneumothorax is detected. Linear opacity at the left lung base likely represents atelectasis. Heart size is mildly enlarged as seen previously. Lung volumes are low. Pulmonary vascular congestion is increased without overt edema.", "output": "Increased pulmonary vascular congestion without overt edema." }, { "input": "Chest, portable upright. Lung volumes are low, causing bronchovascular crowding. The lungs are clear. Moderate cardiomegaly is unchanged. The aorta is tortuous. The hila are remarkable only for mild vascular engorgement without frank edema. There is no pneumothorax or pleural effusion.", "output": "Unchanged moderate cardiomegaly, without evidence of congestive heart failure. There is no evidence of pneumonia." }, { "input": "Chest, PA and lateral. The lungs are clear. Moderate cardiomegaly and aortic tortuosity is unchanged. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidations. No pulmonary edema. Stable enlargement of the cardiomediastinal silhouette. No pleural effusion. No pneumothorax.", "output": "No acute cardiopulmonary abnormality. Stable enlargement of the cardiomediastinal silhouette." }, { "input": "Left pectoral pacemaker and its leads are in unchanged positions. There is new left lung base opacity in the retrocardiac region, likely reflecting left lower lobe atelectasis. There are probable small bilateral pleural effusions. Right lung base atelectasis is increased. New opacity in the right upper lung may reflect asymmetric pulmonary edema. Moderately enlarged cardiac silhouette is similar to before. Focal deformity at the right first rib is unchanged.", "output": "1. New right upper lung opacity may reflect asymmetric pulmonary edema in setting of acute mitral valve regurgitation, however pneumonia or hemorrhage is possible in correct clinical setting. 2. Increased bibasilar atelectasis small pleural effusions." }, { "input": "Left-sided AICD/pacemaker device is re- demonstrated with leads in unchanged positions. There has been interval placement of 2 clips in the region of the mitral valve. Cardiac silhouette size remains markedly enlarged, slightly increased in the interval. The mediastinal contour is unchanged. There is perihilar haziness with mild to moderate pulmonary edema, new in the interval, along with small bilateral pleural effusions, also new. No pneumothorax or focal consolidation is present. Bilateral cervical ribs are incidentally noted. Surgical screws project over the left shoulder.", "output": "Moderate congestive heart failure with moderate pulmonary edema and small bilateral pleural effusions." }, { "input": "Left pectoral ICD in situ with the lead tips present in the right atrium and right ventricle. ET tube in situ with the tip at the level of the medial clavicles 67 mm proximal to the carina. Enteric tube in situ. Swan-Ganz catheter in situ with tip in the proximal pulmonary artery. Post CABG changes. Central and chest drains in situ. Intra-aortic balloon pump catheter in situ with the tip 35 mm proximal to the arch of the aorta. No pneumothorax. Lung volumes appear similar compared to prior. The cardiomegaly is slightly improved. Left basal atelectasis/effusion appear slightly decreased in size compared to prior.", "output": "The tubes and lines are stable. No new complication identified." }, { "input": "Severe cardiac enlargement is again demonstrated. A left-sided AICD is again noted with leads terminating in the regions of the right atrium and right ventricle, unchanged. Mediastinal and hilar contours are similar and there is no pulmonary vascular congestion. Linear opacity in the right lung base likely reflects atelectasis. Linear opacities within the right mid lung field are chronic, and likely reflect areas of scarring. No focal consolidation, pleural effusion or pneumothorax is present. Chronic deformity of the right first rib is again noted.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Left-sided AICD/ pacer device is noted with leads in unchanged positions in the right atrium and right ventricle. Severe cardiomegaly is unchanged. Mediastinal contours are similar with mild atherosclerotic calcifications noted at the aortic knob. There is mild pulmonary edema, new in the interval. Patchy opacities in the lung bases may reflect areas of atelectasis. No pleural effusion or pneumothorax is identified. No acute osseous abnormalities detected. A screw is noted projecting over the left acromiohumeral interval. Chronic right first rib deformity is re- demonstrated.", "output": "Mild pulmonary edema and bibasilar atelectasis." }, { "input": "Heart size is top-normal. The aorta is tortuous. Hilar contours are unremarkable. No evidence for pulmonary edema, pulmonary consolidation, pleural effusion, or pneumothorax. Degenerative changes are seen throughout the thoracic spine. Mild dextroconvex curvature of the upper thoracic spine is noted. Mild anterior wedging of 2 vertebral bodies at the thoracolumbar junction is noted, possibly within physiologic component.", "output": "No evidence for acute cardiopulmonary abnormalities." }, { "input": "PA and lateral views of the chest are provided. Lung volumes are low which limits evaluation. Allowing for this, there is mild bibasilar atelectasis without definite signs of pneumonia or CHF. No pleural effusion or pneumothorax is seen. Heart size appears grossly within normal limits though low lung volumes limits the evaluation. Mediastinal contours are normal. Bony structures are intact. There is no free air below the right hemidiaphragm.", "output": "Limited, normal." }, { "input": "Focal opacity at the left cardiophrenic angle is thought to be due to a fat pad or atelectasis, unchanged. The lungs are otherwise clear without focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is within normal limits. There is tortuosity of the descending thoracic aorta. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Lungs appear lucent compatible with known emphysema. There is no focal consolidation, large effusion or pneumothorax. Heart size is mildly enlarged. Mediastinal contour is unremarkable. Bony structures are intact", "output": "Emphysema without superimposed acute process. Mild cardiomegaly." }, { "input": "Low lung volumes are present, which accentuates the size of the cardiac silhouette which appears moderately enlarged, not substantially changed from the prior study. The aorta is mildly unfolded with atherosclerotic calcifications noted diffusely. Hilar contours are similar with no evidence for pulmonary vascular congestion. Patchy opacities in the lung bases may reflect atelectasis. No pleural effusion, focal consolidation or pneumothorax is detected. There are no acute osseous abnormalities.", "output": "Low lung volumes with patchy bibasilar airspace opacities, likely atelectasis. Pneumonia or aspiration at the lung bases cannot be completely excluded." }, { "input": "The lungs are well expanded and clear without lobar consolidation, pleural effusion, pneumothorax, or pulmonary edema. Mild cardiomegaly is noted. The mediastinal and hilar contours are within normal limits.", "output": "Mild cardiomegaly without acute cardiopulmonary process." }, { "input": "Multifocal areas of consolidation are present, mostly in the right lower lobe, with a lesser degree of involvement in the right middle lobe and posterior segment left lower lobe. Heart size, mediastinal and hilar contours are normal. There are questionable small pleural effusions on the lateral view.", "output": "Multifocal pneumonia. Recommend followup chest x-ray 4 weeks after completion of antibiotic therapy. Findings entered in radiology communications dashboard on date of study." }, { "input": "PA and lateral views of the chest were obtained demonstrating clear well expanded lungs without focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours appear normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear without focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. No displaced fractures identified.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs which are clear. There is no focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "This study is read in conjunction with CT of the chest on the same day. Peripheral wedge-like opacity at the right base is most consistent with infarct. There are no other focal consolidations or pneumothorax. There is blunting of the right costophrenic angle likely due to small pleural effusion. Osseous structures are intact. Cardiomediastinal silhouette is unremarkable.", "output": "Opacity at the right base compatible with opacity seen on CT chest, most likely infarct. Small right pleural effusion." }, { "input": "No radiographs available for comparison. Lung volumes are low and there are multiple adjacent anterolateral right ribs with abnormal contours concerning for fractures. Lungs are otherwise clear with no focal consolidation. Heart size is top normal without pulmonary vascular congestion and pulmonary edema. No pleural effusions or pneumothorax.", "output": "Multiple adjacent anterolateral right ribs with abnormal contours concerning for rib fractures. Recommend dedicated rib radiographs. RECOMMENDATION(S): Recommend dedicated rib radiographs. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ approximately 5 minutes after discovery of the findings." }, { "input": "No focal consolidation is seen. There are relatively low lung volumes on the frontal view. There is no pleural effusion or pneumothorax. The cardiac silhouette is top-normal to mildly enlarged. Mediastinal contours are unremarkable. No pulmonary edema is seen.", "output": "Top-normal to mildly enlarged cardiac silhouette without overt pulmonary edema." }, { "input": "Little interval change since ___. The left pacemaker seen with transvenous leads in the right atrium and right ventricle. Moderate cardiomegaly is stable. Bibasilar atelectasis is mildly improved, particularly in the retrocardiac region. The lungs are essentially clear. Median sternotomy wires are intact and aligned. No complications related to the procedure, including pneumothorax, mediastinal bleed, or pleural bleed.", "output": "Left pacemaker seen with transvenous leads in the RA and RV. No post-procedural complications." }, { "input": "The lungs are moderately well inflated with bilateral perihilar interstitial opacities. There is mild cephalization of vasculature. Trace pleural effusion is only seen on lateral view limiting evaluation for side. No pneumothorax. Stable mild cardiomegaly. Mediastinal contour and hila are otherwise unremarkable. A left chest wall pacer device is seen with lead tips in the right atrium and right ventricle. Intact median sternotomy wires are again noted.", "output": "Mild pulmonary edema with trace pleural effusion, cephalization of vasculature, and stable mild cardiomegaly." }, { "input": "The patient is status post median sternotomy and CABG. Left-sided AICD device is noted with lead terminating in the right ventricle. The heart is moderately enlarged, increased compared to the prior outside study, but this could be due differences in technique. The aorta remains mildly tortuous. There is mild pulmonary vascular congestion. No focal consolidation, pleural effusion or pneumothorax is seen. There are mild degenerative changes in the thoracic spine.", "output": "Slightly increased cardiomegaly with mild pulmonary vascular congestion." }, { "input": "Since ___, a left pectoral pacemaker is seen with transvenous leads in the right atrium and right ventricle. Moderate cardiomegaly is unchanged. Bibasilar atelectasis is increased. No pneumothorax. Median sternotomy wires are intact and aligned.", "output": "Left pectoral pacemaker with leads in the RA and RV. No pneumothorax." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is unchanged. A left chest wall pacemaker is seen with lead in the right ventricle. Median sternotomy wires are intact. Surgical clips are present in the left chest wall. There are no acute skeletal findings.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable view of the chest is compared to previous exam from ___. Lower lung volume is seen on the current exam. The lungs, however, are clear. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs are hyperinflated but clear of confluent consolidation. Biapical pleural based scarring is again is noted, left more so than right. There is no effusion. Cardiac silhouette is slightly enlarged. No acute osseous abnormality detected.", "output": "Hyperinflation without definite acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs are clear without focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Posterior left rib deformities are old. There is no visualized acute fracture.", "output": "No acute cardiopulmonary process." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "There has been significant interval improvement in the layering right-sided pleural effusion which has now nearly completely resolved. There is residual a atelectasis in the right lung base, superimposed infection cannot be excluded. A small left pleural effusion persists. The degree of atelectasis has improved slightly at the left base. A left-sided PICC terminates in the mid SVC. No pneumothorax seen. A tracheostomy is unchanged in appearance compared to the prior study.", "output": "Interval improvement in the right-sided pleural effusion with an airspace opacity at the right lung base likely reflecting atelectasis, superimposed infection cannot be excluded." }, { "input": "Since the most recent examination, an endotracheal tube has been placed. The tip terminates approximately 2.5 cm above the carina. Again seen is a right internal jugular catheter, with its at an in the upper to mid SVC. A right subclavian line seen, with tip terminating in the right atrium. A nasogastric tube in stable position the side port extending into the stomach. No again seen is a stably enlarged cardiac silhouette rule with left lower lobe volume loss and pleural effusion. Mild indistinctness of the pulmonary vasculature is noted, not significantly changed since recent examination from 5 hours prior.", "output": "Interval placement of an endotracheal tube, which terminates approximately 2.5 above the carina." }, { "input": "Mild cardiomegaly is re- demonstrated. The aorta remains tortuous. The mediastinal hilar contours are otherwise unremarkable. Lungs are clear. No focal consolidation, pleural effusion or pneumothorax is seen. There are mild degenerative changes noted in the thoracic spine. Chronic deformity of the left glenohumeral joint is again noted.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Compared to the prior study there is increased opacity at the right base with obscuration of the right hemidiaphragm. It is unclear how much of this is due to volume loss in how much of that is due to a E right lower lobe infiltrate. There is also dense retrocardiac opacity with obscuration of the left hemidiaphragm. This is increased slightly compared to the prior exam. There is mild pulmonary vascular redistribution. The left IJ line and left-sided PICC line tips are unchanged. .", "output": "Increased volume loss/infiltrate in both lower lungs" }, { "input": "Left-sided PICC terminates in the low SVC without evidence of pneumothorax. There is persistent blunting of the left costophrenic angle suggesting small pleural effusion with possibly overlying atelectasis. Right base opacity persists, possibly minimally improved. No large pleural effusion seen on the right. No overt pulmonary edema. Stable cardiac and mediastinal silhouettes.", "output": "Persistent small left pleural effusion with possible overlying atelectasis. Persistent right base opacity may be minimally improved." }, { "input": "A right chest tube has been removed. There is no pneumothorax. Aeration of the right lung has improved. There is some residual basilar atelectasis. A left-sided chest tube remains in place. However, the loop of the pigtail is not completely within the thoracic cavity. The position has not changed since recent radiographs. There is a moderate residual left pleural effusion and small residual right pleural effusion. There are no new abnormal cardiac contours. External pacing leads are in unchanged positions.", "output": "No pneumothorax and improved right lung inflation after removal of right chest tube." }, { "input": "Compared to ___, there is increased bilateral interstitial opacity, especially in the right lower lobe obscuring the right hemidiaphragm, possibly due to worsening pneumonia and less likely layering pleural effusion or atelectasis. Small pleural effusion on the left is also likely. The heart size is unchanged. Tracheostomy and support bones appear unchanged from prior.", "output": "Worsening right lower lobe pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the ___ ___ at 10:13 AM, 15 minutes after discovery of the findings." }, { "input": "Tracheostomy tube is again noted. Left-sided PICC line tip overlies the proximal SVC. Right-sided PICC line is no longer visualized and has presumably been removed. No pneumothorax is detected. The cardiomediastinal silhouette is unchanged. Again seen are what appear to be bilateral right greater the left effusions with underlying collapse and/or consolidation, similar to the prior study. Some platelike atelectasis at the left base is more pronounced on the current study. There is mild diffuse vascular plethora, not significantly changed.", "output": "Interval removal of right-sided PICC line. Otherwise, I doubt significant interval change." }, { "input": "The right-sided PICC is again noted to be position within the right atrium, this be could be withdrawn 3-4 cm for better seating in the distal SVC. There are bilateral chest tubes in-situ. Despite this, there are bilateral pleural effusions, larger on the right than the left. There is bibasilar atelectasis, superimposed infection cannot be excluded. No pneumothorax seen. The visualized bony structures demonstrate moderate degenerative change in the thoracolumbar spine.", "output": "Persistent bilateral pleural effusions. There is associated compressive atelectasis, superimposed infection cannot be excluded." }, { "input": "Tracheostomy tube remains in place. Left PICC tip seen at the lower SVC. There are hazy bibasilar opacities compatible with layering effusions, small to moderate in size, similar to prior. Superiorly, the lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities although chronic changes seen at the shoulders, more extensive on the left.", "output": "Persistent bilateral pleural effusions." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Patient is status post tracheostomy. Stable, moderate cardiomegaly and mediastinal widening. Hilar contours are not well seen. Significant interval increase in large right pleural effusion with adjacent right lung atelectasis. Moderate interval increase in large left pleural effusion. Lung parenchyma is not well assessed given the extent of the large, bilateral pleural effusions. No appreciable pneumothorax.", "output": "Increased, large bilateral pleural effusions. NOTIFICATION: The findings were communicated to Dr. ___ by Dr. ___ ___ text ___ on ___ at 11:42 PM, 10 minutes after discovery of the findings." }, { "input": "A tracheostomy is in-situ. A right-sided PICC terminates in the right atrium, this could be withdrawn 3-4 cm for better positioning in the distal SVC. There are bilateral chest tubes in-situ. These are unchanged in position when compared to the prior study. There is persistent bibasal pleural effusions, similar in degree when compared to the prior study. There is associated bibasilar atelectasis, superimposed infection cannot be excluded.", "output": "Persistent bilateral pleural effusions with associated atelectasis, superimposed infection cannot be excluded. A right-sided PICC terminates in the right atrium, this could be withdrawn 3-4 cm for better positioning in the SVC. NOTIFICATION: Findings discussed with Dr. ___ by telephone at 10am on ___, within 5 minutes of discovery" }, { "input": "Supportive and monitoring devices are unchanged in appearance when compared to the prior study. There are persistent bibasal pleural effusions, similar in extent. There is moderate cardiomegaly. Airspace opacity at the bilateral lung bases may reflect atelectasis versus consolidation.", "output": "No significant interval change when compared to the prior study." }, { "input": "Bilateral chest drains are unchanged in position when compared to the prior study. No pneumothorax seen. There are persistent bilateral moderate-sized pleural effusions with associated atelectasis. A right-sided PICC terminates in the distal SVC or upper right atrium. This is unchanged compared the prior study.", "output": "No significant interval change when compared to the prior study. Persistent bilateral pleural effusions." }, { "input": "Portable AP semi-erect chest radiograph ___ at 05:19", "output": "Right subclavian PICC line, tracheostomy tube, and right internal jugular central line are unchanged in position. The heart remains stably enlarged. There are layering bilateral effusions with bibasilar compressive atelectasis and likely there is now a component of superimposed mild edema. No pneumothorax." }, { "input": "Since ___, no significant changes are appreciated. Moderate, bilateral pleural effusions and associated compressive bibasilar atelectasis are unchanged. Cardiomegaly and cardiomediastinal silhouettes are unchanged with mild pulmonary vascular engorgement and minimal improvement in mild pulmonary edema. An ET tube terminates 4.3 cm above the carina. A right-sided IJ central venous catheter terminates in the lower SVC. The side port of an enteric tube projects over the proximal stomach.", "output": "Unchanged, moderate, bilateral pleural effusions with associated compressive atelectasis. Pulmonary edema minimally improved." }, { "input": "Right-sided internal jugular catheter ends in the low SVC. Mild to moderate pulmonary edema slightly increased. Increasing retrocardiac and left lower lobe opacity. Right lower lobe opacity is slightly decreased. At least moderate left effusion slightly increased. No pneumothorax.", "output": "Increasing asymmetric left lower lobe opacity with mild to moderate pulmonary edema." }, { "input": "Right-sided PICC terminates in the distal SVC as before. A tracheostomy is in unchanged position. A moderate layering right pleural effusion is demonstrated as well as a small to moderate left layering pleural effusion. Bibasilar opacities likely reflect atelectasis. The heart is enlarged but stable from multiple prior exams. There is no pneumothorax. The pulmonary vasculature is minimally engorged in and there is mild interstitial pulmonary edema, improved from the prior.", "output": "Moderate, layering pleural effusions as well as bibasilar opacities which likely reflect atelectasis. No pneumothorax. Mild interstitial edema has improved from the prior." }, { "input": "Midline tracheostomy tube and right-sided PICC are re- demonstrated. There moderate bilateral pleural effusions, similar as compared to prior study. The cardiac and mediastinal silhouettes are stable.", "output": "Moderate bilateral pleural effusions and mild pulmonary vascular congestion. Superimposed infection is difficult to exclude." }, { "input": "The lungs are clear without focal consolidation or edema. There is blunting of the posterior costophrenic angles suggesting small effusions. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities, chronic deformity centered at the left glenohumeral joint is noted.", "output": "Trace pleural effusions. Otherwise no acute cardiopulmonary process." }, { "input": "The right hemidiaphragm is not sharp, which may represent atelectasis and layering effusion. Again noted are 2 right side central venous catheters with unchanged positions of the tips, in the upper to mid SVC and upper right atrium.", "output": "1. Overall stable position of the right-sided central venous catheters. 2. Indistinct right hemidiaphragm, which may be related to atelectasis and layering pleural effusion." }, { "input": "There are bilateral chest tubes in-situ. The left-sided chest tube has withdrawn slightly and unfolded but still appears to be within the pleural space. Bilateral pleural effusions are similar in appearance when compared to the prior study. No pneumothorax seen. The pleural effusions limit assessment of the cardiomediastinal contour. A right-sided PICC terminates in the distal SVC or right atrium.", "output": "On folding of the left-sided chest strain. Persistent bilateral pleural effusions." }, { "input": "In comparison to the chest radiograph obtained 2 weeks prior, there is significant gaseous dilation of the esophagus. There is noted, mild, pulmonary vascular congestion and increased opacities at the bilateral lung bases, possibly dependent pulmonary edema, atelectasis, or developing pneumonia. There is probably a small left pleural effusion. Heart size is minimally enlarged. A right-sided PICC terminates in the right atrium, approximately 3 cm inferior to the superior cavoatrial junction.", "output": "Gaseous esophageal dilation concerning for obstructive pathology. New, mild pulmonary edema with dependent edema, atelectasis, or developing pneumonia. A right-sided PICC terminates within the right atrium, approximately 3 cm inferior to the superior cavoatrial junction." }, { "input": "Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is no focal lung consolidation.", "output": "Normal chest radiograph." }, { "input": "Portable AP chest radiograph was obtained. There is pulmonary edema with possible tiny pleural effusions. The heart is top normal. Mediastinal contour appears normal. There is hilar congestion. No pneumothorax. Bony structures are intact.", "output": "Pulmonary edema with tiny pleural effusions and top normal heart size." }, { "input": "The cardiomediastinal and hilar contours are stable with top-normal heart size. There is no pleural effusion or pneumothorax. The lungs are well expanded without focal consolidation concerning for pneumonia. Pulmonary vascularity is within the patient's baseline, with slight cephalization.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac silhouette is top-normal to mildly enlarged. The aortic knob is again calcified. No overt pulmonary edema is seen.", "output": "Top-normal to mildly enlarged cardiac silhouette. No definite focal consolidation." }, { "input": "Frontal and lateral views of the chest were obtained. There is no focal consolidation, pleural effusion, or pneumothorax. Mild cardiomegaly is unchanged. Mediastinal silhouette and hilar contours are normal. Surgical clips in the upper abdomen are again noted. DISH in the thoracic spine is similar to the prior study.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest were obtained. There has been no significant interval change. No definite focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are stable. Mild degenerative changes are seen along the spine. Surgical clips are seen in the upper abdomen.", "output": "No significant interval change." }, { "input": "Nasogastric tube is coiled upon itself beginning at the level of the GE junction with tip not well seen, but possibly coiled superiorly to the level of the thoracic inlet. The lungs are otherwise relatively clear and unchanged from a recent compared examination. Clips in the epigastrium are unchanged as is moderate cardiomegaly.", "output": "Mild increase in pulmonary vascular congestion with malposition of the nasogastric tube as above. Finding was discovered at ___ and discussed by phone with Dr. ___ by Dr. ___ at ___ on ___." }, { "input": "Increased heart size, pulmonary vascularity, more prominent compared the prior exam. There is new small right pleural effusion. Mildly prominent interstitial markings peripherally, suggest edema. There are surgical clips in the upper abdomen.", "output": "Increased heart size, pulmonary vascularity. Small right pleural effusion. Probable interstitial edema." }, { "input": "The cardiac silhouette size is normal. The aortic knob is calcified. The mediastinal and hilar contours are within normal limits. The previous pattern of pulmonary edema has resolved. Pulmonary vascularity is normal. Lungs are clear. No pleural effusion or pneumothorax is identified. Several clips are demonstrated within the left upper quadrant of the abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There are small right greater than left bilateral pleural effusions. Pulmonary vascular congestion is seen. The cardiac silhouette is enlarged. Right mid to lower lung opacity is seen and consolidation may be present. Evidence of DISH is seen along the spine.", "output": "There are small right greater than left bilateral pleural effusions. Pulmonary vascular congestion is seen. The cardiac silhouette is enlarged. Right mid to lower lung opacity is seen and consolidation may be present. Followup to resolution. Evidence of DISH is seen along the spine." }, { "input": "Low lung volumes limits assessment. Cardiomegaly again noted with hilar congestion and probable mild pulmonary edema. No large effusion is seen. No convincing evidence for pneumonia. No pneumothorax. Bony structures appear intact.", "output": "Cardiomegaly, congestion and mild edema." }, { "input": "There are low lung volumes leading to bronchovascular crowding. The thorax at the level of the diaphragm is under penetrated which may be due to overlying soft tissue. Apparent blunting of the bilateral costophrenic angles may be due to overlying soft tissue although ___ pleural effusions are excluded. Mild bibasilar atelectasis. Cardiac and mediastinal silhouettes are stable. No pneumothorax is seen.", "output": "Low lung volumes which lead to bronchovascular crowding. Apparent blunting of the bilateral costophrenic angles may be due to overlying soft tissue although ___ pleural effusions not excluded." }, { "input": "There is no consolidation, pleural effusion, or pneumothorax. Cardiomediastinal and hilar silhouettes are within normal size.", "output": "No evidence of pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with ___ for Dr. ___ on the telephone on ___ at 3:49 PM." }, { "input": "Lungs are fully expanded and clear. There is no focal consolidation, effusion, or pneumothorax. Specifically, there is no lung lesion. Mediastinal and hilar contours are normal. Heart size is normal. Multiple breast clips are consistent with breast reconstructive surgery.", "output": "No acute intrathoracic process. Specifically, there is no lung lesion." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Subtle, vague, patchy opacities are noted within the right lower lobe and left mid lung field, likely within the left upper lobe, not seen on the prior chest radiograph, and concerning for an infectious process. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities are present.", "output": "Vague patchy opacities in the left upper lobe and right lower lobe concerning for infection. Followup radiographs after treatment are recommended to ensure the resolution of this finding." }, { "input": "Frontal and lateral chest radiographs again demonstrate a right chest port with the tip in the low SVC and a normal cardiomediastinal silhouette. Well aerated lungs are clear. Previously seen density in the left lower lung is decreased and there is no pleural effusion or pneumothorax.", "output": "Clear lungs without evidence of pneumonia. Please note that chest radiograph is not sensitive for PCP pneumonia, and if clinically concerned, a repeat CT chest would be helpful for further evaluation. A preliminary read was provided via telephone by Dr. ___ to Dr. ___ at ___ on ___." }, { "input": "Frontal and lateral radiographs of the chest demonstrate a right chest wall port with the catheter terminating at the approximate cavoatrial junction. No pneumothorax is seen. There is a asymmetric opacity in the left middle lung field which may be due to post-radiation changes. However, if symptoms are present, concurrent pneumonia is possible. There is no pleural effusion. The cardiac contour is top normal. The mediastinal contour is normal.", "output": "Satisfactory positioning of right chest wall Port-A-Cath with the tip terminating at the approximate cavoatrial junction. Opacity in the left middle lung field which likely represents post radiation changes, however concurrent pneumonia is possible if symptoms exist." }, { "input": "Portable frontal view of the chest. A right subclavian PICC ends in the low SVC. The aortic knob is calcified. The heart size is normal. The lungs are clear without focal opacity, pleural effusion or pneumothorax. There is no free air beneath the hemidiaphragms.", "output": "Right PICC ends in the low SVC." }, { "input": "Single portable upright frontal image of the chest. The right-sided PICC terminates in the low SVC. The lungs are hyperinflated and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "1. Right-sided PICC terminating in the lower SVC. 2. Hyperinflated lungs. Findings regarding PICC placement were communicated to ___ at 4:34 a.m. on ___ by page. Findings were communicated to Dr. ___ at 8:31 a.m. on ___ by phone." }, { "input": "The heart is markedly enlarged. The aorta is tortuous. There is a dual-lead pacer with leads terminating in expected position in the right atrium and right ventricle. There is nonspecific pleural and parenchymal scarring at the left lung base. Otherwise, the lungs are clear. There is no pleural effusion or pneumothorax.", "output": "Nonspecific pleural and parenchymal scarring at the left base. No findings specific for past or active TB infection." }, { "input": "Left-sided pacemaker and wires are appropriate position. Moderate cardiomegaly is stable. There is a mild increase in interstitial markings which may represent mild pulmonary edema. There is a small left effusion. No definite focal consolidations. No pneumothorax.", "output": "Mild pulmonary edema." }, { "input": "A left internal jugular central line terminates at the cavoatrial junction. A right subclavian line terminates in the right atrium. Severe cardiomegaly is stable. There is no focal consolidation or pneumothorax. There has been improvement in the right pleural effusion and a small left pleural effusion is stable.", "output": "Improvement in right pleural effusion. Probable small left pleural effusion." }, { "input": "The heart is moderately enlarged and probably increased somewhat since prior examination. Pulmonary vessels are indistinct and the central interstitium is mildly prominent in the mid to lower lungs. The overall impression is of probable mild vascular congestion. There is no pleural effusion or pneumothorax. A healed fracture of the left sixth rib is again present.", "output": "Cardiomegaly and suspected mild pulmonary vascular congestion." }, { "input": "Portable upright frontal view of the chest. The left internal jugular line has been removed. A right-sided Port-A-Cath is accessed and terminates in the low SVC. A double-lumen catheter ends in the mid right atrium. Moderate-to-severe cardiomegaly that appears slightly worse since ___. Bilateral diffuse lower lobe predominant airspace opacities are new since ___. There are bilateral moderate-sized pleural effusions and bibasilar atelectasis. There is no pneumothorax.", "output": "Interval development of pulmonary edema." }, { "input": "Moderate cardiomegaly is unchanged from ___. Hilar contours are normal. Mild prominence of the pulmonary vasculature is unchanged. A nodular opacity is visible in the left upper lung at the junction of the anterior ___ and posterior 4th rib which in retrospect may have been present on the examination from 3 days prior. In addition, there are smaller nodular opacities scattered in the right mid and upper lung. There is no pleural effusion or pneumothorax.", "output": "1. Scattered pulmonary nodules particularly in the left upper lung for which further evaluation with a dedicated noncontrast chest CT is recommended. 2. Unchanged moderate cardiomegaly and mild pulmonary vascular congestion. Results were discussed over the telephone with Dr. ___ by Dr. ___ on ___ at 13:55 at time of initial review." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Lung volumes are low. Heart size is normal. Mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Apart from mild atelectasis at the lung bases, the lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. No acute osseous abnormalities detected.", "output": "Low lung volumes with mild bibasilar atelectasis." }, { "input": "Heart size is mildly enlarged. The mediastinal and hilar contours are normal. There is pulmonary vascular congestion without overt edema. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Pulmonary vascular congestion without overt edema or effusion. No focal consolidation." }, { "input": "The heart size is borderline enlarged. The aorta is mildly tortuous. There is crowding of the bronchovascular structures due to low lung volumes. No overt pulmonary edema is demonstrated. Patchy opacities in the lung bases likely reflect atelectasis. No pleural effusion or pneumothorax is identified. No acute osseous abnormalities demonstrated.", "output": "Low lung volumes with bibasilar airspace opacities likely reflective of atelectasis." }, { "input": "PA and lateral views of the chest. There is faint retrocardiac opacity which could potentially be due to atelectasis. Elsewhere, the lungs are clear. The cardiomediastinal silhouette is stable. Tortuous descending thoracic aorta is seen. No acute osseous abnormality is identified.", "output": "Retrocardiac opacity, potentially atelectasis given lower lung volumes, noting that infection cannot be entirely excluded. Otherwise, unremarkable chest x-ray." }, { "input": "There is no consolidation, pleural effusion or pneumothorax. While there is suggestion of a spine sign on the lateral view, this is unchanged in appearance compared to ___. Cardiomediastinal contours are normal. No acute osseous abnormalities are identified.", "output": "No focal pneumonia." }, { "input": "The lungs are clear without consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. There is tortuosity of the thoracic aorta. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac silhouette size is normal. The aorta is mildly tortuous. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest are obtained. The lung volumes are low. No definite sign of pneumonia or CHF. The heart is mildly enlarged, though this appears stable. Aorta is unfolded. Bony structures are intact.", "output": "Mild cardiomegaly. No signs of pneumonia or CHF." }, { "input": "Frontal and lateral chest radiographdemonstrates well expanded lungs. Lateral to the left heart border is a heterogeneous patch which is more likely to represent residual of pneumonia rather than asymmetric pulmonary edema. No evidence of active infection. No pleural effusion or pneumothorax. Mild enlargement of the cardiomediastinal silhouette noted. Mediastinal contour and hila are unremarkable.", "output": "1. Mild enlargement of cardiomediastinal silhouette. 2. No pulmonary edema or pleural effusion 3. Heterogeneous opacity lateral to the left heart border is more likely to represent residual of prior pneumonia than active infection." }, { "input": "Left-sided Port-A-Cath terminates in the cavoatrial junction without evidence of pneumothorax. Midline tracheostomy tube is re- demonstrated.No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable and unremarkable. No overt pulmonary edema is seen. Gaseous distention of colon is partially imaged.", "output": "No acute cardiopulmonary process." }, { "input": "Left-sided Port-A-Cath terminates at the cavoatrial junction without evidence of pneumothorax. Tracheostomy tube appears unchanged in position. No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable. Gas distention of bowel it is re- demonstrated, partially imaged.", "output": "No acute cardiopulmonary process." }, { "input": "Left-sided Port-A-Cath tip terminates in the proximal right atrium. Heart size is normal. Mediastinal and hilar contours are unremarkable. Tracheostomy tube tip is in unchanged position. Pulmonary vasculature is normal. Lungs are clear. No focal consolidation, pleural effusion or pneumothorax is identified. There is no acute osseous abnormality pattern", "output": "No acute cardiopulmonary abnormality." }, { "input": "Left-sided Port-A-Cath terminates at the cavoatrial junction, stable in position. Midline tracheostomy tube is re- demonstrated.The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are unremarkable. A tracheostomy is appropriately placed. A left Port-A-Cath is seen with the tip at the cavoatrial junction. Air distended colonic loops are noted in the left upper abdomen, similar to prior exam from ___.", "output": "No acute cardiopulmonary process" }, { "input": "Left-sided Port-A-Cath tip terminates in the proximal right atrium, unchanged. Tracheostomy tube tip also terminates in unchanged position. Mild enlargement of the cardiac silhouette is similar. The mediastinal and hilar contours are normal. Pulmonary vasculature is not engorged. Lungs are clear without focal consolidation, pleural effusion or pneumothorax. Diffuse gaseous distention of colonic bowel loops within the upper abdomen is re- demonstrated. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Tracheal tube is seen within the upper airway. Left chest wall port catheter tip is terminating at the cavoatrial junction, unchanged from prior.", "output": "No acute intrathoracic abnormalities." }, { "input": "Tracheostomy tube remains in unchanged position. Left-sided Port-A-Cath tip terminates at the junction of the SVC and right atrium. Heart size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is present. Deformity of the right third rib is unchanged. Gaseous distention of colonic loops of bowel is seen in the upper abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lung volumes are relatively low but the lungs are clear. There is no consolidation, effusion, or edema. Left chest wall port with catheter tip is seen at the cavoatrial junction. Tracheostomy tube remains in place. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs demonstrate unremarkable cardiomediastinal and hilar contours. Lungs are clear. No pleural effusion or pneumothorax evident. Left-sided Port-A-Cath terminates in the upper right atrium/cavoatrial junction. Stable right upper chest deformity possibly prior trauma. Tracheostomy noted. Stable gaseous distention of the visualized portions of the colon.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiograph demonstrates clear lungs bilaterally. No focal consolidation convincing for pneumonia is seen. A tracheostomy tube tip is in unchanged position when compared to prior radiograph dated ___. A left sided Port-A-Cath tip terminates in the proximal right atrium in stable position. Cardiomediastinal and hilar contours are within normal limits. There is no pleural effusion or pneumothorax. No acute osseous abnormalities are detected.", "output": "No acute intrathoracic abnormality." }, { "input": "Position of tracheostomy catheter is unchanged. The catheter for a left chest wall infusion port terminates at the cavoatrial junction. The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal. Gaseous distention of the colon is unchanged from several prior studies.", "output": "No acute cardiopulmonary process." }, { "input": "A tracheostomy tube projects in unchanged location. An accessed left pectoral port catheter tip terminates at the SVC/RA junction. There is no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal silhouette is stable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal dance lateral views of the chest. Tracheostomy and left chest wall port are in stable positions. There is no evidence of a new consolidation nor effusion. Cardiomediastinal silhouette is normal. Osseous structures are unremarkable. Prominent gaseous distention of the colon and stomach is again noted.", "output": "No evidence of pneumonia." }, { "input": "A left-sided porta catheter terminates within the proximal right atrium. The lungs are well expanded and clear without lobar consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is normal in appearance.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. Tracheostomy tube is stable in position. Cardiomediastinal silhouette is within normal limits. There is no visualized pneumomediastinum. Left chest wall port catheter tip seen at the RA/SVC junction as on prior. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Tracheostomy tube tip is in unchanged position. Left-sided Port-A-Cath tip terminates at the junction of the SVC and right atrium. Mild enlargement of the cardiac silhouette is unchanged. Mediastinal and hilar contours are normal. Pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is present.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The left pectoral chest wall port catheter tip ends in the right atrium. Tracheostomy tube projects over the upper mediastinum. In the imaged upper abdomen, gaseous distention of colon noted.", "output": "No acute intrathoracic process. Gas distended loops of colon in the upper abdomen." }, { "input": "Tracheostomy tube is in stable position. Left chest wall port is seen with catheter tip at the RA SVC junction. The lungs are clear without consolidation. There is no effusion. The cardiomediastinal silhouette is within normal limits. Gaseous distension of the colon is partially visualized, similar compared to prior. No free intraperitoneal air.", "output": "No acute cardiopulmonary process." }, { "input": "Left chest wall port seen with catheter tip at the RA SVC junction. Tracheostomy tube is in stable position. The lungs are clear without consolidation or effusion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Left-sided Port-A-Cath tip terminates at the junction of the SVC and right atrium. Tracheostomy tube tip is in unchanged position. Cardiac, mediastinal and hilar contours are within normal limits. Lungs are clear. No pleural effusion or pneumothorax is present. Pulmonary vasculature is normal. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Tracheostomy tube and left-sided Port-A-Cath all remain in unchanged positions. Cardiac, mediastinal and hilar contours are normal. Lungs are clear. No pleural effusion, pulmonary edema, or pneumothorax is present.", "output": "No acute cardiopulmonary process." }, { "input": "Tracheostomy tube is in unchanged position. Left pectoral infusion port terminates at the cavoatrial junction. No evidence of cardiomegaly, vascular congestion, pleural effusion, or acute focal pneumonia.", "output": "No radiographic evidence of pneumonia." }, { "input": "A left chest wall port is again noted, and a tracheostomy is in stable position. Heart size is at the upper limits of normal. The mediastinal contours are otherwise within normal limits . No CHF, focal consolidation, pleural effusion or pneumothorax. Top-normal gas-filled colonic loops in the upper abdomen are again noted.", "output": "No acute pulmonary process identified." }, { "input": "The patient has a tracheostomy tube, as before. A left subclavian central venous catheter terminates in the uppermost portion of the atrium as seen previously. The heart is normal in size. The mediastinal and hilar contours appear unchanged. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "PA and lateral chest radiographs were provided. Tracheostomy tube is appropriately positioned, unchanged. The left chest wall port catheter tip terminates at the cavoatrial junction. The lungs are well expanded. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Midline tracheostomy is again noted. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. Left Port-A-Cath terminates at the cavoatrial junction.", "output": "No acute cardiopulmonary process." }, { "input": "The tip of an accessed left pectoral MediPort extends into the right atrium. Lung volumes are low, but the lungs are grossly clear. The trachea is midline with tracheostomy tube in place. Assessment for tracheitis would be more appropriate with cross-sectional imaging. There is no pneumothorax. The heart and mediastinum are within normal limits despite the projection. There is unchanged interposition of the colon under the diaphragm.", "output": "No change from the study of 1 day prior." }, { "input": "PA and lateral views of the chest are provided. Tracheostomy tube is again seen. There is a Port-A-Cath again seen residing over the left chest wall with catheter tip extending to the level of the low SVC. The lungs are clear without focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours are stable and normal. Bony structures are intact.", "output": "No acute findings in the chest." }, { "input": "Tracheostomy tube appears to be in unchanged position. Left-sided Port-A-Cath tip terminates in the proximal right atrium, unchanged. Cardiac, mediastinal and hilar contours are normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Marked gaseous distension of the colon is noted within the upper abdomen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "AP and lateral chest radiograph demonstrates clear lungs. No focal consolidations are seen. A left chest port is identified with its tip in unchanged position at the cavoatrial junction. Cardiomediastinal and hilar contours are stable. There is no pleural effusion or pneumothorax. No acute osseous abnormality is seen.", "output": "No acute intrathoracic abnormality." }, { "input": "A tracheostomy tube is noted. Left-sided Port-A-Cath again noted, terminating in the proximal right atrium. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Tracheostomy tube tip terminates in unchanged position. Left-sided Port-A-Cath tip terminates in the proximal right atrium, unchanged. Lung volumes are low. Heart size is normal. Mediastinal and hilar contours are within normal limits. Pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is demonstrated. No acute osseous abnormalities are detected. Gaseous distention of colonic loops of bowel in the upper abdomen are incidentally noted.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are normally expanded and clear without focal opacity to suggest pneumonia. A left Port-A-Cath has its tip terminating near the superior cavoatrial junction. Tracheostomy tube terminates approximately 3.6 cm from the carina. The cardiomediastinal silhouette, hilar contours and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. Tracheostomy tube projects over the superior mediastinum. A left chest wall Port-A-Cath is again seen with its tip in the lower SVC. Lung volumes are low though lungs appear clear. No large effusion or pneumothorax. No signs of pneumonia or edema. Cardiomediastinal silhouette is stable. Bony structures are intact. Gas distended colonic loops noted below the diaphragm without evidence for free air.", "output": "No acute findings." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified. A left-sided Port-A-Cath terminates in the right atrium, unchanged. Tracheostomy tube is also unchanged in position.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs. Tracheostomy tube is in appropriate position. A left-sided Port-A-Cath tip is in the right atrium. The lungs are clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Left chest wall port catheter terminates in the upper right atrium. Lungs are clear. There is no pleural effusion or pneumothorax. Cardiomediastinal contour is normal.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. Tracheostomy tube is in stable position. Left chest wall port is seen with tip at the RA/SVC junction. Relatively low lung volumes are seen. There is, however, no region of consolidation or effusion. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "A tracheostomy tube and left-sided Port-A-Cath are unchanged in position. There is no focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. No pneumothorax or pleural effusion. Left Port-A-Cath is seen with tip in the right atrium, unchanged from prior exams. Tracheostomy is appropriately placed.", "output": "1. Unchanged placement of left Port-A-Cath. No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Tracheostomy tube projects over the superior mediastinum. There is a left chest wall Port-A-Cath with catheter tip extending into the lower SVC region. Overlying EKG leads are present. The lungs are clear though volumes are somewhat low. No focal consolidation, large effusion or pneumothorax is seen. The cardiomediastinal silhouette is normal. Bony structures are intact. No signs of free air below the right hemidiaphragm.", "output": "No evidence of pneumonia." }, { "input": "PA and lateral views of the chest provided. Tracheostomy tube projects over the superior mediastinum. A left chest wall Port-A-Cath is in place with catheter tip in the region of the low SVC. The lungs are clear without focal consolidation, large effusion or pneumothorax. No signs of congestion or edema. Heart and mediastinal contours are stable. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No signs of pneumonia or other acute intrathoracic process." }, { "input": "Left subclavian approach port catheter terminates in the high right atrium. Heart size is normal. Cardiomediastinal silhouette and hilar contours are unchanged. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax. Apparent mild colonic distention is unchanged from the prior study.", "output": "No acute cardiopulmonary abnormality." }, { "input": "No focal consolidation, pleural effusion or pulmonary edema is seen, and the cardiomediastinal and hilar contours are normal. Left Port-A-Cath is unchanged in position with tip in the proximal right atrium, and the tracheostomy tube is midline. Chronic gaseous distension of the colon is unchanged from previous studies.", "output": "No evidence of pneumonia. Initial findings were conveyed to Dr. ___ by Dr. ___ on ___ at 10:30 via telephone immediately following review." }, { "input": "Chest frontal and lateral radiograph demonstrates unremarkable cardiomediastinal and hilar contours. Lungs are clear. No pleural effusion or pneumothorax identified. Left-sided Port-A-Cath terminates within the right atrium. Tracheostomy termiantes 4.5 cm above carina. Right chest wall deformity is unchanged. Gaseous distention of the colon noted.", "output": "No acute cardiopulmonary process." }, { "input": "Left Port-A-Cath line tip terminates in the upper right atrium, unchanged. Tracheostomy tube terminates in the upper to mid thoracic trachea. The lungs are normally expanded and clear. There is no focal opacity to suggest pneumonia. Heart size is normal. The mediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. As on prior studies there is gaseous distention of the stomach and loops of bowel in the upper abdomen, likely:", "output": "No convincing evidence of pneumonia. Persisting gaseous distention of bowel loops in the upper abdomen." }, { "input": "Tracheostomy tube is visualized in position. A left subclavian port is noted with the catheter tip terminating in the superior right atrium. Cardiomediastinal silhouette is normal. The lungs are hypoinflated but clear and without evidence of a consolidation, effusion, or pneumothorax. No acute fractures are identified. Colonic interposition is again noted.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "A left subclavian Port-A-Cath terminates near the cavoatrial junction. The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute disease." }, { "input": "Tracheostomy tube projects over the midline, as before. Compared to the prior radiograph from ___, there is increase in interstitial density of the left mid and lower lung, which takes into account the overlying soft tissue. Cardiomediastinal silhouette is normal. Left chest wall port terminates at the upper aspect of the right atrium. Gaseous distention of loops of large bowel are again seen in the left upper quadrant.", "output": "Increase in interstitial opacities in the left mid and lower lung may correspond to a viral infection or atypical pneumonia." }, { "input": "The catheter of a left chest wall port terminates in the proximal right atrium. Tracheostomy catheter terminates above the carina. Heart size and cardiomediastinal contours are normal. The lung volumes are low but the lungs are clear without focal consolidation, pleural effusion, or pneumothorax. There is a chronic deformity of the right third rib. Colonic distention in the upper abdomen is unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "Mild pulmonary vascular congestion is stable to possibly minimally increased. No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. Left Port-A-Cath is again seen, terminating at the cavoatrial junction.", "output": "No focal consolidation. Minimal pulmonary vascular congestion stable to possibly minimally increased." }, { "input": "Left-sided Port-A-Cath terminates at the cavoatrial junction without evidence of pneumothorax. Midline tracheostomy tube is re- demonstrated, similar in appearance. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable..", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Lungs are grossly clear. No pleural effusion or pneumothorax. No free air. Hilar and cardiomediastinal contours are normal. Significant gaseous distention of the large bowel is partially imaged.", "output": "No acute cardiopulmonary process. Prominent gaseous distension of the large bowel is partially imaged and not fully evaluated on this study." }, { "input": "Left chest wall port is again seen. The lungs are clear without consolidation, effusion, or pneumothorax. Tracheostomy tube is in stable position. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process. No focal consolidation." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax. A left chest Port-A-Cath terminates at the cavoatrial junction, as before. There is extremely gaseous distention of the colon in the left upper quadrant.", "output": "Clear lungs. Gaseous distention of the colon the left upper quadrant." }, { "input": "PA and lateral views of the chest provided. Port-A-Cath resides over the left chest wall with catheter tip in the region of the low SVC. A tracheostomy is seen projecting over the superior mediastinum. Lungs are clear bilaterally. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Left-sided Port-A-Cath is seen terminating in the distal SVC/ cavoatrial junction. No pneumothorax is seen. Cardiac silhouette is top-normal. There is mild vascular congestion. No pleural effusion or pneumothorax is seen.", "output": "Top-normal cardiac silhouette size. Mild pulmonary vascular congestion. No focal consolidation." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. There is a midline tracheostomy. Left-sided Port-A-Cath is again seen, terminating at the cavoatrial junction/right atrium. Cardiac and mediastinal silhouettes are stable. Gaseous distention of the colon is again noted.", "output": "No acute cardiopulmonary process." }, { "input": "Since the prior exam, there is slightly increased retrocardiac opacity, suggestive of atelectasis, less likely pneumonia. Otherwise, lungs are clear. Port-A-Cath resides over the left chest wall with catheter tip extending to the low SVC. Cardiomediastinal silhouette is stable. No pneumothorax or effusion. Gaseous distention of colon is noted in the upper abdomen.", "output": "Subtle streaky left lower lobe opacity likely represents mild increase atelectasis, less likely pneumonia." }, { "input": "No significant interval change in the radiographic appearance of the chest. Tracheostomy tube appears unchanged in position. Left Port-A-Cath tip ends at the SVC-RA junction, unchanged. No focal consolidation, edema, effusion, or pneumothorax. Nonspecific -is distension of loops of partially imaged bowel in the upper abdomen is again noted. No acute osseous abnormality.", "output": "No focal pneumonia. No significant interval change in the radiographic appearance of the chest." }, { "input": "Tracheostomy tube is in unchanged position. Left-sided Port-A-Cath tip terminates at the junction of the right atrium and SVC. Cardiac, mediastinal and hilar contours are unchanged with the heart size appearing top normal. Lungs are clear. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The left chest wall Port-A-Cath is unchanged position ending in the right atrium. Tracheostomy tube is in unchanged position. Normal heart size, mediastinal and hilar contours. No focal consolidation, pleural effusion or pneumothorax.", "output": "No acute process" }, { "input": "The tracheostomy tube is in stable position. There is a left Port-A-Cath with its tip terminating at the cavoatrial junction. The heart is normal in size, and the mediastinal and hilar contours are within normal limits. The lungs are clear of focal consolidation, pleural effusion or pneumothorax. No overt pulmonary edema is seen. Distension of colonic loops is noted in the left upper abdomen, and contrast material is noted in the abdomen, reflective of recent video swallow.", "output": "No acute cardiopulmonary process." }, { "input": "A left chest wall port catheter tip terminates at the cavoatrial junction. There is no focal consolidation, pleural effusion or pneumothorax. Mild pulmonary vascular congestion has improved since the prior study. The imaged upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs again demonstrate a tracheostomy in place, unchanged and in appropriate position. A left chest wall port catheter terminating in the upper right atrium. There is a normal cardiomediastinal silhouette and well-aerated lungs without focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen again demonstrates air distended loops of bowel, similar in appearance to multiple prior exams dating back to ___.", "output": "No acute cardiopulmonary process." }, { "input": "Tracheostomy tube is in stable position. Left chest wall port seen with catheter tip in the lower SVC. The lungs remain clear, without focal consolidation or effusion despite low lung volumes. The cardiomediastinal silhouette is within normal limits. Chronic changes of the right third rib are identified. No acute osseous abnormalities. Distention of the bowel in left upper quadrant, presumably colon is similar compared to prior.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of chest demonstrate left-sided Port-A-Cath terminating in the right atrium. Tracheostomy tube is in unchanged position. Vague right lower lobe opacities have been present in the past and likely represent chronic atelectasis or vessels. Stable right upper outer chest deformity. Gaseous distention of the colon is again noted.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. There is no overt pulmonary edema. Some degenerative changes are noted along the spine, although incompletely evaluated on this study.", "output": "No acute cardiopulmonary process." }, { "input": "A single portable semiupright view of the chest is provided. Lung volumes are extremely low resulting in accentuation of pulmonary vasculature. Linear opacities at the left base likely reflect atelectasis. Heart is normal in size and cardiomediastinal contour is unchanged. There is no large effusion. A right-sided internal jugular venous catheter terminates in the right atrium.", "output": "1. Central venous catheter terminates in the right atrium. 2. Extremely low lung volumes with pulmonary vascular crowding and left basilar atelectasis." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest demonstrate slightly lower lung volumes compared to the prior study with minimal left basilar atelectasis. The cardiomediastinal silhouette is unremarkable and there is no evidence of pneumothorax, pulmonary edema or pleural effusion. No focal opacification is identified within the lungs bilaterally.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is status post median sternotomy and aortic valve replacement. Heart size is moderately enlarged but unchanged. The aorta is tortuous with mild atherosclerotic calcifications noted. No pulmonary edema is demonstrated. Small bilateral pleural effusions are new, with adjacent atelectasis in the lung bases. Moderate multilevel degenerative changes are noted in the thoracic spine. There is no pneumothorax.", "output": "Small bilateral pleural effusions and bibasilar atelectasis, new in the interval." }, { "input": "Frontal and lateral views of the chest are obtained. There has been interval removal of previously seen left PICC. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Hilar contours are also unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral images of the chest. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Compared with prior radiographs on ___, lung volumes remain low, with a small right pleural effusion. Vascular congestion has slightly improved. No new focal consolidation or pneumothorax. There is subtle interstitial abnormality, better assessed on CT chest on ___. Stable postop changes in the right lung. The cardiac and mediastinal silhouettes are unchanged.", "output": "Slight improvement in vascular congestion, with continued low lung volumes and small right pleural effusion." }, { "input": "Compared with prior radiographs on ___, there has been interval removal of a right-sided chest tube, with a very tiny right-sided pneumothorax. There is no evidence of tension. Lung volumes are low with bibasilar atelectasis, similar to prior. There is vascular congestion . The cardiac and mediastinal silhouettes are slightly decreased in size from prior.", "output": "Very tiny right-sided pneumothorax status post chest tube removal. NOTIFICATION: The findings were discussed by Dr. ___ with ___ on the telephoneon ___ at the time of the findings." }, { "input": "Patient is status post median sternotomy and aortic and mitral valve repair. Moderate cardiomegaly is unchanged. Right internal jugular central venous catheter tip terminates in the low SVC. Mediastinal contours are similar. Moderate pulmonary edema is not substantially changed. More focal opacities within the lung bases, particularly within the right lung base, may reflect areas of superimposed infection. Small bilateral pleural effusions, larger on the right, are not substantially changed. No pneumothorax is present. Degenerative spurring is noted within the imaged thoracic spine.", "output": "Moderate pulmonary edema, not substantially changed in the interval, with small bilateral pleural effusions, larger on the right. More focal bibasilar airspace opacities, more so within the right lung base, concerning for superimposed infection." }, { "input": "A right IJ central venous catheter terminates in the distal SVC, unchanged. Bilateral airspace opacities have improved, with significantly decreased right costophrenic angle opacification, possibly representing a small effusion. There is no pneumothorax. Moderate cardiomegaly is unchanged. Median sternotomy wires and prosthetic valves project in unchanged location.", "output": "Interval improvement in bilateral airspace opacities, small opacity in the right costophrenic angle may represent a small right pleural effusion." }, { "input": "Cardiac silhouette size is mild to moderately enlarged but unchanged. The mediastinal contour is similar with atherosclerotic calcifications noted at the aortic knob. Mild pulmonary vascular congestion is re- demonstrated. No focal consolidation, pleural effusion or pneumothorax is present. Hypertrophic changes are seen within the thoracic spine.", "output": "Unchanged mild to moderate cardiomegaly and mild pulmonary vascular congestion." }, { "input": "Lung volumes are lower. The heart is normal in size but increased from ___. The mediastinal and hilar contours are unremarkable. Lateral view shows a 14mm wide retrosternal nodule at the level of the sternomanubrial joint. No pleural effusion, pneumothorax or focal airspace consolidation. The pulmonary vascularity is normal. Dense calcifications are seen within the aortic valve.", "output": "1. Normal heart size but increased from ___. 2. Possible aortic valve calcifications 3. Possible retrosternal lung nodule; CT of the chest without contrast is recommended. Findings sent to ED QA nurses at 7:45 on ___." }, { "input": "The lungs are clear of airspace or interstitial opacity. The cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax. No acute or aggressive osseus changes.", "output": "No acute or chronic radiographic intrathoracic pulmonary disease." }, { "input": "As compared to chest radiograph from the same day, overall no substantial change of the right lung. Slight improvement in the left lung. ETT is 3 cm from the carina. The tip of the nasogastric tube in the stomach, partially beyond view of this chest radiograph. Mild pulmonary edema and moderate bilateral effusions unchanged. Persistent lower lobe opacities likely reflect atelectasis and effusions. No pneumothorax.", "output": "Overall no substantial change of the right lung. Slight improvement in the left lung." }, { "input": "Portable AP semi-erect chest radiograph ___ at 10:30 is submitted.", "output": "Endotracheal tube has its tip 3 cm above the carina. A nasogastric tube is seen coursing below the diaphragm with the tip projecting over the proximal stomach. The bilateral pleural effusions appear smaller, but this likely is related to differences in patient positioning. Stable bibasilar opacities favoring atelectasis, although aspiration or pneumonia should also be considered in the correct clinical setting. No evidence of pulmonary edema. No pneumothorax, although the sensitivity to detect pneumothorax is diminished given semi-erect technique. Overall cardiac and mediastinal contours are stable." }, { "input": "The lungs are well inflated. Heterogeneous left lower lobe opacity with small left pleural effusion is noted. Mild vascular congestion is present. Heart size, mediastinal contour, and hila are unremarkable. Enteric feeding tube is seen coursing midline with tip in stomach. An endotracheal tube is in appropriate position 3.3 cm above the level of diaphragm.", "output": "1. Findings worrisome for left lower lobe aspiration pneumonia or pneumonia. 2. Small left pleural effusion. 3. Endotracheal tube in appropriate position. 4. Mild vascular congestion." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "AP portable upright view of the chest. Overlying EKG leads are present. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process" }, { "input": "Ill-defined heterogeneous opacities in left lung base are new and concerning for infection or aspiration. Indistinctness of the left costophrenic angle suggests small pleural effusion. Lung volumes are low. No pneumothorax. Heart size is top normal. Mediastinal contours are stable. Azygos fissure is incidentally noted.", "output": "Left base heterogeneous opacity concerning for infection or aspiration. Probable small left pleural effusion." }, { "input": "The heart is top normal in size. Lung volumes are decreased. There is no focal abnormality to suggest pneumonia. There is no large pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. The mediastinal and hilar contours are within normal limits. As demonstrated on the prior CT, innumerable small nodules are again seen in both lungs in a miliary pattern. No focal consolidation, pleural effusion or pneumothorax is present. The patient is status post right mastectomy. No acute osseous abnormality is identified.", "output": "Innumerable miliary nodules compatible with known metastatic disease, better assessed on the recent CT. No focal consolidation." }, { "input": "Heart size is mildly enlarged but unchanged. Mediastinal contour is similar, with diffuse atherosclerotic calcifications seen throughout the aorta. Hilar contours are unchanged, with mild vascular indistinctness suggestive of mild pulmonary vascular congestion. Patchy opacities in the lung bases may reflect areas of atelectasis but infection is not excluded. The lungs are hyperinflated. No pleural effusion or pneumothorax is identified. Old right-sided rib fractures are again seen. Bilateral humeral prostheses are incompletely imaged.", "output": "Mild pulmonary vascular congestion and bibasilar patchy opacities, possibly atelectasis though infection cannot be excluded." }, { "input": "PA and lateral views of the chest are provided. Lungs appear clear aside from a linear density in the left mid lung which is stable and may represent an area of scarring. No effusion or pneumothorax. The cardiomediastinal silhouette is stable. Right shoulder replacement is again noted with right distal clavicular deformity. Old right rib cage deformity is also noted.", "output": "No acute intrathoracic process." }, { "input": "The lungs are normally expanded. There is no focal airspace opacity to suggest pneumonia. There is no pleural effusion or pneumothorax. The heart is top normal. The mediastinal and hilar contours are normal. Healed right rib fractures are redemonstrated.", "output": "The heart is top normal. There is no evidence of pneumonia." }, { "input": "Nasogastric tube courses below the diaphragm into the stomach. Lungs are well expanded. There is no focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette is normal. Multiple healed old left rib fractures are noted.", "output": "NG tube terminates in the stomach." }, { "input": "Heart size is normal with mild tortuosity of the thoracic aorta, unchanged. Hilar contours are unremarkable. There is a trace right base atelectasis. Lungs are otherwise clear. Pleural surfaces are clear without effusion or pneumothorax. There is no evidence of pneumoperitoneum. Probable posttraumatic chronic changes of the left scapula.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. The lungs appear clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The patient is rotated somewhat to the right. The cardiac silhouette is moderately enlarged. The aorta is tortuous. Left base patchy opacity is seen which could be due to pneumonia or aspiration versus atelectasis. No large pleural effusion is seen. There is no pneumothorax. There may be minimal central pulmonary vascular engorgement without overt pulmonary edema. Dual lead left-sided pacer device is seen, new since the prior study, with leads extending to the expected positions of the right atrium and right ventricle.", "output": "Patchy left base opacity could be due to pneumonia, aspiration, or atelectasis. Cardiomegaly. Central pulmonary vascular engorgement without overt pulmonary edema." }, { "input": "Two views of the chest demonstrate adequate lung volumes, with clear lungs. There is no pleural effusion or pneumothorax. The cardiac silhouette is normal in size, the mediastinal contours are normal. Pulmonary vasculature is mildly engorged.", "output": "Pulmonary vasculature is mildly engorged which can be seen in tachycardia or anemia." }, { "input": "Cardiomediastinal contours are normal. Lungs and pleural surfaces are clear.", "output": "No evidence of pneumonia" }, { "input": "Frontal and lateral views of the chest. Heart size and cardiomediastinal contours are normal. Lungs are clear without focal consolidation, pleural effusion, or pneumothorax.", "output": "No focal consolidation." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.", "output": "No focal consolidation concerning for pneumonia." }, { "input": "Single AP upright portable view of the chest was obtained. There are relatively low lung volumes, which accentuate the bronchovascular markings, particularly at the lung bases. Given this, no focal consolidation is seen. There is no large pleural effusion or evidence of pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. No overt pulmonary edema is seen.", "output": "Low lung volumes without definite acute cardiopulmonary process . Dedicated PA and lateral views of the chest would be helpful for further evaluation if patient able." }, { "input": "There are low lung volumes. This accentuates the size of the cardiac silhouette which is borderline enlarged. The mediastinal and hilar contours are unremarkable, and there is no pulmonary edema. Minimal streaky opacities in the lung bases likely reflect atelectasis. There is no focal consolidation, pleural effusion or pneumothorax. No acute osseous abnormalities present.", "output": "Minimal streaky bibasilar opacities likely reflect atelectasis in the setting of low lung volumes." }, { "input": "Lung volumes are somewhat low. The heart is top-normal in size with mild pulmonary vascular congestion. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "Mild pulmonary vascular congestion with top-normal heart size. No pneumothorax. Consider repeat chest radiograph with improved inspiratory level and standard PA and lateral technique to allow more optimal assessment of the cardiovascular structures. If findings persist, consider echocardiogram for further evaluation." }, { "input": "The cardiomediastinal silhouette is enlarged but stable compared to prior studies. There are multiple bilateral pleural plaques which remain unchanged. Stable bibasilar small pleural effusions with adjacent atelectasis is seen and remains grossly unchanged. The retrocardiac opacity is again seen and remains unchanged likely representing atelectasis.", "output": "Stable bibasilar atelectasis with small bilateral pleural effusions, grossly unchanged from ___ study." }, { "input": "Bilateral calcified pleural plaques. Cardiac enlargement stable. Worsened left perihilar, basilar opacity, atelectasis versus edema. Worsened left retrocardiac opacity, atelectasis versus pneumonitis. Shallow inspiration. Tiny right pleural effusion, similar. Aortic calcification. No pneumothorax. Degenerative arthritis bilateral shoulders. Stable right basilar opacity, likely atelectasis.", "output": "Worsened left perihilar, basilar opacity, atelectasis versus edema. Worsened left retrocardiac opacity, atelectasis versus pneumonitis." }, { "input": "Dense left mid lung airspace opacification may represent a superior subsegment left lower lobe pneumonia or parenchymal mass. Nodular densities project over the lungs bilaterally consistent with pleural plaques related to prior asbestos exposure. There is mild pulmonary vascular congestion with trace pulmonary edema. There is probably a small right pleural effusion. There is no pneumothorax. Cardiomegaly is mild to moderate. The cardiomediastinal silhouette is otherwise unremarkable. Bilateral glenohumeral degenerative changes are partially assessed.", "output": "1. Left midlung airspace opacification may represent acute pneumonia or a parenchymal mass. Should be evaluated by chest CT if not recently performed. 2. Mild volume overload including pulmonary vascular congestion, trace edema, and likely a small right pleural effusion. 3. Extensive pleural plaques consistent with prior asbestos exposure." }, { "input": "Bilateral pleural plaques stable. Aortic calcifications. Cardiac enlargement, has mildly improved. Mildly improved pulmonary vascularity. Nearly resolved previously seen tiny right pleural effusion. Decreased bibasilar atelectasis. Degenerative arthritis bilateral shoulders.", "output": "Mild interval improvement." }, { "input": "Extensive nodular densities project over the lungs bilaterally consistent with pleural plaques secondary to prior asbestos exposure. Interval improvement of previously seen pulmonary vascular congestion and trace pulmonary edema stable right pleural effusion. With this improvement previously seen left mid lung airspace opacification since consistent with known pleural plaques.", "output": "Interval improvement in previously seen pulmonary vascular congestion and trace pulmonary edema with unchanged pleural plaques secondary to known asbestos exposure." }, { "input": "Frontal and lateral views of the chest demonstrate normal cardiomediastinal silhouette. The lungs are clear. There is no pneumothorax, vascular congestion, or pleural effusion. Multilevel moderate lower thoracic spondylosis is present, as is right acromioclavicular osteoarthritis.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest were provided. As seen on recent chest CT, there are bilateral pleural effusions which appear small, with associated right and left lower lobe atelectasis which slightly improved in the interval. Upper and mid lungs appear well aerated. The heart and mediastinal contours appear stable. No definite bony abnormalities are seen.", "output": "Small bilateral effusions with persistent though improving lower lobe atelectasis." }, { "input": "The lung volumes remain low. There is interval improved aeration at the bilateral lung bases from the most recent prior study. Small bilateral pleural effusions and evidence of elevated central venous pressure persist. No pneumothorax is present. There is persistent mild bibasilar atelectasis. The cardiomediastinal silhouette is prominent, related in part to low lung volumes and technique, but stable. A nasogastric tube is seen coursing below the diaphragm and out of view on this image. Subcutaneous emphysema is redemonstrated over the right supraclavicular region. Degenerative changes at the bilateral acromioclavicular joints are also noted.", "output": "1. Improved aeration at the bilateral lung bases with mild persistent atelectasis. 2. Small bilateral pleural effusions and evidence of elevated central venous pressure." }, { "input": "Cardiomediastinal silhouette is stable. Lung volumes are low. There is mild pulmonary edema but no focal consolidation, pleural effusion, or pneumothorax.", "output": "Mild pulmonary edema." }, { "input": "The cardiac, mediastinal, and hilar contours appear unchanged. There are no pleural effusions or pneumothorax. The lungs appear clear. A small curvilinear lucency underneath the left hemidiaphragm is probably within the stomach.", "output": "No evidence for acute cardiopulmonary disease or free air." }, { "input": "There has been minimal progression of small to moderate right pleural effusion with a stable small left pleural effusion. Right pleural thickening is again noted. Upper and mid esophageal stent is unchanged in position. Left infusion port with the tip terminating in this lower SVC. Widely disseminated micronodular show septal thickening is again noted and best evaluated on CT from ___.", "output": "Little change comparison prior study from ___ with minimal progression of small right pleural effusion." }, { "input": "AP upright and lateral chest radiographs are obtained. The position of right apical chest tube, Port-A-Cath, and NG tube is unchanged. Cardiomediastinal contours are stable. There is increased opacification of the left base suggesting increased pleural effusion and surrounding atelectasis. Lungs are otherwise clear. No pneumothorax.", "output": "Increased opacification of the right base likely represents increased pleural effusion and compressive atelectasis, superimposed consolidation cannot be excluded." }, { "input": "PA and lateral chest radiographs are obtained. Right apical chest tube is no longer visualized. No pneumothorax is identified. Cardiomediastinal contours and lungs remain unchanged.", "output": "No definitive evidence of pneumothorax post chest tube removal." }, { "input": "Since the prior exam, a new esophageal stent is in place. There is diffuse interstitial prominence, most likely consistent with mild pulmonary edema. Additionally, there is opacification at the right base, more predominant than elsewhere in the lung parenchyma, which is concerning for aspiration or pneumonia. Small bilateral pleural effusions are present. The cardiomediastinal silhouette is unchanged. The cardiac size is normal. There is no pneumothorax.", "output": "1. Mild-to-moderate pulmonary edema with small bilateral pleural effusions. 2. Opacification of the right base is concerning for aspiration. Alternatively, in the appropriate clinical setting, could be pneumonia." }, { "input": "PA and lateral images of the chest demonstrate well expanded lungs, which are clear. There is interval improvement in the right pleural effusion. There is no left pleural effusion. No pneumothorax is seen. Cardiomediastinal silhouette is unremarkable. Visualized osseous structures are unremarkable.", "output": "Resolving right pleural effusion." }, { "input": "The patient is status post esophagogastrectomy procedure. Nasogastric tube remains in place within the neoesophagus, and post-operative alterations of the right mediastinal contour appear similar. Moderate right pleural effusion appears slightly more prominent, but positional differences between the studies limit comparison. Right basilar atelectasis is unchanged, but linear left basilar atelectasis has slightly worsened.", "output": "Stable postoperative alterations of right mediastinal contour following esophagogastrectomy procedure. Questionable increase in right pleural effusion." }, { "input": "Right chest tubes and left chest wall Port-A-Cath are unchanged in position. NG tube has been removed. There is slight improvement in atelectasis at the right base with more area of the lung visible. A small right pleural effusion is unchanged. There is a tiny right apical pneumothorax, not well appreciated on the prior. Cardiomediastinal silhouette is stable status post minimally invasive esophagectomy. Bony structures are intact.", "output": "1.Tiny right apical pneumothorax. 2.Slight improved aeration in the right lower lobe with small pleural effusion." }, { "input": "PA and lateral views of the chest are provided. Port-A-Cath is again noted residing over the left chest wall with catheter tip extending to the level of the low SVC. There is slight interval increase in right pleural effusion with right lower lobe consolidation concerning for pneumonia. There is mild haziness at the left lung base as well, which could represent atelectasis, though a component of pneumonia is difficult to exclude in the correct clinical setting. No pneumothorax. Overall, cardiomediastinal silhouette is stable. Bony structures are intact.", "output": "Slight increase in right pleural effusion with increased lower lobe opacities concerning for pneumonia." }, { "input": "LINEAR SCARRING AND POSSIBLE BRONCHIECTASIS IN THE LEFT MIDLUNG IS UNCHANGED SINCE ___. THE ___ X 22 MM OVAL OPACITY PROJECTING OVER THE ANTERIOR END OF THE RIGHT FOURTH RIB COULD BE A LUNG NODULE OR SCLEROSIS AND THE RIB OR EVEN THE RIGHT NIPPLE. There is no evidence of focal consolidation, pleural effusion, pneumothorax, or frank pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "NO EVIDENCE OF PNEUMONIA OR CONGESTIVE HEART FAILURE. POSSIBLE RIGHT LUNG NODULE SHOULD BE EVALUATED WITH SHALLOW OBLIQUE VIEWS USING NIPPLE MARKERS. NOTIFICATION: Dr. ___ reported the findings to ___, ___ by telephone ___ ___ at 8:14 AM, 2 minutes after discovery of the findings." }, { "input": "Left lingular consolidations, which on recent torso CT demonstrated to have a central low-density area and concerning for an abscess is unchanged since prior radiograph dated ___. Mild-to-moderate left pleural effusion has increased. There is no pleural effusion or lung opacities of concern on the right side.", "output": "Unchanged left lung consolidation and interval increase in mild-to-moderate left pleural effusion since ___." }, { "input": "A large, near homogeneous opacity of 4 x 4.6 cm in the left lower lung in the pericardiac region which on lateral view overlies the cardiac silhouette and hence confined to the lingula is new since ___. In view of history this may represent lymphomatous deposits, however, other differential diagnosis include lung infection. There is a probable mild left pleural effusion. There is no pleural effusion on the right side. Right lung is clear. Heart size is top normal. Mediastinal and hilar contours are within normal limits and unchanged in appearance as compared to ___.", "output": "Large left lower lung opacity, which is anatomically located in the lingula, is new since ___. In view of history the likely possibilities include a lymphoma deposit, however, lung infection cannot be ruled out. Contrast-enhanced CECT of thorax is recommended for further evaluation. Findings were discussed with nurse ___ Ms. ___ to further communicate findings to concerned physician by phone on ___ at 12:04 p.m." }, { "input": "AP portable upright view of the chest provided. Left chest wall AICD is again seen with leads extending into the region of the right atrium and coronaries sinus. A prosthetic cardiac valve again noted. The heart remains massively enlarged. There is a small right pleural effusion. Mild congestion is noted without frank pulmonary edema. No pneumothorax. Bony structures are intact.", "output": "Marked cardiomegaly with tiny right pleural effusion and mild hilar congestion." }, { "input": "Portable semi-upright radiograph of the chest demonstrates persistent marked enlargement of the cardiac silhouette and asymmetrical left perihilar opacification, which appears to have progressed slightly over the interval. A right-sided subclavian central venous line ends in the upper SVC. The endotracheal tube ends 4 cm from the carina. The Dopoff feeding tube ends in the stomach, with its tip in the region of the gastric fundus, near to the GE junction.", "output": "1. Feeding tube ends in the stomach, with the tip in the region of the gastric fundus, near to the GE junction. 2. Slight interval increase in the degree of asymmetrical left perihilar opacification, which may reflect asymmetrical edema, or developing pneumonia. RECOMMENDATION(S): Feeding tube ends in the stomach, with the tip in the region of the gastric fundus, near to the GE junction. Recommend repositioning prior to use. NOTIFICATION: These findings and recommendations were discussed with ___ ___ (PA) by Dr. ___ ___ telephone at 10:10 on ___, 5 minutes after discovery." }, { "input": "There is very slight rotated positioning. Multiple lines and tubes are present, nominal in position. The right IJ Swan-Ganz catheter tip may lie in the RV or at the origin of the pulmonary outflow tract. No pneumothorax detected. Again seen is cardiomegaly, with sternotomy wires and prosthetic valve. The aortic valve is indistinct, but not clearly changed compared with the most recent prior film. Equivocal slight convexity is seen in the region of the aortopulmonary window, in the setting of air bronchograms and consolidation around the lobar and segmental airways. Mild vascular plethora is again noted, grossly unchanged. Also again seen is left lower lobe collapse and/or consolidation, with obscuration left hemidiaphragm. This has probably increased slightly compare with the prior film. The possibility of a small left effusion cannot be excluded. Minimal atelectasis at the right base is slightly increased. No gross effusion identified.", "output": "1. Lines and tubes as described. 2. Cardiomediastinal silhouette, including indistinctness of the aortic arch, is grossly unchanged. Question minimal new convexity in the aortopulmonary window. 3. Left lower lobe collapse and/or consolidation may be slightly worse. 4. Minimal atelectasis at the right base is slightly increased. 5. No gross pleural effusion is seen on either side. 6. Mild vascular plethora is grossly unchanged." }, { "input": "AP portable upright view of the chest. Midline sternotomy wires and prosthetic cardiac valve again noted. The heart is massively enlarged. Bilateral small pleural effusions are noted, slightly increased on the right. There is increased right lower lung opacity which could represent atelectasis versus pneumonia. No overt edema. No pneumothorax. Mediastinal contour is unchanged with atherosclerotic calcifications at the aortic knob. Bony structures are intact.", "output": "Marked cardiomegaly with small bilateral pleural effusions, slightly increased on the right with minimally increased atelectasis at the right lung base, difficult to exclude a developing pneumonia." }, { "input": "Portable upright chest radiograph ___ at 10:45 is submitted.", "output": "The heart remains markedly enlarged status post median sternotomy with valve replacement. The pulmonary edema has resolved. There is likely a small residual layering right effusion. No focal airspace consolidation is seen to suggest pneumonia. No pneumothorax." }, { "input": "A right-sided PICC line is seen in the mid SVC, without pneumothorax.The patient has had prior sternotomy with aortic valve and mitral valves repair. The heart remains markedly enlarged. The pulmonary vascular enlargement and fluid along the right minor fissure has improved. The right-sided pleural effusion and basal atelectasis/consolidation is stable.", "output": "Right-sided PICC in good position, without pneumothorax. Interval improved interstitial edema. Marked cardiomegaly" }, { "input": "Single portable AP chest radiograph demonstrates interval placement of a left pectorally placed biventricular ICD. The leads appear intact and project over the expected location of the right and left ventricle. There is no pneumothorax. There is severe cardiomegaly without evidence of overt pulmonary edema. Bowel replacement are identified as are median sternotomy wires. Previously seen right pleural effusion is decreased in size.", "output": "Severe cardiomegaly with interval placement of biventricular ICD, its leads which project over the right and left ventricles. No pneumothorax." }, { "input": "The repositioned right Swan-___ catheter tip lies within the mediastinal contours in the region of the right main pulmonary artery. Severe cardiomegaly persists, unchanged from at least ___. Mild pulmonary edema is similar to ___ but new since ___. No definite pleural effusion. No pneumothorax. Calcifications of the aortic knob are unchanged.", "output": "No significant interval change from ___ but mild pulmonary edema is new from ___." }, { "input": "There is severe enlargement of the cardiac silhouette. The aorta is calcified and tortuous. There is a trace left pleural effusion and possible trace right pleural effusion. No pulmonary edema is seen. There is no pneumothorax. No focal consolidation to suggest pneumonia is identified. There is prominence of the central pulmonary arteries.", "output": "Severe enlargement of the cardiac silhouette. No priors for comparison. Consider follow-up echocardiogram if this has not been previously assessed. Mild prominence of the central pulmonary vasculature may be due to underlying pulmonary hypertension. Trace pleural effusions." }, { "input": "Prior chest radiographs ___ through ___:47.", "output": "Severe left lower lobe atelectasis has worsened and small left pleural effusion may have accumulated since ___ following removal of the left basal pleural tube. 3 sequential radiographs show successive advancement of the feeding tube with the wire stylet in place to the distal stomach and an esophageal drainage tube ending in the upper portion of the stomach. Right lung is clear. The large cardiomediastinal silhouette is unchanged since ___ and smaller than it was just after surgery. ET tube is in standard placement. Right subclavian introducer ends at the origin of the SVC." }, { "input": "The cardiac silhouette is markedly enlarged, not changed since the prior examination. Aortic and mitral valve replacements are noted. The pulmonary vasculature is unremarkable. No definite consolidation is noted. Again noted is indistinctness of the right costophrenic angle. Median sternotomy wires are intact and well aligned. The visualized bones show no significant abnormalities.", "output": "Stable examination of the chest without acute intrathoracic process." }, { "input": "Lordotic positioning. There is mild cardiomegaly. There is relatively minimal upper zone redistribution. However, there are diffuse increased interstitial markings and vascular blurring, with more confluent opacity at the right base. The appearance is consistent with interstitial and early alveolar edema. Doubt, but cannot entirely exclude, an underlying infectious infiltrate. No gross effusions. No pneumothorax detected.", "output": "Cardiomegaly, likely with interstitial and early alveolar edema. No effusions. Doubt, but cannot entirely exclude, an underlying infectious infiltrate." }, { "input": "The cardiomediastinal contours are stable in appearance. There is slight interval improvement in the aeration of the lungs compared to the prior exam. There has been interval improvement in the small right pleural effusion, with an adjacent consolidation likely secondary to atelectasis. Small left pleural effusion is stable. There is no pneumothorax.", "output": "Slight interval improvement in the right pleural effusion, with an adjacent consolidation likely secondary to atelectasis, however an infectious process cannot be excluded." }, { "input": "A left Port-A-Cath is unchanged in position with tip projecting over the cavoatrial junction. Cardiomediastinal silhouette and hilar contours are normal. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process; specifically, no evidence of pneumonia." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes. Port-A-Cath tip projects over right atrium. Moderate bilateral pleural effusions are present. Bibasilar opacities are noted. No pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. No pulmonary edema. Partially imaged upper abdomen is unremarkable.", "output": "In comparison to ___ exam, there is interval development of bilateral moderate pleural effusions with bibasilar consolidations, which may represent atelectasis or infection in the appropriate clinical setting. Findings discussed with Dr. ___ at 4:20pm ___ by phone at the time of discovery." }, { "input": "A left subclavian approach Port-A-Cath terminates at the cavoatrial junction. Cardiomediastinal silhouette and hilar contours are unremarkable. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is a left-sided Port-A-Cath, which terminates in the low SVC. The lungs are otherwise well expanded and clear. There is no pneumothorax or pleural effusion. The heart size is normal. The mediastinal and hilar contours are unremarkable. The visualized osseous structures are normal.", "output": "Left-sided port terminates in the low SVC." }, { "input": "Cardiomediastinal contours are stable in appearance. Persistent moderate pleural effusions with an adjacent atelectasis involving the right middle and both lower lobes. Left subclavian Port-A-Catheter is unchanged in position.", "output": "Persistent moderate bilateral pleural effusions and adjacent atelectasis in the right middle and both lower lobes." }, { "input": "Baseline diffuse parenchymal abnormality characterized by fine reticular interlobular septal thickening is compatible with emphysema. A rounded opacity projecting over the heart is unchanged, and most likely due to atelectasis. Right lower lobe linear atelectasis or scarring is also unchanged. There is no new consolidation or pleural effusion. There is no pneumothorax. Spinal degenerative changes and generalized osteopenia are stable. Metallic clips in the right upper quadrant denote prior cholecystectomy.", "output": "No acute pulmonary disease." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs remain hyperinflated, suggesting chronic obstructive pulmonary disease. Areas of bibasilar atelectasis are seen, right greater than left consistent with atelectasis/scarring. No focal consolidation is seen. There is no pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are unremarkable. Degenerative changes are seen along the spine.", "output": "1. COPD. 2. Bibasilar atelectasis." }, { "input": "The newly placed left PICC line terminates in the upper SVC. The right Port-A-Cath terminates in the lower SVC. Since ___, the to focal consolidation in the left lower lung has completely resolved. The lungs are now clear. No pulmonary edema, focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette, hila, and pleura are unremarkable and unchanged.", "output": "1. Left PICC line ends in the upper SVC. 2. Left lower lung pneumonia has resolved. 3. No acute cardiopulmonary process. NOTIFICATION: The findings were discussed by Dr. ___ with ___ on the telephone on ___ at 9:44 AM, 2 minutes after discovery of the findings." }, { "input": "Frontal and lateral chest radiographs demonstrate interval extubation. Small bilateral pleural effusions are present. Unchanged moderate cardiomegaly is present. Right lower lobe opacity is likely from soft tissue superimposed upon the chest. Note is made of calcification of the aortic knob. Thoracic kyphosis, with wedge deformity of multiple thoracic vertebral bodies is unchanged from ___. A inferiorly placed catheter is superimposed upon the thoracic epidural space on the lateral view.", "output": "Unchanged moderate cardiomegaly with small bilateral pleural effusions. No evidence for CHF. These findings were discussed with Dr. ___ at 12:20 p.m. by phone." }, { "input": "AP portable upright view of the chest. The lungs are hyperinflated and clear. Overlying EKG leads are present. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process" }, { "input": "The lungs are clear. No pleural effusion, pulmonary edema, focal consolidation, or pneumothorax. The heart size is normal. No mediastinal widening. The hila and pleura are unremarkable. There left anterior fifth, right fifth anterior, and seventh left lateral rib fractures are minimally displaced. No soft tissue gas is seen.", "output": "1. No pneumothorax or effusion. 2. Multiple bilateral rib fractures as above. Note that chest radiograph is not optimal for evaluation of the thoracic wall. Dedicated Chest CT could be performed if detailed assessment of the chest wall is desired." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are remarkable for near complete resolution of previously identified left basilar abnormality. Near resolution of left lower lobe opacity. .No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality.No new or worsening opacities to suggest pneumonia." }, { "input": "Patchy left base opacity is seen, more conspicuous on 1 of the frontal views than the other, underlying infection or aspiration not excluded although findings may relate to atelectasis. The right lung is clear. Overall, the lungs are hyperinflated. The cardiac and mediastinal silhouettes are stable. No pulmonary edema is seen.", "output": "Patchy left base opacity is seen, more conspicuous on 1 of the frontal views than the other, underlying infection or aspiration not excluded although findings may relate to atelectasis" }, { "input": "Compared with ___, no gross change is identified. A right subclavian PICC line is present. The PICC line tip is not optimally visualized, but probably overlies the distal SVC. No pneumothorax detected. Cardiomediastinal silhouette unchanged, with probable mild cardiomegaly, unchanged. . As before, the right hemidiaphragm is elevated. Again seen is mild diffuse increase in interstitial markings. Hazy is seen on only in the right lung, but in the lower portion of the left lung. No upper zone redistribution. No gross effusion detected on either side.", "output": "Doubt significant interval change. Right greater left increase interstitial markings, elevated right hemidiaphragm and mild cardiomegaly are similar to prior. No pneumomediastinum, pneumopericardium, or pneumothorax detected." }, { "input": "PA and lateral views of the chest provided. Coarsened interstitial markings within the right upper lung and left mid to lower lung concerning for carcinomatosis. Increasing opacity at the right lung base likely reflects known malignancy. A component of postobstructive collapse is difficult to exclude. Heart size difficult to assess. Hilar prominence reflects lymphadenopathy. No pneumothorax.", "output": "Coarsened interstitial markings concerning for lymphangitic carcinomatosis with increasing right basal opacity likely progression of malignancy possibly with postobstructive collapse." }, { "input": "Opacities in the right mid and lower lung consistent with pneumonia. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Unusual contour of the left hila, close attention on follow-up.", "output": "Right lower lobe and probable right middle lobe pneumonia. Unusual left hilar contours, close attention on follow-up. ___ repeat chest radiographs in 4 weeks to evaluate resolution of pneumonia NOTIFICATION: The findings were discussed with ___. by ___, M.D. on the telephone on ___ at 2:30 PM, 5 minutes after discovery of the findings." }, { "input": "Right PICC line tip near cavoatrial junction. Interval drain removal. There is right pleural effusion and probable small left pleural effusion, similar. Right basilar consolidation is similar, likely represents atelectasis. Interstitial prominence in the right lung, and left mid and lower lung is similar compared with ___, has worsened since ___. Findings are concerning for lymphangitic carcinomatosis. Component of edema or infection cannot be excluded. Right hilar fullness, stable. There is no pneumothorax. Heart size is normal. Normal pulmonary vascularity.", "output": "Interstitial prominence with nodularity, worrisome for lymphangitic carcinomatosis. Component of edema or infection cannot be excluded. Similar right pleural effusion with basilar consolidation. Similar right hilar fullness." }, { "input": "Compared with ___ at 19:14 there is more focal irregular consolidation at the right lung base. However, the appearance is similar to ___ at 08:00 Otherwise, I doubt significant interval change. Again seen is a right PICC line with tip overlying the distal most SVC. Cardiomediastinal silhouette is grossly unchanged. Extensive increased interstitial markings in both lungs again noted. Before, the right hemidiaphragm is elevated. No pneumothorax is detected. Small right effusion would be difficult to exclude. No gross left effusion. Doubt CHF. Presence or absence of pericardial effusion would be difficult to evaluate in this setting.", "output": "Focal irregular area of consolidation at the right lung base is more pronounced is in keeping with findings on the 07:55 ___ radiograph, though more pronounced compared with the film from 19:14 ___. Otherwise, I doubt significant interval change." }, { "input": "PA and lateral views the chest were provided. The heart size is normal. The mediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. Stable subtle opacity overlying the left lateral hemithorax may represent overlying soft tissue or old rib fractures. There is no consolidation concerning for pneumonia.", "output": "No pneumothorax." }, { "input": "Nodular opacity described on thoracic spine radiograph of ___ is not evident on this dedicated chest radiograph, and could have been due to summation of structures related to low lung volumes on that exam. Cardiomediastinal contours are normal. Lungs and pleural surfaces are clear appear", "output": "No evidence of lung nodule" }, { "input": "Tip of the right Port-A-Cath terminates in the mid SVC. The lungs are free of consolidation, pleural effusion or pneumothorax. Cardiomediastinal contours are normal. No acute osseous abnormalities.", "output": "Tip of the right Port-A-Cath terminates in the mid SVC." }, { "input": "Heart size is borderline enlarged. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is normal. The lungs are clear. No focal consolidation, pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities are visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The right lower lung consolidation is overall unchanged or minimally improved from the most recent exam but new from the exam earlier yesterday, highly suggestive of aspiration/pneumonia. A retrocardiac opacity is new and may reflect aspiration in the appropriate clinical setting. Pulmonary vascular congestion and mild edema is mild but increased. The heart size is mildly enlarged, overall unchanged. No pneumothorax or pleural effusion. Mild emphysematous changes in the right upper lung.", "output": "Slight interval progression of aspiration/pneumonia and mild edema." }, { "input": "The ETT is in standard position and new. Platelike atelectasis of the right lower lung bases improved. Overall, no significant interval change. Pulmonary vascular congestion and edema persist and are moderate in severity. Retrocardiac opacity is overall unchanged. Effusion or pneumothorax. Top normal heart size is unchanged. Mediastinal contours and hila are also unchanged.", "output": "The patient is now intubated and moderate edema and pulmonary vascular congestion are overall unchanged." }, { "input": "PA and lateral views of the chest provided. Lung volumes are low with bibasilar atelectasis again noted. No large effusion or pneumothorax. Heart and mediastinal contours are stable and within normal limits. Bony structures are intact.", "output": "As above." }, { "input": "Frontal and lateral views of the chest. Heart size and cardiomediastinal contours are normal. Elevation of the hemidiaphragms is likely due to large volume ascites. Lung volumes are low with bibasilar atelectasis. Blunting of the costophrenic angles is similar to prior and consistent with small pleural effusions. No focal consolidation or pneumothorax.", "output": "Small bilateral pleural effusion with elevation of the hemidiaphragms from large volume ascites." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Subsegmental atelectasis in the left lower lobe is noted. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lung volumes are low. Heart size is normal. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is not engorged. Hazy opacities in the lung bases are compatible with atelectasis. Small right pleural effusion is noted. No pneumothorax is identified. There are no acute osseous abnormalities. No subdiaphragmatic free air is present.", "output": "Low lung volumes with bibasilar atelectasis and trace right pleural effusion. No subdiaphragmatic free air seen." }, { "input": "Lung volumes are low. Portable semi-upright radiograph of the chest demonstrates an unchanged cardiomediastinal silhouette and pulmonary vasculature. Again noted are linear streaky opacities in the right lower lung and left base, most consistent with atelectasis. No definite focal consolidation is identified.", "output": "No acute intrathoracic abnormality." }, { "input": "A portable supine frontal chest radiograph demonstrates an endotracheal tube terminating in the mid thoracic trachea. The cardiomediastinal silhouette is normal, allowing for a exaggeration of the cardiac silhouette related to low lung volumes. There is no focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal contours are normal. Bibasilar atelectasis are minimal increased. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable", "output": "Minimally increase bibasilar atelectasis" }, { "input": "Shallow inspiration. There are mild bibasilar opacities, likely atelectasis, mildly more prominent compared to prior. Normal heart size, pulmonary vascularity, accentuated by shallow inspiration. Suggestion of tiny pleural effusions or thickening. No pneumothorax.", "output": "Mild bibasilar opacities, likely atelectasis. Consider pneumonia in appropriate clinical setting. Suggestion of tiny pleural effusions or thickening." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Minimal patchy atelectasis is noted in the lung bases. A small right pleural effusion appears to be present. No pneumothorax is identified. There are no acute osseous abnormalities.", "output": "Mild bibasilar atelectasis with small right pleural effusion." }, { "input": "Portable semi-erect chest radiograph ___ at 12:27 is submitted.", "output": "Interval extubation. Decreased lung volumes with patchy bibasilar opacities likely reflecting atelectasis. Crowding of the vasculature with no evidence of pulmonary edema. No large effusions. No pneumothorax. Overall cardiac and mediastinal contours are likely stable given differences in patient positioning and inspiratory effort." }, { "input": "The lungs are clear. The cardiomediastinal silhouette, hilar contours, pleural surfaces are normal. Note is made of an opacity in the left lower lung base, likely nipple shadow. No pneumothorax, pleural effusion, pulmonary edema, or pneumonia.", "output": "1. No pneumonia. 2. Opacity in the left lower lung base is likely due to nipple shadow, however, a focal mass cannot be excluded. RECOMMENDATION(S): Although likely due to nipple shadows, re-imaging with conventional chest radiographs are recommended for further evaluation of left lower lung opacity." }, { "input": "AP upright and lateral views of the chest provided. Lung volumes are low with bibasilar atelectasis noted. Difficult to exclude a component of aspiration or pneumonia at the lung bases. No large effusion or pneumothorax. Cardiomediastinal silhouette is stable. Bony structures are intact. No displaced rib fracture is seen.", "output": "Bibasilar opacities, likely atelectasis difficult to exclude aspiration or component of pneumonia." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The pulmonary vasculature is not engorged and there is no overt pulmonary edema. The cardiomediastinal and hilar contours are within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures appear within normal limits.", "output": "No evidence for prior or reactivation tuberculosis." }, { "input": "The lungs are hyperexpanded. There is no pleural effusion, pneumothorax or focal airspace consolidation. The cardiac silhouette is normal in size. Prominence of the mediastinum from a markedly tortuous aorta is unchanged. The pulmonary vasculature is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low, and the lungs are clear of focal consolidation, pleural effusion or pneumothorax. The heart size is normal. The mediastinal contours are normal. No displaced rib fractures are seen. Vertebral body height loss in the mid-lower thoracic spine is again noted, and degenerative changes are seen in the right shoulder.", "output": "No acute cardiopulmonary process. No displaced rib fractures are seen. If clinical concern for rib fracture is high, dedicated rib series or CT is more sensitive." }, { "input": "The tip of a right subclavian Infuse-A-Port extends to the superior cavoatrial junction. There is no pneumothorax. There are new left perihilar airspace opacities surrounding the known superior segment left lower lobe lung mass. There is also increased retrocardiac opacification with obscuration of the medial left hemidiaphragm. The right lung is clear. The heart and mediastinum are within normal limits despite the projection.", "output": "Status post left lung biopsy with left lung postprocedural changes and no pneumothorax. Increased retrocardiac opacification is likely due to worsening atelectasis. Clear right lung." }, { "input": "Primarily involving the medial posterior basilar end superior segments of the left lower lobe is a more extensive consolidation than seen on the prior radiographs with air bronchograms. Areas of new perihilar opacity obscure a mass at the left hilum. Previously noted suspicious lymphadenopathy is not well assessed on radiographs. A nodular focus projecting over the right lower lung suggests a nipple shadow and there is persistent partial right middle lobe atelectasis. There is no definite pleural effusion. A Port-A-Cath terminates at the uppermost part of the right atrium.", "output": "Increasing perihilar opacities in the left lung. Although aspiration is a consideration, in the setting on a known left hilar mass suspicious for malignancy, post-obstructive pneumonitis could also be considered." }, { "input": "Right-sided Port-A-Cath tip terminates at the junction of the SVC and right atrium. The patient is slightly rotated. Heart size is normal. Mediastinal contours are unchanged. No pulmonary edema is demonstrated. Bibasilar and left perihilar opacities are either new or worse compared to the prior exam. No pleural effusion is demonstrated, and there is no pneumothorax. Biapical pleural thickening, more pronounced on the left, is unchanged. There are no acute osseous abnormalities.", "output": "Bibasilar and left perihilar opacities, new or worse compared to the prior exam, concerning for recurrent aspiration pneumonia. Underlying mass within the left hilar region is not excluded, and chest CT is recommended for further assessment." }, { "input": "Frontal and lateral views of the chest. Mild cardiomegaly and mediastinal contours are stable. Lungs are clear without focal consolidation, pleural effusion, or pneumothorax. Mild blunting of the right costophrenic angle is stable.", "output": "No acute cardiopulmonary process. Stable mild cardiomegaly." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs remain clear aside from linear opacity at the left lung base most likely atelectasis. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Projecting over the left upper lung between the posterior left ___ and ___ ribs, there is a subtle 6 mm nodule opacity which is not clearly seen on the prior study. The cardiac and mediastinal silhouettes are unremarkable. Hilar contours are stable.", "output": "Subtle 6 mm ovoid nodular opacity projecting over the left upper lung, not clearly seen on prior studies. Suggest further evaluation with nonemergent chest CT. Oblique views may also provide further evaluation." }, { "input": "There are right lower lobe and left lower lobe consolidations as well as bilateral mild pleural effusions, suggestive of an infectious process. The heart size is normal. The mediastinal and hilar contours are unremarkable. There is no evidence of pneumothorax. The osseous structures are unremarkable.", "output": "Right lower lobe and left lower lobe pneumonia." }, { "input": "AP upright and lateral views of the chest provided. Lung volumes are low though allowing for this the lungs appear clear. No definite signs of pneumonia or edema. No large effusion or pneumothorax. Cardiomediastinal silhouette is normal. No acute bony abnormalities.", "output": "No acute findings." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes without pleural effusion, focal consolidation or pneumothorax. The hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Partially imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. There is mild left base atelectasis. No focal consolidation is seen. There is no pleural effusion or pneumothorax. Anterior wedging of a lower thoracic vertebral body is stable since the prior study.", "output": "Left base atelectasis. Otherwise, no acute cardiopulmonary process." }, { "input": "Semi-upright portable view of the chest demonstrates low lung volumes. Bibasilar opacities most likely represent atelectasis. Small left pleural effusion is present. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. Round opacity projecting over the hilar and cardiac silhouette is no longer visualized compatible with patient's history of cyst resection. No pneumothorax. Right-sided chest tube is in place. Partial imaged upper abdomen is unremarkable.", "output": "Bibasilar opacities, likely atelectasis and small left pleural effusion." }, { "input": "AP semi-upright view of the chest demonstrates low lung volumes. Linear opacity in the right lung base likely represents atelectasis. Small left pleural effusion is unchanged. There is no right pleural effusion or pneumothorax. Hilar and mediastinal silhouettes are unchanged. Heart size is normal. Right-sided chest tube is in unchanged position. Partially imaged upper abdomen is unremarkable.", "output": "1. No pneumothorax. 2. Linear opacity in the right lung base, most likely atelectasis and left pleural effusion, unchanged." }, { "input": "The examination is limited due to is placement of the patient's arms across the lower chest, obscuring detail of the lower mediastinum and lung bases as well as the pleura and ribs in this region. Heart size and mediastinal contours are within normal limits, and lungs are grossly clear. Minimal blunting of left costophrenic sulcus posteriorly could reflect pleural thickening or small effusion. Mild compression deformities at the thoracolumbar junction on the lateral radiograph rib indeterminate age without older studies for comparison. No acute, displaced rib fractures are evident on this limited assessment. .", "output": "Limited chest radiograph due to partial obscuration of the lower chest as described above. Within these limitations, no acute traumatic injury is identified in the chest. If clinical suspicion is high, consider repeat radiograph with improved positioning of the arms or a CT scan." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. Mid thoracic dextroscoliosis is noted. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Mild pulmonary vascular congestion. Moderate cardiomegaly with mild enlargement of the aorta, not fully characterized on chest radiograph. Likely small left pleural effusion and adjacent atelectasis. Minimal right lower lobe assess. No pneumothorax.", "output": "No acute pneumonia. Mild pulmonary vascular congestion." }, { "input": "There is an increased opacity overlying the right lower lobe suggestive of right lower lobe pneumonia. Otherwise, the remainder of the lungs are clear. The mediastinal silhouette is normal. Outline of the aorta is normal. No acute fractures are identified. There is no air under the hemidiaphragms.", "output": "Increased opacity overlying the right lower lobe is suggestive of right lower lobe pneumonia." }, { "input": "The patient is status post CABG with intact median sternotomy wires. Mild cardiomegaly is unchanged. The descending thoracic aorta is mildly tortuous. There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. There is mild wedging of a mid thoracic vertebral body, stable since ___.", "output": "Mild cardiomegaly status post CABG without evidence of acute cardiopulmonary process." }, { "input": "AP portable upright view of the chest. Cardiomegaly is again seen. Areas of scarring along the right lung base again seen. There is no focal consolidation concerning for pneumonia. No edema, congestion or pneumothorax. Mediastinal contour stable. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Stable cardiomegaly and right basal lung scarring. No signs of edema or pneumonia." }, { "input": "There has been interval placement of a right internal jugular line, which appears to be in appropriate position. The heart size is top normal. Aside from mild pulmonary edema, and mild pulmonary vascular congestion, the hilar and mediastinal contours are unremarkable. Ill-defined opacities at the lung bases bilaterally have progressed compared to the prior exam. There may be small bilateral pleural effusions. There is no evidence of pneumothorax. The visualized osseous structures are unremarkable.", "output": "1. Interval placement of a right-sided internal jugular line, which terminates in appropriate position. No evidence of a pneumothorax. 2. Slight interval progression of patient's multifocal pneumonia. 3. Mild pulmonary edema." }, { "input": "Heart size is top normal. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is not engorged. Patchy opacities are noted in the lung bases. No pleural effusion or pneumothorax is present though assessment is mildly limited as the left costophrenic angle was not included in the field of view. No acute osseous abnormalities demonstrated.", "output": "Bibasilar patchy airspace opacities. These findings are concerning for infection or aspiration given the history of fever. Follow up radiographs after treatment are recommended to ensure resolution of these findings." }, { "input": "Since prior, there is no significant interval change. Right upper lobe opacity likely reflects post radiation fibrosis or lymphangitic spread of tumor. Elevation of the left hemidiaphragm, more so than in ___, may represent a subpulmonic effusion. Small right pleural effusion is unchanged. Heart and mediastinal contour are stable. There is no pneumothorax. Endotracheal and nasogastric tubes are unchanged in position.", "output": "No significant interval change." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of normal size with normal cardiomediastinal contours. Post-surgical changes are seen at the left hilum, compatible with known lingula-sparing left upper lobectomy. Right apical scarring and emphysema, similar to prior. No focal consolidation, pleural effusion, or pneumothorax. Osseous structures are unremarkable. No radiopaque foreign bodies.", "output": "No acute cardiopulmonary process." }, { "input": "There has been interval reaccumulation of a small right-sided pleural effusion with adjacent atelectasis. There is no left-sided pleural effusion. Redemonstrated is an unchanged interstitial abnormality within the right upper lobe, compatible with the patient's known lymphangitic spread of cancer, as per the prior chest CT examination. No new focal consolidation is identified. There is no pneumothorax or frank pulmonary edema. The heart size is normal. Mediastinal contours are normal.", "output": "1. Interval development of a small right pleural effusion. 2. Unchanged right upper lobe interstitial abnormality, better evaluated on prior chest CT examination, and compatible with lymphangitic carcinomatosis." }, { "input": "The ET tube terminates approximately 2.5 cm above the carina. Although there is a generalized increase in radiodensity in the right lung, which could be secondary to edema, increased opacification at the right lung apex at the site of prior radiation injury, may be secondary to pneumonia. Diffuse interstitial abnormality, particularly within the right upper lobe is compatible with patient's known lymphangitic spread of cancer as seen on the prior chest CT examination, and overall appears slightly worse compared to the prior exam. Mild left basilar atelectasis is persistent. Small bilateral pleural effusions are stable. There is no evidence of a pneumothorax. The heart size is normal.", "output": "1. Generalized increase in radiodensity in the right lung may be secondary to edema, however, pronounced opacification, particularly at the right lung apex is concerning for pneumonia. 2. Diffuse interstitial abnormality throughout the right lung is consistent with patient's known lymphangitic spread of cancer. 3. ET tube terminates approximately 2.5 cm above the carina." }, { "input": "Frontal and lateral radiographs of the chest were obtained. There is mild enlargement of the cardiac silhouette. The moderate right pleural effusion with opacity in the right lower lobe. Prominence of the interstitial markings is noted greater on the right than the left which could reflect asymmetric pulmonary edema. Chain suture in the left upper lung is unchanged. There is a 10 mm nodular opacity projecting over the left upper lung which is not clearly visualized on the lateral. An additional 6 mm nodular opacity projecting over the right upper lung is not clearly visualized on the lateral. No pneumothorax.", "output": "1. 10 mm nodular opacity projecting over the left upper lung and 6 mm nodular opacity projecting over the right upper lung which were not clearly present on the prior studies. Recommend further evaluation with nonemergent chest CT. 2. Prominence of the interstitial markings, greater on the right than the left, likely reflecting asymmetric pulmonary edema. 3. Mild enlargement of the cardiac silhouette and modearte right pleural effusion. 4. Opacity in the right lower lobe likely reflecting a combination of edema and atelectasis; although, superimposed infection is possible." }, { "input": "Since the prior exam, there has been a substantial decrease in the amount of right pleural fluid. A small right pleural effusion persists. There is no left pleural effusion. There is no pneumothorax. An interstitial abnormality in the right upper lobe corresponds to lymphangitic spread of cancer seen on the prior CT. No new opacities identified. There is no pulmonary edema. The mediastinal contours are normal. The heart size is mildly enlarged, and unchanged.", "output": "Substantial decrease in the amount of right pleural fluid. No evidence of pneumothorax. Results were discussed with Dr. ___ at 5:10 p.m. on ___ via telephone by Dr. ___ at the time the findings were discovered." }, { "input": "Single supine AP portable view of the chest was obtained. There are low lung volumes. Cardiomediastinal silhouette appears mildly enlarged with sharp margins, likely in part due to low lung volumes. If high concern for mediastinal injury, CT would be recommended. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax seen. No displaced fracture seen.", "output": "Low lung volumes which likely accentuates the cardiomediastinal silhouette. If concern for mediastinal injury, CT. No displaced rib fracture is seen, although if clinical concern for rib fracture is high, suggest dedicated rib series." }, { "input": "", "output": "Findings suggesting mild fluid overload. New nodular densities projecting over the right lung for which a CT evaluation is suggested when clinically appropriate since these may represent new lung nodules in the setting of known prior malignancy. ______________________________________________________________________________ FINAL REPORT CHEST RADIOGRAPHS HISTORY: Renal failure. History of colon cancer. Question pneumonia. COMPARISONS: ___. TECHNIQUE: Chest, AP upright and lateral. FINDINGS: There is a Port-A-Cath terminating in the cavoatrial junction. The heart is at the upper limits of normal size. The mediastinal and hilar contours appear unchanged. There is mild central pulmonary vascular prominence as well as indistinctness in upper zone redistribution suggesting mild fluid overload. There is a nodular opacity projecting over the right lower lung. An additional one also projects near the site of a Port-A-Cath device in the right mid abdomen. The possibility that these may reflect metastatic disease should be considered. IMPRESSION: Findings suggesting mild fluid overload. New nodular densities projecting over the right lung for which a CT evaluation is suggested when clinically appropriate since these may represent new lung nodules in the setting of known prior malignancy." }, { "input": "Low lung volumes cause bibasilar linear atelectasis. There is no pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal silhouette is normal. The known mildly displaced rib fracture is not appreciated.", "output": "Bibasilar atelectasis. Known mildly displaced rib fracture is not appreciated." }, { "input": "Streaky left retrocardiac opacity likely represents atelectasis. No other consolidation, pleural effusion or pneumothorax. Cardiomediastinal contours are normal. No subdiaphragmatic free air. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "Portable semi-upright AP view of the chest was provided. Patient is rotated and right CP angle is excluded. There are vague opacities in the lower lungs which could represent aspiration. No large effusion or pneumothorax. The overall cardiomediastinal silhouette appears grossly stable, though difficult to assess given patient rotation. The bony structures appear intact with degenerative changes at the shoulders.", "output": "Vague opacities in the lower lungs are concerning for aspiration. Please note evaluation is markedly limited due to poor patient positioning." }, { "input": "PA and lateral chest radiographs again demonstrate plate atelectasis in the right middle and left lower lobes. Additionally, there is a subtle slightly increased retrocardiac opacity and in a proper clinical setting could represent pneumonia. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Linear retrocardiac opacity potentially atelectasis however possibly pneumonia in proper clinical setting." }, { "input": "PA and lateral views of the chest. Linear bibasilar opacities are most suggestive of atelectasis. There is no effusion. Cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications again noted at the arch. No acute osseous abnormalities detected.", "output": "Bibasilar linear opacities most suggestive of atelectasis. Otherwise, unremarkable chest x-ray." }, { "input": "PA and lateral chest radiographs were obtained. A small left pleural effusion is similar to ___. Left retrocardiac atelectasis has improved. A small right effusion may be present. No pneumothorax or new consolidation is present. Median sternotomy wires are intact and mediastinal clips are in appropriate positions. No new abnormal cardiac and mediastinal contours are noted.", "output": "Small left and trace right pleural effusion, similar to ___. Overall, pulmonary aeration has improved." }, { "input": "As compared to the prior examination, there has been no significant interval change. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema identified. Stable, mild cardiomegaly is noted. The aorta is slightly tortuous. Mediastinal and hilar contours are otherwise stable.", "output": "No radiographic evidence for acute cardiopulmonary process. Stable, mild cardiomegaly." }, { "input": "Frontal and lateral views of the chest demonstrates obscuration of the right hemidiaphragm. There is interval increase in right lung opacity with loculated pleural fluid along the lateral right hemithorax. A rounded posterior density a noted in the right lower lung, ?? unclear etiology. The heart size is top normal. There are no suspicious osseous lesions.", "output": "Significant interval progression of right lung opacity and right pleural effusion which appears loculated. Further characterization with CT is recommended." }, { "input": "Frontal and lateral views of the chest. No prior. Low inspiratory effort is seen on the current exam. Bibasilar opacities are therefore likely due to atelectasis. There is no effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No definite acute cardiopulmonary process." }, { "input": "Small residual right pleural effusion and right basilar atelectasis is slightly worse since the prior study. No new consolidation, pulmonary edema or pneumothorax is seen. The left lung is well expanded and clear. The cardiomediastinal and hilar contours are normal.", "output": "Mild increase in the small right pleural effusion and right basilar atelectasis." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded clear lungs. The aorta is tortuous. The heart is not enlarged. There is no pneumothorax, pleural effusion, or consolidation. Mild thoracic scoliosis is seen.", "output": "No pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. No pleural effusion or pneumothorax is seen. Scattered calcified pleural plaques are again seen. No discrete focal consolidation is seen. The cardiac and mediastinal silhouettes are stable. There is mild left basal atelectasis.", "output": "Scattered calcified pleural plaques again seen. Mild basilar atelectasis. Otherwise, no acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest were obtained. Cardiomediastinal silhouette including tortuosity of the thoracic aorta is stable. Lung volumes are low. Streaky bibasilar opacities likely represent atelectasis. Lungs are otherwise clear. There is no large effusion or pneumothorax.", "output": "1. Low lung volumes and mild bibasilar atelectasis. 2. No displaced fractures; however, conventional chest radiography is not sensitive for detection of rib fractures." }, { "input": "The right perihilar opacification and bilateral pleural effusions have resolved. The lungs are clear, though there is plate atelectasis at the right lung base. The heart size is normal, but the pulmonary vasculature is still mildy engorged. The cardiac, hilar, and mediastinal contours are within normal limits.", "output": "Resolved right perihilar pneumonia. Evidence of early CHF." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. Several nodules in the left lung appear unchanged; to some extent these may be calcified. A nodular focus projecting over the lower right chest is most suggestive of a nipple shadow and unchanged. Streaky opacities are somewhat increased at the left lung base but probably due to minor atelectasis. There is no definite pleural effusion or pneumothorax. Compression deformities along the upper lumbar spine are not well visualized, but there is no indication of change. No foreign body is identified.", "output": "Streaky left basilar opacities most suggestive of atelectasis. No foreign body identified." }, { "input": "There is retrocardiac opacity concerning for pneumonia, best seen on the lateral view. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Retrocardiac opacity, concerning for pneumonia, likely left lower lobe. Repeat chest radiograph ___ weeks following antibiotic therapy is recommended. NOTIFICATION: The findings were discussed with ___ , M.D. by ___, M.D. on the telephone on ___ at 6:29 AM, 2 minutes after discovery of the findings." }, { "input": "A ventriculoperitoneal shunt again courses across the anterior right chest without change. The cardiac, mediastinal and hilar contours appear unchanged. The lungs appear clear. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "PA and lateral views of the chest. The lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormality identified. Tubing projecting over the right chest wall is compatible with a shunt catheter.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well inflated and clear. No effusion, pneumothorax, or focal consolidation is present. The cardiac and mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Allowing for low lung volumes, heart is upper limits of normal in size, and pulmonary vascularity is normal. Lungs and pleural surfaces are clear.", "output": "Low lung volumes. No acute cardiopulmonary radiographic abnormality." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "This examination is limited by low lung volumes and underpenetration. Given these limitations, there is likely mild pulmonary edema. There is blunting of the costophrenic angles bilaterally which relates to small bilateral pleural effusions. No focal consolidation is identified in the upper lobes. The cardiac silhouette cannot be fully evaluated.", "output": "Mild pulmonary edema with small bilateral pleural effusions." }, { "input": "A new right-sided internal jugular central venous catheter terminates in the uppermost right atrium. There is no pneumothorax. Each renal collecting system is now opacified with recently administered intravenous contrast, now depicting mild hydronephrosis and hydroureter on the left. Otherwise there has been no significant change in the appearance.", "output": "Status post internal jugular central venous catheter placement terminating in the uppermost part of the right atrium. No pneumothorax. Opacified left renal collecting system and upper ureter with distention suggesting mild hydronephrosis." }, { "input": "Heart size remains mildly enlarged. Mediastinal contour is similar with diffuse atherosclerotic calcifications noted. Low lung volumes are demonstrated with crowding of the bronchovascular structures and possible mild pulmonary vascular congestion. Focal opacity in the retrocardiac region is concerning for pneumonia with blunting of the left costophrenic angle suggestive of a trace left pleural effusion. No pneumothorax is identified. There are no acute osseous abnormalities.", "output": "Left lower lobe pneumonia and trace left pleural effusion. Low lung volumes with possible mild pulmonary vascular congestion" }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. Mild to moderate multilevel degenerative changes are noted in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral chest radiograph demonstrates unremarkable cardiomediastinal and hilar contours. Lungs are clear. No pleural effusion or pneumothorax is evident. No displaced rib fractures identified.", "output": "No acute intrathoracic process." }, { "input": "The patient is status post median sternotomy and CABG. Heart size is mildly enlarged, unchanged. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Linear opacity in the left lower lobe may reflect subsegmental atelectasis or scarring. Remainder of the lungs are clear. No focal consolidation or pneumothorax is present. Blunting of the left costophrenic angle on the lateral view suggests a trace pleural effusion. No acute osseous abnormality is visualized.", "output": "Subsegmental atelectasis versus scarring in the left lower lobe. Trace left pleural effusion." }, { "input": "Bilateral small pleural effusions, left more than right are unchanged. Compared to the prior radiograph from ___, left lower lung atelectasis has minimally improved. Patient is status post median sternotomy with intact sternal sutures. There are no lung opacities concerning for pneumonia. There is no pneumothorax.", "output": "Bilateral small pleural effusions are unchanged since ___. Left lower lung atelectasis has improved." }, { "input": "The patient is status post coronary artery bypass graft surgery and mitral valve replacement. The heart is mildly enlarged. The mediastinal and hilar contours appear within normal limits. A left-sided pleural effusion has decreased and is now small, perhaps with slight loculation. The lungs appear clear. There is no pneumothorax.", "output": "Decreased left-sided pleural effusion. No evidence of pneumonia." }, { "input": "Bilateral lower lobe right greater than left hazy opacities are visualize that are similar in extent compared to the CT from the prior day that showed ground-glass opacities in these regions. The upper lungs are relatively clear. There is no pleural effusion or pneumothorax", "output": "As mentioned on the CT, the bilateral lower lobe ground-glass opacities could be due to the either an infectious infiltrate or hypersensitivity pneumonitis. Clinical correlation and followup are recommended" }, { "input": "PA and lateral views of the chest. There is no focal consolidation. The cardiomediastinal contours are normal. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear and well expanded bilaterally with no areas of focal consolidation, masses or lesions. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. The pleural surfaces and osseous structures are unremarkable.", "output": "No evidence of pneumonia. These results were reported to Dr. ___ at 11:50 a.m. by ___ via phone." }, { "input": "Portable upright chest radiograph ___ 06:37 is submitted.", "output": "Endotracheal tube, right internal jugular central line, and left internal jugular central lines are unchanged in position. A SVC stent remains in place. A feeding tube is seen coursing below the diaphragm with the tip not identified. There is improving perihilar and interstitial edema. There is persistent opacity at the left base with probable layering effusion suggestive of partial lower lobe atelectasis, although pneumonia should also be considered. Overall cardiac and mediastinal contours are stable. No pneumothorax is appreciated." }, { "input": "Frontal and lateral views of the chest. The lungs are clear of consolidation or significant effusion noting that is non posterior costophrenic angles are excluded from the field of view on the lateral projection. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest are obtained. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is not enlarged. The mediastinum and hilar contours are unremarkable.", "output": "No focal consolidation." }, { "input": "There are decreased lung volumes noted. There is no typical appearing lobar pneumonia identified. However, there is a vague area of increased density identified within the right lower lobe, correlating with a similar region of density seen on the lateral projection, which may represent a small consolidation. There is no pleural effusion, pneumothorax, or overt pulmonary edema identified. The heart size is normal. Mediastinal contours are normal.", "output": "Vague right lower lobe opacity which may represent aspiration versus early pneumonia. Findings were communicated by Dr. ___ to Dr. ___ ___ telephone at 10:50 on ___, ___ min after discovery." }, { "input": "PA and lateral views of the chest were provided. The lungs are clear bilaterally. No effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. Hardware is noted in the upper lumbar spine. No free air below the right hemidiaphragm.", "output": "No signs of pneumonia." }, { "input": "Lordotic positioning. A right-sided internal jugular catheter is seen, terminating in the mid SVC. Left-sided pacemaker is identified. Probable background hyperinflation. The cardiac silhouette is probably slightly enlarged. The pulmonary vasculature is somewhat centrally congested. Hazy bilateral opacities are noted. Lung bases are not entirely imaged. Allowing for this, no frank consolidation is detected. No gross effusions are seen. No obvious pneumothorax is identified.", "output": "Right internal jugular catheter terminates in the mid SVC. No obvious pneumothorax identified. Probable COPD. Mild cardiomegaly. Vascular congestion with possible hazy opacities at the bases. s" }, { "input": "The heart is mild to moderately enlarged with a left ventricular configuration. Unfolding and calcification are noted along the aorta. The interstitium is mildly prominent suggesting mild vascular congestion. Small bilateral pleural effusions are suspected, greater on the left than right. Posterior opacification of the left costophrenic sulcus has a convex appearance which may reflect loculated pleural effusion or potentially parenchymal opacity that could be seen with atelectasis. Pneumonia is difficult to exclude, however.", "output": "Findings suggesting mild vascular congestion. Small pleural effusions. Posterior left-sided basilar density, which is highly non-specific but a combination of atelectasis or pleural effusion may be suspected; pneumonia is difficult to completely exclude, however. Follow-up chest radiographs are suggested to show resolution or stability, and comparison to prior radiographs, if available, may be helpful if clinically indicated." }, { "input": "AP upright and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "AP and lateral views of the chest. The lungs are clear of consolidation, effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No displaced rib fractures are identified.", "output": "No acute cardiopulmonary process." }, { "input": "AP portable upright view of the chest. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process" }, { "input": "The lungs are clear without focal consolidation, effusion, or consolidation. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs are clear on this radiograph. Cardiomediastinal silhouette and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "Unremarkable chest radiograph. The patient's known pulmonary nodules are beyond the resolution of this radiograph." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. The heart and mediastinal contours are normal. Bony structures are intact.", "output": "No signs of pneumonia or other acute intrathoracic process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities are present.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There are bibasilar opacities which may be secondary to atelectasis given slightly lower lung volumes. There is no effusion. Superiorly the lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "Bibasilar opacities potentially due to atelectasis noting that infection is not excluded." }, { "input": "PA and lateral views of the chest provided. There is mild posterior basal atelectasis. No convincing evidence for pneumonia or edema. No large effusion or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No evidence of pneumonia." }, { "input": "PA and lateral chest radiograph demonstrates no focal consolidation. Cardiomediastinal and hilar contours are within normal limits. There is no pleural effusion or pneumothorax. Visualized osseous structures are unremarkable. No free air under the right hemidiaphragm is seen.", "output": "No acute intrathoracic abnormality." }, { "input": "Lungs are clear without focal consolidation, effusion, or edema. Mild cardiomegaly is similar compared to prior. Coronary artery stents and median sternotomy wires are noted. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Relatively low lung volumes are seen. That said, there has been interval resolution of the previously seen right-sided pneumonia. The lungs are now clear. There is no effusion and no evidence of pulmonary edema. Median sternotomy wires and coronary artery stents are identified. Degree of cardiomegaly is unchanged. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is status post median sternotomy, CABG, and vascular stenting. Heart is mildly enlarged but stable. The mediastinal and hilar contours are similar with mild unfolding of thoracic aorta. New consolidative process is noted within the right upper lobe compatible with pneumonia. There is mild pulmonary vascular congestion. Small pleural effusion on the right is present. No pneumothorax is identified. Degenerative changes involving the left glenohumeral and bilateral acromioclavicular joints are noted.", "output": "Right upper lobe pneumonia. Followup radiographs after treatment are recommended to ensure resolution of this finding." }, { "input": "No focal consolidation or pulmonary edema. Moderate cardiomegaly. No pleural effusions or pneumothorax. Prior median sternotomy and CABG.", "output": "No acute cardiopulmonary process." }, { "input": "Single upright AP image of the chest. The lungs are well expanded. There is opacity in the right lung base which could represent patchy atelectasis, early pneumonia or aspiration. Clinical correlation is advised. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is mildly enlarged, similar prior exams. Status post median sternotomy.", "output": "Opacity at right lung base which could represent patchy atelectasis, pneumonia or aspiration. Clinical correlation is advised." }, { "input": "Single portable view of the chest. The lungs are clear. The cardiomediastinal silhouette is stable, noting prominence of the upper mediastinum, which is due to tortuosity of the vessels as seen on CTA neck recently performed. Cardiomediastinal silhouette is otherwise unremarkable with a tortuous descending thoracic aorta. Degenerative change is seen at the right shoulder.", "output": "No acute cardiopulmonary process." }, { "input": "A left-sided dialysis catheter terminates in the upper atrium. The patient is status post sternotomy. The cardiac, mediastinal and hilar contours appear unchanged. There is similar moderate relative elevation of the left hemidiaphragm with patchy basilar opacification suggesting minor atelectasis. Elsewhere, the lungs appear clear. There is no definite pleural effusion or pneumothorax. A small pleural effusion would be difficult to appreciate on the left side, however, if one were present.", "output": "No evidence of acute disease." }, { "input": "Frontal views of the chest were obtained. Severe cardiomegaly, mediastinal contours, and elevation of the left hemidiaphragm are not appreciably changed since ___. No new focal consolidation, pleural effusion, or pneumothorax. Sternotomy wires are intact.", "output": "No acute cardiopulmonary process. Stable severe cardiomegaly and elevation of left hemidiaphragm." }, { "input": "The patient is status post sternotomy. The heart is enlarged. The mediastinal and hilar contours appear unchanged allowing for differences in technique including mild rightward shift of mediastinal structures in association with persistent moderate relative elevation of the left hemidiaphragm. Right lateral pleural thickening is stable. There is no evidence for pleural effusion on the right. A mild diffuse interstitial abnormality suggests fluid overload or pulmonary vascular congestion. Blunting of posterior costophrenic sulci may reflect tiny effusions, but the lateral view is limited due to soft tissue attenuation.", "output": "Mild interstitial abnormality suggesting pulmonary vascular congestion or fluid overload. Similar moderate relative elevation of the left hemidiaphragm and cardiomegaly." }, { "input": "Single portable view of the chest compared to previous exam from ___. Right IJ and left-sided central lines are no longer seen. The lungs are not significantly changed. There is persistent elevation of left hemidiaphragm and stable in configuration of the cardiomediastinal silhouette.", "output": "Interval removal of bilateral central lines, otherwise no change." }, { "input": "PA and lateral views of the chest were provided, demonstrating clear, well-expanded lungs without focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Single frontal view of the chest. Sternotomy wires, prosthetic valve, and left chest wall pacer are stable. New bilateral lower lobe hazy opacities are nonspecific and may represent infection, aspiration, or hemorrhage. No pneumothorax or pneumoperitoneum is identified.", "output": "New bilateral lower lobe hazy opacities are nonspecific and may represent aspiration or infection. No pneumoperitoneum." }, { "input": "Moderate size right and large left pneumothoraces are present with bibasilar opacities likely reflective of atelectasis. There is no substantial shift of mediastinal structures. Extensive pneumomediastinum and subcutaneous emphysema is present within the neck and chest wall bilaterally. Large amount of free intraperitoneal air is also noted as well as retroperitoneal air within the upper abdomen. Enteric tube is seen with tip in the stomach. Heart size is normal. Mild atherosclerotic calcifications are noted within the aortic knob. No acute osseous abnormalities demonstrated.", "output": "1. Moderate right and large left bilateral pneumothoraces with associated bilateral lung atelectasis. No substantial shift of mediastinal structures. 2. Extensive free intraperitoneal and retroperitoneal air within the upper abdomen. 3. Extensive pneumomediastinum and subcutaneous emphysema tracking into the neck and chest wall bilaterally. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 6:45PM." }, { "input": "There has been interval placement of a left chest tube with tip terminating near the apex. Previously noted large left pneumothorax has substantially reduced in size, with probable small residual pneumothorax noted. Moderate size right pneumothorax is unchanged. There is persistent atelectasis of both lung bases, not substantially changed in the interval. Extensive pneumomediastinum and subcutaneous emphysema is re- demonstrated as well as free intraperitoneal and retroperitoneal air within the upper abdomen. Enteric tube tip is coiled within the stomach. Oral contrast material is noted within the stomach. Cardiac and mediastinal contours are unchanged. No pulmonary edema is evident. No fractures are identified.", "output": "Interval placement of left chest tube with marked reduction in size of the left pneumothorax, with probable small residual left apical pneumothorax. Persistent moderate right pneumothorax. Extensive pneumomediastinum, subcutaneous emphysema, and intraperitoneal and retroperitoneal air within the upper abdomen appear grossly unchanged." }, { "input": "Interval removal of the endotracheal tube as well as the left chest tube. A gastric tube still extends into the stomach. No discernible pneumothorax is identified. Unchanged opacity in the peripheral left midlung zone. No pleural effusion. The size the cardiac silhouette is unchanged. Interval decrease in the extent of the subcutaneous emphysema over the chest wall and neck.", "output": "Interval removal of the left chest tube and endotracheal tube. No discernible pneumothorax is identified. Persisting opacity in the peripheral left midlung zone." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unremarkable. The pulmonary vascularity is not engorged. Consolidative opacity in the left upper lobe is highly concerning for pneumonia. The right lung is clear. No pleural effusion or pneumothorax is visualized. There are multilevel degenerative changes seen within the thoracic spine as well as within the imaged right acromioclavicular joint.", "output": "Left upper lobe pneumonia. Follow up radiographs are recommended after treatment to ensure resolution of this finding." }, { "input": "The heart is mildly to moderately enlarged. There is no discrete focal consolidation, pleural effusion, or pneumothorax. Mediastinal silhouette is within normal limits.", "output": "Mild to moderate cardiomegaly. No focal consolidation concerning for pneumonia." }, { "input": "Chest, PA and lateral. The lungs are hyperinflated and clear. Moderate cardiomegaly, particularly involving the right heart is unchanged. The hilar and mediastinal contours are normal. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal. Median sternotomy cerclage wires are intact and there are surgical clips in the mediastinum.", "output": "1. No evidence of pneumonia. 2. Hyperinflation of the lungs is suggestive of COPD." }, { "input": "A right PICC line terminates in the distal SVC. There is mild cardiomegaly. No definite findings suggestive of pneumonia. Small bilateral pleural effusions are present. No definite pneumothorax. Sternotomy wires are midline.", "output": "No definite findings suggestive of pneumonia. Small bilateral pleural effusions." }, { "input": "All the monitoring and supporting devices are unchanged in standard position. Interval increase of lung volume with reduced opacification of the right lung for improved vascular congestion. Heart size is still mildly enlarged. No pleural effusion or pneumothorax.", "output": "Interval improvement of vascular congestion, especially to the right. All the monitoring and support devices are unchanged in standard position." }, { "input": "Semi-erect portable chest radiograph shows radiodense tubing from nasogastric tube with the tip and side hole both off the view of the film. This is new compared to a study from approximately 12 hours earlier. Unchanged findings include cardiomegaly and haziness over the right hemithorax, possibly indicating layering pleural effusion.", "output": "Nasogastric tube tip and side hole both below left hemidiaphragm off view of film." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The cardiac silhouette and mediastinal contours are normal. The pulmonary vasculature is normal. There is new lumbar fusion hardware. There is minimal right base atelectasis.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiograph demonstrates unchanged multiloculated right pleural effusion with adjacent atelectasis. The left lung is grossly clear without pleural effusion. There is no pneumothorax. Cardiomediastinal and hilar contours are stable. A right PICC is seen terminating within the mid SVC.", "output": "Unchanged right multiloculated pleural effusion. The left lung is grossly clear." }, { "input": "Portable chest radiograph demonstrates an endotracheal tube with its terminal and 6.5 cm above the level of the carina. Two chest tubes are identified, one terminating in the right apex in the other in the right mid lung. Patient is status post right VATS and decortication with resultant expected pleural effusion. Prior identified loculated pleural effusion much improved. Lung volume remains largely stable when compared to pre-operative films. There is mild interstitial edema and vascular congestion. Cardiomediastinal and hilar contours are unchanged in appearance. No clear pneumothorax is identified.", "output": "Improved right pleaural effusion. New mild interstitial edema and vascular congestion." }, { "input": "Frontal and lateral chest radiograph demonstrates a new lenticular opacithy suggestings a moderate to large right loculated pleural effusion along the lateral upper hemithorax and associated atelectatic changes. There is improved aeration of the right lower lobe, though opacities suggesting atelectasis of portions of the right lower and middle lobes persists. The left lung appears clear with no new consolidation, pleural effusion, or pneumothorax. A right sided PICC is seen terminating at the low SVC as is a left-sided an central line. Allowing for changes in patient position, the cardiomediastinal contour appears unchanged.", "output": "Moderate to large new suspected loculated right-sided pleural effusion and associated atelectatic changes." }, { "input": "Frontal and lateral chest radiograph demonstrates interval removal of right-sided chest tube with no definite pneumothorax identified. There is no pneumothorax on the left. There is a right PICC terminating at the level of the low superior vena cava. Along the right lateral hemithorax is a loculated pleural effusion which has increased since ___ and on lateral view, appears more substantial than appreciated on the frontal view. Left pleural effusion has decreased in size. Mild basilar atelectasis, right greater than left. There is no overt pulmonary edema. A tortuous descending aorta is noted. Mediastinal and hilar contours are unchanged. Moderately gas distended loop of bowel is noted in the left upper quadrant.", "output": "Moderate loculated right pleural effusion increased in size. Interval chest tube removal. No pneumothorax." }, { "input": "Partial atelectasis of the right upper lobe with associated bronchiectasis has slightly progressed in the interval. Lower lobe bronchial wall thickening, best visualized on the lateral radiograph has slightly progressed in the interval. Peripheral right lower lobe and left upper lobe scarring are unchanged. Cardiomediastinal contours are unchanged. There are no pleural effusions or acute skeletal findings.", "output": "Interval slight worsening of partial right upper lobe atelectasis with associated bronchiectasis, and apparent progression in bilateral lower lobe bronchial wall thickening. These findings may be due to the patient's history of MAC infection. Consider followup chest CT for more accurate comparison to previous outside CT of ___." }, { "input": "Frontal and lateral views of the chest were obtained. There is persistent partial atelectasis of the right upper lobe with associated bronchiectasis. There is a small amount of fluid /thickening along the minor fissure. As also seen on the prior study, there is right upper lobe atelectasis with associated bronchiectasis. Lung volumes are lower as compared to the prior study, but otherwise, there appears no significant interval change. The cardiac and mediastinal silhouettes are stable given differences in inspiration.", "output": "No significant interval change given differences in lung volumes." }, { "input": "A portable frontal chest radiograph again demonstrates an endotracheal tube terminating in the mid thoracic trachea, enteric tube extending below the diaphragm an off the inferior edge of the image, right internal jugular catheter terminating in the low SVC, and skin ___ and clips projecting over the mid abdomen, all unchanged. There is again a normal cardiomediastinal silhouette, bilateral pleural effusions right greater than left, and bibasilar atelectasis. A subtle parenchymal abnormality at the base of the right upper lobe could represent an infectious process.", "output": "1. A subtle parenchymal abnormality at the base of the right upper lobe could represent an infectious process. 2. Unchanged bilateral pleural effusions, right greater than left, and bibasilar atelectasis. ___ NOTIFICATION: These findings were communicated via telephone by Dr. ___ to Dr. ___ at 12:10 on ___." }, { "input": "Lines and Tubes: None Lungs: Well inflated with diffuse prominence of interstitial markings and vasculature. New mild haziness in the left retrocardiac and paracardiac region. Pleura: Likely new small left pleural effusion. No pneumothorax. Mediastinum: Cardiomediastinal silhouette is unchanged. Surgical suture material projects over the upper abdomen in the midline. Bony thorax: Unchanged", "output": "No pulmonary edema with likely small left pleural effusion." }, { "input": "A portable semi-erect frontal chest radiograph again demonstrates an endotracheal tube terminating in the mid thoracic trachea, enteric tube extending below the diaphragm and off the inferior edge of the image, and right internal jugular line terminating in the mid to low SVC, all unchanged. The heart is normal in size. The lungs remain hyperinflated, with bilateral small pleural effusions with associated atelectasis and moderately severe edema, unchanged. A subtle parenchymal abnormality of the right upper lobe is also unchanged. There is no pneumothorax.", "output": "Unchanged bilateral pleural effusions with associated atelectasis and moderately severe edema, and possible concurrent right upper lobe pneumonia" }, { "input": "Supine portable AP view of the chest was provided. Lung volumes are low. A single lead pacemaker is seen projecting over the right chest wall with lead tip excluded from the field of view. Low lung volumes limit evaluation. There is mild pulmonary edema with probable small right pleural effusion. Heart size cannot be accurately assessed. The aorta appears unfolded. The bony structures appear intact.", "output": "Pulmonary edema with small right pleural effusion." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. Again seen is a ventriculoperitoneal shunt catheter overlying the right chest.", "output": "No acute cardiopulmonary process." }, { "input": "Portable semi-upright radiograph of the chest demonstrates well expanded, clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation. A pacemaker device is present, with leads terminating in the locations of the right atrium and right ventricle. Again seen is anterior and inferior dislocation of the right humeral head with respect to the glenoid, and fracture through the greater tubercle of the right humerus.", "output": "No acute cardiopulmonary process." }, { "input": "Bibasilar opacities are seen which likely represent combination of pleural effusions and atelectasis although consolidation due to infection or aspiration is not excluded. Superior vena cava stent is re- demonstrated. Cardiac silhouette is mildly enlarged. Mediastinal contours are stable and unremarkable. A square radiopaque structure projects over the right upper hemi thorax, also present on the prior study.", "output": "Bibasilar opacities may be due to atelectasis and small pleural effusions although consolidations due to infection or aspiration not excluded." }, { "input": "There is minimal pulmonary vascular congestion. No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal. Mediastinal contours are grossly unremarkable.", "output": "Minimal pulmonary vascular congestion. No focal consolidation to suggest pneumonia." }, { "input": "Subtle patchy opacity over the left lung base raises concern for pneumonia. Additionally, there is subtle opacity projecting over the right upper lung, which may be additional site of infection. Given that there are no priors for comparison, cannot discern whether findings have improved, stayed the same or worsened since the prior study. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Bilateral, subtle patchy opacities, as above, concerning for multifocal pneumonia. In the absence of priors currently available for comparison, cannot determine whether findings have increased, decreased or remained the same. Comparison with prior studies would be helpful for further evaluation." }, { "input": "PA and lateral views of the chest. The lungs are clear without consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. Mild midthoracic dextroscoliosis is identified. No acute osseous abnormalities are seen.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiograph demonstrates well expanded and clear lungs.No pleural effusion or pneumothorax. No pneumomediastinum. The esophagus is air-filled. Heart size, mediastinal contour, and hila are unremarkable. Limited assessment of the upper abdomen is within normal limits. Evidence of healed left posterior rib fractures.", "output": "Normal chest radiograph. No pneumomediastinum." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest were obtained. A right lower lobe opacity is new from ___. No other opacity is seen. There may be a small pleural effusion. No pneumothorax. Heart size is normal. Mediastinal silhouette is normal. Pulmonary vasculature is more engorged than on the prior study. Pacemaker leads end in the right atrium and right ventricle. Median sternotomy wires are intact. A coronary artery stent is present. Cement material is seen in the lower thoracic spine.", "output": "Focal right lower lobe opacity may be pneumonia or early manifestation of pulmonary edema." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes, which accentuate bronchovascular markings. There is no pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is top normal. There is no pulmonary edema. Bibasilar opacities likely represent atelectasis. Partially imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Overlying EKG leads are present. There is mild left basal atelectasis. There is no focal consolidation, large effusion or pneumothorax. No signs of congestion or edema. The cardiomediastinal silhouette appears normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Mild left basal atelectasis, otherwise unremarkable." }, { "input": "Since the chest radiograph obtained 5 days prior, no significant changes are identified. Moderate to severe cardiomegaly is unchanged. There is no pulmonary vascular congestion, pulmonary edema, or pleural effusion. Lungs are fully expanded and clear. Cardiomediastinal and hilar silhouettes and pleural surfaces are normal.", "output": "No radiographic evidence of pneumonia. Stable, moderate to severe cardiomegaly without pulmonary vascular congestion, pulmonary edema, or pleural effusions." }, { "input": "Left basal opacity compatible with known pneumonia is increased extending into the left midlung. Accompanying increase in vascular congestion is without overt edema. Cardiac size is stable, though silhouette is obscured by this process.", "output": "Increase in left-sided opacities, into the left mid lung, concerning for worsening pneumonia. Finings were discussed by phone with ___, NP, by Dr. ___ at ___ on ___." }, { "input": "A portable AP radiograph of the chest demonstrates persistent mild pulmonary edema, moderate right pleural effusion, and small left pleural effusion. There is no significant change from yesterday. Atelectasis of the left lower lobe persists. Heart size is difficult to assess, but the hilar and mediastinal contours are unchanged. Tortuosity of the aorta as well as atherosclerotic calcifications in the aortic arch are unchanged. A Dobbhoff feeding tube seen coursing into the stomach, terminating at or just beyond the pylorus. There is no pneumothorax.", "output": "Persistent decompensated congestive heart failure with mild pulmonary edema, moderate right and small left pleural effusions." }, { "input": "Decreased vascular congestion is accompanied by slightly decreased left mid lung and unchanged left lower lung opacities. Lungs remain very low in volume with small to moderate bilateral pleural effusions. Heart is poorly assessed but appears mild to moderately enlarged with calcified aortic arch.", "output": "Decreased mild pulmonary vascular congestion with decrease in left mid lung and unchanged left lower lung opacities compatible with known pneumonia. Given the interval improvement, the left midlung opacity may reflect the result of an aspiration event." }, { "input": "AP upright and lateral views of the chest provided. Overlying EKG leads obscure portions of the right lung. There is mild interstitial prominence which could reflect technique, though mild edema is not excluded. No large effusion or pneumothorax. Cardiomediastinal silhouette appears stable. Bony structures are intact.", "output": "Limited, with mild interstitial opacity which could represent mild edema." }, { "input": "Cardiac silhouette size is normal. The aorta is tortuous. The hilar contours are unremarkable. There is no pulmonary edema. Streaky opacities in the lung bases likely reflect atelectasis. No pleural effusion or pneumothorax is identified. There are multilevel degenerative changes in the thoracic spine.", "output": "Mild bibasilar atelectasis." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. The lungs are essentially clear noting minimal linear opacities less conspicuous compared to prior, in the left lower lung and right mid lung. There is no acute consolidation, effusion, or pulmonary vascular congestion. Cardiomediastinal silhouette is within normal limits. Hypertrophic changes are noted in the spine. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process. No findings to suggest a pneumothorax." }, { "input": "The lungs are grossly clear. Nodular opacities projecting over the lung bases bilaterally are most likely nipple shadows. Cardiomediastinal silhouette is within normal limits. Prosthetic aortic valve is seen. Median sternotomy wires and mediastinal clips are noted. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process, no edema. Nodular opacities projecting over the lung bases, most likely nipple shadows however repeat with nipple markers can be performed to confirm." }, { "input": "PA and lateral views of the chest provided. Midline sternotomy wires and prosthetic cardiac valves are again noted. The heart remains moderately enlarged. The mediastinal contour is unchanged with aortic calcification again noted. Hilar congestion is present with mild interstitial edema. Lower lung in opacities as on prior likely reflect atelectasis. There is likely a tiny right pleural effusion. No pneumothorax. No acute bony abnormalities.", "output": "As above." }, { "input": "Moderate cardiomegaly has been stable compared to the exam from ___. There has been interval worsening of moderate pulmonary edema, as well as interval development of an asymmetric right perihilar opacity. Mild bibasilar atelectasis is persistent. There are small bilateral pleural effusions. There is no pneumothorax. The visualized osseous structures are unremarkable.", "output": "1. Moderate pulmonary edema. 2. Asymmetric right perihilar opacity may be secondary to asymmetric edema, however follow up radiographs to ensure resolution is recommended to exclude a developing infection or malignancy. ___ were d/w Dr. ___ by Dr. ___ by phone at 7:___A on the day of the exam." }, { "input": "PA and lateral radiographs of the chest again demonstrate an enlarged cardiomediastinal silhouette, unchanged from ___ with intact median sternotomy wires and mediastinal clips. Prosthetic aortic and mitral valves are again noted. There is unchanged mild vascular congestion. No pneumothorax or pleural effusion is visualized. There is unchanged left basilar atelectasis. There is no other focal airspace consolidation.", "output": "Mild vascular congestion, unchanged from ___." }, { "input": "PA and lateral views of the chest. Borderline cardiomegaly is stable. Previously seen mild pulmonary vascular congestion and pulmonary edema has decreased. No evidence of pneumonia. No pleural effusion or pneumothorax. Normal mediastinal and hilar contours. Sternotomy wires are in appropriate positions. Aortic valve replacement and tricuspid valvuloplasty are in appropriate position.", "output": "Decreased pulmonary vascular congestion and pulmonary edema compared to most recent study." }, { "input": "Heart is moderately enlarged as on prior. Median sternotomy wires and prosthetic cardiac valves are noted. Low lung volumes are noted, particularly on the lateral view accentuating the bronchovascular markings. There is however superimposed pulmonary edema, progressed since prior. There is no large effusion. No acute osseous abnormalities.", "output": "Low lung volumes with superimposed pulmonary edema." }, { "input": "The lungs are well-expanded. There is mild pulmonary edema. No focal consolidations. No pleural effusion or pneumothorax. There is moderate cardiomegaly. Cardiomediastinal hilar silhouettes are otherwise unremarkable, noting dense atherosclerotic calcifications of the aortic knob. Median sternotomy wires and valve replacements are seen.", "output": "Mild pulmonary edema." }, { "input": "Patient is status post median sternotomy and cardiac valve replacements. The cardiac knee and mediastinal silhouettes are stable. No pleural effusion or pneumothorax is seen. There is moderate pulmonary edema.", "output": "Moderate pulmonary edema." }, { "input": "When compared to prior, there has been no significant interval change. Cardiac silhouette is enlarged and atherosclerotic calcifications are noted at the aortic arch. Prosthetic valves and median sternotomy wires are again noted. Hilar engorgement with increased interstitial markings seen throughout, similar to prior. There is no pleural effusion.", "output": "Cardiomegaly with mild pulmonary edema." }, { "input": "Single frontal view of the chest demonstrates multiple intact median sternotomy wires and evidence of prior CABG procedure. The heart is prominent, but likely accentuated by AP technique and low lung volumes. There are aortic arch calcifications, unchanged. Mild interstitial prominence is long standing and certainly less pronounced on current exam. There is no overt pulmonary edema. There is no large pleural effusion. There is subsegmental atelectasis in the retrocardiac region. There is no pneumothorax or pneumomediastinum.", "output": "Low lung volumes. No overt pulmonary edema." }, { "input": "Hilar engorgement is re- demonstrated with interval increase in interstitial markings since the prior study consistent with moderate pulmonary edema. More focal right base opacity may relate to fluid overload, but underlying infection is not excluded in the appropriate clinical setting. Very trace right pleural effusion is difficult to exclude. No pneumothorax is seen. Cardiac and mediastinal silhouettes are stable. Patient is status post median sternotomy and cardiac valve replacements.", "output": "Moderate pulmonary edema. More focal right base opacity may relate to fluid overload, but infectious process is not excluded in the appropriate clinical setting." }, { "input": "Sternotomy, valve replacements. Increased heart size and pulmonary vascularity, mildly improved since prior exam, and accentuated today secondary to shallow inspiration. Improved right basilar opacity. Resolved left basilar opacity. Aortic calcification. Prominent central pulmonary arteries, suggest pulmonary artery hypertension. Degenerative changes thoracic spine, kyphosis, stable. No pleural fluid.", "output": "Mildly decreased heart size, pulmonary vascularity. Suggestion of pulmonary artery hypertension. Improved right basilar opacity." }, { "input": "Right PICC can be traced to the right subclavian vein but not visualized beyond. Sternotomy wires are intact. Pulmonary vascular congestion and cardiomegaly are similar to before. Mild bibasilar atelectasis is noted. There is no pleural effusion.", "output": "1. Right PICC can be traced to the right subclavian vein but not visualized beyond. Consider oblique view chest radiograph for better evaluation. 2. Pulmonary vascular congestion and cardiomegaly are similar to before. RECOMMENDATION(S): Oblique view chest radiograph is recommended." }, { "input": "PA and lateral views of the chest were provided. Midline sternotomy wires and prosthetic cardiac valves are seen as well as mediastinal clips. There is mild pulmonary edema, minimally increased from that seen previously. No large effusions are seen. The heart remains mildly enlarged. Aortic calcifications are noted. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Pulmonary edema, slightly increased compared with prior radiograph. Mild cardiomegaly unchanged." }, { "input": "Mild persisting pulmonary edema. Increasing retrocardiac opacity which may represent atelectasis and/or consolidation. No pleural effusion or pneumothorax identified. Patient is status post prior median sternotomy and cardiac valve replacements.", "output": "Mild pulmonary edema. Increasing retrocardiac opacity may reflect atelectasis and/or consolidation." }, { "input": "Low lung volumes with interval improvement in pulmonary edema. Unchanged cardiomegaly. Aortic knuckle calcification. No pleural effusion. Stable sternotomy sutures.", "output": "Improvement in pulmonary edema and left pleural effusion compared to ___. Cardiomegaly and low lung volumes persist." }, { "input": "AP portable upright view of the chest. Midline sternotomy wires and prosthetic cardiac valve noted. There is stable mild cardiomegaly with moderate pulmonary edema. Small bilateral pleural effusions are likely present. No pneumothorax. Difficult to exclude a superimposed subtle pneumonia. Bony structures are intact.", "output": "Pulmonary edema, stable cardiomegaly, likely small pleural effusions. Difficult to exclude superimposed pneumonia." }, { "input": "Mild pulmonary vascular congestion is unchanged. There is stable appearance of the cardiomediastinal silhouette. The small bilateral pleural effusions are present. No new discrete local infiltrate can be identified. Unchanged appearance of aortic valve replacement and tricuspid valve annuloplasty. No pneumothorax.", "output": "1. No evidence of pneumonia. 2. Unchanged mild pulmonary vascular congestion and stable mild cardiomegaly." }, { "input": "PA and lateral views of the chest were provided demonstrating no focal consolidation, effusion or pneumothorax. The heart and mediastinal contours appear normal. The bony structures are intact. There is no free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear. There is no pneumothorax. The heart and mediastinum are within normal limits. Regional bones and soft tissues are unremarkable.", "output": "Clear lungs with no radiographic evidence of pneumonia. However, if clinical suspicion persists, a dedicated chest CT may be performed for further evaluation." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are grossly stable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process. No significant interval change." }, { "input": "Heart size is normal. The mediastinal and hilar contours are unremarkable. Pulmonary vascularity is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views the chest were viewed. Mild enlargement of the cardiac silhouette is new. There is no pleural effusion or pneumothorax. The lungs are well expanded with mild linear atelectasis at the right lung base. There is no focal consolidation concerning for pneumonia.", "output": "New mild cardiomegaly and/or pericardial effusion. Mild right basilar atelectasis with no other acute process. Change from initial interpretation emailed to ED QA nurses." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unremarkable. The pulmonary vascularity is normal. The lungs are hyperinflated. No focal consolidation or pneumothorax is present. Blunting of the left costophrenic angle posteriorly may be due to chronic pleural thickening versus a trace pleural effusion. Multiple clips are again demonstrated within the left breast. No acute osseous abnormalities are seen. There are mild degenerative changes in the thoracic spine.", "output": "No radiographic evidence for pneumonia or congestive heart failure. Minimal blunting of the left costophrenic angle posteriorly may suggest chronic pleural thickening versus trace pleural effusion." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Lungs are clear. No focal consolidation, pleural effusion or pneumothorax is seen. Lung hyperinflation is re- demonstrated. No acute osseous abnormality is identified. Left breast clips are re- demonstrated.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There are low lung volumes. No focal opacity to suggest pneumonia is seen. No pleural effusion, pulmonary edema or pneumothorax is present. The heart is mildly enlarged. The pleural surface contours are normal.", "output": "No evidence of acute cardiopulmonary process to explain back pain." }, { "input": "PA and lateral views of the chest demonstrate hyperexpansion of the lungs with flattening of the bilateral hemidiaphragms, consistent with emphysema. The cardiomediastinal silhouette is unchanged, with stable mild cardiomegaly. There is no evidence of pleural effusion, pulmonary edema, pneumothorax or focal consolidation concerning for pneumonia. Multilevel degenerative changes are present in the thoracic spine.", "output": "No evidence of pneumonia." }, { "input": "The lungs appear hyperexpanded with flattening of the hemidiaphragm suggestive of COPD. The lungs are however clear. Cardiac and mediastinal silhouette appears within normal limits. There is no evidence of pulmonary edema. Mild atherosclerotic calcifications are noted at the aortic arch. No acute fractures identified.", "output": "No evidence of pulmonary edema. Findings suggestive of COPD." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Analysis is performed in direct comparison with the next preceding similar chest examination of ___. Mild cardiac enlargement as before with contour prominence of the left ventricle in posterior direction. Thoracic aorta mildly widened and elongated, but without local contour abnormalities. The pulmonary vasculature is not congested. The uneven peripheral vascular distribution, which includes areas of increased translucency are consistent with COPD and appear similar as on the previous examination. There is no evidence of new acute pulmonary parenchymal infiltrates and the lateral and posterior pleural sinuses remain free from any effusion. There is no evidence of pneumothorax in the apical area on the frontal view.", "output": "Stable chest findings, pulmonary vascular changes, and low positioned diaphragms compatible with COPD. No acute infiltrates presently." }, { "input": "No change in the hyperinflated lungs with linear opacities in the right upper lobe, right lower lobe, and left lung base, consistent with subsegmental atelectasis or scarring. No new focal consolidations concerning for pneumonia or effusions. Cardiac mediastinal and hilar contours are stable.", "output": "No evidence of pneumonia. NOTIFICATION: The above findings were communicated via telephone by Dr. ___ to Dr. ___ at 12:34 on ___, ___ min after discovery." }, { "input": "PA and lateral views of the chest provided. The lungs are hyperinflated with upper lobe lucency and splaying of bronchovascular markings suggestive of emphysema. No focal consolidation, large effusion or pneumothorax. Cardiomediastinal silhouette is stable. Bony structures are intact peer", "output": "Emphysema without superimposed pneumonia." }, { "input": "Lungs remain hyperinflated with emphysematous changes again noted most pronounced at the apices. The cardiac, mediastinal and hilar contours are unchanged, with the heart size within normal limits. The aorta is diffusely calcified. There is no pulmonary edema, focal consolidation, pleural effusion or pneumothorax. Linear opacities within the right upper lobe peripherally and left lung base are compatible with areas of subsegmental atelectasis and/or scarring. Pleural parenchymal scarring is also noted within the apices bilaterally. Moderate multilevel degenerative changes are noted in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. Again, the lungs are hyperinflated. There are new regions of consolidation in the right lung within the upper and middle lobes. Lungs are otherwise clear of confluent consolidation. Mild right apical scarring is again noted. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "Hyperinflation with regions of consolidation in the right lung. These are compatible with pneumonia in the proper clinical setting. Recommend repeat after treatment to document resolution." }, { "input": "The lungs are clear. There is no pneumothorax. Mild cardiomegaly is unchanged. There is no pleural effusion. Regional bones and soft tissues are unremarkable.", "output": "Clear lungs with no evidence of pneumonia." }, { "input": "The lungs demonstrate emphysematous changes, with hyperinflation and flattening of the diaphragms.There is no focal consolidation. There is borderline cardiomegaly with no vascular congestion, edema or pleural effusion. No pneumothorax is seen. There is a pectus deformity of the sternum. The thoracic aorta is normal in caliber but contains atherosclerotic calcifications.", "output": "1. Probably no pneumonia. If this contradicts clinical evaluation, could obtain oblique views for further evaluation. 2. Baseline emphysematous changes. RECOMMENDATION(S): If high clinical suspicion of pneumonia, consider obtaining oblique views for further evaluation." }, { "input": "ET Tube in mid trachea at 4.5 cm from the carina. Low lung volumes with prominence of the central pulmnary vasculature and mild cardiomegaly suggestive of fluid overload. Mild bibasilar atelectasis. Right hemidiaphragm appear elevated, likely chronic but exaggerated due to projection.", "output": "" }, { "input": "There has been interval extubation with improved lung volumes. There is decreased, now mild, elevation of the right hemidiaphragm. No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. Heart and mediastinal contours are within normal limits.", "output": "Decreased, now mild, elevation of the right hemidiaphragm." }, { "input": "The lungs are clear without consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Doghoff tube tip in the second portion of duodenum. Additional tube coiled over stomach, tip over midesophagus, stable. Endotracheal tube, right PICC line in place. Decreased bilateral perihilar pulmonary opacities, likely improved edema. Stable left upper lung opacity, pleural fluid. Fibro bullous changes right upper lung, similar. Mildly improved left lower lobe consolidation. Pleural effusions are less apparent.", "output": "1. New feeding tube in second portion of the duodenum. 2. NG to the coiled in the stomach with its tip in the mid esophagus. 3. Decreased perihilar pulmonary edema." }, { "input": "AP upright and lateral views of the chest provided. Mild basal atelectasis noted. Lungs are otherwise clear though hyperinflated and somewhat lucent likely reflecting known emphysema. Cardiomediastinal silhouette is stable. Bony structures are intact. No free air below the right hemidiaphragm. Calcifications are prominent in the right and left neck likely reflecting prominent carotid bulb calcification. Bony defect at the right distal clavicle may reflect acute or chronic injury for which clinical correlation advised.", "output": "1. Emphysema with mild bibasilar atelectasis. 2. Prominent carotid bulb calcifications and a carotid ultrasound may be considered to further assess. 3. Bony defect at the right distal clavicle, correlate for focal pain as an acute fracture difficult to exclude." }, { "input": "Vascular congestion on the left lung is noted. Left apex opacity is unchanged since ___ and likely reflects pneumonia. Increased opacities in the right lower lung likely combination of right pleural effusion with pulmonary edema. Retrocardiac consolidation is unchanged. There is no pneumothorax. Cardiac size is normal. Right PICC line in the mid SVC. Interval removal of the Dobbhoff tube.", "output": "Increased pulmonary edema and right pleural effusion. Unchanged appearance of left upper lobe pneumonia. Vascular congestion in the left lung. Unchanged retrocardiac consolidation." }, { "input": "There has been further increase in the bilateral but left side predominant airspace opacities. Unchanged right apical bullous disease without a discrete pneumothorax A suspected trace left pleural effusion is present with adjacent atelectasis. The size and appearance of the cardiomediastinal silhouette is unchanged. Multiple bilateral rib fractures of varying ages are present. A healing fracture of the distal right clavicle is also noted.", "output": "Interval increase in the extent of the nonspecific bilateral airspace opacities, which could be seen in setting of aspiration pneumonitis/pneumonia or pulmonary edema." }, { "input": "The tip of the right PICC line projects over the superior cavoatrial junction. There is increased aeration involving the right mid to lower lung zone with a persisting more confluent opacity located peripherally. Diffusely increased interstitial markings and patchy opacities still persist throughout both lungs. No pleural effusion or pneumothorax identified. The size of the cardiac silhouette is unchanged.", "output": "Increased aeration in the right mid to lower lung zone with a persisting more confluent opacity peripherally in the right mid lung zone. Diffusely increased interstitial markings throughout both lungs." }, { "input": "NG tube has been repositioned and its distal portion no projection the stomach. Otherwise stable appearance of the chest", "output": "NG tube in the stomach." }, { "input": "There is significant bilateral lower lobe opacification compared to prior, consistent with multifocal pneumonia. There is increased diffuse bronchoalveolar markings. No pneumothorax. The cardiomediastinal silhouette is normal. There is bilateral pleural effusion. The left PICC line terminates at lower SVC. No fractures.", "output": "1. Multifocal pneumonia involving the bilateral lower lobes. 2. Pulmonary edema compared to prior." }, { "input": "Stable pulmonary opacities since prior exam. There has been interval insertion of an endotracheal tube, its tip approximately 6.6 cm above the carina. An enteric tube courses below the diaphragm, its tip terminating in the expected anatomic location the body of the stomach. Left-sided PICC is in stable position, its tip at the cavoatrial junction. Right fourth and fifth and left fifth rib fracture are again noted.", "output": "1. Appropriately positioned endotracheal tube. 2. Stable pulmonary opacities since prior exam. 3. Bilateral rib fractures, as on the prior examination. Examination and dictation reviewed with Dr. ___." }, { "input": "There is interval progression of the multifocal airspace opacification which previously involved the right middle and lower lung zones as well as the left lower lung zone, which now also involves the mid and upper lung zones. The heart size is unchanged. No significant cephalization of pulmonary blood vessels. No widening of the vascular pedicle. No large pleural effusions.", "output": "Nonspecific multifocal airspace opacification which shows interval progression in distribution. No interval change in the heart size, pulmonary cephalization or pleural effusions to suggest pulmonary edema. RECOMMENDATION(S): Short-term follow-up imaging recommended to evaluate for disease progression/resolution." }, { "input": "NG tube is cold of the esophagus and extents upward ridging the pharynx. Apparent increase in diffuse bilateral opacities may be due to poor inspiratory effort. ET tube is above the carina and left PICC line in mid SVC.", "output": "NG tube coiled in esophagus." }, { "input": "PA and lateral views of the chest. There is emphysema bilaterally and large bullae in the right lung, similar to prior CT studies. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal and hilar contours are normal. The vertebral heights are maintained. No fractures are identified. There is a likely chronic fracture of the T10 posterior rib on the right.", "output": "1. No acute cardiopulmonary process. 2. Emphysema with large bullae in the right lung. 3. No fractures are identified. If there is further concern, dedicated films in the area of concern can be done." }, { "input": "Bilateral lower lung opacities again seen and increased atelectasis in the left lower lobe with no significant change. Left PICC line in mid to lower SVC. NG tube in the stomach. ET tube above the carina.", "output": "No significant interval change. Bilateral lower lung field opacities." }, { "input": "The tip of the right PICC line projects over the superior cavoatrial junction. No significant interval change in the the bilateral diffuse and confluent air space opacities. The size of the cardiac silhouette is within normal limits. No pleural effusion or pneumothorax identified.", "output": "No significant interval change since the prior exam." }, { "input": "Persistent bilateral lower lobe opacities noted with no significant change since the previous exam. ___ tube above the carina. Central line in SVC. NG tube below the diaphragm.", "output": "Stable bilateral pulmonary opacities." }, { "input": "Previously seen bibasilar opacities have improved, representing resolving aspiration pneumonia. Right apical thin-walled emphysematous bullae are unchanged and better evaluated on the chest CT dated ___. The cardiomediastinal and hilar silhouettes remain unchanged. There are atherosclerotic calcifications of the aortic arch. There is no pleural effusion or pneumothorax. There are old healed fractures of the right fourth and fifth ribs. There is also a subacute fracture of the tip of the right clavicle. A venous catheter in the right arm terminates at the level of the mid humerus. There is old oral contrast in the upper abdomen.", "output": "1. Improved bibasilar opacities, representing resolving aspiration pneumonia. Right apical thin-walled emphysematous bullae are unchanged and better evaluated on the CT torso dated ___. 2. Subacute fracture of the tip of the right clavicle. This preliminary report was reviewed with Dr. ___, ___ radiologist." }, { "input": "The Dobbhoff tube is in unchanged position. Bilateral lower lobe hazy opacities are concerning for multifocal aspiration pneumonia. No pleural effusions or pneumothorax. The cardiomediastinal silhouette is unchanged.", "output": "Bilateral lower lobe aspiration pneumonia. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 12:33 PM, 10 minutes after discovery of the findings." }, { "input": "Frontal and lateral chest radiographs demonstrate unchanged linear opacity in the left lower lung compatible with scar. The lungs are well expanded. There is no pleural effusion or pneumothorax. The cardiac silhouette remains mildly enlarged, the mediastinal contours are normal. A lap gastric band is noted which is changed in orientation as can be seen in prolapse. There are surgical clips in the right upper quadrant.", "output": "1. Mild cardiomegaly. 2. Change in orientation of the gastric Lap Band, as can be seen in prolapse or slippage. Recommend clinical correlation and if indicated evaluation with upper GI. Findings discussed with ___ of the ED at 7:40am." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. Heart size is top normal with tortuous aortic contour.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest were obtained. There has been no significant interval change. There is minor lingular atelectasis. No definite focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable.", "output": "No significant interval change. No acute cardiopulmonary process." }, { "input": "The heart size is normal. Mediastinal and hilar contours are unchanged. Pulmonary vascularity is normal. Except for subsegmental atelectasis in the lingula, lungs are clear. No pleural effusion or pneumothorax is present. Clips are seen in the right upper quadrant of the abdomen. No acute osseous abnormalities are identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest are obtained demonstrating clear well expanded lungs without focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Cervical spinal hardware appears intact. Median sternotomy wires are intact. Prosthetic aortic valve appears intact. Normal cardiomediastinal and hilar contours. Unchanged, minimal bibasilar atelectasis. No focal consolidation to suggest pneumonia. Normal pleural surfaces.", "output": "No evidence of pneumonia. NOTIFICATION: The impression above was entered by Dr. ___ on ___ at 14:37 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "The patient has had prior median sternotomy with aortic valve replacement. Sternotomy wires are intact and aligned. Minimal bibasilar subsegmental atelectasis is unchanged. The lungs are otherwise clear. There is no pneumothorax. The heart and mediastinum are within normal limits.", "output": "Minimal bibasilar subsegmental atelectasis with otherwise clear lungs." }, { "input": "Sternotomy wires and prosthetic valve are unchanged. The cardiomediastinal and hilar contours are normal. The lungs are clear of consolidation. There is no pleural effusion or pneumothorax. No displaced rib fracture is apparent.", "output": "No evidence of intrathoracic trauma." }, { "input": "Compared to the study from the prior day there is no significant interval change in the appearance of the calcified pleural plaques. The heart continues to be moderately enlarged. There are no new infiltrates or effusions.", "output": "No change." }, { "input": "As seen previously, there are multiple bilateral pleural plaques, partially obscuring visualization of the lung fields. The lungs are otherwise clear with no evidence of consolidation. The heart is enlarged and although stable. The mediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. No significant pulmonary vascular congestion or interstitial edema.", "output": "No evidence of pneumonia or pulmonary edema." }, { "input": "", "output": "Cardiomegaly, but no evidence of fluid overload. ______________________________________________________________________________ FINAL REPORT HISTORY: ___-year-old male admitted for hypertensive urgency with Lasix held; now with decreased saturation and acute renal failure. STUDY: PA and lateral chest radiograph. COMPARISON: ___. FINDINGS: The heart size is minimally enlarged. The mediastinal contours demonstrate calcified atherosclerotic disease throughout the aorta. Calcified pleural plaques overlie the lungs and also line the hemidiaphragms. There is no large pleural effusion or pneumothorax. There is no overt pulmonary edema. Degenerative changes are seen throughout the thoracic spine. IMPRESSION: Cardiomegaly, but no evidence of fluid overload." }, { "input": "PA and lateral views of the chest again demonstrate bilateral pleural plaques. There is no focal consolidation, pleural effusion, or evidence of pneumothorax. Indiscrete obscuration of the right lung base seen on PA view may represent an area of plate-like atelectasis. The cardiomediastinal silhouette is stable.", "output": "1. No acute cardiopulmonary process. Indiscrete obscuration of right lung base may represent an area of plate-like atelectasis. 2. Bilateral calcified pleural plaques." }, { "input": "PA and lateral views of the chest provided. Left chest wall Port-A-Cath is again noted with catheter tip in the region of the lower SVC. Mild bibasilar atelectasis is noted. Otherwise lungs are clear. In this patient with provided history of lung cancer, no discrete nodule or mass is identified within either lung. Cardiomediastinal silhouette appears normal. Bony structures appear intact. Vertebroplasty changes in the upper lumbar spine noted. No free air below the right hemidiaphragm.", "output": "Mild bibasilar atelectasis. Port-A-Cath in appropriate position. Please refer to subsequent CT abdomen pelvis for further details." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are hyperinflated and clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Moderate cardiomegaly has been stable compared to exams dated back to ___. The aorta is tortuous, and low lung volumes exaggerate the cardiomediastinal contours, which are otherwise unremarkable. There is mild pulmonary vascular congestion. Compared to the lateral radiograph from ___, there appears to be an interval increase in consolidation in the retrocardiac region. Mild bibasilar atelectasis is persistent. There is no evidence of a pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "Compared to the lateral radiograph from ___, there has been an interval increase in consolidation in the retrocardiac region, which is concerning for pneumonia." }, { "input": "Single portable view of the chest is compared to previous exam from ___. Lower lung volumes are seen on the current exam. There is, however, suggestion of diffuse increased interstitial markings with more confluent opacities at the lung bases. While these could be due to impart atelectasis, underlying edema or infection is also suspected. Cardiac silhouette is unchanged, as are the osseous and soft tissue structures.", "output": "Bilateral parenchymal opacities, worse at the bases, left greater than right, suggestive of underlying edema or bilateral infection superimposed on atelectasis. PA and lateral with better inspiratory effort may help further characterize." }, { "input": "There lungs are low in volume but without focal consolidation. Diffuse opacities likely reflect mild pulmonary edema. There is no pleural effusion or pneumothorax. The cardiac size and cardiac silhouette are obscured by low lung volumes. The mediastinal and hilar contours appear unremarkable.", "output": "Mild pulmonary edema. Repeat imaging after diuresis is recommended to evaluate for concomitant pneumonia." }, { "input": "Persistent pulmonary opacities, vascular engorgement and septal lines refkect mild pulmonary edema. Small left pleural effusion cannot be excluded. Low lung volumes limit assessment of cardiomediastinal silhouette though the cardiac size appears mildly enlarged.", "output": "Unchanged mild pulmonary edema with likely small left pleural effusion." }, { "input": "Cardiac size is top normal. The lungs are clear. There is no pneumothorax or pleural effusion. VP shunt catheter is noted on the right", "output": "No acute cardiopulmonary abnormality ___, MD" }, { "input": "Single frontal view of the chest demonstrates multiple EKG leads projecting over the thorax. The lungs are clear. There is no pneumothorax, vascular congestion, or pleural effusion. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "A subtle area of opacity has developed in the right infrahilar region, partially obscuring the right heart border. This represents a change in the appearance of the chest compared to the tomogram from the previous CT angiogram performed ___. It is concerning for a focal pneumonia in the context of fever and cough. Lungs are otherwise clear, and there are no pleural effusions. Heart size, mediastinal and hilar contours are normal. Skeletal structures are remarkable for a pectus deformity and degenerative changes in the spine.", "output": "New focal right middle lobe opacity, concerning for an early focus of infectious pneumonia. Consider followup chest x-rays in four to six weeks after completion of antibiotic therapy to document resolution. Dr. ___ has been notified of this finding by e-mail with receipt of email acknowledgment on ___." }, { "input": "The previously seen opacity in the right middle lobe is not present on today's study. The lungs remain otherwise clear. There are no pleural effusions. Heart size, mediastinal and hilar contours are normal. Again noted is a pectus deformity and degenerative changes in the spine.", "output": "1. Resolution of focal right middle lobe opacity." }, { "input": "The cardiac silhouette remains moderate to severely enlarged, with a globular configuration, compatible with known pericardial effusion. Mediastinal contour remains unchanged. There are low lung volumes with crowding of the bronchovascular structures. No overt pulmonary edema is present. Small left pleural effusion is similar compared to the prior exam. A trace right pleural effusion is also re- demonstrated. No pneumothorax is present. Patchy opacities in the lung bases likely reflect atelectasis.", "output": "Similar enlargement of the cardiac silhouette compatible with known pericardial effusion. Bibasilar atelectasis with small bilateral pleural effusions, left greater than right." }, { "input": "The lungs are clear. The cardiomediastinal silhouette and hilar contours are normal. The pleural surfaces are normal without effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The heart is top normal in size, and at baseline. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. There are no granulomas or cavitary lesions.", "output": "1. No evidence of tuberculous infection. 2. No evidence of acute cardiopulmonary process." }, { "input": "PA and lateral views the chest provided. Lung volumes are low with bronchovascular crowding noted. No convincing evidence for pneumonia or edema. No large effusion or pneumothorax. Cardiomediastinal silhouette is stable. Bony structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Limited, negative." }, { "input": "Interval improvement in interstitial edema. Low lung volumes and technique accentuate heart size and mediastinum. Deviation of the trachea to the right is due to tortuosity of the great vessels as seen on CT. No effusion or pneumothorax.", "output": "Interval improvement in findings suggestive of pulmonary edema." }, { "input": "The exam is limited by patient's rotation. Within limitations, there are persistent streaky opacities in the left mid and lower lung zones, which are stable from the prior chest radiograph and CT. This likely represents chronic atelectasis or scarring. Additionally, there is a linear opacity in the right lower lung zone, which is also stable. No new opacity is identified. There is no pulmonary edema, pleural effusion, or pneumothorax. The aorta is tortuous and calcified. The heart size is normal.", "output": "Stable bibasilar linear opacities, likely representing atelectasis or scarring. No acute cardiopulmonary process." }, { "input": "Portable AP upright chest radiograph obtained. There is interval development of mild interstitial edema. There is slight asymmetric increase in opacity in the right upper lobe, which could represent a superimposed consolidation/pneumonia. Mediastinal prominence could be due to portable AP technique. Bony structures are intact. Heart size appears grossly within normal limits. No large effusion is seen.", "output": "Interstitial edema with possible superimposed pneumonia in the right upper lobe. Please note evaluation limited given portable AP technique." }, { "input": "The heart is normal in size. There is mild unfolding of the thoracic aorta. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "A triangular opacity extends from the right hilus to the peripheral fissure and right hilar opacity obscures the right bronchus intermedius. Diffuse, right greater than left, emphysematous disease. No pneumothorax or pleural effusion. Heart size is normal.", "output": "Right hilar opacity obscures the right bronchus intermedius and right mid lung opacity extends from the right hilus to the lung periphery. Chest CT is recommended for further evaluation. NOTIFICATION: The findings were discussed via telephone by Dr. ___ with Dr. ___ on ___ at 8:07 AM, 10 minutes after discovery of the findings." }, { "input": "AP view of the chest provided. There is worsening colonic distention, with ___ sign suggestive of pneumoperitoneum. Lung volumes are low, in part due to abdominal distention. Lungs are otherwise clear.", "output": "Findings of pneumoperitoneum, presumably associated with recent surgery. Lungs are clear. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 4:40 PM, 10 minutes after discovery of the findings." }, { "input": "AP and lateral upright radiographs through the chest demonstrate no focal opacity convincing for pneumonia. Cardiomediastinal and hilar contours are within normal limits. There is no pleural effusion or pneumothorax. Osseous structures demonstrate no acute abnormality.", "output": "No focal opacity convincing for pneumonia. If clinically focal findings are present to suggest chest cage abnormality, dedicated rib films could be obtained for further evaluation as conventional radiographs are insensitive for chest cage trauma." }, { "input": "The lungs are well inflated and clear. Heart size mediastinal contours are normal. There is no pleural effusion or pneumothorax. Osseous structures are intact.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest. Linear opacities at the lung bases are most suggestive of atelectasis. Elsewhere the lungs are clear. There is no pneumothorax or large effusion. The cardiomediastinal silhouette is within normal limits noting tortuosity of the descending thoracic aorta. No displaced fractures are identified. Surgical clips seen in the right upper quadrant.", "output": "No definite acute cardiopulmonary process." }, { "input": "The heart size is top normal. The hilar mediastinal contours are unremarkable. There is no overt pulmonary edema. The lung volumes are low, however there is an increase in opacity in the right infrahilar region. There is no pleural effusion, or pneumothorax.", "output": "Increased opacity in the right infrahilar area could be from crowding secondary to low lung volumes, however an acute infectious process cannot be excluded. A repeat frontal radiograph at full inspiration is recommended for further evaluation. RECOMMENDATION(S): Repeat full frontal radiograph at full inspiration. NOTIFICATION: Updated findings were submitted to the ED QA nurse on ___ by Dr. ___ ___" }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is detected. Heart and mediastinal contours are within normal limits. Cervical spine hardware is incompletely imaged.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest demonstrate an area of opacification in the right mid lung, corresponding to resolving right middle lobe process. The left lung is clear. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax or pleural effusion.", "output": "Area of opacification in the right mid lung corresponds to resolving right middle lobe process." }, { "input": "PA and lateral views of the chest are provided. There is mild linear density at the right lung base which is most compatible with atelectasis. No definite consolidation to suggest the presence of pneumonia. No effusion or pneumothorax. The heart and mediastinal contours are normal. The imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Probable linear atelectasis at the right lung base. No convincing signs of pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. Lungs are clear without focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette appears normal. The imaged bony structures are intact. No free air below the right hemidiaphragm.", "output": "Normal chest radiograph." }, { "input": "PA and lateral views of the chest demonstrate slightly increased opacification in the right lower lung zone which on the lateral view is likely located in the right middle lobe. There is no pleural effusion or pneumothorax. Cardiomediastinal contour is unremarkable.", "output": "Findings worrisome for right middle lobe pneumonia." }, { "input": "Allowing for differences in technique, the cardiac, mediastinal and hilar contours appear stable. There is no evidence for pneumomediastinum, or pneumothorax. There is possibly a trace pleural effusion on the left only. The lungs appear clear. There is no free air.", "output": "Suspected trace pleural effusion on the left; otherwise unremarkable." }, { "input": "Frontal and lateral chest radiograph demonstrates well expanded lungs wihtout focal consolidations. There is no pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are clear of airspace or interstitial opacity. The cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax. No acute or aggressive osseus changes.", "output": "No acute radiographic intrathoracic pulmonary disease." }, { "input": "Moderate to large right, and small to moderate left, pleural effusions are re- demonstrated with a left basilar pleural catheter again noted. Fluid continues to be a loculated within the fissures, but slightly decreased compared to the prior study. There are persistent bibasilar airspace opacities likely reflective of compressive atelectasis. Left-sided Port-A-Cath tip terminates at the junction of the SVC and right atrium. The cardiac, mediastinal and hilar contours are unchanged. No pneumothorax is seen. There is no pulmonary vascular congestion. Several clips are demonstrated within the right upper quadrant of the abdomen with a biliary stent.", "output": "Small-to-moderate left and moderate-to-large right pleural effusions with fluid loculated in the fissures. Associated bibasilar atelectasis. The effusions appear slightly decreased in size compared to most recent chest radiograph." }, { "input": "The left Port-A-Cath is in unchanged position ending in the right atrium. Bilateral pleural drains are in unchanged position compared with yesterday. There has been increase in fissural pleural fluid bilaterally especially on the right with no significant change in the bibasilar pleural effusions.", "output": "Interval increase in fissural pleural fluid since yesterday especially on the right. NOTIFICATION: Telephone notification Dr. ___ by Dr. ___ at 11:25 on ___." }, { "input": "Left-sided Port-A-Cath catheter is again seen, terminating in the distal SVC/cavoatrial junction. Again seen are bilateral pleural effusions, large on the right, moderate on the left, with overlying atelectasis, underlying consolidation cannot be excluded. Cardiac and mediastinal silhouettes are stable.", "output": "Large right and moderate left pleural effusions, grossly similar collected possibly slightly increased, as compared to earlier this same date, with overlying atelectasis, underlying consolidation cannot be excluded." }, { "input": "Allowing for differences in technique, comparing with the prior scout view, the cardiac, mediastinal and hilar contours appear unchanged. Lungs are hyperinflated. There is no pleural effusion or pneumothorax. The lungs appear clear. Bones appear demineralized with mild-to-moderate degenerative changes and rightward convex curvature centered along the mid thoracic spine. Along the left upper lateral chest there are irregularities involving the lateral aspect of the descending upper left ribs concerning for one or more rib fractures, possibly involving the second through fourth ribs, although acuity is uncertain since old rib fractures were present on the left before.", "output": "Suspected left upper lateral rib fractures, incompletely characterized and of uncertain acuity. Characterization with dedicated rib films or CT could be considered if more detailed assessment is needed clinically. Although old rib fractures were seen on the prior CT, these appear irregular and are not necessarily old based on the imaging findings. Correlation with physical findings is recommended." }, { "input": "Chest, PA and lateral. Lung volumes are low and there is bibasilar atelectasis. This likely acount for opacity seen in the lower lobe on the lteral view. No definite infiltrate. No chf or effusion. The hilar and cardiomediastinal contours are within normal limits. There is no pneumothorax.", "output": "Low lung volumes with bibasilar atelectasis. Doubt acute pulmonary process." }, { "input": "The cardiac silhouette size is top normal. The aorta is tortuous. Calcifications within the right hilum likely reflect prior granulomatous disease. The pulmonary vascularity is not engorged. Tiny calcified granuloma is demonstrated within the right mid lung field. There is minimal linear atelectasis in the left lung base. No focal consolidation, pleural effusion or pneumothorax is present. Mild degenerative changes are noted in the thoracic spine.", "output": "Linear atelectasis in the left lung base. Evidence of prior granulomatous disease. No acute cardiopulmonary abnormality otherwise identified." }, { "input": "Moderate-sized left pleural effusion has increased in size and is associated with adjacent atelectasis and/or consolidation at the left base as well as elevation of the left hemidiaphragm. Cardiomediastinal contours are slightly shifted towards the right. On the right, linear atelectasis at the right lung base has improved, and a small pleural effusion persists. An air-fluid level at the region of the left thoracoabdominal junction may be within the stomach, but a gas-containing pseudocyst adjacent to the stomach could produce a similar appearance.", "output": "Interval increase in size of moderate left pleural effusion with adjacent atelectasis and/or consolidation. Air-fluid level at the left thoracoabdominal junction may be in the stomach or could reflect a pancreatic pseudocyst adjacent to the stomach given history of this entity. Consider CT for further evaluation." }, { "input": "Post pyloric feeding tube is seen, coursing beyond the stomach, off the inferior borders of the film. The cardiac, mediastinal and hilar contours are unchanged. There is slight rightward shift of midline structures which is stable. Moderate left pleural effusion is re- demonstrated, similar in size, with adjacent atelectasis. Linear opacity in the right lung base is new, and compatible with subsegmental atelectasis. Pulmonary vasculature is normal, and there is no pneumothorax. Degenerative changes are noted within the lumbar spine, and levoscoliosis of the thoracic spine is again seen.", "output": "Unchanged moderate left pleural effusion. Right basilar subsegmental atelectasis." }, { "input": "Frontal and lateral views of the chest. A moderate-sized left pleural effusion is stable to mildly decreased since ___. There is left lower lobe atelectasis. The right lung is clear. No focal opacities are seen. There is no pneumothorax. The cardiac and mediastinal contours are normal. A new transesophageal tube ends beneath the diaphragm.", "output": "Moderate-sized left pleural effusion is stable to mildly decreased in size since ___ with overlying atelectasis" }, { "input": "The lungs are well expanded, without focal parenchymal opacities. There is a large left-sided pleural effusion with associated compressive atelectasis. There might be a small right-sided effusion. There is no pneumothorax. Cardiomediastinal and hilar contours are unremarkable. A feeding tube ends in the abdomen, with the tip out of view, better assessed in the CT.", "output": "Moderate left pleural effusion, slightly worsened from ___. No evidence of pneumonia." }, { "input": "Lungs: The lungs are well inflated. There is no consolidation. Pleura: No pleural effusion is seen. There is no pneumothorax. Heart: The heart is not enlarged. Mediastinum and hila: There is no mediastinal mass. Osseous structures: The osseous structures are normal for age. Other findings: A venous access device terminates in the innominate vein directed to the left of midline. Epigastric surgical clips are noted.", "output": "Port catheter terminates in the innominate vein. NOTIFICATION: Dr. ___ ___." }, { "input": "The upright and lateral views of the chest were obtained. Stable elevation of the right hemidiaphragm is noted. There is no focal consolidation, effusion, or pneumothorax. Overall heart and mediastinal configuration is unchanged. Bony structures are intact.", "output": "No acute intrathoracic process. Stable right hemidiaphragmatic elevation." }, { "input": "PA and lateral views of the chest. Left transvenous pacemaker wire ends in the right ventricle. Lungs are clear. There is no pneumothorax. There is no evidence of rib fracture. No evidence of pneumonia. The cardiac, mediastinal, and hilar contours are normal. No pleural effusions.", "output": "No evidence of pneumothorax or rib fracture." }, { "input": "Frontal and lateral views of the chest and two dedicated views of the right ribs were provided. The lungs are clear bilaterally. There is mild blunting of the right CP angle which could indicate a tiny pleural effusion. Otherwise, the lungs are clear. Cardiomediastinal silhouette is normal. At the level of indicated pain in the right lower rib cage, no definite fracture is identified.", "output": "Possible tiny pleural effusion on the right, otherwise normal." }, { "input": "PA and lateral views of the chest. The lungs are clear. There is no pneumothorax. Cardiomediastinal silhouette is within normal limits. There is persistent mild blunting of a posterior costophrenic angle potentially due to small effusion, unchanged. No acute osseous abnormality detected.", "output": "No definite acute cardiopulmonary process." }, { "input": "AP and lateral views of the chest. There is no confluent consolidation. There is however increased interstitial markings throughout the lungs. There is no effusion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities detected.", "output": "Increased interstitial markings in the lungs could be due to interstitial edema or potentially an atypical infection. Clinical correlation suggested." }, { "input": "There is a large left tension pneumothorax with shift of the mediastinum to the right and flattening of the hemidiaphragm. The right lung is clear. No pleural effusion or pneumonia.", "output": "Large left tension pneumothorax. The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 10:09 PM, ___ upon discovery of the findings." }, { "input": "A trace left apical pneumothorax, which was likely present on the post chest tube radiograph from yesterday, is unchanged. The left chest tube is unchanged in position. The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "Trace left apical pneumothorax is likely unchanged from the post chest tube radiograph from yesterday." }, { "input": "Compared to the prior radiograph, there has been insertion of a left chest tube with reinflation of left lung. Cardiomediastinal contour is normal and the lungs are clear.", "output": "Re-inflation of the left lung status post left chest tube placement." }, { "input": "Cardiac size is normal. The lungs are clear. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary abnormality" }, { "input": "There are low lung volumes, however the lungs are clear. Cardiomediastinal silhouette is normal. No pleural effusion or pneumothorax.", "output": "Low lung volumes, otherwise normal chest radiographs." }, { "input": "There is mild vascular cephalization and interstitial edema but focal opacities concerning for pneumonia. A chronic moderate left-sided pleural effusion associated with left lower lobe collapse is unchanged. Calcified right hilar lymph nodes are noted. The heart is mildly enlarged. Atherosclerotic calcifications at the aortic knob are present. No pneumothorax.", "output": "1. Mild pulmonary edema. 2. Stable chronic moderate left sided pleural effusion with left lower lobe collapse." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Comparison is made with the next preceding portable AP single view chest examination of ___. As before, there is borderline heart size. Considering that the patient has a marked chronic COPD and emphysema present the heart size suggests the possibility of some chronic CHF which can represent the presently existing small bilateral pleural effusions blunting the lateral pleural sinuses and extending in the depending posterior pleural space as noted on the lateral view. Comparison of the frontal views also suggests a diffusely present perivascular haze in the pulmonary circulation is more marked than it was on the previous study one week ago. There is no pneumothorax. Comparison with the previous study does not demonstrate any new discrete local pulmonary parenchymal infiltrate that may represent pneumonia. Similar as shown on previous examinations, there is status post distal left clavicular fracture and displacement.", "output": "Bilateral moderate amount of pleural effusions probably related to chronic CHF. No pneumothorax. Comparison with the next previous portable chest examination, progression of CHF signs in the form of perivascular haze in the pulmonary circulation." }, { "input": "The moderate left pleural effusion has slightly improved in comparison to the prior exam performed three days prior. The small right pleural effusion and loculated right mid lung pleural effusion are stable. Bibasilar atelectasis is not significantly changed. The cardiomediastinal silhouette is stable. An implantable cardiac device is in appropriate position.", "output": "1. Decrease in size of moderate left pleural effusion. 2. Stable small right pleural and loculated effusions. 3. Stable bibasilar atelectasis without new consolidation." }, { "input": "PA and lateral chest radiographs. The lungs are hyperexpanded, likely representing emphysema. However, there is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "AICD is unchanged with leads extending to the right atrium and right lateral ventricle. Cardiomediastinal silhouette is unremarkable. Linear opacity at the left lung base, likely represents atelectasis or pleural scarring, unchanged. There is no pleural effusion or pneumothorax. No evidence of pulmonary edema. No focal consolidation concerning for pneumonia.", "output": "No evidence of pulmonary edema." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. There is eventration of the right hemidiaphragm. Left-sided AICD is seen with leads extending to the expected positions of the right atrium and right ventricle. There also appear to be abandoned leads. No pulmonary edema is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "AP portable upright view of the chest. AICD is unchanged in position. Elevation of the right hemidiaphragm is again noted. The heart remains mildly enlarged. There is subtle increased opacity in the right mid to lower lung which in the right clinical setting could represent an early pneumonia. Left lung appears clear. No large pleural effusion or pneumothorax.", "output": "Increased opacity in the right mid to lower lung is concerning for an early pneumonia." }, { "input": "PA and lateral views of the chest provided. AICD is unchanged with leads extending to the region the right atrium right ventricle. The subtle opacity seen on earlier exam in the right mid to lower lung is less conspicuous and overall lung volumes are improved. Therefore, findings most likely attributable to atelectasis. On the current exam, there is no convincing evidence for pneumonia. No pleural effusion or pneumothorax. No convincing signs of edema. Cardiomediastinal silhouette unchanged. Bony structures are intact.", "output": "Improved lung volumes with decrease conspicuity of right lower lung opacity, therefore, findings more compatible with atelectasis." }, { "input": "No focal consolidation, pleural effusion, or pneumothorax is seen. Heart and mediastinal contours are within normal limits. There is no evidence for pulmonary edema.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. There is no pulmonary edema. Minimal atelectasis is seen in the lung bases. No focal consolidation, pleural effusion or pneumothorax is identified. There are no acute osseous abnormalities. Degenerative changes of the right acromioclavicular joint are noted with a well corticated ossific density superior to the joint seen.", "output": "Mild bibasilar atelectasis." }, { "input": "There is some further interval reexpansion of the right lung, although right pleural effusion remains. There is no pneumothorax. Surgical clips superimposed upon the right chest are again noted. Chain suture in the bilateral lung apices is unchanged. The cardiac silhouette and mediastinal contours remain normal.", "output": "No pneumothorax, with further interval reabsorption of pleural fluid." }, { "input": "PA and lateral views of the chest were reviewed. Compared to the prior study there has been an interval increase in the right-sided pleural effusion that now tracks superiorly along the right lateral hemithorax. The trace left pleural effusion is unchanged. Linear opacity in the right lung may represent compressive atelectasis. The left lung is clear. There is no pneumothorax. Two chest tubes with tips ending in the right lung apex are unchanged in position. ___ in the mid to lower portion of the right lung are again noted. Small collections of fluid in the anterior soft tissues and pleural space are likely related to the recent surgery.", "output": "Interval increase in right-sided pleural effusion. Unchanged left pleural effusions." }, { "input": "There is a right pigtail chest tube in proper position projecting over the right lung. A small right pneumothorax is present. There is no left pneumothorax. There is no consolidation or pleural effusion. The cardiomediastinal silhouette is normal without evidence of shift. Surgical clips overlying the right mid lung and chain sutures in the left upper lung field are unchanged.", "output": "1. Small right pneumothorax. 2. Right chest tube in appropriate position." }, { "input": "Moderate to severe enlargement of the cardiac silhouette is present. The aorta is slightly tortuous. There is mild pulmonary edema with small bilateral pleural effusions. More focal opacities seen within the lung bases could reflect areas of atelectasis. No pneumothorax is identified. There are mild degenerative changes seen in the thoracic spine.", "output": "Mild congestive heart failure with mild pulmonary edema and small bilateral pleural effusions. Probable bibasilar atelectasis." }, { "input": "Lung volumes are low. Allowing for this difference in volumes, there is no significant change compared to ___. No large pleural effusion or pneumothorax. The cardiomediastinal silhouette is stable. No displaced rib fracture is identified.", "output": "No evidence of acute cardiopulmonary process or displaced rib fracture. No pneumothorax." }, { "input": "Frontal and lateral chest radiographdemonstrates well expanded and clear lungs.No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable. Limited assessment of the upper abdomen is within normal limits.", "output": "Normal chest radiograph. No pneumonia." }, { "input": "The heart size is normal. The aortic knob is calcified. The mediastinal contours are unremarkable. Patchy opacities are noted in the lung bases which is concerning for infection. No pleural effusion or pneumothorax is seen. There is likely mild pulmonary vascular congestion. No acute osseous abnormalities are visualized.", "output": "Patchy bibasilar airspace opacities are concerning for infection in the correct clinical setting." }, { "input": "PA and lateral chest radiographs were obtained. Compared to prior study, there has been no significant interval change. There is no evidence of focal opacity to suggest pneumonia. Several small areas of plate like atelectasis are again noted bilaterally. The cardiomediastinal silhouette, hilar contours and pleural surfaces are stable. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Heart. Size is within normal limits. Stable cardiomediastinal silhouette from ___. No pneumothorax. Lung fields are clear.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear. Cardiac size is normal. Hilar and mediastinal contours are normal. No pleural effusion of pneumothorax is seen.", "output": "Clear lungs with no consolidation or pleural effusions." }, { "input": "The cardiac, mediastinal and hilar contours are within normal limits. The pulmonary vascularity is normal. The lungs are clear. No pleural effusion or pneumothorax is present. There are multilevel degenerative changes in the thoracic spine. Multiple old healed right-sided rib fractures are again noted. There is no free air under the diaphragms.", "output": "No acute cardiopulmonary abnormality. No free air under the diaphragms." }, { "input": "Two frontal images of the chest demonstrate ET tube in place with the tip 5.3 cm above the carina. Low lung volumes are seen, likely secondary to poor inspiration. Left lower lobe atelectasis is seen with some elevation of the left hemidiaphragm. The lungs are otherwise clear. There is no pneumothorax or pleural effusion. Cardiomediastinal silhouette is unremarkable.", "output": "ET tube in appropriate position. Left basilar atelectasis. Otherwise, unremarkable chest radiograph." }, { "input": "Lower lung volumes are seen on the current exam. There are patchy regions of consolidation at both bases, left greater than right. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. Old right rib fractures are noted.", "output": "Lower lung volumes on the current exam. While atelectasis may contribute to some of the bibasilar opacities, there is suspicion for underlying pneumonia. Repeat after treatment suggested to document resolution." }, { "input": "No focal consolidation, pleural effusion, or pneumothorax is seen. Biapical pleural thickening is stable. Heart and mediastinal contours are within normal limits. There is no evidence for large free intraperitoneal air under the diaphragm.", "output": "No radiographic evidence for large free intraperitoneal air." }, { "input": "PA and lateral views of the chest provided. Left chest wall AICD unchanged with leads extending to the region the right atrium and right ventricle. Lungs are clear without focal consolidation, large effusion or pneumothorax. There is no convincing evidence of congestion or edema. Mild cardiomegaly is noted. Mediastinal contour is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Mild cardiomegaly, otherwise unremarkable." }, { "input": "Portable supine chest radiograph ___ at 06:56 is submitted.", "output": "Endotracheal tube and nasogastric tube are unchanged position, although the tip of the nasogastric tube is not included on the image. Lung volumes remain somewhat low with no obvious airspace consolidation to suggest pneumonia, although a recent chest CT revealed areas of consolidation in the right middle lobe and at both lung bases. A small nodular opacity at the right lung base most likely represents a vessel on-end when correlated with recent chest CT of ___. No pulmonary edema. Cardiac and mediastinal contours are unchanged." }, { "input": "There is no consolidation, pneumothorax, or large pleural effusion. ET tube terminates 5.4 cm above the carina. Cardiomediastinal and hilar silhouettes are normal size. No displaced rib fracture is identified.", "output": "Clear lungs. No displaced rib fracture is identified." }, { "input": "Lungs are clear. No pleural effusion or pneumothorax. Heart size is normal. Dual lead defibrillator with the tips in the RA and RV is new.", "output": "No acute cardiopulmonary process." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified. Surgical clips are noted in the right axilla, and projecting over the right lung base.", "output": "No acute intrathoracic process." }, { "input": "Mild left basilar atelectasis is seen without definite focal consolidation. No pleural effusion or pneumothorax is seen. The aorta is unfolded and tortuous. The cardiac silhouette is mildly enlarged. No pulmonary edema is seen. Prominent main pulmonary artery was better assessed on prior CT from ___.", "output": "No focal consolidation to suggest pneumonia. Mild cardiomegaly. Tortuous aorta. No pulmonary edema." }, { "input": "The cardiomediastinal and hilar contours are normal. The lungs demonstrate subtle bibasilar opacities. There is no pleural effusion or pneumothorax.", "output": "Subtle bibasilar opacities which in the appropriate context may represent early pneumonia." }, { "input": "PA and lateral views of the chest ___ at 09:56 are submitted.", "output": "There are stable left perihilar and suprahilar hilar opacities with associated volume loss in the left lung consistent with post treatment changes for lung cancer. Lungs remain hyperinflated with changes suggestive of emphysema. No developing airspace consolidation is appreciated. There may be a small left effusion versus pleural thickening. No pneumothorax. No evidence of pulmonary edema." }, { "input": "Re- demonstrated is left infrahilar opacity consistent with chronic post treatment changes, with underlying volume loss and bronchiectasis, better characterized on prior CT. Increased bibasilar opacities are seen compared the prior study which may be due to infection, aspiration, disease progression not excluded. There is blunting of the right costophrenic angle which may be due to a trace pleural effusion. No pneumothorax is seen. Cardiac and mediastinal silhouettes are grossly stable.", "output": "Increased bibasilar opacities as compared to the prior study, may be due to infection, aspiration, disease progression not excluded. Small right pleural effusion. Persistent left infrahilar opacity consistent with chronic posttreatment changes, with underlying volume loss and bronchiectasis, better characterized on prior CT." }, { "input": "The lungs are well inflated and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "Normal chest radiographic examination." }, { "input": "AP upright and lateral views of the chest provided. There is persistent left perihilar opacity which is not significantly changed from the prior exam and may reflect known lung cancer or treatment related scarring. No definite signs of pneumonia. No pleural effusion or pneumothorax. Heart size is normal. Bony structures remain intact. No free air below the right hemidiaphragm.", "output": "Similar overall appearance of left perihilar opacity, may reflect known primary lung cancer or treatment related fibrosis." }, { "input": "There is persistent abnormal soft tissue density centered at the left hilum, potentially related to previously treated malignancy. Previously seen for infrahilar opacity on the left in ___ has resolved. Biapical scarring is again noted. Elsewhere, the lungs are clear. Cardiac silhouette is within normal limits. No acute osseous abnormalities.", "output": "Left perihilar opacity which may be related to post treatment changes although underlying tumor would be difficult to exclude. No new region of consolidation or evidence of infection." }, { "input": "The lungs are well expanded. Bibasilar ill-defined opacities are reidentified not significantly changed from prior examon ___. Of note, new rounded opacities are noted in the left perihilar location measuring approximately 1.4 and 1.3 cm respectively. There may also be another rounded opacity measuring 1.2 cm in the right upper lobe. Cardiomediastinal and hilar contours are grossly unremarkable. There is no pleural effusion or pneumothorax.", "output": "1. New rounded opacities in the left perihilar region and in the right upper lobe in this patient with history of substance abuse raise concern for pulmonary infectious emboli. the differential includes other causes of pulmonary nodules. Further assessment with CT is recommended. 2. Unchanged bibasilar opacities from ___ raise concern for chronic infectious pneumonia, likely from an atypical organism in this immunocompromised patient. Chrnoci aspiration or an inflammatory process might also account for this appearance." }, { "input": "A left perihilar opacity is similar in appearance compared to the radiograph dated ___. There is also dense opacification overlying the mid thoracic spine on the lateral, which is also unchanged. There are persistent bibasilar opacities, which may reflect atelectasis. No new focal consolidations are visualized. No pulmonary edema. No pleural effusion. No pneumothorax.", "output": "1. Persistent left perihilar opacity and dense opacification overlying the mid thoracic spine, similar in appearance compared to the prior radiograph. This is not fully characterized based on its radiographic appearance. 2. Persistent bibasilar opacities, which may reflect atelectasis 3. No new focal consolidations. No gross effusion." }, { "input": "Semi-upright portable AP view of the chest are provided. Overlying EKG wires somewhat limit the evaluation. There is subtle ground-glass nodularity in the lower lungs which could reflect pneumonia. Overall, this appearance has not significantly changed from prior. The upper lungs remain well aerated. No effusion. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Subtle nodularity in the lower lungs, unchanged, could represent pneumonia." }, { "input": "When compared to multiple prior exams, there has been no significant interval change. Persistent left perihilar and lower lung opacities are again seen as well as the right apical opacity. There is no new focal consolidation or effusion. The cardiomediastinal silhouette is stable. No acute osseous abnormalities.", "output": "No significant interval change." }, { "input": "Chest PA and lateral radiograph demonstrates unremarkable cardiomediastinal and hilar contours. There are reticulonodular opacifications in the bilateral lung bases with an increased opacification in the right upper lung. Findings are concerning for a multifocal pneumonia or possibly an atypical infectious process. No pleural effusion or pneumothorax evident. No osseous abnormality is evident.", "output": "Right upper lobe and bibasilar opacification as described above, likely representing a multifocal infectious process, possibly atypical." }, { "input": "Left perihilar opacity is similar in appearance as compared to the prior study. Biapical scarring is again noted. Right apical opacity underlying the fourth rib is stable. No definite new focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No significant interval change from radiographs from ___" }, { "input": "There are infrahilar interstitial abnormalities, without pleural effusion or pneumothorax. The cardiac silhouette is normal in size, the mediastinal contours are normal. There is mild S-shaped scoliosis of the thoracolumbar spine.", "output": "Perihilar interstitial abnormality, which could be consistent with pneumocystis jiroveci pneumonia." }, { "input": "Frontal and lateral views of the chest. There are bilateral lower lobe and right upper lobe consolidations worrisome for pneumonia. Prominence of the left hilus is likely from reactive lymphadenopathy. No pleural effusion or pneumothorax. Heart size is normal. The mediastinal contours are unremarkable.", "output": "Bilateral opacities concerning for multifocal pneumonia, possibly atypical. Findings discussed with Dr. ___ by Dr. ___ at 03:55 AM on ___ by telephone at the time of discovery." }, { "input": "Increased opacity projects over the left hilum in the suprahilar region, seen posteriorly on the lateral view. Given differences in projection and technique these have not significantly changed. Additional right basilar opacity is slightly more conspicuous on the current exam on the frontal view but not clearly delineated on the lateral. Elsewhere, lungs are clear. Cardiomediastinal silhouette is stable. No acute osseous abnormalities.", "output": "Left perihilar opacity which given differences in positioning has not dramatically changed since prior and is compatible with underlying neoplasm with post treatment changes. Right basilar opacity seen only on the frontal view, potentially atelectasis, to be correlated clinically." }, { "input": "Left suprahilar fibrosis and atelectasis in the superior segment of the left lower lobe likely due to prior radiation, as noted on prior studies. No new focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable.", "output": "Left super hilar fibrosis in atelectasis may relate to prior radiation, similar to the prior study. No definite new focal consolidation is seen." }, { "input": "Heart size is normal. Leftward shift of mediastinal structures is similar, due to volume loss in the left lung. Left perihilar and suprahilar fibrosis with bronchiectasis and left lower lobe atelectasis appears grossly unchanged, and likely due to prior radiation therapy. Lungs are hyperinflated with emphysematous changes noted in the upper lobes. No new focal consolidation, pleural effusion or pneumothorax is seen. There is no pulmonary vascular engorgement. No acute osseous abnormality is present.", "output": "Unchanged left suprahilar and perihilar fibrosis with scarring and atelectasis in the left lower lobe, likely due to prior radiation. No new consolidation to suggest pneumonia." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Compared to ___, persistent left perihilar opacity and dense opacification overlying the mid thoracic spine, consistent with radiation changes. Bibasilar atelectasis. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Compared to ___, stable radiation changes in the left lung." }, { "input": "The lungs are mildly hypoinflated with crowding of vasculature and new heterogeneous granular right lower lobe opacity. Persistent left perihilar opacity is unchanged since ___ consistent with known left lung cancer. Biapical scarring again noted. Heart size, mediastinal contour, and hila are otherwise unremarkable. No pleural effusion or pneumothorax.", "output": "1. Stable left perihilar opacity consistent with known left lung cancer, unchanged since ___. 2. Heterogeneous right lower lobe opacity may represent atelectasis, aspiration, pulmonary hemorrhage, or pneumonia. RECOMMENDATION(S): Recommend repeat full inspiration chest radiograph for further evaluation. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the ___ ___ at 9:12 AM, 5 minutes after discovery of the findings." }, { "input": "AP portable upright view of the chest. Mild ground-glass opacities are seen involving the mid to lower lungs which raise potential concern for edema or atypical infection. Patient is known to have a 1.6 cm nodular opacity in the left lower lobe which is difficult to visualize on the radiograph. No large effusion or pneumothorax is seen. The cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "Mid to lower lung ground-glass opacities raise concern for atypical infection versus edema. Known 1.6 cm left lower lobe nodule better assessed on prior CT." }, { "input": "Compared to prior chest radiograph, there has been increased opacification in the left lower lobe and left perihilar region. The appearance of the right lung is grossly stable noting apical opacity likely due to prior radiation. The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. Views of the upper abdomen are unremarkable.", "output": "Increased opacification in the left lower lobe and perihilar region, concerning for pneumonia. Please note that interval followup after treatment will be necessary especially in light of patient's history of malignancy." }, { "input": "When compared to priors dating back to ___, there has been no significant interval change. Opacity in the left mid and lower lung is unchanged. There is no new consolidation or effusion. The cardiomediastinal silhouette is stable. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process. Persistent left mid to lower lung opacity which could be potentially infection, radiation pneumonitis or combination of both." }, { "input": "Since previous examination, increased interstitial abnormality extends from the infrahilar areas bilaterally into the mid and lower lungs and to a lesser degree, in the upper lungs, without focal consolidation, pleural effusion, or pneumothorax. Heart and mediastinal contours are unremarkable.", "output": "Increased interstitial abnormality is suspicious for pneumocystis infection as on the previous examination; however, other atypical infections and pulmonary edema can have a similar appearance in this patient without obvious cardiac history." }, { "input": "Opacities at the right lung apex, superior segment of the left lower lobe, and more generally about the left hilum appear unchanged without evidence for superimposed process. There has been no significant change.", "output": "Stable appearance of the chest." }, { "input": "Since the most recent comparison radiograph, the lungs are better inflated, and there is worsened airspace opacification in the left mid lung.Left hilus is asymmetrically enlarged compared to the right, possibly due to lymphadenopathy.There is no pleural effusion or pneumothorax.", "output": "Increased airspace opacity in the left lower lobe compared to ___. Findings are concerning for infection, however in the setting of known malignancy and the appropriate timing of radiation therapy, this could represent progression of post radiation fibrosis/scarring with or without local recurrence . NOTIFICATION: Findings were paged to Dr. ___ at 00:23" }, { "input": "Portable semi-upright radiograph of the chest demonstrates a normal cardiomediastinal silhouette. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "PA and lateral views of the chest were provided. In this patient with known cancer, there is left perihilar opacity with retraction of the hilum, better characterized on the CT torso dated ___. The overall appearance of the chest appears stable from prior exam. There is no evidence of pneumonia or CHF. No effusion or pneumothorax. The heart size is stable. Bony structures appear intact. An old right deformity is redemonstrated along the eighth right posterior rib.", "output": "Left hilar opacity with upward retraction of the left hilar structures, stable from prior exam in this patient with known lung cancer. No signs of superimposed pneumonia." }, { "input": "Heart size, mediastinal and hilar contours are within normal limits and without change. A subcentimeter well-circumscribed nodular opacity overlies the sixth left anterior rib level and is not clearly visualized on prior radiographs. Although potentially due to a nipple shadow, a small nodular opacity is also observed in the retrosternal region on the lateral view, raising the concern for a possible lingular lung nodule. Lungs are otherwise clear, and there are no pleural effusions. Postoperative changes are present in the cervical spine.", "output": "Questionable lung nodule versus nipple shadow. Initial further evaluation with repeat radiograph with nipple markers is recommended, as communicated by telephone to Dr. ___ on ___ at 9:09 a.m. at the time of discovery." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures appear within normal limits.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process. No focal consolidation to suggest pneumonia." }, { "input": "The study is limited by patient rotation and external objects on the chest. Tracheostomy tube and right PICC are unchanged in position. Moderate bilateral pleural effusions, edema and right lower lobe collapse are similar. No new parenchymal consolidation.", "output": "Moderate bilateral pleural effusions and edema. No significant change." }, { "input": "The enteric tube traverses the diaphragm into the left upper quadrant and its tip is not visualized. The ETT has since been removed. Lung volumes remain low. Asymmetric opacity of the right lower lung is perhaps minimally improved and may reflect atelectasis and small right pleural effusion. The heart is top-normal in size. No pneumothorax.", "output": "1. Replaced nasogastric tube is likely in the stomach. 2. Slight interval improvement in right atelectasis and small right pleural effusion." }, { "input": "Tip of the endotracheal tube projects 4 cm from the carina. Enteric tube terminates below the diaphragm.There is a small right pleural effusion and opacification of the right infrahilar region, which likely represents right middle lobe collapse. Streaky atelectasis in the left infrahilar region is also noted. No pneumothorax.", "output": "1. Satisfactory position of endotracheal and enteric tubes. 2. Small right pleural effusion and likely right middle lobe collapse." }, { "input": "The lungs are moderately well inflated. No pleural effusion or pneumothorax. Heart is top-normal in size. Mediastinal contour and hila are unremarkable. Atherosclerotic calcifications are noted.", "output": "No acute cardiopulmonary process. Specifically, no pulmonary edema." }, { "input": "Moderate cardiomegaly is unchanged. The mediastinal and hilar contours are stable. There is slight worsening of right basilar opacity. Previous vascular congestion is improved. There is no large pleural effusion or pneumothorax.", "output": "Slight worsening right basilar opacity could reflect interval aspiration." }, { "input": "Portable AP upright chest radiograph ___ at 16:32 is submitted.", "output": "The heart remains stably enlarged. Right subclavian PICC line is unchanged in position with the tip in the distal SVC. There is improved aeration at the right base consistent with resolving aspiration. No pulmonary edema or pneumothorax. No large effusion. A portion of an IVC filter is visualized." }, { "input": "The lungs are well-expanded and clear. No pleural effusion or pneumothorax. Stable mild cardiomegaly. Mediastinal contour and hila are unremarkable. There are no pneumothoraces. There is been interval placement of a left IJ catheter with tip terminating along the left upper thorax, likely within the left brachiocephalic vein. Slight kink is seen within the upper portion of the catheter.", "output": "1. New left IJ ___ catheter with tip terminating along left upper thorax. 2. Stable mild cardiomegaly. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the ___ ___ at 1:59 PM, 5 minutes after discovery of the findings." }, { "input": "There is no focal consolidation. An IVC filter is partially imaged. The osseous structures are demineralized. The cardiomediastinal silhouette, including mild cardiomegaly, is stable. There has been interval removal of right approach PICC.", "output": "No focal consolidation or significant pulmonary edema." }, { "input": "The lungs are fully expanded and clear. No pleural effusion, pulmonary edema, or pneumothorax is seen. The heart, mediastinal and pleural surface contours are normal. A density seen projecting over the region of the bifurcation of the left main stem bronchus could represent a vessel or a possible foreign body, not clearly visualized on the lateral view.", "output": "Question of possible radiodense foreign body projecting over the region of the bifurcation of the left main stem bronchus could represent a vessel or a possible foreign body. This may be further evaluated with shallow oblique radiographs." }, { "input": "The patient is rotated somewhat to the right. Given this, The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Evidence of DISH is seen along the thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "Compared with prior radiographs on ___, there is no significant change. The lungs are hyperinflated with flattening of the diaphragms, similar to prior.There is no focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No pneumonia." }, { "input": "The lungs are well-expanded and clear. The cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion, pneumothorax, or focal consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. Pathcy opacities in the left lower lobe suggest pneumonia, perhaps best depicted on the lateral view. Elsewhere, the lungs appear clear. There is no pleural effusion or pneumothorax. Bony structures are unremarkable.", "output": "Left lower lobe opacity worrisome for pneumonia in the appropriate clinical setting. Follow-up radiographs are recommended to show resolution." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No evidence of pneumonia. No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest are compared to previous exam from ___. Indistinct pulmonary vascular markings are seen throughout the lungs. There is no evidence of frank consolidation or large effusion. The cardiac silhouette is massively enlarged, similar in configuration compared to prior. Osseous and soft tissue structures are unremarkable.", "output": "Mild failure. Massive cardiomegaly, similar to previous exam." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Small to moderate bilateral pleural effusions are seen. The heart is severely enlarged which is discordant with the mild pulmonary vascular congestion suggesting underlying pericardial effusion or cardiomyopathy. A retrocardiac opacity may represent atelectasis and/or fluid in the major fissure. Recommend comparison with prior outside hospital study.", "output": "1. Small to moderate bilateral pleural effusions. 2. Severely enlarged heart discordant with mild pulmonary vascular congestion suggesting underlying pericardial effusion or cardiomyopathy. 3. Retrocardiac opacity may represent is and/or fluid in the major fissure. Recommend comparison with prior outside hospital study. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 11:26 AM, 5 minutes after discovery of the findings." }, { "input": "The cardiomediastinal contours are within normal limits. The bilateral hila are unremarkable. The lungs are clear without focal consolidation. There is no evidence of pulmonary vascular congestion. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Analysis is performed in direct comparison with the next preceding similar study of ___. The heart size remains unchanged and is within normal limits. No configurational abnormality is seen. Normal dimension of thoracic aorta without evidence of local contour abnormalities. Pulmonary vasculature is not congested. No signs of acute or chronic parenchymal infiltrates are present. Lateral and posterior pleural sinuses remain free. No pneumothorax in the apical area. Skeletal structures of the thorax demonstrate some diffuse moderate degree of demineralization of the vertebral bodies in the thoracic spine but no evidence of vertebral body compression fracture is present. Similar as on previous examination is evidence of multiple surgical clips in the right lower chest area coinciding with deformity of the right-sided breast shadow is compatible with surgical lumpectomy intervention. These findings appear stable. The same holds for previously identified surgical clips in the left upper abdominal quadrant.", "output": "Stable chest findings. No evidence of acute infiltrates in this ___-year-old female patient with cough for two weeks." }, { "input": "Right-sided AICD device is noted with leads terminating in unchanged positions. Abandoned pacer leads are also noted within the left chest wall. Severe cardiomegaly with left ventricular predominance is again noted. The mediastinal contour is unchanged. There is mild pulmonary vascular congestion, new in the interval. Retrocardiac streaky opacity likely reflects atelectasis. No pleural effusion or pneumothorax is demonstrated. There are no acute osseous abnormalities.", "output": "Retrocardiac atelectasis and new mild pulmonary vascular congestion." }, { "input": "The heart remains moderately enlarged with left ventricular predominance. A right-sided AICD/pacemaker device is again noted with leads in unchanged positions. Abandoned left-sided pacer leads are also noted. The aorta remains unfolded, and the mediastinal and hilar contours are unchanged. Pulmonary vascularity is normal. No pleural effusion or pneumothorax is seen. The lungs are clear. Mild loss of height of a low thoracic vertebral body is unchanged.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Right chest wall pacer is again noted. Additional lead along the left lateral chest wall is similar compared to prior. The lungs are clear without consolidation, effusion, or edema. Cardiac silhouette is enlarged as on prior. No acute osseous abnormalities.", "output": "Cardiomegaly without acute cardiopulmonary process." }, { "input": "There is severe cardiomegaly, unchanged. Mild vascular congestion may be slightly increased. There is no overt pulmonary edema. There is no pleural effusion or pneumothorax. A right chest wall pacing device and its leads are stable in position within the right atrium and right ventricle.", "output": "Mild vascular congestion may be somewhatincreased. Unchanged, severe cardiomegaly." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. Mild hilar congestion is similar to the prior study in ___. No overt pulmonary edema. Severe cardiomegaly is unchanged. Multiple pacer leads are unchanged in position. No acute osseous abnormalities identified.", "output": "Unchanged mild hilar congestion and severe cardiomegaly, without acute cardiopulmonary process." }, { "input": "Severe cardiomegaly is chronic. A right pacemaker generator projects over the right chest wall contiguous with leads which are in unchanged position. Lung volumes are low. There is mild bronchial cuffing consistent with mild edema. Diffuse osteopenia and mild degenerative change of thoracic spine. There is no pneumothorax or pleural effusion.", "output": "Mild pulmonary edema is new from ___. Chronic severe cardiomegaly" }, { "input": "A right chest cardiac device is an unchanged orientation, and associated leads demonstrate a stable configuration in comparison to prior radiograph from ___. There is stable severe cardiomegaly. The mediastinal contours are unchanged. Lung volumes are low. There is pulmonary vascular congestion and likely moderate pulmonary edema. A retrocardiac opacity may represent atelectasis in the setting of low lung volumes, however infection cannot be excluded by radiograph. There is probably a trace left pleural effusion. There is no prior right pleural effusion. There is no pneumothorax.", "output": "1. Stable severe cardiomegaly. Pulmonary vascular ingestion and likely moderate pulmonary edema. 2. Likely small left pleural effusion. 3. Low lung volumes. Retrocardiac opacity likely reflects atelectasis, however infection cannot be excluded by radiograph in the appropriate clinical setting." }, { "input": "Single AP upright portable view of the chest provided. The intervally new right chest wall AICD is seen with 2 leads seen extending into the right atrium and right ventricle. Left-sided leads are also seen extending into the right heart. Cardiomegaly is again noted with stable mediastinal contour. Mild hilar congestion is likely present without frank pulmonary edema. No pleural effusion or pneumothorax. No free air below the right hemidiaphragm is seen. Osseus structures appear intact.", "output": "Stable cardiomegaly. Interval exchange of right chest wall pacer device with leads coursing into the region of the right atrium and right ventricle." }, { "input": "Two views of the chest again demonstrate a right chest wall pacer device with leads overlying the right atrium and ventricle. Left approach leads also terminate over the right heart. These are all unchanged in position. There is severe cardiomegaly, unchanged. Increased prominence is likely related to low lung volumes. Mild hilar congestion is improved compared to early ___. There is no focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process. Unchanged severe cardiomegaly." }, { "input": "Lung volumes are low. There is chronic severe cardiomegaly and mild pulmonary vascular congestion. A right sided pacing device and its leads are in stable position over the right atrium and ventricle. Previously noted right hilus abnormality and small pulmonary nodules are not well seen on this conventional radiograph. .", "output": "Chronic severe cardiomegaly and mild pulmonary vascular congestion." }, { "input": "Heart size is unchanged, and top normal. Mediastinal and hilar contours are unremarkable. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities are present.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified.", "output": "Normal chest x-ray." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. There is no evidence of pneumonia, pneumothorax, or pleural effusion. Cardiac silhouette is normal in size.", "output": "Normal chest x-ray." }, { "input": "AP portable supine view of the chest. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process" }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. There has been no significant change.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Heart size is normal. Mediastinal and hilar contours are within normal limits. Pulmonary vasculature is normal. The lungs are clear. No pleural effusion or pneumothorax is identified. No acute osseous abnormalities are demonstrated.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. The lungs remain clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. There is persistent mild elevation of the left hemidiaphragm and gaseous distention of the stomach. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size and mediastinal contours are normal. No focal consolidation, pleural effusion or pneumothorax. The stomach is distended with air.", "output": "Normal chest radiograph" }, { "input": "Single portable view of the chest. The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "Unremarkable portable chest x-ray." }, { "input": "The right-sided catheter is again seen, similar in position. There is been progressive re-expansion of the right lung, with decrease in size of the right apical pneumothorax and of the pneumothorax seen at the right lung base. There is residual atelectasis at the right lung base, but this is also improved. There does appear to be a small right effusion, similar prior, within associated hydro pneumothorax fluid level. The sizable bleb seen at the upper edge of the right lung on the prior study is not now visualized, but this may be due to changes in the configuration of the lung as it expands. Again seen are sutures at the left lung apex in this the patient with a known history or prior left-sided pneumothorax.", "output": "Continuing re-expansion of the right lung, with interval decrease in size of the right apical and right base pneumothoraces and improvement in the right base atelectasis. As before, there is actually a hydro pneumothorax at the right base, with a small right base pleural effusion." }, { "input": "AP portable upright view of the chest. There is a large right pneumothorax with complete collapse of the right lung. No shift of midline structures to the left to suggest a tension component. No pleural effusion. Suture material at the left lung apex suggests prior surgical resection. Left lung is otherwise unremarkable. Cardiomediastinal silhouette appears normal. Bony structures are intact.", "output": "Large right pneumothorax without signs of tension. Decompression with chest tube advised." }, { "input": "There has been interval placement of a right pleural pigtail catheter. There is a persistent large right pneumothorax. Subcutaneous emphysema is also noted. The left lung is clear with suture material projecting over the apex. The cardiac silhouette is unchanged. No pleural effusion is identified.", "output": "Interval placement of a right pleural pigtail catheter with a persistent large right pneumothorax." }, { "input": "Three chest tubes project over the right hemithorax. The right pneumothorax is tiny, decreased from the prior. No hemothorax/effusion. Interval improvement in subcutaneous emphysema in the right lateral chest wall. The lungs are clear and well-expanded. Suture in the left apex is unchanged. The heart is normal in size. The mediastinum is not widened. The hila and normal limits. No pulmonary edema or focal consolidation.", "output": "Tiny right apical pneumothorax with the chest tubes to water seal." }, { "input": "There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest were obtained. Since the prior exam, there has been development of consolidation in the left lower lobe, which could represent pneumonia or atelectasis and probable adjacent effusion. The patient is known to have adjacent rib fractures and the possibility of a hemothorax is not excluded. The right lung remains clear. Heart size is difficult to assess. Mediastinal contour appears grossly stable. The known rib fractures are better seen on the prior CT scan. Vein in the left upper abdomen is partially imaged.", "output": "Left lower lobe consolidation concerning for atelectasis and/or pneumonia. Left effusion, cannot exclude hemothorax given patient's known adjacent rib fractures as seen on the prior CT torso." }, { "input": "Endotracheal tube and nasogastric tube are in unchanged position. Left subclavian catheter again terminates in the left brachiocephalic vein. Lung volumes are low but improved from the previous examination without focal parenchymal opacity, pleural effusion or pneumothorax. Surgical drains project over the left upper quadrant.", "output": "No acute intrathoracic process." }, { "input": "Portable AP upright chest radiograph obtained. Left basal chest tube is in unchanged position with subcutaneous emphysema along the chest tube insertion site. There is persistent left mid and lower lung opacity which is compatible with persistent loculated effusion and persistent left lower lobe consolidation which has been characterized on a CT from ___, not significantly changed. The right lung remains clear. Bony structures intact.", "output": "No significant change from prior CT dated ___ with persistent left lower lobe consolidation and probable small loculated left pleural effusion." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest. Heart size and cardiomediastinal contours are normal. Lungs are clear without focal consolidation, effusion or pneumothorax.", "output": "Normal chest radiographs." }, { "input": "Lungs are clear. No pulmonary edema. Descending aorta is tortuous or dilated. No cardiomegaly. No pleural effusion. No pneumothorax.", "output": "The descending aorta is either tortuous or dilated. Otherwise, normal chest radiograph." }, { "input": "The lungs are clear bilaterally. No focal consolidations, pleural effusions or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. No pneumomediastinum or pneumoperitoneum.", "output": "No acute intrapulmonary process." }, { "input": "Left-sided Port-A-Cath tip terminates in the mid SVC. Heart size is borderline enlarged. The aorta remains tortuous. Mediastinal and hilar contours within limits. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion focal consolidation or pneumothorax is present no acute osseous abnormality visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Endotracheal tube tip terminates 3.3 cm from the carina. Enteric tube is seen with tip projecting off the inferior borders of the film, but the side-port is above the gastroesophageal junction. Right right-sided Port-A-Cath tip terminates in the low SVC. Heart size is normal. Aortic knob is calcified. Mediastinal and hilar contours are unremarkable. Apart from minimal streaky atelectasis in the left lung base, the lungs are clear. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities demonstrated.", "output": "1. Standard position of the endotracheal tube. 2. Enteric tube side port is above the gastroesophageal junction and should be advanced for optimal positioning. 3. Left basilar atelectasis." }, { "input": "Heart size, mediastinal and hilar contours are normal. New patchy opacities have developed in the left retrocardiac region with associated bronchial wall thickening. No pleural effusion.", "output": "New left lower lobe opacities with adjacent bronchial wall thickening are concerning for a developing pneumonia in this region." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well-expanded and clear lungs. Cardiomediastinal and hilar contours are unremarkable. The aorta is tortuous. There is no pneumothorax, pleural effusion or consolidation.", "output": "No pneumonia." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The heart is normal in size with mediastinal and hilar contours.", "output": "No acute intrathoracic process." }, { "input": "The heart size is normal. Mediastinal and hilar contours are unchanged. Pulmonary vascularity is normal. Lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lungs are well expanded bilaterally and clear. No lesions, pleural effusion, or pneumothorax are identified. There is mild tortuosity of the thoracic aorta. Otherwise, cardiomediastinal silhouette is within normal limits and unchanged. Pleural surfaces are unremarkable.", "output": "No evidence of pneumonia. These findings were reported to Dr. ___ ___ phone at 8:45 p.m. by ___ ___." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unchanged. The pulmonary vasculature is normal. Previously demonstrated patchy opacity within the left lower lobe persists, but appears slightly improved compared to the prior exam. The right lung is clear. No pleural effusion or pneumothorax is present.", "output": "Improved aeration within the left lower lobe with residual patchy opacity likely reflecting improving pneumonia." }, { "input": "PA and lateral views of the chest. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary nodule. The cardiomediastinal silhouette is within normal limits.", "output": "No evidence of active or prior pulmonary tuberculosis." }, { "input": "Two frontal and 1 lateral chest radiographs were obtained. The lungs are hyperinflated. The right costophrenic angle is blunted by a small pleural effusion. There is no consolidation or pneumothorax. Cardiac and mediastinal contours are normal. Convex right thoracic scoliosis is mild.", "output": "Hyperinflated lungs." }, { "input": "There is no consolidation, pleural effusion or pneumothorax. Cardiomediastinal contours are normal. No acute osseous abnormalities identified. There is no subdiaphragmatic free air.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is top normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is top normal in size.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. The heart size and cardiomediastinal contours are normal. The lungs are clear. No focal consolidation, pleural effusion, or pneumothorax. Surgical clips overlie the abdomen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. Lungs are clear. No signs of pneumonia. No effusion or pneumothorax. Heart and mediastinal contours are stable and normal. Bony structures are intact.", "output": "No acute findings in the chest." }, { "input": "Frontal and lateral views of the chest demonstrate increased lung volumes. There is no focal consolidation, pleural effusion, or pneumothorax. The hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Partially imaged upper abdomen is unremarkable. Right lower lobe 5 mm nodular opacity is better seen on ___ CT exam.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "No significant interval change is seen with no focal consolidation, pleural effusion or pulmonary edema visualized. The cardiac and mediastinal contours are unchanged.", "output": "No acute cardiopulmonary disease including pneumonia is seen." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Compared with ___ at 11:29 and allowing for differences in positioning and technique, I doubt significant interval change. Again seen is prominent retrocardiac opacity, with a single surgical clip overlying the cardiac silhouette. As before, the possibility of a left-sided effusion cannot be excluded. Also again seen is upper zone redistribution an atelectasis in the right cardiophrenic region, in the setting of low inspiratory volumes. Allowing for this, the right lung is otherwise grossly clear. No pneumothorax is detected in the setting of lordotic positioning. Prominent lucency is seen in the left upper quadrant of the abdomen, but could represent gas within the stomach.", "output": "1. Doubt significant interval change compared with earlier the same day. 2. Increased retrocardiac opacity again noted, similar to the prior study. 3. No new focal opacity identified . Doubt significant CHF." }, { "input": "Similar appearance of the chest following chest tube (?pericardial drain) removal. The heart is enlarged with a left retrocardiac opacity again seen. Lung volumes continue to be low, and no large pneumothorax is seen.", "output": "As above." }, { "input": "Compared to the most recent prior chest x-ray, no significant change is detected. Inspiratory volumes are slightly low. Again seen is increased retrocardiac density, with obscuration of the left hemidiaphragm. This area of retrocardiac opacity apparently includes the patient's known necrotic lung mass, which was better depicted on the ___ CT scan. There is upper zone redistribution, without overt CHF. There is platelike atelectasis at the right lung base medially. Tubing seen overlying the left hemidiaphragm likely corresponds to the the patient's pericardial drain.", "output": "Doubt significant change compared with ___ at 19:26." }, { "input": "The pericardial effusion has probably decreased in size. There is a moderate left pleural effusion and basilar atelectasis. There is a rounded opacity in the right upper lobe corresponding to subpleural nodule seen on prior chest CT. There is no pneumothorax. Hilar and mediastinal contours are normal.", "output": "Pericardial effusion has probably decreased in size. Moderate left pleural effusion and basilar atelectasis. Right upper lobe rounded opacity corresponding to subpleural nodule seen on previous chest CT." }, { "input": "The lungs are well expanded clear. Mediastinal contours, hila, and cardiac silhouette are normal. No pleural effusion or pneumothorax.", "output": "No evidence of pneumonia." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities are detected.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. There is no visualized pneumomediastinum. No acute osseous abnormalities. No free intraperitoneal air.", "output": "No acute cardiopulmonary process." }, { "input": "Patient is status post median sternotomy and CABG. There has been interval removal of a right IJ central venous catheter. There are low lung volumes. Small bilateral pleural effusions, left greater than right, with overlying atelectasis. Relatively linear opacity in the left mid lung may represent atelectasis, but consolidation is not excluded in the appropriate clinical setting. No pneumothorax is seen. The cardiac and mediastinal silhouettes are grossly stable.", "output": "Low lung volumes. Left greater than right small bilateral pleural effusions with overlying atelectasis. Relative linear opacity in the left mid lung may represent atelectasis, but consolidation from pneumonia is not excluded in the appropriate clinical setting." }, { "input": "Again seen is a mildly tortuous thoracic aorta. Otherwise, the cardiomediastinal silhouettes are stable and within normal limits. The bilateral hila are unremarkable. The lungs are clear. There is no evidence of pulmonary vascular congestion there is biapical pleural-parenchymal scarring. There is no pneumothorax or pleural effusion. Old healed left tenth rib fracture. Unchanged thoracic scoliotic curve.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs were obtained. Lung volumes are low, but the lungs are clear. No effusion or pneumothorax is present. The heart and mediastinal contour are normal.", "output": "No acute pulmonary process." }, { "input": "The moderate size, loculated left basal hydropneumothorax though traversed by a pigtail drain, has increased slightly since ___. A small, left fissural fluid loculation is stable. A band of atelectasis persistently distorts the left heart border. The hilar and mediastinal contours are otherwise unremarkable. The right lung and pleural space are normal.", "output": "Slight interval increase in moderate, loculated left basal hydropneumothorax despite indwelling pigtail drain. Stable atelectasis in the lingula and small left fissural pleural effusion. These findings were discussed with Dr. ___ at 12:28pm by Dr. ___ ___, by telephone on the day of the exam." }, { "input": "Heart size is normal with tortuous aorta. Hilar contours are normal. Again appreciated is a left nondependent hydropneumothorax with significantly increased fluid components, much of which appears to be loculated. There is adjacent left base atelectasis. The right lung is essentially clear. No expansile lytic bony lesions are identified. Surgical clips project over the right upper quadrant.", "output": "Persistent left hydropneumothorax with substantial increase in fluid component, much of which appears to be loculated. Results were discussed over the telephone with Dr. ___ by ___ at 11:32 a.m. on ___ at time of initial review." }, { "input": "There again appears to be slight interval increase in the loculated left basal pneumothorax compared to the film from ___ performed at 10:18 a.m. The pigtail catheter appears to be in place. There is again minimal left-sided pleural effusion, stable compared to the prior exam. The fissural loculation in the left upper lung appears stable compared to radiographs dating back to ___. The heart size is normal. The hilar and mediastinal contours are unremarkable.", "output": "Interval increase in the loculated left basal pneumothorax. These findings were discussed with Dr. ___ at 4:57pm by Dr. ___ ___, by telephone, on the day of the exam." }, { "input": "PA and lateral views of the chest demonstrate a left-sided pneumothorax that is similar in size to prior. A left lower hemithorax chest tube is unchanged. There is, in addition the appearance of a left pleural effusion. The right lung is essentially clear.", "output": "Persistent hydropneumothorax, however, no larger than prior, status post chest tube clamping." }, { "input": "There appears to be a slight interval increase in the loculated left basal pneumothorax. The pigtail catheter appears to be in place. There is minimal left-sided pleural effusion, stable compared to the prior exam. The fissural loculation in the left upper lung appears stable compared to radiographs dating back to ___. The heart size is normal. The hilar and mediastinal contours are otherwise unremarkable.", "output": "1. Interval increase in the loculated left basal pneumothorax. 2. Stable minimal left sided pleural effusion. These findings were discussed with Dr. ___ at 11:43 a.m. by Dr. ___ by telephone on the day of the exam." }, { "input": "Large left-sided pleural effusion has increased in size compared to the prior studies. Obscuration of the left hemidiaphragm and the left heart border from collapse of the left lower lobe and lingula is seen, and shift of mediastinum to the left is more prominent. Superimposed infection cannot be excluded. Right lung appears well expanded and clear without focal consolidation. There is no right-sided pleural effusion.", "output": "Increased large left-sided pleural effusion and left lung collapse. An underlying consolidation masked by the effusion and atelectasis cannot be excluded." }, { "input": "There is a moderate-to-large dependent left lower hemithorax pleural effusion which appears to have slightly increased in size compared to the study on ___ and is responsible for associated left lower lobe atelectasis. The right lung is clear. There is no evidence of mediastinal shift, suggestive of left lower lung volume loss. There is no evidence of a pneumothorax. The visualized osseous structures are unremarkable.", "output": "Slight interval increase in the left lower hemithorax pleural effusion. The right lung is clear." }, { "input": "PA and lateral chest views were obtained with patient in upright position. The heart size appears within normal limits. No configurational abnormality is seen. Thoracic aorta and mediastinal structures are unremarkable. The pulmonary vasculature is not congested. The right hemithorax is unremarkable. On the left, there is evidence of pleural effusion blunting the lateral pleural sinus and obliterating the diaphragmatic contours. The density continues along the lateral chest wall and reaches the apical portion in the form of a minor 2 mm wide density. As there is no evidence of any air-fluid level in the pleural space at any level, a new pneumothorax can be excluded. The accessible pulmonary vasculature does not show any congestive pattern and no new acute infiltrates are seen. Parenchyma of left lower lobe cannot be assessed as it is obscured by the pleural density. The next preceding torso CT of the preceding day (___) is reviewed, so to compare via at that time existing pleural density with today's finding. Paying attention to the different patient position between the two studies, precise detail estimate of fluid difference in the pleural space difficult, but a rough estimate of pleural effusion amount on the CT, compared to today's finding is compatible with the reported 550 mL thoracocentesis of pleural effusion. Although the CT examination does not give any conclusive evidence for any parenchymal abnormality in the left lower lobe, the CT demonstrated status post right-sided nephrectomy and central liver mass as noted during review of the scan.", "output": "Reduction of left-sided pleural effusion, but still moderate degree of remaining pleural effusion estimated to another 500 mL remaining." }, { "input": "A pigtail catheter is noted projecting over the right mid lung field laterally. There has been marked interval decrease in size of the previously demonstrated right pneumothorax, with only a small residual apical pneumothorax demonstrated. Previously noted leftward shift of mediastinal structures is also improved. The cardiac and mediastinal contours are normal. Lungs are clear without focal consolidation. No pleural effusion is demonstrated.", "output": "Status post right chest tube placement with marked interval reduction in size of the right pneumothorax, with only a residual small apical pneumothorax now seen. Previously noted leftward shift of mediastinal structures has resolved." }, { "input": "There has been interval exchange of a right pigtail thoracostomy tube with a larger bore drain. No pneumothorax is detected. There is no focal consolidation or pleural effusion. The heart size remains normal.", "output": "Interval upsizing of a right thoracostomy tube. No pneumothorax." }, { "input": "There has been interval placement of a right pigtail catheter, and there is improved aeration of the right lung. A small apical pneumothorax is likely present. The lungs are otherwise clear of focal consolidation, and the cardiac and mediastinal silhouette is within normal limits.", "output": "Interval placement of a right pigtail catheter with improved aeration of the right lung. A small right apical pneumothorax is likely present." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There is moderate right-sided pneumothorax. The maximum distance between the inner chest wall and outer pleural edge is about 3.5 cm. The pneumothorax appears probably unchanged. There is very slight leftward shift of mediastinal structures although perhaps slightly decreased.", "output": "Moderate right-sided pneumothorax including minimal leftward shift. The size of the pneumothorax appears not significantly changed and the degree of shift slightly decreased." }, { "input": "Endotracheal tube terminates 2.7 cm above the carina, likely related to changes in chin positioning. Right IJ venous catheter and enteric tube are in unchanged position. Lower lung volumes accentuate the bronchovascular structures. There is mild vascular engorgement and early pulmonary edema. No definite pneumonia or pleural effusions identified. An ossific density is again seen over the right acromion and distal right clavicle.", "output": "Mild pulmonary vascular engorgement and early pulmonary edema." }, { "input": "Endotracheal tube tip terminates 4.7 cm from the carina. Orogastric tube tip courses below the left hemidiaphragm, off the inferior borders of the film. The heart size is mildly enlarged. The aorta is tortuous and calcified. There is upper zone vascular redistribution and mild perihilar haziness compatible with mild pulmonary vascular congestion. Patchy ill-defined opacities in the lung bases could reflect aspiration, atelectasis or infection. No large pleural effusion or pneumothorax is identified. No acute osseous abnormality is seen. Ossific density is seen projecting over the right acromion and distal right clavicle.", "output": "Standard positioning of the endotracheal and orogastric tubes. Patchy bibasilar airspace opacities could reflect atelectasis but aspiration and infection are not excluded. Mild pulmonary vascular congestion." }, { "input": "There are diffuse bilateral parenchymal opacities. There is no large effusion. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "Diffuse bilateral parenchymal opacities." }, { "input": "Heart size remains mildly enlarged. The aorta is tortuous. Mediastinal and hilar contours are otherwise unremarkable. Pulmonary vasculature is normal. Linear opacities within the left upper lung field may reflect atelectasis or scarring. No focal consolidation, pleural effusion or pneumothorax is present. Lungs are hyperinflated. Mild degenerative changes are seen within the thoracic spine. Multiple rounded radiopaque densities projecting over the right shoulder are likely external to the patient. Marked narrowing of the right acromiohumeral interval suggests rotator cuff disease.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The left lower lobe of consolidation that was seen on yesterday's chest x-ray is re-demonstrated. There is also development of new diffuse opacities that are more prominent at the lung bases, likely due to pulmonary edema. No evidence of lobar collapse. Mild pulmonary vascular congestion. Stable mild to moderate cardiomegaly. No acute osseous abnormality.", "output": "1. Unchanged appearance of known LLL pneumonia. 2. New mild/moderate pulmonary edema." }, { "input": "There is new focal consolidation at the left lung base adjacent to the left heart border. Lateral view demonstrates an opacity projecting over the lower thoracic spine, suggesting left lower lobe pneumonia. Right lung is essentially clear. Small bilateral pleural effusions are noted, slightly increased since ___. No pneumothorax or pulmonary edema. Mediastinum and hila are within normal limits. Stable mild to moderate cardiomegaly.", "output": "1. New left lower lobe pneumonia. Recommend follow-up CXR in ___ weeks after treatment to document resolution. 2. Small bilateral pleural effusions, slightly worse compared to ___. NOTIFICATION: Findings telephoned to Dr. ___ by Dr. ___ on ___ at 4:47PM, time of discovery." }, { "input": "The lungs are well expanded. There is bilateral diffuse interstitial thickening and hilar engorgement, right worse than left, as well as vascular upper re-distribution compatible with interstitial edema and vascular congestion. Mild to moderate cardiomegaly is unchanged. There is a small right-sided pleural effusion. No pneumothorax is identified.", "output": "Moderate interstitial pulmonary edema and vascular congestion in the setting of mild to moderate cardiomegaly. No definite focal opacities concerning for pneumonia." }, { "input": "The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "Normal chest." }, { "input": "Lung volumes are low. Bilateral diffuse interstitial opacities are not significantly changed. There is no focal consolidation. No pleural effusion or pneumothorax is seen. Heart size is normal.", "output": "1. Bilateral interstitial opacities, better evaluated on recent CT chest. 2. No focal consolidation to suggest acute pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. Low lung volumes results in bronchovascular crowding. There is no focal consolidation, pleural effusion or pneumothorax. Bibasilar atelectasis is noted. Heart size is normal. Mediastinal silhouette and hilar contours are within normal limits.", "output": "No pneumonia, edema, or effusion." }, { "input": "The lung volume is low. There is bilateral diffuse interstitial opacities with no significant change from prior. Definitive consolidation is difficult to exclude due to the diffuse interstitial lung disease. There is mild pleural effusion, unchanged from prior. No pneumothorax. The cardiomediastinal silhouette is normal. No fractures.", "output": "1. Diffuse interstitial opacities with no significant change from prior. 2. There is no clear consolidation, which is in possible to exclude in the presence of diffuse interstitial lung disease." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were obtained. Heart is normal in size and cardiomediastinal contour is notable for a curvilinear density along the right cardiophrenic angle, sharply marginated, present on prior studies, likely representing a hiatal hernia. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "Compared to the prior study from earlier today, there is no interval change in the position of the pacemaker leads or the pacemaker generator. There is no pleural effusion. The cardiac and mediastinal contours are unchanged and the lungs are clear.", "output": "No interval change in position of pacemaker leads, since 8:30 this morning, and no development of pleural effusion." }, { "input": "Dual lead left-sided pacer is again seen at, unchanged in position. The patient is status post median sternotomy and CABG. The cardiac and mediastinal silhouettes are grossly stable. No pleural effusion or pneumothorax is seen. No definite focal consolidation. No overt pulmonary edema.", "output": "Dual lead left-sided pacemaker with leads without significant change in position. Otherwise, no acute cardiopulmonary process." }, { "input": "Compared to the prior study there is no interval change in cardiac lead positioning. The heart size is enlarged but stable. Lung parenchyma is clear. No pleural abnormality.", "output": "No interval change since ___" }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. No pulmonary edema is seen. The patient is status post median sternotomy and CABG. Left-sided 2 lead pacemaker is stable in position.", "output": "No acute cardiopulmonary process." }, { "input": "Compared to the prior study from ___, the heart size is essentially unchanged allowing for differences in technique. Mediastinal surgical clips and median sternotomy wires are stable. Left chest wall pacemaker generator and right atrial and ventricular leads appear appropriately positioned.", "output": "Appropriately positioned cardiac pacing wires with no evidence of pleural or pericardial effusion." }, { "input": "The heart is mildly enlarged. Sternal wires and multiple surgical clips are seen throughout the heart, stable compared to the prior exam. The hilar and mediastinal contours are unremarkable. There is no evidence of interstitial edema or pulmonary vascular congestion. No focal opacities suggestive of an infection are identified. There is no pleural effusion or pneumothorax.", "output": "No new infiltrates suggestive of infection. No secondary signs suggestive of congestive heart failure." }, { "input": "The heart size is normal. Mediastinal and hilar contours are normal. The pulmonary vascularity is normal. There is minimal streaky opacity within the left lower lobe, likely reflective of atelectasis. Blunting of the left costophrenic angle on the lateral view posteriorly suggests a small left pleural effusion. No right-sided pleural effusion or pneumothorax is definitively seen. There are mildly displaced fractures of the left lateral ___ and likely 9th ribs.", "output": "Mildly displaced fractures of the left ___ and likely ___ lateral ribs. Mild left lower lobe atelectasis and probable trace left pleural effusion." }, { "input": "There is no longer an apical component to the previously described left pneumothorax. A small-to-moderate left pleural effusion persists on the left with few areas of streaky associated atelectasis. An air-fluid level best seen on the lateral view indicated some degree of hydropneumothorax. There is no evidence of diaphragmatic flattening or mediastinal shift. Right mid rib fractures are nondisplaced, not well appreciated on the current exam.", "output": "Resolution of apical portion of left pneumothorax with lower left hydropneumothorax; no evidence of tension." }, { "input": "The cardiac, mediastinal and hilar contours are is probably unchanged allowing for decrease in lung volumes. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Mild bibasilar atelectasis. There is a new small left pleural effusion. No right pleural effusion. Heart size, mediastinal contour, and hila are unremarkable. No pneumothorax.", "output": "1. Bibasilar atelectasis. 2. Small left pleural effusion." }, { "input": "Heart size is normal. Mediastinal and hilar contours are within normal limits. Lungs are clear. Pulmonary vascularity is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are present.", "output": "Normal chest radiograph." }, { "input": "The lungs are hyperinflated and grossly clear. Cardiomediastinal and hilar silhouettes are normal. Pleural surfaces are normal.", "output": "Hyperinflated lungs which may represent underlying obstructive airways disease. Clinical correlation is recommended to assess for possible asthma or COPD. No evidence of interstitial lung disease or cardiomegaly." }, { "input": "The cardiac, mediastinal and hilar contours are normal. The lungs are hyperinflated with bullous changes seen at the lung apices. No focal consolidation, pleural effusion or pneumothorax is visualized. Degenerative changes with prominent osteophytes are again noted throughout the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Single portable AP chest radiograph was provided. Lungs are well expanded. They appear hyperlucent with increased reticulation, likely representing emphysema. No large focal consolidation, pleural effusion, or pneumothorax. Retrocardiac opacities are incompletely evaluated and may be normal but difficult to evaluate on this single projection. There are calcifications of the aorta. The bones are osteopenic.", "output": "Findings consistent with emphysema. Retrocardiac opacities may be normal, but is difficult to evaluate on this single projection. If there is clinical concern for pneumonia, a lateral projection may be helpful." }, { "input": "Single portable chest radiograph demonstrates unchanged exam. As before there is mild hyperinflation with relative hyperlucency of the bilateral upper lungs and paucity of vessels suggesting underlying emphysema. Stable retrocardiac opacification likely represents atelectasis though cannot exclude infection in the correct clinical setting. Dense atherosclerotic calcifications are noted within the aortic arch. Prominence of the right pulmonary artery suggests a degree of pulmonsry arterial hypertension. Heart size is not enlarged.", "output": "Unchanged exam. Stable retrocardiac opacification, most likely atelectasis though pneumonia not definitively excluded. Findings suggestive of pulmonary arterial hypertension." }, { "input": "Cardiac silhouette size is normal. The aortic knob is densely calcified. Mediastinal and hilar contours are unchanged, with bilateral hilar enlargement suggestive of pulmonary arterial hypertension. Lungs are hyperinflated with paucity of pulmonary vascular markings towards the upper lobes compatible with severe emphysema. Patchy opacities in the lung bases likely reflect atelectasis, though infection cannot be completely excluded in the correct clinical setting. No large pleural effusion or pneumothorax is seen, although the extreme right costophrenic angle is excluded from the field of view. There is no pulmonary vascular congestion.", "output": "Severe emphysema. Enlarged hila bilaterally suggestive of pulmonary arterial hypertension. Patchy opacities at the lung bases likely reflect atelectasis, though infection cannot be excluded in the correct clinical setting. ADDENDUM: Note is made of a right-sided PICC, ending in the mid SVC. This finding was communicated to IV nurse, ___, by Dr. ___ at 1:50 a.m. via telephone on ___." }, { "input": "Upright portable radiograph of the chest demonstrates clear lungs and normal hilar and cardiomediastinal contours. The increased apparent opacity in the right lower lung is due to a combination of minimal atelectasis, pulmonary vasculature, and prominent costochondral calcifications. There is no pneumothorax or pleural effusion. There are dense atherosclerotic calcifications in the aortic arch. Pulmonary vascularity is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Moderate cardiomegaly is stable compared to the prior exam. The aorta is mildly tortuous, and mild widening of the mediastinum is likely post-operative. There appears to be interval increase in a small left-sided pleural effusion with adjacent atelectasis. There has been interval improvement in the mild pulmonary edema. The median sternotomy wires appear to be intact without evidence of fracture.", "output": "Slight interval increase in small left pleural effusion with adjacent opacity likely secondary to atelectasis." }, { "input": "The visualized lung fields are clear of any focal consolidation, pleural effusions or pneumothorax, although streaky opacity in the lingula suggests very minor atelectasis. The heart is at the upper limit of normal in size. The aorta is moderately unfolded. The bony structures are unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Cardiac silhouette size is normal. Mediastinal and hilar contours are unremarkable. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Single portable view of the chest is compared to previous exam from ___. Lungs are notable for bibasilar atelectasis, but are otherwise clear. Cardiomediastinal silhouette is stable. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "An endotracheal tube has been placed with the tip terminating approximately 4 cm above the carina at the level of the thoracic inlet. An OG tube courses below the diaphragm with the tip terminating in the left upper quadrant, likely within the stomach. The cardiomediastinal silhouette is within normal limits. There is no large pleural effusion or pneumothorax. Multiple opacities predominantly in the left mid lung zone may represent multifocal infection or malignancy. There is also retrocardiac opacification and subtle increased density in the right lung base. No acute osseous abnormality is detected.", "output": "1. Appropriate position of support devices. 2. Multifocal opacities predominantly in the left mid lung zone could represent multifocal infection or malignant involvement. Further evaluation with dedicated CT of the chest is recommended." }, { "input": "Frontal and lateral radiographs of chest demonstrate well expanded clear lungs. There is no pneumothorax, consolidation, or pleural effusion. The cardiomediastinal and hilar contours are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal contours are normal. There is no pleural effusion or pneumothorax. The lungs are well expanded without focal consolidation concerning for pneumonia. The upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. Amplatz closure device projects over the cardiac silhouette. Cardiomediastinal silhouette and hilar contours are normal. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality. No evidence of tuberculosis." }, { "input": "PA and lateral views of the chest provided. Surgical clips noted in the upper abdomen. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are well expanded and clear. There is mild cardiomegaly. Upper mediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "Mild cardiomegaly is noteworthy in a patient of this age group. No evidence of pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are well expanded. There is no focal consolidation, pleural effusion or pneumothorax. Opacity adjacent to the right heart border is unchanged since ___ and corresponds to a fat pad on prior CT. Heart size is normal. Mediastinal silhouette and hilar contours are normal.", "output": "No pneumonia, edema or effusion. No change from ___." }, { "input": "The lungs are clear.The cardiac, hilar and mediastinal contours are normal.No pleural abnormality is seen. Opacity adjacent to the right heart border corresponds to a prominent mediastinal fat pad.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation, pleural effusion, or pneumothorax is seen. Mediastinal contours are within normal limits. Right medial lower lung opacity appears unchanged.", "output": "Stable chest radiographs without evidence for acute change." }, { "input": "The cardiomediastinal and hilar contours are normal. Lung volumes are somewhat low. There is an opacity in the right lower lobe consistent with pneumonia. There are small bilateral effusions. There is no pneumothorax.", "output": "Left lower lobe pneumonia. NOTIFICATION: Findings discussed with Dr. ___ at 10:30 on ___ by Dr. ___." }, { "input": "PA and lateral views the chest provided demonstrate no focal consolidation concerning for pneumonia. No effusion or pneumothorax. A nodular opacity projecting over the heart on lateral view and abutting the right heart border on the frontal view is compatible with known metastatic nodule seen better on prior CT chest. There is no pleural effusion or pneumothorax. The heart is normal in size. Compression deformity of T7 and T8 are grossly unchanged.", "output": "No pneumonia or CHF. Metastatic disease better assessed on prior CT chest." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lung fields are clear. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable. Mild endplate compression deformities of T7 and T8 are unchanged. A 2.3 cm rounded density seen on the lateral view is consistent with a known pulmonary nodule. Intrathoracic metastatic disease is better evaluated on CT chest ___.", "output": "1. No evidence of pneumonia. Extensive intrathoracic metastatic disease is better evaluated on chest CT ___. 2. Mild endplate compression deformities of T7 and T8 are unchanged." }, { "input": "AP portable upright view of the chest. Cardiomegaly is noted with mild pulmonary edema. No large effusion or pneumothorax is seen. A single lead pacemaker is seen extending into the right ventricle. The mediastinal contour is grossly unremarkable. The bony structures are intact.", "output": "Cardiomegaly with mild pulmonary edema." }, { "input": "A left pectoral pacemaker has been removed, but one of its leads remains in place. A new right pectoral pacemaker has been placed with its lead extending towards the left ventricle. Pulmonary edema has nearly resolved. There is no pneumothorax. Lung volumes are low, but there is no obvious consolidation. A small right pleural effusion has slightly decreased. There is stable cardiomegaly despite the projection.", "output": "Status post placement of new single lead pacemaker with no pneumothorax. Improved pulmonary edema. Slightly decreased small right pleural effusion. Stable cardiomegaly." }, { "input": "PA and lateral views of the chest. The right chest tube has been removed. There is no pneumothorax. Small bilateral pleural effusions and left lower lobe atelectasis are unchanged. Overall unchanged from study done five hours prior.", "output": "Chest tube has been removed. No pneumothorax. Lung findings are unchanged compared to study done five hours earlier." }, { "input": "A right large-bore internal jugular approach catheter tip remains in unchanged position within the upper SVC. A right basilar chest tube tip also remains in stable position. There are scattered areas of right greater than left basilar atelectasis. In addition there is apparent nodular opacification such as projecting over the left mid lung zone measuring up to 9 mm where previously smaller pulmonary nodules were noted on CT examination from ___. There is engorgement of the pulmonary vasculature without frank interstitial pulmonary edema. Cardiomediastinal and hilar contours are stable demonstrating mild cardiomegaly. There are no large pleural effusions or pneumothorax. The endotracheal tube has been removed in the interim. The epidural catheter is no longer apparent.", "output": "1. Removal of the endotracheal tube. Remaining support hardware in unchanged positions. 2. Nodular opacification demonstrated within the left mid lung zone where previously noted smaller pulmonary nodules were noted on ___ is concerning for progression of disease." }, { "input": "One portable upright chest x-ray. Chest tube seen ending in the medial lower right hemithorax. No pneumothorax is seen. Small bilateral pleural effusions are unchanged. There is left lower lobe atelectasis. The right internal jugular catheter and endotracheal tubes have been removed. The previously seen nodule in the left lung is not well seen on this study. No consolidation.", "output": "1. No pneumothorax. Chest tube is in the medial lower right hemithorax. 2. Unchanged small bilateral pleural effusions. Left lower lobe atelectasis." }, { "input": "The heart size is normal. Again seen are subtle right lower lobe opacities appear unchanged compared to the exam from ___. There has been an interval increase in the size of the opacification at the left lateral pleural region, likely secondary to increased size in bony lesions. The left lingular consolidation appears stable compared to the study from ___ and could be secondary to worsening metastatic disease or superimposed infection. The hilar and mediastinal contours are otherwise unremarkable.", "output": "1. Interval increase in the size of the left lateral opacities, likely secondary to worsening bony metastases. 2. Stable left lingular consolidation concerning for infection or metastastic disease." }, { "input": "Lungs are hyperinflated. The previous ground-glass opacity surrounding the fiducial marker in the left upper lobe has improved, reflecting partial resolution of hemorrhage. Small to moderate left pneumothorax is new since the prior exam. Left pleural effusion has increased since the prior study, now small to moderate. The right lung is grossly clear and known nodules are better evaluated on prior CT.", "output": "1. New small to moderate left hydropneumothorax. 2. Interval improvement in the left upper lobe hemorrhage from prior procedure. NOTIFICATION: At the time of this report, patient is in the Emergency department for the left hydropneumothorax as confirmed per discussion with Ed staff." }, { "input": "Left-sided pigtail catheter again projects over the left lung base. There is no visualized pneumothorax. Hazy opacity projects over the left mid lung with fiducial marker, unchanged, likely related to prior intervention. Streaky right basilar opacity is likely atelectasis. Cardiomediastinal silhouette is within normal limits.", "output": "No significant interval change." }, { "input": "Since prior, there has been interval placement of left-sided pigtail catheter projecting over the left costophrenic angle. There is no visualized pneumothorax on the current exam noting that the chin obscures portion of the lung apices bilaterally. Left basilar opacity is at least partially due to atelectasis. Fiducial marker now projects over the left mid upper lung focal opacity as seen on prior. Known spiculated right upper lung nodule is also noted. Cardiomediastinal silhouette is unchanged.", "output": "Interval placement of left-sided pigtail catheter. No visualized pneumothorax." }, { "input": "The cardiomediastinal and hilar contours are normal. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No radiographic evidence of pneumonia." }, { "input": "A pacing device projects over the left chest with leads in the right atrium, right ventricle, and coronary sinus. Sternotomy wires are intact. The heart size is within normal limits. The mediastinal contours demonstrate calcified atherosclerotic disease of the aortic knob and a tortuous aorta, following the scoliotic curvature of the spine. A large hiatal hernia is present. The lungs show no lobar consolidation or collapse. There is no pulmonary edema or pleural effusion nor is there pneumothorax. Incidental note is made of osteopenia of the bilateral humeral heads.", "output": "Hiatal hernia but no acute cardiopulmonary process." }, { "input": "PA and lateral views the chest provided demonstrate clear well expanded lungs without focal consolidation, large effusion or pneumothorax. No signs of congestion or edema. Heart size, mediastinal contour, and hila are unremarkable. Bony structures intact.", "output": "No acute intrathoracic process including no signs of pneumonia." }, { "input": "Midline sternotomy wires are unchanged. The pacers/defibrillating improved projecting over the left chest with leads in the right ventricle. The heart size is enlarged, similar to prior studies. The lungs demonstrate no consolidation, but mild interstitial edema. There is no large pleural effusion or pneumothorax.", "output": "Stable cardiomegaly and interstitial edema compatible with continued heart failure." }, { "input": "One portable AP upright view of the chest. Severe cardiomegaly is stable. There is pulmonary vascular engorgement and mild interstitial pulmonary edema, less severe compared to ___. No evidence of pneumonia. There are no pleural effusions or pneumothorax. Left transvenous pacemaker wires are seen in the appropriate position. Median sternotomy clips are in appropriate position.", "output": "Severe cardiomegaly, pulmonary vascular engorgement, and mild interstitial edema consistent with congestive heart failure, less severe compared to ___." }, { "input": "Portable frontal view of the chest demonstrates hyperexpanded lungs. Moderate cardiomegaly is noted with perihilar vascular congestion, progressed from prio. There is no pleural effusion or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Most superior sternotomy wire appears fractured. Biventricular pacemaker device is in place.", "output": "Moderate cardiomegaly with perihilar vascular congestion, appears progressed from ___ exam." }, { "input": "PA and lateral views of the chest ___ at 16:53 is submitted.", "output": "Pneumomediastinum is again seen. No free intraperitoneal air appreciated. Contrast is seen within the visualized colon. Lungs are well inflated without evidence of focal airspace consolidation, pleural effusions, pulmonary edema or pneumothorax. Overall cardiac and mediastinal contours are stable." }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. Minimal pneumomediastinum is noted, corresponding to findigns on CT. Heart size is normal.", "output": "Minimal pneumomediastinum. Clear lungs." }, { "input": "The lungs are clear. No effusion, consolidation or pneumothorax is present. The heart and mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest are compared to previous exam from ___. The lungs remain clear. Cardiomediastinal silhouette is stable. Osseous and soft tissue structures are unchanged, noting probable post-traumatic changes in the right coracoclavicular region.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs are clear. Heart is top-normal in size. Focal eventration of the right hemidiaphragm noted. No large effusion or pneumothorax. Mediastinal and hilar configuration appears normal. Chronic bony changes at the right shoulder are re- demonstrated. No acute bony abnormality.", "output": "No acute findings." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. Since prior, tracheostomy tube is no longer seen. The lungs are clear. Costophrenic angles are sharp. Mild scarring vs. atelectasis in the left lower lobe noted. Elevation of the right hemidiaphragm is stable. The cardiomediastinal silhouette is stable as are the osseous and soft tissue structures.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. No pulmonary edema, pleural effusion, or pneumothorax. No focal consolidations are seen. Chronic deformity of the right acromioclavicular joint is unchanged.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal to mildly enlarged. The mediastinal contours are stable and unremarkable. Mild anterior wedging of a couple mid thoracic vertebral bodies is stable. Chronic changes are again seen at the right acromioclavicular joint and at the right coracoclavicular interval.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. There is streaky right mid-lower lung opacities similar to prior suggestive of atelectasis. Elevation of the right hemidiaphragm is similar to prior. The cardiomediastinal silhouette is within normal limits. Posttraumatic changes in the region of the right coracoclavicular region are again noted.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. The hilar and mediastinal contours are within normal limits. There is no pneumothorax, focal consolidation, or pleural effusion.", "output": "No acute intrathoracic process." }, { "input": "Mild cardiomegaly is unchanged. Mediastinal contour is normal. There is no focal consolidation, effusion or pneumothorax. No signs of congestion or edema. Chronic deformity of the right acromioclavicular joint is unchanged. There is subtle deformity at the lateral arch of the right ninth and tenth ribs which may represent acute fractures no findings are suboptimally assessed. Consider dedicated rib series to confirm.", "output": "Possible right ninth and tenth lateral rib fractures which, if needed, can be confirmed on dedicated rib series." }, { "input": "AP single view of the chest has been obtained with patient in sitting semi-upright position. Comparison is made with the next preceding similar study of ___. Tracheostomy cannula in place and unchanged in position. No pneumothorax has developed. Again, the patient is slightly rotated to the left with slightly asymmetric overlying soft tissues, obscuring the left base up to some mild degree. There is no evidence of new pulmonary abnormalities and no evidence of CHF.", "output": "Stable chest findings." }, { "input": "PA and lateral images of the chest were obtained. The lungs are clear bilaterally without focal consolidation or congestive heart failure. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. Stable post-traumatic changes at the right shoulder from chronic shoulder joint sepation. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Evaluation of the lateral views is limited due to patient's arm positioning. The lung volumes are low which causes apparent enlargement of the cardiac silhouette. The aorta is slightly unfolded. The lungs are clear without focal opacity, pleural effusion or pneumothorax. There are degenerative changes in the right acromioclavicular and coracoclavicular joints.", "output": "No opacity concerning for pneumonia." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal to mildly enlarged. Chronic deformity at the right coracoclavicular interval.", "output": "No acute cardiopulmonary process. No focal consolidation." }, { "input": "Heart size is mildly enlarged. Mediastinal hilar contours are unremarkable. Pulmonary vasculature is not engorged. Minimal retrocardiac patchy opacity is felt to reflect atelectasis. No focal consolidation, pleural effusion or pneumothorax is present. Mild to moderate multilevel degenerative changes are noted in the thoracic spine. Chronic deformity of the right scapula and acromioclavicular joint is again noted.", "output": "Minimal retrocardiac patchy opacity, likely atelectasis." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for pneumonia. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No acute intrathoracic abnormalities." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified. Surgical clips in the upper abdomen are noted.", "output": "No acute cardiopulmonary process." }, { "input": "Mild enlargement of the cardiac silhouette is re- demonstrated. Aorta remains mildly tortuous with calcifications seen at the aortic knob. There is no pulmonary vascular congestion. No focal consolidation is demonstrated. Patchy bibasilar airspace opacities may reflect atelectasis. No pneumothorax or pleural effusion is definitively noted.", "output": "Mild bibasilar patchy opacities likely reflective of atelectasis." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. The lungs are clear. Costophrenic angles are sharp. The cardiomediastinal silhouette is within normal limits. Mild atherosclerotic calcification seen at the aortic arch. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Comparison is made with the next preceding portable chest examination obtained 10 hours earlier during the same day. Heart size is unchanged and remains normal. Thoracic aorta unremarkable. No mediastinal abnormalities are present. Several linear densities on the left base and mild blunting of the pleural lateral sinus is present as before and coincides with the previously described local chest wall emphysema related to stab wounds and surgical repair. The amount of chest wall emphysema present reaches up to the axillary area and appears to be stable in comparison with the next previous portable chest examination. As before, some local strands of chest wall emphysema are overlying the apical area, but there is no conclusive evidence for any apical pneumothorax. Thus, both lungs remain well aerated.", "output": "Local stab wounds with small atelectasis on left base but no evidence of massive infiltrates, large pleural effusion or apical pneumothorax." }, { "input": "The patient is rotated to the left. Right-sided large-bore central venous catheter likely terminates in the right atrium. The patient is status post median sternotomy. There is obscuration of the left hemidiaphragm and left base opacity seen which may be due to atelectasis however, underlying consolidation or small pleural effusion is difficult to entirely excluded. There is mild left mid lung atelectasis/scarring. No pneumothorax is seen. The cardiac silhouette is top-normal. No overt pulmonary edema.", "output": "The patient is rotated to the left. Left base opacity and obscuration of the hemidiaphragm may be due to atelectasis and small pleural effusion, consolidation is difficult to exclude. There is evidence of bowel signature over the inferior left hemithorax, superior to the level of the right hemidiaphragm and the left hemidiaphragm may be elevated or there may be a hiatal hernia." }, { "input": "Frontal and lateral views of the chest. As on prior, there is dense consolidation at the left lung base obscuring hemidiaphragm. This may be due to a combination of consolidation, atelectasis and effusion. Hiatal hernia suspected. The right lung remains clear. 2 separate right subclavian lines are identified with the larger catheter seen with tip terminating in the right atrium. The smaller catheter tip is not clearly delineated on the current exam. Degenerative changes in the spine without acute abnormality.", "output": "Dense left basilar opacity similar to previous exam which may be due to a combination of effusion, atelectasis and consolidation." }, { "input": "A single portable supine chest radiograph was provided. The right lung appears well expanded without focal consolidation. There is a left lower lung and retrocardiac opacity. Given the shift of the cardiac silhouette leftward, there is likely component of volume loss. Pneumonia cannot be excluded. A left pleural effusion may be present. There is no pneumothorax. A right central line with two tips terminates in the lower right atrium. The bones are intact. There are no displaced fractures. Calcifications project over the upper abdomen, may be within the pancreas.", "output": "Left lower lobe retrocardiac opacity likely due to volume loss given the shift of the mediastinum, however component of infection or effusion cannot be excluded. Calcifications projecting over the upper abdomen, potentially pancreatic- correlate withpossibile history of chronic pancreatitis. Prior imaging, should it become available would be of use." }, { "input": "Frontal and lateral chest radiographs demonstrate clear lungs without pleural effusion or pneumothorax. Previously described right upper lobe opacity has improved. The cardiac silhouette remains top normal in size, the mediastinal contours are normal. A rim-calcified mass is superimposed on the liver and measures 7.5 x 3.3 cm, unchanged from ___ and partially imaged in ___.", "output": "1. No acute chest abnormality. 2. Rim-calcified mass superimposed upon the liver for which further evaluation with cross-sectional imaging is recommended." }, { "input": "A right upper lobe opacity is consistent with pneumonia. THere is a faint suggestion of a \"finger in glove\" appearence. Indistinctness of the right heart border suggests an additional right middle lobe consolidation. No effusion, nodule, or pneumothorax is present. Cardiac and mediastinal contours are normal. A 2.8 x 4.8cm calcified structure projects over the liver.", "output": "1. Right upper lobe, and possibly right middle lobe pneumonia. Given upper lobe involvement, risk factors for TB should be evaluated. The appearence may also fit with allergic bronchopulmonary aspergillosis. 2. 5cm calcified liver lesion is, in retrospect, unchanged since ___ when it appears incidentally in the outer field of view of a lumbar spine radiograph. Suggest correlation with prior imaging or consideration of a liver ultrasound. The finding of right upper lobe pnuemonia was communicated with phone with Dr ___ at ___ on ___. Additional differentials and finding 2 were communicated with Dr ___ ___ email at ___." }, { "input": "The lungs are clear.The cardiac, hilar and mediastinal contours are normal.No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is moderately enlarged on this AP view. The aorta is tortuous and moderately calcified. The lungs are hyperinflated consistent with emphysema. There is biapical scarring. There is no pneumothorax or focal consolidation. There may be a small left pleural effusion. No definite rib fractures are identified. Note is made of a calcified splenic artery.", "output": "Hyperinflated lungs consistent with emphysema. No evidence of focal consolidation or pneumothorax. Small left pleural effusion versus pleural thickening." }, { "input": "The lungs are hyperinflated. There is no focal consolidation. There is mild biapical pleural thickening. There is no pleural effusion or pneumothorax. The cardiac silouhette is borderline enlarged.", "output": "Hyperinflated lungs consistent with obstructive pulmonary disease. No acute cardiopulmonary process." }, { "input": "Heart size is at the upper limits of normal. Calcific atherosclerotic changes of the aortic arch. Mild cephalization of pulmonary blood vessels. Mild coarsening of the bronchovascular markings. Kerley B lines noted in the lower lung zones. Suspected small bilateral pleural effusions. Apical scarring is unchanged. No pneumonia. Spondylotic changes of the thoracic spine.", "output": "Findings suggestive of mild cardiac decompensation in the form of interstitial pulmonary edema. No airspace consolidation to suggest pneumonia." }, { "input": "ET tube is 3.6 cm above the carina. The NG tube tip is in the stomach. There new bilateral lower lobe infiltrates.", "output": "New bilateral lower lobe infiltrates worrisome for infection." }, { "input": "Supine portable AP view of the chest was provided. The endotracheal tube is seen with its tip residing 2.9 cm above the carina. The NG tube courses into the left upper abdomen with the tip excluded from view. The lung volumes are low, though the lungs appear clear. The cardiomediastinal silhouette appears grossly unremarkable. No bony abnormalities are seen.", "output": "Appropriately positioned endotracheal and nasogastric tube." }, { "input": "Left chest wall port is again seen with catheter tip at the RA/SVC junction. The lungs are clear without focal consolidation, large effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. Surgical clips project over the abdomen. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "Portable AP upright radiograph demonstrates a left chest port, catheter tip which projects at or just below the anticipated location of the cavoatrial junction. Heart size is normal. Lungs are without a focal opacity convincing for pneumonia. There is no pleural effusion, pneumothorax, or evidence of pulmonary edema. Imaged upper abdomen demonstrates multiple class which projects just the midline of the left upper quadrant. An IVC filter is noted. Clips additionally project within the left hemi abdomen inferiorly with jejunostomy tube noted.", "output": "No opacity convincing for pneumonia." }, { "input": "The lungs are well-expanded and clear. No focal consolidation, edema, effusion, or pneumothorax. The heart is normal in size. The mediastinum is not widened. This exam is not dedicated for imaging the ribs, but slight contour irregularity of the right lateral fifth and sixth ribs could indicate nondisplaced fractures or superimposed normal structures.", "output": "1. No acute cardiopulmonary process. 2. Possible right and sixth lateral rib nondisplaced fractures or superimposed normal structures. Correlate with focal exam findings and recommend repeat dedicated rib films if confirmation is desired." }, { "input": "Frontal and lateral radiographs of the chest were acquired. The lungs are clear. The heart size is normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen.", "output": "No acute cardiac or pulmonary process." }, { "input": "The patient is status post median sternotomy and aortic and tricuspid valve surgery. Stable appearance of cardiomediastinal contours. Persistent interstitial edema. Patchy and linear bibasilar atelectasis is also demonstrated as well as a small right pleural effusion. Left internal jugular catheter remains in place within the left superior vena cava.", "output": "1. Small right pleural effusion with adjacent right basilar atelectasis. 2. Cardiomegaly and interstitial edema." }, { "input": "Since the prior radiograph two days prior, there has been worsening mild pulmonary edema. There is no consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is unchanged with a normal postoperative appearance. Sternal wires and the prosthetic cardiac valve are unchanged in appearance.", "output": "1. Worsening mild pulmonary edema. 2. No pneumothorax. Results were discussed with Dr. ___ at 12:15 on ___ via telephone by Dr. ___ ___ minutes after the findings were discovered." }, { "input": "AP single view of the chest has been obtained with patient in semi-upright position. Analysis is performed in direct comparison with the next preceding similar study of ___. Status post thoracotomy, moderate cardiac enlargement and evidence of aortic valve prosthesis as well as tricuspid valve annuloplasty as before. The removal of the right-sided pleural effusion of the preceding day remains successful as the right-sided diaphragmatic contour and pleural sinus is free, demonstrating the pigtail-end catheter in unchanged position. No pneumothorax has developed. The pulmonary vascular pattern again demonstrates perivascular haze throughout which in comparison appears slightly increased again. This may have led to question a left-sided pneumonia, a diagnosis which is questionable.", "output": "Persistent successful status post right-sided thoracocentesis, mildly increasing pulmonary congestive pattern with perivascular haze. Diagnosis of left-sided pneumonic infiltrate is questionable unless compelling clinical findings are present." }, { "input": "PA and lateral views of the chest demonstrate interval increase in size of right pleural effusion, along with complete atelectasis of the right middle and lower lobes, raising concern for bronchial obstruction. The right upper lobe and left lung are grossly clear. The heart size is unchanged. Median sternotomy wires and post-surgical changes associated with aortic valve replacement are unchanged.", "output": "Interval increase in right pleural effusion with complete atelectasis of the right middle and lower lobes, raising concern for bronchial obstruction. The above findings were communicated to Dr. ___ by Dr. ___ ___ telephone at 4:55pm, ___ min after discovery." }, { "input": "PA and lateral views of the chest show stability of the moderate right pleural effusion with complete collapse of right middle lobe and lower lobe. Right upper lobe and left lung are still clear. Median wires are related to sternotomy in patient with history of aortic valve replacement and are unchanged. Heart size is stable. There is no pneumothorax.", "output": "Little change" }, { "input": "The patient is status post sternotomy and both mitral and aortic valve replacements. Moderate cardiomegaly is unchanged. The mediastinal and hilar contours appear stable. There is new mild-to-moderate relative elevation of the right hemidiaphragm which suggests volume loss and a patchy opacity in the right lower lobe has increased and is worrisome for pneumonic consolidation. There is probably also some degree of new opacification in the right middle lobe. A vague opacity is also new in the right suprahilar region in the right upper lobe, potentially an early focus of pneumonia. There is no definite pleural effusion.", "output": "Findings suggest multifocal pneumonia involving the right lung." }, { "input": "Cardiac silhouette remains moderately enlarged slightly increased from prior exam. There has been interval increase in central pulmonary vascular engorgement as well as interstitial edema. A focal right lower lung consolidation has increased in severity and is worrisome for pneumonia. There is no large pleural effusion or pneumothorax. A right internal jugular central venous catheter is unchanged in position.", "output": "Worsening pulmonary congestion and edema as well as worsening right lower lung consolidation worrisome for pneumonia. Results were discussed over the telephone with Dr. ___ by ___ at 10:48 on ___ at time of initial review." }, { "input": "Reappearance of moderate right pleural effusion obscures the right heart border. There is elevation of the right hemidiaphragm. The cardiac silhouette continues to be mildly enlarged with no signs of vascular congestion. No focal consolidation is seen. Left internal jugular catheter ends in a known left persistent vena cava.", "output": "Reappearance of moderate right pleural effusion." }, { "input": "There is a single-lead pacemaker/ICD device whose lead terminates in the right ventricle as before. The tricuspid and aortic valves has been replaced. Hazy opacities that are predominantly central within each lung suggest mild pulmonary edema. A persistent pleural effusion with loculated character appears unchanged on the right, with probable atelectasis opacifying a substantial portion of the right lower hemithorax, as before. There is probably a trace pleural effusion only on the left. No pneumothorax is demonstrated.", "output": "Findings suggesting mild pulmonary edema. Similar moderate-sized right pleural effusion, probably loculated to some extent, with persistent lung opacification that can probably be attributed to associated atelectasis." }, { "input": "Portable chest radiograph ___ at 11:21 is submitted.", "output": "Left sided single lead pacer unchanged in position. Right internal jugular central line with tip in the proximal right atrium. There continue be small stable bilateral pleural effusions with decrease in the amount of loculated fluid on the left. Status post median sternotomy with stable cardiac and mediastinal contours. Interval appearance of mild interstitial edema. Bibasilar patchy opacities likely reflect atelectasis. No obvious pneumothorax." }, { "input": "A portable frontal chest radiograph demonstrates an endotracheal tube terminating in the mid thoracic trachea, intact sternal wires, a left chest wall pacer device with the lead projecting over the right ventricle, right central catheter terminating in the upper right atrium, enteric tube terminating in the stomach, and interval placement of a left chest tube which projects over the left lung base. There is no appreciable pneumothorax. Bilateral small pleural effusions and bibasilar atelectasis is unchanged compared to the most recent chest radiograph on ___. No new focal consolidation is identified. The visualized upper abdomen is unremarkable.", "output": "Interval placement of a left chest tube, without appreciable pneumothorax. Bilateral small pleural effusions and bibasilar atelectasis are unchanged compared to ___." }, { "input": "There is overall little change compared with prior exam dated ___ with slight decrease in hazy opacification of the right hemithorax and improvement in pulmonary vascular engorgement and small right pleural effusion although this could be attributable to upright positioning of the patient compared to semi erect positioning on the previous study. Cardiac silhouette remains moderately enlarged. The right IJ central venous catheter is unchanged in position with the tip projecting over the mid SVC. Mild bibasilar atelectasis is unchanged.", "output": "Little change since prior study with slightly improved appearance of the vascular congestion and right pleural effusion although this could be due to different technique." }, { "input": "Since the prior study, there is little change in opacification of the right lung base, likely combination of atelectasis and effusion, moderate cardiomegaly, and location of pacemaker leads and prosthetic aortic and tricuspid valves. Infection at the right lung base cannot be excluded. There is mild pulmonary vascular congestion.", "output": "Unchanged mild cardiomegaly, mild pulmonary vascular congestion, and small right pleural effusion with adjacent right basilar opacification, likely atelectasis but infection cannot be excluded." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Comparison is made with the next preceding portable AP single view chest examination of ___. The patient is now examined in standing upright position. There is status post sternotomy and significant cardiac enlargement as before. Within the cardiac shadow, metallic portions of three different valve prostheses can be identified. One is a circular metallic ring in the position of the aortic valve, the second one a similar oval-shaped ring formation in the mitral valve position, and the third one an open circle rather typical for a tricuspid valve annuloplasty. Correlating the position of these valves to the outer contours of the heart, one can state that there is remaining marked enlargement of the left atrium, but the increased distance between the tricuspid valvuloplasty and the anterior heart border speaks much in favor of a right ventricular enlargement as well as an enlarged right atrium. Prominence of the ascending aortic contour is moderate. The pulmonary vasculature is presently not congested, and on previous portable examination identified edema pattern as well as evidence of right-sided pleural effusion has normalized. No new parenchymal abnormalities are seen, and no pneumothorax is identified in the apical area. Again observed is a fractured second rib in the left apical area, apparently the result of previous sternotomy and intrathoracic cardiac intervention. When comparison is extended to the next preceding PA and lateral chest examination of ___, the patient is in better condition now as the cardiac enlargement has regressed and the pleural effusion has been absorbed completely.", "output": "Marked improvement of CHF in patient with history of triple valve replacement." }, { "input": "PA and lateral views of the chest were provided. Midline sternotomy wires and prosthetic cardiac valves are redemonstrated. The heart is stable and top normal in size. There is improvement in overall pulmonary aeration with minimal lower lung atelectasis. No pneumothorax or pleural effusion is seen. Bony structures are intact.", "output": "Improved aeration in the lungs with no effusion and mild bibasilar atelectasis." }, { "input": "There is stable mild cardiomegaly. The hilar and mediastinal contours are unremarkable. Median sternotomy wires appear to be intact. There is a left-sided IJ central venous line in appropriate position in a known left sided SVC. There is a right-sided pigtail catheter, which appears to be in unchanged position. There has been a slight interval increase in the small right pleural effusion. There is a stable small left pleural effusion. No evidence of a pneumothorax.", "output": "Right-sided pigtail catheter appears to be in appropriate position, however there has been a slight interval increase in the small right pleural effusion." }, { "input": "Small right pleural effusion has slightly increased in size compared to ___ with associated right lung basilar atelectasis. Lungs are otherwise clear without focal consolidation or pulmonary edema. Left IJ central venous line ends in a known left SVC. The cardiac silhouette continues to be mildly enlarged, and the median sternotomy wires are intact. The mediastinal and hilar contours are normal.", "output": "Small right pleural effusion has slightly increased since ___" }, { "input": "Since ___, bilateral small pleural effusions and bibasilar atelectasis are unchanged. No new focal consolidation is identified. No pneumothorax. Unchanged mild cardiomegaly. Tip of the endotracheal to is seen 4.1 cm above the carina. Right double-lumen central line terminates in the right atrium. A feeding tube is seen in the stomach. Left pectoral pacemaker is seen with transvenous leads in the right ventricle. Left chest tube positioning has been adjusted. Median sternotomy wires are intact and well aligned.", "output": "1. Unchanged bilateral pleural effusions and bibasilar atelectasis since ___. 2. All support devices are in appropriate position." }, { "input": "PA and lateral views of the chest. A small to moderate right pleural effusion is new compared to most recent study. A right lower lobe opacity has persisted since ___ may represent pneumonia. Left lung is clear. There is no left pleural effusion. Aortic and mitral valve replacement and tricuspid annuloplasty are seen. Sternotomy wires are in place. No pneumothorax. Moderate cardiomegaly is unchanged. The mediastinal and hilar contours are normal.", "output": "1. Increased right pleural effusion, now small to moderate. 2. Right lower lobe opacity may represent pneumonia. The other opacities in the right lung have resolved." }, { "input": "There is mild pulmonary edema. A moderate right pleural effusion is not significantly changed. A consolidation at right base is not definitive on this examination however is confirmed on the subsequent CT. No pneumothorax is seen. There is moderate cardiomegaly with tortuosity of the aorta. The patient is status post median sternotomy with CABG and valve replacements.", "output": "Mild pulmonary edema with right pleural effusion. Consolidation at right base is not definitive on this examination however is confirmed on the subsequent CT." }, { "input": "The left PIC line is unchanged in position compared to the prior radiograph. It enters a left-sided approach and makes a descent at the level of the aortic arch in keeping with known left-sided superior vena cava. There is stable mild cardiomegaly. The hilar and mediastinal contours are unremarkable. There has been slight interval improvement of the large right pleural effusion associated with atelectasis/consolidation. There is no pneumothorax. The replaced valves tricuspid and aortic are redemonstrated. There has been mild improvement of the previously noted interstitial edema. There has been interval improvement in the opacities in the left mid and lower lungs.", "output": "1. Slight interval improvement in the large right pleural effusion. 2. Improvement in the previously noted bilateral pulmonary edema. 3. Stable left lower lung opacities compared to the prior exam." }, { "input": "AP semi upright view of the chest provided. There is no focal consolidation or pneumothorax. Right pleural effusion is similar to prior. There is a new moderate to large left pleural effusion. Cardiomegaly is similar to prior. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "1. There is a new moderate to large left pleural effusion. 2. Right pleural effusion is similar to prior." }, { "input": "PA and lateral views of the chest ___ at 12:55 are submitted.", "output": "Stable bilateral layering pleural effusions with bibasilar airspace process likely reflecting compressive atelectasis. There has been interval appearance of mild interstitial and pulmonary edema. Left-sided pacer remains in place with the lead traversing a left superior vena cava to the right ventricular apex. Status post median sternotomy with mitral annular ring. No pneumothorax." }, { "input": "The patient is status post median sternotomy and aortic valve replacement. A right internal jugular central venous catheter is unchanged in position with the tip terminating in the low SVC. A small caliber left IJ line is also noted. The lung volumes are slightly decreased. There is slight elevation of the left hemidiaphragm compared to the right. The cardiac silhouette remains enlarged but stable. The mediastinal contours are prominent postoperatively. There is mild calcification of the aortic knob. Mild to moderate pulmonary edema is increased from the most recent prior study. There is increased streaky opacification at the right lung base compared to the most recent prior study. In the absence of aspiration, this most likely reflects atelectasis. Mild opacification of the left lung base is unchanged and compatible with mild atelectasis. No significant pleural effusion or pneumothorax is detected.", "output": "1. Mild to moderate pulmonary edema, increased from ___. 2. Small right pleural effusion and bibasilar atelectasis on the right greater than the left." }, { "input": "Small bilateral pleural effusions are seen on the lateral chest radiograph with the right pigtail catheter at the lung base. Cardiomegaly continues to be seen with no pulmonary edema or focal consolidation. Median sternotomy wires are intact, and left-sided IJ central venous line is in appropriate position.", "output": "Small bilateral pleural effusions are seen." }, { "input": "Frontal and lateral views of the chest are obtained. The patient is status post median sternotomy and aortic and tricuspid valve repair. There has been interval development/increase in bilateral, right greater than left, pleural effusions with overlying atelectasis. Right base opacity may relate to effusion and atelectasis, although underlying consolidation cannot be excluded. The cardiac silhouette remains mildly enlarged. The aorta is calcified and tortuous. Displaced anterolateral left second rib fracture is again seen. There is minimal pulmonary vascular congestion.", "output": "Interval increase/development of bilateral, right greater than left, pleural effusions with overlying atelectasis. Right base opacity may be due to a combination of pleural effusion and atelectasis, however, underlying consolidation cannot be excluded. Cardiomegaly and minimal pulmonary vascular congestion." }, { "input": "Single AP view of the chest was reviewed. There has been interval increase in the right pleural effusion, now moderate, with right basilar atelectasis. Mild edema is also seen. There is no pneumothorax. The presence of the right pleural effusion limits assessment of the right cardiomediastinal contours, but the remainder of the cardiomediastinal and hilar contours appear stable. Median sternotomy wires are in similar configuration with aortic and tricuspid valve replacements.", "output": "Increase in right pleural effusion, now moderate, with underlying atelectasis. Mild pulmonary edema. Repeat chest radiograph after resolution of right pleural effusion is recommended to reassess the lungs and mediastinum." }, { "input": "Right pleural catheter has been removed with slight decrease in pleural effusion and no definite pneumothorax. Small left effusion has decreased in size. Atelectasis is seen at the right base, and no focal consolidation or pulmonary edema is seen. Mild cardiomegaly persists, and the median sternotomy wires are intact. The left central venous line is in appropriate position in a known left-sided SVC.", "output": "Right pleural catheter removed with decreased right effusion and no definite pneumothorax." }, { "input": "The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is no focal lung consolidation.", "output": "No radiographic evidence of pneumonia." }, { "input": "Frontal and lateral views of the chest. The heart size and cardiomediastinal contours are stable with minimal tortuosity of the aortic contour. Biapical scarring is small and unchanged. The lungs are otherwise clear without focal consolidation, pleural effusion, or pneumothorax.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Heart size and cardiomediastinal contours are stable with minimal tortuosity of the aortic contour. Biapical pulmonary scarring is similar to prior. Prominence of the right peritracheal soft tissues is similar to prior films from ___ and ___ and may relate to the patient's known multinodular goiter. No CHF, focal consolidation, pleural effusion, or pneumothorax is detected. Slight anterior wedging of a mid thoracic vertebral body, ? T7, is unchanged compared with ___.", "output": "No acute pulmonary process detected. In particular, no pneumothorax or pneumonia identified." }, { "input": "PA and lateral views of the chest. No prior. There is evidence of volume loss in the left hemithorax with increased opacity better characterized on the lateral compatible with left upper lobe collapse. Soft tissue fullness seen in the left hilar region in combination with upper lobe collapse, the S sign of Golden. The right lung is grossly clear. Cardiomediastinal silhouette is within normal limits, noting shift to the left. Osseous and soft tissue structures are unremarkable.", "output": "Left upper lobe collapse and fullness of the left hilum worrisome for underlying obstructing mass lesion. CT scan had been ordered at time of dictation, based on discussion between Dr. ___ ___ attending ___ physician." }, { "input": "PA and lateral views of the chest were provided. There is improved aeration of the left upper lobe with left upper lobe nodularity again seen. There is right basilar atelectasis and tiny right pleural effusion. Right hilar prominence corresponds to known tumor. No free air below the right hemidiaphragm. Heart size appears normal. Bony structures appear grossly intact.", "output": "No free air below the right hemidiaphragm. Right basilar atelectasis with small right pleural effusion and right hilar mass and left upper lobe mass again noted. Please refer to subsequent CT of the torso for further details." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no evidence for pleural effusion or pneumothorax. The lungs appear clear. The bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "There is minimal bibasilar atelectasis. The heart size is moderately enlarged. Mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen.", "output": "1. No acute cardiac or pulmonary process. 2. Moderate cardiomegaly." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "A pacemaker is seen overlying the left chest with a single intact lead terminating in the right ventricle. The lungs are well expanded and clear. The pulmonary vasculature is normal. There is stable enlargement of the cardiomediastinal silhouette. Heart size is normal. The mediastinal and hilar contours are normal. No pleural effusion or pneumothorax is seen. Multiple posterior right rib fractures are visualized, unchanged since at least ___.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is left lower lobe opacity, with subtle suggestion of air bronchograms on the frontal view, worrisome for pneumonia. Subtle patchy right base opacity may be due to atelectasis or additional site of consolidation. No large pleural effusion or pneumothorax is seen. There is a right middle lobe linear atelectasis/scarring. There has been interval removal of a left-sided central venous catheter. Cervical spine hardware is noted but not well evaluated on this chest radiograph study. The cardiac and mediastinal silhouettes are stable.", "output": "Left lower lobe pneumonia. Subtle patchy right base opacity may be due to atelectasis or ___ site of consolidation." }, { "input": "Right middle lobe linear atelectasis/scarring is again seen. There has been interval resolution of previously seen left lower lobe pneumonia. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. No evidence of free air beneath the diaphragms.", "output": "No acute cardiopulmonary process. No evidence of free air beneath the diaphragms." }, { "input": "A left-sided of battery pack and pacemaker lead is noted with the leads terminating in the right atrium and the right ventricle. Median sternotomy wires are noted to be broken with a small lucency in between then, perhaps a sign of chronic dehiscence. There is mild-to-moderate cardiomegaly, particurally an englarged left ventricle. Hilar contours are normal.", "output": "Correct lead positioning in the right atrium and right ventricle. Cardiomegaly." }, { "input": "Left chest wall dual lead pacing device is again seen. The lungs are clear without evidence of edema. The cardiomediastinal silhouette is stable. Median sternotomy wires, many of which are fractured, are again noted. Mediastinal clips are also noted. Degenerative changes seen at the shoulders and posttraumatic changes of the proximal left humerus as on prior.", "output": "No acute cardiopulmonary process." }, { "input": "AP single view of the chest has been obtained with patient in semi-upright position. There is status post sternotomy and the presence of multiple surgical clips in the left mediastinal structures are indicative of previous bypass surgery. A permanent pacer is identified in left anterior axillary position seen to be connected to two intracavitary electrodes with termination points compatible with right atrial appendage and apical portion of right ventricle correspondingly. There is mild cardiac enlargement but no evidence of pulmonary vascular congestion is seen and the lateral pleural sinuses are free from any fluid accumulation. No evidence of pneumothorax in the apical area.", "output": "Apparently appropriately placed dual intracavitary electrode permanent pacer without evidence of pneumothorax." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. The lungs are well-expanded and clear without focal consolidation concerning for pneumonia. The upper abdomen is unremarkable.", "output": "No pneumonia or other acute process." }, { "input": "Upright and lateral views of the chest provided. There are midline sternotomy wires and tiny mediastinal clips again noted. Lungs are clear. No focal consolidation, effusion, pneumothorax. The cardiomediastinal silhouette appears normal. Fragmented upper sternotomy wire is noted. Right AC joint arthropathy is noted. Degenerative spurring in the mid thoracic spine noted.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral chest radiographs were provided. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. Imaged upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Patchy and linear opacities in the right middle and both lower lobes are new. Chest port appears in place. Cardiomediastinal silhouette is normal. Multiple osseous metastatic lesions are again identified with a patchy appearance of the bones.", "output": "1. Patchy right middle and bilateral lower lobe opacities correspond to findings concerning for right lung pneumonia and left basilar atelectasis on separately dictated CT scan of same date. 2. Multiple osseous metastases again noted, but better delineated on dedicated CT from the same day." }, { "input": "The right Port-A-Cath terminates in the right atrium. There is increasing bibasilar atelectasis. Multiple patchy opacities overlying the left thorax likely correspond to sclerotic ribs. Diffuse sclerotic and lytic bone lesions are again noted, consistent with known osseous metastatic disease. There are small bilateral pleural effusions, unchanged. Compression deformities in the mid thoracic vertebral bodies is noted.", "output": "Worsened bibasilar atelectasis. Pneumonia cannot be excluded." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear unchanged. The lungs appear clear. There are no pleural effusions or pneumothorax. Mildly prominent anterior osteophytes along the lower thoracic spine appear similar.", "output": "No evidence of acute disease." }, { "input": "Lung volumes are low. The heart size is normal. Mediastinal and hilar contours are unchanged with continued widening of the mediastinum. The pulmonary vasculature is normal. Elevation of the right hemidiaphragm persists with a small right pleural effusion again noted. Patchy bibasilar opacities likely reflect atelectasis. No pneumothorax is identified. Fiducial markers are seen within the right upper quadrant of the abdomen.", "output": "Bibasilar patchy opacities, likely atelectasis, with chronic elevation of the right hemidiaphragm and small right pleural effusion." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion, pneumothorax. No free air below the right hemidiaphragm. Cardiomediastinal silhouette appears normal. Bony structures are intact.", "output": "No acute findings in the chest. No evidence of pneumoperitoneum." }, { "input": "A small right pleural effusion is unchanged. There is persistent collapse involving the right lower lobe. This finding partially counts for the apparent elevation of the right hemidiaphragm. The left lung is clear. There is no pneumothorax. The mediastinal and hilar contours are unremarkable. Fiducial markers are seen in the liver.", "output": "Small right pleural effusion with continued right lower lobe collapse, unchanged from 5 days prior." }, { "input": "Cardiomediastinal contours are normal. Bibasilar atelectasis larger on the left have increased on the left. Small left effusion has increased. There is no evident pneumothorax. There are low lung volumes. Left rib fractures are better seen in prior CT.", "output": "Minimal increase in bibasilar atelectasis larger on the left and small left pleural effusion" }, { "input": "The lungs are clear where not obscured by overlying cardiac leads. There is no focal consolidation, effusion, or edema. There is moderate cardiomegaly. Atherosclerotic calcifications are seen in the thoracic aorta. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Left pectoral cardiac pacing device with transvenous leads following their expected courses to the right atrium and ventricle. There is no focal consolidation, effusion, or pneumothorax. Moderate cardiomegaly. No pulmonary edema.", "output": "Left, transvenous cardiac pacing device with leads following their expected course to the right atrium and ventricle. No radiographic evidence of complication." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of normal size with normal cardiomediastinal contours. Lung volumes are low and bibasilar atelectasis is seen. No focal consolidation, pleural effusion, or pneumothorax. Pulmonary vasculature is unremarkable. Wedge deformity of a lower thoracic vertebral body is similar to prior. No radiopaque foreign body.", "output": "Bibasilar atelectasis with low lung volumes." }, { "input": "The lungs are well expanded and clear bilaterally with no areas of focal consolidation, pleural effusion, mass lesion, or evidence of pneumothorax. Cardiomediastinal silhouette is stable with mildly tortuous aorta. There is a prominent left pulmonary artery observed; however, this is unchanged when compared to chest radiograph of ___. Mild degenerative changes of the thoracic spine are seen with stable wedge deformity seen in the lower thoracic spine vertebra.", "output": "No evidence of infection or malignancy." }, { "input": "The heart size is normal. The mediastinal contours are unchanged with minimal tortuosity of the thoracic aorta. There are mild aortic calcifications. The pulmonary vascularity is not engorged. Linear opacities within the left lower lobe are compatible with subsegmental atelectasis. No focal consolidation, pleural effusion or pneumothorax is present. DISH is seen within the thoracic spine.", "output": "No acute cardiopulmonary abnormality. Subsegmental atelectasis in the left lower lobe." }, { "input": "The lungs are clear. There is no evidence of effusion, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. The pulmonary vasculature is unremarkable.", "output": "Normal chest radiograph." }, { "input": "The lungs are clear without focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. There is no evidence of congestive heart failure. DISH is seen along the thoracic spine, unchanged from prior exam.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are hypoinflated with left lower lobe atelectasis. Heart is top-normal in size. Mediastinal contour and hila are unremarkable. No pleural effusion or pneumothorax. Limited assessment of the osseous structures are notable for changes consistent with DISH. No large volume free intraperitoneal air.", "output": "1. Hypoinflated lungs with left lower lobe atelectasis. 2. No pulmonary edema. 3. No large volume free intraperitoneal air. RECOMMENDATION(S): If persistent concern of free intraperitoneal air recommend true upright or lateral decubitus radiograph for further evaluation." }, { "input": "There are innumerable nodular opacities throughout both lungs, consistent with known metastatic pulmonary nodules. Overall, the appearance is grossly unchanged compared with ___. No obvious new infiltrate is identified. However, the extent of the abnormality makes it difficult to identify a subtle superimposed pneumonic infiltrate or other subtle superimposed opacity.", "output": "As above." }, { "input": "A portable frontal chest radiograph demonstrates a repositioned endotracheal tube in proper position. The remainder of the exam is unchanged, including severe pulmonary edema and a severely distended stomach.", "output": "1. Repositioned endotracheal tube in proper position. 2. Severe pulmonary edema. 3. Severely distended stomach which may benefit from decompression with a nasogastric tube. These findings were discussed via telephone by Dr. ___ with Dr. ___ at ___ on ___." }, { "input": "Portable AP upright chest radiograph was provided. A stent within the aortic valve and aortic root is again noted. Lung volumes are low, limiting evaluation. As seen previously, there is diffuse ground-glass opacity within the lungs which could reflect the presence of pulmonary edema, though given findings on recent chest CT, differential includes chronic hypersensitivity pneumonitis. There is no pleural effusion. The cardiomediastinal silhouette is stable. Bony structures appear intact.", "output": "Diffuse ground-glass opacities within the lungs with no significant change from prior exam raises concern for pulmonary edema versus chronic hypersensitivity pneumonitis as suggested on recent CT exam. Please correlate clinically." }, { "input": "New NG tube has sidehole in mid gastric cavity. All the reminder monitoring and supporting device are unchanged and in standard position. Persistent low lung volume with improvement of bilateral opacity, due to improved pulmonary edema. Heart size is top normal. There is no pneumothorax or pleural effusion. Gastric dilatation improved.", "output": "improved pulmonary edema and gastric distension after NG placement." }, { "input": "A supine portable frontal chest radiograph demonstrates the endotracheal tube within the right mainstem bronchus. New diffuse heterogeneous bilateral opacities are consistent with severe pulmonary edema. There is no pneumothorax. Also noted is a severely distended stomach.", "output": "1. Endotracheal tube within the right mainstem bronchus. 2. New diffuse heterogeneous bilateral opacities, consistent with severe pulmonary edema. 3. Severely distended stomach. The patient may benefit from decompression with a nasogastric tube. These findings were discussed via telephone by Dr. ___ with Dr. ___ at ___ on ___." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal silhouette is unremarkable. There is no pneumothorax or pleural effusion. Visualized osseous structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Single supine AP portable view of the chest was obtained. Dual-lead left-sided pacemaker is again seen with leads seen without significant change in position. There is mild left base atelectasis. The right lung is clear. No large pleural effusion or pneumothorax is seen. The aorta is calcified and tortuous. The cardiac silhouette is stable. There is diffuse osteopenia.", "output": "Mild left base atelectasis. Otherwise, no acute cardiopulmonary process seen." }, { "input": "A small circular opacity measuring 1.2 cm is seen in the right lower lung. No parenchymal consolidation is seen. No pleural effusion or pneumothorax is seen. Cardiomediastinal silhouette appears largely unchanged.", "output": "Right lower lung 1.2 cm nodule for which the frontal and oblique films with nipple markers are recommended. NOTIFICATION: The impression above was entered by Dr. ___ on ___ at 18:40 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "Previously reported right lower lung nodule is no longer evident. Left lower lobe consolidation has resolved. Lungs are clear, and there are no pleural effusions. Cardiomediastinal contours are normal.", "output": "Resolution of left basilar pneumonia" }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. Heart size and cardiomediastinal contours are normal. Slight prominence of the hilar bronchial markings may represent a mild degree of peribronchial inflammation. No focal consolidation, pleural effusion, or pneumothorax.", "output": "No focal consolidation. Minimal peribronchial inflammation." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unremarkable. The lungs are clear and the pulmonary vascularity is normal. No pleural effusion, focal consolidation, or pneumothorax is seen. There are mild degenerative changes in the mid thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Unchanged positioning of the tracheal stent, projecting over the thoracic inlet. The increased retrocardiac opacity may reflect atelectasis and/or consolidation. No pleural effusion or pneumothorax identified. The size of the cardiomediastinal silhouette is within normal limits.", "output": "New retrocardiac opacity may reflect atelectasis and/or consolidation." }, { "input": "A tracheal stent projects over the the thoracic inlet, higher in position than on the prior radiograph. No focal consolidation, pleural effusion or pneumothorax identified. The size of the cardiac silhouette is within normal limits.", "output": "Interval trachea stent revision, now positioned at the level of the thoracic inlet, higher than on the prior examination." }, { "input": "AP portable upright view of the chest. Lung volumes are low limiting assessment. There is a right upper extremity access PICC line with its tip located in the mid SVC region. A tracheal stent is noted at the level of the thoracic inlet. The position appears unchanged from prior CT exam. Lung volumes are low with mild bibasilar atelectasis. Remainder of the lungs appear clear. Overall cardiomediastinal silhouette appears unchanged. Bony structures appear intact.", "output": "As above." }, { "input": "Low bilateral lung volumes. No focal consolidation, pleural effusion or pneumothorax identified. The size of the cardiac silhouette is enlarged but this may be secondary to magnification from the AP technique and low lung volumes. The tracheal stent again is noted to project over the thoracic inlet.", "output": "Low bilateral lung volumes. No focal consolidation or evidence of pulmonary edema." }, { "input": "Right IJ central line tip near the SVC junction. Tracheal stent is in place. Endotracheal tube has been removed. There is minimal left basilar atelectasis. Right lung is clear. No pleural fluid. Normal heart size, pulmonary vascularity.", "output": "Minimal left basilar atelectasis." }, { "input": "Tracheal stent in situ. Endotracheal tube in situ in a high position with the tip above the level of the thoracic inlet (just above the tracheal stent) 10 cm proximal to the carina. The cardiomediastinal shadow is unchanged. There is interval progression of the left lower lobe atelectasis. No pneumothorax.", "output": "ET tube position as described above. Interval progression of the left lower lobe atelectasis." }, { "input": "The lung volumes are normal. No focal consolidations. The cardiac silhouette is top-normal in size. Mediastinal and hilar contours are normal. The pleural surfaces are normal. A tracheal stent is stable in projects over the thoracic inlet.", "output": "No acute cardiopulmonary process." }, { "input": "The lung volumes are low. There is mild prominence of lung vasculature without lobar consolidation or frank pulmonary edema. Cardiomediastinal silhouette is within normal range. The new tracheal stent is in appropriate position. EKG leads overlie the chest wall. There is diffuse mild demineralization.", "output": "1. Mild prominence of lung vasculature without atelectasis or pulmonary edema. 2. Tracheal stent is in appropriate position, unchanged compared to ___." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. There is no free air below the right hemidiaphragm. Cardiomediastinal silhouette appears normal. Bony structures are intact.", "output": "No acute findings in the chest. No signs of pneumoperitoneum." }, { "input": "Lungs are fully expanded and clear. No pneumothorax or pleural effusion. Heart size is normal. Marked widening of the left mediastinum is unchanged and corresponds to a known descending thoracic aortic aneurysm. Cardiomediastinal hilar silhouettes are otherwise unchanged and unremarkable. Heart size is normal.", "output": "No pneumothorax or other acute cardiopulmonary abnormality. Unchanged widening of the left mediastinum corresponds to a known descending thoracic aortic aneurysm." }, { "input": "Frontal and lateral views of the chest are compared to previous exam from ___. The lungs are clear of focal consolidation. Biapical scarring is again noted. There is no pneumothorax. Cardiomediastinal silhouette is unchanged. Lower cervical fixation hardware again noted. No displaced fracture is seen.", "output": "No definite acute cardiopulmonary process." }, { "input": "AP and lateral chest radiographs demonstrate moderate cardiomegaly. However, there is no interstitial edema or large pleural effusion. There is no pneumothorax. Hypertrophic changes seen in the spine.", "output": "No acute cardiopulmonary process." }, { "input": "AP and lateral upright views of the chest were reviewed. Compared to the prior study of ___ the previously described mild pulmonary edema has resolved. On todays study the lungs are clear without focal infiltrate, pleural effusion or pneumothorax. The heart size has decreased and is now top normal.", "output": "No radiographic evidence of pneumonia or acute heart failure." }, { "input": "As compared to ___, endotracheal tube terminates 3.5 cm from the carina. The nasogastric tubes is curled in the known large hiatus hernia containing the majority of the stomach as well as loops of transverse colon. Right IJ catheter is in the right atrium. Moderate pulmonary edema has increase since the prior. Small bilateral effusions are stable. No pneumothorax.", "output": "Moderate pulmonary edema has slightly increased." }, { "input": "Since earlier same day chest radiograph, the endotracheal tube is positioned in the right mainstem bronchus and will need to be pulled back by about 5-6 cm. New opacities in the right upper and mid lung are likely due to either worsening of pre-existing developing pneumonia or aspiration. Bilateral pleural effusions, moderate on the left and small on the right, with interval increase on the right. Lung volumes remain low. The heart size is normal. Right internal jugular central line is in unchanged position in the right atrium. Note is made of a large hiatal hernia.", "output": "1. ETT terminates in the right mainstem bronchus. 2. Worsening Opacities in the right upper and mid lung may reflect aspiration or edema superimposed upon pre-existing infectious process. RECOMMENDATION(S): Recommend pulling back of ETT by 5-6 cm. NOTIFICATION: The findings were discussed by Dr. ___ with RN ___ on the telephoneon ___ at 10:44 AM, 5 minutes after discovery of the findings." }, { "input": "There is a large retrocardiac opacity with component of air compatible with a large hiatal hernia. Faint left basilar opacity seen laterally is likely atelectasis. Elsewhere, lungs are clear. Cardiac silhouette is top-normal. No acute osseous abnormalities. Surgical clips in the right upper quadrant suggest prior cholecystectomy.", "output": "Large hiatal hernia. No definite acute cardiopulmonary process." }, { "input": "The lungs are normally expanded and clear. The cardiomediastinal silhouette, hilar contours and pleural surfaces are normal. There is a trace right pleural effusion but no pneumothorax.", "output": "Trace right pleural effusion without evidence of pneumonia." }, { "input": "Since the prior study there is an improvement in aeration of the lungs with slight improvement in heterogeneous bibasilar opacities. Moderate cardiomegaly persists and there is increased opacification in the right lower lobe. Chain sutures are again noted in the right upper lung. There is no evidence of pleural effusion or pneumothorax. Mild central vascular congestion is noted.", "output": "Interval improvement in appearance of pulmonary edema from ___, now only mild vascular congestion, with large region of opacification of the right lower lung which could be secondary to infection." }, { "input": "Rotated positioning. Allowing for this, there is probable background COPD. Chain sutures noted in the right upper zone. There is mild to moderate cardiomegaly, similar to the prior film. Aorta is unfolded. Right paratracheal soft tissues likely represent vascular structures in someone of this age. There is upper zone redistribution and diffuse vascular blurring. There is hazy opacity at both lung bases, likely representing small layering effusions, with underlying collapse and/or consolidation. Note is made of a slightly irregular contour of the trachea.", "output": "1. Background COPD. Cardiomegaly. 2. Diffuse vascular plethora vascular blurring and small effusions. This likely represents CHF. The differential diagnosis could include infectious or inflammatory processes in the appropriate clinical setting. This appearance appears significantly more pronounced compared with the outside film from ___. Underlying collapse and/or consolidation present. 3. Slightly patulous appearance to the trachea, similar to the prior film. Clinical correlation requested." }, { "input": "The patient is status post coronary artery bypass graft surgery. The heart is again mild-to-moderately enlarged. The mediastinal and hilar contours appear unchanged. The lung volumes are low. There are again patchy opacities in both lower lungs, more extensive in the left lower lobe than right but considerably improved. It is difficult to exclude small persistent effusions but these are markedly improved. Bony structures are unremarkable.", "output": "Improving pleural effusions and basilar opacities with persistent but decreased left lower lobe opacity. Although superimposed infection is difficult to exclude, the appearance could be explained by atelectasis, scarring, potentially with residual loculated effusion." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The endotracheal tube terminates 6.5 cm above the carina. The orogastric tube is within stomach. Appearance of the heart and lungs otherwise unchanged. No pneumothorax or pleural effusion.", "output": "Satisfactory position of endotracheal and orogastric tubes. Otherwise no interval change." }, { "input": "The lungs are normally expanded and clear. The cardiomediastinal silhouette, hilar contours and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary abnormality." }, { "input": "Left-sided AICD / pacemaker device is noted with single lead terminating in the right ventricle. Dual lumen central venous catheter tip terminates in the proximal right atrium. Moderate to severe enlargement of cardiac silhouette is unchanged. Lung volumes are low. Mediastinal and hilar contours are stable. There is crowding of the pulmonary vascular markings, with probable mild pulmonary vascular congestion. No focal consolidation, pleural effusion or pneumothorax is demonstrated. Minimal atelectasis is seen in the lung bases.", "output": "Low lung volumes with mild bibasilar atelectasis and probable mild pulmonary vascular congestion." }, { "input": "Frontal and lateral views of the chest. The lungs are hyperinflated with flattening of the diaphragms. Linear bibasilar opacities may be due to scarring. There is no large confluent consolidation or effusion. The cardiomediastinal silhouette is within normal limits. There is mild anterior wedging of the lower thoracic/upper lumbar vertebral body which is age indeterminate, could be old. No definite acute osseous abnormality identified.", "output": "1. Hyperinflation without definite superimposed acute cardiopulmonary process. 2. Mild anterior wedging of the lower thoracic/upper lumbar vertebral body, which is age indeterminate, potentially old." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The chest is hyperinflated. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Lung volumes are low. There is no definite consolidation, effusion or pneumothorax. There is subtle opacity along the left heart border which is thought to represent overlap of the left hemidiaphragm with the left ninth rib at this level. No effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No signs of pneumonia." }, { "input": "PA and lateral views of the chest are compared to previous exams from ___. The lungs remain clear. The cardiomediastinal silhouette is within normal limits. Hypertrophic changes are noted. osseous and soft tissue structures are otherwise unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest were obtained. The heart is normal in size and cardiomediastinal contour including tortuosity of the thoracic aorta is unchanged. Linear bibasilar opacities are unchanged and likely represent mild atelectasis. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No evidence of pneumonia." }, { "input": "There is right greater than left biapical pleural thickening. No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal. Mediastinal contours are unremarkable. Some degenerative changes are seen along the spine. The bones appear relatively osteopenic.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are slightly diminished. Cardiac silhouette remains mildly enlarged but unchanged. Hilar prominence is compatible with known central lymphadenopathy. The known, numerous nodular metastases are better evaluated on the recent chest CT. No pleural effusion, pneumothorax or focal airspace consolidation. Rib deformities from prior fractures are again seen.", "output": "1. No acute cardiopulmonary process. 2. Known metastatic disease is better evaluated on the CT chest from 10 days prior." }, { "input": "Heart size is mildly enlarged but unchanged. The aortic knob is calcified. Enlargement of the hila bilaterally is compatible with pulmonary arterial hypertension as well as underlying lymphadenopathy. The mediastinal contours are unchanged. Scattered ill-defined nodular opacities are relatively similar compared to the prior exam, compatible with known metastatic lesions. There is mild pulmonary vascular engorgement. No pleural effusion, new focal consolidation or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Scattered ill-defined nodular opacities compatible with known metastatic disease, relatively unchanged compared to the prior study. Enlargement of the hila bilaterally, likely reflective of pulmonary arterial hypertension and underlying lymphadenopathy. Mild pulmonary vascular engorgement." }, { "input": "Right upper lobe subsegmental atelectasis has resolved. The lungs are clear. There is no pneumothorax. The heart appears enlarged suspected projection. The pulmonary arteries appear prominent, as in the past. Prominent supraclavicular soft tissues corresponds to known multinodular goiter.", "output": "Stable appearance of supracervical soft tissues related to known multinodular goiter. Clear lungs. Stable cardiomegaly. Stable pulmonary hypertension." }, { "input": "PA and lateral views of the chest provided. Cardiomegaly is mild and stable. Mild bibasilar atelectasis without definite signs of pneumonia. No large effusion or pneumothorax is seen. No pneumothorax is seen. No overt edema. Bony structures are intact. Mediastinal contour is stable. Mild hilar engorgement is suspected.", "output": "Mild cardiomegaly and hilar engorgement without frank edema or pneumonia." }, { "input": "The lungs are clear. The cardiomediastinal silhouette slightly enlarged, unchanged. There is no pleural effusion. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs are fully expanded and clear. No pleural abnormalities. Heart size is top-normal. Cardiomediastinal and hilar silhouettes are normal. Median sternotomy wires are midline and intact.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The patient is status post median sternotomy and CABG. Dense mitral annular calcifications are noted. Cardiac silhouette size is normal. The aorta is mildly tortuous and diffusely calcified. Pulmonary vasculature is normal. Streaky opacities in the lower lobes likely reflect atelectasis. There is no focal consolidation, pleural effusion or pneumothorax. Ossification of the anterior longitudinal ligament is noted. There are clips from prior cholecystectomy in the right upper quadrant of the abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lung fields are clear. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable.", "output": "Normal chest radiograph." }, { "input": "There is a large patchy opacity in the right middle and lower lobes consistent with pneumonia. The lungs are otherwise well expanded. There is no pneumothorax or pleural effusion. The cardiomediastinal silhouette is unchanged. Rightward scoliosis of the spine and multilevel degenerative changes are noted.", "output": "Right middle and lower lobe pneumonia. These findings were discussed with Dr. ___ by Dr. ___ ___ telephone at 2:45 p.m." }, { "input": "The heart is again mild-to-moderately enlarged. The main pulmonary artery contour appears moderately enlarged. The aortic arch is calcified. Opacities at the lung bases have markedly improved, leaving streaky opacities, most prominent at the left retrocardiac region. There is increased interstitial abnormality suggesting mild vascular congestion. There is no pleural effusion or pneumothorax. Mild-to-moderate rightward convex curvature centered along the lower thoracic spine with multilevel mild degenerative changes noted along the lower thoracic levels. The bones appear demineralized.", "output": "1. Findings suggesting mild vascular congestion, although somewhat increased. 2. Marked improvement in basilar opacities with residual streaky opacities, greater on the left than right, suggestive of atelectasis or resolving infection." }, { "input": "Other than a right upper lobe granuloma, the lungs are clear with no focal opacities concerning for pneumonia. There are no pleural effusions or pneumothorax. The cardiomediastinal and hilar contours are stable, with heart within the upper limits of normal in size. Pulmonary vascularity is normal. There is dextroconvex scoliosis of the thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "Please note, this study is being interpreted on ___. Is unclear why there was a delay in reading of this film for interpretation. The cardiac silhouette is mildly enlarged, larger than on the prior study. There small bilateral pleural effusions that are larger than on the prior exam. There is volume loss at both bases, and the underlying infectious infiltrate cannot be excluded and either lower lung. There is also an area of patchy alveolar infiltrate in the right upper lung. There is mild pulmonary vascular redistribution.", "output": "CHF. There are also areas of volume loss/ infiltrate in both lower lungs that have increased compared to prior. An infectious infiltrate cannot be excluded" }, { "input": "There is pulmonary vascular congestion with indistinct pulmonary vascular markings seen throughout. Bibasilar opacities are seen, progressed on the right when compared to prior and new streaky left basilar opacities as well. There are small bilateral pleural effusions, also new from prior. Cardiac silhouette is difficult to assess as it is silhouetted particularly on the right, but is at least mildly enlarged, similar to prior.", "output": "Pulmonary vascular congestion and small bilateral pleural effusions. Right greater than left basilar opacities which could represent superimposed infection. Recommend repeat after treatment to document resolution especially in setting of previously seen right-sided consolidation without documented resolution in the interim." }, { "input": "The tip of the ET tube cannot be assessed on this film due to overlying spinal hardware. NG tube tip is in the stomach. There is a new left subclavian line with tip in the distal SVC. Right IJ line tip is in the distal SVC. There is a moderate right pleural effusion with right lower lobe volume loss. There is dense retrocardiac opacity compatible with volume loss/infiltrate/effusion. There is mild pulmonary vascular redistribution. The heart size is mildly enlarged.", "output": "Compared to the prior exam, the aeration of the upper lobes is slightly improved" }, { "input": "A portable frontal chest radiograph again demonstrates a right-sided PICC, with the tip obscured by spinal hardware. Additional views are required for better localization.", "output": "Right-sided PICC with the tip obscured by spinal hardware, requiring additional oblique views for better localization." }, { "input": "The heart is normal in size. A number of calcifications project over the lower central mediastinum and suggest calcified subcarinal lymph nodes. A calcified granuloma is noted in the right lung. The lungs appear otherwise clear, however, without evidence for acute process. There is no pleural effusion or pneumothorax. Bony structures are unremarkable aside from mild degenerative changes along the mid thoracic spine.", "output": "Calcified granuloma in the mid right lung and clustered calcifications in the mediastinum, probably associated with prior granulomatous exposure. No evidence of acute disease, however." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged, allowing for differences in technique, including a calcified aortopulmonary window lymph node. There is no pneumothorax or definite pleural effusion. There is mild perihilar congestion, but otherwise the lungs appear clear. Surgical clips project over the upper abdomen.", "output": "Findings suggesting mild vascular congestion." }, { "input": "PA and lateral views of the chest. No prior. The lungs are clear without focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "There is a Swan-Ganz catheter appropriately positioned. The endotracheal tube and nasogastric tube have been removed. Bibasilar chest tubes have also been removed. No pneumothorax is appreciated. There is mild vascular congestion as well as small bilateral pleural effusions greater on the left.", "output": "No pneumothorax appreciated following chest tube removal." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Frontal and lateral chest radiographs demonstrate a left chest wall pacer with leads overlying the right atrium and ventricle, as well as intact sternal wires. The cardiomediastinal silhouette is normal. The lungs are well aerated. There is a small to moderate right pleural effusion with associated atelectasis, as well as a trace left pleural effusion. No focal consolidation or pneumothorax is appreciated.", "output": "No evidence of pneumonia. Small to moderate right pleural effusion and trace left pleural effusion with associated atelectasis." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. Asymmetric heterogeneous opacification suggests multifocal pneumonia in the right lung. Right mid lung opacities are vague but somewhat rounded so septic nodules are possible this may perhaps be explained primarily by pneumonia. There is also a fairly well defined right infrahilar opacity suggesting pneumonia with air bronchograms. In addition, although more diffuse vague bilateral opacification may also be due to infection, coinciding pulmonary edema is suspected. There are probably small pleural effusions.", "output": "Findings suggest multifocal pneumonia, probably with coinciding pulmonary edema and small pleural effusions. Right mid lung opacities are vague and perhaps somewhat nodular; relatively large septic emboli air are possible but these may be primarily areas of consolidation." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. Minimal fluid or thickening is seen involving the right minor fissure. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest demonstrate the lungs are well expanded and clear. There is no evidence of pneumothorax, pulmonary edema, or pleural effusion. The cardiomediastinal silhouette is unremarkable. No focal opacities are seen.", "output": "No acute cardiopulmonary process. No evidence of pneumothorax." }, { "input": "Chest, PA and lateral radiographs demonstrate stable mediastinal and hilar prominence due to known lymphadenopathy. Heart size is top normal. On a background of mild pulmonary edema, there is increased opacification noted in the left upper and lower lung, concerning for infectious process. Stable small left pleural effusion. Large bore catheter terminates at the cavoatrial junction. Minimal rightward deviation of catheter may be due to lymphadenopathy.", "output": "Likely left upper and lower lobe pneumonia superimposed on mild pulmonary edema. Small left pleural effusion." }, { "input": "Portable chest radiograph demonstrates an endotracheal tube 5 cm above the carina. Although in appropriate position, care should be taken not to withdraw the endotracheal tube any further. An enteric tube descends in and uncomplicated course, its terminal end not visualized. Cardiomegaly is stable appearing. The lungs are grossly clear with mild vascular congestion and small, if any, pleural bilateral effusions. No pneumothorax.", "output": "Mild vascular congestion and small of any bilateral pleural effusions. Endotracheal tube 5 cm above the level of the carina. Care should be taken not to withdraw any further." }, { "input": "Portable frontal chest radiograph demonstrates interval removal of enteric and endotracheal tube. A right PICC is seen terminating at the mid SVC. As compared to chest radiograph ___, there are improved lung volumes with persistent but small bilateral pleural effusions. The lungs are grossly clear. Severe cardiomegaly is chronic.", "output": "Improved lung volumes. No significant changes." }, { "input": "The cardiac, mediastinal and hilar contours are normal. The lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. There are mild degenerative changes in the thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal silhouette and hilar contours are unremarkable. Lungs are clear. There are no pleural effusions or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. No prior. Patient is extremely kyphotic. The lungs are clear of confluent consolidation; however, there are diffusely increased interstitial markings throughout, potentially due to chronic lung disease or mild edema. There is also a curvilinear likely calcific density projecting over left mid lung, potentially along the pleura. There is no pleural effusion. Cardiac silhouette is slightly enlarged. Kyphosis again noted.", "output": "Slightly increased interstitial markings of the lungs, potentially due to chronic lung disease; however, component of mild edema is also possible. Curvilinear calcific density projecting over the left lung, potentially along the pleura, however, also might be in the lung. No prior for comparison. No confluent consolidation." }, { "input": "Exam is limited secondary to patient positioning, his chin overlies the lung apices bilaterally. Coarse interstitial markings seen throughout the lungs bilaterally which have been chronic back to ___. There are small bilateral pleural effusions. Enlarged cardiac silhouette has not significantly changed given differences in positioning and technique. Accentuated thoracic kyphosis is again noted. Osseous structures are not well assessed due to osteopenia.", "output": "Small bilateral pleural effusions without definite superimposed acute cardiopulmonary process given limitations of positioning." }, { "input": "AP and lateral views of the chest. The lungs are clear of confluent consolidation. There is no large effusion. Calcific density again projects over the left mid lung. The cardiac silhouette is enlarged but stable. Tortuous aorta seen with calcifications atherosclerotic calcifications. Eccentric kyphosis is identified.", "output": "No definite acute cardiopulmonary process." }, { "input": "2 views of the chest demonstrate clear lungs. The cardiac, hilar, and mediastinal contours are normal. No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is mildly enlarged. There is moderate unfolding of the thoracic aorta, but otherwise the mediastinal and hilar contours appear within normal range. There is mild-to-moderate relative elevation of the right hemidiaphragm. No pleural effusion or pneumothorax is seen. There are patchy predominantly streaky opacities at both lung bases that are suggestive of minor atelectasis. Otherwise, the lungs appear clear. Moderate anterior osteophyte formation is noted throughout the thoracic spine. Cholecystectomy clips project over the right upper quadrant.", "output": "1. Streaky bibasilar opacities, most suggestive of atelectasis, although not entirely specific. 2. Mild-to-moderate relative elevation of the right hemidiaphragm. 3. Mild cardiomegaly and unfolding of the thoracic aorta." }, { "input": "Portable AP upright chest film ___ at 13 11 is submitted.", "output": "There is improved aeration at the left base, although persistent patchy opacity with associated layering effusion likely reflects residual atelectasis or resolving pneumonia. There is also improved aeration within the right lung possibly related to improved inspiration and resolving airspace disease. The right hilum appears somewhat prominent but when correlated with the recent chest CT of ___, this likely reflects a combination of small hilar lymph nodes and prominent vascular structures. The heart remains enlarged. No pneumothorax." }, { "input": "Since the prior radiograph, heterogeneous opacities in the right upper and lower lungs have worsened, resulting in more confluent consolidation. Additionally, new retrocardiac opacity may represent worsening atelectasis or infection. Superimposed pulmonary edema is likely. Heart size and mediastinal contour is unchanged. Small bilateral pleural effusions are likely.", "output": "Interval worsening in consolidation of the right lung, as well as new consolidation at left lung base. Findings are concerning for multifocal infection. Superimposed pulmonary edema is also likely." }, { "input": "Heart size remains mildly enlarged. The mediastinal contour is similar. There is mild pulmonary edema with pulmonary vascular indistinctness and perihilar haziness, more progressed in the interval. Small bilateral pleural effusions, greater on the left are noted, not substantially changed in the interval. Streaky opacities in the lung bases likely reflect areas of atelectasis. No pneumothorax is demonstrated. Moderate to severe multilevel degenerative changes are noted in the thoracic spine with bridging anterior osteophytes.", "output": "Mild pulmonary edema, slightly worse in the interval, with small bilateral pleural effusions and bibasilar atelectasis." }, { "input": "There is interval improvement in the left mid lung opacity. There is an ill-defined opacity of the left lower lobe that is new since chest radiograph taken on ___, but corresponds with left lower lobe nodule noted on recent CT chest. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unchanged.", "output": "Interval improvement of left mid lung opacity. Left lower lobe ill-defined opacity could be a metastatic disease given patient's history of breast cancer or a pneumonia given progression since chest radiograph from 1 month prior. Can consider either follow-up in 2 months or repeat chest CT to further characterize the opacity or biopsy for definite diagnosis . NOTIFICATION: The findings were discussed with Dr. ___, ___D. by ___, ___D. on the telephone on ___ at ___:___ PM, 2 minutes after discovery of the findings." }, { "input": "In comparison to ___ chest radiograph, a peripheral region of consolidation in the left mid lung has worsened in the interval. Cardiomediastinal contours are stable. Right lung and pleural surfaces remain clear.", "output": "Worsening peripheral left mid lung consolidation, for which the differential diagnosis includes infectious pneumonia, radiation pneumonitis (the extent of radiographic abnormalities is greater than typically observed in the setting of breast cancer radiation therapy), organizing pneumonia, and less likely infarction. RECOMMENDATION(S): Consider chest CT for further characterization of the left lung consolidation. NOTIFICATION: The impression and recommendation above was entered by Dr. ___ on ___ at 09:14 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "Right chest tube and pigtail catheter are seen. Right subcutaneous emphysema persists. Right pleural effusion with underlying consolidation appears similar compared to prior. The left lung is clear. Heart and mediastinal contours appear unchanged.", "output": "Stable chest radiograph." }, { "input": "Single portable view of the chest demonstrates opacification of most of the right hemithorax with interval increase in right-sided pleural effusion, now quite large, which has significantly increased in size over the course of 10 days, and may be partially loculated. The left lung is essentially clear. Cardiac size remains stable as does the left hilar contour. There is no left pleural effusion.", "output": "Very large right-sided pleural effusion which may be partially loculated, increased significantly since the prior study, with underlying atelectasis." }, { "input": "Status post thoracentesis, the right-sided pleural effusion has decreased in size, although significant amount of pleural fluid as well as adjacent atelectasis still remain. Minimal left lower lobe atelectasis is present. Otherwise, the left lung is clear. Cardiac apex is stable. There is no pneumothorax.", "output": "Decrease in size in right-sided pleural effusion, although still significant in size with right sided atelectasis/partial lung collapse. No evidence of pneumothorax." }, { "input": "There is mild cardiomegaly and mild pulmonary edema. There is no pleural effusion or pneumothorax. There is no focal lung consolidation. ICD lead ends in the right ventricle.", "output": "Mild cardiomegaly and mild pulmonary edema." }, { "input": "Heart size is normal. The aortic knob is mildly calcified. Mediastinal and hilar contours are within normal limits. Pulmonary vasculature is normal and the lungs are clear. No pleural effusion, focal consolidation or pneumothorax is seen. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "AP portable view of the chest. Enteric tube ends just distal to the gastroesophageal junction with side port in the distal esophagus. Compared to prior study, there are new bilateral basilar opacities which may represent aspiration given the increase in opacities over the short interval time. Small bilateral pleural effusions are new. No pneumothorax. Heart size is normal.", "output": "1. New bibasilar opacities, right greater than left, since radiographs done four hours prior, are concerning for aspiration. Small bilateral pleural effusions. 2. Enteric tube side port ends in the distal esophagus and should be advanced. These findings were discussed with Dr. ___ by Dr. ___ ___ at 9:34 a.m. on ___ by telephone at the time of discovery." }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. There is no evidence of radiopaque foreign body visualized within the intrathoracic trachea. The cardiomediastinal silhouette is within normal limits.", "output": "No radio-opaque foreign body or acute cardiopulmonary process." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The heart is normal in size with normal cardiomediastinal contours.", "output": "No acute intrathoracic process." }, { "input": "The carina is not well delineated. The tip probably lies approximately 2.3 cm above the carina. An orogastric tube is present and extends beneath the diaphragm off the film. Other NG type tube is seen extending beneath diaphragm, off film. A left subclavian central line tip overlies the distal SVC. No pneumothorax is detected. Cardiomediastinal silhouette is probably unchanged allowing for technical differences and lower inspiratory volumes. There is upper zone redistribution and mild diffuse vascular blurring, consistent with CHF, similar to the ___. Again seen are small bilateral effusions, possibly minimally improved.", "output": "Lines and tubes as described. CHF, similar to prior. Bibasilar effusions are probably slightly improved. Associated bibasilar atelectasis again noted." }, { "input": "Pulmonary vascular congestion is mild. There may be a trace left effusion. There is no focal consolidation or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No pneumonia." }, { "input": "There is a moderate right pleural effusion with increased haziness in the adjacent right mid to lower lung zone. No pneumothorax identified. Pulmonary edema is also present. The size the cardiomediastinal silhouette is mildly enlarged. Degenerative changes of both shoulders, greater on the left.", "output": "New pulmonary edema. Bilateral lower lung zone hazy and patchy opacities may be secondary to pulmonary edema however superimposed multifocal pneumonia should also be considered given the provided clinical history." }, { "input": "The tip of the endotracheal tube projects over the mid thoracic trachea. A left subclavian central venous line catheter tip extends to the cavoatrial junction. Two enteric tubes extend below the level the diaphragms but beyond the field of view of the radiograph. There has been interval advancement of the Dobhoff feeding tube. The tip of the endotracheal tube projects over the mid thoracic trachea. Moderate bilateral pleural effusions with overlying atelectasis. No pneumothorax identified. The size the cardiomediastinal silhouette is within normal limits.", "output": "Unchanged moderate bilateral pleural effusions with overlying atelectasis. The seen on this radiograph. Tip of a left subclavian central venous catheter extends to the cavoatrial junction. Interval advancement of the Dobhoff feeding tube, however the distal tip is not" }, { "input": "AP upright and lateral views of the chest provided. No radiopaque foreign bodies seen within the imaged field. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Pectus excavatum deformity of the sternum is noted. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process. No radiopaque foreign body in the imaged soft tissues." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. No radiopaque foreign bodies are identified.", "output": "No acute cardiopulmonary abnormality. No radiopaque foreign bodies are identified." }, { "input": "Heart size is top normal. The mediastinal and hilar contours are unremarkable. Pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is identified. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart size is normal. The cardiomediastinal silhouette and hilar contours are stable. The lungs are clear without focal consolidation, effusion or pneumothorax. No acute bony abnormality is identified.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral chest radiographs. The lungs are clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Moderate cardiomegaly is a stable. Widening mediastinum due to lymphadenopathy and increase in size of the hilum bilaterally due to enlargement of the pulmonary arteries is stable. Multifocal bilateral lower lobe predominant opacities are new consistent with multifocal pneumonia. There is no pneumothorax or large pleural effusion. Right PICC tip is in the right atrium. There appears to be a coronary stent.", "output": "Multifocal pneumonia" }, { "input": "The right-sided PICC line tip at the cavoatrial junction is again visualized. The heart continues to be mildly enlarged and there is pulmonary vascular redistribution. However much of the hazy alveolar infiltrate has cleared. There is no new infiltrate", "output": "Slight improvement in fluid overload." }, { "input": "Right PICC line tip near cavoatrial junction. Mildly improved bibasilar opacities since prior exam. Cardiac enlargement. Interval improvement of pulmonary vascularity. Prominent central pulmonary arteries, suggest pulmonary arterial hypertension. Coronary artery stent in place. Small pleural effusions.", "output": "Interval mild improvement" }, { "input": "Right PICC line in place tip in the low SVC, stable. Heart is enlarged, stable. There is coronary stent in place. There is no pulmonary edema. Enlarged central pulmonary arteries, suggest pulmonary arterial hypertension. There is minimal vascular congestion, more prominent. No pleural fluid.", "output": "Cardiac enlargement with minimal vascular congestion. Suggestion of pulmonary arterial hypertension." }, { "input": "Right PICC line tip at low SVC. Borderline heart size, pulmonary vascularity, similar. No consolidations. Chest otherwise normal.", "output": "Stable exam" }, { "input": "Lung volume is low. Mild left lower lobe opacity is likely atelectasis. There is no pneumothorax or pleural effusion. Cardiomediastinal silhouette is normal size. Pulmonary vascular congestion is mild.", "output": "No pneumothorax. Mild pulmonary vascular congestion." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. No signs of pneumomediastinum Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Analysis is performed in direct comparison with the next preceding similar study of ___. Heart size is difficult to assess because of overlying left-sided pulmonary abnormalities. Heart size is probably normal as there is no evidence of pulmonary vascular congestion. Multiple previous chest examinations are reviewed in sequence, demonstrating that the fibrotic changes have progressed continuously since ___. Comparison with the next preceding chest examination of ___ demonstrates further progress to a lesser degree. Again, there are bilateral, mostly basal linear changes, most marked on the left side where there also blend with the mediastinal structures and obscure the cardiac contours. On the left base laterally, in the vicinity of the chest wall, there are increased local densities identified, which are suggestive of possibly new acute processes. The diagnosis is not conclusive in light of the previously existing rather advanced changes. It is therefore suggested to treat the patient for the present acute infection and take a followup chest examination with shorter time interval (one week) to see if these changes are regressing.", "output": "Mild regression of chronic fibrotic changes since ___. Suspicion for local left lower lobe lateral infiltrate. Recommend followup." }, { "input": "There is a new patchy opacity in the left lower lobe which partly obscures the left hemidiaphragm. Otherwise, extensive fibrosis appears unchanged. Evidence of prior wedge resection is again noted at the level of the lingula. There is no pneumothorax. Cardiac silhouette appears stable. Osseous structures are grossly unremarkable.", "output": "1) New left lower lobe opacity suggestive of left lower lobe pneumonia. Followup CXR recommended in 4 weeks after therapy to ensure resolution. 2) Similar appearance of interstitial pulmonary fibrosis." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear and well expanded without pleural effusion, pneumothorax, or consolidation. Osseous structures are unremarkable. There are unchanged surgical clips in the right upper quadrant.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable view of the chest. The lungs are clear. Cardiomediastinal silhouette is within normal limits. Surgical clips seen in the right upper quadrant and surgical chain sutures in the left upper quadrant. No acute osseous abnormality detected.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are clear. No effusion, pneumothorax or consolidation is present. Heart and mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest demonstrates mild cardiomegaly which is decreased from prior. No focal consolidation, pleural effusion or pneumothorax. No evidence of free air under the diaphragm.", "output": "No free air under the diaphragm." }, { "input": "Mild cardiomegaly is overall similar compared to prior exams dated back to ___. The hilar and mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for pneumonia. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No focal consolidations concerning for pneumonia identified." }, { "input": "The heart is mildly enlarged with a left ventricular configuration. Lung volumes are very low, probably accounting for streaky opacities in the posterior lower lobes suggesting minor atelectasis. A mildly prominent interstitial abnormality could suggest mild congestion but is of uncertain significance noting very low lung volumes which may exaggerate substantially exaggerate normal interstitial markings.", "output": "Very low lung volumes; mild interstitial prominence, possibly within normal range for technique versus mild congestion or diffuse inflammatory change." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unremarkable. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. Degenerative changes with anterior osteophytes are noted within the thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The heart appears mildly enlarged, even allowing for technique. Multiple external electrodes overlie the patient's chest. Within these limitations, there is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Linear opacity in the right lung laterally is likely due to scarring versus atelectasis. The lungs are otherwise clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. There is mild compression deformity of a mid thoracic vertebral body, age indeterminate.", "output": "No acute cardiopulmonary process. Age-indeterminate mid thoracic mild compression deformity, correlation regarding symptoms is suggested." }, { "input": "Low lung volumes contribute to bibasilar atelectasis. Cardiac size is normal. No focal opacities concerning for infectious process. There may be a small amount of fluid within the fissure on the right with an adjacent area of segmental atelectasis. No pneumothorax. Aorta is tortuous. Gaseous distention of the stomach results in left diaphragmatic elevation. No free air under the diaphragms.", "output": "Bibasilar atelectasis. Gaseous distention of the stomach." }, { "input": "PA and lateral views of the chest were provided demonstrating no focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours appear normal. The imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "There is elevation of the right hemidiaphragm as on prior. Focal left basilar opacity posteriorly is grossly unchanged given differences in technique compared to prior CT scan. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified. Surgical clips seen in the upper abdomen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. The lungs are clear. The cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. There is no pulmonary edema.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is status post recent median sternotomy and aortic valve replacement. Cardiomediastinal contours are stable in appearance in the post-operative period. Slight improvement in degree of left lower lobe atelectasis but unchanged small left pleural effusion. Minimal atelectasis at right lung base and small right pleural effusion are also similar to the prior study. No visible pneumothorax. On the lateral radiograph, an apparent small air-fluid level is present in the upper retrosternal region. This cannot be compared to prior studies due to absence of a lateral view on previous exams.", "output": "1. Improving left lower lobe atelectasis and persistent small pleural effusions, left greater than right. 2. Apparent small retrosternal air-fluid level on lateral view, which could reflect post-operative changes in the anterior mediastinum or a small loculated hydropneumothorax." }, { "input": "Compared to prior study there is no significant interval change.", "output": "Unchanged." }, { "input": "A right internal jugular catheter terminates in the upper to mid superior vena cava. There has been near resolution of the right pleural effusion, now tiny. There is no pneumothorax. A rounded area of consolidation is seen inferiorly, only on the lateral view, and was not appreciated on the pre-operative study. The cardiac silhouette remains mildly enlarged but improved. Postoperative mediastinal widening is resolving.", "output": "1. Rounded inferior lung opacity, only seen on the lateral view, could represent post-operative rounded atelectasis. Attention on follow up is recommended if the patient does not have fever. 2. Near resolution of right pleural effusion, now tiny." }, { "input": "Endotracheal tube terminates in the mid thoracic trachea. Enteric tube terminates in the stomach. Multiple right-sided rib fractures are noted, without pleural effusion or pneumothorax. Bilateral regional opacification, not dense enough to be called consolidation, likely represent sequela of aspiration.", "output": "1. Satisfactory position of endotracheal and enteric tubes. 2. Multiple right-sided rib fractures without pneumothorax or pleural effusion. 3. Bilateral airspace opacification likely reflecting aspiration." }, { "input": "The lung volumes are low to moderate. An ET tube is unchanged in position. An enteric tube has its side port within the stomach. A right PICC line is unchanged. There is obscuration of the left medial hemidiaphragm and blunting of the left costophrenic angle. This is most consistent with a small left pleural effusion and atelectasis.", "output": "Enteric tube in appropriate position." }, { "input": "The endotracheal tube, PICC line and nasogastric tube are all unchanged in appearance when compared to the prior study. Multiple right-sided rib fractures are noted. These are unchanged in appearance compared to multiple prior studies. Mild cardiomegaly with haziness of the pulmonary vasculature may in part be due to low lung volumes but may also reflect a degree of fluid overload. Linear atelectasis at the left lung base. No pneumothorax seen.", "output": "No significant interval change when compared to the prior study." }, { "input": "A right-sided PICC is in-situ, terminating in the mid to distal SVC. Endotracheal tube is in-situ, this terminates 4.5 cm above the level of the carina. A nasogastric tube is seen, the tip is not visualized but lies below the diaphragm in the left upper quadrant. There is persistent left lower lobe atelectasis. There is mild cardiomegaly with enlargement and haziness of the pulmonary vascular consistent with pulmonary vascular congestion. No focal consolidation seen.", "output": "No significant interval change when compared to the prior study." }, { "input": "ET tube is in appropriate position, 4 cm above the carina. The right PICC line is unchanged. Right lateral rib fractures are similar in appearance to prior. The hemidiaphragms and left heart border are better delineated. There is decreased bilateral alveolar opacities. The heart size appears smaller.", "output": "1. Endotracheal tube is appropriately positioned. 2. Improving pulmonary edema." }, { "input": "As compared to prior chest radiograph from ___, lung volumes have decreased which accentuate the cardiac silhouette and bronchovascular structures. There is no focal consolidation, pleural effusion or pneumothorax. Patient is status post lingulectomy, with surgical sutures project along the left cardiac border.", "output": "No acute cardiopulmonary process." }, { "input": "Right-sided pheresis catheter tip terminates at the cavoatrial junction. Opacity seen only on the lateral view overlying the right infrahilar region could represent superimposition of structures or a cavity. There is no pleural effusion. No pneumothorax. Mediastinum, hila and pleural surfaces are unremarkable. Heart size is normal.", "output": "Right-sided pheresis catheter tip terminates at the cavoatrial junction. Opacity seen only on the lateral view overlying the right infrahilar region could represent superimposition of structures or a cavity. Recommend oblique views for further evaluation. RECOMMENDATION(S): Oblique views to further evaluate right infrahilar region for possible consolidation. NOTIFICATION: The impression and recommendation above was entered by Dr. ___ on ___ at 17:20 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "PA and lateral chest radiographs demonstrate focal opacity in the both lower lobes compatible with atelectasis or early pneumonia. There is biapical scarring. There may be a tiny right pleural effusion. The cardiomediastinal silhouette is normal. A tortuous aorta is noted. Cholecystectomy clips are noted. Multiple old bilateral rib fractures are noted, and a mild to moderate compression deformity of an upper lumbar vertebral body is age-indeterminate.", "output": "Bilateral lower lobe opacities represent atelectasis or early pneumonia." }, { "input": "PA and lateral views of the chest. Right chest wall pacing device obscures visualization of portions of the right lung. Leads are seen at the right ventricular apex and right atrium. Biapical scarring is noted, left greater than right. The lungs are clear of consolidation or effusion. Cardiomediastinal silhouette is within normal limits noting a slightly tortuous aorta. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "Dual lead right-sided pacemaker is again seen with lead extending to the expected positions of the right atrium and right ventricle.No new focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Patchy lingular opacity at the lateral left lung base may relate to atelectasis and scarring although developing pneumonia is not excluded. The right lung is clear. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Patchy lingular opacity at the lateral left lung base may relate to atelectasis and scarring although developing pneumonia or pulmonary infarct is not excluded in the appropriate clinical setting." }, { "input": "PA and lateral views of the chest provided. There is elevation of the left hemidiaphragm. The left hemidiaphragm maintains its normal rounded contour. There is no consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette appears grossly unremarkable, though the left heart border is poorly assessed. Bony structures are intact.", "output": "Elevated left hemidiaphragm likely accounts for exam findings of decreased air movement at the left lung base." }, { "input": "Upright portable radiograph of the chest demonstrates low lung volumes with bibasilar atelectasis. The heart size is top normal, but unchanged compared to the prior study. Mild pulmonary vascular congestion is present. There is no pleural effusion, overt pulmonary edema, or focal consolidation concerning for pneumonia. No pneumothorax is identified. A nasogastric tube is seen coursing through the esophagus, into the stomach, and terminating in the gastric body.", "output": "Appropriate position of NG tube, terminating in the gastric body. Pulmonary vascular congestion with no overt pulmonary edema." }, { "input": "A linear opacities at the bilateral lung bases may represent subsegmental atelectasis versus scarring. No other focal opacities are identified. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. Atherosclerotic calcifications are noted at the aortic knob.", "output": "Bibasilar opacities suggestive of atelectasis howver infection cannot be excluded." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. A small nipple-like projection at the level of the aortic knob is a normal radiographic variant and is secondary to a left superior intercostal vein overlying the aortic arch. There is no pleural effusion or pneumothorax.", "output": "Unremarkable chest radiographic examination." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "There are in general low lung volumes with retrocardiac and left lower lobe atelectasis along with some streaky atelectasis in the right lower lobe. Crowding of the bronchovascular structures is noted, but no evidence of overt pulmonary edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal in size.", "output": "Bilateral atelectasis likely due to low lung volumes. Follow up PA and lateral radiographs can be obtained when the patient is stable to better evaluate for lung pathology." }, { "input": "Right pectoral infusion port terminates in upper SVC. Mild left lung base opacity is likely due to atelectasis and overlying soft tissues. There is no pneumothorax or large pleural effusion. Cardiomediastinal and hilar silhouettes are unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. There is asymmetric density projecting over the left ___ costochondral junction when compared to the right. This could be due to degenerative changes. However given vague opacity in Raiders triangle on the lateral view, shallow obliques are suggested to confirm. Elsewhere, at the lungs are clear. The cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No definite acute cardiopulmonary process. Asymmetric density projecting over the left ___ costochondral junction which is likely degenerative in nature however shallow bilateral oblique suggested to confirm." }, { "input": "PA and lateral views of the chest. No prior. The lungs are clear. There is no effusion or pneumothorax. Cardiomediastinal silhouette is normal. Osseous and soft tissue structures are notable for hypertrophic changes in the spine.", "output": "No acute cardiopulmonary process." }, { "input": "Left PICC line tip is in the azygos vein, a change from prior radiograph. Normal heart size, pulmonary vascularity. There are no infiltrates. No pleural fluid.", "output": "PICC line tip is in the azygos vein." }, { "input": "Cardiomediastinal contours are stable with moderate cardiomegaly and tortuous aorta. Mild pulmonary edema has improved. . There is no pneumothorax. Bilateral effusions are small. . There are moderate degenerative changes in the thoracic spine. Patient is status post CABG. Sternal wires are aligned", "output": "Improved now mild pulmonary edema" }, { "input": "There is mild pulmonary edema. There is no confluent consolidation. No large effusion or pneumothorax on this portable film. Cardiac silhouette is mildly enlarged, similar compared to prior. Median sternotomy wires are again noted.", "output": "Mild pulmonary edema. No focal consolidation." }, { "input": "The patient is status post median sternotomy with sternotomy wires intact and well aligned. No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. The heart size is normal. Mediastinal contours are normal. No bony abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac and mediastinal silhouettes are stable. Again, the aorta is tortuous with possible mild dilatation of the ascending aorta. No focal consolidation is seen. There is no pleural effusion or pneumothorax.", "output": "No significant interval change. Again seen tortuous aorta with possible dilatation of the ascending region, slightly less conspicuous as compared to the prior study. No focal consolidation. No overt pulmonary edema." }, { "input": "Heart size is upper limits of normal. The mediastinal and hilar contours are remarkable for a tortuous thoracic aorta with possible component of dilation in the ascending region. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Mild scoliosis is noted.", "output": "Tortuous thoracic aorta with possible component of dilation in the ascending region. No evidence of congestive heart failure or pneumonia." }, { "input": "The lungs are well inflated and clear. Bilateral nipple shadows noted. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest are obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Chronic slight blunting of the costophrenic angle is seen. The cardiac and mediastinal silhouettes are stable and unremarkable, as are the hilar contours.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were reviewed and compared to the prior studies. Normal lungs, heart, pleural and mediastinal surfaces.", "output": "No radiographic evidence of pneumonia." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. The lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. The imaged bony structures are intact. No free air is seen below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "There is no focal consolidation, effusion, or pneumothorax. There is mild to moderate bibasilar atelectasis, worse on the right than the left. The cardiomediastinal silhouette is normal. Right chest port catheter tip is in the upper to mid SVC. Enteric tube courses below the diaphragm, with the tip out of view. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Right chest port catheter tip is in the upper to mid SVC." }, { "input": "AP portable semi upright view of the chest. Port-A-Cath resides over the right chest wall with catheter tip in the upper SVC as on prior exam. Hilar congestion with perihilar ground-glass opacity suggesting edema. No large effusion or pneumothorax. Heart size is normal. Mediastinum appears prominent concerning for underlying adenopathy. No acute fracture is seen.", "output": "Port positioned appropriately. Mediastinal prominence concerning for adenopathy. Hilar congestion and mild pulmonary edema." }, { "input": "Right-sided Port-A-Cath tip terminates in the upper SVC, unchanged. Heart size is within normal limits. The mediastinal contours are similar. There is mild pulmonary vascular congestion, new in the interval. Patchy atelectasis is seen in the lung bases. Small bilateral pleural effusions are present. No pneumothorax is identified. There are no acute osseous abnormalities.", "output": "Mild pulmonary vascular congestion with small bilateral pleural effusions and bibasilar atelectasis." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs which are without focal consolidation. There is mild left base atelectasis. No pleural effusion or pneumothorax is seen. The visualized upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "No focal consolidation is seen. The posterior costophrenic angles are relatively underpenetrated, presumed due to overlying patient body habitus, without pleural effusion seen. There is no evidence of pneumothorax. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "Low lung volumes exaggerate the cardiomediastinal silhouette, which is otherwise unremarkable. There is mild bibasilar atelectasis. No focal consolidations concerning for pneumonia are identified. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No focal consolidations concerning for pneumonia identified." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Levoscoliosis of the thoracic spine is noted. No displaced fractures are visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cardiac silhouette size is mildly enlarged. The aorta is mildly tortuous. The pulmonary vasculature is normal. Hilar contours are unremarkable. Consolidative opacity in the left lower lobe is concerning for pneumonia. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Left lower lobe pneumonia. Followup radiographs after treatment are recommended to ensure resolution of this finding." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral chest radiographs demonstrate no focal consolidation, pleural effusion, pneumothorax, or pulmonary vascular congestion. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "A mild background generalized interstitial abnormality is identified. There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits. Scoliosis is noted centered within the mid thoracic spine.", "output": "Age-indeterminate mild generalized background interstitial abnormality." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal and the lungs are clear without focal consolidation. No pleural effusion or pneumothorax is visualized. No acute osseous abnormality is demonstrated.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cardiomediastinal silhouette is unremarkable. There is mild fullness of the right hilum. The left hilum is unremarkable. The lungs are clear. There is no pleural effusion or pneumothorax. There is no intraperitoneal free air.", "output": "1. No intraperitoneal free air. 2. Fullness of the right hilum. Further evaluation may be obtained by CT evaluation in a non-emergent setting." }, { "input": "The cardiac silhouette is mildly enlarged, unchanged from prior. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "Stable cardiomegaly. No acute process" }, { "input": "Frontal and lateral views of the chest are compared to previous exam from ___. The lungs are clear of consolidation or effusion. Cardiomediastinal silhouette is within normal limits. Tortuous aorta is noted. Osseous and soft tissue structures are unremarkable. There is increased lucency at the right lung base, likely below the hemidiaphragm suspicious for intraperitoneal air.", "output": "Increased lucency at the right lung base thought most likely to be below the hemidiaphragm suspicious for free intraperitoneal air, potentially from recent surgery; however, amount of air is more than expected given time since surgery. Findings discussed with ___ resident at 1:40 pm at time of discovery." }, { "input": "PA and lateral views of the chest were obtained. The heart is moderately enlarged. There is atherosclerotic calcification at the aortic knob. There is no focal consolidation, effusion, or pneumothorax. No definite signs of CHF. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Mild cardiomegaly, otherwise unremarkable." }, { "input": "PA and lateral views of the chest were provided. The lungs are clear and well inflated. No pneumothorax, effusion, or focal consolidation is seen. Cardiomediastinal silhouette is normal. Bony structures are intact. There is no free air below the right hemidiaphragm.", "output": "No acute findings in the chest, specifically no signs of pneumothorax." }, { "input": "The NG tube is coiled in the lower esophagus and will need to be reinserted. The chest tube has been removed. Left subclavian line tip in the SVC is unchanged. The tip of the ET tube is not well visualized secondary to the overlying NG tube and other wires. There is volume loss at both bases with dense retrocardiac opacity.", "output": "NGT coiled in esophagus. Findings discussed with nurse practitioner ___ by Dr. ___ by phone at ___ PM on ___ at the time of approving this report, 10 minutes after discovery of the finding." }, { "input": "The feeding tube tip is off the film, at least in the stomach. Right-sided chest tube is again seen. Left subclavian line tip is in the superior vena cava. There continues to be a retrocardiac opacity consistent volume loss/infiltrate/effusion. Right lower lobe volume loss is again seen. There is no pneumothorax.", "output": "No pneumothorax." }, { "input": "An endotracheal tube is 4 cm above the carina. A left subclavian catheter terminates in the upper SVC. An enteric tube is seen coursing along the esophagus, out of the field of view cough likely terminating within the stomach. There is no pneumothorax. There is persistent mild to moderate pulmonary edema with better aeration of the right lung. Bilateral small pleural effusions with overlying atelectasis are slightly worse to unchanged. The cardiac silhouette is moderately enlarged. There is a postoperative appearance of the mediastinum which is slightly wider than yesterday. Subcutaneous air is unchanged.", "output": "1. Satisfactory support devices. 2. Persistent mild-to-moderate pulmonary edema, small bilateral pleural effusions and moderate cardiomegaly with improved aeration of the right lung." }, { "input": "Again seen is a right PICC line with tip terminating in the low SVC. Median sternotomy wires are in position. Cardiomediastinal and hilar contours are stable. There is no pleural effusion or pneumothorax. The left retrocardiac opacity has improved since the prior study. No new focal parenchymal opacity is present.", "output": "No pleural effusion." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. The heart size is normal. Mediastinal contours are normal. No bony abnormality is detected. Surgical clips are again noted within the right upper abdomen.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal contour is normal. Lungs are clear without focal consolidation. There is no effusion or pneumothorax. There is no evidence of pulmonary vascular congestion. Surgical clips are noted in the right upper abdomen.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Subtle opacity in the left lower lung is concerning for an early pneumonia. Right lung is clear. No large effusion or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Subtle opacity in the left lower lung is concerning for an early pneumonia." }, { "input": "The heart size is normal. The hilar and mediastinal contours are within normal limits. There is no pneumothorax, focal consolidation, or pleural effusion.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest. There are increased opacities in the lungs at the bases and most conspicuous in the right mid lung. Blunting of the posterior costophrenic angle on the right is compatible with a small effusion. Cardiomediastinal silhouette is within normal limits. Osseous structures demonstrate no acute osseous abnormality.", "output": "Small right effusion and hazy opacities in the lungs at the bases and the right mid lung could be due to atelectasis, infection, or aspiration" }, { "input": "The lungs are clear of consolidation, effusion, or congestion. Nodular opacity projecting over the right lung base is thought to be most likely nipple shadow. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process. Nodular opacity overlying the right lung base most likely a nipple shadow but should be confirmed with nipple markers with repeat PA view." }, { "input": "The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "Normal radiographs of the chest." }, { "input": "Heart size is mildly enlarged. Mediastinal and hilar contours appear unchanged with enlargement of the pulmonary arteries, better assessed on the previous CT, compatible with pulmonary arterial hypertension. There is upper zone vascular redistribution without overt pulmonary edema. Chronic interstitial opacities are again noted predominantly along the periphery and lung bases with bronchiectasis also noted in the lower lobes. Patchy ill-defined opacities are re- demonstrated in both lower lung fields as well as within the upper lobes bilaterally, more so on the right. Overall, the findings within the left lung base and left upper lobe appear minimally improved, with the opacities in the right lung base perhaps slightly worse. Small bilateral pleural effusions are likely present. No pneumothorax is demonstrated. Remote left-sided rib rib fractures are again seen.", "output": "Patchy ill-defined opacities within both upper lobes, more so on the right, as well as within both lung bases, findings concerning for superimposed infection on a background of chronic interstitial abnormality and bronchiectasis. Small bilateral pleural effusions." }, { "input": "AP portable upright view of the chest. There are small bilateral pleural effusions with mild pulmonary edema. Lower lobe atelectasis likely present though cannot exclude a component of pneumonia. No large pneumothorax. Overall cardiomediastinal silhouette is stable. Bony structures are intact with inferior spurring at the shoulders. Chronic left rib deformity is noted", "output": "Mild edema, small bilateral effusions, lower lung atelectasis, difficult to exclude a superimposed pneumonia." }, { "input": "AP portable upright view of the chest. There has been no change from prior exam. Peripheral and lower lobe opacities are noted which could represent an atypical pneumonia versus aspiration. Small effusions may be present. No large pneumothorax. Cardiomediastinal silhouette is unchanged. No acute bony injuries. Old left rib deformity.", "output": "Peripheral and lower lobe opacities concerning for atypical infection versus aspiration. Probable small bilateral pleural effusions." }, { "input": "Chronic interstitial abnormality and bronchiectasis re- demonstrated. There is persistent blunting of the bilateral costophrenic angles. Slight increase in opacity at the left mid lung and perihilar regions may be due to superimposed pulmonary edema versus infection. On the lateral view, there is a a 1.9 x 1.9 cm rounded opacity posteriorly overlying the anterior mid thoracic spine, not clearly identified on chest CT from ___. Recommend follow-up chest CT for further assessment as pulmonary nodule is not excluded. Old left-sided rib deformity re- demonstrated.", "output": "1.9 x 1.9 cm rounded opacity rib projecting posteriorly overlying the anterior mid thoracic spine, not clearly identified on chest CT from ___; recommend dedicated chest CT for further assessment, as pulmonary nodule may be present. Re- demonstrated chronic interstitial abnormality in bronchiectasis. Persistent blunting of the bilateral costophrenic angles. Slight increase in opacity at the left mid lung and perihilar regions may be due to superimposed pulmonary edema versus infection. RECOMMENDATION(S): Chest CT." }, { "input": "There is little overall change in the appearance of the chest since the prior study from ___. Widespread chronic interstitial fibrotic changes, bilateral lower lobe bronchiectasis, and extensive subpleural nodularity persists. No new consolidation is identified. The heart size is stable. There is no pneumothorax. Degenerative changes of the bilateral glenohumeral joints are noted.", "output": "Chronic interstitial fibrotic changes, lower lobe bronchiectasis, and extensive subpleural nodularity is similar compared to prior studies." }, { "input": "The lungs are clear without evidence of pulmonary edema or consolidation. There is no pleural effusion or pneumothorax. Moderate cardiomegaly is unchanged from the prior exam. Atherosclerotic calcifications are noted in the aorta. A dual-chamber pacemaker is present with the wires in proper position. Evidence of an abdominal aortic stent is partially visualized on the lateral radiograph.", "output": "1. No acute cardiopulmonary process. 2. Stable moderate cardiomegaly." }, { "input": "Left chest wall pacemaker is seen with leads in unchanged position. Since the prior radiograph, there appears to be increased consolidation at the left base with obscuration of the left hemidiaphragm, possibly due to volume loss; however, this may be due to technical reasons. The right lung is clear. Cardiomediastinal silhouette is unchanged.", "output": "Increased opacification of the left retrocardiac region and base, which may be due to increased volume loss or technical reasons." }, { "input": "The heart is enlarged, as before. A dual-lead pacemaker/ICD device appears in a similar configuration. Mild unfolding and calcification involving the thoracic aorta appears similar. The mediastinal and hilar contours appear unchanged. The lung volumes are low. Patchy bibasilar opacities are nonspecific as to etiology and appear slightly decreased within the left lower lobe. Interstitial pulmonary edema has also improved. There is a small right-sided pleural effusion that appears increased with blunting of the left posterior costophrenic sulcus that may reflect a tiny effusion which is unchanged. Degenerative changes along the thoracic spine are similar.", "output": "Improvement in interstitial edema and bibasilar opacities. Small but apparently increased right-sided pleural effusion." }, { "input": "No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal. The aorta is somewhat tortuous. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. The heart size is normal. Mediastinal contours are normal. No bony abnormality is detected.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "Single upright AP image of the chest. The lungs are well expanded. There is opacity at the left lung base which is supsicious for pneumonia. There is pleural thickening at the left lung base, which could represent loculated pleural effusion. There is also diffuse left-sided pleural thickening with overall volume loss, which maybe related to previous infection or hemothorax. There is no right pleural effusion or pneumothorax. The cardiomediastinal silhouette is mildly enlarged. Destruction and sclerosis of both glenohumeral joints is noted, suggestive of possible rheumatoid arthritis.", "output": "1. Opacity at the left lung base, supsicious for bacterial or atypical pneumonia, including tuberculosis. 2. Pleural thickening at the left lung base, which could represent loculated pleural effusion. 3. Destruction and sclerosis of both glenohumeral joints is noted, suggestive of possible rheumatoid arthritis." }, { "input": "A portable view of the chest shows interval placement of a Dobhoff tube, which enters the stomach then loops superiorly ending in the distal esophagus. A right subclavian line is pulled back and sits within the subclavian vein. The cardiomediastinal contour is stable. Bibasilar opacities are unchanged as are small pleural effusions.", "output": "1. Interval placement of a Dobhoff with the tip located in the distal esophagus. 2. Right subclavian line has been pulled back and now resides within the right subclavian vein. Findings were discussed with Dr. ___ by Dr. ___ ___ telephone on ___ at 15:30, ___ min of the findings remain." }, { "input": "Subtle lateral left base opacity is felt to more likely represent atelectasis rather than consolidation. It is not clearly seen on the lateral view. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable. Hilar contours are stable.", "output": "Subtle lateral left base opacity is felt to more likely represent atelectasis rather than consolidation." }, { "input": "The lungs remain clear. The heart is normal in size. The aorta is tortuous. Mediastinal structures are stable in appearance. There is a moderate thoracic scoliosis convex to the right. The thorax is grossly intact. There is no significant change.", "output": "No active cardiopulmonary disease." }, { "input": "There is new poorly defined area of consolidation in the superior segment right lower lobe and adjacent right hilar enlargement, likely reflecting reactive lymphadenopathy. Consolidative opacities have a nodular component. Remaining lungs are clear. No pleural effusions or pneumothorax. The cardiopericardial silhouette is not enlarged.", "output": "A new consolidation in the superior segment of the right lower lobe, likely represents an acute infectious pneumonia in this clinical setting. Although likely bacterial, TB and fungal organisms should also be considered in the appropriate clinical setting. RECOMMENDATION(S): A follow-up radiograph in ___ weeks is suggested to ensure resolution. NOTIFICATION: The impression and recommendation above was entered by Dr. ___ on ___ at 15:44 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "Frontal and lateral views of the chest. The lungs are clear. The cardiomediastinal silhouette is normal. Osseous and soft tissue structures demonstrate no acute abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There are multifocal scattered areas of atelectasis with no focal consolidations concerning for pneumonia. Mild peribronchial cuffing is compatible with previously stated history of small airways disease. There are no pleural effusions or pneumothorax. The cardiomediastinal and hilar contours are stable, demonstrating mild tortuosity of thoracic aorta. Pulmonary vascularity is normal. There are mild degenerative changes of thoracolumbar spine as manifested by marginal osteophytic formation.", "output": "No evidence of focal pneumonia." }, { "input": "Right pectoral infusion port terminates at mid SVC. The post radiation appearance of the previously large anterior mediastinal mass is unchanged since ___. There is well-circumscribed area of radiation fibrosis in the in the left perihilar region with traction bronchiectasis. The area of fibrosis superior denser more contracted on lateral view compared to prior. There is small pleural effusion on the left. Leftward retraction of mediastinum and elevation of left hemidiaphragm is similar to prior. Cardiac silhouette is distorted but normal size.", "output": "1. Post treatment contour of involuted left mediastinal mass is stable compared to ___. 2. Progressive maturation of radiation fibrosis in the left lung perihilar region. 3. No recurrence of intrathoracic malignancy." }, { "input": "As on prior, there is a large left-sided mediastinal mass. Small left pleural effusion is unchanged. There is no pneumothorax. The right lung remains clear. No acute osseous abnormalities identified.", "output": "No significant interval change from prior." }, { "input": "In comparison to the chest radiographs obtained ___, there are 2 rounded nodules projecting over the lateral left lung, not identified on recent radiographs or CT chest dated ___. There has been interval increase in the size of the moderate left pleural effusion with associated increased left basilar atelectasis. Left perihilar radiation fibrosis appears unchanged. The right lung is fully expanded and clear without focal consolidations or suspicious pulmonary nodules.", "output": "Two new pulmonary nodules lateral left lung. Recommend CT chest for further evaluation. Interval increase in moderate left pleural effusion and associated left basilar atelectasis. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ On the telephone on ___ at 2:44 PM, approximately 45 minutes after discovery of the findings." }, { "input": "New small left-sided pleural effusion. Left anterior mediastinal mass and left upper lobe nodular opacities are unchanged. Right lower lobe linear opacities are also unchanged. Right-sided Port-A-Cath with the tip in the low SVC. No pneumothorax.", "output": "New small left-sided pleural effusion. Stable left anterior mediastinal mass." }, { "input": "PA and lateral views of the chest provided. Right Port-A-Cath ends at the mid SVC. Radiation changes in the mid to upper lung on the left in the perihilar region with retraction of the trachea. Mild tenting of the left hemidiaphragm also likely represents radiation changes. No pleural effusion or pneumothorax. A large mediastinal mass is stable from ___. Moderate degenerative changes throughout the lower thoracic spine are unchanged.", "output": "1. Radiation changes in the mid to upper left lung in the perihilar region with retraction of the trachea are seen. Mild tenting of the left hemidiaphragm also likely represents radiation changes. 2. A large mediastinal mass is stable from ___." }, { "input": "Frontal and lateral views of the chest were performed and demonstrate clear lungs. There is no pleural effusion, pneumothorax or focal airspace consolidation. There is no evidence of aspiration. The cardiac, hilar and mediastinal contours are normal. There are no acute osseous abnormalities appreciated. The imaged upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Enteric tube terminates in the region of the stomach below the left hemidiaphragm. Lung volumes are somewhat low. The cardiomediastinal and hilar contours are within normal limits. Streaky opacity at the left base likely represents atelectasis. No pneumothorax or large pleural effusion.", "output": "NG tube terminates in the region of the stomach below the left hemidiaphragm. Minimal left basal atelectasis." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. The mediastinum is not widened. No displaced fracture is seen.", "output": "No acute cardiopulmonary process. Mediastinum is not widened." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities are present.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process" }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest. The lungs are clear without effusion, consolidation, or pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process. Consider dedicated shoulder films for detailed evaluation of the shoulder." }, { "input": "PA and lateral chest radiographs demonstrate intact median sternotomy wires and CABG clips. Crowding of bronchovascular bundles in the retrocardiac region likely represents atelectasis. There is no focal consolidation, pleural effusion, or pneumothorax. The heart size is normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear with no evidence of a consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. No acute fractures are identified. There is no air under the hemidiaphragms.", "output": "No acute cardiopulmonary process." }, { "input": "A frontal upright view of the chest was obtained portably. Low lung volumes result in bronchovascular crowding. Increased density at the left lung base is unchanged from ___. A small focus of linear atelectasis is seen in the lingula. The remainder of the lungs is clear. There is no substantial pleural effusion. No pneumothorax. Heart size is normal. The mediastinal silhouette and hilar contours are normal allowing for lung volumes. No upper abdominal or osseous abnormality is identified.", "output": "Mildly increased opacity at the left lung base is likely atelectasis, but could represent aspiration or pneumonia in the appropriate clinical setting." }, { "input": "Cardiomediastinal contours are stable. Multifocal predominately linear atelectasis is present in both lower lungs. A more focal patchy opacity in the left retrocardiac region may reflect more extensive atelectasis, but differential diagnosis includes aspiration and developing infectious pneumonia. Small pleural effusions are also noted.", "output": "Patchy left retrocardiac opacity, which may reflect atelectasis, aspiration or early pneumonia. Short-term followup radiographs may be helpful in this regard. Bibasilar linear atelectasis." }, { "input": "There is minimal left base atelectasis. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are relatively low. Again seen are diffusely increased interstitial markings throughout the lungs. Given differences in technique, there has been no significant interval change since prior exam. There is no new confluent consolidation or effusion. The cardiomediastinal silhouette is stable. No acute osseous abnormalities.", "output": "Diffuse increased interstitial markings throughout the lungs compatible with chronic interstitial process. No definite superimposed acute cardiopulmonary process." }, { "input": "Compared to the prior exam there has been some interval improvement in the right-sided lung disease but there is still some persistent alveolar infiltrate in scattered areas of the right lower lobe and right and left lateral lung. It is unclear how much of this is chronic disease or how much of it is persistent infection were", "output": "Slight improvement in the interstitial markings bilaterally" }, { "input": "Slightly lower lung volumes are noted when compared to prior. Diffusely increased interstitial markings are seen throughout the lungs which were present on prior but are now more conspicuous. There is no focal consolidation or large effusion. Cardiomediastinal silhouette is stable. No acute osseous abnormalities.", "output": "Increased interstitial markings in the lungs bilaterally more conspicuous on today's exam but present previously, potentially due to chronic interstitial process although component of interstitial edema or atypical infection are possible." }, { "input": "Compared with the prior study, lung volumes are slightly lower. Diffusely increased interstitial lung markings are again seen, compatible with known history of chronic interstitial lung disease. Evaluation of the ribs is limited by overlying structures, however there does not appear to be any evidence of acute rib fracture. Cardiomediastinal silhouette is unchanged since the prior study. No large effusion or pneumothorax. Degenerative changes of the glenohumeral and AC joints are similar. Similar appearance of the rightward deviated trachea.", "output": "1. Limited evaluation of the ribs due to overlying structures. However, no definite acute rib fracture detected. 2. Re demonstration of diffusely increased interstitial lung markings, compatible with progression of known chronic interstitial lung disease. Again, in the appropriate clinical setting, this may also represent atypical infection or a component of interstitial edema." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Comparison is made with the next preceding similar study of ___. The heart size is moderately enlarged. No typical configurational abnormality is seen. Thoracic aorta generally widened and elongated with calcium deposits in the wall, mostly at the level of the arch. Pulmonary vasculature is not congested. No signs of acute or chronic parenchymal infiltrates are present and the lateral and posterior pleural sinuses are free. No pneumothorax in the apical area. Skeletal structures grossly within normal limits; however, some moderate demineralization of the skeletal structures with slightly accentuated kyphotic curvature in the thoracic spine is noted. In comparison with the next preceding chest examination of ___, no significant interval change.", "output": "Stable chest findings in elderly gentleman. No signs of acute pulmonary infiltrates or acute CHF." }, { "input": "Frontal lateral views of the chest were performed (3 exposures). Streaky opacification in the lung bases is thought to represent atelectasis as seen on the same day CT. There is no focal consolidation to suggest pneumonia. There is no pleural effusion or pneumothorax. The cardiac silhouette is top-normal in size. There is a hiatal hernia. The mediastinal contours and pleural surfaces are normal. Retained enteric contrast is seen within the imaged upper abdomen. There is a left nondisplaced rib fracture.", "output": "No acute cardiopulmonary process. There is a left non-displaced rib fracture." }, { "input": "Heart size is normal. Thoracic aorta is mildly tortuous. Hilar contours are unremarkable. A streaky bibasilar atelectasis is identified. There are no focal consolidations worrisome for pneumonia. There is no pleural effusion or pneumothorax.", "output": "Streaky bibasilar atelectasis, otherwise unremarkable examination. Results were discussed over the telephone with Dr. ___ by Dr. ___ at 9:45 a.m. on ___ at time of initial review." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Previously described nonspecific left upper lobe opacity has resolved. Lungs are currently clear except for minimal linear atelectasis or scar at the bases. Biapical thickening, right greater than left is relatively similar to older studies dating back to ___ and likely due to pleural and parenchymal scarring. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is a small abnormal density in the right midlung zone immediately superior to the oblique fissure, which was not present on the prior study and appears to pull up on the oblique fissure. This is atypical for atelectasis, and early pneumonia, particularly in an immunosuppressed patient, cannot be ruled out. Chest CT for further characterization or empiric pneumonia treatment with followup radiographs in ___ weeks is recommended. There is no pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "1. New small abnormal density in the right midlung zone for which either chest CT for further characterization or empiric pneumonia treatment with followup radiographs in ___ weeks is recommended. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 3:56 PM, 1 minute after discovery of the findings." }, { "input": "Compared to the prior examination, there has been minimal interval change. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema identified. Redemonstrated is biapical pleural thickening. The heart size is normal. Mediastinal contours are stable.", "output": "No radiographic evidence for acute cardiopulmonary process. Findings were communicated by Dr. ___ to ___, NP via telephone at ___:___am on ___, 5 minutes after discovery." }, { "input": "Heart size is normal. The aorta remains mildly tortuous. Mediastinal and hilar contours are similar. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is present. Minimal patchy opacity within the left upper lung field is new compared to the prior study. Relatively symmetric scarring within the lung apices is re- demonstrated as well as a focal. No acute osseous abnormalities are visualized.", "output": "Subtle ill-defined patchy opacity in the left upper lung field, new from prior, may reflect an area of developing infection." }, { "input": "A right Port-A-Cath is seen, terminating in the low SVC/ cavoatrial junction. There is mild elevation of the right hemidiaphragm. The cardiac silhouette is not enlarged. Mediastinal contours are unremarkable. There are perihilar opacities which may be due to pulmonary edema, infection not excluded in the appropriate clinical setting. No pleural effusion or pneumothorax.", "output": "Right Port-A-Cath terminates in the low SVC/ cavoatrial junction. Elevated right hemidiaphragm. Perihilar opacities could be due to pulmonary edema and/ or infection." }, { "input": "Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. Linear opacity at the right lung base is consistent with atelectasis or scarring. There is no focal consolidation.", "output": "Left basilar atelectasis. No evidence of pneumonia." }, { "input": "Single frontal view of the chest. Endotracheal tube terminates 2.2 cm above the carina. NG tube terminates in the stomach. Heart size and mediastinal borders are stable. Bibasilar atelectasis is similar to prior. No pleural effusion or pneumothorax.", "output": "ET tube terminates 2.2 cm above the carina, similar to prior." }, { "input": "Spine portable AP view of the chest was provided. The endotracheal tube is seen with its tip residing approximately 2.4 cm above the carina. An NG tube courses into the left upper abdomen with its tip excluded from view. The lungs appear grossly clear. No large effusion or supine evidence for pneumothorax is seen. Cardiomediastinal silhouette appears normal. The imaged osseous structures are intact.", "output": "Appropriately positioned tubes. Otherwise, unremarkable." }, { "input": "Heart size is top normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Comparison is made to prior study from ___. There is scoliosis. There is new area of consolidation within the left lower lobe suspicious for pneumonia or aspiration given the patient's clinical history. The upper lung fields are clear. Heart size is within normal limits. There are no pneumothoraces.", "output": "Consolidation in the left lower lobe suspicious for pneumonia." }, { "input": "Upper lobe predominant emphysema is unchanged. The cardiomediastinal silhouette is within normal limits. No pneumothorax, focal consolidation, or pleural effusion.", "output": "No acute cardiopulmonary process. Pulmonary emphysema." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is not engorged. Lung volumes are lower compared to the previous study with patchy bibasilar airspace opacities noted. Attenuation of the pulmonary vascular markings towards the apices is compatible with underlying emphysema. No pleural effusion or pneumothorax is identified.", "output": "Low lung volumes with patchy bibasilar airspace opacities, worrisome for pneumonia." }, { "input": "Cardiomediastinal contours are normal. The lungs are hyperinflated, patient has known emphysema. Ill-defined peribronchial opacities in the lower lobes and in the left mid lung likely represent multifocal pneumonia. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable", "output": "Emphysema Findings are consistent with multifocal pneumonia given the clinical history" }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There is no evidence of free intraperitoneal air in the visualized portion of the upper abdomen.", "output": "No acute cardiopulmonary abnormality. No free air seen in the visualized upper abdomen." }, { "input": "Endotracheal tube tip 4 cm above carina. Worsened bibasilar opacities, atelectasis versus pneumonitis. Shallow inspiration accentuates heart size. Normal pulmonary vascularity. No pneumothorax. No pleural effusion.", "output": "Mildly worsened bibasilar opacities, atelectasis versus pneumonitis." }, { "input": "Mild bibasilar atelectasis. No pleural effusion or pneumothorax identified. The size of the cardiac silhouette is within normal limits.", "output": "Mild bibasilar atelectasis. No evidence of pulmonary edema." }, { "input": "AP upright and lateral views of the chest provided. Hyperinflation with prominent retrosternal clear space suggests COPD. No focal consolidation concerning for pneumonia. No large effusion or pneumothorax. No overt signs of edema. Cardiomediastinal silhouette appears normal. Bony structures are intact. No free air is seen below the right hemidiaphragm.", "output": "COPD without superimposed pneumonia." }, { "input": "Enteric tube tip is in the proximal stomach. Shallow inspiration. Bibasilar opacities, likely atelectasis, similar to prior. Probable small pleural effusions, similar. Mildly enlarged pulmonary vascularity, similar. Dilated bowel loops in the upper abdomen are partially seen.", "output": "Enteric tube tip in proximal stomach" }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The inspiratory lung volumes are appropriate. The lungs demonstrate diffuse innumerable rounded lesions many of which are calcified in a perihilar distribution greater on the left than the right consistent with patient's history of Cowden disease with numerous pulmonary hamartomas. There is no pleural effusion or pneumothorax. The pulmonary vasculature is essentially normal. Evaluation of the hilar in cardiomediastinal contours is limited due to diffuse pulmonary lesions but appears within normal limits. There is calcification of the aortic knob. No acute osseous abnormality is detected.", "output": "Innumerable pulmonary lesions many of which are calcified and consistent with a hamartomas related to the patient's known Cowden disease. Superimposed infection is difficult to exclude in this setting, especially without prior chest radiographs available for comparison." }, { "input": "PA and lateral views of the chest provided. Left upper extremity PICC line is seen with its tip terminating in the low SVC. Bilateral pulmonary opacities, many containing calcification, are overall unchanged in this patient with known Cowdens disease, these represent numerous pulmonary hamartomas. Given the extensive background opacity, difficult to exclude a superimposed subtle pneumonia though none is clearly identified. No large effusion or pneumothorax. Heart size appears grossly stable. Mediastinal contour is similarly unchanged. No acute bony abnormality. No free air below the right hemidiaphragm.", "output": "PICC line appears in appropriate position. Extensive pulmonary opacities consistent with known Cowdens disease representing pulmonary hamartomas. No definite signs of superimposed pneumonia." }, { "input": "RIGHT CONVEX SCOLIOSIS. HEART SIZE IS NORMAL. NO PNEUMONIA OR LUNG NODULES. SPIRAL DENSITY PROJECTED IN THE RIGHT MIDLUNG IS SEEN TO OVERLIE THE ANTERIOR CHEST WALL SOFT TISSUES ON THE LATERAL VIEW AND MAY BE RELATED TO EXTERNAL ARTIFACT.", "output": "NO PNEUMONIA." }, { "input": "The lungs are relatively hyperinflated, suggesting chronic obstructive pulmonary disease. Extensive costochondral calcification is seen. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable with the cardiac silhouette mildly enlarged and the aortic calcified and tortuous. Partially imaged is a right humeral prosthesis. Degenerative changes at the left shoulder with a possible loose body again seen.", "output": "No acute cardiopulmonary process." }, { "input": "One AP upright and lateral view of the chest. There is no focal consolidation. Heart is mildly enlarged and there is mild vascular congestion. There is no pleural effusion or pneumothorax. Again seen is right shoulder arthroplasty. There is decreased demineralization of all of the bones. The wedge deformity in the upper lumbar spine is similar to prior study.", "output": "Mild cardiomegaly and pulmonary vascular congestion." }, { "input": "The lungs are hyperinflated, but clear of consolidation. Costophrenic angles are sharp. Cardiac silhouette is mildly enlarged. Atherosclerotic calcifications noted at the arch. Right shoulder arthroplasty is noted in addition to severe degenerative changes at the left shoulder. Compression deformity seen in the upper lumbar spine of uncertain age and clinical correlation suggested.", "output": "Hyperinflation without acute cardiopulmonary process. Cardiomegaly. Wedge deformity in an upper lumbar vertebral body, the timing of which is uncertain and clinical correlation is suggested." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unremarkable. The lungs are clear and the pulmonary vascularity is unremarkable. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "AP view of the chest. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process. Conventional chest radiograph is not sensitive for detecting chest cage trauma, if indicated recommend dedicated rib views in area of concern." }, { "input": "The heart is mild-to-moderately enlarged with a left ventricular configuration. The aortic arch is calcified. There is moderate elevation of the posterior left hemidiaphragm. Possibly, this reflects a Bochdaleck hernia. Blunting of the left costophrenic sulcus suggests there may be a small effusion or scarring. Patchy interstitial abnormalities may be due to airway inflammation or slight congestion, noting peribronchial cuffing. More focal patchy left basilar opacity is nonspecific but could be seen with atelectasis. This could be associated with elevation of the posterior hemidiaphragm. Patchy vascular calcifications are widespread, particularly along the aorta. There are no definite rib fractures. Thin anterior flowing osteophytes are noted throughout the mid-to-lower thoracic spine.", "output": "Findings of mild interstitial abnormality which may be due to slight congestion or airway inflammation. Patchy left basilar opacity is nonspecific but could probably be seen with atelectasis. No definite rib fractures are visualized but CT imaging is more sensitive." }, { "input": "Lung volumes are low which accentuates the size of the cardiac silhouette which is top normal. Mediastinal and hilar contours are unremarkable. Crowding of bronchovascular structures is demonstrated without overt pulmonary edema. Patchy opacities are noted in both lower lobes, likely atelectasis, and not substantially changed from the previous study. No focal consolidation, pleural effusion or pneumothorax is present.", "output": "Low lung volumes with patchy opacities in the lung bases, likely atelectasis." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. The pulmonary vascularity is normal. Except for minimal atelectasis in the left lung base, the lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. There are multilevel degenerative changes in the thoracic spine. Remote left posterior rib fracture is again seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Overlying external artifact partially obscures the view. Endotracheal tube is seen, terminating approximately 4.9 cm above the level the carina. No focal consolidation is seen. No large pleural effusion or pneumothorax. The cardiac silhouette is top-normal. Mediastinal contours are grossly unremarkable. Old posterior left-sided rib fracture was better seen on prior study, an external lead likely overlies it on the current study. Right upper quadrant surgical clips are incidentally noted.", "output": "Endotracheal tube in appropriate position. No acute cardiopulmonary process." }, { "input": "Heart size is normal. The aorta is mildly tortuous. Mild atherosclerotic calcifications are noted at the aortic knob. Pulmonary vasculature is normal. Lungs are clear. No focal consolidation, pleural effusion or pneumothorax is seen. Moderate degenerative changes are noted in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lung volumes are low. The heart appears enlarged which may be secondary to low lung volumes.Increased retrocardiac opacity likely secondary to atelectasis in the setting of low lung volumes. No pleural effusion or pneumothorax is seen. The mediastinal silhouette is unremarkable.", "output": "Low lung volumes and increased left basilar atelectasis. No focal consolidation detected." }, { "input": "Heart size and pulmonary vascularity are large, worsened since prior. Mild bibasilar opacities, likely atelectasis. Suggestion of small left pleural effusion. Sternotomy. No pneumothorax.", "output": "Increased heart size, pulmonary vascularity, mildly worsened since prior. Bibasilar opacities, likely atelectasis." }, { "input": "Compared to chest radiographs from ___, moderate central vascular congestion has minimally improved. Moderate cardiomegaly is stable. Lung volumes remain low. Small left pleural effusion has improved. Tiny right pleural effusion persists. Persistent mild bibasilar opacities likely reflect atelectasis. No pneumothorax.", "output": "1. Minimally improved central vascular congestion without overt pulmonary edema. Stable moderate cardiomegaly. 2. Improved small left pleural effusion. Persistent tiny right effusion. 3. Unchanged mild bibasilar opacities, suggestive of atelectasis." }, { "input": "Cardiac size is top normal. small bilateral effusions, atelectasis and mild vascular congestion are new. Osseous structures are unremarkable.", "output": "New vascular congestion and small bilateral effusions" }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. The imaged upper abdomen is unremarkable. The bones are intact.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear, the cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax.", "output": "No acute cardiothoracic process including no evidence of pneumonia." }, { "input": "There are bilateral diffuse interstitial opacities with foci of more patchy consolidation along the right lung base, which is significantly worsened compared with ___. There are bilateral pleural effusions, right worse than left, also significantly worsened from prior. Assessment of the cardiac size cannot be performed due to obscuration of the lateral margins. There is a large combined hiatal/left diaphragmatic hernia with the contents extending to the left lateral thoracic wall, unchanged from ___. There is no evidence of pneumothorax.", "output": "1. Pulmonary edema with associated pleural effusions. Superimposed infection cannot be excluded given patchy opacities in the right lower lobe. 2. Large combined hiatal and left diaphragmatic hernia, unchanged from ___." }, { "input": "As compared to prior chest radiograph from ___, there has been interval placement of a right IJ central venous catheter with its tip terminating in the mid SVC. There is no definite pneumothorax. As before, there is mild enlargement of the cardiac silhouette. Bilateral hilar enlargement is likely due to pulmonary hypertension. The mediastinal contours are otherwise unremarkable. There is mild pulmonary vascular congestion and probable small bilateral pleural effusion. Opacities at the lung bases likely reflect atelectasis, although underlying pneumonia cannot be excluded.", "output": "1. Right IJ central venous catheter terminates in the mid SVC. No pneumothorax. 2. Pulmonary edema with bilateral small pleural effusion. Opacities at the lung bases likely reflect atelectasis, however an underlying pneumonia cannot be excluded." }, { "input": "There is mild enlargement of cardiac silhouette. Bilateral hilar enlargement is present. The mediastinal contours are unremarkable. Moderate pulmonary edema is demonstrated with vascular indistinctness, and small bilateral pleural effusions. Opacification of the lung bases likely reflects compressive atelectasis although pneumonia is not excluded. There is no pneumothorax. No acute osseous abnormality is detected.", "output": "Moderate pulmonary edema with small bilateral pleural effusions. Bilateral hilar enlargement compatible with pulmonary arterial hypertension. Probable bibasilar atelectasis, although infection is not excluded." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Several clips project medial to the proximal aspect of the right humerus.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Removal of left subclavian vascular catheter with no visible pneumothorax. Stable appearance of cardiomediastinal contours. Lungs and pleural surfaces are clear. Moderate gastric distention is present with nasogastric tube in place.", "output": "No evidence of pneumonia." }, { "input": "An endotracheal tube is in place with the tip terminating just below the level of the thoracic inlet. A nasogastric tube is seen coursing below the diaphragm and folding on itself within the stomach with the tip terminating in the distal stomach. A left subclavian approach central venous catheter is unchanged in position with the tip terminating at the cavoatrial junction. The inspiratory lung volumes remain low. There is streaky opacification of the bilateral lung bases, which is unchanged and compatible with atelectasis. Mild pulmonary vascular congestion is noted without overt pulmonary edema. No pneumothorax or large pleural effusion is detected. There is no focal consolidation concerning for pneumonia. The cardiac silhouette is normal in size. The mediastinal and hilar contours are within normal limits.", "output": "1. Unchanged position of support devices. 2. Mild bibasilar atelectasis. 3. Mild pulmonary vascular congestion." }, { "input": "Single frontal view of the chest demonstrates a left subclavian approach central venous catheter with tip in the low SVC, as well as an enteric tube extending inferiorly out of view. The cardiomediastinal silhouette is within normal limits allowing for AP technique. The lungs are reasonably well expanded and clear. There is no pneumothorax, large pleural effusion, or pulmonary edema.", "output": "No acute cardiopulmonary process." }, { "input": "An endotracheal tube terminates 5 cm from the carina. Eneteric catheter tip terminates at the pylorus. A left subclavian line is seen in the region of the superior cavoatrial junction. There has been interval decrease of the lung volumes. Left lower lobe opacification is unchanged from prior examination and could either represent pneumonia or atelectasis. The right lung is clear. There is no pneumothorax or pleural effusion. There is mild cardiomegaly, exaggerated by low lung volumes and by vascular engorgement. Mediastinal and hilar contours are unremarkable.", "output": "1. Low lung volumes. 2. Unchanged left lower lobe pneumonia or atelectasis." }, { "input": "Endotracheal tube terminates 2.5 cm above the carina. Enteric catheter courses below the left hemidiaphragm loops in the stomach and travels out of view. Cardiomediastinal and hilar contours are unremarkable. Streaky opacification in the retrocardiac space likely represents atelectasis, though infection/aspiration is not excluded in the clinical setting. No pleural effusion or pneumothorax.", "output": "1. Endotracheal tube terminates 2.5 cm above the carina. 2. Left retrocardiac opacification, likely atelectasis." }, { "input": "AP and lateral views of the chest. Previously seen pleural effusions have resolved. There is no superimposed confluent consolidation. Degree of cardiomegaly is unchanged. Atherosclerotic calcifications noted at the arch. Degenerative changes seen in the shoulders bilaterally.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. Cardiomegaly is mild. Hila are equivocally prominent. Mediastinal contour is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Mild cardiomegaly with subtle hilar prominence which could reflect mild congestion. No convincing evidence for pneumonia." }, { "input": "Small/moderate bilateral pleural effusions are again noted. There is retrocardiac opacity only visualized on the frontal view without correlate on the lateral. Cardiac enlargement is unchanged as well as mild pulmonary vascular congestion without overt pulmonary edema.", "output": "No significant interval change of bilateral pleural effusions and vascular congestion. Retrocardiac on the frontal view is not confirmed on the lateral and may be due to technique and/or atelectasis." }, { "input": "The heart is mildly enlarged. The mediastinal and hilar contours appear stable. There are some very small suspected bilateral pleural effusions. Fissures are mildly thickened. The interstitium is mildly prominent, most suggestive of mild congestive heart failure. Bones appear demineralized.", "output": "Findings most suggestive of mild pulmonary edema." }, { "input": "Compared to chest radiographs from ___, heart size has decreased, now mildly enlarged. When compared to prior chest radiograph of similar technique on ___, left pleural effusion is minimally improved, while right effusion is unchanged. Mild central vascular congestion without overt pulmonary edema persists. Retrocardiac and mild bibasilar opacities, suggestive of atelectasis, have improved. Mediastinal and hilar contours are stable.", "output": "1. Interval decrease in heart size, now mildly enlarged. Minimally improved small left pleural effusion. Stable small right pleural effusion. 2. Improving retrocardiac and bibasilar opacities, consistent with atelectasis. 3. Persistent mild central vascular congestion without overt pulmonary edema." }, { "input": "The left pleural effusion has increased in size since ___, now moderate. Bibasilar opacities likely reflect atelectasis. No focal consolidations. Mild interstitial pulmonary edema. Stable enlargement of the cardiomediastinal silhouette. No pneumothorax.", "output": "1. Interval enlargement of the left pleural effusion, now moderate. 2. Mild interstitial pulmonary edema." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There are probably trace pleural effusions. The interstitium is mildly prominent including thickening of fissures suggesting mild congestion. The chest is hyperinflated.", "output": "Findings suggest mild vascular congestion. No convincing evidence of pneumonia." }, { "input": "Single portable view of the chest. As on prior, there are increased interstitial opacities. More conspicuous right basilar opacity is seen, and there are probable right greater than left pleural effusions. Degree of cardiomegaly is unchanged. Atherosclerotic calcifications noted at the aortic arch.", "output": "Interstitial edema and probable right greater than left effusions. More dense right basilar opacity could represent superimposed pneumonia. If desired, PA and lateral could be obtained to further characterize." }, { "input": "As compared to the most recent prior examination dated ___, there is a very small suspected right pleural effusion. There is no evidence of lobar consolidation or parenchymal edema. Cardiomegaly is noted, similar as compared to the prior exam. No acute osseous abnormalities are detected.", "output": "Small right pleural effusion. Stable cardiomegaly. No evidence of parenchymal edema." }, { "input": "Moderate enlargement of the cardiac silhouette is unchanged. Atherosclerotic calcifications of the aortic knob are again noted. The mediastinal contour is similar. There is mild pulmonary edema, not substantially changed in the interval. Hazy opacities in both lung bases, more so on the left, likely reflect small layering bilateral pleural effusions. Patchy bibasilar opacities likely reflect compressive atelectasis. No pneumothorax is clearly evident. There are no acute osseous abnormalities.", "output": "Mild pulmonary edema, not substantially changed in the interval with small layering bilateral pleural effusions and bibasilar atelectasis." }, { "input": "The heart is moderately enlarged, especially the left atrium. A moderate interstitial abnormality suggest congestive heart failure. There is a pleural effusion on the left, probably small to moderate in size, and a small right-sided pleural effusion. Fissures appear thickened. There is no pneumothorax. Interstitial type opacification is most confluent in the posterior right lower lobe, although suspicion is that this is also edema.", "output": "Findings most consistent with moderate interstitial pulmonary edema, accompanied by pleural effusions. Attenation in follow-up suggested regarding more confluent opacity at the right lung base although edema is again the suspected etiology; coinciding pneumonia is not excluded, however." }, { "input": "There is mild prominence of pulmonary vasculature and development of bilateral linear interstitial opacities consistent with ___ B-lines, new as compared to ___. There is no focal consolidation. Heart size is within normal limits. There is no pneumothorax. There is multilevel mild loss of vertebral body height in the upper thoracic spine, unchanged.", "output": "Interstitial pulmonary edema, mild. No focal consolidation. RECOMMENDATION(S): Reassessment with chest radiograph after diuresis is recommended." }, { "input": "There is bibasilar atelectasis/scarring. No definite focal consolidation is seen. The lungs remain hyperinflated. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "Bibasilar atelectasis/ scarring without focal consolidation." }, { "input": "Heart size is normal. Aorta is mildly tortuous. Prominence of the central pulmonary arteries is present bilaterally. Lungs are slightly overexpanded but grossly clear except for focal linear atelectasis versus scar at the left lung base. There are no pleural effusions or acute skeletal findings.", "output": "Focal linear opacity in left lower lobe is a very nonspecific finding, but linear atelectasis can be observed in the setting of pulmonary embolism, the clinically suspected diagnosis provided in the history for this exam. With this in mind, further evaluation with CT pulmonary angiogram should be considered to more definitively evaluate for the possibility of pulmonary embolism given the clinical suspicion for this entity." }, { "input": "AP upright and lateral views of the chest provided. Tracheostomy projects over the superior mediastinum with several clips noted projecting over the neck. The heart is mildly enlarged. No focal consolidation suggesting pneumonia. The lungs appear hyperinflated. No signs of edema. No pleural effusion or pneumothorax. A chronic left lower ribcage deformities noted. No acute fracture.", "output": "Mild cardiomegaly, no pneumonia." }, { "input": "Frontal and lateral chest radiograph demonstrates mildly hyper expanded lungs with bibasilar atelectasis. Left lung is clear. Faint heterogeneous opacity within the right middle lobe. Again seen is subtle blunting of the left costophrenic angle likely related to scar versus small pleural effusion. No right pleural effusion. No pneumothorax. Heart size, mediastinal contour, and hila are otherwise unremarkable. Limited assessment of the upper abdomen is within normal limits.", "output": "1. New right middle lobe opacity concerning for pneumonia or aspiration pneumonia. 2. Persistent blunting of left costophrenic angle likely related to scar or small chronic pleural effusion. 3. Mildly hyperinflated lungs." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Lungs are clear and the pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. Mild degenerative changes are noted in the thoracic spine. There is no free air under the diaphragms.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. Evidence of the DISH is seen along the spine.", "output": "No acute cardiopulmonary process. No significant interval change." }, { "input": "Frontal and lateral views of the chest. The lungs are clear of focal consolidation, effusion or pulmonary vascular congestion. Cardiomediastinal silhouette is within normal limits. Median sternotomy wires are noted. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for pneumonia. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No acute intrathoracic abnormalities identified. These findings were discussed with Dr. ___ by Dr. ___ by phone at ___:___ a.m. on the day of the exam." }, { "input": "AP single view in upright position shows stable position of the right subclavian PICC with tip ending in the upper SVC. Moderate lung volume is normal without consolidation or nodules suspicious for infection or malignancy. Linear atelectsis is at the left lung base. Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax.", "output": "Linear atelectasis at the left lung base, no sign of acute cardiopulmonary process." }, { "input": "Heart size, mediastinal and hilar contours are normal. Lungs are grossly clear except for minimal linear opacities at the extreme lung bases. There are no pleural effusions or acute skeletal findings.", "output": "Minimal linear basilar atelectasis or scarring. No areas of consolidation to suggest acute pneumonia." }, { "input": "PA and lateral views the chest were viewed. The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Low lung volumes with streaky opacities at both lung bases may represent atelectasis or infection in the correct clinical setting.", "output": "Low lung volumes with bibasilar streaky opacities, which may represent atelectasis or pneumonia in the correct clinical setting." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided demonstrate no signs of pneumonia or CHF. No pleural effusion or pneumothorax is seen. Cardiomediastinal silhouette is normal. Bony structures are intact. There is no free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "AP upright and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Lung volumes are low. Assessment of the chest is limited by patient rotation and the patient's chin obscuring assessment of the left apex. Heart size appears mildly enlarged but similar. The aorta is mildly tortuous. The mediastinal and hilar contours are grossly unchanged. Crowding of bronchovascular structures is present without overt pulmonary edema. Patchy opacities in the lung bases may reflect areas of atelectasis. No focal consolidation or pleural effusion is seen. There is no right-sided pneumothorax with assessment for a left apical pneumothorax being limited. No acute osseous abnormality is visualized.", "output": "Limited study due to rotation and obscuration of the left apex. Low lung volumes with bibasilar patchy opacities, likely atelectasis, but infection is not excluded in the correct clinical setting." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or edema. The cardiomediastinal silhouette is normal. No acute osseous abnormalities.", "output": "Normal chest x-ray." }, { "input": "PA and lateral views of the chest provided. Surgical clips projecting over the left breast and left axilla are unchanged. Mild bibasilar atelectasis is unchanged. Otherwise, the lungs are grossly clear. No pleural effusion or pneumothorax. Hilar contours are normal. Increase in right paratracheal radiodensity combined with blunting of the paratracheal stripe and the slightly outward bulging of the mediastinal contour.", "output": "1. There is an increase in a right paratracheal radiodensity combined with blunting of the paratracheal stripe and the slightly outward bulging of the mediastinal contour. CT is recommended to exclude presence of mediastinal abnormalities. 2. No pneumonia." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. Clips are noted in the left axilla. Recommend correlation with prior surgical history. Moderate degenerative changes are noted in the thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. Mild basal opacity may represent atelectasis given associated volume loss, though cannot exclude an early pneumonia. Cardiomegaly is mild. No large effusions or pneumothorax. Bony structures are intact.", "output": "Mild basal opacity likely atelectasis, less likely pneumonia. Mild cardiomegaly." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are well expanded and clear without focal consolidation, pleural effusion or pneumothorax. Heart size is normal. The mediastinal silhouette is stable with mild aortic tortuosity. Hilar contours are normal.", "output": "No pneumonia, edema, or effusion." }, { "input": "Frontal and lateral chest radiographs demonstrate stable cardiomegaly. Mediastinal and hilar contours are unremarkable. Lungs are clear. No pleural effusion or pneumothorax evident. No osseous abnormality identified.", "output": "Stable moderate cardiomegaly. No findings concerning for pneumonia." }, { "input": "Portable AP semi-upright view of the chest was reviewed. When compared to the prior study, there has been interval increase of diffuse bilateral pulmonary opacifications that are worse on the right. Opacifications obscure the cardiac and mediastinal contours that are otherwise normal. The costophrenic angles are clear and there is no pneumothorax. The soft tissues and bones are unchanged.", "output": "Interval worsening of diffuse bilateral pulmonary opacifications consistent with the clinical diagnosis of pneumonia. Considering the extent of the disease, pneumonia with a component of ARDS has to be considered." }, { "input": "Portable upright view of the chest demonstrates low lung volumes. There are diffuse bilateral airspace opacities, which have progressed since prior. Small focal consolidations are seen in the right lung base abutting the right cardiac border. No pleural effusion is seen. There is no pneumothorax. Hilar and mediastinal silhouettes are unchanged. Heart size is mildly enlarged. Partially imaged upper abdomen is unremarkable.", "output": "Diffuse bilateral airspace opacities, have progressed since ___ exam. The above findings most likely represent multifocal infection. Pulmonary edema and ARDS are less likely differential considerations." }, { "input": "Lungs are clear aside from a 5mm well defined opacity projecting over the upper margin of the posterior right 7th rib. There is no pleural effusion or pneumothorax. The heart is normal in size. Normal cardiomediastinal silhouette.", "output": "5 mm opacity projecting over the upper margin of the posterior right 7th rib. Further evaluation with shallow oblique chest radiographs is recommended. Please request that the images be reviewed by a radiologist before the patient leaves the Radiology Department. This information was entered in the radiology department's online record for notification of critical results on ___." }, { "input": "Low lung volumes are seen with streaky bibasilar opacities which are likely atelectasis. No definite confluent consolidation is identified. Cardiomediastinal silhouette is within normal limits for technique. Tortuosity of the descending thoracic aorta is noted. Enteric tube tip projects over the gastric fundus.", "output": "NG tube tip at the gastric fundus." }, { "input": "ET tube terminates 7 cm above the carina. Transesophageal tube terminates in the stomach. There is increased left lung base opacification, probably atelectasis. Cardiac silhouette is exaggerated by poor lung volume. There is severe degenerative changes of bilateral glenohumeral joint, right more than left.", "output": "ET tube terminates 7 cm above the carina." }, { "input": "Endotracheal tube, enteric tube, and right PICC line are in satisfactory position. Heart size is stable and left lower lobe atelectasis is unchanged. Bilateral pleural effusions right greater than left appear larger, however this may be secondary to patient positioning. No pulmonary edema.", "output": "1. Satisfactory support lines and tubes. 2. Unchanged left lower lobe collapse. 3. Bilateral pleural effusions, right greater than left." }, { "input": "Right lung base opacity is improved. Left lung base opacity is stable. The bibasilar opacities are likely due to atelectasis. There are probably small bilateral pleural effusions. Cardiomediastinal silhouette is normal size.", "output": "Improved right lung base atelectasis." }, { "input": "Endotracheal and enteric tubes are unchanged in position. Small left pleural effusion and bilateral lower lobe collapse are similar. Bronchial opacification may signify retained endobronchial secretions. No new consolidation.", "output": "No significant interval change from 17:00 on ___" }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No evidence of free air is seen beneath the right hemidiaphragm.", "output": "No acute process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "As compared to chest radiograph from 1 day prior, interval insertion of a Dobhoff tube with the tip in the proximal body of the stomach. Pulmonary edema has improved and is now mild. Persistent bibasilar opacities have not subsequent changed and are likely a combination of pleural effusion and atelectasis, slightly increased.", "output": "Tip of the Dobhoff tube is in the body of the stomach." }, { "input": "Lung volumes are unchanged compared to the prior study. There has been some improvement in aeration of the left mid lung, possibly due to clearing of pulmonary edema. There are persistent bilateral perihilar airspace opacities with prominence of the pulmonary vasculature consistent with pulmonary edema. Support and monitoring devices are unchanged in appearance compared to the prior study. No pneumothorax or pleural effusion seen. Calcified pleura at the left apex again noted.", "output": "Rapid interval improvement in the consolidation in the left perihilar region suggests this may be clearing pulmonary edema." }, { "input": "Compared to ___, there is increased perihilar opacities, localized to the upper lobes, which may be due to pulmonary edema or possibly pneumonia. The heart and mediastinum are unchanged from prior. Right-sided central line terminates in the upper SVC. ET tube is in standard position. The NG tube is in the stomach and out of view. No pneumothorax is seen.", "output": "Increased upper lobe perihilar opacities, possibly due to pulmonary edema and/or pneumonia." }, { "input": "There is no pulmonary edema. No consolidation, large pleural effusion, or pneumothorax is identified. Cardiac silhouette is mildly enlarged. Lung volume is low. Left hemidiaphragm appears less sharp than on the prior study of ___", "output": "Loss of sharp definition of left hemidiaphragm contour, potentially due to early consolidation or small pleural effusion. If clinical suspicion for pneumonia remains high, consider obtaining PA and lateral chest radiograph for further evaluation." }, { "input": "Heart size is top-normal with on folding of the thoracic aortic arch. Cardiomediastinal silhouette and hilar contours are otherwise unremarkable. Mild right base atelectasis. Lungs are otherwise clear. No pleural effusion or pneumothorax. Tiny clips in the superior mediastinum noted.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Single AP view of the chest provided. A new right PICC line ends in the mid SVC. Mild bibasilar atelectasis, right greater than left, is likely secondary to low lung volumes. No pleural effusion or pneumothorax. Hilar and cardiomediastinal contours are normal.", "output": "1. A new right PICC line ends in the mid SVC. 2. No pneumothorax." }, { "input": "There is no consolidation, pleural effusion, or pneumothorax. Sternal surgical hardware is in unchanged position with frontal view compared to ___. There is better visualization of right heart border as expected. On lateral view, there is improved degree of pectus excavatum compared to the preoperative chest radiograph on ___. Alignment of the sternum is parallel with the thoracic spine.", "output": "Unremarkable appearance of status post surgical repair of pectus excavatum. No pneumothorax." }, { "input": "Compared with prior radiographs on ___, there has been interval loosening of one screw in the upper sternum. The sternum has overall improved alignment compared with prior. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Interval loosening of one screw in the upper sternum, with overall improved alignment of the sternum compared with prior." }, { "input": "In comparison with chest radiograph from ___, there is little overall change. Sternal alignment is maintained and there is no evidence of hardware loosening or failure. Lungs are clear without focal consolidation, pleural effusion or pneumothorax. Mediastinal and hilar contours are normal. Heart size is normal.", "output": "No evidence of hardware loosening or failure. Sternal alignment is maintained." }, { "input": "Right-sided Port-A-Cath tip terminates at the junction of the SVC and right atrium. Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Subsegmental atelectasis is seen in the right middle lobe. Lungs are otherwise clear. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormality is visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax or pneumomediastinum. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "Normal radiographs of the chest." }, { "input": "Frontal and lateral views of the chest were obtained. There is no focal consolidation, pleural effusion or pneumothorax. Heart size is normal. Mediastinal silhouette and hilar contours are normal. In the right posterior ninth rib, there is an edge adjacent to the rib. This most likely represents artifact, but if the patient has pain at this site, this may represent a fracture.", "output": "1. No pneumothorax. 2. Additional edge at the right posterior ninth rib may be artifact. Correlate with site of patient's pain to evaluate for fracture. Dr. ___ ___ findings with Dr. ___ by phone at 4:45pm ___. NOTE: No fracture is seen at this level on subsequent CT Abdomen/pelvis ___." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded lungs. Linear atelectasis is seen in the left base. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "Linear atelectasis at the left base." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "There has been a slight interval improvement in the pulmonary vascular congestion and bilateral pulmonary edema. No definite focal consolidation is seen. There is no pneumothorax or definite pleural effusion. There is moderate cardiomegaly, stable compared to exams dated back to at least ___. The hilar and mediastinal contours are unchanged.", "output": "1. No new definite opacities suggestive of pneumonia identified. 2. Slight interval improvement of the bilateral pulmonary vascular congestion and pulmonary edema." }, { "input": "Portable upright and lateral chest radiographs were obtained. Examination is limited due to poor penetration and low lung volumes. No focal consolidation, pleural effusion or pneumothorax is identified. The heart is enlarged with otherwise normal mediastinal and hilar contours.", "output": "Limited study without acute intrathoracic process." }, { "input": "The lungs are clear with left pleural effusion noted. No focal consolidation or pneumothorax is seen. There is no right effusion. The heart is top normal in size. Normal cardiomediastinal silhouette. Surgical clips noted in the right breast.", "output": "Small left pleural effusion. Though nonspecific, in the appropriate clinical setting, an isolated pleural effusion can be associated with pulmonary embolism. By report, the patient is scheduled for a VQ scan to explore this possibility." }, { "input": "There is a new right central line with tip in the right atrium. The heart is moderately enlarged. There is pulmonary vascular redistribution. There is right lower lobe area of increased opacity that could represent volume loss or infiltrate. There is also some retrocardiac opacity that could represent volume loss or infiltrate.", "output": "1. CHF. 2. An underlying infectious infiltrate at the bases cannot be excluded." }, { "input": "Frontal and lateral chest radiographs demonstrate unchanged mild cardiomegaly and vascular congestion. The lungs are otherwise clear, without focal consolidation. There is no pleural effusion or pneumothorax.", "output": "1. No acute cardiopulmonary abnormality. 2. Unchanged mild cardiomegaly and vascular congestion." }, { "input": "Cardiac silhouette size is normal. The aorta remains tortuous and diffusely calcified. Mediastinal and hilar contours are unchanged. The pulmonary vasculature is not engorged. Linear opacities within the periphery of the right lung base likely reflect areas of scarring. No focal consolidation, pleural effusion or pneumothorax is present. Mild degenerative changes are noted in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest were obtained. There is minimal right middle lobe atelectasis/scarring without definite focal consolidation, similar to the prior study. No pleural effusion is seen. The aorta remains calcified and tortuous. The cardiac silhouette is not enlarged. Degenerative changes are seen at the acromioclavicular joints.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs again demonstrate small bilateral pleural effusions. The lungs otherwise are clear and there is no pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Stable trace bilateral pleural effusions." }, { "input": "The endotracheal tube ends 3.4 cm above the level carina. The tunneled right internal jugular central venous catheter is unchanged in position. A skin fold on the left obscures what was previously defined as atelectasis on the radiograph from ___. Mild to moderate right lower lung atelectasis unchanged. Small pleural effusions are increased. There is no pneumothorax.", "output": "1. Bibasilar atelectasis, likely unchanged. 2. Increased small pleural effusions." }, { "input": "No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The aorta is calcified. The cardiac silhouette is not enlarged. A right humeral prosthesis is seen although not optimally evaluated. Degenerative changes are seen at the bilateral acromioclavicular joints. Surgical clips are noted overlying the left axilla.", "output": "No acute cardiopulmonary process." }, { "input": "A tunneled right internal jugular central venous catheter ends in the right atrium, near the tricuspid valve, unchanged. Lung volumes remain low. There are new bilateral lower lung heterogeneous opacities, likely atelectasis. There is new mild interstitial pulmonary edema. The heart size is difficult to assess. Small bilateral pleural effusions are new. There is no pneumothorax.", "output": "1. New bilateral lower lung opacities, likely atelectasis, although aspiration or infection could have an identical appearance. 2. New mild interstitial pulmonary edema. 3. New small bilateral pleural effusions." }, { "input": "The new endotracheal tube ends 4.3 cm above the level of the carina. The tunneled right-sided catheter is unchanged in position. Slightly improved lung volumes allow better visualization of unchanged bibasilar atelectasis. Small pleural effusions are unchanged.", "output": "Appropriately positioned endotracheal tube. Otherwise, no significant change." }, { "input": "A right subclavian venous catheter has been placed, since the prior study, which terminates in the right atrium. The cardiac, mediastinal and hilar contours appear unchanged. There is again mild elevation of the right hemidiaphragm. On this study, there is a new substantial but plate-like opacity in the right mid lung, which is highly suggestive of atelectasis; an infectious cause seems unlikely to explain this appearance. The left lung is clear. There is no definite pleural effusion or pneumothorax.", "output": "Status post interval placement of dialysis catheter. Focal right lung opacity, suggestive of atelectasis; short-term follow-up radiographs may be helpful." }, { "input": "Since prior, there has been no significant interval change. Elevation of the right hemidiaphragm and platelike atelectasis is stable. The left lung is clear. There is no large pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal and hilar contours are normal. Subclavian catheter ends in the right atrium.", "output": "No significant interval change. No evidence of pneumonia or pulmonary edema." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are normal. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "PA and lateral views of the chest provided. Multiple foreign bodies are again seen within the soft tissues of the right shoulder and upper back. These likely represent shot gun pellets. Lungs are clear without signs of pneumonia or edema. No large effusion or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Lungs are clear. No focal consolidation, pleural effusion or pneumothorax is seen. Mild degenerative changes are noted in the thoracic spine. Numerous punctate radiopaque densities are noted projecting over the right upper chest, neck and shoulder compatible with shotgun pellets.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Multiple median sternotomy wires are re-identified. There are mediastinal surgical clips, as well as a left mediastinum vascular stent. The cardiac silhouette is mildly enlarged. The bilateral hila are unremarkable. There is suggestion of pulmonary vascular congestion without overt pulmonary edema. There is no definite focal consolidation. There is no pneumothorax or pleural effusion.", "output": "Likely mild cardiomegaly and pulmonary vascular congestion without frank pulmonary edema." }, { "input": "The patient is status post previous median sternotomy and coronary bypass surgery. Cardiomediastinal contours are stable in appearance. There is no evidence of pulmonary edema or pneumonia. Minor areas of linear atelectasis are noted in the left mid and lower lung region as well as slight elevation of left hemidiaphragm.", "output": "1. No evidence of pulmonary edema. 2. Linear atelectasis in left mid and lower lung regions." }, { "input": "The lungs remain hyperinflated with flattening of the diaphragms and relative lucency of the upper lobes, consistent with chronic obstructive pulmonary disease with pulmonary emphysema. There is persistent right base opacity similar as compared to the prior study, though slightly increased as compared to ___. Findings could be due to underlying pneumonia or aspiration. No large pleural effusion is seen. There is no pneumothorax. The cardiac and mediastinal silhouettes are grossly stable. Old bilateral rib fractures are again seen.", "output": "1. COPD with pulmonary emphysema. 2. Right base opacity appears slightly increased. Findings may be due to progression of pneumonia; however, underlying pulmonary lesion is not excluded, particularly given underlying COPD. Recommend followup to resolution, consider nonurgent chest CT given background of COPD." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs remain hyperinflated with flattening of the diaphragms, suggesting chronic obstructive pulmonary disease. Again, there is basilar scarring. No new focal consolidation is seen. There is no pleural effusion or evidence of pneumothorax. The cardiac and mediastinal silhouettes are stable, with the aorta calcified and tortuous and the cardiac silhouette not enlarged. There is an old-appearing fracture of the lateral right ninth rib, with evidence of callus seen.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. There is severe emphysema. Heterogeneous opacity at the right lung base, could be aspiration. At the lateral aspect of the left lung, there is an area of increased opacity which could relate to pleural thickening. There is no definite pleural effusion or pneumothorax.", "output": "Heterogeneous opacity at the right lung base could be aspiration. Increased opacity at the lateral aspect of the left lung, could relate to pleural thickening. Further evaluation with lateral and oblique views is recommended. Findings discussed with Dr. ___ by ___ via telephone on ___ at 10:00 AM." }, { "input": "Frontal and lateral views of the chest. The lungs are hyperinflated. On the lateral view, there is increased density in the posterior costophrenic sulcus with blunting of the posterior costophrenic angles bilaterally which is new. Based on the frontal view, this is likely a localizing to the right base medially. This is in aregion of previously seen scarring but is suspicious for superimposed consolidation and possible trace effusions. Elsewhere the lungs are clear. Focal opacity at the right lung base laterally on the frontal view is likely due to changes in the anterior 7th rib. Old right ___ rib fracture is again seen. Cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications seen at the aortic arch.", "output": "Right basilar opacity compatible with pneumonia in the proper clinical setting. Possible trace bilateral effusions." }, { "input": "Frontal and lateral radiographs of the chest demonstrate markedly hyperinflated lungs with increased AP diameter and flattening of the diaphragms indicating severe emphysema. The subtle opacity seen on the prior radiograph has improved. Remote healed right rib fracture is noted. The mediastinal and hilar contours are normal aside from mildly tortuous aorta. No pleural effusion or pneumothorax is seen.", "output": "Improved area of opacification at the right base. No other definite focal pneumonia." }, { "input": "Infusion port is within the right chest wall with intact catheter terminating in the low SVC. Lungs are clear. There is no pleural effusion. There is no pulmonary nodule. Pulmonary vasculature, cardiomediastinal silhouette, and aorta are within normal limits.", "output": "Effusion catheter in the low SVC. Otherwise unremarkable chest radiographs." }, { "input": "A Port-A-Cath terminates in the superior vena cava. The cardiac, mediastinal and hilar contours appear unchanged. There is patchy opacity obscuring the left heart border, but unchanged, probably due to minor atelectasis. The heart is normal in size. Nipple shadows are visualized bilaterally. There are no pleural effusions or pneumothorax.", "output": "No evidence of acute disease." }, { "input": "Right-sided Port-A-Cath tip terminates in the SVC. Heart size is normal. Mediastinal and hilar contours are unremarkable. There is no pulmonary vascular congestion. Lungs are clear. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities. Several clips again noted within the midline upper abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. Port-A-Cath resides over the right chest wall with catheter tip in the mid SVC. Lungs are clear bilaterally. Clips are noted in the upper abdomen. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Portable AP upright frontal radiograph of the chest demonstrates symmetrically well inflated lungs. Streaky bibasilar opacities likely reflect mild bronchovascular crowding. No focal consolidation concerning for pneumonia, pleural effusion or pneumothorax is detected. The pulmonary vasculature is not engorged. The cardiac silhouette is normal in size. The cardiomediastinal and hilar contours are within normal limits. The trachea is midline. The visualized upper abdomen is gasless.", "output": "No acute cardiopulmonary process." }, { "input": "Right-sided Port-A-Cath terminates in the low SVC without evidence of pneumothorax.No definite focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Right-sided Port-A-Cath tip terminates at the junction of the SVC and right atrium. Cardiac size is normal. Mediastinal and hilar contours are within normal limits. Lungs are clear. No focal consolidation, pleural effusion or pneumothorax is present. Pulmonary vasculature is normal. A common bile duct stent is demonstrated in the right upper quadrant of the abdomen along with multiple clips projecting over the epigastric region. No acute osseous abnormality is visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Central venous catheter terminates at the cavoatrial junction. The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Right-sided Port-A-Cath tip terminates at the cavoatrial junction, unchanged. Lungs are clear without focal consolidation, effusion, or pneumothorax. Cardiomediastinal and hilar silhouettes are unchanged since the prior radiograph. Known epigastric surgical clips and partially imaged CBD stent are again noted.", "output": "No focal consolidation concerning for pneumonia." }, { "input": "A right-sided Port-A-Cath is present with the tip in the mid SVC. The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Right-sided Port-A-Cath tip terminates at the SVC/right atrial junction. Lung volumes remain low with bibasilar atelectasis appearing unchanged. Cardiac and mediastinal contours are similar. Pulmonary vasculature is not engorged. No pneumothorax or pleural effusion is detected. A percutaneous biliary catheter is noted coursing through a biliary stent. Multiple clips are noted about the midline abdomen and right upper quadrant of the abdomen. No subdiaphragmatic free air is noted.", "output": "Low lung volumes with persistent bibasilar atelectasis." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Right-sided Port-A-Cath terminates at the low SVC/ cavoatrial junction.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Cardiac and mediastinal silhouettes are stable and unremarkable. A right-sided Port-A-Cath is again seen, unchanged in position, terminating in the mid SVC.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax. A right chest port terminates at the cavoatrial junction.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette and hilar contours are normal. There is no pleural effusion or pneumothorax. No radiopaque foreign body is identified. Osseous structures are grossly intact.", "output": "No evidence of acute cardiopulmonary process. No radiopaque foreign bodies identified." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The chest is perhaps mildly hyperinflated. The lungs appear clear. Bony structures appear within normal limits.", "output": "Mild hyperinflation. No evidence of acute cardiopulmonary disease." }, { "input": "PA and lateral views of the chest are provided. Lungs are clear. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "No focal consolidation is seen. There is no large pleural effusion or pneumothorax. The cardiac silhouette is moderately enlarged. Aortic knob is calcified. No pulmonary edema is seen.", "output": "Moderate cardiomegaly without pulmonary edema." }, { "input": "PA and lateral chest views were obtained with patient in upright position. The heart size is normal. No configurational abnormalities identified. Unremarkable appearance of thoracic aorta. No wall calcifications. The pulmonary vasculature is not congested. No signs of acute or chronic parenchymal infiltrates are present and the lateral and posterior pleural sinuses are free. No pneumothorax in the apical area. Skeletal structures of the thorax are grossly unremarkable. Our records do not include a previous chest examination available for comparison.", "output": "Chest findings are within normal limits. Thus, no evidence of acute pulmonary infiltrate or vascular congestion in this ___-year-old male patient with protracted cough." }, { "input": "As compared to ___, increasing moderate left effusion. Slight worsening of the retrocardiac and left basilar opacity. The right lung is relatively unchanged low lung volumes. Cardiomediastinal contours are unchanged. Right-sided internal jugular catheter in similar position.", "output": "Slight increase in moderate layering left-sided effusion and left basal opacity." }, { "input": "Patient is status post median sternotomy and CABG. Heart size is top-normal. The mediastinal and hilar contours are unremarkable. The pulmonary vasculature is not engorged. Streaky atelectasis is demonstrated in the lung bases without focal consolidation. Sutures are again noted within the left mid lung field. No pleural effusion or pneumothorax is detected. There are no acute osseous abnormalities.", "output": "Streaky atelectasis within the lung bases. No focal consolidation." }, { "input": "There is a moderate left pleural effusion. , this appears increased compared to the prior study however there was likely layering of the pleural effusion on the prior study as the patient was semi-erect. Left lower lobe atelectasis versus consolidation. The right internal jugular catheter is been removed. Median sternotomy and coronary artery bypass graft sutures are unchanged in appearance. The cardiomediastinal contour is unchanged. Suture material is seen in the left hemi thorax. No pneumothorax seen.", "output": "Apparent increase in the left-sided pleural effusion may in fact be due to layering of the effusion on the prior study. Left lower lobe atelectasis versus consolidation." }, { "input": "Patient is status post median sternotomy and CABG. The cardiac and mediastinal silhouettes are stable. There is subtle increase in opacity of the left mid to lower lung which is decreased compared to ___, but slightly more apparent compared to ___, underlying infectious process not excluded. No pleural effusion or pneumothorax is seen. No overt pulmonary edema. Sutures again seen in the left mid lung region.", "output": "Subtle opacity projecting over the left mid to lower lung could be due to a subtle pneumonia." }, { "input": "Both lungs are expanded. There are no lung opacities concerning for pneumonia or aspiration. No pleural abnormality. Hemidiaphragm is mildly elevated. Mediastinal and hilar contours are normal.", "output": "Bilateral clear lungs. No pleural effusion." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. The aorta is mildly tortuous. Contrast material is seen in the bowel.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lungs: The lungs are well inflated. There is no consolidation. Pleura: No pleural effusion is seen. Heart: The heart is not enlarged. Mediastinum and hila: There is no mediastinal mass. Osseous structures: Minimal old dextroscoliosis is present. Other findings: None", "output": "Lungs clear." }, { "input": "The lungs are clear. There is no focal consolidation, pleural effusion or pneumothorax. The cardiac silhouette is normal. The osseous structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. Mild long-standing bilateral hilar enlargement is probably due to chronic lymph node enlargement. This examination neither suggests nor excludes the diagnosis of pulmonary embolism. There is no pneumothorax. The heart and mediastinum are within normal limits. Left upper quadrant metallic surgical clips are again noted.", "output": "Clear lungs." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "Normal chest radiograph." }, { "input": "The lungs are clear. There is no evidence of pneumonia, pneumothorax, or pleural effusion. Cardiac silhouette is normal in size.", "output": "Normal chest x-ray." }, { "input": "PA and lateral views of the chest were obtained demonstrating two surgical drains residing in the right upper abdomen compatible with recent post-surgical status. Please note, patient's recent surgery was performed on ___. There is marked elevation of the right hemidiaphragm with complete collapse of the right lower lobes. No significant pleural effusion is seen. Heart size cannot be assessed due to obscuration of the right heart border. Mediastinal contour appears grossly unremarkable. The bony structures are intact.", "output": "Elevated right hemidiaphragm with complete right lower lobe collapse. Surgical drains in the right hemi-abdomen. Please correlate with consequent CT abd/pelvis." }, { "input": "Although a right pleural pigtail drainage catheter has not changed position, since ___ a moderate volume of pleural fluid has reaccumulated, extending up the lateral costal surface and into the fissure. There is no pneumothorax. The consolidation in the right lower lobe is probably atelectasis given the history of longstanding effusion. The cardiomediastinal silhouette is mildly enlarged, but stable.", "output": "1. Moderate right pleural effusion reaccumulated over one day. 2. Recurrent right lower lobe atelectasis, less likely pneumonia." }, { "input": "Patient is status post partial resection of the right lobe of the liver. Moderate right pleural effusion associated atelectasis of right lower lobe is unchanged since prior radiograph from ___ (Better assessed on chest CT from ___). Right hemidiaphragm margin is obscured by the pleural effusion. Air lucencies in the right hypochrondriac region is due to bowel loops occupying liver resection site. Two drain tubes are present in the right hypochondium. Left lung is clear. There is no pleural effusion or pneumothorax. Heart size, mediastinal and hilar contours are unchanged.", "output": "Known moderate right pleural effusion associated with atelectasis of right lower lung, unchanged since ___" }, { "input": "PA and lateral chest views were obtained with patient in upright position. Analysis is performed in direct comparison with the next preceding similar chest examination of ___. The previously described two right-sided pleural drainage tubes remain in place. The right-sided pleural density that obscures the right-sided diaphragm appears rather unchanged on both frontal and lateral views. No new parenchymal pulmonary abnormalities are identified. No significant mediastinal shift has developed.", "output": "Moderate amount of right-sided pleural effusion, stable appearance in comparison with study with five days' examination interval." }, { "input": "PA and lateral views of the chest were obtained. Patient has two surgical drains again noted in the right upper quadrant. There is elevation of the right hemidiaphragm with collapse of the right middle and right lower lobes unchanged. A right pleural effusion is again noted. There is persistent aeration in the right upper lobe. Left lung is clear aside from mild subsegmental lower lobe atelectasis. No significant change in cardiomediastinal contour though the right heart border is obscured. Bony structures are intact.", "output": "Persistent collapse of the right middle and right lower lobes with right pleural effusion." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. The lungs are clear of consolidation, effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits denoting atherosclerotic calcifications at the arch. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is elevation of the right hemidiaphragm. There is peribronchial cuffing present. There are bilateral lower lung opacities concerning for infection. No additional opacities are seen. There is no evidence of pleural effusion or pneumothorax. Aortic arch calcifications are seen. Heart is normal in size. Mild degenerative change is present about the acromioclavicular joints bilaterally. There is also a curvilinear calcification adjacent to the greater tuberosity of the humeral head of the right shoulder that may represent hydroxyapatite deposition disease.", "output": "1. Bilateral lower lung opacities concerning for acute infectious process. 2. Right lower lobe atelectasis with elevation of the right hemidiaphragm. 3. Hydroxyapatite deposition disease about the right shoulder." }, { "input": "No focal consolidation, pneumothorax, or pulmonary edema is seen. Cardiac silhouette and mediastinal contours are normal. Left proximal humeral opacity is noted and marked on chest radiograph. Differential includes benign bone island versus metastatic lesion. Recommend review of previous imaging to identify if new or chronic process.", "output": "Left proximal humeral lesion noted with the differential including benign bony island versus metastatic disease. Recommend reviewing previous imaging if available to identify chronicity. Otherwise, normal chest radiograph." }, { "input": "Right internal jugular line ends at lower SVC, and the feeding tube ends into the stomach. Abdominal drain tubes are seen in the right hypochondriac region. Since ___, moderate right pleural effusion associated with right lower lung atelectasis has improved. There is small left pleural effusion and left basilar atelectasis which has significantly improved. Upper lungs are clear. No new lung opacities of concern. Heart size is normal. Mediastinal and hilar contours are unremarkable.", "output": "Since ___, moderate right and small left pleural effusions associated with bibasilar atelectasis have improved." }, { "input": "There is an opacity at the right lung base with silhouetting of the right hemidiaphragm likely representing small-to-moderate right pleural effusion with adjacent atelectasis. However, a developing pneumonia in this region cannot be excluded. Additionally, there is a small left pleural effusion. Cardiomediastinal silhouette is normal. The upper lung zones are clear. There are no acute fractures identified.", "output": "Bilateral pleural effusions, small to moderate on the right and small on the left, with adjacent airspace atelectasis. Pnuemonia must be excluded in the proper clinical setting." }, { "input": "Heart size is borderline enlarged. Mediastinal and hilar contours are normal. Lungs are clear and the pulmonary vasculature is normal. No pleural effusion, focal consolidation or pneumothorax is identified. No acute osseous abnormalities seen.", "output": "Borderline enlarged heart. No evidence of pulmonary edema." }, { "input": "Portable AP upright chest radiograph obtained. The heart is mildly enlarged with a left ventricular configuration. There is no overt sign of pneumonia or CHF, though there may be mild interstitial prominence which could represent edema in the right clinical setting. No large effusion or pneumothorax is seen. Mediastinal contour appears grossly unremarkable. Bony structures are intact.", "output": "Mild cardiomegaly with LV configuration and possible minimal interstitial pulmonary edema. Please note evaluation limited due to portable AP technique." }, { "input": "Frontal and lateral radiographs of the chest demonstrate hyperexpanded, clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. The sternum appears intact on the lateral view.", "output": "No acute cardiopulmonary process. No sternal fracture is clearly noted. If there is continued concern for a sternal fracture, please note that CT is a more sensitive exam." }, { "input": "Minimal basilar atelectasis is seen without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen. It is difficult to evaluate the right glenohumeral joint ; correlate clinically for possible subluxation.", "output": "Minimal basilar atelectasis. No displaced fracture is seen. It is difficult to evaluate the right glenohumeral joint ; correlate clinically for possible subluxation." }, { "input": "The lungs are clear without consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "There is moderate cardiomegaly, which has improved since ___. Lungs are clear. Hila, mediastinum and pleural surfaces are normal.", "output": "No radiographic evidence of an acute cardiopulmonary process." }, { "input": "There has been expected interval decrease in size of cardiac silhouette with shift of pericardial fluid to the left pleural space now with a moderate left pleural effusion and associated basilar atelectasis. The left lung apex and the right lung are clear. There is no pneumothorax.", "output": "Expected shift of fluid from the pericardial space to the left pleural space, now with moderate left pleural effusion and associated atelectasis. Resolution of pneumothorax." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Compared to the prior radiograph, lung aeration has improved. Right middle lobe atelectasis is present, and the right hilus is indistinct. Further details were gleaned on the CT chest from ___. The left lung is clear without pleural effusions.", "output": "1. Right middle lobe atelectasis is present with an indistinct right hilus. These are better evaluated on the prior CT chest from ___. 2. Left lung is clear." }, { "input": "Cardiac silhouette size is normal. Mediastinal and hilar contours are unchanged. The pulmonary vasculature is normal. New focal consolidation is demonstrated in the right middle lobe. There are small bilateral pleural effusions, right greater than left. No pneumothorax is demonstrated. There are mild degenerative changes noted in the thoracic spine.", "output": "Right lower lobe pneumonia with small bilateral pleural effusions. Follow up radiographs after treatment are recommended to ensure resolution of this finding." }, { "input": "Heart size is normal with mild tortuosity of the thoracic aorta. Hilar contours are unremarkable. Lungs are clear. Most pleural surfaces are normal except for posterior thickening probably due to healed left posterolateral rib fractures. Midthoracic disc space narrowing is due to chronic disc degeneration.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Very mild pulmonary edema. No acute focal consolidation. No pleural effusions or pneumothorax. Mild cardiomegaly with prior median sternotomy and CABG.", "output": "Very mild interstitial edema." }, { "input": "AP upright chest radiograph demonstrates clear lungs bilaterally. Cardiomediastinal and hilar contours are within normal limits. There is no pneumothorax, pleural effusion, or pulmonary edema. No nondisplaced rib fracture is identified..", "output": "No acute intrathoracic abnormality. No displaced rib fracture. If concern for rib fracture persists, consider dedicated rib films with radiopaque marker indicating the site of clinical concern." }, { "input": "PA and lateral views of the chest. The lungs are clear. There is no pleural effusion, pneumothorax, or focal consolidation. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "No previous images. The heart is normal in size and lungs are clear without vascular congestion or pleural effusion.", "output": "No evidence of pneumonia or other acute abnormality." }, { "input": "Frontal and lateral radiographs were reviewed. Heart size is top normal. Mediastinal and hilar contours are stable. There is no pleural effusion or pneumothorax. Lungs are clear. Pulmonary vasculature is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided demonstrating clear well-expanded lungs without focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette appears normal. No signs of congestive heart failure. Bony structures are intact. There is no free air below the right hemidiaphragm. The imaged loops of bowel appear unremarkable.", "output": "No acute findings in the chest. No free air." }, { "input": "Stable, extensive bilateral opacities representing calcified pleural plaques and calcified diaphragmatic pleura suggest previously identified asbestos-related disease. Normal cardiomediastinal and hilar contours. No pneumothorax, pleural effusion, or acute pneumonia. No definite osseous or soft tissue abnormalities.", "output": "No acute pneumonia." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lung fields are clear. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest. Heart size is normal and cardiomediastinal contours are stable. Haziness along the cardiac margins is similar to prior and likely due to epicardial fat pads. Lungs are clear without focal consolidation, pleural effusion, or pneumothorax. Bilateral acromioclavicular joint degenerative changes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. The lungs are clear without focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours appear within normal limits. Bony structures are intact. No free air below the right hemidiaphragm. Prominent epicardial fat pad likely accounts for the haziness along the cardiac margins.", "output": "No acute intrathoracic process." }, { "input": "The heart size is normal. The hilar and mediastinal contours are within normal limits. There is no focal consolidation or nodule, pneumothorax, or pleural effusion. The examination is unchanged in comparison to the ___ examination.", "output": "No new pulmonary nodule or mass." }, { "input": "Cardiomediastinal silhouette and hilar contours are normal. A tiny opacity in the right mid-lung is likely a focus of residual fibrosis from a prior pneumonia. Lungs are otherwise clear. There is no pleural effusion or pneumothorax. Gallstones project over the right upper quadrant.", "output": "1. Small focus of a remnant fibrosis from healing of old pneumonia in right mid lung without evidence of acute infection. 2. Gallstones." }, { "input": "In the first view, the orogastric tube is seen looping at the level of the lower neck. In a subsequent radiograph, the orogastric tube is seen in the upper abdomen with the tip out of view. There is an endotracheal tube that ends 2.7 cm above the carina. Lung volumes are low accounting for some bronchovascular crowding but no focal opacities. Minimal interstitial thickening is present. Moderate cardiomegaly obscures the left lung base. There is no pleural effusion or pneumothorax.", "output": "1. Endotracheal tube in appropriate position. An orogastric tube ends in the abdomen with the tip out of view. 2. Moderate cardiomegaly with a minimal interstitial thickening suggesting minimal interstitial edema in the setting of low lung volumes." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. No free intraperitoneal air.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are unremarkable. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "Frontal and lateral chest radiographs demonstrate clear hyperexpanded lungs. There is no pleural effusion or pneumothorax. The cardiac silhouette and mediastinal contours are normal. There is an LV configuration to the left heart border, which combined with a tortuous aorta suggests hypertension.", "output": "Hyperexpanded lungs, without evidence of pneumonia." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral upright chest radiographs demonstrate clear lungs bilaterally. No focal consolidation is identified concerning for pneumonia. Patient is status post median sternotomy with intact wires identified. Cardiomediastinal and hilar contours are within normal limits, overall similar in appearance to prior examination dated ___. There is no pleural effusion or pneumothorax identified. Visualized osseous structures demonstrate no acute abnormality.", "output": "No acute intrathoracic abnormality identified." }, { "input": "A single frontal view of the chest was obtained. In the right middle lobe, there is mild obscuration of the right heart border. There is no definite consolidation. There is no pulmonary edema, pleural effusion, or pneumothorax. The lung volumes are low. The cardiomediastinal silhouette is normal. The patient is status post a median sternotomy. The wires are intact.", "output": "Obscuration of the right heart border could be due to crowding of bronchovascular structures due to low lung volumes or underlying pneumonia. Recommend further evaluation with a PA and lateral chest radiographs with deeper inspiration. Results were discussed with the ___ attending Dr. ___ at that time the findings were discovered at 11:30 p.m. on ___ in person by Dr. ___." }, { "input": "The lungs are clear. The cardiomediastinal silhouette and hila appear normal. There is no pleural effusion and no pneumothorax. Intact sternotomy wires are seen.", "output": "No acute cardiothoracic process." }, { "input": "The patient is status post median sternotomy and CABG. Endotracheal tube tip terminates approximately 5 cm from the carina and the orogastric tube tip is within the stomach. The heart size is normal. The aorta is slightly unfolded. There is crowding of the bronchovascular structures due to low lung volumes. Streaky opacities within the lung bases likely reflect atelectasis. No large pneumothorax is identified on this supine study. A possible trace right pleural effusion may be present as the right costophrenic angle is slightly indistinct. No acute osseous abnormalities seen.", "output": "Endotracheal and orogastric tube tips are in standard positions. Low lung volumes with streaky opacities in the lung bases, likely atelectasis. Possible trace right pleural effusion." }, { "input": "The patient is status post median sternotomy and CABG. The heart size is normal. The mediastinal and hilar contours are unremarkable, and there is no pulmonary vascular congestion. Apart from minimal streaky opacity in the left lung base likely reflecting atelectasis, the lungs are clear. No pleural effusion, focal consolidation or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Minimal left basilar atelectasis. Otherwise no acute cardiopulmonary abnormality." }, { "input": "An AP and lateral views of the chest were obtained. There is evidence of stable left basilar atelectasis. No consolidation is identified. There is no pulmonary edema, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal. The patient is status post a median sternotomy. The wires are intact.", "output": "Stable mild atelectasis; no evidence of pneumonia." }, { "input": "The lungs are clear without focal consolidation. There is a focal opacity in the retrosternal clear space on the lateral view which is unchanged dating back to ___. There is no effusion or vascular congestion. The cardiomediastinal silhouette is stable. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs. Median sternotomy wires are intact. Mediastinal clips are again noted. Opacity projecting over the anterior inferior chest on the lateral view only has no correlate other than fat on CT abdomen pelvis from ___ which included this level. Otherwise, the lungs are clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "AP and lateral chest radiographs. Median sternotomy wires are intact. CABG clips are noted. Lung volumes are low but there is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Suggestion of esophageal hiatal hernia. Lungs clear. Shallow inspiration. Minimal right basilar atelectasis Normal pulmonary vascularity.", "output": "Minimal right basilar atelectasis" }, { "input": "The heart and mediastinum are unremarkable. Again seen is right lower lobe atelectasis with associated elevation of the right hemidiaphragm. There is no evidence of focal consolidation. Again seen is a substantial right mediastinal shift of the upper trachea that may be associated with thyroid enlargement.", "output": "1. No evidence of pneumonia. 2. Right lower lobe atelectasis with associated elevated right hemidiaphragm" }, { "input": "Frontal and lateral radiographs of the chest demonstrate mild asymmetry at the right lung base compared to the left. This may represent overlying breast shadow although in the right clinical situation, pneumonia cannot be ruled out. There is no evidence of vascular congestion or interstitial edema. No pleural effusions are identified. No pneumothorax is seen. The heart, mediastinum, and hilar contours are normal.", "output": "Mild opacification at the right base which may, in the right clinical situation, represent pneumonia. No evidence of pulmonary edema." }, { "input": "Left internal jugular line is present with tip in the upper SVC. An enteric tube can be followed to the level of the distal esophagus, but the tube cannot be followed beyond that point. There is a small left pleural effusion. There is no pneumothorax or right pleural effusion. There are low lung volumes. Left retrocardiac opacity is present, likely reflecting atelectasis. Pulmonary vasculature is within normal limits. The patient is status post right rotator cuff repair.", "output": "Small left pleural effusion and left basilar atelectasis. No pulmonary edema." }, { "input": "Portable AP upright chest radiograph was obtained. The lungs are relatively well expanded and clear. Linear atelectasis is seen in the left lower lobe. There is no focal consolidation, pleural effusion or pneumothorax. Left subclavian catheter has been removed. The heart is moderately enlarged with tortuous aortic contour.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest were provided. The heart appears mildly enlarged. Bilateral pleural effusions are present, left greater than right. Probable compressive lower lobe atelectasis is also present, left greater than right. Mild pulmonary interstitial edema is also suspected. Mediastinal contour is stable. Surgical anchors are noted in the right humeral head. Otherwise, the bony structures appear unremarkable.", "output": "Interval development of bilateral pleural effusions, small-to-moderate and slightly larger on the left with associated lower lobe compressive atelectasis. Cardiomegaly also noted with equivocal mild interstitial pulmonary edema." }, { "input": "A left subclavian central venous catheter is present with the tip in the upper SVC. The enteric tube has been removed. Since the prior exam, the lung volumes have improved. There is stable mild bibasilar atelectasis. There is no pleural effusion, pulmonary edema, or pneumothorax. The mediastinal contours are normal. The heart size is mildly enlarged.", "output": "Improved lung volumes. No evidence of pulmonary edema." }, { "input": "The lungs are well-expanded and clear. The cardiomediastinal silhouette is normal. No pleural effusion or pneumothorax. No osseous abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. Heart size is top-normal. Mediastinal contour is unremarkable. Imaged osseous structures are intact. Chronic right clavicular midshaft deformity noted. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "These images show no change in a calcified nodule in the left upper lobe. No consolidation suggestive of pneumonia is seen. The heart and mediastinal contours and bony structures are not changed.", "output": "No suspicious interval change and no pneumonia seen." }, { "input": "Frontal and lateral views of the chest were obtained. Slightly external artifact projects to the superior aspect of the image. Given this, no focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Cardiac and mediastinal silhouettes are stable and unremarkable, as are the hilar contours.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs are clear of focal consolidation, effusion, or vascular congestion. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The mediastinum is widened secondary to known ascending aortic aneurysm, but is unchanged from prior exams. There is no new mediastinal widening. The cardiac silhouette is stably enlarged. Bilateral moderate pleural effusions are unchanged with associated bibasilar atelectasis. There are no new consolidations. There is no pneumothorax.", "output": "1. Unchanged appearance of the mediastinum. 2. Bilateral moderate pleural effusions. 3. Bibasilar atelectasis." }, { "input": "Very limited view of the chest without obvious pneumothorax or edema. The patient is rotated, limiting evaluation of the cardiomediastinal silhouette, but an enlarged calcified aorta is again noted. Right lower lung nodule is obscured. Note is made of a large right calcified thyroid nodule.", "output": "Very limited study due to patient rotation without evidence for large pneumothorax." }, { "input": "Lung volumes are low. The heart is probably mildly enlarged. The mediastinum is not widened. Retrocardiac opacity may reflect some atelectasis, difficult to fully assess as there leads projecting over the left mid hemi thorax. There is mild pulmonary vascular congestion. No overt edema. No pleural effusion. No pneumothorax. No acute osseous abnormality.", "output": "1. Low lung volumes and mild pulmonary vascular congestion versus crowding in the setting of low lung volumes. 2. Mild cardiomegaly. 3. The mediastinum is not widened." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well expanded and clear. The previously seen irregular focal opacity in the left base and adjacent lucency is no longer apparent. No consolidation, effusion, or pneumothorax is present. The cardiac and mediastinal contours are normal.", "output": "Normal chest radiograph. Resolution of previously seen opacity in the left base which may have been focal atelectasis." }, { "input": "THERE ARE LOW INSPIRATORY VOLUMES, WITH BIBASILAR ATELECTASIS. MILD PROMINENCE OF THE CARDIOMEDIASTINAL SILHOUETTE IS LIKELY RELATED TO THE LOW INSPIRATORY VOLUMES AND TECHNIQUE. THERE IS UPPER ZONE REDISTRIBUTION, BUT NO OVERT CHF. NO FRANK CONSOLIDATION. NO GROSS EFFUSION. NO PNEUMOTHORAX DETECTED. THE LEFT HEMIDIAPHRAGM IS SLIGHTLY ELEVATED, WITH UNDERLYING AIR-FILLED COLONIC SPLENIC FLEXURE. THIS APPEARANCE IS SIMILAR TO ___, THOUGH THE LOOP OF BOWEL IS SLIGHTLY DILATED ON TODAY'S EXAMINATION.", "output": "LOW INSPIRATORY VOLUMES. BIBASILAR ATELECTASIS. THE POSSIBILITY OF AN UNDERLYING INFILTRATE CANNOT BE ENTIRELY EXCLUDED." }, { "input": "The cardiac silhouette size is normal. Worsening areas of opacification are demonstrated within both mid lung fields as well as within the right lung base, findings concerning for multifocal pneumonia. Multiple bilateral pulmonary nodules are obscured due to this new parenchymal process. Mediastinal contours are unchanged with widening of the left superior mediastinal contour compatible with known lymphadenopathy. There is mild pulmonary edema and small bilateral pleural effusions. No pneumothorax is identified. Emphysematous changes and hyperinflation of lungs are again noted.", "output": "Worsening parenchymal opacifications within both mid lung fields and right lung base, concerning for multifocal pneumonia. Previously seen multiple bilateral pulmonary nodules are obscured by this acute pulmonary process. Mild pulmonary edema and small bilateral pleural effusions." }, { "input": "The lungs are hyperinflated. There is no focal consolidation or pneumothorax. Blunting of the left costophrenic sulcus may be due to a small pleural effusion. Since ___, the heart is much larger, raising the possibility of increased pericardial effusion, less likely cardiomyopathy. Pulmonary nodules are better assessed on CT ___. Scarring in the right mid lung is again seen.", "output": "1. No pneumonia. Possible tiny left effusion. 2. Short-interval increase in cardiac silhouette size from ___ raises the possibility of increased pericardial effusion, less likely cardiomyopathy. Findings discussed with Dr. ___ by phone at 11:40pm ___." }, { "input": "Portable AP upper chest film ___ at 08:28 is submitted.", "output": "A left pleural catheter remains in place and there is no significant interval change in appearance of the left-sided pleural effusion with associated patchy atelectasis in the left mid and lower lung. Patchy opacity at the right base is also stable and may reflect atelectasis. Superimposed infection cannot be excluded. There may be a small left apical pneumothorax with the lung edge overlying the left third posterior rib. This can be better assessed on followup imaging. No pulmonary edema. NOTIFICATION: Results were communicated to the patient's nurse, ___, by phone on ___ at 11:09am 10 minutes after the time of discovery." }, { "input": "AP portable upright view of the chest. An NG tube courses inferiorly into the left upper quadrant. A left chest tube is in place, stable in position from prior exam. There are bilateral pleural effusions which are small with associated mild compressive lower lobe atelectasis. Mild pulmonary edema persists. The heart size remains within normal limits. The mediastinal contour is normal. Bony structures are intact. Gaseous distension of bowel in the upper abdomen noted with skin ___ present.", "output": "Persistent pulmonary edema with small bilateral effusions and compressive lower lobe atelectasis. Left chest tube and nasogastric tubes remain in place." }, { "input": "The very small left apical pneumothorax has increased compared with the prior study of ___, now moderate in size. Allowing for rotation there is no apparent midline shift. There are stable atelectatic changes at the left apex and both lung bases. A moderate left pleural effusion is increased with associated compressive atelectasis. The density of the left mid lung likely represents loculated pleural effusion, however consolidation cannot be ruled out. The cardiomediastinal silhouette is normal. There is no pulmonary edema.", "output": "1. Moderate left apical pneumothorax has increased. 2. Moderate left pleural effusion with associated compressive atelectasis has increased. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 10:05AM, at the time the findings were discovered." }, { "input": "Cardiomediastinal contours are stable allowing for differences in lung volumes. There has been marked interval improved aeration in the left lower lobe with residual retrocardiac opacity remaining as well as mild elevation of the left hemidiaphragm. Bandlike, linear atelectasis is also present in the lingula. Small left pleural effusion has slightly decreased in size. The right lung and pleural surfaces are clear. Distended loops of bowel with air-fluid levels in the imaged upper abdomen are incompletely imaged on this study.", "output": "Improving left lower lobe atelectasis and decreasing small left pleural effusion. INCOMPLETELY EVALUATED DISTENDED LOOPS OF BOWEL IN THE IMAGED UPPER ABDOMEN. CONSIDER DEDICATED ABDOMINAL RADIOGRAPH SERIES FOR MORE COMPLETE EVALUATION IF WARRANTED CLINICALLY." }, { "input": "The cardio mediastinal silhouettes are unchanged in appearance. There are increased interstitial opacities bilaterally, however, there is an overall poor inspiratory effort and low lung volumes which limits interpretation, as this may simply be due to crowding of normal vascular structures. It is recommended to repeat radiograph with improved inspiratory effort for better visualization of lung parenchyma. There is loss of definition of the right lateral costophrenic angle which is likely due to small right pleural effusion. There are no pneumothoraces.", "output": "1. Limited study due to poor inspiratory effort and low lung volumes with apparent new interstitial process, likely edema. Recommend repeat radiograph with improved inspiration. 2. Small right pleural effusion." }, { "input": "There is an NG tube seen with distal tip projecting over the mid mediastinum, side port at the level of the clavicles. This was discussed over the phone with the surgical team at the time of radiograph review. The cardiomediastinal silhouette is unchanged. There is improvement in previously visualized right base/cardiophrenic opacity. There is stable left lower lung atelectasis, obscuring the left hemidiaphragm. There is no evidence of pulmonary vascular congestion or pulmonary edema. There is no pneumothorax. There may be minimal bilateral pleural effusions.", "output": "1. NG tube with distal tip projecting over mid mediastinum. 2. Improvement in right basilar opacity. Stable left basilar atelectasis. 3. Possible minimal bilateral pleural effusions. NOTIFICATION: Positioning of NG tube was discussed over the phone by Dr. ___ with Dr. ___ on ___ at 10:30, at the time of review." }, { "input": "Lung volumes are slightly reduced. The heart size is top normal. The mediastinal and hilar contours are unremarkable. Mild interstitial prominence with peribronchial cuffing could suggest slight vascular congestion or airway inflammation. Patchy opacities in the lung bases may reflect atelectasis but are nonspecific, and aspiration is not excluded. No focal consolidation, pleural effusion or pneumothorax is seen.", "output": "Mild interstitial prominence with peribronchial cuffing could suggest mild pulmonary vascular congestion or airway inflammation. Patchy bibasilar opacities are nonspecific, possibly atelectasis but aspiration is not excluded." }, { "input": "The cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax. There is left basilar atelectasis.", "output": "Left basilar atelectasis. No pneumonia." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lung fields are clear. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Mild enlargement of the cardiac silhouette is unchanged. The aorta remains tortuous. The mediastinal hilar contours are normal. The pulmonary vasculature is not engorged. There is minimal blunting of the costophrenic angles bilaterally suggestive of trace pleural effusions, unchanged. No pneumothorax is present. Clips from prior cholecystectomy are noted in the right upper quadrant of the abdomen.", "output": "Unchanged trace bilateral pleural effusions. Otherwise, no acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. There are trace bilateral pleural effusions, similar to prior. No pneumothorax is seen. The cardiac and mediastinal silhouettes are unchanged.", "output": "1. Trace bilateral pleural effusions are similar prior. 2. No focal consolidation or edema." }, { "input": "PA and lateral views of the chest provided. Lung volumes are low. Lungs are grossly clear. No pneumothorax. Small, bilateral pleural effusions. Hilar contours are normal. The aorta is mildly tortuous.", "output": "Small, bilateral pleural effusions. Otherwise, normal chest radiograph." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. No rib fractures are identified. Minimal degenerative changes are seen in the thoracic spine.", "output": "No acute cardiopulmonary abnormality. No rib fractures are identified. If further assessment of the ribs is necessary, consider a dedicated rib series." }, { "input": "PA and lateral chest radiographs demonstrate clear lungs bilaterally. The cardiomediastinal and hilar contours are within normal limits. No pneumothorax is identified. No acute osseous abnormality is seen. There is no pleural effusion.", "output": "No acute intrathoracic abnormality is identified." }, { "input": "Cardiac, mediastinal, and hilar contours are within normal limits. There is no evidence for pulmonary edema, pulmonary consolidation, pleural effusion, or pneumothorax. Minimal linear scarring in the lateral basal left lower lobe, near the left lateral costophrenic angle, is unchanged. There are endplate degenerative changes in the thoracic spine. The ribs are not adequately penetrated, as expected on chest radiographs. No displaced rib fracture or rib deformity from a prior fracture is identified.", "output": "No evidence for active cardiopulmonary disease." }, { "input": "PA and lateral views of the chest. The lungs are clear without consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is stable. Old healed left lateral rib fractures are again noted. No acute displaced fractures identified. Compression deformities of the mid thoracic and upper lumbar vertebral bodies are unchanged.", "output": "No definite acute cardiopulmonary process. No visualized displaced fracture identified. If desired dedicated rib series can be performed." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.Small well-circumscribed rounded lucency overlying the proximal left clavicle is possibly a small bone cyst.", "output": "No evidence of fracture. However, chest radiograph is not an optimal method to evaluate the osseous structures. If clinical concern remains, consider CT chest or bone enhanced views." }, { "input": "Compared to the prior radiograph, very subtle increase in pulmonary vascular markings may be due to mild pulmonary vascular congestion. Otherwise, the heart size, mediastinal, and hilar contours are normal, except for enlarged ascending aorta. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.Compression deformity of a lower thoracic vertebral body is unchanged.", "output": "1. No new focal consolidation concerning for pneumonia. 2. Compared with the prior radiograph, very subtle increase in pulmonary vascular markings may be due to mild pulmonary vascular congestion. 3. Most likely enlarged ascending aorta. Correlation with chest CT is to be considered. NOTIFICATION: The above findings and recommendation for chest CT were communicated via telephone by Dr. ___ to Dr. ___ at 09:09 on ___." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. Heart size is normal. Mediastinal silhouette and hilar contours are normal. Eventration of the hemidiaphragms is seen. A wedge compression deformity in the lower thoracic spine is unchanged from ___.", "output": "No pneumonia, edema or effusion." }, { "input": "No focal consolidation, pleural effusion or pulmonary edema is seen, and the cardiac and mediastinal contours are normal.", "output": "No acute cardiopulmonary disease seen." }, { "input": "Frontal and lateral views of the chest were obtained. The heart size is mildly enlarged. Increased opacity at the medial right lung apex is increased since ___. Though this may represent a mediastinal vessel, a mass is not excluded. Pulmonary vascular markings are unremarkable. No focal consolidation, substantial pleural effusion, or pneumothorax. No radiopaque foreign body.", "output": "An opacity at the medial right lung apex has increased since ___. Non-emergent CT (ideally with contrast) is recommended for further evaluation. Findings were communicated via phone on ___ at ___ by Dr. ___ to Dr. ___." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. No pneumomediastinum is demonstrated. Bony structures are unremarkable.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Frontal and lateral views of the chest were obtained. Right middle lobe opacity is likely pneumonia. The remainder of the lungs are clear. There is no pleural effusion or pneumothorax. Biapical thickening is noted. The cardiac silhouette is mildly enlarged. Mediastinal silhouette and hilar contours are normal.", "output": "Right middle lobe pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. Right lower lobe opacity is worrisome for pneumonia. The left lung is clear. There is no pleural effusion or pneumothorax. Minimal biapical pleural thickening is stable. The cardiac and mediastinal silhouettes are stable. The cardiac silhouette is top normal. The aorta is slightly tortuous.", "output": "Right lower lobe pneumonia. Recommend followup to resolution." }, { "input": "Frontal and lateral chest radiographs were obtained. The previous right lower lobe opacity has essentially cleared. There is no new focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette and hilar contours are normal.", "output": "Interval complete resolution of right lower lobe pneumonia." }, { "input": "Bedside AP radiograph of the chest demonstrates near-complete opacification of the right hemithorax with interval development of pneumothorax. The pigtail catheter appears to lie in the expected location of the pleural space. There is increase in the degree of rightward tracheal deviation. Diffuse left lung opacities consistent with disseminated tumor as seen on the CT of the chest obtained at the same time. There is no left-sided pneumothorax or effusion.", "output": "1. Development of pneumothorax without tension, after chest tube placement, better evaluated on the CT of the chest performed at the same time. 2. Opacification of the right hemithorax, when correlated with the CT findings, is mostly due to infiltration of airspaces with tumor as opposed to significant component of pleural fluid." }, { "input": "Bedside AP radiograph of the chest demonstrates interval removal of the small pleural catheter. There remains a substantial pneumothorax, particularly in the upper right hemithorax, although some of the air in the middle and lower hemithorax has been replaced, likely by fluid. The near total opacification of the right hemithorax and extensive opacities in the left lung are a result of extensive tumor infiltration and unchanged. Mild rightward tracheal shift is unchanged. There is no left-sided pneumothorax or pleural effusion.", "output": "Persistence of right pneumothorax with slight decrease in size or redistribution. NOTE: Findings were communicated to Dr. ___ by Dr. ___ ___ telephone on ___ at 9:45 a.m." }, { "input": "Frontal and lateral views of the chest are compared to previous exam from ___. There is near-complete opacification of the right hemithorax, minimal aerated lung at the right lung base. There is no significant shift of the mediastinum suggesting combination of underlying effusion with atelectasis and possible consolidation or cancer. There is also increased parenchymal opacity in the left lung which is more confluent at the base in the lower lobe, which could represent a superimposed infectious process. Underlying malignancy is also possible. Cardiomediastinal silhouette is difficult to assess given diffuse bilateral abnormalities. Osseous and soft tissue structures are unremarkable.", "output": "Near-complete opacification of the right hemithorax likely due to a combination of effusion and underlying atelectasis with possible consolidation/tumor. Left lung regions of parenchymal opacity potentially due to infectious process with underlying malignancy also possible." }, { "input": "Bedside AP radiograph of the chest redemonstrate a right-sided pneumothorax, developed after placement of a pleural catheter. There is no change in the size nor the degree of mild rightward shift of the trachea. Underlying right hemi-thoracic opacity is due to disseminated replacement of airspaces with tumor, as supposed to a large component of pleural effusion. The left lung is also unchanged, with diffuse opacities resulting from disseminated tumor. There is no left-sided effusion or pneumothorax.", "output": "Stable appearance of disseminated lung cancer and right-sided pneumothorax." }, { "input": "The lungs are clear without focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified. Surgical ___ project over the neck bilaterally.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are normally expanded and clear. The heart is not enlarged. The mediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes which accentuate bronchovascular markings. There is no focal consolidation, pleural effusion or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is top normal.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The heart is top normal in size. The mediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "Normal chest radiographs." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well expanded and clear. There is no focal consolidation, effusion, or pneumothorax. The cardiac and mediastinal contours are normal. There is no pneumoperitoneum.", "output": "Normal chest radiograph." }, { "input": "Low lung volumes are present. Moderate enlargement of the cardiac silhouette is unchanged. The mediastinal and hilar contours are grossly similar. There is crowding of bronchovascular structures without overt pulmonary edema. Patchy opacities in the lung bases are similar compared to the prior study, likely reflective of atelectasis. No large pleural effusion or pneumothorax is identified. Hypertrophic changes are again seen in the thoracic spine.", "output": "Low lung volumes with probable bibasilar atelectasis, not substantially changed from prior." }, { "input": "Frontal and lateral views of the chest. The lungs are clear of focal consolidation or effusion or edema. Previously seen multifocal regions of consolidation are no longer visualized. The cardiac silhouette is moderately enlarged but stable compared to prior. No acute osseous abnormalities detected. Degenerative changes seen in the spine. Surgical clips project over the upper abdomen.", "output": "No acute cardiopulmonary process. Resolution of previously seen multifocal regions of consolidation." }, { "input": "Mild cardiomegaly has been stable compared to exams dated back to at least ___. There may be mild pulmonary vascular congestion, otherwise the hilar and mediastinal contours are normal. There is a small left pleural effusion. NG tube extends below the diaphragm with the tip likely in the proximal stomach. There is no evidence of pneumothorax.", "output": "NG tube side hole terminates in the proximal stomach. Mild pulmonary vascular congestion. ___ d/w Dr. ___ by Dr. ___ by phone at 7A on the day of the exam." }, { "input": "Previous pulmonary edema has nearly resolved. The cardiac silhouette continues to is mildly enlarged. Small pleural effusions are present, left greater than right.", "output": "Near resolution of pulmonary edema." }, { "input": "Frontal and lateral radiographs of the chest demonstrate low lung volumes, which results in bronchovascular crowding. Interval increase in size of the bilateral pleural effusions. The right pleural effusion is small. The left pleural effusion is moderate. Increased opacity of the bilateral bases likely represents atelectasis. Increased interstitial markings coupled with indistinctness of the hila is consistent with mild-to-moderate pulmonary edema. The cardiomediastinal and hilar contours are unchanged.", "output": "1. Interval increase in size of bilateral pleural effusions, within moderate size left and small right pleural effusions. 2. Interval worsening of pulmonary edema, which is now mild-to-moderate." }, { "input": "Lung volumes are low, accentuating the hilar structures with bibasilar atelectasis and small right effusions. Biapical pleural thickening is noted. The heart is mildly enlarged. There is no pneumothorax or focal consolidation.", "output": "Mild cardiomegaly with low lung volumes, bibasilar atelectasis, and small right pleural effusion." }, { "input": "Mild cardiomegaly and mediastinal contours are stable. Minimal blunting of the posterior costophrenic angles is consistent with trace pleural effusions. There is slight interstitial prominence consistent with mild pulmonary edema, but no focal consolidation or pneumothorax. A vascular stent is present in the upper abdomen.", "output": "Stable mild cardiomegaly with increased interstitial prominence consistent with mild pulmonary edema. Trace bilateral pleural effusions. No focal consolidation." }, { "input": "When compared to prior, there has been no significant interval change. There is persistent pulmonary edema. More confluent infrahilar opacity on the right could represent superimposed infection. There is no large effusion. Degree of cardiomegaly is unchanged. No acute osseous abnormalities.", "output": "Pulmonary edema with more confluent opacity in the right infrahilar region which could represent edema versus superimposed infection." }, { "input": "Area of opacity in the right lung base is likely atelectasis. Left lung base atelectasis is improved compared to ___. Pleural effusion is minimal, if any. Mild pulmonary vascular congestion is noted. Moderately enlarged cardiac silhouette is similar to prior. Right Dual channel dialysis catheter terminates in and right atrium.", "output": "Area of opacity in the right lung base is likely atelectasis. Pneumonia is possible in correct clinical setting." }, { "input": "Heart size remains mild to moderately enlarged. The mediastinal and hilar contours are unchanged with a small hiatal hernia again noted. There is mild pulmonary vascular congestion. There are small bilateral pleural effusions, not changed from the prior study. Retrocardiac patchy opacity may reflect atelectasis though infection is difficult to exclude. Hypertrophic changes are again noted within the thoracic spine. No subdiaphragmatic free air is identified.", "output": "Mild pulmonary vascular congestion and small bilateral pleural effusions. Retrocardiac atelectasis, though infection cannot be completely excluded." }, { "input": "Cardiac enlargement. Pulmonary vascularity has mildly improved. Interstitial edema has improved. Mild left pleural effusion is more prominent. Very shallow inspiration on the lateral radiograph. Bibasilar opacities have improved. Metallic density projected over upper abdomen.", "output": "Improved pulmonary edema and pulmonary vascularity. Left pleural effusion is more prominent. Bibasilar opacities are improved." }, { "input": "Right appear infrahilar opacity and left mid to lower lung opacities could relate to pulmonary edema versus multifocal infection. There is blunting of the left costophrenic angle which may be due to consolidation and atelectasis, but a small pleural effusion is not excluded. There is no evidence of pneumothorax. The cardiac and mediastinal silhouettes are grossly stable.", "output": "Right apparent infrahilar opacities as well as left base opacity may be due to multifocal pneumonia with possible superimposed pulmonary edema." }, { "input": "PA and lateral views of the chest were obtained. Vague opacity in the left lower lung and right upper lobe are concerning for pneumonia. Please refer to subsequent CT for further evaluation. Otherwise the lungs appear clear. Heart and mediastinal contour appear normal. Bony structures are intact.", "output": "Multifocal pneumonia better assessed on the subsequent CTA of the chest." }, { "input": "AP and lateral views of the chest. There are new diffuse opacities in both lungs, right greater than left likely due to slight leftward rotation. There are small bilateral pleural effusions, left greater than right. There is mild cardiomegaly. No pneumothorax.", "output": "New diffuse bilateral opacities likely represent moderate pulmonary edema with mild cardiomegaly and small bilateral effusions, most consistent with CHF exacerbation. Underlying pneumonia cannot be excluded." }, { "input": "Heart size remains moderately enlarged but unchanged. The mediastinal contour is similar. There is mild pulmonary edema. Low lung volumes are present with minimal atelectasis at the lung bases. No pleural effusion or pneumothorax is present. Diffuse idiopathic skeletal hyperostosis is present within the thoracic spine.", "output": "Mild pulmonary edema." }, { "input": "Mild enlargement of cardiac silhouette is unchanged. Mediastinal contour appears similar. Low lung volumes result in crowding of bronchovascular structures without overt pulmonary edema. Patchy opacities are noted in the lung bases likely reflective of atelectasis. No pneumothorax or pleural effusion is present. No subdiaphragmatic free air is present. Clips are noted in the left upper quadrant of the abdomen.", "output": "Low lung volumes with probable bibasilar atelectasis." }, { "input": "Low lung volumes are seen and patient is rotated to the left on the frontal view limiting exam. There is no confluent consolidation or effusion. Cardiomediastinal silhouette is grossly unchanged. Right chest wall dual lumen central venous catheter is new since prior. There is no visualized pneumothorax. Hypertrophic changes noted in the spine.", "output": "No definite acute cardiopulmonary process." }, { "input": "The heart is enlarged in the aorta is slightly tortuous, probably with slight prominence of the hila. This appearance is not significantly changed compared with ___ there is upper zone redistribution and mild vascular plethora, without other evidence of CHF. There is patchy retrocardiac density. There are small left-greater-than-right effusions.", "output": "1. Cardiomegaly, with mild CHF. This CHF findings are probably very slightly more pronounced than on the prior film. Small left-greater-than-right effusions noted. 2. Left lower lobe collapse and/or consolidation. The possibility of a pneumonic infiltrate cannot excluded." }, { "input": "PA and lateral views of the chest provided. The heart is mildly enlarged. There are trace bilateral pleural effusions. Linear density in the left mid lung is unchanged likely representing a focus of scarring. There is no overt edema or convincing signs of pneumonia. Flattened diaphragms with widened AP diameter of the chest may reflect underlying COPD. No pneumothorax. Mediastinal contour is stable. Bony structures are intact. No free air below the right hemidiaphragm. DISH related changes of the T-spine noted.", "output": "Mild cardiomegaly with tiny pleural effusions. No overt evidence for pneumonia or edema. Probable underlying COPD." }, { "input": "Dialysis catheter terminates in the right atrium but has been perhaps retracted slightly. The cardiac, mediastinal and hilar contours appear stable including moderate cardiomegaly. There is no trace pleural effusions are suspected. Streaky retrocardiac opacity suggests atelectasis. The lungs appear otherwise clear.", "output": "Perhaps slight retraction of dialysis catheter. No evidence of acute cardiopulmonary disease. Stable cardiomegaly." }, { "input": "Frontal and lateral chest radiographs demonstrate moderate cardiomegaly, which is likely unchanged but accentuated by lower lung volumes compared to prior radiographs. There is also results in bronchovascular crowding. There is mild vascular congestion. The left hemidiaphragm is obscured, consistent with a retrocardiac opacity, which may be due to a small left pleural effusion. There is no pneumothorax.", "output": "1. Retrocardiac opacity, new since ___. This may represent a small left pleural effusion. 2. Moderate cardiomegaly. 3. Mild vascular congestion. NOTIFICATION: These findings were discussed via telephone by Dr. ___ ___ with Dr. ___ at ___ on ___, upon initial review." }, { "input": "No significant interval change. Mild pulmonary vascular congestion is overall and top- normal heart size are unchanged. No pleural effusion or pneumothorax. Extensive degenerative changes of the thoracic spine are overall unchanged. Surgical clips are noted on the lateral view projecting over the upper abdomen.", "output": "Stable mild cardiomegaly." }, { "input": "Frontal and lateral views of the chest. The lungs are clear without consolidation, or overt pulmonary edema. There is no large effusion. The cardiac silhouette is enlarged but stable. Tortuous descending thoracic aorta is again seen. Surgical clips seen in the upper abdomen. No acute osseous abnormality is identified.", "output": "Cardiomegaly without definite superimposed acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. There is no focal consolidation, pleural effusion or pneumothorax. Heart size is top normal. There are normal mediastinal and hilar contours. No pleural effusion.", "output": "Heart size top normal. No acute cardiopulmonary process." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable", "output": "No acute cardiopulmonary abnormalities" }, { "input": "The lungs are clear. There is no evidence of pneumonia, pneumothorax, or pleural effusion. Cardiac silhouette is normal in size.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs are well-expanded and clear. No focal consolidation, effusion, edema, or pneumothorax. The heart is normal in size. The mediastinum is not widened. Multi-level degenerative changes of the thoracic spine are noted.", "output": "No acute cardiopulmonary process." }, { "input": "Nerve stimulator device pack projects over the left lower chest with single lead projecting cephalad into the left neck. Heart size is normal. Mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest. The lungs are clear where not obscured by overlying stimulator device on the left chest. The cardiomediastinal silhouette is within normal limits. Degenerative changes seen at the acromioclavicular joints.", "output": "No definite acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Midline sternotomy wires are noted. The lungs are clear. No signs of pneumonia or CHF. No effusion or pneumothorax. The cardiomediastinal silhouette is normal. The imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The patient is status post median sternotomy. Heart size is normal. Mediastinal and hilar contours are unremarkable, and the pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities demonstrated.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cardiomegaly is moderate and limits assessment of the retrocardiac lungs. Prominence of the upper mediastinum is likely a combination of unfolding of the aorta and projection. The hila are likely prominent with a tapered appearance raising the question of pulmonary hypertension. There is pulmonary edema, with vascular plethora I interstitial and possible areas of alveolar edema. More confluent opacity seen at the right lung base. There is also row increased retrocardiac density consistent with left lower lobe collapse and/or consolidation. Allowing for positioning, no gross effusions identified.", "output": "Cardiomegaly and CHF with interstitial and alveolar edema. Left lower lobe collapse and/or consolidation. Possibility of an underlying pneumonic infiltrate cannot be excluded." }, { "input": "Small opacity in the periperhy of the left lower lung represents chronic atelectasis. Moderate cardiomegaly is unchanged. The mediastinal and hilar contours are stable. There is no pulmonary edema. There are likely tiny bilateral pleural effusions. Lung volumes are increased compatible with COPD. The calcified right thyroid nodule is redemonstrated. The aorta is tortuous and calcified. There is no pneumothorax.", "output": "1. Stable moderate cardiomegaly. No pulmonary edema. 2. Increased lung volumes compatible with COPD. 3. Chronic mild left lower lobe atelectasis. 4. Possibly tiny bilateral pleural effusions." }, { "input": "There is a moderate cardiomegaly. The hilar and mediastinal contours are unremarkable, except to note moderate aortic knob calcifications. Lungs are mildly hyperinflated, but no focal consolidation, pleural effusion or pneumothorax is seen. A calcified right thyroid lobe nodule is again redemonstrated.", "output": "Cardiomegaly. No other acute cardiopulmonary pathology." }, { "input": "Moderate to severe cardiomegaly is similar compared to the previous study with dense mitral annular calcifications as well as evidence of prior coronary artery stenting. The aorta remains tortuous and diffusely calcified. Mild pulmonary edema is demonstrated along with small bilateral pleural effusions, all of which have progressed since the previous chest radiograph. Patchy opacities are seen in the lung bases which may reflect areas of atelectasis. No pneumothorax is detected. Multiple clips are noted within the left upper abdomen. The osseous structures are diffusely demineralized.", "output": "Mild pulmonary edema and small bilateral pleural effusions, progressed from the previous examination. Patchy bibasilar airspace opacities, potentially atelectasis, however infection or aspiration cannot be completely excluded in the correct clinical setting." }, { "input": "Lungs are well expanded. There is mild hilar fullness suggestive of mild pulmonary vascular congestion. No edema is seen. There is no pleural effusion or pneumothorax. Cardiac silhouette appears mildly enlarged. The aorta is tortuous.", "output": "No acute cardiopulmonary process." }, { "input": "Patient is slightly rotated. The lungs are moderately well inflated with bibasilar atelectasis. No pleural effusion or pneumothorax. Heart is top-normal in size. Mediastinal contour and hila are unremarkable. Limited assessment of the left upper abdomen again demonstrates clips. Visualized osseous structures demonstrate multilevel compression deformities with minimal progression of a mid thoracic vertebral body in comparison to ___. No retropulsion.", "output": "1. Minimal progression of mid thoracic vertebral body compression deformity since ___. Assessment for focal tenderness is recommended. 2. Bibasilar atelectasis. 3. No pneumothorax." }, { "input": "Since ___, minimal pulmonary edema, small residual bilateral pleural effusions, left greater than right, and mild bibasilar and retrocardiac atelectasis are improved. Mild cardiomegaly is unchanged. No pneumothorax. Calcifications are noted in the mitral and aortic annulus.", "output": "Minimal pulmonary edema, small bilateral pleural effusions, left greater than right, and mild bibasilar and retrocardiac atelectasis are improved since ___." }, { "input": "PA and lateral views of the chest. No prior. There is subtle increased opacity identified in the right mid lung and at the right base laterally, which could represent focal regions of consolidation. Elsewhere, the lungs appear grossly clear. There is no pleural effusion. Cardiomediastinal silhouette is within normal limits. Mitral annular calcifications are seen. Atherosclerotic calcification is seen within the aorta, which is tortuous. Surgical clips identified in the upper abdomen. Soft tissues are otherwise unremarkable, as are the osseous structures.", "output": "Subtle increased parenchymal opacity in the right lung, potentially representing pneumonia in the proper clinical setting. Repeat exam recommended after treatment to document resolution." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral radiographs of the chest demonstrate clear lungs. The cardiac, hilar, and mediastinal contours are normal. No pleural abnormality is seen. Cervical spine disc spacer is noted.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are unremarkable. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lung volumes improve with repeat imaging. Vague opacities of the left lung base, projecting over the spine on the lateral view, are consistent with aspiration. There is no pleural effusion or pneumothorax. Heart is normal size. The mediastinal and hilar contours are unremarkable.", "output": "Vague opacities at the left lung base are consistent with aspiration." }, { "input": "The lungs are clear with no evidence of a consolidation, effusion, or pneumothorax. There is moderate cardiomegaly with suggestion of right ventricular and left atrial enlargement. The remainder of the mediastinal structures are normal. No acute fractures are identified.", "output": "Moderate cardiomegaly with suggestion of right ventricular and left atrial enlargement. Further characterization by ECHO is recommended, if not performed previously." }, { "input": "Faint increased opacity is noted at the right lower lobe and likely representative of atelectasis. Otherwise, the lungs are clear with no evidence of a consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. No acute fractures are identified.", "output": "Faint increased opacity at the right lower lobe is likely representative of atelectasis. However, an early developing pneumonia must be excluded in the proper clinical setting." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are well expanded and clear without focal consolidation, pleural effusion or pneumothorax. The heart size is top normal. Mediastinal silhouette and hilar contours are normal.", "output": "No pneumonia, edema, or effusion." }, { "input": "Hyperlucency at the right lung base with elevation of the minor fissure and depression of the right hemidiaphragm are consistent with right lower lobe hyperinflation, possibly secondary to congenital lobar emphysema. The heart size is normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen. Degenerative changes are noted at the right glenohumeral joint.", "output": "1. No acute cardiac or pulmonary process. 2. Findings consistent with right lower lobe hyperinflation, possibly secondary to congenital lobar emphysema or a different process causing air trapping. Recommend further evaluation with non-emergent CT. Findings were discussed with Dr. ___ by Dr. ___ ___ telephone at 1:29 p.m. on the day of the study." }, { "input": "PA and lateral views of the chest were provided. There is mild cardiomegaly with central hilar engorgement and mild interstitial pulmonary edema. No large effusion or pneumothorax is seen. No focal consolidation suggesting pneumonia. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Mild cardiomegaly with mild pulmonary edema." }, { "input": "PA and lateral views of the chest provided. The lungs are clear. No convincing evidence for pneumonia. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is stable. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well expanded and clear. There is no focal consolidation, effusion, or pneumothorax. Cardiac and mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Again seen is a left-sided dual-chamber pacemaker through a left subclavian approach, with leads terminating in the right atrium and right ventricle. There is no pneumothorax, pleural effusion, or focal consolidation. There is mild cardiomegaly. There is no vascular congestion.", "output": "Left-sided dual chamber pacemaker with leads terminating in the right atrium and right ventricle, no evidence of complication." }, { "input": "There has been interval removal of a left thoracostomy tube. No pneumothorax is identified. Bilateral pleural effusions, right greater than left are unchanged in size from the prior study. The right pleural effusion is moderate. The heart is normal in size and less globular in appearance from the prior examination.", "output": "Bilateral effusions are stable. No evidence of pneumothorax status post chest tube removal." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax. There is no free air under the diaphragm.", "output": "No free air under the diaphragm. Clear lungs." }, { "input": "Mediastinal and pulmonary vascular congestion and mild cardiomegaly are signs of cardiac decompensation. The mediastinum and hila are normal. No pleural effusions are seen. There is no focal lung consolidation.", "output": "Mild heart failure." }, { "input": "Portable AP upright chest radiograph was obtained. Low lung volumes limit evaluation. Heart size appears top normal and stable. Left mid lung linear density is likely atelectasis. No definite signs of pneumonia or overt CHF. No large pleural effusions or pneumothorax. There is an old left rib cage deformity along the left fifth posterior arch.", "output": "Low lung volumes, mild cardiomegaly. Otherwise unremarkable." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. There is mild obscuration of the inferior aspect of the right heart border which can be explained by patient's slight pectus excavatum. The lungs are clear of consolidation or effusion. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low, which results in bronchovascular crowding. An area of increased density at the left base likely represents a sclerotic focus in left ninth rib. The heart is not enlarged. The aorta is tortuous. No pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. No pleural effusion or pneumothorax is present. Pulmonary vascularity is normal. There are no acute osseous abnormalities.", "output": "Normal chest radiograph." }, { "input": "A hazy opacity is seen in the right lower lung on AP view. The upper lungs are clear. Hyperinflated lungs and upper lung vascular deficiency suggests emphysema. The pulmonary artery is mildly enlarged. The heart size is unchanged. No pulmonary edema, pneumothorax, or pleural effusion.", "output": "Hazy opacity seen in the right lower lung on AP view is concerning for pneumonia. RECOMMENDATION(S): Follow-up in 4 weeks is recommended with conventional chest radiographs to monitor resolution. However, if there is any clinical suspicion for underlying lesion, a CT Chest could be obtained for further evaluation. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the ___ ___ at 1:21 AM, 40 minutes after discovery of the findings." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs remain clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs demonstrate no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "An ill-defined opacity is seen which is appreciated only on the lateral view located in the posterior and lower lungs. This is seen only on the lateral view. This may be located in either of the lower lobes. Upper lungs are clear. There is no pleural abnormality. Heart size, mediastinal and hilar contours are normal. Mild atherosclerotic calcification is present in the aortic arch.", "output": "Ill-defined opacity in the lower lungs appreciated on the lateral radiograph is concerning for focus of infection. This is seen only on the lateral view and anatomically may be located in either of the lower lobes. Followup radiographs is recommended in four weeks after appropriate treatment to assess for interval changes." }, { "input": "The patient is rotated in the RPO position, causing asymmetric opacification of the left lung. No acute focal consolidation. No interstitial edema. Mild cardiomegaly. Again there is evidence of prior surgical fusion.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well expanded. Suture projecting overlying the left chest suggests a prior resection. There is linear opacity at the right lung base likely representing atelectasis. Diffuse pattern of reticulonodular opacity is seen in the left mid and lower lung, similar to prior exam and of indeterminate etiology. There is no evidence of pneumothorax or pleural effusion. The cardiomediastial silhouette is unremarkable. No acute fracture is seen. Cervical spinal hardware is noted.", "output": "1. Diffuse pattern of reticulonodular opacity is seen in the left mid and lower lung, similar to prior exam and of indeterminate etiology. Recommend clinical correlation. Nonemergent CT could be performed for further evaluation, if clinically indicated. 2. Linear opacity in the right lung base, likely representing atelectasis. 3. No acute fracture is seen, however if clinical concern for rib fracture persists, dedicated films could be obtained." }, { "input": "Single portable view of the chest. When compared to prior, there has been interval placement of a right central venous catheter with tip in the mid-to-lower SVC. There is no pneumothorax. There are persistent linear bibasilar opacities and surgical chain sutures in the right mid and lower lung. Interstitial markings throughout the lungs suggest interstitial edema. Cardiomediastinal silhouette is unchanged, noting aortic valve replacement.", "output": "New right IJ line in appropriate position. No pneumothorax." }, { "input": "Right IJ line has been removed. Right mid and lower lung surgical chain sutures again noted. Streaky retrocardiac opacity is again identified. Superiorly the lungs are clear. The cardiomediastinal silhouette is within normal limits. Median sternotomy wires and mediastinal clips are again seen.", "output": "Streaky retrocardiac opacity potentially atelectasis although clinical correlation regarding possibility of infection is suggested." }, { "input": "Single portable view of the chest. Linear bibasilar opacities may be due to atelectasis or scarring. Right mid lung surgical chain sutures are again identified. Superiorly, the lungs are grossly clear. The cardiomediastinal silhouette is stable. Median sternotomy wires are again noted. No acute osseous abnormalities.", "output": "Linear bibasilar opacities suggestive of atelectasis. Otherwise, unremarkable portable chest x-ray." }, { "input": "Frontal and lateral views of the chest were obtained. Patient is status post median sternotomy. Chain sutures overlie the right mid lung. There is underlying streaky opacity, similar compared to ___ at outside institution. Mild basilar atelectasis is seen. No definite new focal consolidation is seen. The cardiac and mediastinal silhouettes are grossly stable. No overt pulmonary edema is seen.", "output": "Post-procedural changes again seen. Right-sided chain sutures seen. Mild basilar atelectasis. No definite acute cardiopulmonary process." }, { "input": "Single portable frontal chest radiograph demonstrates enteric feeding tube coursing mid line with tip in stomach and side ports above the gastroesophageal junction. Right IJ tip is in mid SVC. Intact median sternotomy wires, mediastinal clips, and chain suture material projecting over the right mid lung. The lungs are moderately well inflated. Elevation of the left hemidiaphragm with retrocardiac opacity is most consistent with atelectasis. Right lung is clear. No pleural effusion or pneumothorax. Stable mild cardiomegaly. Mediastinal contour and hila are unremarkable. Limited assessment of the upper abdomen demonstrates 3 stacked mildly dilated loops of bowel within the left upper quadrant.", "output": "1. Findings concerning for small-bowel obstruction have been more fully evaluated by dedicated abdominal CT. 2. Enteric feeding tube in stomach with side port above the gastroesophageal junction. Consider advancing 10 cm for better positioning. 3. Bibasilar patchy and linear atelectasis; elevation of the left hemidiaphragm. 4. Right IJ tip in mid SVC. 5. Stable mild cardiomegaly." }, { "input": "The patient is status post median sternotomy and aortic valve repair. Heart size is normal. Mediastinal contour is unchanged with mild tortuosity of the thoracic aorta. New opacification is noted involving the right mid and lower lung fields, with streaky left basilar opacity also demonstrated. The patient is status post wedge resections of the right upper lobe with several sutures again seen within the right mid to lower lung field. Blunting of the right costophrenic angle appears unchanged. Small left pleural effusion may be present. There is no pulmonary vascular engorgement. There is no pneumothorax. No acute osseous abnormalities are identified.", "output": "Large area of opacification involving the right mid and lower lung fields, new compared to the prior exam, concerning for an infectious process. Left basilar opacity may reflect atelectasis or additional site of infection. Probable small left pleural effusion." }, { "input": "Frontal and lateral views of the chest. Heart size is normal and mediastinal contours are stable. Markedly tortuous aortic contour is similar to prior and due to a proximal descending aortic graft. 4.4 cm pleural based density in the left costophrenic angle is consistent with herniated fat, as seen on ___ chest MRI. No focal consolidation, pleural effusion, or pneumothorax. Postsurgical changes of the left hemithorax with left 5th rib deformity and elevated left hemidiaphragm are stable.", "output": "No acute cardiopulmonary process. Stable appearance of the chest with tortuous aortic contour and left costophrenic angle herniated fat." }, { "input": "Cardiomediastinal contours are stable with cardiac size normal and tortuous aorta with aneurysmal dilatation better seen in prior CT. Elevation of the left hemidiaphragm is chronic. The lungs are clear. Opacity in the left lower lateral hemi thorax is consistent with known fat containing diaphragmatic hernia. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary abnormalities" }, { "input": "Heart size is normal. Stable tortuosity of the thoracic aorta. Normal hilar contours. Stable elevation of the left hemidiaphragm with an unchanged opacity at the left costophrenic angle, consistent with a known, fat containing diaphragmatic hernia. Normal pleural surfaces. Clear lungs.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures appear within normal limits.", "output": "No evidence of acute disease." }, { "input": "The lungs are moderately well expanded with mild vascular congestion. Right lung is clear. Left lower lobe heterogeneous opacity is most consistent with atelectasis given elevation of left hemidiaphragm. No additional focal opacity. Heart size, mediastinal contour, and hila are unremarkable. No pleural effusion or pneumothorax.", "output": "1. No acute cardiopulmonary process. 2. Left lower lobe atelectasis. 3. Mild vascular congestion." }, { "input": "A left pectoral AICD remains in place. Sternotomy wires are intact and aligned. There is no pneumothorax. Borderline interstitial pulmonary edema is unchanged. Extensive splenic artery calcifications are incidentally noted. Moderate scoliosis is unchanged.", "output": "Borderline interstitial pulmonary edema. Stable marked cardiomegaly." }, { "input": "Cardiac silhouette is moderately enlarged. The aorta is calcified. Patient is status post median sternotomy. Triple lead left-sided pacer device, AICD is stable in position. Pulmonary edema has improved in the interval. Patchy medial right base opacity on the frontal view is not substantiated on the lateral view and may relate to overlap of vascular structures with possible atelectasis. No pleural effusion is seen. There is no pneumothorax.", "output": "Cardiac silhouette is moderately enlarged. The aorta is calcified. Patient is status post median sternotomy. Triple lead left-sided pacer device, AICD is stable in position. Pulmonary edema has improved in the interval. Patchy medial right base opacity on the frontal view is not substantiated on the lateral view and may relate to overlap of vascular structures with possible atelectasis. No pleural effusion is seen. There is no pneumothorax." }, { "input": "There has been interval placement of an endotracheal tube, which terminates just distal to the clavicles. The patient has had median sternotomy with CABG. A left pectoral AICD remains in place. A newly placed Swan-Ganz catheter terminates in the right descending pulmonary artery. Retained pacer leads are in place. There is no pneumothorax. Marked cardiomegaly is unchanged. Bilateral airspace opacities are slightly improved. New retrocardiac airspace opacification is likely due to atelectasis. Extensive splenic artery calcifications are incidentally noted.", "output": "New retrocardiac airspace opacity is most likely due to atelectasis. Mild pulmonary edema is minimally improved." }, { "input": "The patient is status post median sternotomy and CABG. Left-sided AICD/pacemaker device is noted with leads terminating in the regions of the right atrium, right ventricle, and coronary sinus. Moderate enlargement of the cardiac silhouette the appear slightly increased compared to the previous exam. The aorta is diffusely calcified. Perihilar haziness and vascular indistinctness is more pronounced on the right compared to left, and likely reflects asymmetric pulmonary edema, mild to moderate in degree. Small right pleural effusion is noted. No pneumothorax is identified. S-shaped scoliosis of the thoracolumbar spine is present along with multilevel moderate degenerative changes.", "output": "Mild to moderate asymmetric pulmonary edema, more pronounced on the right, with trace right pleural effusion. Followup radiographs after diuresis are recommended to exclude infection in the right lung." }, { "input": "PA and lateral views of the chest provided. There are linear opacities in the left lower lobe likely representing subsegmental atelectasis. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. No free air below the right hemidiaphragm is seen.", "output": "1. Left basilar atelectasis. 2. No definite focal consolidation." }, { "input": "Normal heart, lungs, pleura and mediastinal surfaces. There are degenerative changes in the thoracic spine.", "output": "Clear lungs." }, { "input": "The lungs are well-inflated and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax. Included upper abdomen is unremarkable. Osseous structures are grossly intact.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. Multiple right lateral rib fractures are seen with callus formation. No free intraperitoneal air.", "output": "No acute cardiopulmonary process." }, { "input": "There is moderate left pleural effusion and atelectasis. There is no pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. A healed left clavicle fracture is noted.", "output": "Moderate left pleural effusion and atelectasis." }, { "input": "As compared to chest radiograph from the same day, increasing and layering posteriorly pleural effusions, moderate on the left and small on the right. Pulmonary vascular congestion also persists. Worsening opacification the left lower lobe. Right lower lobe atelectasis is also marginally worsened. Endotracheal tube 6 cm from the carina and the first side port of the nasogastric tube remains in the proximal stomach.", "output": "Increasing in left pleural effusion with mild-moderate pulmonary vascular congestion. Interval increase in substantial retrocardiac opacity and right lower lobe opacity." }, { "input": "Heart size and cardiomediastinal contours are normal. Lungs are clear without focal consolidation, pleural effusion, or pneumothorax.", "output": "Normal chest radiographs." }, { "input": "In comparison chest radiographs obtained 1 day prior, there are minor changes in bibasilar atelectasis and pleural effusions. There are linear foci of atelectasis in the lower lungs bilaterally. Lungs are otherwise clear without focal consolidation. A small right pleural effusion is not appreciated and there is no evidence of a left pleural effusion. Heart size is normal and unchanged without pulmonary vascular congestion or pulmonary edema. Cardiomediastinal silhouette and the neo esophagus are unremarkable in appearance. No pneumothorax.", "output": "Linear foci of atelectasis as described above with a small, right pleural effusion. No evidence of pneumonia or pneumothorax." }, { "input": "Lungs are well expanded and clear. There is a small right-sided pleural effusion, slightly decreased. There is no pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Compared with prior radiographs on ___, there has been interval resolution of a left lung base opacity.The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Surgical clips are stable.", "output": "Resolution of previously seen left lung base opacity. No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. There is interval placement of a left-sided Port-A-Cath, terminating in the distal SVC. No pneumothorax is seen. There is no focal consolidation, pleural effusion, or evidence of pneumothorax. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. There is no pulmonary edema. The heart is normal in size, and the mediastinal contours are normal. No radiopaque foreign bodies are seen.", "output": "Normal chest radiograph. No radiopaque foreign body seen." }, { "input": "Single portable view of the chest. No prior. Lungs are clear of focal consolidation or large effusion. There is enlargement of the cardiac silhouette. Prosthetic valve and median sternotomy wires identified. No acute osseous abnormalities.", "output": "Enlargement of the cardiac silhouette which could be due to cardiomegaly, although given history and configuration, pericardial effusion is certainly possible." }, { "input": "Two portable views of the chest are compared to previous exam from ___. As on prior, there is increased retrocardiac opacity which partially silhouettes the hemidiaphragm. Elsewhere, the lungs are clear of confluent consolidation. Calcified granulomas are identified over the left upper lung. Costophrenic angles are sharp. Cardiomediastinal silhouette is stable as are the osseous and soft tissue structures.", "output": "Retrocardiac opacity which could be due to either atelectasis versus consolidation. Two-view chest may help further characterize." }, { "input": "There is no evidence for free intraperitoneal air under the diaphragms on this view. Obscuration of the left costophrenic angle with left lower lung opacity may be secondary to atelectasis, but is incompletely evaluated on this view. No pneumothorax is detected. Heart size is top normal. The aorta is tortuous with calcification.", "output": "Left lower lung opacity, which is incompletely evaluated on this view and on subsequent CT abdomen. Lateral radiograph is recommended for initial further evaluation. This finding and recommendation were discussed with Dr. ___ by Dr. ___ by phone at 8:18 a.m. on ___ after attending radiologist review of this study and recommendation of lateral radiograph." }, { "input": "The right costophrenic angle is not fully included on the image. Given this, there is opacity at the left costophrenic angle with lateral left base opacity which may be due to pleural effusion with atelectasis and/or pleural thickening. No definite focal consolidation is seen. The cardiac and mediastinal silhouettes are stable. There may also be a trace right pleural effusion/pleural thickening. No pneumothorax is seen.", "output": "Left costophrenic angle not fully included on the image. Opacity at the peripheral bilateral lung bases, left greater than right, may be due to pleural effusions and/or pleural thickening." }, { "input": "The inspiratory lung volumes are slightly improved from the most recent prior study. Patchy bibasilar airspace opacities likely reflect atelectasis. No focal consolidation concerning for pneumonia, pleural effusion or pneumothorax. The pulmonary vasculature is not engorged and there is no overt pulmonary edema. The cardiac silhouette is normal in size. The mediastinal and hilar contours are within normal limits. Dense calcification of the aortic knob is re-demonstrated. Deformity at the right lateral fourth rib is compatible with healed prior fracture. No acute displaced rib fractures are detected.", "output": "1. Probable mild bibasilar atelectasis. 2. No acute displaced rib fractures but an old healed right lateral fourth rib fracture." }, { "input": "Frontal and lateral views of the chest. Increased interstitial markings are again seen compatible with patient's known chronic lung disease. Surgical chain sutures again seen in the right mid and lower lung. There is no confluent consolidation nor effusion. The cardiomediastinal silhouette is stable. Right shoulder arthroplasty is again seen. No acute osseous abnormalities detected.", "output": "Findings compatible with the patient's known chronic lung disease without superimposed acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Linear densities in the left mid to lower lung could represent atelectasis and bronchovascular crowding. No convincing sign of pneumonia or edema. No large effusion or pneumothorax. Suture material is seen along the periphery of the right mid lung as on prior. Cardiomediastinal silhouette appears unchanged. Right humeral head prosthesis noted.", "output": "As above." }, { "input": "There low lung volumes with bronchovascular crowding. Bibasilar opacities are seen which likely reflect atelectasis, but cannot exclude aspiration or pneumonia in the right clinical setting. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "Bibasilar opacities which likely reflect atelectasis, but cannot exclude aspiration or pneumonia in the right clinical setting." }, { "input": "Elevation of the right hemidiaphragm is unchanged. The cardiac, mediastinal and hilar contours are similar. Heart size is normal. There is crowding of the bronchovascular structures, but no overt pulmonary edema is demonstrated. Linear opacities in the right lung base are compatible subsegmental atelectasis. No new focal consolidation, pleural effusion or pneumothorax is present. Degenerative changes of both acromioclavicular joints are noted.", "output": "Right basilar subsegmental atelectasis." }, { "input": "The heart appears to be borderline enlarged. The mediastinal contours are unremarkable. There are low lung volumes which causes crowding of the bronchovascular structures, but no overt pulmonary edema is demonstrated. Elevation of right hemidiaphragm is age indeterminate. Atelectasis is demonstrated in both lung bases. No left-sided pleural effusion or pneumothorax is visualized. There are no acute osseous abnormalities.", "output": "Low lung volumes with bibasilar atelectasis. Elevation of the right hemidiaphragm is of unknown chronicity. Comparison with previous radiographs is recommended." }, { "input": "Heart size is top normal with a left ventricular configuration, which may be accentuated by lower lung volumes. Lungs are clear without focal consolidation, pleural effusion, or pneumothorax. Mediastinal and hilar contours are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear of focal consolidation, pleural effusion or pneumothorax. The heart size is normal. The mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. The lungs are clear. There is no effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable. No free air is seen below the diaphragm.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "Unremarkable chest radiographic examination." }, { "input": "Lung volumes are low with resultant vascular crowding limiting the evaluation. There is moderate bibasilar atelectasis. There is no definite focal airspace opacity on this single projection to suggest pneumonia. There is unchanged eventration of the right hemidiaphragm. Moderate cardiomegaly is unchanged. Dilation of the pulmonary artery is re- demonstrated. There is no large pleural effusion or pneumothorax.", "output": "1. Low lung volumes and bibasilar atelectasis. 2. No convincing evidence of pneumonia on this single projection. 3. Stable moderate cardiomegaly and pulmonary artery dilation." }, { "input": "Two views of the chest provided. Lung volumes are low, however the lungs are grossly clear. No pleural effusion or pneumothorax. Hilar and cardiomediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Portable supine frontal view of the chest. The endotracheal tube is 5.5 cm above the carina. An upper enteric tube ends in the stomach, with its most proximal side port located below the gastroesophageal junction. A new right internal jugular line ends in the mid superior vena cava. Consolidation in the right lower lobe is unchanged and remains concerning for pneumonia or aspiration. There is no pleural effusion or pneumothorax. The heart size is normal. There are old right rib fractures. The aorta is tortuous. Prominence of the left hilum persists and corresponds to a lymphadenopathy seen on the chest CT.", "output": "A new right internal jugular line ends in the mid SVC. The endotracheal tube now ends 5.5 cm above the carina. Otherwise, unchanged appearance of the thorax." }, { "input": "Portable supine frontal view of the chest. The endotracheal tube ends 4.5 cm above the carina. An upper enteric tube ends in the stomach. The most proximal side port is below the gastroesophageal junction. Consolidation in the right lower lobe is concerning for pneumonia or aspiration. There is no pleural effusion or pneumothorax. The heart size is normal. The aorta is ectatic. The left hilum is prominent. The stomach is filled with gas. Old right rib fractures are noted.", "output": "Lines and tubes in appropriate position. Right lower lobe consolidation concerning for pneumonia or aspiration. COMMENT: ___ discussed with ___." }, { "input": "Low lung volumes are again noted with bibasilar atelectasis. Superiorly, the lungs are clear. The cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications are noted at the aortic arch. There are degenerative changes at the shoulders.", "output": "Low lung volumes without definite acute cardiopulmonary process." }, { "input": "The cardiac silhouette is mildly enlarged. The hilar and mediastinal contours are stable. There is mild bibasilar. There is no pulmonary edema. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "Mild bibasilar atelectasis." }, { "input": "Right-sided Port-A-Cath tip terminates in the mid SVC. The cardiac, mediastinal and hilar contours are normal. Subsegmental atelectasis is seen within the right lower lobe. No focal consolidation, pleural effusion or pneumothorax is demonstrated. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cardiac silhouette size remains mildly enlarged. The mediastinal contour is unchanged with unfolding of the thoracic aorta again noted. Pulmonary vasculature is not engorged. Hilar contours are normal. Subsegmental atelectasis is demonstrated in the lung bases. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Mild bibasilar atelectasis." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No focal consolidation is present. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Patchy left lower lobe opacity is seen, raising concern for pneumonia. This opacity appears less extensive as compared to the prior chest radiograph from ___. Bibasilar atelectasis is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "Patchy left lower lobe opacity concerning for pneumonia." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. An opacity in the left lower lobe suggests pneumonia. There is also potentially medial right lower lobe opacity.", "output": "Findings suggesting pneumonia." }, { "input": "Bilateral lungs are well expanded and clear. There are no lung opacities concerning for pneumonia. There is no pleural effusion. The mediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process. Findings were conveyed to Dr. ___ on ___ at 4:24 p.m." }, { "input": "Frontal and lateral chest radiographs were obtained. Except for minima subsegmental atelectasis in the right lung base laterally, the lungs are clear with no evidence of consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette remains stable with the heart size within normal limits. Osseous structures remain grossly unremarkable.", "output": "Little change in comparison to prior study from ___, with no acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest are provided. An AICD is again seen with leads extending into the expected location of the right atrium and right ventricle. Midline sternotomy wires and mediastinal clips are again seen. The lungs are clear without focal consolidation, effusion, or pneumothorax. No signs of CHF. The heart and mediastinal contour is stable with atherosclerotic calcifications seen throughout the thoracic aorta. There are no definite rib fractures and the thoracic spine aligns normally. Calcific densities in the right upper quadrant compatible with known gallstones.", "output": "No acute injuries." }, { "input": "Frontal and lateral views of the chest. There is prominence of the central pulmonary vascular markings suggesting pulmonary vascular congestion. Lungs are clear of consolidation or effusion. Cardiomediastinal silhouette is stable. Median sternotomy wires and mediastinal clips are again noted. Left chest wall dual-lead pacing device is seen with lead tips in the right ventricular apex and right atrium. Dense atherosclerotic calcifications seen throughout the thoracic aorta which is slightly tortuous. Calcified gallstones seen in the right upper quadrant.", "output": "Pulmonary vascular congestion. No focal consolidation." }, { "input": "Left chest wall dual lead pacing device is again seen. The lungs are now clear. There is no effusion or vascular congestion. The cardiomediastinal silhouette is within normal limits. Median sternotomy wires and mediastinal clips are again seen. Hypertrophic changes seen in the spine without acute osseous abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "Increased interstitial markings are seen throughout the lungs without predominant basilar distribution, overall similar compared to prior film and PET-CT. There is no superimposed focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities detected.", "output": "Bibasilar predominant increased interstitial markings compatible with patient's known chronic interstitial lung disease. No superimposed acute cardiopulmonary process." }, { "input": "The lungs are clear.The cardiac, hilar and mediastinal contours are normal.No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are relatively low, and note is made of development of coarse reticular opacities within the mid and lower lungs bilaterally. Relative hyperlucency of the upper lobes with the attenuation of vessels may reflect coexisting upper lobe emphysema. A slightly more confluent opacity is present in the lingula, partially obscuring the left heart border, and could be due to focal scarring, localized infection, or neoplasm. There are no pleural effusions or acute skeletal findings.", "output": "Mid and lower lung predominant interstitial opacities, concerning for chronic interstitial lung disease such as NSIP or UIP. Recommend high-resolution chest CT for further characterization, as well as to evaluate a more focal area of abnormality in the lingula. Findings entered into radiology communications dashboard on ___." }, { "input": "There is no consolidation, pleural effusion, or pneumothorax. Reticular interstitial pattern in bilateral lung bases similar to before. Cardiomediastinal and hilar silhouettes are normal size.", "output": "No pulmonary edema." }, { "input": "Endotracheal tube tip terminates approximately 7 cm from the carina, in standard position. An electronic device is seen projecting over the aortic arch and main pulmonary artery. The heart is top normal in size with left ventricular predominance. There is no pulmonary vascular congestion. Streaky opacity in the left lung base with mild tenting of the diaphragm suggests atelectasis with volume loss. Blunting of the costophrenic angles bilaterally likely reflects the presence of small bilateral pleural effusions. No pneumothorax is identified. There are no acute osseous abnormalities.", "output": "Endotracheal tube tip in standard position. Retrocardiac opacity likely reflects atelectasis. Infection is not completely excluded. Small bilateral pleural effusions." }, { "input": "PA and lateral views of the chest provided. Lung volumes are low. The heart appears top-normal. No large effusion or pneumothorax. No signs of congestion or edema. Bony structures are intact. No free air below the right hemidiaphragm. Mediastinal contour is normal.", "output": "Top normal heart size, otherwise unremarkable." }, { "input": "AP view of the chest demonstrates clear lungs. There is no focal consolidation, pleural effusion or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. The heart size is normal. There is no pulmonary edema. Multiple surgical clips project over left lateral chest. A round density projecting over L1 vertebral body may be external to the patient or represent surgical hardware. Partially imaged upper abdomen is otherwise unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "A portable frontal chest radiograph demonstrates a right internal jugular approach catheter terminating in the mid SVC. The cardiomediastinal silhouette is normal and the lungs well-aerated without pleural effusion, or pneumothorax. Subtle opacity in the right cardiophrenic angle could represent an early pneumonia. The visualized abdomen is unremarkable.", "output": "Right internal jugular catheter terminating in the mid SVC. No pneumothorax. Subtle opacity in the right cardiophrenic angle could represent an early pneumonia. Correlate with physical exam. Follow-up with repeat chest radiograph can be obtained as clinically indicated. NOTIFICATION: Updated findings were communicated via telephone by Dr. ___ to Dr. ___ at 10:20 on ___." }, { "input": "The lungs are well-expanded and clear. No focal consolidations. Normal appearance of the cardiomediastinal silhouette. No pleural effusion. No pneumothorax. No acute osseous abnormalities detected.", "output": "No evidence of displaced rib fracture or pneumothorax." }, { "input": "There is a moderate hiatal hernia. Heart size is enlarged. Mild central vascular prominence. No interstitial edema. Moderate bibasilar atelectasis. No pleural effusions.", "output": "Large hiatal hernia. Moderate bibasilar atelectasis." }, { "input": "Frontal and lateral views of the chest. There has been interval development of significant right mid to lower lung opacity which is likely in part due to an effusion with possible underlying consolidation or atelectasis. Patient's known mass is also at the right lung base. There is also a rounded mass in the left lung base compatible with known malignancy. Cardiomediastinal silhouette cannot be adequately assessed. Left chest wall port is seen with catheter tip in the region of the RA/SVC junction There is a rounded opacity projecting over the left lung base compatible with known mass.", "output": "Interval development of right mid to lower lung opacity likely in part due to effusion with underlying consolidation and potentially atelectasis on top of patient's known bibasilar masses." }, { "input": "Subclavian catheter ends at the cavoatrial junction, unchanged since prior examination. There is increased opacification of the right lung, mainly for increased pleural effusion. The right atelectasis seems overall unchanged, the left lower lobe atelectasis and pleural effusion are unchanged. Heart size is presumably enlarged partially obscured by right lower lobe pathology. Pulmonary edema is improved, especially on the right lung. There is no pneumothorax.", "output": "Increased pleural effusion on the right lung with reduced pulmonary edema." }, { "input": "There is elevation of the right hemidiaphragm. The lungs are clear without focal consolidation or effusion. The cardiomediastinal silhouette is within normal limits. Old healed left posterior rib fractures are identified. Vertebroplasty changes are noted in the lower lumbar spine.", "output": "Elevated right hemidiaphragm, no prior available for evaluation of chronicity. Otherwise, unremarkable chest x-ray." }, { "input": "The lungs are clear. The cardiomediastinal silhouette and hilar contours are unremarkable. There is no evidence of pleural effusions or pneumothoraces. There is a surgical clip and sutures in the left upper quadrant. The bones are intact.", "output": "No acute cardiopulmonary process." }, { "input": "There has been interval removal of mediastinal drain and left sided chest tube. No pneumothorax is identified. The lung parenchyma is essentially unchanged in appearance with mild bibasilar atelectasis. Stable cardiomegaly and mediastinal silhouettes. Monitoring and support devices are otherwise unchanged. Sternotomy wires are intact.", "output": "No significant changes with removal of left chest tube and mediastinal drain." }, { "input": "Frontal and lateral views of the chest were obtained. The patient is status post median sternotomy and CABG. The cardiac silhouette remains enlarged. Mediastinal contours are grossly stable, although possibly slightly less prominent as compared to the prior study given differences in technique. There are scattered areas of mid lung linear atelectasis/scarring. Small-to-moderate bilateral pleural effusions are seen along with possibly fluid in the minor fissure. No definite focal consolidation is seen.", "output": "Small bilateral pleural effusions. Persistent enlargement of the cardiac silhouette. Mediastinal contours are grossly stable to possibly slightly less prominent as compared to the prior study." }, { "input": "A semi-upright frontal view of the chest was obtained portably. The carina is not well seen, but the endotracheal tube is directed towards the right main stem bronchus. A nasogastric tube follows the expected course, although the tip is below the inferior level of the image. Low lung volumes result in bronchovascular crowding. Right linear atelectasis is seen. Mild opacity in the right upper lobe may represent atelectasis or early infection. Heart size is within normal limits. No pleural effusion or pneumothorax.", "output": "1. The carina is not well visualized, but the endotracheal tube is directed towards the main stem bronchus and could be be retracted to avoid right bronchial intubation. 2. Mild right upper lung opacity may represent atelectasis or early infection. Follow up is recommended. Finding #1 is discussed with Dr. ___ at 4:45 a.m. ___ upon discovery." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. There are small bilateral pleural effusions. The lungs are otherwise clear with no focal consolidations or pneumothorax. A left subclavian central venous catheter line terminates in the mid SVC, unchanged in position from prior examination. Right clavicular fracture is unchanged.", "output": "Small bilateral pleural effusions. No pneumonia." }, { "input": "", "output": "Lungs clear. Heart size normal. No evidence of central lymph node enlargement. No findings to suggest pneumonia. The left PICC line ends in the mid SVC." }, { "input": "Cardiomediastinal and hilar contours are stable with mild tortuosity of the descending aorta and normal heart size. There is no pleural effusion or pneumothorax. There is no focal consolidation concerning for pneumonia. Pulmonary vasculature is within normal limits. A left PICC line is present with tip terminating in the mid SVC.", "output": "No acute cardiopulmonary process." }, { "input": "Lung fields are well inflated, and clear. Right IJ catheter is unchnged ending in atriocaval junction There is no pleural fluid Cardiac silhouette is normal. Aorta is mildly elongated.", "output": "There is no sign of acute cardio-pulmonary process." }, { "input": "Left subclavian PICC is noted with the catheter tip at the proximal SVC. Previously visualized left subclavian central venous catheter has been removed. The lungs are clear with no evidence of a consolidation, effusion, or pneumothorax. Cardiac and mediastinal silhouettes are normal. Old right healed midclavicular fracture is again ntoed.", "output": "Left subclavian PICC with the tip in the proximal SVC." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. The lungs are well expanded and clear. Note is made of a right internal jugular catheter in place with tip terminating at the cavoatrial junction. Note is made of an old right clavicular fracture.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. Tunneled venous catheter seen with tip at the RA/SVC junction. The lungs remain clear. The cardiomediastinal silhouette is normal. No acute osseous abnormalities detected. Old right mid clavicular fracture is again noted.", "output": "No acute cardiopulmonary process." }, { "input": "AP single view of the chest has been obtained with patient in sitting semi-upright position. Comparison is made with the next preceding similar study obtained on ___. Remarkable is that the heart size has increased during the latest 24 hours examination interval. There is no typical configurational abnormality, but the finding could be explained by increasing circulating blood volume. The pulmonary vasculature is slightly more distended but does not show any evidence of extravasation in the form of interstitial or alveolar edema and the lateral pleural sinus remain free. No evidence of new acute pulmonary parenchymal infiltrates are seen. No pneumothorax existing in the apical area. Remarkable is that the previously described right-sided PICC line projects now with its tip into the upper portion of the right atrium. This may be related to the described increase of the heart volume unless the PICC line has been advanced inadvertently. Observe that PICC line may cause mechanical arrhythmias if in contact with the right atrial wall.", "output": "Heart size increased indicating augmented circulating blood volume, but no evidence of pulmonary edema or pleural effusion. Observe comments made regarding previously placed PICC line." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are unremarkable. A right internal jugular tunneled large-bore catheter is in place with the tip terminating at the low SVC. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic process." }, { "input": "Frontal radiographs of the chest demonstrate normal heart size. A left sided PICC terminates in the upper SVC. The cardiomediastinal silhouette and hilar contours are normal. The lungs are clear. No pleural effusion or pneumothorax. No displaced rib fracture identified.", "output": "No pneumonia" }, { "input": "Compared the prior study, lung volumes are low. There is increased opacity at the left lung base consistent with a combination of pleural effusion and atelectasis. This has increased slightly when compared the prior study. Superimposed infection cannot be excluded. There is unchanged moderate cardiomegaly with mild prominence of the pulmonary vasculature consistent with mild pulmonary vascular congestion.", "output": "Interval increase in the left-sided pleural effusion with associated atelectasis. Superimposed infection cannot be excluded." }, { "input": "Portable upright chest radiograph ___ at 07:33 is submitted.", "output": "Endotracheal tube, right internal jugular Swan-Ganz catheter, nasogastric to and mediastinal and pleural tubes remain unchanged in position. Interval improvement but residual mild pulmonary and interstitial edema. Status post median sternotomy with expected postoperative cardiac and mediastinal contours. Left basilar retrocardiac opacity likely reflects atelectasis in the setting of small effusion. No obvious pneumothorax." }, { "input": "Since prior, there has been mild interval improvement of a left pleural effusion with associated atelectasis. Mild vascular congestion persists. Heart size has also decreased. The right lung is grossly clear. Median sternotomy wires are intact.", "output": "Mild interval decrease in left pleural effusion since ___." }, { "input": "Portable supine chest radiograph ___ at 13:29 is submitted.", "output": "Interval removal of mediastinal and chest tubes with no obvious pneumothorax identified, although the sensitivity to detect pneumothorax is diminished given supine technique. Endotracheal tube, right internal jugular Swan-Ganz catheter and nasogastric tube are unchanged in position. Status post median sternotomy with stably enlarged postoperative cardiac and mediastinal contours. Interval appearance of asymmetric mild pulmonary and interstitial edema. Probable small left effusion." }, { "input": "Portable semi-erect chest radiograph ___ at 19:54 is submitted.", "output": "Right internal jugular Swan-Ganz catheter, endotracheal tube, and mediastinal and chest tubes are unchanged in position. Nasogastric tube is seen coursing below the diaphragm with the tip not identified. The patient is status post median sternotomy for CABG with expected postoperative cardiac and mediastinal contours. Interval improvement in aeration of the left lung but persistent mild to moderate pulmonary and interstitial edema. Layering left effusion with more focal patchy airspace disease at the left base favoring atelectasis, although pneumonia cannot be excluded. No obvious pneumothorax." }, { "input": "There is persistent hyperexpansion of the lungs, without focal consolidation, pleural effusion, or pneumothorax. Cardiomediastinal and hilar silhouettes are normal.", "output": "No focal consolidation concerning for pneumonia." }, { "input": "The lungs are clear consolidation, effusion, or vascular congestion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lung volumes are normal. Normal size of cardiac silhouette. No pneumonia, pleural effusions or pneumothorax. Normal hilar and mediastinal contours.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "AP portable upright view of the chest. No free air seen below the right hemidiaphragm. Lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process. No signs of pneumoperitoneum." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are unremarkable. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. The lungs appear clear without focal consolidation. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Clips are seen in the upper abdomen likely reflective of prior cholecystectomy.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lines and Tubes: Enteric tube terminates in the stomach. Lungs: Low lung volumes with unchanged bibasilar linear atelectasis. No lobar consolidation. Pleura: There is no pleural effusion or pneumothorax Mediastinum: Stable cardiomediastinal silhouette. Bony thorax: No interval change.", "output": "Enteric tube terminates in the stomach. Low lung volumes with bibasilar linear atelectasis, unchanged." }, { "input": "Heart size is mildly enlarged but unchanged. The mediastinal and hilar contours are stable. Pulmonary vasculature appears mildly indistinct suggestive of mild pulmonary vascular engorgement. Linear and patchy bibasilar atelectasis is noted in the lung bases without focal consolidation. No pleural effusion or pneumothorax is identified. Punctate calcification in the left apex may be vascular in origin. There are no acute osseous abnormalities.", "output": "Bibasilar atelectasis and probable mild pulmonary vascular engorgement." }, { "input": "A frontal chest radiograph demonstrate low lung volumes with increased prominence of the cardiac silhouette and bronchovascular crowding. There is bibasilar atelectasis, left greater than right. Mild scarring in the left mid-lung is unchanged. No definite focal consolidation, pleural effusion, or pneumothorax is identified. The visualized upper abdomen is unremarkable.", "output": "Low lung volumes with increased prominence of the cardiac silhouette and bronchovascular crowding, as well as bibasilar atelectasis." }, { "input": "Bibasilar linear atelectasis is new. There are no other focal airspace opacities to suggest pneumonia. The cardiomediastinal silhouette has not significantly changed. Blunting of the left costophrenic sulcus suggests possible small left pleural effusion.", "output": "1. Bibasilar atelectasis and possible small left pleural effusion. 2. Aspiration cannot be excluded on this study. Portable AP radiograph does not optimally evaluate for aspiration; a PA and lateral radiograph is recommended for further evaluation." }, { "input": "Compared with most recent prior radiograph, bibasilar atelectasis has improved. The prior possible effusion has resolved. There is stable appearance of tortuous aorta and normal heart size. No focal consolidation or pneumothorax.", "output": "No pneumonia." }, { "input": "Frontal lateral chest radiographs demonstrate low lung volumes with increased prominence of the cardiac silhouette and bronchovascular crowding. Bilateral opacities are consistent with mild to moderate pulmonary edema, unchanged. Volume loss in the right hemithorax is likely related to a PERSISTENT subpulmonic pleural effusion. THERE MAY BE a new small left pleural effusion. No pneumothorax is visualized. The visualized upper abdomen is unremarkable.", "output": "1. No focal consolidation to suggest pneumonia. 2. Low lung volumes, with unchanged mild to moderate pulmonary edema. 3. PERSISTENT SMALL TO MODERATE SUBPULMONIC RIGHT PLEURAL EFFUSION. PROBABLE NEW SMALL LEFT PLEURAL EFFUSION." }, { "input": "There is bibasilar atelectasis, and a left midlung linear opacity likely represents atelectasis versus scarring. There is a possible small left pleural effusion. There is no focal consolidation or overt pulmonary edema. The heart is mildly enlarged.", "output": "Small left pleural effusion." }, { "input": "Frontal and lateral views of the chest. Again seen are bibasilar linear opacities with some additional linear opacities in left mid lung suggestive of atelectasis versus scarring. There is no new region of consolidation nor effusion. Cardiomediastinal silhouette is stable. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Streaky perihilar opacities are unchanged likely representing scarring. There is no focal consolidation concerning for pneumonia. No edema. No effusion or pneumothorax. Cardiomediastinal silhouette is stable. Bony structures are intact.", "output": "Scattered areas of linear scarring. No evidence of pneumonia or edema." }, { "input": "Since ___, the multifocal airspace consolidations have progressed, particularly in the upper lobes bilaterally. Concurrent edema is also worse. Cardiomediastinal silhouette is normal. Right pleural effusion has increased.", "output": "1. Overall progression of multifocal pneumonia, particularly in the upper lobes bilaterally. 2. Slight increase in right pleural effusion." }, { "input": "A tracheostomy tube is in place. Compared with the most recent chest x-ray from ___ at 23:23, there is relatively extensive new opacity in the left lower zone, with retrocardiac density, obscuration of the left hemidiaphragm and hazy opacity extending along the left lower chest wall. There is a very slightly coarsened appearance to the vessels/parenchymal markings in the left upper zone, which is new, but no focal consolidation or evidence of CHF. The cardiac silhouette is also slightly larger. Aside from minimal atelectasis at the right lung base, the right lung and costophrenic sulcus are clear.", "output": "Prominent new opacity at the left lung base, consistent with left lower lobe collapse and/or consolidation. An element of pleural fluid would be difficult to exclude." }, { "input": "Cardiomediastinal silhouette is within normal limits. No CHF, focal infiltrate, pleural effusion, or pneumothorax is detected. There is no pleural effusion or pneumothorax. Hazy density over both lower lungs relates to the patient's bilateral breast prostheses. The upper portion of an IVC filter and question a balloon from a G-tube are noted. Compared with ___, the tracheostomy tube and left subclavian PICC line have been removed. The previously seen left base left lung base opacity has resolved.", "output": "No evidence of pneumonia." }, { "input": "There is bibasilar atelectasis. The lungs are clear of focal consolidation or pneumothorax. A tracheostomy is stable in position, and a left PICC terminates within the upper SVC. The cardiac and mediastinal silhouette are within normal limits.", "output": "No new consolidation." }, { "input": "Portable supine chest film ___ at 506 is submitted.", "output": "There is a layering right effusion with associated patchy airspace disease in the right mid and lower lung which would be concerning for pneumonia given its focality. Endotracheal tube, nasogastric tube and left subclavian central line are unchanged in position. Overall cardiac and mediastinal contours are stable. No evidence of pulmonary edema. Left lung is grossly clear." }, { "input": "The right subclavian central line has been removed. The endotracheal tube, left-sided PICC line, and enteric tubes are unchanged in position. A right upper quadrant IVC filter is partially imaged. There is no pneumothorax. Minimal biapical scarring and platelike right lung atelectasis are unchanged. The lungs are otherwise clear. The heart and mediastinum are within normal limits despite the projection.", "output": "Status post removal of right subclavian central venous catheter with no other significant interval change." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. No pulmonary edema is seen. Bibasilar opacifications are due to the patient's bilateral breast implants. The heart size is normal. The mediastinal and hilar contours are normal. There has been interval removal of a right PICC. An IVC filter and left upper quadrant gastrostomy tube is noted.", "output": "No acute cardiopulmonary process." }, { "input": "The patient has a tracheostomy. A new PICC line terminates in the lower superior vena cava. The cardiac, mediastinal and hilar contours open are probably unchanged although the cardiac contour is partly obscured by a new moderate left-sided pleural effusion with probable opacification of portions of the left lower lobe and lingula. More superiorly the left lung remains clear. The right lung also remains clear. There is no evidence for pleural effusion on the right side.", "output": "New left-sided pleural effusion with opacifications probably attributed atelectasis. Infection does not need to be invoked to explain this appearance but is not excluded." }, { "input": "Portable semi-erect chest film ___ at 04:06 is submitted.", "output": "Endotracheal tube has its tip 4 cm above the carina. The left internal jugular central line has its tip in the mid SVC. A nasogastric tube is seen coursing below the diaphragm with the tip projecting over the stomach. Lungs appear well inflated. There is a layering right effusion as well as interval development of focal airspace consolidation with air bronchograms in the right medial lung base. Given that the patient is intubated, this may reflect the presence of mucus plugging with collapse or pneumonia. Clinical correlation is advised. No pulmonary edema. No pneumothorax. NOTIFICATION: The patient's nurse, ___, was notified by phone of the findings of this study on ___ at 12:58 at the time of discovery." }, { "input": "AP portable upright view of the chest. Marked dextroscoliosis of the thoracic spine again noted. Lungs remain clear. Heart size is difficult to assess. No definite fracture.", "output": "No acute findings. Please refer to subsequent torso CT for further details." }, { "input": "Multiple right rib fractures are identified as seen on prior CT. Small pneumothorax seen on prior CT is not appreciated on this study. No consolidation or pleural effusion is identified. Cardiomediastinal and hilar silhouette are normal size.", "output": "No acute cardiopulmonary process. Multiple right rib fractures." }, { "input": "Lower lung volumes seen on the current exam. The lungs are grossly clear. The cardiac silhouette is enlarged but this is likely accentuated by technique and low lung volumes. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well inflated and clear. No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable. A left chest wall pacer device lead tips are in the right atrium and right ventricle.", "output": "No acute cardiopulmonary process. Specifically no evidence of interstitial lung disease." }, { "input": "Single frontal view of the chest. Heart size and cardiomediastinal contours are normal. There is asymmetric elevation of the right hemidiaphragm, unchanged from prior. No focal consolidation, pulmonary edema, pleural effusion, or pneumothorax.", "output": "No focal consolidation or pulmonary edema." }, { "input": "There has been placement of a left-sided 2 lead pacemaker with lead tips in the right atrium and right ventricle. The heart size is upper limits of normal. Lungs are clear. There are no pneumothoraces.", "output": "Intact left-sided pacemaker without cardiopulmonary process, including pneumothoraces." }, { "input": "The patient is status post sternotomy. The heart is borderline in size. Patchy calcification is noted along the aortic arch. Hilar contours are unremarkable. There is no pleural effusion or pneumothorax. Parenchymal detail is blurred somewhat but there is suspicion for a developing opacity in the right upper lung lobe.", "output": "Limited examination but concern for possible developing pneumonia in the right upper lobe. If feasible clinically, short-term follow-up with standard PA and lateral radiographs may be helpful to reassess." }, { "input": "Prior CABG, AVR and median sternotomy. The wires are in stable position and not correct. Interval development of mild interstitial pulmonary edema. There is mild to moderate cardiomegaly. A small left-sided pleural effusion. There is retrocardiac and left basal opacity, likely atelectasis. There is focal kyphosis of the lower thoracic spine with multiple compression fractures, overall have not significantly changed since ___.", "output": "Mild interstitial pulmonary edema and small left pleural effusion with atelectasis." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. There is no consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs, mediastinum, heart, and pleural surfaces are normal. There is no evidence of pneumonia.", "output": "No evidence of pneumonia. These findings were discussed with Dr. ___ at 2:20 p.m. on ___ by telephone." }, { "input": "Normal heart size, mediastinal and hilar contours. A nodular opacity projecting between the right sixth and seventh posterior ribs may reflect area of fibrosis from radiation change. Subpleural fibrosis in the right upper lobe is better seen on prior CT. No new focal consolidation, pleural effusion or pneumothorax. Diffuse osseous metastatic disease is again seen.", "output": "No pneumonia." }, { "input": "Cardiac size is top normal. Pacer leads are in standard position with tips in the right atrium and right ventricle. The lungs are clear. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable", "output": "No acute cardiopulmonary abnormalities" }, { "input": "The cardiomediastinal and hilar contours within normal limits. The lungs are well expanded. There is mild atelectasis at the right lung base. Otherwise, there is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well expanded and clear. There is no focal consolidation, effusion, or pneumothorax. Cardiac and mediastinal contours are normal.", "output": "Normal chest radiograph." }, { "input": "In comparison to the chest radiographs obtained ___, no significant changes are appreciated. Lungs are fully expanded and clear without consolidations or suspicious pulmonary nodules. No pleural abnormalities. Heart size is normal. Cardiomediastinal and hilar silhouettes are normal.", "output": "No radiographic evidence of pneumonia or other significant cardiopulmonary abnormalities." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Attenuation of pulmonary vascular markings towards the apices is compatible with centrilobular emphysema. No focal consolidation, pleural effusion or pneumothorax is present. There is no pulmonary edema. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality. Emphysema." }, { "input": "Right internal jugular central venous catheter terminates in the mid SVC, unchanged. Cardiomediastinal silhouette is stable. Lungs are clear. Bibasilar opacities likely reflect mild atelectasis and development of mild pulmonary interstitial edema. There is no large effusion or pneumothorax.", "output": "Increased mild pulmonary interstitial edema." }, { "input": "AP view of the chest. ET tube ends 2.5 cm from the carina. Swan-Ganz catheter appears coiled in the right pulmonary artery. Enteric tube ends in the stomach. Two abdominal drains are seen and are unchanged. Cardiomediastinal and hilar contours are normal. No focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process. Lines and tubes are unchanged in position. The Swan-Ganz catheter is again seen coiled in the right pulmonary artery." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax or pleural effusion. There are mild degenerative changes in the thoracic spine", "output": "No acute cardiopulmonary abnormalities" }, { "input": "PA and lateral views of the chest were provided. The lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures are intact. No displaced rib fracture is seen. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well expanded. A 1cm trianguar opacity projects over the inferior margin of the right hilus and is not explained by normal structures. There is no consolidation, effusion or pneumothorax. Cardiac and mediastinal contours are normal.", "output": "Apparent 1cm nodule projecting over the right hilus may be due to summation of shadows. Repeat radiographs with routine oblique views are recommended to confirm the authenticity of the finding. This recommendation was communicated to the ED QA nurse team via email at ___ ___ ___." }, { "input": "The lungs are clear. There is no pneumothorax. The heart and mediastinum are within normal limits despite the projection. A moderate hiatal hernia is unchanged.", "output": "Clear lungs. Stable moderate hiatal hernia." }, { "input": "Frontal and lateral views of the chest were obtained. Evidence of a large hiatal hernia is again seen. No definite new focal consolidation. There is no large pleural effusion, although trace pleural effusion would be difficult to exclude posteriorly. The cardiac silhouette is top normal to mildly enlarged. The aorta remains tortuous. Multiple old left-sided rib fractures are again demonstrated. Degenerative changes are again seen along the spine, although not well assessed.", "output": "Evidence of large hiatal hernia again seen. No definite acute cardiopulmonary process." }, { "input": "There is subtle with pneumomediastinum best visualized in the right superior mediastinal region extending superiorly into the lower right cervical region. A hazy opacity at the right lung base may represent early pneumonia. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Pneumomediastinum. No pneumothorax. A hazy opacity at the right lung base may represent early pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 10:21 AM, 20 minutes after discovery of the findings." }, { "input": "There are new surgical clips in the left neck. There is a new ET tube which is in satisfactory position. The heart size is stable. The cardiac and mediastinal silhouettes are stable. There is no pleural effusion or pneumothorax. The lungs are clear.", "output": "Satisfactory placement of ET tube." }, { "input": "PA and lateral images of the chest demonstrate well expanded lungs which are clear. There is no pneumothorax or pleural effusion. Cardiomediastinal silhouette is unremarkable. Visualized osseous structures are unremarkable.", "output": "Normal chest radiograph." }, { "input": "The lungs are well expanded and clear. Mediastinal contours, hila, and cardiac silhouette are normal. The aorta is tortuous. There is no pleural effusion or pneumothorax. No osseous abnormality identified within limits of plain radiography.", "output": "No pneumonia or evidence of traumatic injury within the limits of plain radiography." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs which are clear. There is no focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is a persistent ill-defined area of increased density in the left infrahilar region. The lungs appear otherwise clear. The heart is normal in size. Mediastinal structures are otherwise unremarkable. The bony thorax is grossly intact.", "output": "Persistent sidewall left lower lobe opacity concerning for pneumonia. No definite change." }, { "input": "No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process. No focal consolidation to suggest pneumonia." }, { "input": "PA and lateral chest radiographs demonstrate AICD leads terminating in standard positions. Median sternotomy wires and changes related to prior CABG are noted. There is mild basilar atelectasis. The lungs are otherwise clear. There is no focal consolidation, pleural effusion, or pneumothorax. Atherosclerotic calcifications are noted in the aorta. The cardiomediastinal silhouette is otherwise unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "THE LUNGS ARE HYPERINFLATED. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are hyperinflated but clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is normal. The aorta is tortuous. The mediastinal and hilar contours are otherwise unremarkable. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities detected. There is mild loss of height of a couple of vertebral bodies at the thoracolumbar junction which appear chronic.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest. Compared to prior, there is improved left basilar aeration compared to prior. Retrocardiac air-fluid level is suggestive of a hiatal hernia unchanged from priors. Posterior costophrenic angles are not well seen potentially due to effusions. Superiorly, the lungs are clear. Cardiac enlargement stable. No acute osseous abnormalities detected. Left PICC is seen with tip in the mid SVC.", "output": "Probable small bilateral effusions without acute cardiopulmonary process." }, { "input": "Underlying trauma board and other external artifact partially obscure the view. Given this, no focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No evidence of acute intrathoracic process." }, { "input": "There are small bilateral pleural effusions. Overall there is mild pulmonary vascular congestion. Als, there is patchy right upper lobe opacity which could relate to prominent vascular structures, but underlying consolidation may be present. Stable left base atelectasis/scarring is seen.", "output": "Small bilateral pleural effusions. Prominence of the pulmonary vasculature suggests fluid overload. Additional patchy right upper lobe opacity could relate to prominent vessels although underlying infectious process is not excluded in the appropriate clinical setting." }, { "input": "FRONTAL AND LATERAL VIEWS OF THE CHEST: There are trace bilateral pleural effusions, only appreciated on the lateral view. There is mild pulmonary vascular congestion with indistinctness of the upper lobe vasculature. No focal consolidation or pneumothorax. Heart size is normal. Mediastinum and hilar structures are unremarkable.", "output": "Trace bilateral pleural effusions and minimal pulmonary vascular congestion." }, { "input": "PA and lateral views of the chest are provided. The lungs appear clear bilaterally without focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette appears normal and stable. The imaged osseous structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Again seen are a similar way of surgical ___ overlying the mid anterior mediastinum. Post-surgical mediastinal widening is similar as compared to one day ago, with stable extent of moderate bilateral pulmonary edema. The Swan-Ganz catheter is in expected position. Bilateral mediastinal drains and a left chest tube are stable in location. There is no pneumothorax or large pleural effusion.", "output": "No short interval change since ___." }, { "input": "Again seen is the small right apical pneumothorax. This is similar in size compared to films from the prior evening. Cardiomegaly, pulmonary vascular redistribution, and bilateral pleural effusions are again seen. There are bilateral lower lobe areas of volume loss/infiltrate marrow that are slightly more prominent on the current film. The feeding tube tip is off the film. The right subclavian line with tip at the cavoatrial junction is unchanged.", "output": "1. CHF with increased effusions compared to prior. Cannot rule out underlying infectious infiltrate. 2. Unchanged pneumothorax" }, { "input": "A pre-existing left PICC has tip in the upper SVC. There is interval placement of a new left subclavian approach central venous catheter with tip in the lower SVC. An existing enteric tube traverses below the diaphragm and out of view. Cardiomegaly is unchanged. The mediastinal and hilar silhouette and stable. There is increased bilateral pleural effusions and persistent retrocardiac atelectasis and/or consolidation. There is no evidence of pneumothorax. Median sternotomy wires are intact.", "output": "1. New left subclavian line placement in appropriate position, without pneumothorax. 2. Interval enlargement of bilateral pleural effusions with associated atelectasis. 3. Indwelling left PICC." }, { "input": "There is a new right pneumothorax that is mild to moderate in size. This finding was called to ___ at the time of discovery of the finding at 8:20 by Dr. ___ by telephone. The ETT has been removed. The feeding tube tip is off the film, at least in the stomach. The right subclavian line tip is at the cavoatrial junction. There is pulmonary vascular redistribution and perihilar haze compatible with fluid overload. The heart is moderately enlarged, increased compared to prior. There are bilateral pleural effusions, left greater than right. There are bilateral lower lobe infiltrates , also increased in the interval.", "output": "1. CHF, increased compared to prior. 2. New right pneumothorax" }, { "input": "AP single view of the chest has been obtained with patient in semi-upright position. Comparison is made with a similar preceding study obtained three hours earlier during the same day. During the latest interval, a right-sided pigtail-end drainage catheter has been introduced through the lower lateral chest wall remaining with its pigtail tip end in the lateral lower portion of the right pleural sinus. The drainage was very effective as the pleural effusion on the right base has been practically eliminated totally making the contour of the right diaphragm well visible. There is no evidence of pneumothorax in the apical area of the right hemithorax. Previously described tracheal cannula remains in unchanged appropriate position. The pulmonary vascular pattern has not been altered. The left-sided basal pleural density which appeared similar with the previous appearance of the right side remains unchanged.", "output": "Successful drainage of right-sided pleural effusion." }, { "input": "The patient is status post sternotomy and repair of ascending aorta. There is similar marked enlargement of both the left atrial appendage and main pulmonary artery, accounting for enlarged lobular left upper cardiac borders. The lower part of the chest is partly excluded, making it difficult to exclude very small effusions but there is some degree of retrocardiac opacification suggested on the frontal view only.", "output": "Possible retrocardiac opacification, although without correlate on the lateral view, perhaps an artifact. If there is persistent concern for an evolving pulmonary process, repeat radiographs showing the entirety of the lung bases could be considered in short-term follow-up." }, { "input": "As compared to prior chest radiograph from ___, there has been interval decrease of the right-sided pleural effusion. Residual fluid is still noted along the right costophrenic angle. There has been interval increase of the left-sided pleural effusion. There is no pneumothorax. Support and monitoring devices remain in unchanged position.", "output": "Interval decrease of right-sided pleural effusion with increasing left pleural effusion. No pneumothorax." }, { "input": "Left-sided PICC line tip terminates at the mid SVC. The tip of an additional catheter is seen terminating in the axilla on the right. Tracheostomy tube projects over the thoracic midline. As compared to prior chest radiograph from ___, there is a dense consolidation in the right lower lobe extending superiorly towards the minor fissure. There has been interval increase of the right sided pleural effusion. There is a right sided perihilar opacity which may occupy the superior segment of the right lower lobe. A persistent left-sided pleural effusion precludes the ability to see through the heart, cannot exclude retrocardial atelectasis. There is mild superimposed pulmonary edema. There is no pneumothorax.", "output": "1. Increased large area of dense consolidation occupying the right lower lobe with indeterminate quantity of effusion. 2. Persistent left pleural effusion." }, { "input": "There is a new right-sided chest tube. The right pneumothorax is again seen and is slightly smaller than on the prior study. There is improved aeration of the right lower lobe. There is decreased right effusion. The continues to be a retrocardiac opacity. Feeding tube with tip off the film is unchanged. The right IJ line has been removed. Left-sided PICC line without with tip in SVC is unchanged.", "output": "New right chest tube with slight decrease in size of right pneumothorax." }, { "input": "AP single view of the chest has been obtained with patient in semi-upright position. Analysis is performed in direct comparison with the next preceding similar study obtained on the preceding day, ___. Status post sternotomy as before. Unchanged position of previously described NG tube and right-sided chest tubes terminating in right apical area. Cardiac enlargement as before and hazy density over left lung base most likely representing pleural effusion layering in the posterior compartments. The on previous examination identified small less than 1 cm wide apical pneumothorax cannot be identified anymore. This indicates effective drainage via the right-sided chest tubes. No new pulmonary parenchymal abnormalities are seen.", "output": "Dissappearance of small right apical pneumothorax residual. Stable chest findings." }, { "input": "Tracheostomy and sternotomy wires are in place. A pleural pigtail catheter projects over the right costophrenic angle. A left PICC line tip terminates at the mid SVC. A peripheral catheter is identified with the tip terminating in the right axilla. As compared to prior chest radiograph from ___, there still remains a tiny apical right pneumothorax. There is opacification of the left hemidiaphragm which likely relates to atelectasis and pleural effusion. There is right basal atelectasis. There is severe cardiomegaly.", "output": "1. Tiny right apical pneumothorax. 2. Retrocardiac opacities likely due to atelectasis and pleural effusion." }, { "input": "A tracheostomy and sternotomy wires are in place. A pleural pigtail catheter projects over the right costophrenic angle. A left PICC tip terminates at the upper-to-mid SVC. A thin tubular structure terminating in the right axilla may represent an additional peripherally placed IV line. Trace apical pneumothorax may be present, but there is no large pneumothorax, mediastinal shift, or diaphragmatic flattening. Crescentic lucency along the lateral aspect of the right chest represents air within a skinfold. The heart size is at the upper limits of normal. Retrocardiac opacity persists, and blunting of the left costophrenic angle may represent a moderate pleural effusion there. Minimal right basal atelectasis is present, but no large pleural effusion exists on the right.", "output": "1. Trace apical pneumothorax without appreciable right pleural effusion. 2. Moderate left-sided pleural effusion with continued retrocardiac consolidation - considerations include atelectasis or pneumonia." }, { "input": "A tracheostomy tube is in place. The patient is status post median sternotomy. A right pleural pigtail catheter again projects over the right costophrenic angle. A left PICC is unchanged in position with the tip terminating in the upper to mid SVC. A right PICC is again noted with the tip terminating at the level of the right axilla. There is no definitive evidence of pneumothorax. There is slightly increased opacification of the left lung base likely reflecting a combination of moderate left pleural effusion and underlying atelectasis or consolidation. Right basilar atelectasis is slightly improved from the most recent prior study. Enlargement of the cardiac mediastinal silhouette is unchanged. Calcification of the aortic knob and descending thoracic aorta is re- demonstrated.", "output": "1. No definitive pneumothorax. 2. Right PICC terminating at the level of the right axilla, as before. 3. Slightly increased moderate left pleural effusion and underlying atelectasis or consolidation. 4. Improved right basilar atelectasis." }, { "input": "Single frontal view of the chest demonstrates intact median sternotomy wires and interval removal of an enteric tube and right chest tube and, with minimal subcutaneous emphysema along the right chest wall. There is somewhat similar mild perihilar vascular congestion and stable moderate left pleural effusion and increased small right pleural effusion with associated atelectasis. Coarse calcifications along the aortic arch is unchanged. The upper lungs remain relatively well aerated. Previously seen tiny right apical pneumothorax is no longer appreciable.", "output": "Interval removal of right chest tube without discernible pneumothorax." }, { "input": "Comparison can be made to ___. The heart is normal in size. The mediastinal and hilar contours appear within normal limits. Incidental note is made of an azygos fissure, which is a common normal variant. There is a similar mild prominence of central pulmonary arterial vascularity but fairly similar with no definite evidence for acute change. The bony structures are unremarkable.", "output": "Mildly prominent central pulmonary vessels, as seen previously, but without definite evidence for acute cardiopulmonary disease." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Numeral bilateral pulmonary nodules/masses are again seen. The largest is located within the right lower lobe with some areas of central lucency better seen on the lateral view and prior chest CT. Small bilateral pleural effusions are noted. There is a moderate hiatal hernia. Cardiomediastinal silhouette is otherwise unremarkable. No acute osseous abnormalities.", "output": "Diffuse bilateral pulmonary metastases. Given significant burden of disease, evaluation for subtle new opacity is limited although none is definitively seen." }, { "input": "As compared to prior chest radiograph from ___, left PICC line tip is curving along the tracheobronchial angle and now terminates in the azygos vein. Right pigtail catheter is in unchanged position and Dobhoff tube terminates in the stomach. There has been interval decrease of a small right apical pneumothorax. Moderate bilateral pleural effusions have increased, with a fissural component on the right and likely a loculated component on the left. There is bibasilar atelectasis, worse on the right.", "output": "1. Left PICC line tip now terminates in the azygos vein, for which repositioning is recommended. 2. Interval decrease of small right apical pneumothorax. 3. Increasing moderate bilateral pleural effusions. These findings were discussed with Dr. ___ by Dr. ___ via telephone on ___ at 11:44 a.m., at the time of discovery." }, { "input": "The right-sided central line has been removed. Heart size is within normal limits. There is no focal consolidation, pleural effusions, or signs for acute pulmonary edema. No pneumothoraces are seen. There is mild wedging of 2 lower thoracic vertebral bodies, unchanged from the chest CT from ___", "output": "No acute cardiopulmonary process." }, { "input": "No biliary stent is visualized. Midline surgical ___ are seen over the upper abdomen. Partially visualized is an abdominal drain which crosses midline and courses inferiorly out of view. Lung volumes are low with bibasilar atelectasis. A lower lobe opacity projects over the spine and is difficult to determine whether it originates in the right or left lower lobe on frontal view. A small right pleural effusion is stable from ___.", "output": "1. No biliary stent visualized. Further evaluation with abdominal radiograph could help localize the stent. 2. Lower lobe opacity projecting over the spine, concerning for pneumonia. 3. Small right pleural effusion, stable from ___. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 3:40 PM, 10 minutes after discovery of the findings." }, { "input": "There is interval decrease in right pleural effusion. There is lucency at the right base but no definite pneumothorax. The patient is positioned slightly oblique to the left. There is an increase in left pleural effusion. The left lung appears congested with alveolar infiltrates slightly worsened prior although this may be positional. The feeding tube tip is in the stomach. PICC line tip is at the cavoatrial junction.", "output": "Decreased right pleural effusion without definite pneumothorax but followup is recommended." }, { "input": "The left-sided IJ appears to extend posteriorly on the lateral film with the tip likely in the azygous vein. The left-sided chest tube abuts the mediastinum and is unchanged in position compared to the prior exam. There is an enteric tube that traverses below the diaphragm with the tip in the body of the stomach. Small bilateral pleural effusions are stable. Mild bibasilar atelectasis is also stable. There is no focal consolidation. The previously noted small left apical pneumothorax is not visualized on this exam.", "output": "1. Lateral view demonstrates the left-sided IJ coursing posteriorly and terminating likely into the azygous vein. 2. Stable bilateral small pleural effusions and mild bibasilar atelectasis. These findings were discussed with Dr. ___ at 5:16 p.m. by Dr. ___ by telephone on the day of the exam." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. There is minimal right basal opacity. No large pleural effusion or pneumothorax.", "output": "Minimal right basal opacity likely reflects atelectasis however infection should be considered in the appropriate clinical setting." }, { "input": "Cardiomediastinal and hilar contours are stable. There is slight worsening of the right base opacification, indicating increased pleural effusion and atelectasis. There are also asymmetric increased interstitial markings in the right upper lung, slightly increased compared to prior. Plate-like atelectasis in the left base is stable. There is no left pleural effusion. Enteric tube is seen in standard position with the tip coursing off the film.", "output": "Slight worsening of the right base atelectasis and pleural effusion." }, { "input": "The NG tube traverses below the diaphragm with the tip in the fundus of the stomach. There is a left-sided chest tube which abuts the mediastinum, unchanged in position. There is a left-sided IJ with its tip from the anterior radiograph, unchanged in position compared to the exam from ___. The left-sided PICC line terminates in the low SVC. The heart size is normal. The hilar and mediastinal contours are normal. There has been slight interval improvement of the small right pleural effusion and mild right basilar atelectasis. There is a stable left subpulmonic effusion and mild left basilar atelectasis. Overall, there has been slight interval improvement of the bilateral mild pulmonary edema. The small left apical pneumothorax is not seen on this exam.", "output": "Interval improvement of the bilateral mild pulmonary edema. Interval improvement of the right lung base atelectasis and right small pleural effusion." }, { "input": "Similar as on preceding examination of ___, the patient had to be examined in sitting position using AP frontal and left lateral views. The right-sided pigtail end catheter remains in unchanged position. A small amount of pleural effusion has further diminished, results in an isolated small fluid accumulation in the posterior pleural sinus. The pigtail end catheter is in anterior direction on the right base and this area is completely drain free. The remaining apical pneumothorax cap is minimal in size and does not become wider than 1 cm. Bilateral plate small peripheral atelectasis are unchanged and no new pulmonary parenchymal abnormalities are seen. Previously described left-sided PICC line remains in unchanged position. Osseous defect status post surgical intervention in distal half of right-sided clavicle unchanged.", "output": "Further regression of pleural effusion and minimal sized pneumothorax." }, { "input": "", "output": "Portable frontal chest radiograph. FINDINGS: Moderate pulmonary edema and moderate left greater than right bilateral effusions have mildly improved. A left PICC and right dual-lumen dialysis catheter are unchanged in position. The stomach is significantly distended despite an appropriately placed NG tube. IMPRESSION: 1. Mild improvement of moderate pulmonary edema and bilateral left greater than right effusions. 2. Significantly distended stomach despite NG tube placement which may suggest a suboptimally functioning NG tube." }, { "input": "Left PICC line terminates in mid-to-lower SVC. Nasogastric tube projects over the gastric fundus, the tip is not included in this examination. Right pigtail catheter remains in unchanged position. As compared to prior chest radiograph from ___, small residual bilateral effusions are identified, more on the left. Small right apical pneumothorax persists. There is increased atelectasis of the right lower lung and left retrocardiac opacity is likely due to atelectasis. Cardiomegaly is unchanged. There is evidence of a clavicular fracture on the right.", "output": "1. Small bilateral pleural effusions, worse on the left. 2. Small right apical pneumothorax. 3. Increased right lower lobe atelectasis and left retrocardiac opacity, likely due to atelectasis." }, { "input": "Two PA and a single lateral view of the chest were viewed. The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. The lungs are well expanded and clear. Pulmonary vasculature is within normal limits. Note is made of discontinuity of the right clavicle, secondary to an old fracture.", "output": "No acute cardiopulmonary process." }, { "input": "A left PICC is unchanged with the tip terminating in the mid SVC. A right basilar pleural pigtail catheter is also unchanged. An enteric feeding tube is seen coursing below the diaphragm with the tip terminating in the post-pyloric small bowel. The small right apical pneumothorax is decreased in size from ___. Small bilateral pleural effusions are unchanged with increased opacification of the right lung base representing worsening atelectasis. Left basilar atelectasis is unchanged. The cardiomediastinal silhouette is within normal limits and unchanged.", "output": "1. Unchanged position of support devices. 2. Decreased size of small right apical pneumothorax from ___. 3. Unchanged small bilateral pleural effusions and associated bibasilar atelectasis, worse on the right from ___." }, { "input": "", "output": "AP chest at 8:46 compared to ___: Mild to moderate pulmonary edema has worsened since ___. Moderate bilateral pleural effusion is not enlarging. . There is no pneumothorax. Cardiomediastinal silhouette is normal. Feeding tube passes into the distal stomach and out of view. Dual channel right supraclavicular central venous catheter ends in the right atrium, left PICC ends in the mid SVC, alongside a right central catheter and catheter introducer. There is no pneumothorax." }, { "input": "Frontal and lateral views of the chest were obtained. Slight blunting of the right costophrenic angle persists and there may be a trace residual right pleural effusion. Overall, the lung volumes remain low. No definite focal consolidation is seen. There is no pneumothorax. The cardiac, mediastinal, and hilar contours are stable.", "output": "No significant interval change." }, { "input": "", "output": "Moderate to large bilateral pleural effusion has increased since ___ with probable worsening of moderate widespread pulmonary opacification most commonly edema but conceivably infection or hemorrhage. Heart size is normal and mediastinal veins are not dilated. Feeding tube passes into the stomach and out of view. Left PICC line ends in the mid to lower SVC and a right supraclavicular dual channel dialysis set ends in the lower SVC and upper right atrium. No pneumothorax." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for pneumonia. There is no pleural effusion or pneumothorax. Deformity of the right clavicle is unchanged compared to the prior exam from ___.", "output": "No acute intrathoracic process." }, { "input": "Right pigtail pleural catheter remains in place, with a marked decrease in size of right pleural effusion compared to the prior study, with a residual small effusion remaining. Additionally, a small pneumothorax is present at the right lung apex. Cardiomediastinal contours are within normal limits, and previously present pulmonary edema has resolved. Left retrocardiac opacity has partially improved and is likely due to atelectasis. Previously moderate left pleural effusion has decreased in size with residual small pleural effusion remaining.", "output": "1. Decreased right pleural effusion with residual small effusion and small right apical pneumothorax. 2. Improving left lower lobe atelectasis and slight decrease in small left pleural effusion." }, { "input": "The lung volumes are low. There is no evidence of pneumonia. The cardiomediastinal silhouette and hilar contours are largely unchanged. The pleural surfaces are normal without effusion or pneumothorax. Old right clavicular fracture is unchanged in appearance. A biliary drain is seen projected over the right upper abdomen and air is seen in the esophagus.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "A right tunneled central venous catheter terminates at the right atrium. A left PICC terminates at the mid right atrium. A nasogastric tube extends to at least the level of the stomach and beyond the scope of this study. The heart size is normal. Central pulmonary vascular congestion and moderate interstitial edema is similar since ___. A moderate left pleural effusion is slightly improved. Persistent left retrocardiac opacities reflect atelectasis. There is no pneumothorax.", "output": "1. Unchanged moderate pulmonary edema. 2. Decreased moderate left pleural effusion. 3. Unchanged left lower lobe atelectasis. 4. Left PICC terminates at the right atrium. To terminate within the SVC, the line would need to be withdrawn at least 3.5 cm. The initial findings were discussed by Dr. ___ with Dr. ___ ___ telephone at the time of interpretation, 09:15, ___." }, { "input": "Linear anterior mid lung opacity seen on the lateral view most likely represents atelectasis or scarring. No definite focal consolidation is seen. There is no pleural effusion or pneumothorax. Mild biapical pleural thickening is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Mild linear anterior mid lung opacity seen on the lateral view most likely represents atelectasis or scarring. No definite focal consolidation seen." }, { "input": "The lungs are well inflated and clear. No focal consolidation, effusion, or pneumothorax is present. The heart is mildly enlarged.", "output": "No acute cardiopulmonary process or evidence of active or latent tuberculosis." }, { "input": "The heart size is within normal limits. The mediastinal contours demonstrate a small-to-moderate hiatal hernia. A nodular density projects above the left hilus. The lungs ___ volumes but are clear. There is no pleural effusion or pneumothorax. Degenerative changes are seen in the spine. Opacity in the left upper quadrant may represent splenomegaly.", "output": "1. Hiatal hernia, but no acute cardiopulmonary process. 2. Left suprahilar nodular density - shallow obliques may be helpful - discussed with ___ at 8:06 am on ___ by ___ over the phone." }, { "input": "The lungs are well-expanded and clear. No focal consolidation, effusion, edema, or pneumothorax. The heart size is normal. The mediastinum is not widened. No evidence of acute fracture. No subdiaphragmatic free air.", "output": "No acute cardiopulmonary process. Normal chest radiograph." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures appear within normal limits. There has been no significant change.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. There is mild elevation of the left hemidiaphragm compared to before with persistent streaky opacity, not significantly changed and suggesting minor scarring. There is no definite evidence of pneumonia. The bony structures appear within normal limits.", "output": "Findings suggesting minor atelectasis at the left lung base, but otherwise unremarkable." }, { "input": "Lungs are fully expanded and clear. Probable trace left pleural effusion. No pneumothorax.. Heart size is normal. Cardiomediastinal and hilar silhouettes are normal. A radiopaque device projects over the left anterior chest wall.", "output": "Probable trace left pleural effusion. In the absence of a known etiology, pulmonary embolism is a consideration. If clinical concern, recommend a D-dimer or chest CTA for further evaluation." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Screws within the right humeral head partially imaged. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. There is similar mild relative elevation of the right hemidiaphragm. Streaky right mid and lateral left lower lung opacities appear unchanged and suggest background scarring. The lateral view also depicts similar retrocardiac opacity probably in the left lower lobe, which is also streaky in configuration and more suggestive of atelectasis than pneumonia. These findings are similar to the prior study. There is no pleural effusion or pneumothorax.", "output": "No definite change in left basilar opacities, streaky in morphology and suggestive of atelectasis based on longer chronicity." }, { "input": "PA and lateral views of the chest provided. Airspace opacity within the right upper lobe and to a lesser extent right lower lobe remains concerning for pneumonia. Relative prominence of the right pulmonary hilum could reflect the presence of reactive lymph nodes, though underlying mass is difficult to exclude. The left lung is clear. Patient is known to have emphysema. The heart size is stable. Bony structures are intact.", "output": "Persistent opacity in the right lung could represent pneumonia. Right hilar prominence in the setting of treated pneumonia is concerning for underlying malignancy and CT is advised. Findings were discussed with Dr. ___." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral chest radiographs demonstrate a left PICC terminating in the mid SVC. The right IJ catheter terminates in the right atrium. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits.", "output": "Left PICC terminates in the mid SVC." }, { "input": "The lungs are well inflated and clear. Heart size and mediastinal contours are normal. There is no pleural effusion or pneumothorax. Osseous structures are intact. Dystrophic calcifications over the right breast likely correspond to fibroadenomas, last imaged on a mammogram from ___.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cardiomediastinal contours are within normal limits without change. Lungs are clear except for chronic focal linear left basilar scar. There are no pleural effusions, and no calcified pleural plaques are evident. Right hemidiaphragm is chronically elevated, probably due to eventration of the anterior and midportions.", "output": "Stable radiographic appearance of the chest with no findings to suggest asbestosis. High-resolution chest CT is more sensitive than conventional radiographs for detecting subtle interstitial lung abnormalities and may be considered if clinical suspicion persists." }, { "input": "The lungs are clear of focal consolidation, pleural effusion or pneumothorax. The heart size is normal. The mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "A right-sided Port-A-Cath is in place with the tip terminating 6 cm caudal to the carina in the high right atrium. Cardiomediastinal silhouette and hilar contours are normal. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "Right-sided Port-A-Cath with tip in high right atrium without complication. Results were discussed over the telephone with Dr. ___ by Dr. ___ ___ at 13:07 on ___ at time of initial review." }, { "input": "Increased interstitial markings again seen throughout the lungs which are unchanged and were further characterized by a prior CT. Linear left basilar opacity may represent superimposed atelectasis although infection is not excluded. The cardiomediastinal silhouette is stable. No acute osseous abnormalities.", "output": "Increased interstitial markings throughout the lungs compatible with a chronic underlying process better seen by prior CT. Linear left basilar opacity may be due to superimposed atelectasis although acute infection would be possible." }, { "input": "Heart size is mildly enlarged, unchanged. Mediastinal and hilar contours are similar. Pulmonary vasculature is not engorged. Mild interstitial abnormality is seen within the lung bases, similar to prior, likely reflective of a chronic interstitial lung disease as seen on the prior chest CT. No focal consolidation, pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality. Mild chronic interstitial lung disease." }, { "input": "PA and lateral views of the chest were provided. Lung volumes are low, and allowing for this, subtle increase in the bronchovascular markings likely reflects some degree of crowding of bronchovasculature, though mild pulmonary edema would be difficult to exclude in the correct clinical setting. There is no overt sign of pneumonia. There is no effusion or pneumothorax. The cardiomediastinal silhouette is stable. Bony structures are intact.", "output": "Possible mild interstitial edema. Limited exam due to low lung volumes. Otherwise grossly unremarkable." }, { "input": "Lung volumes are low. Given AP technique, the heart is mildly enlarged. There is mild interstitial edema. No focal consolidation or pneumothorax is seen.", "output": "Cardiomegaly and mild interstitial edema." }, { "input": "The inspiratory lung volumes are slightly decreased with resultant bronchovascular crowding. Prominent interstitial lung markings as seen on ___, may be related to mild interstitial pulmonary edema. No focal consolidation, pleural effusion or pneumothorax is appreciated on this single frontal view. The cardiomediastinal and hilar contours are within normal limits.", "output": "Decreased lung volumes with probable mild interstitial pulmonary edema." }, { "input": "Mild to moderate interstitial edema is re- demonstrated. No definite focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "Interstitial edema." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. There is an unchanged persistent diffuse interstitial abnormality. Although vascular congestion may mimic this appearance, the lack of change suggests that this is probably primarily due and perhaps solely due to emphysema and mild interstitial lung disease of long chronicity. There is no pleural effusion or pneumothorax. There has been no definite change.", "output": "Similar persistent interstitial abnormality." }, { "input": "When compared to prior, there has been no significant interval change. Increased interstitial abnormality in the lungs, right greater than left is similar compared to prior. There is no confluent consolidation or effusion. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "Persistent increased interstitial markings in the lungs suggesting chronic underlying interstitial process, similar to prior, without superimposed acute cardiopulmonary process." }, { "input": "The exam is limited by patient body habitus. There is no focal consolidation, pleural effusion or overt pulmonary edema. There is no pneumothorax. The heart is normal in size.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Again seen increased interstitial markings diffusely bilaterally, consistent with underlying chronic interstitial lung disease. There may be a component of mild superimposed vascular congestion. . No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are stable.", "output": "Increased interstitial markings consistent with chronic lung disease; with possible superimposed mild vascular congestion. No definite focal consolidation." }, { "input": "The lung volume is small. No consolidation. There is chronic diffuse opacities, unchanged from prior. No consolidation. No pleural effusions. No pneumothorax. The heart size is normal and unchanged. The mediastinum is normal. No fractures.", "output": "1. Chronic unchanged diffuse opacities due to chronic lung disease. 2. No acute cardiopulmonary process." }, { "input": "The heart size is top normal, unchanged. The tortuous aorta is also unchanged. Lungs are clear without effusion, pneumothorax, or focal consolidation concerning for pneumonia. An opacity projecting over the heart on the lateral view is unchanged since ___ and is likely an extensive fat pad.", "output": "No evidence of pneumonia." }, { "input": "Lung volumes are low. Heart size is mildly enlarged with a left ventricular predominance. The mediastinal and hilar contours are unchanged. Crowding of the bronchovascular structures is present due to low lung volumes without overt pulmonary edema. Minimal patchy opacities in the lung bases likely reflect areas of atelectasis or scarring. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormalities demonstrated.", "output": "Mild bibasilar atelectasis." }, { "input": "2 lead left-sided pacemaker is seen with leads extending to the expected positions of the right atrium and right ventricle. No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear of consolidation, effusion, or vascular congestion. There is mild cardiac enlargement and tortuosity of the thoracic aorta. No acute osseous abnormalities come hypertrophic changes noted in the spine.", "output": "Cardiomegaly without acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart size is normal. Mediastinal and hilar contours are unremarkable. Lungs are clear. Pulmonary vascularity is normal. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities are visualized.", "output": "No acute cardiopulmonary process." }, { "input": "Persistent multifocal bilateral parenchymal opacities persist, perhaps minimally improved since ___ in the right upper lung. No frank pulmonary edema. Heart size is normal. No pneumothorax.", "output": "Persistent multi focal bilateral the goal pass views, slightly improved since ___ but remain concerning for multifocal pneumonia or an atypical infection including PCP." }, { "input": "Relatively low lung volumes are seen. Irregular opacity projecting over the left upper lung as well as bibasilar opacities are similar compared to prior x-ray. Findings may be due to combination of atelectasis or chronic changes from prior infection. The cardiomediastinal silhouette is unchanged. No acute osseous abnormalities.", "output": "Persistent bibasilar and left upper lung interstitial abnormality which have not significantly changed since ___ exam. Consider PA and lateral for better delineation." }, { "input": "Cardiac silhouette size is normal. The mediastinal hilar contours are unremarkable. Diffuse ill-defined airspace opacities are noted in both lungs, more pronounced in the left lung compared to the right. There is no pulmonary vascular congestion, pleural effusion or pneumothorax. No acute osseous abnormality is seen.", "output": "Diffuse ill-defined opacities in both lungs, more pronounced on the left. Findings are concerning for either multifocal pneumonia or PCP, although the latter would be somewhat atypical given the somewhat asymmetric distribution of the airspace opacities." }, { "input": "Persistently low lung volumes. Overall improvement of ground-glass opacities better seen on prior CT. There are however peribronchial opacities in the left upper lobe and bilateral lower lobes, left greater than right. The cardiomediastinal and hilar contours are stable. The pleural surfaces are normal. Degenerative changes of the thoracic spine.", "output": "Left upper lobe and bilateral lower lobe opacities. Some may represent chronic fibrotic changes while some may represent resolving infection." }, { "input": "The cardiomediastinal silhouette is normal. The hila are normal. The bilateral diffuse ill-defined interstitial opacities have improved. No evidence of new pneumonia. The left costophrenic angle is better appreciated compared to prior. No pleural effusion. No pneumothorax. No fractures.", "output": "1. Improved bilateral the fused interstitial opacities. 2. No new pneumonia. No evidence of TB." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified.", "output": "Normal chest x-ray." }, { "input": "PA and lateral views of the chest provided. Dextroscoliosis of the T-spine is noted with associated deformity of the thorax. Allowing for this, lungs are clear. Cardiomediastinal silhouette is normal. No acute osseous abnormality.", "output": "No acute findings. Please refer to subsequent CT chest for further details." }, { "input": "PA and lateral views of the chest demonstrate massive elevation of the right hemidiaphragm, reducing lung volume to one-third of the original volume. There is mild elevation of the left hemidiaphragm, as well, which is resulting in bronchovascular crowding at the base. There is no evidence of pneumonia or other focal infectious process on this exam. There is some tortuosity to the aorta. Bowel loops are seen interposed between the diaphragm and the liver.", "output": "Massive elevation of the right hemidiaphragm reducing the right lung to the one-third of its original volume. No evidence of pneumonia or other focal infection. These findings were communicated to Dr. ___ by telephone at the time they were discovered at 3:04 p.m. on ___." }, { "input": "There are low lung volumes with bibasilar atelectasis, obscuring assessment of the heart and mediastinal structures. An ovoid structure in the upper portion of the right mediastinum likely represents a vascular structure. Additionally, the remaining visualized portion of the lungs demonstrates crowding of the bronchovascular structures and interstitial prominence, likely reflecting some degree of pulmonary edema. Lateral view demonstrates no appreciable pleural effusion. Patchy opacities in the lung bases are noted, likely atelectasis though infection cannot be excluded. No pneumothorax seen in this upright radiograph. Severe degenerative changes are present at the right glenohumeral and acromioclavicular joints with a probable chronic rotator cuff injury.", "output": "Low lung volumes with mild pulmonary edema and bibasilar atelectasis - underlying pneumonia cannot be excluded." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged including moderate tortuosity of the aorta. There is moderate-to-severe relative elevation of the right hemidiaphragm as before. Streaky opacification associated with the elevated right hemidiaphragm would be compatible with chronic atelectasis. In addition, however, there is medial left basilar streaky opacity in the retrocardiac region, for which atelectasis could be considered versus pneumonia in the appropriate setting. Lastly, there is a focal new left mid lung opaciy, potentially a focus of bronchopneumonia. Background mild interstitial abnormality is unchanged and may be associated with slight congestion, although atypical infection could be considered in the appropriate setting.", "output": "New left mid and lower lobe opacities, concerning for bronchopneumonia in the appropriate setting. Similar marked elevation of the right hemidiaphragm; streaky opacification in the right lower lobe is compatible with associated atelectasis although infection is hard to exclude particularly since there is no direct prior comparison for the lateral view." }, { "input": "AP and lateral views of the chest provided. There is a small amount of associated subcutaneous emphysema within the right chest wall. Interval ET tube removal. Lungs are well inflated and grossly clear. No pleural effusion. Faint line projecting over the right lung apex may represent tiny residual apical pneumothorax. Hilar contours are normal. The cardiomediastinal contour is normal.", "output": "Possible residual tiny right apical pneumothorax. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 11:43 AM, 15 minutes after discovery of the findings." }, { "input": "PA and lateral views of the chest provided. Interval removal of a pigtail catheter from the right hemi thorax. Moderate subcutaneous emphysema along the right chest wall is unchanged. A large left upper lobe mass appears unchanged, however was better evaluated on CT chest ___. An additional 5 mm left lower lobe pulmonary nodule is not seen. A tiny right apical pneumothorax appears unchanged. Hilar contours are normal. Mild cardiomegaly is unchanged.", "output": "1. A tiny right apical pneumothorax appears unchanged from ___. 2. Interval removal of the right chest tube. Moderate subcutaneous emphysema is unchanged within the right chest wall. 3. A large left upper lobe mass appears grossly unchanged from CT chest ___." }, { "input": "The cardiomediastinal silhouette is difficult to assess given posttreatment changes in left lung. Mediastinal surgical clips are noted. There is opacity in the left lower lung with elevation of the left hemidiaphragm and blunting of left lateral CP angle with left lateral pleural thickening. This correlates to findings on a CT chest from ___, likely relating to post treatment changes in the left lung. The left upper lung is grossly clear. The right lung is mildly hypoinflated but clear. There is no pneumothorax. There is no right pleural effusion. There is no pulmonary edema.", "output": "Post-treatment changes in the left lung correlate to findings from prior CT chest from ___, not appreciably changed. No evidence of superimposed acute cardiopulmonary process." }, { "input": "AP portable supine view of the chest. ET tube is seen with its tip positioned 8 cm above the carinal. An NG tube courses inferiorly with its tip in the expected region of the distal esophagus. AICD noted though the tip is not clearly visualized. Overlying defibrillator pad is seen. Diffuse pulmonary opacities concerning for pulmonary edema. The possibility of aspiration or pneumonia difficult to exclude. Bilateral pleural effusions are likely present. The heart size cannot be assessed. Evaluation for in pneumothorax is limited on this supine radiograph. No acute osseous abnormalities are detected.", "output": "Lines and tubes positioned as described. Consider advancement of NG tube for more optimal positioning. Bilateral pleural effusions, severe pulmonary edema, cannot exclude pneumonia." }, { "input": "The lung volumes are low compared to prior. Mild increased right infrahilar opacity is likely due to crowding of the vessels. No pleural abnormality is seen. The cardiomediastinal silhouette is unchanged and normal.", "output": "No significant lymphadenopathy and unchanged compared to ___." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is present. Clips are noted in the right axilla. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "As compared to prior chest radiograph from ___, lung volumes have decreased accentuating the cardiac silhouette and bronchovascular structures. No focal consolidations concerning for pnuemonia are identified. There is no pulmonary edema, pleural effusions or pneumothorax.", "output": "No radiographic evidence of an acute cardiopulmonary process." }, { "input": "A left subclavian catheter line is seen projecting within the SVC. A nasogastric tube projects over the gastric fundus. As compared to most recent prior exam, there has been no significant change. There is stable mild cardiomegaly. There is no evidence of pneumonia. There are no pleural effusions or pneumothorax.", "output": "Stable chest examination with no evidence of pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. Pectus excavatum is again seen, accentuating the cardiac silhouette. There are extensive costochondral calcifications. No new focal consolidation is seen. There is no pleural effusion or pneumothorax. There are calcifications along the aorta. Minimal loss of height of the superior endplate of a lower thoracic vertebral body is stable.", "output": "No acute cardiopulmonary process." }, { "input": "The support and monitoring devices are unchanged. The first side port of the nasogastric tube remains at the GE junction. The overall appearance of the lung are unchanged with hyperinflation and linear calcific opacity in the periphery of the right lung. No acute focal consolidation or interstitial edema. The cardiomediastinal and hilar contours are within normal limits. Localized lucency in the right costophrenic angle likely represents localized bullous disease.", "output": "1. No significant interval change. 2. Hyperinflation suggestive of COPD and calcified pleural plaque in the right lung. 3. Localized lucency in the right costophrenic angle likely represents localized bullous disease and less likely a loculated basilar pneumothorax" }, { "input": "Endotracheal tube terminates approximately 4.9 cm above the level of the carina. Enteric tube courses below the diaphragm, terminating in left upper quadrant ; side port appears to be at the level of the gastroesophageal junction, consider advancement so that it is well within the stomach. Right subclavian central venous catheter terminates in the low SVC. No evidence of pneumothorax is seen. The lungs are hyperinflated appear blunting of the costophrenic angles may be due to small pleural effusions. Possible pleural plaque is seen particularly over the right upper to mid hemi thorax. The cardiac and mediastinal silhouettes are unremarkable. .", "output": "Endotracheal tube terminates approximately 4.9 cm above the level of the carina. Enteric tube courses into the left upper quadrant, however, the distal side port appears to be at the level of the gastroesophageal junction, consider advancement so that it is well within the stomach. Right subclavian central venous line terminates in the low SVC without evidence of pneumothorax. Possible small bilateral pleural effusions." }, { "input": "The endotracheal tube is in satisfactory position terminating 6.2 cm above the carina. There is a linear opacity the at the right lung in the periphery. Areas of streaky atelectasis is identified at the right lung base. There are bilateral small pleural effusions. The cardiomediastinal silhouette and hilar contours are within normal limits. No pneumothorax is seen.", "output": "1. Endotracheal tube terminates 6.2 cm above the carina. 2. Linear opacity at the periphery of the right lung for which a dedicated chest CT is recommended for further evaluation if not previously obtained. 3. Bilateral small pleural effusions." }, { "input": "There is a focal opacity at the right lung base, localize to the lower lobe on the lateral view concerning for pneumonia. The heart remains moderately enlarged. There is no pleural effusion or pneumothorax.", "output": "1. Right lower lobe opacity concerning for pneumonia. 2. Moderate cardiomegaly. NOTIFICATION: Findings emailed to ED QA nurse by Dr.___ at 11:10am on ___." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. There is persistent enlargement of the cardiac silhouette. No pulmonary edema is seen.", "output": "Persistent enlargement of the cardiac silhouette. No focal consolidation." }, { "input": "The lungs are clear.Moderate cardiomegaly is stable since ___. Mediastinal and hilar contours are normal.No pleural abnormality is seen.", "output": "Stable cardiomegaly. No acute process." }, { "input": "No focal consolidation is seen. There may be a tiny pleural effusion. Enlarged cardiac silhouette and mild pulmonary vascular prominence is again noted. No pneumothorax is detected.", "output": "Possible trace pleural effusion with otherwise stable chest radiograph." }, { "input": "The cardiac silhouette is enlarged. The mediastinal and hilar contours are normal. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "Cardiomegaly. No acute cardiopulmonary process." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. The mediastinum is not widened. Incidental note is made of an azygos lobe.", "output": "No acute cardiopulmonary process." }, { "input": "There are relatively low lung volumes. Left mid lung linear atelectasis/scarring is seen. There is no focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is mildly enlarged. The aorta is calcified and tortuous. While there may be minimal central pulmonary vascular engorgement. There is no overt pulmonary edema. No displaced fracture is seen.", "output": "Mild enlargement of the cardiac silhouette with possible minimal central pulmonary vascular engorgement, without overt pulmonary edema." }, { "input": "Heart size is normal. The aorta is tortuous, unchanged. Mediastinal and hilar contours are otherwise unremarkable. Pulmonary vasculature is normal. Lungs are clear. No focal consolidation, pleural effusion or pneumothorax is seen. No acute osseous abnormality is visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal and hilar contours are normal. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well expanded. An ill-defined ovoid opacity is noted in the left mid lung, with a correlate that abuts the major fissure in the lateral view, extending into the upper lobe. No other focal opacities are present. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "Left upper lobe pneumonia. Recommend follow-up to resolution to exclude underlying lesion." }, { "input": "A left upper lobe lesion persists and is unchanged from the immediate prior radiographs of ___. This is decreased from the radiographs of ___. No new focal opacity is seen. The heart size and cardiomediastinal contours are unchanged.", "output": "Unchanged left upper lobe nodule as compared to the prior examination, though is decreased in size from the examination prior to that in ___. If the patient remains symptommatic, this could represent persistent pneumonia and follow up radiographs in approximately 4 weeks could be obtained to evaluate for resolution. If however the patient is no longer symptommatic, this could represent an underlying lesion and dedicated chest CT would be recommended. Findings discussed with Dr. ___ at 3:10 pm ___." }, { "input": "Left-sided vagal nerve stimulator is again seen. The cardiac and mediastinal silhouettes are stable. There is no definite focal consolidation. No large pleural effusion is seen. There is slight blunting of the left costophrenic angle which may be due to overlying soft tissue although a trace pleural effusion would be difficult to exclude. No pneumothorax is seen.", "output": "Slight blunting of the left costophrenic angle which may be due to overlying soft tissue although a trace pleural effusion would be difficult to exclude. Otherwise, no significant interval change." }, { "input": "AP and lateral views of the chest. Lower lung volume is seen on the frontal exam with secondary crowding of the bronchovascular markings. The lungs are clear of focal consolidation or effusion. The cardiomediastinal silhouette is unchanged. Hypertrophic changes are noted in the spine. Left vagal nerve stimulator device is again seen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest demonstrate well-expanded and clear lungs. Heart is top normal in size and cardiomediastinal contour is unremarkable. There is no pleural effusion or pneumothorax. Anterior bridging osteophytes are noted along the spine. A vagal nerve stimulator is again seen.", "output": "No acute intrathoracic abnormality." }, { "input": "Lung volumes remain low with consequent enlargement of cardiac silhouette and crowding of the pulmonary bronchovascular structures. No consolidation seen. A vagal nerve stimulator is seen in the left upper chest however no leads are visualized. A nasogastric tube terminates in the stomach. Dilated, air-filled loops of small bowel are seen in the upper abdomen, incompletely evaluated on this study.", "output": "The nasogastric tube terminates in the stomach." }, { "input": "A left vagal nerve stimulator is in unchanged position. Low lung volumes accentuate the cardiomediastinal contours and result in crowding of bronchovascular structures. With this limitation in mind, there is likely mild pulmonary vascular congestion but no overt evidence of pulmonary edema or pneumonia. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable. Elevation of left hemidiaphragm is likely due to adjacent gastric distension.", "output": "No evidence of pneumonia. If clinical suspicion persists, repeat radiograph with improved inspiratory level may be helpful for more complete assessment." }, { "input": "The airway stent is not well visualized on the current study. Outside CT study demonstrated extensive nodular pleural disease which makes assessment for intraparenchymal disease difficult on this frontal film. Compared to the prior chest x-ray in our system the amount of metastatic disease has substantially increased. There is opacities in the right upper lobe and is unclear if these are due to infiltrate or the superimposed pleural disease. Scarring in the left lateral lung is again visualized. The cardiac silhouette is mildly enlarged, similar to prior.", "output": "Extensive metastatic disease makes assessment of the right lung difficult. The stent is not adequately visualized WET READ VERSION #1 ___ ___ ___ 6:14 PM ___ year old woman with status post airways stent. TECHNIQUE: Frontal chest radiograph was obtained with the patient in the upright position. COMPARISON: Chest CT from ___ and ___ FINDINGS: Opacities in the right lobe are compatible with postsurgical changes and known metastatic disease. The visualized left lung is appears clear of consolidation. Extent within the airways are not well seen. The cardiac silhouette is normal in size. WET READ VERSION #2 ___ ___ ___ 8:07 AM ___ year old woman with status post airways stent. TECHNIQUE: Frontal chest radiograph was obtained with the patient in the upright position. COMPARISON: Chest CT from ___ and ___ FINDINGS: Opacities in the right lobe are compatible with postsurgical changes and known metastatic disease. The visualized left lung is appears clear of consolidation. Extent within the airways are not well seen. The cardiac silhouette is normal in size. IMPRESSION: No change. ______________________________________________________________________________ FINAL REPORT EXAMINATION: CHEST (PORTABLE AP) INDICATION: ___ year old woman with s/p stent // s/p airway stent" }, { "input": "The airway stent is not well visualized. The right upper lobe opacity has minimally decreased. The background anterior, right hilar and right lower lobe pleural masses are stable, within right middle lobe volume loss. There is scarring in left lateral. The cardiac silhouette remains enlarged unchanged. No pneumothorax. Multiple rib deformities are seen the left.", "output": "No significant interval change." }, { "input": "The stent is not visualized. There has been some interval partial clearing of the opacity seen in the upper lobe on the most recent study from ___. However, there continues to be a right upper lobe infiltrate. The right lower lobe continues to have volume loss/infiltrate. The left heart border is obscured and is unclear if there is volume loss or infiltrate in the left lower lobe", "output": "Compared to the prior study there has been some improvement in the aeration of the right upper lobe and worsening in the aeration of the left lower lobe" }, { "input": "A 1.0 cm pulmonary nodule is seen anteriorly on the lateral film which corresponds to the nodule seen on chest CT from ___ in the right middle lobe. The other known pulmonary nodules seen on prior chest CT from ___ are not well seen on today's radiograph. There is no evidence of pneumonia or pleural effusion or pneumothorax. The cardiomediastinal contours are normal. Moderate compression fracture of an upper thoracic vertebral body, may be slightly worse compared to ___.", "output": "No acute cardiopulmonary process.A 1.0 cm pulmonary nodule is seen anteriorly on the lateral film which corresponds to the nodule seen on chest CT from ___ in the right middle lobe. The other known pulmonary nodules seen on prior chest CT from ___ are not well seen on today's radiograph. Moderate compression fracture of an upper thoracic vertebral body, may be slightly worse compared to ___." }, { "input": "There is no pleural effusion, pneumothorax or focal airspace consolidation. Prominence of the pulmonary arteries is consistent with pulmonary arterial hypertension and is unchanged. There is evidence of emphysema within the upper lobes. Heart size is unchanged and top normal in size. There is an exaggerated senile kyphosis of the thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "Slightly limited evaluation due to detector plate artifact. Heterogeneous retrocardiac opacity noted. No pleural effusion or pneumothorax. Mild cardiomegaly is noted. Mediastinal contour and hila are otherwise unremarkable.", "output": "Findings suspicious for left lower lobe pneumonia. Clinical correlation recommended. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the ___ ___ at 12:33 PM, 5 minutes after discovery of the findings." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are normal. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Moderate to severe enlargement of the cardiac silhouette is present. Mediastinal contours unremarkable. There is mild interstitial pulmonary edema with perihilar haziness and increased interstitial opacities bilaterally. No pleural effusion, focal consolidation or pneumothorax is present. Mild multilevel degenerative changes are noted in the thoracic spine.", "output": "Moderate to severe cardiomegaly with mild interstitial pulmonary edema." }, { "input": "PA and lateral views of the chest. The lungs are clear. The cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. Relatively low inspiratory effort seen on the current exam with secondary crowding of the bronchovascular markings. Linear right basilar opacity is seen most likely due to atelectasis. Superiorly the lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities detected.", "output": "Linear right basilar opacity most likely due to atelectasis given the low lung volumes. Infection is not entirely excluded. If desired, repeat frontal view with improved inspiratory effort can be performed to further clarify." }, { "input": "Frontal and lateral views of the chest were obtained. Relative patchy opacity in the left lung base on the frontal view is not well substantiated on the lateral view and could be due to atelectasis or early infection. No large pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Partially imaged is cervical hardware in the lower cervical spine.", "output": "Patchy left base opacity only seen on the frontal views, could be due to atelectasis, although infectious process is not excluded in the appropriate clinical setting." }, { "input": "Mild enlargement of the cardiac silhouette is present. The mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Lungs are clear. No focal consolidation, pleural effusion or pneumothorax is present. Mild loss of height anteriorly of ___ mid thoracic vertebral bodies is likely chronic.", "output": "Mild cardiomegaly without pulmonary edema." }, { "input": "There has been interval placement of a right Pleurx catheter with substantial improvement of the right effusion, now with small remnant fluid. There is a likely small left pleural effusion. There is mild pulmonary edema and vascular congestion relatively unchanged from prior exam. Enlarged cardiac silhouette and hilar contours are stable. A left pectoral pacer is unchanged in position. There is no pneumothorax.", "output": "Right Pleurx catheter in place with substantial improvement in right pleural effusion. Persistent small left effusion, and mild pulmonary edema and vascular congestion." }, { "input": "There is a large right-sided pleural effusion, slightly increased in size compared with prior exam. There is diffuse increased interstitial markings, Kerley B lines, and upper vascular redistribution, but no focal opacities. Large cardiomegaly is redemonstrated. There is no left-sided pleural effusion and no pneumothorax. Sternotomy wires are intact.", "output": "Findings compatible with pulmonary edema." }, { "input": "There is a new left-sided dual lead pacemaker with tips projecting over the expected location. Heart there is increased right-sided pleural effusion. Moderate cardiomegaly, pulmonary vascular redistribution and alveolar infiltrates, right greater than left compatible with asymmetric pulmonary edema that has worsened compared to the film from the prior day. There is no pneumothorax.", "output": "Worsened pulmonary edema." }, { "input": "There is a large right and small left pleural effusion with mild pulmonary vascular redistribution and moderate cardiomegaly. The findings are compatible with CHF. Given technique, the extent of the CHF is similar compared to prior. Dual lead pacemaker with leads in similar location compared to prior is again seen. The patient is status post sternotomy with sternal wires and mediastinal clips.", "output": "No significant change. CHF." }, { "input": "Frontal and lateral views of the chest are obtained. There is mild-to-moderate diffuse bilateral interstitial edema. Right pleural effusion with overlying atelectasis. Patient is status post median sternotomy and CABG. Mild-to-moderate cardiomegaly persists. Degenerative changes are seen along the spine.", "output": "Moderate interstitial pulmonary edema. Right pleural effusion with overlying atelectasis. Persistent cardiomegaly." }, { "input": "The patient is status post median sternotomy and CABG. Mild to moderate enlargement of cardiac silhouette is unchanged. The aortic knob remains calcified. There is worsening pulmonary edema which is now mild in extent. A moderate to large right pleural effusion appears relatively unchanged compared to the prior exam. There is continued right basilar opacification which may reflect compressive atelectasis though underlying infection cannot be excluded. No pneumothorax is identified, and a left-sided pleural effusion is not noted.", "output": "Worsening mild pulmonary edema. Persistent moderate to large right pleural effusion with associated right basilar opacification likely reflecting compressive atelectasis though infection cannot be completely excluded." }, { "input": "There has been interval resolution of the large right-sided pleural effusion status post thoracentesis. There is a new small right pneumothorax with apical and basal components. Mild interstitial edema is unchanged. Moderate cardiomegaly is unchanged. Stable postsurgical mediastinal contour. A left pacer is in place unchanged in position.", "output": "Small right postprocedural pneumothorax with apical and basilar components. Interval resolution of right pleural effusion. Results were discussed over the telephone with Dr. ___ at 13:16 on ___ at time of initial review." }, { "input": "There are few calcific nodular densities identified at the right lung base laterally likely calcified granulomas. Elsewhere, the lungs are clear without consolidation, effusion or pneumothorax. Cardiomediastinal silhouette is normal. No acute osseous abnormalities identified. There is no free intraperitoneal air.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Lungs are well-expanded and clear without focal consolidation concerning for pneumonia. The upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Compared to the prior radiograph, there is increased opacification in the retrocardiac region, which could represent atelectasis or developing infection. The lungs are otherwise clear. Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax.", "output": "Increased retrocardiac opacification could represent atelectasis or developing infection." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest were provided. Calcified pleural plaque is noted, which may account for the scattered opacities within both lungs. The lung volumes are low, which limits the assessment. Given the rounded appearance of a lesion projecting over the right mid-to-upper lung, a CT is needed to ensure the aforementioned lesions represent pleural calcified plaque. There is mild bibasilar atelectasis and bronchovascular crowding without discrete evidence for pneumonia or overt CHF. No large effusions or pneumothorax seen. Midline sternotomy wires are noted. There is a prosthetic cardiac valve. The heart size and mediastinal contour appear within normal limits. No acute bony injuries.", "output": "Scattered calcified pleural plaque, likely accounts for the rounded and vague opacities projecting over both lungs. Recommend CT to confirm, on a non-emergent basis." }, { "input": "The lungs are well expanded. A small right pleural scar is unchanged. The cardiac silhouette remains top normal in size, with probable mild retrocardiac atelectasis. The mediastinal contours are normal. The pulmonary vasculature is normal.", "output": "Top normal heart size, with small right pleural scar and minimal retrocardiac atelectasis." }, { "input": "Portable semi-upright radiograph of the chest demonstrates an enlarged cardiac silhouette, with sternotomy wires. Left-sided 2 lead pacemaker is present, with lead tips over right atrium and right ventricle. The pulmonary vasculature is indistinct. There is a right lower lobe opacity, not seen on prior examination, concerning for pneumonia in the appropriate clinical context. A small right pleural effusion may be present. Patchy opacity at the left base may represent atelectasis. Surgical clips are seen in the right upper abdomen immediately to the left of midline. .", "output": "Findings consistent with CHF/ edema. Right lower lobe opacity, of uncertain etiology or significance. The differential includes atelectasis in the setting of CHF. However, in the appropriate clinical context, it is concerning for pneumonia. This should be followed to assess for evolution/confirm resolution. RECOMMENDATION(S): Follow-up chest radiographs to assess for evolution/resolution of opacity at the right lung base." }, { "input": "AP upright and lateral views of the chest were provided. The lung volumes are quite low, which limit the evaluation. There is crowding of bronchovasculature resulting of the low lung volumes. Given this appearance, a subtle pneumonia is difficult to exclude. No large effusion or pneumothorax is seen. The cardiomediastinal silhouette appears grossly unremarkable, although the patient is rotated to the left, which limits evaluation. The bony structures appear intact.", "output": "Limited study with low lung volumes. No overt evidence of pneumonia or CHF. If there is strong clinical concern for acute pathology, a repeat is recommended with more optimized technique." }, { "input": "There is a metallic stent graft along the descending aorta and prior sternotomy. FINDINGS: There is similar moderate elevation of the right hemidiaphragm. A mild interstitial abnormality and cephalization of pulmonary vascularity suggests slight congestion, but otherwise the lungs appear clear. There is no pleural effusion or pneumothorax. The bones are probably demineralized.", "output": "Status post stent graft placement and sternotomy. Findings suggesting mild vascular congestion." }, { "input": "The patient is status post aortic stent graft placement, with similar appearance of the graft and adjacent aortic contour. Cardiac silhouette remains enlarged, but there is no evidence of pulmonary edema. Within the lungs, minor areas of atelectasis are present at both lung bases. Questionable pleural effusions have developed.", "output": "Minor bibasilar atelectasis and possible small pleural effusions." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal to mildly enlarged. There is mild elevation of the right hemidiaphragm.", "output": "Mild elevation of the right hemidiaphragm. Top-normal to mildly enlarged cardiac silhouette. No focal consolidation." }, { "input": "There are new multifocal patchy opacities in the bilateral lungs, which in the setting of sickle cell disease is concerning for acute chest syndrome. The heart size is top normal. No pneumothorax. Surgical clips from a prior cholecystectomy are noted in the right upper quadrant.", "output": "New multifocal patchy opacities in the lungs, which in the setting of sickle cell disease is concerning for acute chest syndrome." }, { "input": "The heart size is mildly enlarged but unchanged. Mediastinal and hilar contours are normal. Minimal streaky left lower lobe opacity likely reflects atelectasis. No focal consolidation, pleural effusion or pneumothorax is identified. Splenic shadow is absent. Clips are seen in the right upper quadrant the abdomen.", "output": "Streaky left lower lobe opacity likely reflects atelectasis. Infection however is not completely excluded." }, { "input": "A newly placed Dobbhoff tube enters the right mainstem bronchus. A newly placed tracheostomy tube is 3.4 cm above the carina. A left-sided internal jugular catheter tip terminates in the distal SVC. An opacification of the posterior right upper lobe is unchanged. Otherwise, the lungs are clear. There is no pneumothorax or definite pleural effusion. The cardiac and mediastinal contours are normal. Cholecystectomy clips are noted.", "output": "1. Dobbhoff tube in the right mainstem bronchus. These findings were discussed with Dr. ___ by Dr. ___ at ___ hours on ___ by telephone immediately at the time of discovery. 2. Persistent right upper lobe opacification." }, { "input": "PA and lateral chest radiographs demonstrate mild cardiomegaly, improved when compared to prior examinations. There is no pulmonary vascular congestion or evidence of pulmonary edema. The lungs are clear and there is no pneumothorax. Surgical clips are noted in the right upper quadrant. Sclerotic appearance to lower thoracic vertebrae appears to also involve the lumbar spine, though it is not appreciated on most recent radiograph. This can be more completely evaluated with frontal and lateral views of the Lumbar spine.", "output": "No acute cardiopulmonary process." }, { "input": "AP portable view of the chest. Heart size is top normal. There is mild pulmonary vascular congesion. The mediastinal contours are normal. No focal consolidation, pleural effusion, or pneumothorax.", "output": "Mild pulmonary vascular congestion. Recommend PA and lateral views after hemodynamic status improves." }, { "input": "A right PICC terminates in the mid to distal superior vena cava. Tracheostomy tube is in satisfactory position. An enteric tube is present and terminates out of the field of view, likely within the duodenum. A left internal jugular catheter has been removed in the interim. Cholecystectomy clips are noted. The known right upper lobe posterior consolidation is slightly decreased in density. Mild pulmonary edema is stable. There is no pleural effusion, pneumothorax or new focal consolidation. The cardiac and mediastinal contours are normal. The splenic shadow is absent.", "output": "Slight decrease in density of the right upper lobe consolidation." }, { "input": "Portable upright chest radiograph ___ at 11:46 is submitted.", "output": "Cardiac and mediastinal contours are stable. Lungs appear well aerated without evidence of focal airspace consolidation, pleural effusion or pneumothorax. Surgical clips are again seen in the region of the right superior mediastinum. Clips in the right upper quadrant consistent with prior cholecystectomy. Prominent amount of gas in the splenic flexure." }, { "input": "There is little change compared to a prior study. Heart size remains mildly enlarged. Hilar contours are unremarkable. Mild interstitial edema is unchanged. There is a small right pleural effusion. Endotracheal tube and right PICC line are in appropriate position. There is no pneumothorax. Small amount of pneumoperitoneum is present, likely from recent PEG tube placement and was also present on recent CT examination.", "output": "Little change compared to a prior examination with re-demonstration of minimal interstitial edema and small right effusion. No focal consolidation worrisome for infectious process. Trace pneumoperitoneum is likely from recent PEG tube placement." }, { "input": "PA and lateral views of the chest were obtained. Cardiomediastinal silhouette is notable for mild stable cardiomegaly. Lungs are well expanded and clear. Mild pulmonary edema is present. No effusion or pneumothorax.", "output": "Cardiomegaly and mild pulmonary edema. No consolidation." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs. There is vascular congestion without frank pulmonary edema. No focal consolidation, pleural effusion, or pneumothorax is appreciated. The visualized upper abdomen is unremarkable.", "output": "Mild vascular congestion without frank pulmonary edema." }, { "input": "Frontal and lateral views of the chest again mild demonstrate patchy opacification in the left lung base, which is likely atelectasis. There is no pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal. Previously seen right sided PICC is no longer seen. Cholecystectomy clips are noted within the right upper quadrant.", "output": "Patchy opacification left lung base may represent atelectasis, although, aspiration cannot be excluded." }, { "input": "There are increased bilateral intersitial markings. But the lungs are without a focal consolidation, effusion, or pneumothorax. The heart is moderately enlarged Endotracheal tube is appropriately positioned within the mid trachea. No acute fractures are identified but the ribs appear enlarged with a salt and pepper appearance. Surgical ___ are noted throughout the upper neck.", "output": "1. ET tube in appropriate position. 2. The heart is enlarged and there are increased interstitial markings. Continued followup is recommended. 3. Enlarged ribs with a patchy salt and pepper appearance, consistent with patient's known hyperparathyroidism." }, { "input": "ET tube remains in standard position. An enteric tube is present with tip in the stomach, but side port in the esophagus. Cardiomediastinal and hilar contours are stable with moderate cardiomegaly. There is no pleural effusion or pneumothorax. There is worsening consolidation in the right upper lobe, consistent with pneumonia. Cephalization may be physiologic in a supine position. Surgical clips are noted in the right upper quadrant.", "output": "1. Worsening right upper lobe consolidation consistent with pneumonia. 2. Enteric tube should be advanced 5 cm to place the side port in the stomach." }, { "input": "Mild interstitial pulmonary edema and pulmonary vascular congestion. Mild to moderate cardiomegaly. No pleural effusions or pneumothorax. Surgical clips over the upper neck related prior thyroid surgery. Heterogeneous diffusely sclerotic bone with sclerosis of bilateral subchondral humeral heads. Note is also made of an absent spleen and prior cholecystectomy.", "output": "Diffuse mild interstitial abnormality likely pulmonary edema. Bilateral mild sclerosis of the humeral heads can be avascular necrosis. Diffuse sclerosis of the bones likely due to patients known diagnosis ESRD and sickle cell disease. RECOMMENDATION(S): Repeat radiograph after hemodialysis could be considered to ensure resolution of interstitial abnormality." }, { "input": "Low lung volumes are seen with secondary crowding of the bronchovascular markings. There is no consolidation or effusion. The cardiac silhouette is accentuated by low lung volumes but is likely within normal limits. No acute osseous abnormalities identified.", "output": "Low lung volumes without acute cardiopulmonary process." }, { "input": "Mild hyperinflation of the lungs results in relative flattening of both hemidiaphragms. The lungs are grossly clear, with no pneumothorax, pleural effusion, pulmonary edema, or focal airspace opacity. The cardiomediastinal silhouette is unremarkable. No displaced rib fractures are identified.", "output": "Hyperinflation, with no displaced rib fracture or focal airspace consolidation." }, { "input": "AP portable upright view of the chest. Left IJ CV catheter tip terminates in the low SVC. There has been interval extubation and removal of the nasogastric tube. Diffuse pulmonary opacities are slightly improved and likely represent edema though a superimposed pneumonia would be difficult to exclude. Pleural effusions are likely small. Cardiomediastinal silhouette is stable. No pneumothorax. Bony structures are intact. Skin ___ project over the mid abdomen.", "output": "Interval extubation and removal of nasogastric tube. Persistent pulmonary opacities appear slightly improved though raise concern for persistent edema with possible superimposed pneumonia." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable", "output": "No acute cardiopulmonary abnormalities" }, { "input": "The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. Lung volumes are low, but no focal consolidation is seen. There is no acute osseous abnormality. Views of the upper abdomen are unremarkable.", "output": "No radiographic explanation for chest pain." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette. A density overlying the right mid lung is likely within the soft tissue. A left lower lobe hyperdensity was previously evaluated with CT chest in ___ and corresponds with a clinical history of retained/dislodged metal forceps tip. The lungs are well-aerated and clear without pulmonary edema or focal consolidation. There is no pleural effusion or pneumothorax.", "output": "Clear lungs without pulmonary edema or focal consolidation." }, { "input": "Left lower lobe consolidation raises concern for pneumonia. Findings could also relate to atelectasis. Multiple pulmonary nodules are noted, better assessed on CT. There appears to be a trace left pleural effusion. No definite pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Left-sided Port-A-Cath terminates in the right atrium.", "output": "Left lower lobe consolidation raises concern for pneumonia. Possible trace left pleural effusion. Multiple pulmonary nodules better assessed on CT." }, { "input": "Portable upright chest radiograph ___ at 16:06 is submitted.", "output": "Multiple pulmonary nodules are again seen consistent with known metastatic disease. Bilateral effusions with adjacent patchy opacity likely reflecting atelectasis. No new airspace consolidation is seen to suggest pneumonia. Overall cardiac and mediastinal contours are stable. No evidence of pulmonary edema. Left internal jugular Port-A-Cath has its tip in the proximal right atrium." }, { "input": "Multiple bilateral pulmonary nodules are again seen. There is scarring/ atelectasis at the lateral left lung base as well pleural thickening. There is persistent blunting of the left costophrenic angle. There is also slight blunting of the right costophrenic angle. Patchy left base retrocardiac opacity is seen, nonspecific, could relate to infection or metastatic disease. No pneumothorax is seen. Left-sided Port-A-Cath terminates in the right atrium.", "output": "Multiple bilateral pulmonary nodules are again seen. There is scarring/ atelectasis at the lateral left lung base as well pleural thickening. There is persistent blunting of the left costophrenic angle. There is also slight blunting of the right costophrenic angle. Patchy left base retrocardiac opacity is seen, nonspecific, could relate to infection or metastatic disease. No pneumothorax is seen. Left-sided Port-A-Cath terminates in the right atrium." }, { "input": "Cardiomediastinal contours are normal. There are new bilateral pleural effusions right greater than left with volume loss at both bases. The bilateral pulmonary nodules are again visualized are better characterized on the CT from ___", "output": "New bilateral pleural effusions." }, { "input": "Numerous bilateral pulmonary nodular lesions consistent with metastases are overall more conspicuous as compared to the prior study. No definite new focal consolidation is seen. There is persistent blunting of the costophrenic angles, suggesting small pleural effusions, increased at least on the right. No pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. Left-sided Port-A-Cath terminates in the proximal right atrium.", "output": "Multiple bilateral pulmonary nodules overall appear more conspicuous as compared to the prior study, which may be due to differences in technique /penetration, although is concerning for slight progression of disease. No definite new focal consolidation seen. Small right pleural effusion, new/increased compared to the prior study. Persistent blunting of the left costophrenic angle." }, { "input": "Heart size is normal. The mediastinal and hilar contours are unremarkable. The pulmonary vasculature is not engorged. At least 2 nodular opacities are seen within the right upper lobe, the largest measuring up to 12 mm, and an additional nodular opacity is seen projecting over the left mid lung laterally measuring up to 10 mm. Linear opacities in the lung bases likely reflect areas of atelectasis. No pleural effusion, focal consolidation or pneumothorax is seen. Marked gaseous distension of colonic loops of bowel in the upper abdomen are noted. No acute osseous abnormality is detected.", "output": "1. Several nodular opacities within both lungs measuring up to 12 mm which require further assessment with CT of the chest if no previous imaging studies are available for comparison. Bibasilar atelectasis. 2. Marked gaseous distention of colonic loops of bowel in the upper abdomen. Clinical correlation is recommended and consider dedicated imaging of the abdomen for further assessment if needed. RECOMMENDATION(S): 1. Comparison with previous imaging of the chest is recommended, and if none are available, CT of the chest is necessary. 2. Marked gaseous distention of colonic loops of bowel in the upper abdomen. Clinical correlation is recommended and consider dedicated imaging of the abdomen for further assessment if needed." }, { "input": "The heart is normal in size. There is slight unfolding of the thoracic aorta. The mediastinal and hilar contours are otherwise unremarkable. There are multiple nodular opacities in each lung, the most prominent of which projects over the left mid-to-upper lung with a rounded contour. There is no pleural effusion or pneumothorax. Mild degenerative changes are noted along the thoracic spine.", "output": "No findings suggestive of congestive heart failure, but multiple nodular opacities, worrisome for malignancy, although other etiologies could be considered. Correlation with clinical history and chest CT are suggested if the etiology for these is unknown. Findings discussed with Dr. ___ at 1:10 am by telephone on ___." }, { "input": "PA and lateral views of the chest were obtained. Lungs are well expanded and clear. Pulmonary vascularity is within normal limits. Heart is normal in size, and cardiomediastinal contour is unremarkable. There is no pleural effusion or pneumothorax. The upper abdomen is unremarkable and bones are grossly intact.", "output": "No acute cardiopulmonary process." }, { "input": "AP portable upright view of the chest. Endotracheal tube is seen with its tip residing 4.3 cm above the carina. There is no focal consolidation, effusion, or pneumothorax. Mild retrocardiac atelectasis is noted. Heart size appears top-normal. The mediastinal contour is normal. Imaged osseous structures are intact.", "output": "Endotracheal tube positioned appropriately. Top normal heart size." }, { "input": "Cardiomediastinal silhouette and hilar contours are unremarkable. Multiple nodular opacities in the right lung are better evaluated on prior CT examination. Patient is status post transbronchial biopsy and then there is a small right apical pneumothorax present. There is no large pleural effusion. The left lung is essentially clear.", "output": "Status post right transbronchial biopsy with associated small right apical pneumothorax. Results were discussed over the telephone with Dr. ___ by Dr. ___ at 1:58 p.m. on ___ at time of initial review." }, { "input": "Large prominent stomach air bubble. New small right pleural effusion with continued fluid in the superior pleural space with no significant change in right upper lobe opacity. Mild tracheal deviation to the left from a known thyroid goiter as seen on CT. No pneumopericardium, pneumomediastinum or pneumothorax. Improvement in subcutaneous emphysema. No new focal opacity or pulmonary edema. Heart size, mediastinal contour and hila are normal. Tortuous aorta noted.", "output": "1. New small right pleural effusion with continued fluid in superior pleural space. 2. No change in the right upper lobe opacity. No pneumothorax." }, { "input": "PA and lateral radiographs of the chest demonstrate interval improvement in right apical opacity previous seen in ___. Residual opacity at the right apex likely represents scarring. There is no opacity concerning for airspace consolidation. No pleural effusion or pneumothorax is seen. The cardiac, mediastinal, and hilar contours are normal. Left pleural lipoma is noted.", "output": "Right apical parenchymal scarring with no evidence of pneumonia." }, { "input": "Compared to examination from two hours prior, there has been significant progression of right pneumothorax which is large in size easily seen apically, laterally and inferiorly with clear delineation of the right upper lobe and minor fissure with signs of early tension with flattening of the right hemidiaphragm. The left lung remains clear.", "output": "Significant increase in size of a large right pneumothorax with early tension. Results were discussed over the telephone with the interventional pulmonary team by Dr. ___ at 2:40 p.m. on ___ at time of initial review and again with Dr. ___ at 3:57 p.m." }, { "input": "In the interval since the prior study, there has been development of large posterior right upper lobe opacity. Findings are concerning for pneumonia. In the prior chest CT from ___, a 14 mm spiculated nodule is seen in the posterior right upper lob; conceivable but much less likely, there may have been quite significant growth of the nodule in the interval. Also, correlate with any history of intervening procedure. Right paratracheal opacity with leftward indentation of the trachea is consistent with patient's known enlarged right lobe of the thyroid. No large pleural effusion is seen in the small amount of pleural fluid along the right lung apex is difficult to exclude. There is no evidence of pneumothorax. The aorta is calcified and slightly tortuous. The cardiac silhouette is not enlarged. There is no overt pulmonary edema.", "output": "Large posterior right upper lobe opacity is concerning for pneumonia. On prior chest CT from ___, a 14 mm spiculated nodule is in the posterior right upper lob; conceivable but much less likely quite significant growth of the nodule in the interval. Also, correlate with any history of intervening procedure. The large posterior right upper lobe opacity was not seen on chest radiograph from ___. Right paratracheal opacity with leftward deviation of the trachea again seen, consistent with patient's known enlarged right lobe of thyroid." }, { "input": "Opacity in the right lower lung with silhouetting of a portion of the right hemidiaphragm, right shift of the heart, and probable elevation of the right hemidiaphragm is most compatible with atelectasis, new from the prior exam. The remaining right lung and left lung are essentially clear. No edema or large pleural effusion. No pneumothorax. The heart size is normal. The mediastinum is not widened. No acute osseous abnormality. Incompletely imaged coarse calcifications projecting over the right upper abdomen are consistent with sequelae of prior granulomatous disease, imaged more completely on the recent CT abdomen and pelvis.", "output": "Interval development of right lower lobe atelectasis, likely from aspiration and mucoid impaction of the airway when compared with prior imaging. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 9:05 PM, 1 minutes after discovery of the findings." }, { "input": "Normal heart size. Normal hilar contours. Increased opacity at the right base with complete obscuration of the contours of both the right hemidiaphragm and right heart border and rightward mediastinal shaft reflect complete collapse of the right middle lobe and worsening of severe right lower lobe atelectasis. The left costophrenic sulcus is not imaged, but the remainder of the left lung is clear. No pneumothorax. New, small region of consolidation in the right upper lobe close to the fissures could be early pneumonia, and, along with persistent atelectasis due to aspiration or uncleared bronchial secretions. Minimal pulmonary edema is unchanged.", "output": "1. Complete collapse of the right middle lobe and interval worsening of substantial, right lower lobe atelectasis. 2. Possible early pneumonia, right upper lobe. Consider aspiration or retained bronchial secretions. 3. Persistent mild pulmonary edema." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable, unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "A right PICC has been retracted and ends in the upper superior vena cava. Right lower lobe collapse has improved. Left lower lobe collapse has worsened. Parenchymal opacities are unchanged on the right and worse on the left. Mild pulmonary vascular congestion is also unchanged. The cardiac and mediastinal contours are stable.", "output": "1. Improved right lower lobe collapse. New left lower lobe collapse. 2. Parenchymal opacities are unchanged on the right and worse on the left. 3. Retraction of the PICC, now terminating in the upper superior vena cava." }, { "input": "Left PICC terminates in the low SVC. Right IJ catheter terminates in the mid SVC. Bilateral mid and lower lung parenchymal opacities have progressed, representing multifocal pneumonia. Superimposed pulmonary edema cannot be excluded. Upper lung zones are relatively spared. Stable appearance of the cardiomediastinal silhouette. No large pleural effusions. No pneumothorax.", "output": "1. Left PICC and right IJ catheter in appropriate position. 2. Progressing bilateral parenchymal opacities, representing multifocal pneumonia, however superimposed pulmonary edema cannot be excluded." }, { "input": "AP portable upright view of the chest. There has been interval significant increase in right pleural effusion, now large in size with residual partial aeration of the right upper lobe. Mild edema is likely present. There is likely a small left effusion with left basilar atelectasis. The heart size is difficult to assess. No large pneumothorax. Bony structures are intact.", "output": "Increased right pleural effusion now large in size with mild interstitial edema." }, { "input": "AP portable upright view of the chest. There is a large right pleural effusion which appears to have increased in the interval with associated lower lobe compressive atelectasis. There is mild left basilar atelectasis. Heart size is difficult to assess. Mediastinal contour also limited in overall assessment due to adjacent effusion. No large pneumothorax.", "output": "Increased, large right pleural effusion with associated compressive atelectasis in the right mid to lower lung. Mild atelectasis left lung base." }, { "input": "New from ___, is a moderate right pleural effusion with associated volume loss. Additionally, there is fullness of the right hilum. Minimal blunting of the left costophrenic angle it may represent an additional small left pleural effusion. There is no focal consolidation to suggest pneumonia although a right lower lobe process cannot be excluded. Mild pulmonary edema is present. Right-sided cardiac border is obscured. Mediastinal silhouette is normal.", "output": "1. New moderate right pleural effusion with associated volume loss and fullness of the right hilum; c hest CT with contrast is recommended for further evaluation. 2. No definite pneumonia however, a right lower lobe process cannot be excluded. 3. Mild pulmonary edema." }, { "input": "The heart is mildly enlarged. There is a retrocardiac opacity obscuring the left hemidiaphragm, suggesting a consolidation in the left lower lobe. Air bronchograms are noted within the opacity. Elsewhere, the lungs appear clear. There are no pleural effusions or pneumothorax.", "output": "Findings most consistent with consolidative pneumonia in the left lower lobe. Followup radiographs are recommended to show resolution after treatment in approximately eight weeks." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lung volumes are low, resulting in crowding of the bronchovascular structures. The left costophrenic angle is blunted, which may reflect left basilar effusion versus atelectasis, although infection cannot be excluded. No lobar consolidation, pleural effusion, pneumothorax, or overt pulmonary edema is seen. The heart size is normal. Mediastinal contours are normal.", "output": "Left CPA blunting may reflect atelectasis versus small pleural effusion. Findings may also reflect infection in the appropriate clinical setting." }, { "input": "The lungs are well inflated and clear. Heart size and mediastinal contours are normal. There is no pleural effusion or pneumothorax. Osseous structures are intact.", "output": "No acute cardiopulmonary process." }, { "input": "Severe cardiomegaly appears increased compared to the prior study. Aorta remains tortuous. Rightward deviation of the trachea is unchanged, and due to an underlying large thyroid nodule, as seen on the prior chest CTA. Central pulmonary vascular congestion is present along with perihilar haziness and probable trace right pleural effusion with small amount of fluid in the right minor fissure. Patchy atelectasis is seen in the lung bases without focal consolidation. No pneumothorax is seen.", "output": "Severe cardiomegaly with central pulmonary vascular congestion and probable trace right pleural effusion. Patchy atelectasis in the lung bases." }, { "input": "Chest, AP and lateral. Low lung volume causes crowding of the pulmonary vasculature. There is bilateral lower lobe atelectasis but the lungs are otherwise clear. Moderate cardiomegaly is unchanged given technique. There is central pulmonary vascular engorgement but no edema. There is no pneumothorax or large pleural effusion. Rightward tracheal deviation is chronic and likely secondary to an enlarged thyroid gland.", "output": "Cardiomegaly with pulmonary vascular engorgement but no frank edema. No evidence of pneumonia." }, { "input": "Heart size is normal. The mediastinal and hilar contours are within normal limits. Pulmonary vasculature is not engorged. Scarring is demonstrated within the lung apices. Hazy ovoid opacification is seen projecting over the medial aspect of the left apex measuring approximately 2.7 x 1.5 cm, not seen on the previous study or on the lateral, and could potentially be artifactual. Remainder of the lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. Diffuse atherosclerotic calcifications are seen in the thoracic aorta.", "output": "Hazy ovoid opacity projecting over the medial aspect of the left apex, not seen on the lateral view, could be artifactual. Otherwise, no acute cardiopulmonary abnormality. RECOMMENDATION(S): Consider repeat PA view with obliques for further assessment." }, { "input": "There appears to be medial right upper lung/paramediastinal scarring. No focal consolidation, pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Aortic knob calcification is seen. The lungs are relatively hyperinflated. Right apical pleural thickening noted.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are hyperinflated. There is a 6 mm nodular opacity projecting over the right upper lung. The lungs are otherwise clear without consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. No displaced fractures identified.", "output": "Hyperinflation of the lungs suggesting emphysema. Nodular opacity projecting over the right upper lung for which a nonurgent chest CT is suggested. No displaced fractures identified on this nondedicated exam." }, { "input": "PA and lateral views of the chest provided. Streaky retrocardiac opacity likely reflect mild atelectasis or scarring. Otherwise, lungs are clear. No convincing evidence for pneumonia or edema. No large effusion or pneumothorax is seen. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Two views were obtained of the chest. The lungs are well-expanded and clear without pleural effusion or pneumothorax. The heart is normal in size with normal mediastinal contours.", "output": "No acute intrathoracic process." }, { "input": "The right upper lobe pneumonia and perihilar opacities have resolved. The lungs are clear. The cardiomediastinal silhouette is normal.", "output": "Resolved right upper lobe pneumonia." }, { "input": "Frontal and lateral views of the chest demonstrate consolidation of the right upper lung, consistent with infection. There is apparent associated perihilar prominence suggestive of reactive lymphadenopathy. The cardiac silhouette is prominent, accentuated by low lung volumes. The thoracic aorta is slightly unfolded. There is no pneumothorax or pleural effusion. Trace subsegmental atelectasis may be present at the left base. The left lung is otherwise clear.", "output": "Findings consistent with the right upper lobe pneumonia. Recommend followup to resolution once treated with full course of antibiotics." }, { "input": "Compared to chest radiographs from ___, there is no significant change. Lungs are clear without focal consolidation, effusion, or pneumothorax. Mediastinum, hila and pleural surfaces are unremarkable. Heart size is normal.", "output": "No evidence of pneumonia." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No evidence of pneumonia. If there is high clinical suspicion for obstructive lesion, recommend chest CT for further evaluation." }, { "input": "The heart is normal size and cardiomediastinal silhouette is unremarkable. Lungs are well-expanded and clear. The previously described faint opacity the right lower lung is no longer apparent and therefore likely represented an area of atelectasis. There is no pulmonary edema, focal consolidation, pleural effusion, or pneumothorax.", "output": "No acute intrathoracic process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. There is a faint opacity in the right lower lung. There is no pleural effusion or pneumothorax.", "output": "Faint opacity in the right lower lung could represent an area of aspiration or early pneumonia. Clinical correlation is recommended. NOTIFICATION: Findings discussed with Dr. ___ by NSR via phone on ___ at 7:50 AM." }, { "input": "Single AP view of the chest was reviewed. Enteric tube is present 5.6 cm above the carina. Enteric tube is noted, but sideholes are near the gastroesophageal junction. The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Lungs are well expanded and clear.", "output": "1. No acute cardiopulmonary process. 2. Advancement of enteric tube by several centimeters is recommended to ensure positioning of sideholes in the stomach." }, { "input": "The ET tube is unchanged. NGT extends below the diaphragm, with the side port in the proximal stomach. The heart continues to be moderately enlarged. There is mild pulmonary vascular redistribution with increase in interstitial markings suggesting an element of fluid overload", "output": "Increased fluid overload." }, { "input": "Endotracheal tube tip is 4.1 cm from the carina. Enteric tube tip seen in the region of the gastric fundus. Low lung volumes are seen with linear retrocardiac opacity potentially atelectasis. The lungs are otherwise grossly clear. Cardiac silhouette appears enlarged but likely accentuated due to low lung volumes. Lower thoracic dextroscoliosis is noted.", "output": "ET tube tip 4.1 cm from the carina." }, { "input": "Compared to the prior study there is no significant interval change", "output": "No change" }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Lungs are well-expanded and clear without focal consolidation concerning for pneumonia. Pulmonary vasculature is within normal limits. The upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "AP single view portable chest x-ray shows normal lung volume and no consolidation. There is no pulmonary edema. There is no pleural effusion or pneumothorax. Heart size is still mildly enlarged. The aorta is elongated.", "output": "No pulmonary edema or acute cardiopulmonary processes." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded clear lungs. There is widening of the superior mediastinum suggestive of lymphadenopathy in the right lower paratracheal station in the AP window. The heart is not enlarged. There is no pneumothorax of pleural effusion or consolidation.", "output": "1. Widening of the superior mediastinum is concerning for lymphadenopathy in the right lower paratracheal station and AP window. 2. No pneumonia. IMPRESSION: Findings were discussed with Dr. ___ by Dr. ___ ___ telephone at 5:05pm on ___, 5 minutes after discovery." }, { "input": "It is difficult to precisely compare the size of the moderate-to-large left pleural effusion with prior chest x-ray from ___ from outside facility due to current upright positioning in comparison to supine positioning on prior, although it is probably stable. The left upper lung is partially aerated. The right lung demonstrates areas of linear atelectasis but is otherwise clear. Heart size is difficult to assess. The right hilum is unremarkable. The left hilum is obscured. There is no evidence of pneumothorax.", "output": "Probable interval stability of moderate to large left pleural effusion, allowing for differences due to patient positioning in comparison to prior. Right lung linear atelectasis, otherwise clear. No right pleural effusion. No pneumothorax." }, { "input": "Lung volumes remain low but slightly improved on the left with improved aeration of the left lung base. A left-sided chest tube is in-situ, unchanged in appearance. No pneumothorax seen. There is minimal airspace opacity in the left lower lobe which may reflect re-expansion pulmonary edema, there is likely a small residual pleural effusion. There is some residual left basilar atelectasis. The right lung appears grossly clear. The cardiomediastinal contour is unchanged compared to the prior study.", "output": "No significant interval change when compared to the prior study except to note slight improvement in the degree of aeration of the left lung base." }, { "input": "The cardiomediastinal and contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Single AP upright portable view of the chest was obtained. There is slight blunting of the left costophrenic angle which may be due to a pleural effusion. Evidence of hiatal hernia is again seen. No definite focal consolidation is seen. There is no evidence of pneumothorax. The cardiac and mediastinal silhouettes are stable and unremarkable. Bilateral vagal nerve stimulators are again seen, without significant change in position.", "output": "Slight blunting of the left costophrenic angle may be due to trace pleural effusion. Streaky left base retrocardiac opacity most likely relates to atelectasis/scarring and was also seen on the prior study." }, { "input": "Frontal and lateral views of the chest. Despite low inspiratory effort, the lungs are clear. There is no consolidation, effusion or pulmonary vascular congestion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. There is mild elevation of the left hemidiaphragm. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "There are no prior studies for comparison. Partially imaged mediastinum is normal. Lungs are clear. There is no focal consolidation, pleural effusions, or pulmonary edema. Bony structures are intact.", "output": "No acute cardiopulmonary process." }, { "input": "There are vertical linear lucencies along the left paratracheal stripe, possibly reflecting a pneumomediastinum. Recommend clinical correlation for possible trauma. The heart is normal in size, and the lungs are clear without focal consolidation, pleural effusion or pulmonary edema.", "output": "Vertical linear lucencies along the left paratracheal stripe may reflect pneumomediastinum. Recommend clinical correlation for possible pneumomediastinum and possible trauma. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ ___ on the telephoneon ___ at 2:26 PM, 5 minutes after discovery of the findings." }, { "input": "The cardiac silhouette is enlarged. Right basilar and retrocardiac opacities are noted, which and infectious process cannot be excluded. There is mild pulmonary edema. No large pleural effusion or pneumothorax identified.", "output": "Right basilar end retrocardiac opacity could represent an infectious process in the appropriate clinical setting. Cardiomegaly and mild pulmonary vascular congestion. No large pleural effusion." }, { "input": "The lungs are hyperinflated, compatible with history of emphysema noted on prior CT. No focal consolidation, edema, effusion, or pneumothorax. The heart is normal in size. The mediastinum is not widened. No evidence of rib fractures on this nondedicated exam.", "output": "No focal pneumonia or evidence of heart failure." }, { "input": "PA and lateral views of the chest. The lungs are clear without effusion or pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "A very small area of peribronchial opacity is seen in the right mid lung zone, which may represent a small pneumonia. Could consider shallow obliques for better evaluation of this area. There is no edema, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Very small right peribronchial opacity may be a small pneumonia. Can consider shallow obliques for better evaluation of this area if clinically warranted. A message was left for ___ at ___ via telephone at 12 pm on ___ by Dr. ___." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is detected. Heart and mediastinal contours are within normal limits.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "The lungs are relatively hyperinflated. There is minimal bibasilar atelectasis. No focal consolidation, large pleural effusion, or evidence of pneumothorax is seen. The cardiac silhouette remains mildly enlarged. The mediastinal contours are stable. Subtle chronic appearing deformity of the posterior lateral left 7th rib is again seen, stable. No acute displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Mild degenerative changes are similar along the thoracic spine.", "output": "No evidence of injury." }, { "input": "The endotracheal tube terminates 4.8 cm above the carina. The orogastric tube courses through the esophagus and terminates at the gastroesophageal junction. The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "1. No acute cardiopulmonary process. 2. ET tube positioned appropriately. 3. Advancement of OG tube by at least 10 cm is recommended." }, { "input": "Heart size is mildly enlarged with tortuous thoracic aorta. Hilar contours are difficult to fully evaluate due to presence of increased bilateral infrahilar and right suprahilar opacities likely representative of aspiration. There is no large pleural effusion and there is no pneumothorax. An NG tube projects over the contour of the left main stem bronchus and the tip is flipped around directed superiorly.", "output": "1. Increased bilateral infrahilar and right suprahilar opacities likely representative of aspiration or possibly atelectasis. 2. Malpositioned NG tube located in the supradiaphragmatic location projecting over the left main stem bronchus most likely in a large hiatal hernia vs contained within the airway. The former is more probable given the wide turn the distal tube makes. Results were discussed over the telephone with Dr. ___ at 9:15 a.m. on ___ five minutes after discovery." }, { "input": "There is increased perihilar opacity. Extent peripherally. The findings are worrisome for increased mass in the right hilum and possible intra parenchymal bleed. There is a small right effusion.", "output": "Increased perihilar opacity extending peripherally concerning for increasing mass with or without intraparenchymal bleed. Right pleural effusion." }, { "input": "PA and lateral views of the chest are provided. The lungs are clear without focal consolidation, effusion, pneumothorax. The heart and mediastinal contours are normal. Bony structures are intact. Mildly hypertrophic changes at the right distal clavicle could indicate mild arthropathy.", "output": "No signs of pneumonia." }, { "input": "The lung volumes are normal. Normal size of cardiac silhouette. No pleural effusions. No focal parenchymal opacity suggesting pneumonia. No pulmonary edema. No pneumothorax. Normal hilar and mediastinal contours. The osseous structures are stable.", "output": "No acute cardiopulmonary process." }, { "input": "Low bilateral lung volumes with interval increase in size of the pleural effusions, particularly the left. Interval worsening of the patchy airspace opacities in both lungs which may reflect pulmonary edema or multifocal pneumonia. No pneumothorax identified. The evaluation of the cardiomediastinal silhouette is limited secondary to the adjacent pleural effusions.", "output": "Interval increase in size of the pleural effusions, particularly on the left. Increasing patchy airspace opacities bilaterally which may reflect worsening pulmonary edema or multifocal pneumonia." }, { "input": "The previous bilateral pleural effusions have resolved. Substantial apical thickening bilaterally and lung scarring, the sequela of likely radiation therapy is unchanged. The cardiac size is normal. No evidence of pneumonia.", "output": "Resolution of pleural effusions. Sequela of radiation induced changes including biapical scarring and fibrosis." }, { "input": "Medial right lower lobe consolidation is worrisome for pneumonia. The left lung is clear. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Right lower lobe pneumonia." }, { "input": "Patchy right lower lobe opacity may reflect atelectasis versus pneumonia. There is no pleural effusion, pneumothorax or pulmonary edema. The heart is normal in size.", "output": "Patchy right lower lobe opacity may reflect atelectasis versus pneumonia." }, { "input": "In comparison to prior study, there is new left basilar opacity, projecting posterior to the major fissure on the lateral view, compatible with a left lower lobe pneumonia. There is no associated effusion. Possible additional opacity is noted on the PA view at the right lung base. The remainder of the lungs are well aerated. Hilar and cardiomediastinal contours are normal. There is no pulmonary vascular congestion or edema. No free air is seen under the hemidiaphragm, and there are no acute osseous abnormalities.", "output": "Left lower lobe pneumonia. Possible additional right basilar opacity. Dr. ___ was informed of these finding at 3 p.m. on ___ by Dr. ___." }, { "input": "The cardiomediastinal and hilar contours are normal. The lungs are clear; specifically, there has been resolution of the left lower lobe pneumonia; additionally a more subtle bibasal opacity is also resolved. There is no pleural effusion or pneumothorax.", "output": "Resolution of pneumonia; no acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "On the frontal radiograph, there is an ill-defined opacification at the right lower lung laterally as well as a increased opacity seen below the diaphragm margin. On the lateral view, there is a linear opacity which is obscuring portion of the right hemidiaphragm but with lung parenchyma posterior to this opacity. There is minimal blunting of the right lateral and posterior costophrenic sulcus, suggesting a small pleural effusion. No focal opacities are identified in the left. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax. No bony abnormalities are identified.", "output": "Right lower lobe consolidation compatible with pneumonia in the proper clinical setting, likely multifocal. Follow up in ___ weeks after treatment is suggested to assess for resolution. Small right pleural effusion." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Pulmonary vascularity is normal and the lungs are clear. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest were obtained. There is elevation of the left hemidiaphragm with overlying atelectasis. No definite focal consolidation is seen. There is slight blunting of the posterior right costophrenic angle which may be due to pleural thickening or a trace pleural effusion. The left lung is clear. No pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "Elevation of the right hemidiaphragm with overlying right base atelectasis. Slight blunting of the posterior right costophrenic angle may relate to pleural thickening versus a very trace pleural effusion." }, { "input": "The lungs are clear without consolidation, effusion, or edema. Cardiac silhouette is top-normal. Multiple radiopaque densities project over the anterior and mediastinum, presumably postsurgical. Laparoscopic band is visualized in the upper abdomen. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is of normal size with normal cardiomediastinal contours. The pulmonary vasculature is normal. The lungs are clear without focal or diffuse abnormality. No pleural effusion or pneumothorax. No radiopaque foreign body. Osseous structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable with the cardiac silhouette top normal. Hilar contours are also stable and unremarkable. No displaced fracture is seen. Minimal degenerative changes are noted along the spine.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well-expanded and clear. Cardiac silhouette is top normal in size and unchanged from ___. Mediastinal contours and hila are normal. No pleural effusion or pneumothorax.", "output": "No pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No overt pulmonary edema is seen. No displaced fracture is identified.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax or pleural effusion. There are moderate degenerative changes in the thoracic spine", "output": "No evidence of intrathoracic metastatic disease" }, { "input": "The patient is status post median sternotomy. The heart size is mildly enlarged, increased in size compared to the previous study. Mediastinal and hilar contours are unremarkable. There is no pulmonary edema. Minimal atelectasis is noted at the lung bases. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Mild bibasilar atelectasis. Slightly enlarged heart size compared to the previous exam." }, { "input": "Patient is status post median sternotomy. Heart size is mildly enlarged, slightly decreased compared to the prior exam. Mediastinal contours are unchanged. There is mild pulmonary vascular congestion without overt pulmonary edema. Streaky atelectasis is noted in the lung bases. No pleural effusion, focal consolidation or pneumothorax is present. No acute osseous abnormalities seen.", "output": "Mild pulmonary vascular congestion and mild atelectasis at the lung bases. No focal consolidation to suggest pneumonia." }, { "input": "Frontal and lateral views of the chest. The lungs are clear of focal consolidation, effusion, or frank pulmonary edema. The cardiomediastinal silhouette is within normal limits. Median sternotomy wires are again noted. No acute osseous abnormality is detected. Note is made of patient's arm down by her side on the lateral view.", "output": "No definite acute cardiopulmonary process." }, { "input": "The patient is status post median sternotomy, with with sternotomy wires seen intact and well aligned. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema identified. The heart size is normal. Mediastinal contours are normal. No bony abnormality is detected.", "output": "No definitive acute cardiopulmonary process." }, { "input": "The cardiac silhouette remains mildly enlarged. There is mild pulmonary edema. No pleural effusion or pneumothorax. Median sternotomy wires appear intact.", "output": "Mild pulmonary edema. If there is ongoing clinical concern for dissection, then CT angiographic imaging would be recommended for further assessment." }, { "input": "AP and lateral views of the chest. Single AP view of the chest. The lungs however are grossly clear. Blunting of the left lateral costophrenic angle may be due to overlying soft tissues. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. Dual lead left-sided pacer device is stable in position.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Fibrotic changes at the right apex are again noted. There is no focal consolidation concerning for pneumonia. The patient is status post right mastectomy.", "output": "Clear left upper lobe with no current signs of pneumonia." }, { "input": "Patient is status post right mastectomy, surgical clips overlying the right hemithorax. Volume loss in the right lung with elevation of the right hemidiaphragm is chronic and related to radiation fibrosis seen at prior CT.The lungs are clear without focal consolidation. Calcific densities projecting over the right lung apex are within the anterior right first rib. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Portable semi-erect chest radiograph ___ at 02:48 is submitted.", "output": "Overall, there is improving aeration throughout both lungs suggestive of resolving but persistent pulmonary and interstitial edema. The heart remains markedly enlarged. Mediastinal contours are stable. No pneumothorax. No developing airspace consolidation to suggest pneumonia at this time." }, { "input": "A subtle nodular opacity is present in the right upper lobe at the level of the second right anterior rib, difficult to assess due to overlap with the adjacent scapular border at apparently new compared to the prior radiograph. No additional nodules are observed in the remainder of the lungs. Heart is enlarged but stable in size. There is no pleural effusion. Scoliosis is again demonstrated.", "output": "Right upper lobe nodular opacity, not fully evaluated by chest radiography. Recommend chest CT for confirmation and further characterization. NOTIFICATION: The impression and recommendation above was entered by Dr. ___ on ___ at 11:07 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "AP portable supine view of the chest. Cardiomegaly is again noted with mild residual pulmonary edema. No focal consolidation concerning for pneumonia. No large effusion or pneumothorax on this supine radiograph. Bony structures appear grossly stable.", "output": "Stable cardiomegaly with mild pulmonary edema. No convincing signs of pneumonia." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes and no pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. Mild tortuosity of the descending aorta is noted. There is no pulmonary edema. Left sided rib fractures, involving left posterior 5th rib and left lateral ___, ___ and possibly 4th ribs are of indeterminate age; given lack of recent trauma or point tenderness at these locations, they are more likely not acute. Degenerative changes are seen along the spine.", "output": "No evidence of acute cardiopulmonary process. Left sided rib fractures, as above, indeterminate age; given lack of recent trauma or point tenderness at these locations, they are more likely not acute. Findings discussed with Dr. ___ on ___ at 3:45PM via telephone by Dr. ___" }, { "input": "Frontal and lateral views of the chest were compared to previous exam from ___. The lungs remain clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. Osseous structures again notable for hypertrophic changes in the spine and prior left lateral rib fractures.", "output": "No acute cardiopulmonary process." }, { "input": "A Dobhoff tube is present. On view 1., the tip overlies the distal mediastinum, possibly reaching the GE junction. On view 2., the tip is not visualized and presumably extends beneath the GE junction. Based on this common additional view to include the abdomen would be required to see the radiopaque tip. Compared with the prior film, cardiomediastinal silhouette is grossly unchanged. However, there is increased vascular engorgement and mild vascular blurring at the bases, consistent with CHF. The possibility of small effusions cannot be excluded. PICC line again noted in the mid to distal SVC.", "output": "1. On the second film, the radiopaque Dobhoff tip tube extends beyond the GE junction, into the abdomen, but is not included on the film. 2. Compared with the prior film, there is now evidence of CHF, with vascular engorgement and probable interstitial edema at the bases. Possible small bilateral effusions." }, { "input": "Comparison is made to prior study from ___. Heart size is within normal limits. Lungs are clear. Bony structures are intact.", "output": "No signs for acute cardiopulmonary process." }, { "input": "A left pectoral Port-A-Cath tip terminates in the low SVC. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is stable. Surgical clips project over the central upper abdomen.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable. No displaced fracture is seen.", "output": "No acute cardiopulmonary process. No significant interval change." }, { "input": "PA and lateral views of the chest provided. Port-A-Cath resides over the left chest wall catheter tip position in the lower SVC. Lungs are well aerated. Previously noted left basal opacity has resolved fully. Cardiomediastinal silhouette appears normal. Bony structures are intact. Clips are noted in the upper abdomen midline.", "output": "No acute intrathoracic process. Port-A-Cath in appropriate position." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable and stable. Left-sided Port-A-Cath terminates in the low SVC.", "output": "No acute cardiopulmonary process." }, { "input": "Left-sided Port-A-Cath terminates in the low SVC without evidence of pneumothorax. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is of normal size with normal cardiomediastinal contours. The lungs are clear without focal or diffuse abnormalities. No pneumothorax or pleural effusion. The pulmonary vasculature is unremarkable. The osseous structures are unremarkable. No radiopaque foreign body.", "output": "No acute cardiopulmonary process." }, { "input": "Left chest wall port is again noted. The lungs are clear without consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. Surgical clips project over the mid upper abdomen", "output": "No acute cardiopulmonary process." }, { "input": "Left-sided Port-A-Cath terminates in the low SVC without evidence of pneumothorax.The lungs are clear without focal consolidation. No pleural effusion is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Left-sided Port-A-Cath terminates in the low SVC. Lung volumes are normal. There is no consolidation, pleural effusion or pneumothorax. Cardiomediastinal contours are normal. No acute osseous abnormalities identified. No subdiaphragmatic free air. Surgical clips are noted in the upper mid abdomen.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest demonstrate ill-defined subtle opacification at the lung bases. The cardiomediastinal and hilar contours are normal. There is no pneumothorax or pleural effusion. Pleural surfaces are unremarkable.", "output": "Subtle ill-defined opacities at the lung bases, which may reflect areas of atelectasis but are consistent with the radiologic appearance of a viral or mycoplasma pneumonia. Recommend 4 week followup after treatment is completed to assess for resolution. Findings were discussed with Dr. ___ ___ the telephone by Dr. ___ on ___ at 15:50, ___ min after findings were made." }, { "input": "The lungs are hyperexpanded suggestive of chronic obstructive pulmonary disease. Otherwise, the lungs are clear with no evidence of focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. No acute fractures are identified.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. There has been interval resolution of previously noted opacities in the lower lungs. There is no new consolidation. No effusion or pneumothorax. The cardiomediastinal silhouette is normal. Clips are noted in the right upper quadrant. The bony structures are intact.", "output": "No acute findings with complete interval resolution of previously detected pneumonia." }, { "input": "PA and lateral views of the chest were obtained. There are underlying emphysematous changes. There is no convincing focal consolidation concerning for pneumonia. A vague opacity in the left lower lobe is likely secondary to chronic scarring. No pleural effusion, pulmonary edema, or pneumothorax is seen. The cardiomediastinal and hilar silhouette is normal. Bony structures are intact.", "output": "No convincing signs of pneumonia. A vague opacity in the left lower lobe is likely secondary to chronic scarring." }, { "input": "The lungs are hyperinflated. Again, there is chronic bronchiectasis. There is no opacity, pulmonary edema, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Evidence of COPD and chronic bronchiectasis. No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs demonstrate hyperexpansion, suggestive of COPD. The lungs are otherwise clear. The cardiomediastinal silhouette is normal. Surgical clips noted in the right upper quadrant.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal contours are within normal limits and without change. Relative hyperlucency of the upper lobes of the lungs with associated attenuated vessels may reflect emphysema in the setting of a history of COPD. Superimposed upon chronic areas of linear opacity in the lower lung is a slightly more confluent opacity in the left retrocardiac region, likely projecting posteriorly over the lower spine on the lateral view. Additionally, there is a second questionable area of new opacity in the right lung base medially. No pleural effusions are identified, and bones are diffusely demineralized, without acute findings.", "output": "Findings concerning for focal left lower lobe (and possibly bibasilar) pneumonia. Considering history of COPD, followup chest x-ray in six weeks after completion of antibiotic therapy is recommended to document complete resolution. Findings entered into radiology communications dashboard on ___." }, { "input": "Frontal and lateral views of the chest were obtained. The heart size and cardiomediastinal contours are normal. Bilateral bronchiectasis is chronic. The lungs are otherwise clear. There is no evidence of trauma to lungs, pleura or chest cage, although nondisplaced rib fractures are readily missed on conventional chest radiographs.", "output": "No acute cardiopulmonary process." }, { "input": "As compared to the prior examination dated ___, there has been minimal interval change. Redemonstrated are hyperinflated lungs with flattening of the hemidiaphragms seen on the lateral projection. Chronic bronchiectasis is again noted. There is no focal consolidation, pulmonary edema, pleural effusion, or pneumothorax identified. The cardiomediastinal silhouette is normal.", "output": "Stable COPD and chronic bronchiectasis. No evidence to suggest an acute cardiopulmonary process." }, { "input": "Redemonstrated are subtle bibasilar airspace opacities, essentially unchanged as compared to the prior examination. There is no pleural effusion, pneumothorax, or frank pulmonary edema identified. The heart size is normal. Mediastinal contours are normal. Surgical clips are seen within the right upper quadrant.", "output": "Stable bibasilar airspace opacities." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures appear intact. An old deformity of the left mid clavicular shaft is noted. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Deformity of the left midclavicular shaft is unchanged. There are mild degenerative changes in the lower thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Portable upright AP chest radiograph shows left internal jugular tunneled hemodialysis catheter with the tip at the level of the right atrium. No new lung parenchymal consolidation or mediastinal change is seen. Small right pleural effusion may be present but the blunted lateral CP angle there is not different compared to ___. Old healed proximal right humeral fracture.", "output": "Expected appearances status post left tunneled hemodialysis catheter without findings to account for pain" }, { "input": "Increased interstitial markings are seen throughout the lungs with more conspicuous right basilar opacity compared to prior. The right-sided pleural effusion is not dramatically changed since prior. Known right upper lobe pulmonary nodule is better seen on prior CT scan, partially visualized on the lateral. Cardiomediastinal silhouette is unchanged. Left chest wall port is again noted. No acute osseous abnormalities identified.", "output": "Increased interstitial markings throughout the lungs may represent mild edema. Persistent right sided pleural effusion with more conspicuous right basilar opacity which could represent atelectasis versus superimposed infection. Please correlate clinically." }, { "input": "Single portable radiograph of the chest demonstrates low lung volumes with bibasilar atelectasis with no evidence of large pleural effusions. There is no evidence of pneumothorax or overt pulmonary edema. No definite focal consolidation is seen.", "output": "No overt pathology." }, { "input": "The patient is status post aortic valve replacement and probably coronary artery bypass graft surgery. A right internal jugular venous catheter terminates at approximately the confluence of the right internal jugular vein with the right subclavian. The cardiac, mediastinal and hilar contours appear stable. There is similar volume loss at the left lung base with patchy atelectasis. It is difficult to exclude a pleural effusion on the left. There is no indication of pleural effusion on the right.", "output": "Right internal jugular catheter terminating at the confluence of the right internal jugular and subclavian veins. No evidence of acute disease." }, { "input": "Moderate enlargement of the cardiac silhouette is unchanged. The aorta is mildly tortuous with atherosclerotic calcifications noted at the aortic knob. Mild pulmonary vascular congestion is demonstrated, as seen previously. Streaky opacities within the lung bases are present without focal consolidation. No large pleural effusion or pneumothorax is detected. Surgical anchors are re- demonstrated in the left femoral head.", "output": "Mild pulmonary vascular congestion with streaky bibasilar opacities, likely atelectasis." }, { "input": "Small bilateral pleural effusions, has increased compared to the most recent prior exam from ___. Mild cardiomegaly, is unchanged compared to multiple prior exams dated back to ___. Mild pulmonary vascular congestion is noted, otherwise the hilar mediastinal contours are normal. Mild bibasilar atelectasis. Subtle retrocardiac opacity as well as mild interstitial thickening, may be secondary to pulmonary edema. There is no evidence of pneumothorax. Signs of left rotator cuff repair.", "output": "1. Mild pulmonary edema. 2. Interval increase in small bilateral pleural effusions. 3. Mild bibasilar atelectasis. Superimposed infection cannot be excluded." }, { "input": "Heart size remains mildly enlarged. The mediastinal and hilar contours are similar. Pulmonary vasculature is not engorged. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cardiac and mediastinal silhouettes are stable compared ___. No focal consolidation is seen. There is no large pleural effusion or pneumothorax. Mild central pulmonary vascular engorgement persists. No overt pulmonary edema is seen.", "output": "Mild central pulmonary vascular engorgement persistent moderate cardiomegaly. No new focal consolidation to suggest pneumonia." }, { "input": "Since the prior study, there is a been interval improvement in bibasilar atelectasis and bilateral pleural effusions. Mild cardiomegaly is unchanged. No focal consolidation concerning for pneumonia is identified. Pulmonary edema has nearly resolved with only minimal interstitial edema remaining. Left humeral head anchor screws are again noted.", "output": "Improved bibasilar atelectasis and bilateral pleural effusions since the prior study. Mild cardiomegaly persists, and pulmonary edema has nearly resolved." }, { "input": "Heart size remains mildly enlarged. The mediastinal and hilar contours are unremarkable. Patient has been extubated. No radiopaque foreign bodies are seen. There is mild pulmonary vascular congestion, slightly improved in the interval. Streaky atelectasis is noted in the lung bases, improved, without evidence of pleural effusion or pneumothorax. There are no acute osseous abnormalities.", "output": "No radiopaque foreign bodies. Mild pulmonary vascular congestion, slightly improved in the interval. Mild bibasilar atelectasis, also improved." }, { "input": "The heart is mildly enlarged, even allowing for technique. There is mild pulmonary edema. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "1. Mild pulmonary edema and mild cardiomegaly. 2. No focal consolidation." }, { "input": "AP portable upright view of the chest. There is a small left pleural effusion with associated left basal opacity likely representing atelectasis, difficult to exclude a developing pneumonia. There is mild hilar congestion without frank edema. The cardiomediastinal silhouette is unchanged. Bony structures are intact. Anchors are noted in the left humeral head.", "output": "Hilar congestion with small left pleural effusion. Left basal opacity likely atelectasis, difficult to exclude a developing pneumonia." }, { "input": "Mild to moderate enlargement of the cardiac silhouette is unchanged. The mediastinal contour is similar with mild unfolding of thoracic aorta again noted. There is mild pulmonary vascular congestion, minimally improved from the previous exam. No focal consolidation or pneumothorax is seen, however assessment of the lung apices medially is slightly limited by the patient's neck and chin projecting over this area. Small bilateral pleural effusions are noted. No subdiaphragmatic free air is visualized. A TIPS catheter within the right upper quadrant of the abdomen is again noted.", "output": "Mild pulmonary vascular congestion and small bilateral pleural effusions. No subdiaphragmatic free air." }, { "input": "Compared with the prior study, new bibasilar opacities, right greater than left, are noted. On lateral view, right middle lobe opacity is also present. Persistent prominence of the cardiac silhouette with indistinct engorged pulmonary vessels are consistent with pulmonary vascular congestion. Small bilateral effusions have improved. No pneumothorax.", "output": "1. New bilateral lower lung and right middle lobe opacities, right greater the left, concerning for aspiration or pneumonia, given the clinical history. 2. Persistent pulmonary vascular congestion." }, { "input": "Moderate pulmonary vascular congestion and mild to moderate associated interstitial pulmonary edema has increased compared with the prior study. Moderate cardiomegaly appears grossly unchanged. There may be a small right pleural effusion. There is no pneumothorax or focal consolidation.", "output": "New moderate pulmonary vascular congestion with associated interstitial pulmonary edema" }, { "input": "The endotracheal and enteric tubes have been removed. Right-sided chest tube remains in place. Small right apical pneumothorax is unchanged. Moderate left chest wall subcutaneous emphysema is stable. There is minimal bibasilar subsegmental atelectasis with otherwise clear lungs. A small right pleural effusion is unchanged. The heart and mediastinum are within normal limits despite the projection.", "output": "Status post removal of endotracheal and enteric tubes with no other significant interval change." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "As compared to the prior examination, there has been minimal interval change. The lung volumes are decreased. Redemonstrated is a right-sided AICD with leads noted to terminate within the right atrium and right ventricle. There is no evidence of associated pneumothorax. The patient is status post valve replacement with median sternotomy wires noted to be well-aligned. Redemonstrated is mild to moderate cardiomegaly, likely exaggerated by the decreased lung volumes. Stable, widening of the mediastinum is noted.", "output": "Dual lead, right-sided AICD with leads seen terminating within the right atrium and right ventricle." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute disease." }, { "input": "Frontal and lateral views of the chest. The lungs are clear of focal consolidation, effusion, or pulmonary vascular congestion. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormality identified.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Midline sternotomy wires as well as a stent within a bypass graft again noted. Cardiomediastinal silhouette is stable with atherosclerotic calcifications along the unfolded thoracic aorta. Lungs are clear. No pleural effusion or pneumothorax. Fixation hardware projects over the right humerus.", "output": "No acute intrathoracic process." }, { "input": "As before, the patient is status post midline sternotomy and CABG, with a displaced coronary stent projecting to the left of midline. There is minimal left lower lung atelectasis. The lungs are otherwise clear. There is minimal left apical pleuroparenchymal thickening/scarring, as seen on CT from ___. There are no pleural effusions. No pneumothorax is seen. The heart is normal in size. The descending thoracic aorta is tortuous, as before. Aorta calcifications are seen. Splenic artery calcifications are noted in the left upper abdominal quadrant. A vascular stent projects over the mid abdomen, incompletely imaged.", "output": "No acute cardiac or pulmonary findings." }, { "input": "AP and lateral views of the chest. The lungs are clear without consolidation, effusion, pulmonary vascular congestion or pneumothorax. Cardiomediastinal silhouette is unchanged noting median sternotomy wires and mediastinal clips. Vascular stents within a venous bypass graft are again noted. The descending thoracic aorta is tortuous. Orthopedic hardware seen in the proximal right humerus. No definite acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Tracheal stent and bilateral mainstem bronchial stents are in grossly stable position. The proximal end of the tracheal stent projects at the level of the clavicles. Heart size and cardiomediastinal contours are normal. Lungs are clear without focal consolidation, pleural effusion, or pneumothorax.", "output": "Grossly stable position of tracheal and bilateral mainstem bronchial stents. No pneumothorax or focal consolidation." }, { "input": "No consolidation, pleural effusion or pulmonary edema is seen, and the cardiac and mediastinal contours are normal. Osseous structures are grossly unremarkable.", "output": "No acute cardiopulmonary disease including pneumonia or effusion." }, { "input": "The lungs are clear except for minimal streaky density bilaterally consistent with subsegmental atelectasis scarring as before. There is no pneumothorax. The heart is normal in size. The aorta is calcified. Mediastinal structures are stable. A bipolar transvenous pacemaker is place. The bony thorax grossly intact. There is no significant change.", "output": "No active cardiopulmonary disease." }, { "input": "Right-sided dual-chamber pacemaker device is new in the interval with leads terminating in the right atrium and right ventricle. Moderate cardiomegaly is accentuated by a suboptimal inspiratory effort. Aorta is mildly unfolded. There is crowding of bronchovascular structures with mild pulmonary vascular congestion, but no overt pulmonary edema. Patchy opacities in the lung bases likely reflect areas of atelectasis. No pleural effusion or pneumothorax is identified. There are no acute osseous abnormalities.", "output": "Low lung volumes with probable bibasilar atelectasis and mild pulmonary vascular congestion." }, { "input": "The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "No acute cardiopulmonary process." }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or frank pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is a moderate pleural effusion on the left with streaky retrocardiac opacity, probably compatible with associated atelectasis. However, projecting over the right lower lung, and probably in the right lower lobe, is a consolidative opacity for which pneumonia should be considered. There is no pneumothorax. A large rim calcified structure in the right upper quadrant suggests one or two large gallstones.", "output": "Moderate left-sided pleural effusion. Widespread airspace disease in the right lower lung worrisome for pneumonia. Cholelithiasis." }, { "input": "Heart size is normal. The aorta is mildly unfolded. The mediastinal and hilar contours are normal. Pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is present. Triangular 8 mm focal opacity projects over the left mid lung field on the frontal view. There are no acute osseous abnormalities.", "output": "1. No acute cardiopulmonary abnormality. 2. 8 mm triangular focal opacity projecting over the left mid lung field. This could reflect a pulmonary nodule, and oblique views may be helpful for further assessment." }, { "input": "There is stable tortuosity of the thoracic aorta. The cardiac silhouette is stable. The hila are unremarkable. There is no focal lung consolidation. There is no pulmonary vascular congestion or pulmonary edema. There is no pneumothorax or pleural effusion.", "output": "Subtle opacity in the region of the lower lobes only seen on lateral view is of uncertain significance. Oblique views of the chest could be obtained for further evaluation if indicated. Otherwise, no evidence of acute cardiopulmonary process elsewhere." }, { "input": "The lungs are well-expanded. There is a left basilar hazy opacities, new when compared to prior. Superiorly, lungs are clear. Cardiac silhouette is top-normal. Tortuosity of the thoracic aorta is again noted. No acute osseous abnormalities.", "output": "Subtle hazy left basilar opacity, potentially atelectasis noting that infection would be possible in the proper clinical setting." }, { "input": "The lungs are well-expanded and clear. No focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. The thoracic aorta appears slightly widened compared to the prior exam. The heart size is normal. The hila and pleura are within normal limits.", "output": "1. No focal consolidation to suggest pneumonia. 2. Possible dilatation of the thoracic aorta compared to the prior exam, not fully evaluated with chest radiography. Recommend a CT to further evaluate the aorta. NOTIFICATION: The impression above was entered by Dr. ___ on ___ at 15:30 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "Left-sided Port-A-Cath tip terminates in the proximal right atrium. Heart size is top normal. Aorta remains tortuous. Mediastinal and hilar contours are similar. Pulmonary vasculature is not engorged. Lung volumes are low with bibasilar patchy opacities, likely atelectasis. No focal consolidation, pleural effusion or pneumothorax is present. Skin ___ are seen overlying the upper abdomen as well as intra-abdominal catheters and several clips. No subdiaphragmatic free air is seen.", "output": "Bibasilar atelectasis. No subdiaphragmatic free air." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. Of unknown, there is a prosthetic aortic valve projected over the heart.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiac, mediastinal, and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The cardiac silhouette size is top normal. The mediastinal and hilar contours are unchanged. Atherosclerotic calcifications are noted throughout the thoracic aorta. Pulmonary vasculature is normal. Lungs are hyperinflated. Known spiculated lesion within the right lower lobe persists, but better assessed on the prior CT. No focal consolidation, pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Prior bilateral rib fractures are again seen.", "output": "No acute cardiopulmonary abnormality. Known right lower lobe spiculated lesion is better assessed on the prior CT." }, { "input": "Single AP supine portable chest radiograph obtained. The lungs appear clear and well expanded. No supine evidence for pneumothorax or effusion. Cardiomediastinal silhouette appears normal. An old deformity of the right mid clavicular shaft is noted. No definite acute osseous injuries.", "output": "No acute findings in the chest. Please refer to subsequent CT of the chest for further details." }, { "input": "There is no pleural effusion, pneumothorax or focal airspace consolidation. The cardiac, mediastinal and hilar structures are unremarkable. Evidence of prior breast reconstruction is seen on the right.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. There is no free intraperitoneal air below the hemidiaphragms. The osseous structures are unremarkable without evidence of a fracture.", "output": "No acute cardiopulmonary process or evidence of a fracture." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "No focal opacity to suggest pneumonia is seen. No pleural effusion, pulmonary edema, or pneumothorax is present. Streaky opacity at the left base likely represents subsegmental atelectasis and there is thickening along the left major fissure. Calcified granulomas appear unchanged. The heart size is normal.", "output": "No radiographic evidence of pneumonia." }, { "input": "Unchanged right upper lobe calcified granuloma. Atelectatic changes are seen in the right upper lobe, unchanged since ___. The cardiomediastinal silhouette and hila are normal. There is no pleural effusion or pneumothorax.", "output": "No acute cardiothoracic process. CT is recommended for chronic upper lobe atelectatic changes to rule out underlying neoplasm." }, { "input": "There is no focal consolidation, pleural effusion, or pneumothorax. An azygos fissure is noted on the right. Cardiomediastinal silhouette is normal. The osseous structures are intact.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are unremarkable. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No definite acute intrathoracic process." }, { "input": "The lungs are well-expanded and clear. The cardiomediastinal silhouette is unremarkable. There is no pleural effusion, pulmonary edema, pneumothorax, or focal airspace consolidation. No subdiaphragmatic free air is noted. Gas-filled loops of transverse and descending colon are noted in the left upper quadrant.", "output": "No acute cardiopulmonary pathology. No subdiaphragmatic free air." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "There is diffuse patchy opacification at the bilateral lung fields with predominance in the bases, compatible with moderate pulmonary interstitial edema. The pulmonary vasculature is congested. No large pleural effusion or pneumothorax is detected. The cardiac silhouette is enlarged but stable. The mediastinal contours are prominent with unfolding of the thoracic aorta.", "output": "Stable cardiomegaly and moderate congestive heart failure." }, { "input": "Sternotomy wires intact. Right IJ tip is in right atrium. Interval mild decrease in left lower lobe atelectasis, left pleural effusion and pulmonary edema. Slight decrease in otherwise mildly enlarged heart with normal mediastinal contour and hila. The right lung is clear without pleural effusion. No pneumothorax.", "output": "Interval improvement of pulmonary edema, left lower lobe atelectasis, and left pleural effusion. No pneumothorax." }, { "input": "PA and lateral views of the chest were provided. Lungs appear clear and hyperinflated. No focal consolidation, effusion, or pneumothorax is seen. Cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm seen.", "output": "No acute intrathoracic process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Mild degenerative changes are seen in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is mildly enlarged with mild unfolding of the thoracic aortic arch. Hilar contours are normal. There is no frank fluid overload. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "Mild cardiomegaly without fluid overload. No evidence for pneumonia." }, { "input": "Cardiac silhouette size is. The mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary abnormality. No acute osseous abnormality visualized. If there is continued concern for a rib fracture, consider a dedicated rib series." }, { "input": "As compared to prior chest radiograph from ___, there is persistence of a very small pneumothorax at the left apex, which remains unchanged. Bibasilar atelectasis is unchanged. Several small pulmonary nodules are again visualized. No new focal consolidations are identified. There is redemonstration of free intra-abdominal air, likely related to prior abdominal surgery.", "output": "Unchanged small left apical pneumothorax." }, { "input": "As compared to prior radiograph from ___, there has been interval placement of a left chest drain. A small left apical lateral pneumothorax is identified. There is bibasilar atelectasis and interstitial edema. There are no pleural effusions. The heart is normal in size. Free intraperitoneal air is seen below both hemidiaphragms, likely related to recent surgery.", "output": "Small left apicolateral pneumothorax. These findings were discussed with Dr. ___ by Dr. ___ ___ telephone on ___ at 9:30 AM, at time of discovery." }, { "input": "PA and lateral views of the chest were provided. Nodular opacities project over the right lower lung measuring up to approximately 2.3 cm, better assessed on prior CT from ___. There is no consolidation concerning for pneumonia. No effusion or pneumothorax. Cardiomediastinal silhouette appears stable. Bony structures are intact.", "output": "Metastatic lesions within the chest appear similar to prior CT. No signs of superimposed pneumonia." }, { "input": "AP and lateral views of the chest. Again seen are bilateral nodular opacities in the lungs compatible with patient's known metastatic disease. New from prior chest x-ray but seen on interval CT scan is a left-sided pleural effusion with associated atelectasis. Increased pleural based opacity on the left laterally adjacent to the lung base is likely progression of metastatic disease as well. Trace right effusion is also seen. There is no definite superimposed acute consolidation although one would be difficult to exclude and definite acute osseous abnormality detected.", "output": "Left-sided pleural effusion, as seen on prior chest CT, with additional increased left basilar opacity potentially due to progression of metastatic disease although superimposed acute process would be difficult to exclude." }, { "input": "There are low lung volumes, which results in bronchovascular crowding. There is engorged central pulmonary vasculature, indistinctness of the hila, and mild to moderate interstitial pulmonary edema. The heart is enlarged. There are small bilateral pleural effusions. No pneumothorax.", "output": "Mild to moderate interstitial pulmonary edema. NOTIFICATION: These findings were discussed with Dr.___ by Dr. ___ ___ telephone at 22:15 on ___, at the time of discovery." }, { "input": "There are persistent small bilateral pleural effusions, larger on the right. The degree of pulmonary edema is improved. Moderate cardiomegaly is again noted. No acute osseous abnormalities.", "output": "Small bilateral pleural effusions with mild interstitial edema although improved since prior exam. No focal consolidation." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for pneumonia. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No acute intrathoracic abnormalities identified." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unremarkable. Lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are seen.", "output": "Normal chest radiograph." }, { "input": "Portable radiograph of the chest demonstrates median sternotomy wires as well as prosthetic aortic valve, in appropriate position. The heart size appears mildly enlarged, and there is bilateral perihilar haziness as well as increased prominence of the interstitial markings within the bilateral lungs, consistent with pulmonary edema. There are bilateral pleural effusions, left greater than right, which obscures the left heart border, and underlying infection cannot be completely excluded, however no focal pneumonia is identified. Bibasilar atelectasis is present. Surgical clips are present in the upper mid abdomen as well as over the right chest wall, presumably from prior mastectomy.", "output": "Pulmonary edema with bilateral pleural effusions and bibasilar atelectasis. Although no focal pneumonia is seen, an underlying infectious process cannot be completely excluded." }, { "input": "Sternotomy wires are midline and intact and a prosthetic cardiac valve is again noted. Surgical clips are again noted within the upper mid abdomen and overlying the right upper hemithorax. The cardiac, mediastinal and hilar contours are mildly prominent consistent with mild cardiomegaly unchanged from prior exam. No pneumothorax is noted. A small left pleural effusion with associated compressive left basilar atelectasis is slightly worse compared to prior exam. Platelike bibasilar atelectasis is noted. Compression fractures involving the mid thoracic vertebrae are unchanged since the most recent prior exam. Atherosclerotic calcification of the carotid arteries is noted bilaterally.", "output": "Small left pleural effusion slightly increased compared to prior exam." }, { "input": "The patient is status post aortic valve replacement. Mitral annular calcifications are unchanged. The heart is at the upper limits of normal size. The mediastinal and hilar contours appear unchanged. There is mild interstitial abnormality, suggesting vascular congestion. Streaky left basilar opacification with new mild relative elevation of the left hemidiaphragm is most suggestive of atelectasis. The lateral view depicts an increased small-to-moderate pleural effusion on the right since the prior examination, but quite similar to before on the left. Surgical clips project over the right axilla and epigastric region.", "output": "Mild interstitial abnormality suggesting pulmonary congestion. Increased volume loss at the left lung base. Increased right-sided pleural effusion." }, { "input": "AP upright and lateral chest radiographs were obtained. The lungs are well expanded. The left pleural effusion and overlying atelectasis may be slightly larger compared with ___. There is no new consolidation or pneumothorax. Cardiomegaly has slightly progressed since ___. Aortic tortuosity is similar. Median sternotomy wires are intact. Mitral valve prosthesis is well seated. Right axillary and epigastric clips are in unchanged positions. Multilevel thoracic vertebral compression fractures are unchanged.", "output": "Slightly increased size of a left pleural effusion and atelectasis since ___." }, { "input": "Lung volumes are low. The heart is moderately enlarged. Additionally, bibasilar and retrocardiac airspace opacities are noted, and may represent pneumonia in the proper clinical setting. Streaky linear atelectasis versus scarring is noted along the lateral aspect of the mid right lung. Probable small bilateral pleural effusions are present. Sternotomy wires are well aligned. The patient is status post aortic valve replacement. Redemonstrated are surgical clips projecting over the right axilla.", "output": "1. Bibasilar pneumonia could be due to aspiration. 2. Moderate cardiomegalywithout pulmonary edema with probable small bilateral pleural effusions." }, { "input": "A single portable view of the chest is provided which is limited by respiratory motion. Low lung volumes result in bronchovascular crowding. A right-sided central venous catheter is seen terminating in the mid SVC. The patient is status post median sternotomy. Cardiac and mediastinal silhouettes are stable. No pneumothorax is seen. Right axillary clips and upper abdominal clips are again noted.", "output": "No overt evidence of infectious process." }, { "input": "Moderate cardiomegaly is seen with mild stable interstitial edema. Opacification at the left lung base obscuring the hemidiaphragm is suggestive of a small left pleural effusion with adjacent atelectasis, although a superimposed infectious process cannot be excluded. There is a small right pleural effusion. Median sternotomy wires are again noted and right axillary surgical ___ are seen. An aortic valve replacement is seen. Compression deformity with vertebral plana involving the mid thoracic spine is stable compared to the prior exam.", "output": "1. Mild interstitial edema. 2. Left lower lobe opacification likely secondary to a small pleural effusion with adjacent atelectasis, however a superimposed infectious process cannot be excluded." }, { "input": "Median sternotomy wires are intact. There are surgical clips in the right axilla. There is an increase in interstitial markings, particularly at the lung bases and worsening opacities, left greater than right. Opacity of the left base obscures the hemidiaphragm and left heart border is due to a combination of increasing moderate pleural effusion and chronic consolidation. Underlying pneumonia is not excluded. The mediastinal contours are unchanged. There is no evidence of large pneumothorax. Moderate cardiomegaly is unchanged.", "output": "Increasing moderate cardiomegaly, mild pulmonary edema, and moderate left pleural effusion which suggests pericardial effusion may also be present. Updated results telephoned to Dr. ___ by ___ at 8:45 am, ___, 10 minutes after discovery." }, { "input": "The lungs are well expanded with diffuse bilateral heterogeneous interstitial and alveolar opacities. A moderate-sized left pleural effusion with left lower lobe atelectasis is seen. The right pleural surface is normal. No pneumothorax. The heart is partially obscured by pleural effusion; however, is enlarged with mediastinal vein dilatation. Mediastinal contour is otherwise unremarkable and there is prominence of the hilum bilaterally. Sternotomy wires are unchanged in position and are intact. Right axillary clips, mitral annulus calcification, and valvular replacement are again noted.", "output": "1. Moderate pulmonary edema with increased moderate left pleural effusion. 2. Left lower lobe opacity likely represents left pleural effusion and atelectasis; however, underlying consolidation is difficult to exclude." }, { "input": "Upright AP and lateral radiographs of the chest are provided. These images demonstrate pulmonary vascular engorgement, mild interstitial pulmonary edema, enlargement of the cardiac silhouette, and small bilateral pleural effusions. The pattern is most consistent with decompensated congestive heart failure however a concurrent infectious process in the lung bases cannot be fully excluded. An artificial aortic valve surgical clips in the mediastinum and upper abdomen, and median sternotomy cerclage wires are present. There are multiple compression fractures in the thoracic spine which are stable for at least a year.", "output": "Mild decompensated congestive heart failure. Concurrent infectious process at the lung bases cannot be fully excluded." }, { "input": "The cardiomediastinal and hilar contours are stable. Patient is status post aortic valve repair. Mitral annular calcifications are again seen. Bilateral pleural effusions, right greater than left, have increased since the prior study. Mild interstitial prominence is again seen, slightly increased since the prior study and indicative of mild pulmonary edema. Patient is status post median sternotomy. Surgical clips overlying the right axilla and epigastric regions are again present.", "output": "Increased bilateral effusions with associated atelectasis and mild pulmonary edema." }, { "input": "The patient is status post aortic valve replacement surgery. Mitral annular calcifications are prominent. The cardiac, mediastinal and hilar contours are probably unchanged allowing for differences in technique. There is increasing opacity at the left lung base including involvement of much of the left lower lobe with an opacity suggesting pneumonia. There is probably a coinciding pleural effusion. Better delineated is a small and probably new pleural effusion on the right. Surgical clips project over the right axilla and epigastric region. Thoracic compression fractures are unchanged. The bones appear demineralized.", "output": "Increasing left basilar opacification suggesting pneumonia in the left lower lobe. Small bilateral pleural effusions." }, { "input": "Moderate cardiomegaly is seen with mild pulmonary edema. There is also opacification at the left lung base obscuring the hemidiaphragm concerning for a moderate pleural effusion and atelectasis, but the effusion appears decresaed. An underlying pneumonia cannot be fully excluded. A small right pleural effusion is noted. Median sternotomy wires are again noted, and right axillary surgical ___ are seen. An aortic valve replacement is noted.", "output": "Cardiomegaly associated with mild pulmonary edema. Left lower lobe opacification likely represents a moderate pleural effusion with associated atelectasis, though an underlying consolidation cannot be fully excluded. Left basilar opacification has improved, however." }, { "input": "The heart remains enlarged. Mild interstitial pulmonary edema has slightly worsened. Opacification at the left base is unchanged and may reflect atelectasis, aspiration or pneumonia. There is no pneumothorax. As before median sternotomy wires are intact. Surgical clips project in the right axilla. Aortic valve replacement is seen. Again there is compression deformity with vertebra plana involving the mid thoracic spine.", "output": "1. Cardiac enlargement and worsening of mild interstitial edema. 2. Persistent opacity at the left base may reflect atelectasis and pleural effusion, however an underlying pneumonia cannot be excluded." }, { "input": "Portable view of the chest was reviewed. Again seen are median sternotomy wires as well as a prosthetic aortic valve, in standard positions. Significant mitral annular calcifications are again noted. There is mild cardiomegaly, stable over the past 10 days. A left pleural effusion with underlying atelectasis obscures the left heart border. There is no pneumothorax. Mild pulmonary edema is seen. Slightly increased and more confluent interstitial markings in the right lateral mid lung may be indicative of an infectious process. Alternatively, mitral regurgitation may result in asymmetric right upper lobe pulmonary edema from aberrant blood flow into the right superior pulmonary vein.", "output": "Bilateral pleural effusions with pulmonary edema. More confluent consolidation in the right mid lung may represent a developing pneumonia or asymmetric pulmonary edema related to mitral regurgitation." }, { "input": "There has been near resolution of the previously seen mild pulmonary edema. Additionally, the small left pleural effusion has improved. There is likely a small right pleural effusion. There is no focal airspace consolidation or pneumothorax. The heart size is normal and improved. Dense calcifications are seen within the mitral valve. There may be a small left lung nodule which is new from ___. The aortic valve prosthesis, right axillary and abdominal clips are unchanged. Wedge compression deformities of the thoracic spine are unchanged. Patient is status post a right mastectomy.", "output": "1. Improved small left pleural effusion and near resolution of mild pulmonary edema. 2. Possible left lung nodule for which follow up chest radiograph is recommend in 6 weeks. These findings were discussed with Dr. ___ by Dr. ___ at 11:26 on ___ by telephone at the time of discover." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. Hypertrophic changes are noted in the spine without acute osseous abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. The cardiac contour appears within normal limits. Atherosclerotic calcifications are noted at the aortic arch and the aorta is otherwise unremarkable. No acute fractures are identified. Mild degenerative changes are visualized throughout the thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "AP and lateral views of the chest. The lungs remain clear. Cardiomediastinal silhouette is normal. No acute osseous abnormality detected.", "output": "No acute cardiopulmonary process." }, { "input": "Endotracheal tube, Swan-___ catheter, orogastric tube, mediastinal drains and left chest tube have been removed. Median sternotomy wires are stable as well as mitral valve replacement. Lung volumes are slightly decreased, expected after extubation. There is improved pulmonary vascular congestion. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process. No pneumothorax." }, { "input": "The lungs are normally expanded and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The patient is status post median sternotomy and mitral valve replacement. Stable postoperative appearance of cardiomediastinal contours and sternal wires. Improving bibasilar atelectasis. Persistent small left pleural effusion and interval resolution of small right pleural effusion. Possible splenic enlargement in left upper quadrant.", "output": "Improving bibasilar atelectasis and resolution of small right pleural effusion. Persistent small left pleural effusion." }, { "input": "No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No overt pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "There is a focal region of consolidation projecting over the anterior left sixth rib without localization on the lateral view. Elsewhere, the lungs are clear. Cardiomediastinal silhouette is stable noting prosthetic mitral valve. No acute osseous abnormalities.", "output": "Focal opacity projecting over the left lung on the frontal view, not definitely seen on the lateral view. If more definitive characterization desired, consider shallow obliques see if it persists." }, { "input": "The lungs are clear without effusion or pulmonary edema. The cardiomediastinal silhouette is within normal limits and unchanged given differences in technique. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. No focal consolidations concerning for pneumonia are identified. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No acute intrathoracic abnormalities identified." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Relatively low lung volumes are seen. The lungs, however, are clear of confluent consolidation or large effusion. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "Low lung volumes without acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. When compared to prior, there has been essentially complete resolution of the opacity in the left lower lobe. There is vague persistent right mid lung opacity identified which is likely due to scarring given stability. There is no effusion or new consolidation. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process, specifically no evidence of cardiomegaly." }, { "input": "The lungs are clear of focal consolidation, pleural effusion or pneumothorax. The heart size is normal. The mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No overt pulmonary edema is seen. There is no displaced fracture identified.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. Thoracolumbar scoliosis is partially imaged. No displaced fracture is identified.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size appears mildly enlarged but similar. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Minimal patchy opacities are noted in the lung bases. No focal consolidation, pleural effusion or pneumothorax is evident. There are mild degenerative changes in the upper lumbar spine. No acute osseous abnormality is visualized.", "output": "Minimal bibasilar patchy opacities, likely atelectasis." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Surgical clips are again seen overlying the right upper lung. The cardiomediastinal silhouettes are stable and within normal limits. The bilateral hila are unremarkable. The lungs are clear without focal consolidation. There is no pulmonary vascular congestion or pulmonary edema. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs were provided. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Clips are present in the right upper lobe. There are no displaced rib fractures.", "output": "No acute cardiopulmonary process or displaced fractures." }, { "input": "Right-sided Port-A-Cath tip terminates in the low SVC. Heart size is normal. Known mediastinal mass seen on outside imaging is not well assessed on this current radiograph, although there is suggestion of narrowing of the central airways, as seen on the prior CT. Lungs are hyperinflated with emphysematous changes noted in the apices. No focal consolidation, pleural effusion or pneumothorax is present. Compression deformity of a vertebral body at the thoracolumbar junction is unchanged from the prior CT examination where it was demonstrated to be a pathologic fracture.", "output": "Known mediastinal mass is better assessed on previous CT. Emphysema. No pneumonia." }, { "input": "Lungs are clear. Cardiac silhouette is normal in size. No pleural effusion or pneumothorax.", "output": "Unremarkable chest x-ray." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. Surgical clips seen in the neck. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax The osseous structures are unremarkable there i there is also visualized on the lateral exam. This may represent an area of volume loss or early infiltrate. S a small area of increased opacity at the left CP angle. This is more prominent than on the prior study", "output": "Small area of opacity at the left CP angle which is new compared to ___" }, { "input": "PA and lateral views of the chest were provided. The heart is top-normal in size. There are tiny bilateral pleural effusions. No evidence of pulmonary edema is seen. Atherosclerotic calcifications are seen along the thoracic aorta. The imaged bony structures appear intact. No free air below the right hemidiaphragm is seen.", "output": "Tiny bilateral pleural effusions, borderline cardiomegaly." }, { "input": "Elevation of the left hemidiaphragm with right sided mediastinal shift is unchanged. There is no focal consolidation. There is no pneumothorax. There is blunting of the costophrenic angle which likely represents a small effusion.", "output": "No evidence of pneumonia. Probable small left pleural effusion." }, { "input": "Dobbhoff tube has tip ending in proximal gastric cavity and can be advanced 5 cm. Tracheostomy tube is in standard position and unchanged since ___. Lung is well inflated and clear, without consolidation, nodules. Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax.", "output": "New Dobbhoff tube has tip ending in proximal gastric cavity and can be advanced 5 cm. Exam is otherwise unchanged since ___. Findings were paged to Dr. ___ at 4:10 p.m. by Dr. ___." }, { "input": "A tracheostomy tube remains in place. There are unchanged scattered foci of linear atelectasis with otherwise clear lungs. No new consolidation or pleural effusion is present. There is no pneumothorax. The heart and mediastinum are within normal limits despite the projection.", "output": "No evidence of pneumonia." }, { "input": "A tracheostomy tube remains in place. There is no pneumothorax. A bandlike retrocardiac airspace opacity is more prominent, and may reflect increased atelectasis or infection.", "output": "Increasing left basilar retrocardiac opacity may be due to atelectasis or infection." }, { "input": "Single semi-erect portable chest radiograph demonstrates no focal opacity convincing for pneumonia. Cardiomediastinal and hilar contours are stable in appearance. The right costophrenic angle is incompletely imaged. No overt pulmonary edema. No large effusion is appreciated. A trach is identified terminating 2.8 cm above the level of the carina. No acute osseous abnormalities detect appear", "output": "No convincing evidence of pneumonia." }, { "input": "AP portable upright view of the chest. A tracheostomy tube is present. There is no focal consolidation, pneumothorax, or pleural effusion. The heart size is normal. The hilar and mediastinal contours remain within normal limits.", "output": "No focal consolidation." }, { "input": "The tracheostomy is midline and unchanged. The lungs are grossly clear without consolidation to suggest pneumonia. Cardiomediastinal and hilar contours are normal.", "output": "No evidence of pneumonia." }, { "input": "A portable frontal chest radiograph demonstrates a nasogastric tube with the tip in the stomach. The cardiomediastinal silhouette is normal. The lungs are clear and there is no pleural effusion or pneumothorax. The tracheostomy tube is unchanged in position.", "output": "Exchange of a nasogastric tube, with the tip in the stomach." }, { "input": "AP upright and lateral views of the chest were provided. A left arm access PICC line is seen with its tip in the low SVC. The lung volumes are low with lower lung atelectasis. No definite signs of pneumonia. No effusion or pneumothorax. Heart size and mediastinal contour appear normal. Bony structures are intact.", "output": "Appropriately positioned PICC line. Lower lung atelectasis noted." }, { "input": "Cardiac, mediastinal and hilar contours are unchanged with the heart size within normal limits. The aorta is mildly unfolded. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is present. There are mild diffuse degenerative changes in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "2 views were obtained of the chest. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. Cardiac size is normal with mildly tortuous aortic contour.", "output": "No acute intrathoracic process." }, { "input": "No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. There has been interval removal of a right-sided Port-A-Cath.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is demonstrated. There are no acute osseous abnormalities.", "output": "Normal chest radiograph." }, { "input": "The lungs are clear with no consolidation, and pulmonary vasculature is normal. There is no pleural effusion or pneumothorax. Cardiomediastinal silhouette is normal.", "output": "No pneumonia" }, { "input": "A portable radiograph of the chest demonstrates an appropriately positioned endotracheal tube, 5.3 cm above the carina. An orogastric tube enters the stomach, though side port appears above the gastroesophageal junction. Lung volumes are markedly low. This causes exaggeration of the cardiomediastinal contour as well as crowding of pulmonary vasculature. Bibasilar airspace opacities most likely reflect atelectasis. There is no pneumothorax or pleural effusion.", "output": "Appropriately positioned endotracheal tube. Side port of orogastric tube appears just above the gastroesophageal junction and should be slightly advanced. Low lung volumes with bibasilar atelectasis. NOTIFICATION: Findings regarding the positioning of the OG tube were communicated to Dr. ___ by Dr. ___ on ___ at 15:40." }, { "input": "Linear opacities in the bilateral lower lobes most likely represent atelectasis. The lung volumes are low and there is no focal consolidation, pleural effusion or pneumothorax. The cardiac and mediastinal contours are stable. There is no free air beneath the hemidiaphragms.", "output": "No acute cardiopulmonary process, specifically no free intraperitoneal air." }, { "input": "The left costophrenic angle is excluded from the field of view. Where seen, lungs are grossly clear. The cardiac silhouette is enlarged but likely exaggerated by portable technique. No displaced fractures identified.", "output": "Unremarkable portable chest x-ray" }, { "input": "The exam is limited by the patient's body habitus. Within the limitations, the lungs are show no focal consolidation or edema. There is no pleural effusion or pneumothorax. On the lateral view, there is an ovoid 1.5 cm calcific structure which may represent a calcified infrahilar node or calcified granuloma. The mediastinal contours are normal. The heart size is at the upper limits of normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. Moderate degenerative changes are noted in the thoracic spine.", "output": "No acute cardiopulmonary process. NOTIFICATION: Results were discussed with Dr. ___ at 15:40 on ___ via telephone by Dr. ___ 5 minutes after the findings were discovered." }, { "input": "Mild cardiomegaly has been stable compared to multiple prior exams dating back to ___. The hilar and mediastinal contours are unremarkable. Small bilateral pleural effusions are persistent. There is mild bibasilar atelectasis. There is no evidence of a pneumothorax.", "output": "Mild bibasilar atelectasis. No evidence of pneumothorax." }, { "input": "A right-sided IJ central venous catheter is again seen, terminating in the right atrium. The patient is status post aortic valve replacement. There is persistence of small bilateral pleural effusion, with a very similar morphology when compared to the prior examination. There is probably related atelectasis. No definite consolidative process is seen. No evidence of pneumothorax.", "output": "Persistent small bilateral pleural effusions." }, { "input": "The lungs are well-expanded and clear. No focal consolidation, effusion, edema, or pneumothorax. The heart is normal in size. The mediastinum is not widened. The descending thoracic aorta is slightly tortuous. Multilevel degenerate changes of the thoracic spine are mild.", "output": "No focal pneumonia." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. There is no free air below the right hemidiaphragm. The lungs appear clear bilaterally. Cardiomediastinal silhouette appears normal. No effusion or pneumothorax is seen. The bony structures are intact.", "output": "No acute abnormalities, no free air below the right hemidiaphragm." }, { "input": "The inspiratory lung volumes are appropriate. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The pulmonary vasculature is not engorged. The cardiomediastinal and hilar contours are within normal limits. No acute osseous abnormality is detected.", "output": "No focal consolidation concerning for pneumonia." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "The heart is normal in size. The mediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. The lungs appear clear. No free air is identified. A biliary stent projects over the right upper quadrant of the abdomen. There are also surgical clips projecting over the right upper quadrant, mostly commonly seen after cholecystectomy.", "output": "No evidence of acute disease. No free air identified." }, { "input": "The cardiac, mediastinal and hilar contours appear stable including mild cardiomegaly and a large hiatal hernia. There is no pleural effusion or pneumothorax. Slight blunting at the right costophrenic sulcus is probably due to minor scarring. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "There is persistent blunting of the right costophrenic angle, seen since at least ___ which could be due to a small pleural effusion, however, given chronicity, may relate to pleural thickening. The cardiac silhouette remains mildly enlarged. Evidence of a hiatal hernia is again seen. Right paratracheal opacity without indentation on the adjacent trachea is again seen and grossly stable. Large hiatal hernia with air-fluid levels seen on the lateral view. No focal consolidation or pneumothorax. Mediastinal contours are stable with calcification of the aorta seen.", "output": "Chronic blunting of the right costophrenic angle. Large hiatal hernia. No focal consolidation or other significant change from the prior study." }, { "input": "No definite focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. Patient is status post aortic valve repair.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture seen. Mild degenerative changes are seen along the spine.", "output": "No acute cardiopulmonary process." }, { "input": "The lung volumes are low. Streaky posterior left basilar opacities suggest minor atelectasis. Otherwise, the lungs appear clear. There are no pleural effusions or pneumothorax. Although not optimally assessed, the cardiac, mediastinal, and hilar contours are probably within normal limits for technique.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "PA and lateral views of the chest were obtained. Heart is normal size, and cardiomediastinal silhouette is unchanged. Lung volumes have increased, however, right infrahilar opacities persist. There is no pleural effusion or pneumothorax.", "output": "Right infrahilar opacification has not improved and could represent persistent pneumonia." }, { "input": "Single AP upright portable view of the chest was obtained. There are low lung volumes, which accentuate the bronchovascular markings. Given this, there is patchy right basilar opacity which could be due to atelectasis in combination with vascular engorgement, although consolidation from infection is not excluded. No large pleural effusions are seen, although trace effusions will be difficult to exclude. There is no evidence of pneumothorax. Cardiac and mediastinal silhouettes are unremarkable. Hilar contours are prominent, likely accentuated by low lung volumes; however, pulmonary vascular engorgement may be present.", "output": "1. Low lung volumes which accentuate the bronchovascular markings. Patchy right basilar opacity, pneumonia not excluded versus atelectasis. 2. Prominence of the hila, likely accentuated by low lung volumes; however, vascular engorgement may be present." }, { "input": "PA and lateral views of the chest. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs remain clear. The cardiomediastinal silhouette is stable. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The there has been interval removal of the right PICC line. The cardiomediastinal silhouette is normal. There is no focal consolidation, effusion or pneumothorax. There is no pulmonary vascular congestion. The previously identified micronodular pattern of opacification has not recurred. The bony structures of the thorax are grossly within normal limits.", "output": "No pneumonia." }, { "input": "Interval worsening of interstitial pulmonary edema, now moderate. Mild cardiomegaly is new. There is no focal consolidation, pleural effusion, or pneumothorax. Biapical pleural thickening is noted.", "output": "Interval development of mild cardiomegaly and moderate interstitial pulmonary edema." }, { "input": "Frontal and lateral chest radiographs demonstrate a micronodular pattern of parenchymal opacification with a lower lobe predominance. There are low lung volumes which accentuate the pulmonary vasculature. The heart size remains normal. The mediastinal contours are unremarkable. There is no lymphadenopathy. There is no effusion or pneumothorax.", "output": "Micronodular pattern of parenchymal opacification predominantly in the lower lobes, similar in appearance compared with ___ of this year. While this might represent recurrent atypical infection (viral), other considerations include a pneumoconiosis or sarcoidosis although findings were not present one year prior arguing against the latter two. This is unlikely to represent metastasis given its stability over one month, though this remains a consideration. Findings were discussed with Dr. ___ at 3:40 p.m. by phone." }, { "input": "There low lung volumes. Perihilar and bibasilar opacities more likely reflect interstitial edema rather than pneumonia. No pleural effusion is seen. There is no evidence of pneumothorax. The cardiac and mediastinal silhouettes are stable. The distal aspect of the right-sided PICC is faintly seen on the frontal view coursing into the SVC, distal aspect not well seen.", "output": "Low lung volumes. Perihilar and bibasilar opacities more likely reflect mild interstitial edema rather than pneumonia." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. There is no pleural effusion or pneumothorax. The lungs appear clear aside from patchy posterior opacity that appears unchanged, probably due to minor atelectasis.", "output": "No evidence of pneumonia." }, { "input": "Increased interstitial opacity and upper zone redistribution compatible with pulmonary edema. No large pleural effusion or focal consolidation. Heart size is mildly enlarged, as before. No pneumothorax. Osseous structures are unremarkable.", "output": "1. Mild-to-moderate pulmonary edema, not significantly changed from ___. 2. Mild cardiomegaly. 3. No large pleural effusion or focal consolidation." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. There is no pulmonary edema. The heart is normal in size, and the mediastinal contours are normal. A coronary artery stent is noted.", "output": "No acute cardiopulmonary process." }, { "input": "There is hyper lucency and paucity of vessels in the upper lobes consistent with emphysema. Evaluation of the bases is slightly limited due to body habitus. There is no definite focal consolidation, pleural effusion, or pneumothorax. Cardiomediastinal silhouette is unremarkable. There are no acute bony findings.", "output": "Hyperlucent upper lobes with paucity of vessels consistent with emphysema." }, { "input": "PA and lateral chest views obtained with patient in upright position are analyzed in direct comparison with the next preceding PA and lateral chest examination of ___. Cardiac and mediastinal structures are unaltered. Pulmonary vasculature not congested. Slightly high-positioned diaphragms indicative of poor inspirational effort and probably the course of the lateral plate thin atelectasis mostly located in dorsal segments of the lower lobes. These atelectases are new in comparison with the previous study, however, there is no evidence of new acute parenchymal infiltrates and no pneumothorax has developed.", "output": "Poor inspirational effort and bilateral plate atelectasis but absence of any acute pneumonic infiltrate." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. Minimal left base atelectasis may be present.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs demonstrate unremarkable cardiomediastinal and hilar contours. Lungs are clear. No pleural effusion or pneumothorax evident. No osseous abnormality is identified.", "output": "Normal chest radiograph." }, { "input": "No significant change since ___. The lungs are clear without focal consolidation or pulmonary edema. No pleural effusion or pneumothorax. The heart size is normal, and the mildly dilated or tortuous descending aorta and is unchanged since at least ___. Mediastinal contours, hila, and pleura are normal.", "output": "No acute cardiopulmonary process, including no radiographic evidence of aspiration." }, { "input": "There is possible subtle left basilar retrocardiac opacity which may be due to atelectasis although underlying consolidation is not excluded. The right lung is clear. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "Possible subtle left basilar retrocardiac opacity seen on the frontal view may be due to atelectasis although underlying consolidation is not excluded. If symptoms continue, consider nonurgent chest CT." }, { "input": "The heart size is mildly enlarged. There are bilateral pleural effusions and volume loss at both bases. There is mild pulmonary vascular redistribution. The patient is status post CABG with multiple mediastinal clips.", "output": "Worsened CHF." }, { "input": "Semi-upright portable AP chest radiograph is obtained. A dual-barrel Port-A-Cath projects over the right chest wall with catheter tip extending into the cavoatrial junction. Lung volumes are low. No pneumonia or CHF. No pleural effusion or pneumothorax. Heart and mediastinal contours are stable. Bony structures are intact. A right percutaneous nephrostomy tube is noted projecting over the right hemiabdomen.", "output": "No signs of pneumonia." }, { "input": "The lung volumes are low, accentuating the vascular markings. There is no consolidation or edema. There is no pleural effusion or pneumothorax. No definite pulmonary nodules are identified. The cardiomediastinal silhouette is normal. A right subclavian Port-A-Cath is present with the tip terminating at the atriocaval junction. It is unchanged in position. A right percutaneous nephrostomy tube is present. There is a compression deformity in a mid thoracic vertebral body which is new from ___, but of indeterminate age.", "output": "1. No definite pulmonary nodules. If concern for small metastases persists, CT is a more sensitive test for evaluation. 2. Compression deformity in the mid thoracic spine is new from ___, but of indeterminate age. 3. No evidence of pneumonia." }, { "input": "AP upright and lateral views of the chest were provided. A Port-A-Cath resides over the right chest wall with catheter tip extending into the right atrium. Blunted right CP angle is compatible with pleural effusion. There appears to be mild interstitial edema. Cardiomediastinal silhouette appears normal. Atherosclerotic calcification along the aortic knob is noted. No free air below the right hemidiaphragm.", "output": "Interstitial edema with small right pleural effusion." }, { "input": "Lung volumes are low. Heart size is normal. Mediastinal and hilar contours are unremarkable. Patchy opacities in the lung bases may reflect aspiration, atelectasis or pneumonia. No pleural effusion or pneumothorax is present. There is no pulmonary vascular congestion. No acute osseous abnormalities detected.", "output": "Bibasilar patchy opacities, more so on the left, may reflect atelectasis, aspiration or infection." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are hyperexpanded and there is flattening of the diaphragms consistent with chronic lung disease. Lungs are otherwise clear. No focal consolidation, pleural effusion or pneumothorax is identified. Visualized osseous structures are grossly intact.", "output": "No radiographic evidence of an acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs without focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process. Normal heart size." }, { "input": "Compared with prior radiographs on ___, there is no significant change.There are small bilateral pleural effusions, unchanged. There is no new focal consolidation. There is stable bilateral apical scarring. No pneumothorax is seen. Cardiomegaly is unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal contours are normal. Lungs and pleural surfaces are clear.", "output": "No acute cardiopulmonary radiographic abnormality." }, { "input": "Of note, the image is underpenetrated. Lung volumes are low. The cardiomediastinal and hilar contours are within normal limits. Patchy bibasilar opacities are most likely representative atelectasis. No focal consolidation is identified. There is no evidence of pneumothorax or large pleural effusion.", "output": "Low lung volumes. Patchy bibasilar atelectasis with no evidence of focal consolidation." }, { "input": "PA and lateral views of the chest were obtained. Compared with ___, I doubt significant interval change. MIld hyperinflation of the lungs raises the question of background COPD. The heart is at the upper limits of normal or slightly enlarged. The aorta is calcified and slightly tortuous. NO chf, focal inifiltrate, or gross effusionis identified. MInimal blunting of both costophrenic angles is noted. Slight bowing of a distal lower lobe fissure on the lateral view could reflect imonor volume loss/atelectasis. Mild t-scpine degenerative change noted.", "output": "No acute pulmonary process identified. No pneumothorax identified. No rib fracture detected on these lung technique films." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. There is mild tortuosity of the descending aorta. No focal consolidation, pleural effusion or pneumothorax is identified.", "output": "No acute cardiopulmonary process." }, { "input": "Compared to prior chest radiographs, there has been interval removal of the Port-A-Cath. No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is detected. Minimal linear density in the left mid lung may represent a focus of atelectasis or post-radiation change. The aorta is mildly tortuous. Heart size is within normal limits, particularly given AP technique.", "output": "No evidence for acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are unchanged. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Moderate degenerative changes of the thoracic spine with bridging anterior osteophytes are re- demonstrated.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal and hilar contours are normal. Diffuse patchy airspace opacification noted in the right lung base, which is concerning for an acute infectious process versus aspiration. The left lung is well expanded and clear. No pleural effusion or pneumothorax is seen. No acute osseous abnormality is seen. Mild degenerative changes are seen in the thoracic spine.", "output": "Patchy opacification in the right lung base, concerning for pneumonia versus aspiration." }, { "input": "PA and lateral views of the chest provided. AICD projects over the left chest wall with lead tip extending to the region of the right ventricle. The heart is mildly enlarged. There is no evidence of pneumonia or CHF. No effusion or pneumothorax seen. Bony structures are intact.", "output": "No acute intrathoracic process." }, { "input": "The ___ radiograph from 17:48 shows increased near-complete opacification of the left hemithorax. Two left chest tubes remain in place. The aerated right lung is grossly clear. The heart and mediastinum cannot be accurately assessed. The followup radiograph from 20:23 shows slightly increased gaseous distension of the stomach, and no other significant interval change. The ___ radiograph shows decreased gaseous distention of the stomach, and no other relevant change.", "output": "Increased near complete opacification of the left hemithorax, which is likely due to a combination of worsening atelectasis or increased large pleural effusion." }, { "input": "Lines and Tubes: Again visualized are 2 left-sided chest tubes in unchanged position. The laterally located chest tube has a side hole projecting in the subcutaneous tissues of the lateral chest wall, as before. Lungs: There is persistent near complete opacification of the left hemi thorax, likely a combination of known hematoma/pleural effusion and postsurgical changes including atelectasis. Right lung is clear. No right pleural effusion present Pleura: Known left hematoma, status post VATS for evacuation. No right pleural effusion or pneumothorax. Mediastinum: Mild cardiomegaly with shift of mediastinum to the left side. Bony thorax: No significant interval change.", "output": "Persistent near complete opacification of the left hemi thorax sparing the left upper lobe, likely a combination of residual pleural effusion/hemothorax and underlying atelectasis. 2 left-sided chest tubes are in unchanged position. The laterally located chest tube has a side hole projecting in the subcutaneous tissues of the lateral chest wall, as before. Right lung clear, no right pleural effusion." }, { "input": "A portable frontal chest radiograph again demonstrates an enlarged cardiomediastinal silhouette. The right lung is fairly well-aerated. The left lung demonstrates decreased aeration and increased pleural effusion. 2 left chest tubes are in place. Of note, the side port of the superior chest tube is extra thoracic, within the soft tissues of the chest wall. There is a small amount of subcutaneous emphysema in the soft tissues of the left neck. The visualized upper abdomen is unremarkable.", "output": "1. Decreased aeration of the left lung with increased left pleural effusion. 2 left chest tubes are in place, with the side port of the superior chest tube extra thoracic, within the soft tissues of the chest wall. 2. Small amount of subcutaneous emphysema in the soft tissues of the left neck. NOTIFICATION: These findings were communicated via telephone by Dr. ___ ___ to Dr. ___ at 17:10 on ___." }, { "input": "Lungs are low in volume with dense retrocardiac and patchy right basal opacities, which may reflect atelectasis; however, particularly on the left, pneumonia would be difficult to exclude. Accompanying pleural effusions may also be present. No pneumothorax is seen. The heart is moderately to markedly enlarged.", "output": "1. Dense retrocardiac opacity and bibasal opacities could reflect atelectasis and pleural effusion; however, infectious process would be difficult to exclude. Accompanying pleural effusion, particularly on the left, may also be present. Consider PA and lateral examination with full inspiration to better assess. 2. Moderate to marked cardiomegaly." }, { "input": "The ___ radiograph from 17:48 shows increased near-complete opacification of the left hemithorax. Two left chest tubes remain in place. The aerated right lung is grossly clear. The heart and mediastinum cannot be accurately assessed. The followup radiograph from 20:23 shows slightly increased gaseous distension of the stomach, and no other significant interval change. The ___ radiograph shows decreased gaseous distention of the stomach, and no other relevant change.", "output": "Increased near complete opacification of the left hemithorax, which is likely due to a combination of worsening atelectasis or increased large pleural effusion." }, { "input": "Portable AP chest radiograph. Compared to the prior radiograph, there are increased bilateral pulmonary opacities consistent with mild pulmonary edema. There is increase in retrocardiac opacification as well as small bilateral pleural effusions. There is no focal consolidation or pneumothorax. Moderate cardiomegaly is stable.", "output": "Interval development of mild pulmonary edema with stable small bilateral pleural effusions." }, { "input": "Left-sided chest tube is in unchanged position. There is a persistent, unchanged loculated left pleural effusion with patchy aeration of underlying left lung. Right lung is clear. No change in cardiomediastinal silhouette. Bony thorax is unchanged.", "output": "No interval change." }, { "input": "Lines and Tubes: There has been interval removal of 1 of the left-sided chest tubes. The remaining chest tube is in stable position. Lungs: There is mild improved aeration in the left lung with clear right lung. Pleura: Loculated left pleural effusion persists, unchanged. Mediastinum: No change in cardiomediastinal silhouette. Bony thorax: No interval change.", "output": "Interval removal of 1 of the left-sided chest tubes with stable position of the remaining tube. Mild interval improved aeration of the left lung with unchanged loculated left pleural effusion. Clear right lung." }, { "input": "The ___ radiograph from 17:48 shows increased near-complete opacification of the left hemithorax. Two left chest tubes remain in place. The aerated right lung is grossly clear. The heart and mediastinum cannot be accurately assessed. The followup radiograph from 20:23 shows slightly increased gaseous distension of the stomach, and no other significant interval change. The ___ radiograph shows decreased gaseous distention of the stomach, and no other relevant change.", "output": "Increased near complete opacification of the left hemithorax, which is likely due to a combination of worsening atelectasis or increased large pleural effusion." }, { "input": "PA and lateral radiographs of the chest demonstrate clear lungs and normal hilar and cardiomediastinal contours. There is no pneumothorax or pleural effusion and the pulmonary vascularity is normal. A portion of cervical fusion hardware can be seen in the upper portion of the image.", "output": "No evidence of pneumonia. NOTE: Findings were communicated to Dr. ___ by Dr. ___ ___ telephone on ___ at 14:20." }, { "input": "There are increased opacities in the perihilar distribution bilaterally but particularly on the right side. In this area, there is also evidence of peribronchial cuffing, but whether this is within the bronchus or around the bronchus is uncertain. This constellation of findings could be seen in cardiac failure and pulmonary edema process leading towards infection such as viral pneumonia is not ruled out. There is minimal left lower lobe atelectasis. There are no pleural effusions. The cardiac size is normal.", "output": "Perihilar opacities, right greater than left, along with peribronchial cuffing. Pulmonary edema versus an infectious process such as viral pneumonia are considerations." }, { "input": "Free air is seen beneath the diaphragm, compatible with the patient's recent cholecystectomy. The lungs are clear without focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is with normal limits.", "output": "No acute cardiopulmonary process. Pneumoperitoneum is compatible with recent abdominal surgery." }, { "input": "The lungs are well expanded and clear. Mediastinum, hila, and cardiac silhouette are normal. Prominent coronary artery calcifications are present. There is no pneumothorax or pleural effusion.", "output": "No pneumonia" }, { "input": "The cardiac, mediastinal and hilar contours appear stable. Streaky opacities at each lung base suggest minor atelectasis or scarring. The chest appears hyperinflated. Irregular pulmonary architecture is suggestive of underlying obstructive pulmonary disease. There are no pleural effusions or pneumothorax.", "output": "No evidence of acute disease. Findings suggesting obstructive pulmonary disease." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. Hemidiaphragms are flattened suggesting hyperinflation. There is no definite pleural effusion, although a small effusion would be difficult to exclude on the right, where there is persistent patchy posterior opacification in the right lower lobe. Although the opacity seems more extensive on the frontal view, it is suspected that for the most part opacities have improved given substantial decrease on the lateral view. However, opacification may wax and wane, not discernable on recent radiographs from ___ for example, but present on earlier ones from ___, with a very similar configuration. Bones show abnormal sclerosis, which suggest metastatic disease, although not otherwise assessed in detail.", "output": "Waxing and waning opacity in the posterior right lower lobe, which appears overall less dense on this examination compared to the most recent one. The possibility that this appearance may reflect recurrent infection in the same area is not excluded, however." }, { "input": "The cardiomediastinal and hilar silhouette are unremarkable. The lung volumes are slightly hyperexpanded. There is a right lower lobe consolidation concerning for infection. There is no effusion or pneumothorax. No acute bony changes are identified.", "output": "Right lower lobe consolidation worrisome for pneumonia. Recommend follow-up to resolution." }, { "input": "The lungs are well expanded. There is a consolidative opacity in the left lung base with air bronchograms, concerning for pneumonia or aspiration. Diffuse opacity is also seen in the left lung base, which may represent a layering small left pleural effusion. There is no pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "Consolidative opacity in the left lung base with air bronchograms, concerning for pneumonia or aspiration. Possible layering small left pleural effusion." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. There is retrocardiac opacity seen best on the lateral view as well as a new right basal opacity consistent with aspiration. There is no evidence of pneumothorax.", "output": "Retrocardiac opacity and new right basal opacity consistent with aspiration." }, { "input": "Mild to moderate interstitial pulmonary edema is new from the prior study. There is probably a small left pleural effusion. There is no significant right-sided pleural effusion. There is no focal consolidation or pneumothorax. The cardiomediastinal silhouette is unchanged. Patient is status post CABG. Sternotomy hardware is in unchanged position", "output": "New mild to moderate interstitial pulmonary edema. Probable small left pleural effusion." }, { "input": "The lungs are essentially clear noting mild left basilar atelectasis. Cardiomediastinal silhouette is within normal limits. Prior median sternotomy hardware is noted as well as mediastinal clips. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs are clear. There is no consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. Hypertrophic changes are noted in the spine. No acute osseous abnormality is are noted.", "output": "No acute cardiopulmonary process." }, { "input": "Single AP portable radiograph of the chest. There are diffuse, asymmetric, alveolar opacities with air bronchograms in the left upper and right lower lobes. These are new since the prior radiograph. No pleural effusions are seen. Unchanged appearance of a port in the right chest wall with a catheter terminating in the right atrium. The cardiac silhouette is unchanged. No pneumothorax is seen.", "output": "New left upper and right lower lobe opacities concerning for multifocal pneumonia." }, { "input": "AP upright and lateral views of the chest were provided. Port-A-Cath resides over the right chest wall with catheter extending to the level of the low SVC. The lungs appear clear without focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette appears normal. The bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "PA and lateral chest radiographs were provided. There is no focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette is unremarkable. Osseous structures unremarkable. There is no free air under right hemidiaphragm.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs were provided. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is unremarkable. There are no acute skeletal abnormalities or free air under the diaphragm.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low. The heart is top-normal in size,. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute process." }, { "input": "The lungs are well inflated. There is no pleural effusion, pneumothorax or focal airspace consolidation. The heart is normal size. The mediastinal and hilar structures are unremarkable. A right upper paratracheal opacity is unchanged from ___ and is likely vascular. Mediastinal clips are noted. There is no displaced rib fracture.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications are noted at the aortic arch and there is tortuosity of the descending thoracic aorta. No displaced fractures identified.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is not enlarged. Aorta is calcified and unfolded. Right paratracheal soft tissues likely represent vascular structures in someone of this age. The lungs are hyperinflated, suggesting background COPD. No CHF, consolidation, pleural effusion or pneumothorax detected. No subdiaphragmatic free air detected. Linear densities projecting over lower right chest likely represent surgical clips. Multilevel degenerative changes are noted throughout the thoracic spine. Mild anterior wedging of several mid thoracic vertebral bodies is noted, but does not appear acute.", "output": "No acute pulmonary process identified." }, { "input": "The lung volumes are relatively low, but clear. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral images of the chest were obtained with the patient in the upright position. Again seen are surgical clips in the right hilum and volume loss in the right lung consistent with right middle lobectomy. There is a small persistent right effusion, the left lung is clear. Cardiomediastinal silhouette is unchanged from previous imaging. Visualized osseous structures are unremarkable.", "output": "Essentially unchanged chest radiograph from previous imaging. Right pleural effusion." }, { "input": "Lungs are well expanded with minimal residual right basal atelectasis. Post-surgical changes are seen with chain suture and clips in the right mid and lower lung. Apically directed right-sided chest tube is seen with small apical pneumothorax. Left lung is clear. Stable fullness of the azygos vein is compatible with mild vascular congestion without edema. Heart is stably enlarged. Subcutaneous air noted in the right lateral chest wall.", "output": "Small right apical pneumothorax with chest tube in place. Findings and changes from the initial interpretation were discussed with Dr. ___ at 11:09 on ___, 10 minutes after discovery." }, { "input": "PA and lateral radiographs of the chest once again depict volume loss in the right lung consistent with right middle lobectomy, as well as surgical clips in the right hilum. The small layering right pleural effusion has resolved, and there is an expected collection of fluid occupying the right middle lobe resection bed, with possible pleural thickening at this location. Aside from tortuosity of the aorta, the hilar and mediastinal contours are normal. There is no pneumothorax, and the pulmonary vascularity is normal, without edema.", "output": "1. Resolution of small layering right pleural effusion with a persistent small amount of loculated pleural fluid occupying the right middle lobectomy bed, accompanied by minimal pleural thickening. 2. No pneumothorax." }, { "input": "There is no focal consolidation, pleural effusion, or pneumothorax. Lung volumes are low, likely due to recent procedure. There are linear opacities at the right base, likely atelectasis. Cardiomediastinal silhouette is stable.", "output": "No pneumothorax. Atelectasis at the right base and low lung volumes." }, { "input": "The small left apical pneumothorax is unchanged in appearance. There is a prominent air-fluid level on the left side consistent with moderate pleural effusion. Subcutaneous air in the left chest wall is unchanged in appearance. Again seen is substantial atelectasis at the left base, which is unchanged. The right lung is clear.", "output": "1. Small left apical pneumothorax is unchanged in appearance. 2. Prominent air-fluid level on left side consistent with moderate pleural effusion." }, { "input": "Previously noted pigtail chest tube has been removed. No definite pneumothorax is seen. Subcutaneous emphysema within the left neck and left lateral chest and abdominal wall appears slightly increased compared to the prior exam. Hazy opacification within the left lung base likely reflects a combination of a small pleural effusion with left basilar atelectasis. Patchy right basilar atelectasis is also demonstrated. There is no pulmonary edema. The cardiac, mediastinal and hilar contours are unchanged.", "output": "No pneumothorax identified post removal of chest tube. Slightly increased amount of subcutaneous emphysema along the left neck and left lateral chest and abdominal wall. Small left pleural effusion and bibasilar atelectasis." }, { "input": "Left-sided pigtail catheter tip projects over the left upper lung field, with a moderate amount of subcutaneous emphysema seen in the left chest wall extending into the left neck. A small apical left pneumothorax is present. Patchy opacity within the left lung base may reflect atelectasis. Cardiac silhouette size is mildly enlarged. The aorta is mildly tortuous. There is no pulmonary edema. Small left pleural effusion may be present. No right-sided pneumothorax is seen. There is minimal atelectasis in the right lung base.", "output": "Status post left pigtail chest tube placement with persistent small left apical pneumothorax. Subcutaneous emphysema within the left chest wall and left neck. Left basilar opacity likely reflects atelectasis with possible small left pleural effusion." }, { "input": "A left pigtail chest tube tip projects over the left upper lung field. Previously seen left apical pneumothorax is not clearly visualized on the current exam. There does appear to be a small air-fluid level posteriorly on the left which could reflect a small loculated hydropneumothorax. Re- demonstrated is subcutaneous emphysema within the left neck and chest wall. Left basilar patchy opacity likely reflects atelectasis. Minimal atelectasis is also noted in the right lung base. The cardiac, mediastinal and hilar contours are unchanged, and no pulmonary edema is demonstrated.", "output": "Previously noted left apical pneumothorax is not clearly visualized on the current exam, though there does appear to be a small loculated hydropneumothorax posteriorly on the left. Left basilar atelectasis." }, { "input": "Single portable view of the chest. No prior. There is retrocardiac opacity which silhouettes the medial hemidiaphragm and descending aorta. Increased pleural-based opacity seen laterally at the left lung base. This could potentially be due to an effusion. Elsewhere, the lungs are clear. Cardiac silhouette is enlarged, potentially accentuated by technique. Posterior thoracic/lumbar spinal fixation hardware is seen with midline surgical ___. Anterior cervical fixation hardware is also seen. There is apparent erosion of the distal aspect of the right clavicle which is incompletely evaluated.", "output": "Left basilar opacity, in part due at an effusion with possible underlying atelectasis or consolidation. If possible, PA and lateral, may opt for additional detail, when the patient is amenable." }, { "input": "Coarse calcification projecting over the right mid lung is stable. No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Some degenerative changes are again seen along the spine.", "output": "No acute cardiopulmonary process. No significant interval change." }, { "input": "PA and lateral views of the chest demonstrate the lungs are well expanded and clear. The cardiomediastinal silhouette is unchanged, with stable mild cardiomegaly. A dual-lead pacemaker device with pulse generator over the left chest wall and leads terminating in the right atrium and right ventricle is stable in position. There is no pneumothorax, pleural effusion, pulmonary edema, or focal airspace opacity.", "output": "No acute pulmonary pathology." }, { "input": "Frontal and lateral chest radiographs demonstrate a left chest dual lead pacemaker, with the leads unchanged in position overlying the right atrium and ventricle, without radiographic abnormality. The cardiomediastinal silhouette is normal. The lungs demonstrate a large volume and are clear. There is no pleural effusion or pneumothorax.", "output": "Dual lead pacemaker with the leads unchanged in position overlying the right atrium and ventricle, without radiographic abnormality. A preliminary read was provided, via telephone, by ___, MD, to ___, NP, at ___ on ___." }, { "input": "Single frontal chest radiograph demonstrates unremarkable hilar contours. Atherosclerotic calcifications are present in the aortic arch. The cardiac silhouette is not enlarged. There are bibasilar opacifications, left greater than right which may represent atelectasis though superimposed infectious process or aspiration is not excluded. No pneumothorax identified. Mild blunting of the bilateral costophrenic angles suggests small bilateral pleural effusions. Multilevel degenerative changes are present in the thoracic spine.", "output": "Bibasilar opacification which may reflect atelectasis or pneumonia. Clinical correlation is advised. Possible trace pleural effusions." }, { "input": "Mild right mid lung and lower lung linear opacities seen on the frontal view are not appreciated on the lateral view and most likely relate to atelectasis. The left lung is clear. There is no pleural effusion or pneumothorax. The cardiac silhouette is not enlarged. The aorta is calcified and slightly tortuous. Surgical clips overlie the right axilla.", "output": "Mild linear opacities in the right mid-to-lower lung on the frontal view, not appreciated on the lateral view, most likely relate to atelectasis. No definite focal consolidation." }, { "input": "There are relatively low lung volumes. No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Low lung volumes limits evaluation. Bronchovascular crowding likely accounts for subtle increase in hilar opacity. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Lung volumes are low. Heart size is normal. Mediastinal and hilar contours are unremarkable. Crowding of the bronchovascular structures is present without pulmonary edema. Minimal bibasilar patchy opacities are similar compared to the prior study, likely reflective of atelectasis in the setting of low lung volumes. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormality is detected.", "output": "Low lung volumes with probable bibasilar atelectasis. No focal consolidation." }, { "input": "Bilateral effusions are still present but improved since last radiograph. Mild vascular congestion has resolved, and the heart size is mildly enlarged postoperatively. No focal consolidation or pneumothorax is seen.", "output": "Mild bilateral pleural effusions, improved since last radiograph." }, { "input": "The tip of Left PICC has moved superiorly approximately by 2 cm and now terminates in upper to mid SVC. Lung volumes remain low. Bilateral pleural effusions are small. Cardiomediastinal silhouette is within normal size.", "output": "The tip of left PICC has moved superiorly approximately by 2 cm and now terminates at upper to mid SVC." }, { "input": "The tip of the Dobhoff tube extends below the level the diaphragms but beyond the field of view of this radiograph. The tip of the right PICC line projects over the mid SVC. Low bilateral lung volumes, particularly the right. Ala large right pleural effusion is again present with subjacent atelectasis. Unchanged perihilar fullness. Small left pleural effusion. No pneumothorax identified.", "output": "The tip of the Dobhoff tube projects below the level of the diaphragms but beyond the field of view of this radiograph. No significant interval change in the pulmonary edema and large right pleural effusion with subjacent atelectasis/consolidation." }, { "input": "Right-sided PICC tip terminates in the proximal right atrium. Moderate enlargement of the cardiac silhouette is re- demonstrated. The mediastinal contour appears unchanged. Bilateral hilar enlargement with perihilar haziness and vascular indistinctness is compatible with mild pulmonary edema, slightly worse in the interval. A large right pleural effusion is substantially increased in the interval. A small left pleural effusion is also likely present. Bibasilar opacities likely reflect areas of atelectasis. No pneumothorax is identified.", "output": "Mild pulmonary edema, worse in the interval. Substantial increase in size of large right pleural effusion with bibasilar airspace opacities, potentially atelectasis, but infection is not excluded. Small left pleural effusion is without substantial interval change." }, { "input": "Cardiac silhouette is enlarged but stable from prior exam. There is bibasilar atelectasis and a small left pleural effusion which is only seen on the lateral. There is no definite focal consolidation or pneumothorax. The osseous structures are unremarkable.", "output": "1. Small left pleural effusion. 2. Bibasilar atelectasis." }, { "input": "There are low lung volumes. Underpenetration of the lung bases due to patient body habitus makes assessment slightly suboptimal. Prominence and indistinctness of the hila and perihilar opacity suggest pulmonary edema. Linear left mid lung atelectasis/scarring is seen. Small right and possibly small left pleural effusions are seen. There is no evidence of pneumothorax. The cardiac silhouette is mild to moderately enlarged.", "output": "Mild to moderate cardiomegaly, pulmonary edema, and small pleural effusions suggest CHF, underlying infection/pneumonia difficult to exclude." }, { "input": "Portable AP upright chest radiograph obtained. The lungs are clear, though low lung volume slightly limits evaluation. Plate-like left mid lung atelectasis is noted. No signs of pulmonary edema. No pleural effusion or pneumothorax. Cardiomediastinal silhouette appears normal.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac, mediastinal, and hilar silhouettes are unremarkable.", "output": "No acute cardiopulmonary process or pneumonia or mass." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality. Old healed right lateral lower rib fractures identified.", "output": "No acute cardiopulmonary process." }, { "input": "Normal heart, lungs, pleura and mediastinal surfaces. Cervical spine hardware is noted.", "output": "No acute cardiopulmonary process seen." }, { "input": "PA and lateral chest radiograph demonstrates a mildly enlarged heart though this appears increased in size relative to prior study dated ___. Currently, the heart measures ___.2 cm when previously it measured ___.3 cm at the same level. Prominent interstitial markings with ___ B-lines, perihilar hazy opacities are consistent with pulmonary edema. Small bilateral pleural effusions are additionally present. There is no pneumothorax. Osseous structures are unremarkable.", "output": "Relative to prior examination dated ___, the heart is enlarged with prominent interstitial markings and perihilar opacities consistent with pulmonary edema. NOTIFICATION: Findings communicated to Dr. ___ by ___ ___ via telephone at 7:17 am on ___ at the time study was reviewed." }, { "input": "Moderate to severe cardiomegaly is a stable. Moderate pulmonary edema has improved. There is no pneumothorax or enlarging pleural effusions. Sternal wires are aligned. Patient is status post CABG.", "output": "Improved pulmonary edema. COPD" }, { "input": "Compared with the prior radiograph, moderate cardiomegaly is unchanged, and pulmonary edema has improved, now mild in severity. There is no pneumothorax or enlarging pleural effusions. Intact median sternotomy wires and mediastinal clips, post CABG.", "output": "Persistent moderate cardiomegaly, with improved pulmonary edema, now mild in severity." }, { "input": "AP upright and lateral views of the chest provided. Midline sternotomy wires and mediastinal clips again noted. The heart is enlarged, with apparent mild increased from prior exam, please correlate for pericardial effusion. The hila appear slightly congested though there is no frank edema. No large effusion or pneumothorax is seen. Bony structures are intact.", "output": "Interval cardiac enlargement is concerning for development of a pericardial effusion. Hilar congestion without frank edema." }, { "input": "The lungs are clear.The heart size is normal. Mediastinal contours remarkable for slightly tortuous descending thoracic aorta, which is unchanged.No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. The lungs are clear without consolidation, effusion, or pulmonary vascular congestion. Biapical scarring is again noted. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are height there inflated. Mild biapical scarring is again seen. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "Single frontal view of the chest was obtained. The heart is of normal size with normal cardiac and mediastinal contours. The pulmonary vessels are unremarkable. The lungs are clear without focal or diffuse abnormality. No pleural effusion or pneumothorax is present. A small metallic density overlies the right humeral head. The osseous structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The endotracheal tube has been pulled back and now ends 3 cm above the carina. The nasogastric tube ends in the stomach. Left basilar opacity has almost resolved. The right lung is clear. There is no pneumothorax or pleural effusion. The aortic knob is calcified. The heart size is normal.", "output": "1. The endotracheal and nasogastric tube are now in appropriate position. 2. The left retrocardiac opacity has almost resolved." }, { "input": "Overlying support devices obscure the film. The patient is rotated. The endotracheal tube is seen at the level of the carina approaching the right mainstem bronchus and should be retracted. The nasogastric tube is coiled in the neck. The right lung is clear. The heart is likely within normal limits given rotation. There is a left retrocardiac opacity. The lungs are otherwise clear without pneumothorax.", "output": "1. The endotracheal tube ends in the right mainstem bronchus. The nasogastric tube is coiled in the neck. 2. A retrocardiac cardiac opacity could represent atelectasis, infection or aspiration. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 11:08 PM, 5 minutes after discovery of the findings." }, { "input": "Since the most recent examination, the patient is extubated. A transesophageal tube has been removed. A right-sided internal jugular sheath remains, terminating in the upper SVC. Lung volumes are low. Possible, small postoperative pneumopericardium is noted. Since the most recent examination, there is progressive atelectasis of the left lower lobe. Likely small, bilateral pleural effusions are present. No definite consolidation is identified. No definite pneumothorax is identified.", "output": "Expected postoperative appearance of the chest with possible, residual small pneumopericardium." }, { "input": "The lungs are clear. No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The heart is normal in size. The left main pulmonary artery appears slightly prominent, but is not overtly enlarged. Calcifications of the aortic knob are mild. The mediastinum is not widened. The left hemidiaphragm is elevated, likely secondary to overdistension of the stomach. Mild multi-level degenerative changes of thoracic spine noted.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. There is no pulmonary edema. The heart is normal in size, and the mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "AP and lateral chest radiographs were obtained. There is a ground-glass/hazy increased opacity in the right lower lobe on the frontal and lateral projections. There is no effusion or pneumothorax. Cardiac and mediastinal contours are normal.", "output": "Right lower lobe opacity may represent early/developing infectious pneumonia." }, { "input": "Frontal and lateral views of the chest. No pleural effusion, pneumothorax, or focal airspace consolidation. Cardiac silhouette is normal in size, and unchanged accounting for technique. The lung volumes are low which results in crowding of the bronchovascular structures. Despite this, there is mild pulmonary edema with bronchial cuffing, indistinctness of the hilar borders and vascular redistribution. There is mild prominence of the right hilus, thought to reflect a dilated main pulmonary artery. There is no focal airspace consolidation worrisome for pneumonia.", "output": "Mild pulmonary edema Findings discussed with Dr. ___ by Dr. ___ at 07:48 on ___ by telephone at the time of discovery." }, { "input": "Mild cardiomegaly is overall stable compared to the prior exam. There is mild pulmonary vascular congestion as well as diffuse mild pulmonary edema. There is no large pleural effusion or pneumothorax. No focal consolidations concerning for pneumonia are identified. On the lateral view, there is a rounded opacity projecting over the lower thoracic spine, which was not clearly seen on the prior exams.", "output": "1. Mild pulmonary edema. 2. Rounded opacity seen on the lateral view projecting over the lower thoracic spine may be secondary to a confluence of vessels with osteophytosis, however additional oblique views are recommended to exclude malignancy. D/w Dr. ___ at 8:___A on the day of the exam by phone by Dr. ___." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs without focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Endotracheal tube tip is seen 2.9 cm from the carina. Enteric tube tip seen within the lower mediastinum likely at the level of the gastroesophageal junction. There is dense retrocardiac opacity which may be due to combination of the an effusion with underlying consolidation. There may also be a small right pleural effusion. There is pulmonary vascular congestion without overt pulmonary edema. There is moderate cardiomegaly. Atherosclerotic calcifications noted at the aortic arch. No acute osseous abnormalities.", "output": "ET tube in appropriate position. Enteric tube tip at the GE junction and should be advanced. Left basilar opacity likely due to effusion with adjacent atelectasis noting that infection is not excluded. Probable small right effusion. Vascular congestion without overt edema." }, { "input": "The patient is intubated with an endotracheal tube terminating 3.5 cm above the level the carina. A right internal jugular catheter terminates in the mid SVC. A nasogastric tube terminates below the left hemidiaphragm. Lung volumes are unchanged compared to the prior study. There is persistent left lower lobe atelectasis versus consolidation. The bilateral pleural effusions have decreased in size. No consolidation or pneumothorax seen. Persistent prominence of the bilateral hila likely reflect pulmonary arterial enlargement.", "output": "Slight interval improvement in bilateral pleural effusions. Persistent left lower lobe atelectasis." }, { "input": "There are persistent moderate to large bilateral pleural effusions, larger on the right than on the left. Moderate pulmonary edema has also progressed since prior. Enteric tube tip projects over in the stomach. Right PICC is in stable position, tip projecting over the lower SVC. Cardiac silhouette is difficult to assess but is likely enlarged.", "output": "Pulmonary edema with moderate to large bilateral effusions, larger on the right. Superimposed infection particularly at the lung bases would be difficult to exclude." }, { "input": "Bilateral perihilar parenchymal opacities consistent with pulmonary edema are decreased, improved since ___. ET tube terminates 26 mm above the carina. Right internal jugular venous catheter terminates in the low SVC. Transesophageal tube terminates within the stomach. Persistent moderate cardiomegaly is unchanged since ___. No evidence of pleural effusion or pneumothorax. Cardiomediastinal borders and hilar structures are normal.", "output": "Pulmonary edema is improved since ___. ET tube terminating 26 mm above the carina. Consider pulling back 1-2 cm." }, { "input": "ET tube terminates 17 mm above the carina. Right internal jugular venous catheter terminates in low SVC. Transesophageal tube terminates in the stomach. Severely enlarged cardiac silhouette is similar to 3 hr prior. Retrocardiac left lung base opacity is persistent.", "output": "Right internal jugular venous catheter terminates in low SVC. ET tube terminates 17 mm above the carina. Consider pulling back by 2 cm." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. No mass lesion is identified. Heart size is normal. Mediastinal silhouette and hilar contours are normal. The scapula is not well evaluated on this study.", "output": "Normal chest radiographs. If a scapular abnormality is suspected clinically, dedicated scapular radiograph would be recommended." }, { "input": "Frontal and lateral views of the chest. No prior. The lungs are clear. There is no effusion, consolidation, or pneumothorax. Cardiac silhouette is slightly enlarged. Median sternotomy wires with mediastinal clips are noted. Hypertrophic changes are noted in the spine. Osseous and soft tissue structures are otherwise unremarkable.", "output": "Cardiomegaly, without acute cardiopulmonary process." }, { "input": "PA lateral views of the chest. Lungs well expanded and clear. A narrow AP diameter of the chest is noted. No pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable. Scoliosis is seen.", "output": "No acute cardiopulmonary process." }, { "input": "AP portable upright view of the chest. Overlying EKG leads are present. The heart remains moderately enlarged with calcification projecting over the heart likely mitral annular calcification. There is mild interstitial pulmonary edema and hilar engorgement. A small left effusion is difficult to exclude. No pneumothorax. No convincing evidence for pneumonia. No acute bony injury.", "output": "Stable cardiomegaly with hilar congestion and mild interstitial edema." }, { "input": "There is interstitial pulmonary edema, which has worsened in comparison to prior chest radiograph. There is a left retrocardiac opacity with silhouetting of the diaphragm and air bronchograms. Heart size is stable. The mediastinal and hilar contours are stable. No pneumothorax is seen. Again visualized is a calcified mitral annulus.", "output": "1. Left retrocardiac opacity with air bronchograms, which likely represents atelectasis, although underlying pneumonia cannot be ruled out. 2. Worsening interstitial pulmonary edema." }, { "input": "There is mild interstitial pulmonary edema but no focal opacity suggestive of pneumonia. Apparent opacity in the right cardiophrenic angle is felt to represent summation of bronchovascular bundles with the posterior ribs. Moderate cardiomegaly is present. There is no pleural effusion or pneumothorax. Extensive atherosclerotic calcifications of the aorta are seen. Bony callus from old right clavicular fracture is also noted.", "output": "Interstitial pulmonary edema in the setting of moderate cardiomegaly. Apparent opacity in the right cardiophrenic angle is felt to represent summation of bronchovascular bundles with the posterior ribs." }, { "input": "Portable semi-erect chest film ___ at 09:06 is submitted.", "output": "The heart remains stably enlarged which may reflect cardiomegaly, although pericardial effusion should also be considered. Mediastinal contours are unchanged. There is stable mild perihilar and interstitial edema. No large effusions. No pneumothorax." }, { "input": "There is severe cardiomegaly, with widening of the mediastinal contour. Additionally, there is a 3.5-cm additional rounded contour at the apical lateral aspect of the aortic knob, which appears to be vascular, but is unusual in size and location. The hilar contours show some prominence of central pulmonary vasculature. Trace effusions are present with mild vascular congestion. Incidental note is made of an azygos fissure. There is no pneumothorax.", "output": "1. Severe cardiomegaly with mild pulmonary vascular congestion. 2. 3.5-cm additional rounded contour at the apical lateral aspect of the aortic knob, which is of unclear etiology. Further evaluation with a dedicated chest CT with contrast is recommended. Results were uploaded to the online ___ critical results database." }, { "input": "PA and lateral views of the chest provided. Cardiomegaly is moderate. Overall contour of the mediastinum is unchanged with prominence of the aortic knob previously assessed by CT. There is no focal consolidation, large effusion or pneumothorax. There are right and left perihilar linear densities which likely represents minimal atelectasis or scarring. There is an azygous fissure. No acute fracture is seen. No free air below the right hemidiaphragm.", "output": "Cardiomegaly. No evidence of acute injury to the chest." }, { "input": "There is interval decrease in size of moderate right pleural effusion status post thoracentesis with persistent patchy opacification at the right lung base compatible with re-expansion pulmonary edema. There is no definite evidence of pneumothorax. The left lung remains clear. The cardiac silhouette is enlarged but stable. The mediastinal and hilar contours are within normal limits.", "output": "Interval decrease in right pleural effusion status post thoracentesis with re-expansion pulmonary edema of the right lung base. No pneumothorax." }, { "input": "PA and lateral chest radiographs show hyperinflation suggestive of emphysema. Bibasilar consolidations are consistent with pneumonia. There are also small bilateral pleural effusions. There is no pneumothorax. The heart size is normal.", "output": "Bibasilar pneumonia and bilateral pleural effusions." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process. Specifically, no pneumothorax." }, { "input": "There are bilateral diffuse airspace opacities, with more confluent consolidations in the lung bases. A nodular component cannot be excluded. Assessment of the pleural sulci is limited as both were left out of the imaging frame. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax. Endotracheal tube is seen ending 4.8 cm above the carina. There is no cardiomegaly.", "output": "1. Severe diffuse bilateral airspace opacities might represent pulmonary edema, pulmonary hemorrhage or widespread infection. Further assessment with chest CT is recommended. 2. Endotracheal tube ending 4.8 cm above the carina." }, { "input": "ET tube remains in good position. There is an upper alimentary tube whose tip is not seen, but appears to be coiled towards its distal end. Bilateral diffuse airspace opacities are much improved on this study, but slight increased markings in the bilateral upper lobes and the right lower lobe are still present. There is no pleural effusion or pneumothorax. Cardiomediastinal and hilar contours are normal.", "output": "Almost complete resolution of bilateral diffuse airspace opacifications consistent with diagnosis of pulmonary edema." }, { "input": "Portable supine radiograph of the chest demonstrates low lung volumes with resulting bronchovascular crowding. There is stable appearing bibasalar atelectasis and mild pulmonary edema. The cardiomediastinal and hilar contours are unchanged. A left-sided subclavian central venous line ends at the distal SVC. The tracheostomy tube is in good position. Nasogastric tube ends in the stomach. There is no pneumothorax.", "output": "Nasogastric tube ends in the stomach." }, { "input": "Supine portable radiograph of the chest demonstrates very low lung volumes with resulting bronchovascular crowding. There is improving atelectasis at the left base, and stable atelectasis at the right base. The cardiomediastinal and hilar contours are unchanged. Left-sided subclavian central venous line ends at the mid SVC. Tracheostomy tube ends 3.5 cm from the carina. The Dobbhoff tube tip is seen oropharynx.", "output": "Dobbhoff tube tip is in the oropharynx. COMMENTS: These findings were discussed with ___ by Dr. ___ ___ telephone at 9:05 a.m. on ___, 10 minutes after the findings were discovered." }, { "input": "Assessment is limited due to low lung volumes and significant artifact from trauma board. Allowing for this limitation, the endotracheal tube is seen ending approximately 4 cm above the carina and the esophageal tube ends below the gastroesophageal junction, with the tip out of view. Low lung volumes accounting for bronchovascular crowding. No cardiomegaly is identified. Apparent widening of the vascular pedicle is likely due to position and low lung volumes.", "output": "Appropriate position of the endotracheal and esophageal tubes. Low lung volumes." }, { "input": "AP and lateral chest radiograph demonstrate hyperinflated clear lungs . The heart is within upper limits of normal in size. Patient is status post median sternotomy. There is no pulmonary edema. There is no pleural effusion or pneumothorax. No acute osseous abnormality is detected.", "output": "No acute intrathoracic abnormality. Probably COPD" }, { "input": "Normal cardiomediastinal and hilar contours. A small fat pad is seen abutting the left heart border inferiorly. Lungs are clear. Smooth pleural surfaces.", "output": "No acute intrathoracic process." }, { "input": "AP portable upright view of the chest. Right subclavian catheter again noted in unchanged position. There is a 3 cm rounded opacity projecting over the left upper lung, more conspicuous than on outside hospital exam and new from ___ exam. Bibasilar atelectasis, right greater than left with mild elevation of the right hemidiaphragm noted. Cardiomediastinal silhouette is stable. No large effusion or pneumothorax. No convincing signs of free air below the right hemidiaphragm. Bony structures are intact.", "output": "1. Right upper lobe mass measuring approximately 3 cm for which CT chest recommended for further assessment. 2. No evidence of free air below the right hemidiaphragm." }, { "input": "There has been interval removal of a left-sided internal jugular central venous line and nasogastric tube. A large, rounded opacity involving the left upper lobe correlates with the left upper lobe mass seen on chest CT dated ___, which appears to have enlarged in the interval. The heart remains moderately enlarged and demonstrates moderate central pulmonary vascular congestion without overt interstitial pulmonary edema. No evidence of pneumothorax or pleural effusion.", "output": "1. Moderate cardiomegaly and central pulmonary vascular congestion. 2. Large left upper lobe opacity compatible with the patient's known left upper lobe mass, which was suspicious for malignancy on ___ by chest CT appears to have enlarged in the interval." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process" }, { "input": "There is increased vascular congestion with interstital prominence suggesting mild pulmonary edema. Small bilateral pleural effusions are present. There is no consolidation or pneumothorax. The cardiac silhouette is significantly enlarged, most prominent on the right side. Atherosclerotic calcification of the aorta is noted. The patient is status post a midline sternotomy. The wires are intact. Multiple clips are seen within the mediastinum.", "output": "1. Moderate pulmonary edema. 2. Bilateral small pleural effusions. 3. Moderate to severe right sided cardiomegaly." }, { "input": "In comparison to ___ chest radiograph, there is a new small right pleural effusion obscuring the right hemidiaphragm. Additionally, the right pigtail catheter appears to have changed position; some of the side ports are now external to pleural surface resulting in accumulation of the right pleural fluid. There is also interval worsening of the right lower lung atelectasis. The left lung is well-expanded and clear. The right lateral seventh and eighth rib minimally displaced fractures are again seen; there is mild subcutaneous emphysema of the overlying soft tissue. The cardiomediastinal and hilar contours are stable. There is no pulmonary edema or pneumothorax.", "output": "1. The right pigtail catheter has changed in position, and some of the side ports are now external to the pleural space. Associated accumulation of a small right pleural effusion and worsening right lower lobe atelectasis. 2. Minimal subcutaneous emphysema of the soft tissues overlying the lateral right seventh and eighth rib fractures. RECOMMENDATION(S): Discussed findings with ___ at 11:45 via telephone conversation (___). The impression and recommendation above was entered by Dr. ___ on ___ at 11:47 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "A right pigtail drain has been placed in the interim with the tip projecting over the lateral mid right hemithorax with apparent resolution of the pneumothorax on this single upright AP view. Residual pneumothorax, if present, is tiny. Right lateral seventh and eighth rib fractures are minimally are nondisplaced. Lung volumes are slightly low. Lungs are clear except for minor atelectasis at both bases. The heart is top-normal in size. The mediastinum is not widened.", "output": "No evidence of substantial pneumothorax after interval placement of right pigtail drain." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No evidence of pneumonia." }, { "input": "There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Mild calcification of the aortic knob is similar to prior.", "output": "No acute intrathoracic process." }, { "input": "The mediastinal contours are within normal limits. The thoracic aorta is tortuous with mild calcification of the aortic knob. The cardiac silhouette is normal in size. The hilar contours are within normal limits. The lungs are symmetrically well-expanded and well-aerated without focal consolidation, pleural effusion or pneumothorax. The pulmonary vasculature is not engorged. Mild multilevel degenerative changes are noted in the thoracic spine.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "There has been interval removal of a right-sided IJ central venous catheter. There is subtle left mid-to-lower lung, there is subtle left lower lobe opacity which could be due to atelectasis, infection or aspiration. There is interval improvement in right base opacity. There may be a trace left pleural effusion. No definite right pleural effusion is seen. There is no overt pulmonary edema. No pneumothorax. The cardiac and mediastinal silhouettes are stable.", "output": "Interval removal of right IJ central venous catheter. Subtle left lower lobe opacity may be due to infection or aspiration. Interval improvement in right base opacity. Small left pleural effusion." }, { "input": "The heart size is normal. The aorta remains mildly tortuous. The mediastinal and hilar contours are otherwise unremarkable, without evidence of pulmonary vascular congestion. Lungs are clear. No focal consolidation, pleural effusion or pneumothorax is identified. No acute osseous abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Endotracheal tube terminates 4.5 cm from the carina. Enteric tube terminates beyond the diaphragm, out of the field-of-view. Lung volumes are low with heterogeneous bilateral opacities concerning for infection or aspiration. Blunting of the lateral costophrenic angle seen on the left. No pneumothorax.", "output": "1. Satisfactory position of endotracheal and enteric tubes. 2. Heterogeneous bibasilar opacities concerning for multifocal pneumonia or aspiration. 3. Suspected left pleural effusion." }, { "input": "A right central venous catheter tip extends to the cavoatrial junction. There is no focal consolidation, pleural effusion or pneumothorax identified. An opacity in the peripheral right lower lung zone may reflect material external to the patient. The size the cardiomediastinal silhouette is within normal limits.", "output": "No radiographic evidence of acute cardiopulmonary disease. An opacity overlying the peripheral right lower lung zone may reflect material external to the patient however if there is persisting clinical concern for a parenchymal process, a repeat radiograph could be considered." }, { "input": "Right subclavian central line tip upper SVC, similar. No pneumothorax. Minimal interstitial prominence bilateral costophrenic ___, ___ represent edema, new since prior exam. No consolidations. No pleural fluid.", "output": "Minimal basilar interstitial prominence, ___ represent edema. ." }, { "input": "The cardiomediastinal and hilar contours are normal. There is mild atelectasis at the right lung base. There is no large pleural effusion, focal consolidation or pneumothorax.", "output": "Mild atelectasis of the right lung base. Otherwise no acute cardiopulmonary process." }, { "input": "The heart is normal in size and the lungs are clear without vascular congestion or pleural effusion. There is elevation of the right hemidiaphragm.", "output": "No acute abnormality." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal to mildly enlarged. Triple lead left-sided pacer device is seen with the proximal aspect of 1 lead appearing abandoned.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation, effusion or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable chest radiograph. Extensive bilateral pulmonary parenchymal opacifications are evident across multiple prior radiographs dating back to ___; however, opacifications appear slightly increased on today's exam, possibly reflecting worsened background pulmonary edema, though superimposed infectious process is not definitively excluded. Stable elevation of right hemidiaphragm. Blunting of the right costophrenic angle appears unchanged, but cannot exclude a small right pleural effusion. Pacemaker leads and sternotomy sutures are intact. No osseous lesion evident.", "output": "Persistent but increasingly prominent bilateral pulmonary opacities may reflect chronic disease superimposed on background edema, though cannot exclude superimposed infectious process. Possible small right pleural effusion." }, { "input": "PA and lateral views of the chest demonstrates persistent postsurgical appearance status post right upper lobe lobectomy from ___. Additionally, median sternotomy wires and dual lead pacemaker device as well as aortic valve replacement are unchanged. An IVC filter is in place. Persistent left apical scarring is again seen. There is vague opacification within the right lower lobe posteriorly, less conspicuous than on recent chest CT, but likkly still present possibly representing aspiration or pneumonia. Prominence of the pulmonary vessels is less apparent compared with radiographs from ___. No new focal opacities are identified. There is no pneumothorax. The cardiomediastinal silhouette is stable in appearance.", "output": "Persistent hazy opacification within the posterior right lower lobe, less conspicous than on recent chest CT, possibly representing aspiration or pneumonia. No new focal opacities are identified. Recommendations for followup imaging per recent CT." }, { "input": "The lung volumes are low. There no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "Moderate cardiomegaly is re- demonstrated. The mediastinal and hilar contours are unchanged. Lungs are hyperinflated with no focal consolidation. No pleural effusion or pneumothorax is identified. The pulmonary vasculature is normal. The osseous structures are diffusely demineralized with marked thoracic kyphosis, rib cage deformity, and fusion of several mid thoracic vertebral bodies.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The final radiograph demonstrates endotracheal tube at the carina and should be retracted for better positioning. The enteric tube is beyond the diaphragm. Rotation of the radiograph alters the appearance of the cardiomediastinal silhouette. The lungs are poorly evaluated this study, but appear grossly clear.", "output": "Final radiograph demonstrates the endotracheal tube at the carina, and should be retracted for better positioning." }, { "input": "When compared to prior, there has been no significant interval change. Rib cage deformity and accentuated thoracic kyphosis are again seen limiting detailed evaluation of the lung parenchyma which is grossly clear. Cardiomediastinal silhouette is stable in configuration.", "output": "No definite acute cardiopulmonary process." }, { "input": "There is no consolidation, pleural effusion, or pneumothorax. Cardiac silhouette is normal size. Thoracic scoliosis is unchanged. Metallic density in the soft tissues of at the right lateral chest wall is again noted.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. The lung volumes are low. There is no evidence for substantial pleural effusion, although a very small one would be difficult to completely exclude on the left side. Instead, the main finding is opacification of the left lower lobe suggesting pneumonia. There is similar reverse S-shaped curvature to the visualized thoracolumbar spine.", "output": "Findings suggesting left lower lobe pneumonia." }, { "input": "A portable frontal chest radiograph demonstrates a normal cardiomediastinal silhouette. There is little overall change compared to prior exam approximately 7 hours prior, as well as the day prior. There is no new focal consolidation. Pleural effusions are minimal, if any. There is no appreciable pneumothorax.", "output": "Little overall change compared to prior exam." }, { "input": "AP upright chest radiograph demonstrates bibasilar opacities new since prior study dated ___. A metallic opacity is identified within the right parahilar region corresponding to right upper lobe solid nodule as identified on PET-CT performed ___. There is no large pleural effusion, pneumothorax, or evidence of pulmonary edema. Cardiomediastinal and hilar contours are stable.", "output": "Bibasilar opacities are new relative to prior examination, which in the appropriate clinical setting, are suggestive of infectious process." }, { "input": "Mild pulmonary vascular congestion. Left retrocardiac and basilar opacity. Mild cardiomegaly. Probable small bilateral pleural effusions. No pneumothorax.", "output": "Mild pulmonary vascular congestion. Left retrocardiac and basilar opacity. Mild cardiomegaly. Probable small bilateral pleural effusions. No pneumothorax." }, { "input": "Known spiculated opacity with fiducial marker projects over the right hilum is not clearly delineated on today's exam. The lungs are otherwise grossly clear. The cardiomediastinal silhouette is stable. Atherosclerotic calcifications are seen at the aortic arch.", "output": "No acute cardiopulmonary process. Node spiculated opacity in the right perihilar region better seen on prior PET-CT." }, { "input": "1.7 x 1.4 cm hyperdensity along the right upper hemi thorax is most consistent with known lung lesion seen on ___ CT. A heterogeneous right lower lobe opacity is only seen on frontal projection. Plate like opacity along the left lower lobe is most consistent with atelectasis. The lungs are otherwise well inflated and clear. No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable. Aortic arch calcifications are present.", "output": "1. 1.7 cm pulmonary lesion within the right upper hemi thorax, better characterized on ___ CT. 2. Heterogeneous right lower lobe opacity is most consistent atelectasis, however differential includes early pneumonia in the appropriate clinical setting. 3. Left lower lobe atelectasis" }, { "input": "There is no pneumothorax. Cardiomegaly is stable. Main pulmonary artery is enlarged. New fiducial seed projects in the right hilum. Ill-defined opacities in the left mid to lung are more conspicuous than before, differential diagnosis could represent infection or less likely atelectasis. Right lower lobe atelectasis has increased. Retrocardiac opacities are likely atelectasis.", "output": "No pneumothorax. Increasing opacities in the left mid lung differential diagnosis include infection, aspiration. Less likely atelectasis" }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. Heart size is top normal to mildly enlarged. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Normal chest radiograph without evidence of active or latent tuberculosis." }, { "input": "Since prior exam, there are new moderate bilateral pleural effusions. Additionally, there is haziness at the right base, which could be pneumonia or aspiration. Alternatively, it could be compressive atelectasis related to the effusions. The interstitial markings are increased, likely due to mild edema and lower lung volumes. Atherosclerosis of the aortic arch is unchanged. Mild cardiomegaly is stable. There is no pneumothorax.", "output": "1. New small-to-moderate bilateral pleural effusions. 2. More focal hazy opacification of the right base may be aspiration or pneumonia. 3. Mildly increased interstitial markings consistent with mild edema. Results were discussed with the emergency room attending at 9:15 a.m. on ___ via telephone by Dr. ___ at the time the findings were discovered." }, { "input": "Single frontal view of the chest was obtained. The patient is rotated somewhat to the left. There is no focal consolidation, pleural effusion, or evidence of pneumothorax. The cardiac and mediastinal silhouettes are stable. No overt pulmonary edema is seen.", "output": "No significant interval change. No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest demonstrates the lungs are well expanded. There is no evidence of pneumothorax, pleural effusion or pulmonary edema. No focal consolidation is seen. The patient is somewhat rotated, however the cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Left-sided AICD with single lead following its expected course to the right ventricle. There is no pneumothorax or mediastinal widening. No focal consolidation. No pleural effusion. There is no central vascular congestion or overt pulmonary edema. Moderate cardiomegaly has increased since prior exam.", "output": "1. Left-sided AICD with single lead following expected course to the right ventricle. No pneumothorax or mediastinal widening. No pleural effusion. 2. Moderate cardiomegaly, increased since prior exam." }, { "input": "Normal heart, mediastinum, hila, lungs, and pleural surfaces.", "output": "Normal chest radiograph." }, { "input": "Cardiac silhouette is mildly enlarged and accompanied by upper zone vascular re-distribution, minimal peribronchial cuffing and slight perihilar haze. Thickening of the fissures is also demonstrated on the lateral view as well as small dependent pleural effusions. No acute skeletal findings.", "output": "Cardiomegaly and mild congestive heart failure." }, { "input": "There is mild pectus deformity. An equivocal area of increased opacity is seen along the right cardiac border. A right-sided Port-A-Cath tip ends in the distal SVC. The heart is not enlarged. There is no pneumothorax or pleural effusion.", "output": "An equivocal area of increased opacity is seen along the right cardiac border in this patient with mild pectus deformity. If the decision to treat depends on this finding, more radiographic certainty could be obtained through an additional film in the left anterior oblique position. RECOMMENDATION(S): Re-evaluation of the right middle lobe with left anterior oblique chest radiograph." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal silhouette is unremarkable. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low. Heart size is exaggerated as a result of low lung volumes and appears mildly enlarged. Mediastinal and hilar contours are unremarkable. There is mild crowding of the bronchovascular structures without pulmonary edema. Linear opacities in the lung bases are compatible with areas of atelectasis. No focal consolidation, pleural effusion or pneumothorax is present. Mild degenerative changes are detected in the imaged thoracolumbar spine.", "output": "Low lung volumes with bibasilar atelectasis." }, { "input": "PA and lateral chest radiographs. Again seen are hyperexpanded and hyperlucent lungs with prominent interstitial markings compatible with known history of emphysema. There is a right apical pleural cap which likely represents scarring and/or pleural fluid after recent pleurodesis. There is no focal consolidation or pneumothorax. The cardiac silhouette is long and tubular. The bones are intact.", "output": "Emphysema with right apical pleural cap, likely scarring and pleural fluid after pleurodesis." }, { "input": "There are three right chest tubes in place and in unchanged position, two of which terminate in the apex. The large, persistent, right apical pleural space, measuring 9.0 cm from the top of the thoracic cage to the collapsed right upper lobe, is unchanged. There is no mediastinal shift or hemidiaphragmatic flattening to suggest tension. Increased area of density in the collapsed right upper lobe is likely hematoma from recent surgery. The extent of soft tissue air collection in the right chest wall has not changed.", "output": "Persistent large right apical pleural space with no evidence of tension. Stable right lung hematoma and atelectasis." }, { "input": "Since the prior exam, the pigtail pleural catheter has been removed and replaced with two right-sided chest tubes. There is a moderate-sized apical pneumothorax on the right, measuring 7.2 cm from the top of the thoracic cage to the top of the collapsed right upper lobe. Right chest wall emphysema has progressed. There is no mediastinal shift or hemidiaphragmatic flattening to suggest tension.", "output": "Increase in right apical pneumothorax with two chest tubes in place and no evidence of tension." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Analysis is performed in direct comparison with the next preceding similar study of ___. Heart size and mediastinal structures unchanged. The previously identified basal pleural densities that obliterate the right-sided lateral pleural sinus has further regressed; some pleural thickening remains. Previously still identifiable contours of the chest tube tract have now resolved completely. Apically located air bubbles in the pleural space have also resolved and an apparent pleural scar cap has developed without evidence of any active pulmonary or pleural abnormalities. Overall appearance of rather advanced emphysematous pulmonary changes persist. No evidence of new pulmonary infiltrates or vascular abnormalities. The previously remaining small amounts of air pockets in the right axillary area have now resolved completely.", "output": "Development of scar formations, but no evidence of new pulmonary or pleural abnormality. General impression of advanced emphysema persists." }, { "input": "A left apical chest tube remains in place. There is no pneumothorax. Marked hyperinflation with flattening of the hemidiaphragms due to emphysema are unchanged. The heart and mediastinum are within normal limits. Left chest wall subcutaneous emphysema is unchanged.", "output": "No significant interval change. No pneumothorax." }, { "input": "The right apical chest tube appears unchanged. Previously noted substantial right pneumothorax has significantly decreased. Lucent foci are still noted at the right lung apex and may be representative of pneumothorax versus subcutaneous foci of air. Right axillary subcutaneous foci of air are also decreased. Stable right basilar pleural thickening is again noted and appears relatively unchanged and minimally improved. Right upper paramediastinal opacity is again noted and consistent with postsurgical changes. The cardiomediastinal and hilar contours are otherwise unchanged.", "output": "1. Significant decreased in previously noted right apical pneumothorax. Small lucent foci are again noted overlying the right apex and may be small foci of pneumothorax versus subcutaneous air. Chest tube appears in place with the tip terminating at the origin of the thoracic inlet. 2. Right lower lobe opacities appear minimally improved. These findings were discussed by Dr. ___ with ___ via telephone at 3:44 pm on ___." }, { "input": "Portable upright chest radiograph was provided. There are three right chest tubes in place. However, despite the presence of these chest tubes, there is a moderate right pneumothorax with significant collapse of the right upper lobe. Extensive right chest wall and right neck subcutaneous emphysema is noted, increased from prior exam. There is no shift of midline to the left. The left lung is clear.", "output": "Moderate right pneumothorax despite the presence of three right chest tubes. Increasing right chest wall emphysema. Finding was discussed with the patient's nurse at the time of this dictation." }, { "input": "In comparison with study of ___, with the chest tube on pneumostat, there is little change in the substantial pneumothorax in the right upper zone. Post-surgical changes are again seen at the right base. The left lung is clear.", "output": "Little change in the appearance of the pneumothorax." }, { "input": "The lungs are hyperinflated compatible with known emphysema. No focal consolidation is identified. The cardiomediastinal silhouette and hilar contours are stable. There is mild scarring at the right lung apex. A left chest tube terminates at the apex without residual pneumothorax. Osseous structures are grossly intact.", "output": "No pneumothorax. Hyperinflated lungs compatible with emphysema." }, { "input": "Persistent moderate-to-large right apical pneumothorax and right chest wall subcutaneous gas are without significant change since ___. Right-sided chest tube side holes are positioned in the pneumothorax; however, the tip terminates within the soft tissues of the thoracic inlet. Stable right basilar pleural thickening containing multiple small locules of air is consistent with provided history of pleurodesis. Right lower lung opacification is unchanged compared to ___, and given airway secretions evident on ___ CT, this likely represents aspiration. Right upper paramediastinal opacity is consistent with recent blebectomy. Cardiomediastinal and hilar contours are otherwise unremarkable.", "output": "1. Stable moderate to large right apical pneumothorax with unchanged extensive subcutaneous gas due to persitent air leak. Bronchopleural fistula??? and/or chest tube malfunction???. Chest tube holes are contained within pneumothorax but tip terminates within the soft tissues of the thoracic inlet. 2. Right lower lobe opacification, likely due to aspiration" }, { "input": "Right chest drain overlies the right mid hemithorax. No pleural effusion or pneumothorax. Small right chest wall emphysema relates to the chest tube placement. Upper lobe predominant emphysematous and bullous changes are redemonstrated. The cardiomediastinal and hilar contours are normal.", "output": "Emphysema. No pneumothorax." }, { "input": "There has been interval removal of right apical chest tube with no large pneumothorax identified. Lucent foci are noted over the right apex, and are likely representative of foci of subcutaneous air versus a small pneumothorax. Otherwise, subcutaneous air in the right axilla appears unchanged. Stable right basilar pleural thickening is noted along with right paramediastinal opacity, consistent with post-surgical changes. Cardiomediastinal and hilar contours are otherwise unchanged.", "output": "Interval removal of right apical chest tube with no evidence of a large pneumothorax. Lucent foci are noted over the right apex and are likely representative of subcutaneous foci of gas versus a small pnemothorax. These findings were discussed by Dr. ___ with ___ via telephone at 3:44 pm on ___." }, { "input": "A right chest tube is in similar position to the prior study. Again seen is a moderate to large pneumothorax on the right, slightly decreased in size since the prior study. There is extensive subcutaneous gas seen in the right lateral chest wall. There is a new right pleural effusion. Opacities are concerning for pneumonia. The left lung is hyperinflated but clear. Cardiomediastinal silhouette is unchanged. The bones are intact.", "output": "1. Decrease of moderate to large right pneumothorax compared to the prior study. 2. New pleural effusion and opacity at the right base, likely representing infection." }, { "input": "Frontal and lateral chest radiograph demonstrates unremarkable cardiomediastinal and hilar contours. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary process." }, { "input": "As compared to ___ radiograph, with mild cardiomegaly has slightly increased, and is accompanied by pulmonary vascular congestion, interstitial edema and small bilateral pleural effusions. Focal opacity in right lower lobe partially obscures the posterior right hemidiaphragm.", "output": "Congestive heart failure with interstitial edema and small pleural effusions. Focal right basilar opacity could reflect atelectasis or aspiration, but followup radiographs after diuresis may be helpful to exclude a developing pneumonia at the site if warranted clinically." }, { "input": "The heart appears borderline at the upper limits or normal size. There is slight unfolding of the thoracic aorta. The mediastinal, hilar and cardiac contours appear unchanged. The lungs appear clear. There are no pleural effusions or pneumothorax.", "output": "Borderline cardiomegaly. No evidence of acute disease." }, { "input": "Patchy right middle lobe opacity is worrisome for pneumonia. No pleural effusion or pneumothorax is seen. The heart is top-normal in size. No pulmonary edema is seen.", "output": "Patchy right middle lobe opacity raises concern for pneumonia. Atelectasis what also be in the differential diagnosis." }, { "input": "There is no consolidation, pleural effusion, or pneumothorax. Cardiac silhouette is mildly enlarged, similar to before.", "output": "Mildly enlarged cardiac silhouette is similar to before. No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs again demonstrate a mildly enlarged cardiac silhouette, slightly exaggerated by low lung volumes. There is no focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process. Mildly enlarged cardiac silhouette as before, exaggerated by low lung volumes." }, { "input": "No focal consolidation is seen. No large pleural effusion is seen. There is no evidence of pneumothorax. The cardiac and mediastinal silhouettes are stable. No overt pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were reviewed. Compared to the most recent prior study, lung volumes have improved and only mild subsegmental left lower lobe atelectasis remains. Otherwise, the lungs are clear. There is no pleural effusion or pneumothorax. Postoperative mediastinal enlargement continues to decrease, however, the mediastinum remains mildy enlarged. Moderate cardiomegaly is unchanged. A right internal jugular line ends in the upper superior vena cava.", "output": "1. Lung volumes have increased and mild left lower lung atelectasis has improved since ___. 2. Postoperative mediastinal enlargement has improved since ___. 3. Moderate cardiomegaly is unchanged." }, { "input": "Frontal and lateral chest radiographs demonstrate stable moderate cardiomegaly. Stable prominence of the asygous vein without overt pulmononary edema. Mediastinal and hilar contours are unchanged. No pleural effusion or pneumothorax identified. Minimal atelectatic changes are noted particularly in the lung bases. No focal opacification concerning for pneumonia identified. Sternotomy sutures are intact.", "output": "Stable moderate cardiomegaly. No pneumonia. No pleural effusions." }, { "input": "Frontal and lateral chest radiographs demonstrate stable moderate cardiomegaly. The mediastinum remains mildly enlarged, likely post-operative. Subsegmental left lower lobe atelectasis is again seen. There is no pleural effusion or pneumothorax.", "output": "1. Stable left lower lobe subsegmental atelectasis. 2. Stable post-operative changes from recent CABG." }, { "input": "Frontal and lateral views of the chest. The lungs are clear. There is no effusion, consolidation, or pulmonary vascular congestion. Cardiac silhouette is slightly enlarged. No acute osseous abnormalities detected.", "output": "Mild cardiomegaly without definite cardiopulmonary process or congestive failure." }, { "input": "PA and lateral views of the chest were provided. Diffuse though lower lung predominant interstitial opacities are re-demonstrated compatible with patient's known interstitial lung disease. There is no superimposed consolidation, or effusion/pneumothorax. The heart and mediastinal contours appear stable. Bony structures are intact.", "output": "No acute interval change in diffuse interstitial lung disease." }, { "input": "PA and lateral chest radiographs were obtained. Diffuse ill-defined opacities have become more prominent at both lung bases since the prior examinations. No pneumothorax is present. Mild cardiomegaly is stable.", "output": "Current radiograph may represent exacerbation of chronic diffuse infiltrative disease such as hypersensitivity pneumonitis or reflect the superimposition of a secondary acute process such as edema or pneumonia on top of chronic changes." }, { "input": "Frontal and lateral views of the chest are compared to previous exam from ___ and CT chest from ___. Again seen are diffuse bilateral ill-defined opacities throughout the lungs, which appear more conspicuous at the bases. There is no new large dense consolidation, nor effusion. The lung volumes appear appropriate. Cardiomediastinal silhouette is unchanged as are the osseous and soft tissue structures.", "output": "Diffusely increased interstitial markings in the lungs bilaterally similar to prior exam, compatible with patient's known chronic underlying lung disease. Please note that new subtle regions of consolidation or interstial edema would be difficult to exclude given diffuse background parenchymal changes." }, { "input": "Diffuse lower lung predominant interstitial opacity appears similar compared to prior, consistent with patient's known interstitial lung disease. Small bilateral pleural effusions may be present. No pneumothorax is seen. Heart size is enlarged. Increased prominence of the azygous vein suggests fluid overload. The study is slightly limited by motion artifact.", "output": "Interstitial lung disease with cardiomegaly, prominent azygous vein and possible small bilateral pleural effusions." }, { "input": "Frontal and lateral views of the chest. When compared to previous exams there has been no definite interval change. Again seen is diffuse interstitial abnormality which is most pronounced at the bases. There is no definite new consolidation or effusion. Cardiomediastinal silhouette and osseous structures are unchanged.", "output": "Diffuse interstitial anatomy interstitial abnormality compatible with patient's history of NSIP. No definite superimposed acute consolidation one could be obscured by the diffuse underlying abnormality." }, { "input": "The inspiratory lung volumes are appropriate. Note is again made of diffuse interstitial opacities with lower lung predominance compatible with the patient's known interstitial lung disease. No superimposed focal consolidation is seen to suggest pneumonia. No pleural effusion or pneumothorax is detected. The cardiac silhouette is mildly enlarged but stable. The mediastinal contours are unchanged. No acute osseous abnormality is detected.", "output": "No acute interval change in diffuse interstitial lung disease." }, { "input": "Since ___ there has been mild interval development of vascular congestion, interstitial pulmonary edema. There are stable fibrotic changes demonstrated at the lung bases. There are no new focal opacities concerning for pneumonia. The cardiomediastinal and hilar contours are stable demonstrating mild cardiomegaly and tortuosity of the thoracic aorta. There are no pleural effusions or pneumothorax.", "output": "1. Interval development of mild interstitial pulmonary edema and vascular congestion. No focal pneumonia. 2. Stable bibasilar fibrotic change as better demonstrated on prior CT examinations such as ___." }, { "input": "Heart size and cardiomediastinal contours are normal. Lung volumes are low but the lungs are clear without focal consolidation, pleural effusion, or pneumothorax. Small foci of soft tissue gas overlying both breasts is consistent with recent reduction mammoplasty.", "output": "No acute cardiopulmonary process." }, { "input": "Left mid and lower lung consolidation and right lower medial lung consolidations have minimally worsened over the last 24 hours. Increased retrocardiac density is likely due to a combination of consolidation and/or atelectasis and is unchanged. Left pleural effusion is presumed to be small and stable. Moderately enlarged heart size, mediastinal and hilar contours are similar in appearance.", "output": "Left mid-lower lung and right lower medial lung consolidations have worsened over last 24 hours. Retrocardiac increased density which is likely consolidation and/or atelectasis and presumed small left pleural effusion is similar." }, { "input": "PA and lateral views of the chest provided. Cardiomegaly is again noted with hilar congestion and minimal interstitial edema. No large effusion or pneumothorax. No convincing evidence for pneumonia. Mediastinal contour is normal. Bony structures are intact.", "output": "Cardiomegaly, hilar congestion and mild interstitial pulmonary edema." }, { "input": "Frontal and lateral views of the chest are compared to previous exam from ___. There is new patchy consolidation identified in the left lower lobe. Given low lung volumes, the lungs are otherwise grossly clear. Cardiac silhouette is enlarged but stable. Osseous and soft tissue structures are unremarkable.", "output": "Left lower lobe consolidation compatible with pneumonia in the proper clinical setting. Recommend repeat after treatment to document resolution." }, { "input": "Frontal and lateral views of the chest were obtained. The cardiac silhouette is mildly enlarged. There are perihilar opacities which may be due to mild pulmonary edema. Bibasilar opacities may relate to fluid overload; however, a superimposed infection is not excluded. No large pleural effusion is seen, although a trace right pleural effusion may be present. There is no pneumothorax. Mediastinal contours are stable.", "output": "Mild enlargement of the cardiac silhouette with mild pulmonary edema, increased since the prior study. Bibasilar opacities may relate to fluid overload, although superimposed infection is not excluded. Possible very trace right pleural effusion." }, { "input": "There are reduced lung volumes which accentuates the size of the cardiac silhouette which is moderately enlarged. Apparent mediastinal widening is also likely secondary to low lung volumes, and otherwise appears relatively unchanged compared to the prior exam. There is mild pulmonary edema. Additionally, more focal consolidative opacity in the retrocardiac region is concerning for pneumonia. Small bilateral pleural effusions are noted. There is no pneumothorax. No acute osseous abnormalities are present.", "output": "Retrocardiac opacity concerning for pneumonia. Mild pulmonary edema and small bilateral pleural effusions." }, { "input": "There are relatively low lung volumes and bibasilar atelectasis. Slight prominence of the hila may be due to vascular engorgement without overt pulmonary edema. No definite focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac silhouette is top normal. The aorta is tortuous.", "output": "Low lung volumes and bibasilar atelectasis. Possible pulmonary vascular engorgement without overt pulmonary edema." }, { "input": "No focal consolidation is identified. The cardiomediastinal silhouette is normal given low lung volumes and AP technique. There is no pleural effusion or pneumothorax. Visualized upper abdomen is unremarkable. Old left rib fractures are identified.", "output": "No acute cardiopulmonary process." }, { "input": "Left PICC tip terminates in ___ upper SVC. ___ heart size is normal. Mediastinal and hilar contours are unchanged, with calcification noted at ___ aortic arch. Lungs are clear. No pleural effusion or pneumothorax is visualized. No acute osseous abnormality seen. Surgical skin ___ project over ___ upper midline abdomen, with a biliary drain partially imaged within ___ midline upper abdomen.", "output": "Left PICC tip within ___ upper SVC. No acute cardiopulmonary abnormality." }, { "input": "AP upright and lateral views of ___ chest were provided. A left arm PICC line is seen with its tip residing in ___ mid SVC. There is a catheter positioned in ___ upper abdomen, which is only partially imaged, though unchanged from prior. ___ lungs are clear without signs of pneumonia or CHF. No effusion or pneumothorax is seen. ___ cardiomediastinal silhouette is normal. Bony structures are intact. No free air below ___ right hemidiaphragm.", "output": "No acute findings in ___ chest. PICC line appropriately positioned." }, { "input": "Single view of ___ chest shows no interval changes since prior examination with left subclavian PICC ending in proximal-to-mid SVC. ___ lungs are fully inflated and clear. Cardiomediastinal silhouette is normal. There is no pneumothorax or pleural effusion.", "output": "There are no signs of acute cardiopulmonary processes." }, { "input": "___ heart is normal in size. ___ mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. ___ lungs appear clear. A pigtail catheter projects over ___ epigastric region.", "output": "No evidence of acute disease." }, { "input": "Frontal and lateral views of ___ chest. ___ lungs are clear where not obscured by overlying cardiac leads. ___ cardiomediastinal silhouette is within normal limits. No acute osseous abnormality detected. Lucency in ___ right upper quadrant is compatible with patient's known pneumobilia.", "output": "No acute cardiopulmonary process." }, { "input": "___ cardiomediastinal and hilar contours are within normal limits. There is mild calcification of ___ aortic knob. There is no focal consolidation, pleural effusion or pneumothorax. Contrast is again seen within ___ biliary ducts, although less extensive than prior. Note is made of a biliary stent and a left nephrostomy catheter.", "output": "No acute cardiopulmonary process." }, { "input": "Upright portable view of ___ chest demonstrates left PIC catheter tip projecting over confluence of brachiocephalic veins. Lungs are clear without focal consolidation, pleural effusion or pneumothorax. Hilar and mediastinal silhouettes are unchanged. Aortic arch calcifications are again noted. Heart size is top normal. No pulmonary edema.", "output": "Left PIC catheter tip projects at ___ level of confluence of brachiocephalic veins." }, { "input": "Heart size is normal. ___ aorta remains tortuous. Aortic knob calcifications are again seen. Pulmonary vascularity is normal. Lungs are clear. Left PICC has been removed. No pleural effusion or pneumothorax is present. Biliary stent catheter is seen projecting over ___ right upper quadrant of ___ abdomen. No acute osseous abnormalities are seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs which are clear. There is no focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "Normal chest radiograph." }, { "input": "Portable semi-upright radiograph of the chest demonstrates low lung volumes with bronchovascular crowding. There is increased heterogeneous opacification seen in the mid and lower right lung fields consistent with asymmetric pulmonary edema versus aspiration. Small right-sided pleural effusion. Cardiomediastinal and hilar contours are unchanged. There is no pneumothorax.", "output": "Heterogeneous opacification of the right mid and lower lung fields is concerning for asymmetric pulmonary edema versus aspiration." }, { "input": "Mild interstitial pulmonary edema, is asymmetric right greater than left. Small bilateral pleural effusions. No acute focal consolidation. Mild cardiomegaly. No pneumothorax.", "output": "Mild interstitial pulmonary edema with bilateral small effusions." }, { "input": "A single AP chest radiograph was obtained. Bilateral airspace opacities obscure both hemidiaphragms. The hila are indistinct bilaterally, but more enlarged on the right. Bilateral pleural effusions are small. There is a partial collapse of the left lower lobe. Mild cardiomegaly may be slightly worse compared with ___. There is no pneumothorax.", "output": "Bilateral airspace opacities are partially due to CHF. The assymetric hilar enlargement suggests that there may be an additional component of infection and reactive adenopathy on the right." }, { "input": "The heart size is top normal. There is mild pulmonary vascular congestion as well as mild pulmonary edema. Opacities are seen at the lung bases bilaterally, increased compared to the prior exam. Small bilateral pleural effusions have also increased compared to the prior exam. There is no evidence of pneumothorax.", "output": "1. Findings consistent with pulmonary edema. 2. Bibasilar opacities are concerning for pneumonia. 3. Small bilateral pleural effusions, increased in size compared to the prior exam from ___." }, { "input": "As compared to ___, mild interstitial pulmonary edema has improved, however there is increased central vascular enlargement. There is also persistent left retrocardiac atelectasis. Bilateral small pleural effusions are also stable. The heart is mildly enlarged.", "output": "Slight interval improvement of interstitial pulmonary edema with worsening central pulmonary vascular congestion." }, { "input": "AP portable upright view of the chest. Bilateral pleural effusions are noted with hilar congestion and mild pulmonary edema. In addition, lower lobe opacities may represent a superimposed pneumonia. No pneumothorax. Cardiomediastinal silhouette is stable. Bony structures are intact.", "output": "Pulmonary edema with bilateral pleural effusions. Given the lower lobe opacities, difficult to exclude a superimposed pneumonia." }, { "input": "There are bilateral parenchymal opacities with an upper lung distribution. The cardiac silhouette is mildly enlarged, similar compared to prior. Atherosclerotic calcifications noted at the aortic arch. There are trace bilateral effusions. No acute osseous abnormalities identified, hypertrophic changes noted in the spine.", "output": "Bilateral parenchymal opacities which could be seen in the setting of bilateral infection or potentially edema. Small bilateral effusions." }, { "input": "The lung volumes are low, limiting evaluation. On one of the lateral views, there is a small wedge-shaped opacity overlying the heart in the distribution of the right middle lobe. This could represent focal atelectasis, although a small right middle lobe pneumonia is difficult to completely exclude. The lungs are otherwise clear. There is no edema, pleural effusion, or pneumothorax. Previously seen small bilateral pleural effusions have essentially resolved in the interval. The mediastinal contours are normal. The heart is mildly enlarged, and allowing for technique, unchanged from prior exams. Degenerative changes are noted in the lower thoracic spine.", "output": "1. Small wedge-shaped opacity in the right middle lobe, on one view only, may represent focal atelectasis or pneumonia or artifact. 2. Unchanged cardiomegaly." }, { "input": "An endotracheal tube terminates 3.9 cm above the carina. The left IJ central venous catheter terminates at the origin of the SVC. The right central venous catheter terminates near the cavoatrial junction. Mild pulmonary edema has improved. Lung volumes remain no and bibasilar opacities likely reflective of atelectasis persist. A smaller pleural effusion is stable. Heart size top-normal unchanged. No pneumothorax", "output": "Mild pulmonary edema, improved." }, { "input": "Large-bore right-sided central venous catheter, is dual lumen with lumens terminating in the distal SVC and SVC/cavoatrial junction. There are trace pleural effusions. Previously seen right base opacity has decreased in the interval with some residua remaining. No pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "Trace pleural effusions. Decrease in right base opacity with some residual remaining. Dual lumen right-sided dialysis catheter appears to terminate in the distal SVC and distal SVC/cavoatrial junction." }, { "input": "Frontal and lateral views of the chest were obtained. There is no focal consolidation, pleural effusion or pneumothorax. Previous right upper lobe pneumonia has resolved. Small linear opacity at the left lung base is likely a combination of mediastinal fat and atelectasis. Heart size is normal. Mediastinal silhouette and hilar contours are normal. Pulmonary vasculature is normal. No acute osseous abnormality is identified.", "output": "No acute intrathoracic process." }, { "input": "Large-bore right-sided central venous catheter terminates in the right atrium. There has been interval removal of a left-sided central venous catheter.New bilateral perihilar opacities suggests moderate pulmonary edema although underlying infection is not excluded. There are small bilateral pleural effusions. No pneumothorax is seen. Cardiac silhouette is mildly enlarged. Mediastinal contours are unremarkable.", "output": "New bilateral perihilar opacities concerning for moderate pulmonary edema, superimposed infection not excluded. Small bilateral pleural effusions." }, { "input": "Mild enlargement of the heart is re- demonstrated. Mediastinal contours are unchanged. There is mild pulmonary edema, with asymmetric opacity in the right lung compared to the left which may reflect asymmetric pulmonary edema. Small bilateral pleural effusions, right greater than left are also noted, with bibasilar atelectasis. No pneumothorax is detected. Moderate multilevel degenerative changes are noted in the thoracic spine.", "output": "Probable asymmetric mild to moderate pulmonary edema, more pronounced on the right, with small bilateral pleural effusions." }, { "input": "The lungs are clear.The cardiac, hilar and mediastinal contours are normal.No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral chest radiographs were obtained. The lungs are low in volume with an opacity in the superior segment of the right lower lobe. There is no pleural effusion or pneumothorax. The heart is normal in size with normal cardiomediastinal contours.", "output": "Opacity in the superior segment of the right lower lobe could reflect atelectasis particularly given low lung volumes, however infection should be considered in the appropriate clinical setting. Consider repeat evaluation with improved inspiration when patient is able." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. The bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "Exam is limited as the costophrenic angles and right lung base are excluded from the field of view. Increased interstitial markings are noted suggesting vascular congestion. Moderate cardiomegaly is suspected. Dense mitral annular calcifications are noted. No displaced fractures identified.", "output": "Limited exam without new consolidation." }, { "input": "As on the prior exam, there are low lung volumes, likely accentuating the transverse diameter of the cardiomediastinal silhouette, unchanged. The hila are prominent, which may reflect crowding of normal bronchovascular structures and pulmonary vascular congestion. There is no overt pulmonary edema. There is no focal lung consolidation. There is no pneumothorax or pleural effusion. Posterior spinal fusion hardware consisting of rods with transpedicular screws is grossly unremarkable on limited radiographic evaluation.", "output": "Low lung volumes. No acute cardiopulmonary process. Stable chest radiograph" }, { "input": "Low lung volumes significantly limit assessment. There is mild perihilar vascular prominence likely representing congestion. There is no definite focal consolidation, pleural effusion, or pneumothorax. There is an abnormally widened mediastinal contour, minimally changed from ___. Evaluation of the cardiac silhouette is limited There is no free intraperitoneal air. Posterior spinal fusion hardware is noted overlying the lower thoracic and upper lumbar vertebral bodies. There is no fracture.", "output": "As above. Please refer to subsequent CT chest for further details. NOTIFICATION: 1. Prominence of the perihilar vessels likely representing mild congestion. 2. No consolidation." }, { "input": "Portable frontal radiograph of the chest demonstrate stable top-normal heart size with low lung volumes. No focal consolidation, pleural effusion or pneumothorax.", "output": "No pneumothorax. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 10:00 AM, 2 minutes after discovery of the findings." }, { "input": "The aorta appears tortuous and calcified with some widening of the mediastinal contour. The morphology is unchanged. The lung volumes are low. There is no definite pleural effusion or pneumothorax. Prominent perihilar vessels suggesting mild fluid overload.", "output": "Findings suggesting mild vascular congestion. Transfusion associated lung injury may appear similar to pulmonary edema, however, but radiographic findings are mild." }, { "input": "Frontal and lateral views of the chest. Relatively low inspiratory effort on the frontal view accentuates the cardiac silhouette which is likely within normal limits. The lungs are clear of consolidation. There is no effusion. Mild hypertrophic changes seen in the spine.", "output": "No acute cardiopulmonary process." }, { "input": "Postsurgical changes are noted in the right upper lobe. Previously visualized tiny right apical pneumothorax is no longer clearly identified. The right hemidiaphragm remains elevated and there has been minimal increase in right lower lobe opacities likely representing a combination of small pleural effusion with adjacent atelectasis. However, an overlying infection cannot be excluded. Cardiac and mediastinal silhouette structures remain stable. The left hemithorax is clear. No acute fractures are identified.", "output": "Increased opacities at the right lung base likely representing a small pleural effusion with adjacent atelectasis. However, the overlying infectious process cannot be excluded." }, { "input": "Lung volumes are low. The heart is normal in size. The mediastinal and hilar contours are within normal limits. There is a moderate right pleural effusion, not significantly changed from the prior study allowing for differences in technique. There is minimal adjacent right basilar atelectasis. The left lung is clear. No evidence of left pleural effusion. No pneumothorax identified.", "output": "Persistent right pleural effusion and minimal right basal atelectasis." }, { "input": "Lung volumes are low. The right pleural effusion and adjacent atelectasis have significantly decreased since the prior radiograph in ___. There is no effusion in the left hemithorax. The lungs are otherwise free of consolidations or pneumothorax. No acute osseous abnormalities. Surgical clips are noted in the right apex and right mid lung zone. Cardiomediastinal silhouette is stable.", "output": "Right pleural effusion has significantly decreased since ___. There are no new masses or pulmonary nodules." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "There is new bronchial wall thickening as compared to the prior radiograph, but no focal consolidations that are concerning for bacterial pneumonia. Cardiac silhouette is normal size. No pleural effusion or pneumothorax. Severe atherosclerotic calcifications in the aortic knob are unchanged.", "output": "Bronchial wall thickening may be due to bronchitis or aspiration." }, { "input": "Findings the cardiac size is normal. There is increased interstitial markings with pulmonary vascular redistribution, small bilateral effusion, ___ ___ B-lines. This is worsened compared to the study from 2 days prior", "output": "Pulmonary edema." }, { "input": "The cardiomediastinal and hilar contours are unchanged. Dense calcifications of the aortic knob are again noted. There is no pleural effusion or pneumothorax. The lungs are hyperexpanded with a new focal opacity at the right lung base. Increased interstitial markings diffusely are noted with increased peribronchial thickening.", "output": "New right lower lobe opacity in a backround of increased interstitial markings concerning for pneumonia. Dr. ___ ___ these results with Dr. ___ ___ telephone at 7:42 AM on ___." }, { "input": "There is mild pulmonary vascular congestion and interstitial edema. The cardiomediastinal silhouette is normal. Calcifications of the aortic arch are present. There is no pleural effusion or pneumothorax. Visualized upper abdomen is unremarkable. Osseous structures are grossly intact.", "output": "Mild pulmonary vascular congestion and interstitial edema. No focal consolidation." }, { "input": "The lungs are clear of focal consolidation, pleural effusions or pneumothoraces, and biapical scarring is noted. The heart is normal in size, and the mediastinal silhouette is within normal limits.", "output": "No acute cardiopulmonary process. No signs of amiodarone toxicity." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Atherosclerotic calcifications are noted at the aortic knob. Lungs are clear. The pulmonary vascularity is normal. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. An interstitial abnormality has substantially improved, although there is still peribronchial cuffing which can be identified with a heterogeneous distribution, predominantly in the lower lungs, greater on the right than left, a fairly similar overall pattern to the prior study.", "output": "Findings suggestive of airway inflammation, but no definite pneumonia." }, { "input": "The visualized lung fields show coarsened lung markings which may reflect chronic lung disease. There is no evidence of acute cardiopulmonary disease including pleural effusions, focal consolidation or pneumothorax. The cardiac and mediastinal silhouette is unchanged.", "output": "No acute cardiopulmonary process. Coarsened lung markings could represent chronic lung disease, which can be evaluated by non-emergent CT if continued concern." }, { "input": "Status post right VATS wedge. No appreciable pneumothorax. Left retrocardiac atelectasis. The right lung is relatively clear. Subcutaneous emphysema in the right chest wall is minimal. Right ___ tube in good position.", "output": "No significant pneumothorax." }, { "input": "The heart is normal in size. The right hilus is asymmetrically enlarged. The aorta is tortuous. There is mild pulmonary vascular congestion without frank edema. Retrocardiac and right basal opacities could represent atelectasis or infection in the appropriate setting. No pneumothorax or pleural effusion.", "output": "Mild vascular congestion without frank edema. Bibasilar opacities are consistent with atelectasis however infection should be considered in the appropriate setting. Enlarged right hilus may be related to vascular congestion or underlying mass. Recommend evaluation with CT when clinically appropriate. NOTIFICATION: ." }, { "input": "PA and lateral views of the chest provided. A right arm PICC line is seen with its tip at the expected level of the upper SVC. Lungs are clear bilaterally. No effusion or pneumothorax is seen. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Appropriately positioned right arm PICC line. No signs of complication." }, { "input": "A PICC line terminates at the cavoatrial junction. The cardiac, mediastinal and hilar contours are stable. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "PICC line terminating at the ___ junction." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities are demonstrated. No subdiaphragmatic free air is seen.", "output": "Normal chest radiograph. No free air under the diaphragms." }, { "input": "There is mild bibasilar atelectasis; otherwise, the lungs are clear with no evidence of consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. No acute fractures are identified.", "output": "No acute cardiopulmonary process." }, { "input": "A right-sided Port-A-Cath terminates in the mid SVC. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "A small left pleural effusion and left-sided atelectasis are unchanged. There is no new opacity to suggest pneumonia. There is no pulmonary edema, right pleural effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Post-surgical changes from a prior CABG are present. Left-sided Port-A-Cath is noted with the tip in the upper right atrium.", "output": "Unchanged left pleural effusion. No evidence of pneumonia. Results were discussed with Dr. ___ at 12:10 p.m. on ___ via telephone, 5 minutes after the findings were discovered." }, { "input": "Frontal and lateral chest radiographs demonstrate sternal wires, mediastinal clips, and a left subclavian approach central catheter which terminates at the cavoatrial junction. The heart is top-normal in size. The lungs are well-aerated and clear, without focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. Several calcified granulomas appear unchanged. The lungs appear otherwise clear.", "output": "No evidence of acute disease." }, { "input": "PA and lateral views of the chest. The lungs are clear of focal consolidation. Focal opacity which silhouettes mid left cardiac border is compatible with epicardial fat pad seen on prior CT scan. There is abnormal contour with ___ contour in the region of the AP window just inferior to the aortic knob. The cardiomediastinal silhouette is otherwise notable for an ectatic descending thoracic aorta. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process. Abnormal contour in the region of the AP window which appears in continuity with the descending thoracic aorta. Dedicated chest CT is suggested to further characterize." }, { "input": "Single AP upright portable view of the chest was obtained. No evidence of free air is seen beneath the diaphragm. However, there is right base opacity that could be due to infection, aspiration, or metastatic disease. There is also patchy left mid lung opacity, increased since the prior study. Recommend followup to resolution. Left-sided port is again seen, terminating in the right atrium. No pleural effusion or pneumothorax. The cardiac silhouette is not enlarged. There is slight prominence of the ascending aorta, as seen on prior chest CT.", "output": "1. No evidence of free air beneath the diaphragms. 2. Patchy right base opacity and left mid lung opacification could be due to multifocal infection, aspiration or malignant process not excluded. Recommend followup to resolution. 3. Prominence of the right mediastinum is similar compared to ___ scout image from CT, which may in part relate to prominent ascending aorta. Continue follow-up." }, { "input": "There are persistent right middle and lower lung opacities, which are similar in extent but decreased in density compared to prior. There are bilateral pleural effusions with retrocardiac atelectasis. Left Port-A-Cath appears to be in similar position. There has been interval placement of an esophageal catheter which courses below the diaphragm, its tip projecting over the right upper quadrant. No pneumothorax is detected. Heart and mediastinal contours are stable.", "output": "Improving right pneumonia with new bilateral pleural effusions." }, { "input": "The cardiomediastinal silhouette is normal. There is no evidence of pleural effusion or pneumothorax. Lung volumes are lower than prior. There is subtle increased opacification of the right lung base. Bronchial wall thickening may be due to history of asthma. No acute osseous abnormality. Degenerative changes of the acromioclavicular joint bilaterally. Surgical clips again noted in the left upper quadrant.", "output": "Subtle increased opacity of the right lung base, with may represent a developing pneumonia. Short-term followup radiographs may be helpful in this regard. NOTIFICATION: Findings discussed with Dr. ___ by Dr. ___ ___ telephone on ___ at 10:00." }, { "input": "Frontal upright, and lateral chest radiographs demonstrate well-expanded lungs. Cardiomediastinal contours are unremarkable. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No evidence of pneumonia." }, { "input": "The endotracheal tube terminates 2.3 cm from the carina. The enteric tube courses below the diaphragm and outside of the field of view within the stomach. Low lung volumes cause bronchovascular crowding and subsegmental atelectasis bilaterally. Retrocardiac and medial right lung base opacities likely represent atelectasis. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. Cholecystectomy clips are noted in the right upper quadrant.", "output": "1. Endotracheal tube terminates 2.3 cm from the carina. 2. Low lung volumes." }, { "input": "Lungs are hyperinflated. Lungs are clear of consolidation, pleural effusion or pneumothorax. Soft tissue prominence at the right cardiophrenic angle has remained unchanged since the earliest available chest radiograph on ___. This finding is usually due to mediastinal fat, or occasionally a pericardial cyst. Heart size is top-normal. Mediastinal contours are normal. No acute osseous abnormalities are identified.", "output": "1. No acute cardiopulmonary process. 2. Right cardiophrenic soft tissue prominence may be due to mediastinal fat or a pericardial cyst. There is no reason to pursue additional imaging, unless lymphadenopathy is suspected clinically." }, { "input": "AP upright and lateral views of the chest provided.There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is stable. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. There are mild multilevel degenerative changes in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest. No prior. The lungs are clear. The cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size and pulmonary vascularity are normal. Lungs and pleural surfaces are clear.", "output": "No radiographic evidence of congestive heart failure." }, { "input": "The lungs are clear. There is no evidence of pneumonia, pneumothorax, or pleural effusion. Cardiac silhouette is normal in size.", "output": "No acute cardiopulmonary process" }, { "input": "AP portable supine view of the chest. Evaluation is limited due to overpenetrated technique. The endotracheal tube has been intervally advanced, with its tip now residing approximately 2 cm above the carinal. An NG tube is seen coursing inferiorly into the left upper abdomen though the tip is excluded from view. Further evaluation is not possible given technical limitations.", "output": "ET tube positioned appropriately. NG tube courses into the left upper abdomen." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Minimal patchy bibasilar opacities likely reflect atelectasis. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormalities detected.", "output": "Minimal patchy opacities in the lung bases, likely atelectasis. Developing infection, however, is not completely excluded in the correct clinical setting." }, { "input": "Moderate cardiomegaly is similar compared to ___ the larger when compared to more recent prior from ___. Compared to ___, there is mild increase in pulmonary vasculature and enlargement of the bilateral hilar and mediastinal silhouette, which may be secondary to increased pulmonary pressure. There is minimal amount of fluid tracking in the minor fissure. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Mild pulmonary edema. Increased size of the cardiac silhouette compared to prior raises the possibility worsening cardiomegaly versus underlying pericardial effusion." }, { "input": "The heart size is moderately enlarged but unchanged. Mediastinal and hilar contours are stable. The pulmonary vasculature is not engorged. Minimal patchy opacity in the left lung base may reflect atelectasis though infection is not completely excluded. No pleural effusion or pneumothorax is visualized. There are no acute osseous abnormalities.", "output": "Minimal patchy left basilar opacity could reflect atelectasis but infection is not completely excluded." }, { "input": "Single portable view of the chest. The lungs are clear of consolidation or large effusion. The cardiac silhouette is slightly enlarged compared to prior likely in part due to portable technique. No acute osseous abnormalities detected.", "output": "No definite acute cardiopulmonary process." }, { "input": "Heart size is mildly enlarged but unchanged. The mediastinal and hilar contours are unremarkable. The pulmonary vasculature normal. The lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs are clear without focal consolidation, effusion, or pulmonary edema. Incidentally noted is an azygos fissure. The cardiomediastinal silhouette is within normal limits. There is tortuosity of the descending thoracic aorta. Orthopedic hardware seen in the right humeral head.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided, demonstrating no focal consolidation, effusion or pneumothorax. The heart and mediastinal contours are normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear without consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. Anterior cervical fixation hardware is visualized. There is a chronic left posterior ninth rib fracture. Chronic posttraumatic changes also seen at the right shoulder.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. The pulmonary vascularity is normal. The lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are seen. Partially imaged is cervical spinal fusion hardware.", "output": "No acute cardiopulmonary abnormality. No displaced rib fractures identified. If there is continued clinical concern for rib fracture, a dedicated rib series is recommended." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. New the heart size is normal. The mediastinal and hilar contours are normal. Cervical spine hardware is partially seen.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No overt pulmonary edema is seen. Partially imaged cervical surgical hardware is noted.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is status post sternotomy and probably coronary artery bypass graft surgery. The heart is normal in size. The aorta is calcified and mildly tortuous. There is no pleural effusion or pneumothorax. Fissures are mildly thickening suggesting a slight state of fluid overload. However there is no evidence for parenchymal edema. Minimal opacification at the lung bases suggests minor atelectasis or perhaps chronic change. The bones appear demineralized.", "output": "No convincing findings for acute cardiopulmonary disease." }, { "input": "PA and lateral views of the chest. The lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormality is identified.", "output": "Normal chest x-ray." }, { "input": "A right-sided chest tube is present. There is no pneumothorax. The lungs are hypoinflated. In the left midlung zone there is linear atelectasis which was not present on the previous study. The heart is prominent in size.. The osseous structures are normal for age. Monitor leads overlie the chest.", "output": "Right chest tube and is curled in the with right apex. There is no pneumothorax. Linear atelectasis left midlung zone." }, { "input": "Since the prior chest x-ray on ___, there has been interval removal of the right-sided chest tube. There is a well circumscribed oval-shaped opacity in the right lung base that is new/more prominent than the prior chest x-ray. The right lower lobe nodule was recently evaluated by a PET-CT on ___. There is a linear area of scarring in the prior chest tube tract. There is also a small right pleural effusion. Stable appearance of cardiomediastinal silhouette. No acute osseous abnormalities.", "output": "1. Interval removal of the right-sided chest tube. No pneumothorax. 2. Well circumscribed right lung base opacity likely represents a ___-___ pleural effusion." }, { "input": "Frontal and lateral views of the chest demonstrate no acute cardiopulmonary process. There is no pleural effusion, pneumothorax or focal airspace consolidation. The cardiac and mediastinal contours are normal. The imaged upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lung fields are clear. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Moderate right and small left pleural effusions are noted with adjacent opacities likely compressive atelectasis. Heart size is difficult to discern but is at least, likely mildly enlarged. The aorta is slightly unfolded. There is no pulmonary edema or pneumothorax. No acute osseous abnormalities seen.", "output": "Bilateral pleural effusions, moderate on the right and small on the left with compressive bibasilar atelectasis." }, { "input": "A new ill-defined opacity surrounding the lingular lesion at site of recent biopsy. No pneumothorax. The remaining lung fields and cardiac and mediastinal silhouettes are unremarkable.", "output": "New ill-defined opacity surrounding known lingular nodule suggests post biopsy hemorrhage. No pneumothorax." }, { "input": "There is increased density of the consolidation in the lingula following biopsy of a partially calcified mass. There is mild blunting of the left costophrenic angle, compatible with a possible small effusion. There is no pneumothorax. Right lung is grossly clear. The cardiomediastinal silhouette is stable.", "output": "1. Increased density of lingular consolidation following biopsy, DUE TO LOCAL HEMORRHAGE AND ATELECTASIS 2. No pneumothorax OR HEMOTHORAX." }, { "input": "The segmentectomy site is unchanged. The left pleural effusion has decreased. The radiolucency in the retrosternal area is likely a small amount of pleural air, decreased from prior. The left lung is otherwise clear. The right lung is well expanded and clear. The cardiomediastinal silhouette is normal and unchanged.", "output": "1. Unchanged segmentectomy site and smaller left pleural effusion. 2. The retrosternal pleural air is smaller." }, { "input": "The wedge-shaped left lower hemithorax opacification is consistent with recent left lingular segmenectomy. Normal post VATS lingular segmentectomy changes are noted and dense surgical sutures are seen at the segmentectomy site. There is a small left pleural effusion. The right lung is well expanded and clear. There are no complications nor pneumothorax seen.", "output": "1. Normal post lingular segmentectomy changes noted in the left hemithorax without complications nor pneumothorax. 2. Small left pleural effusion." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. The lungs are clear. There is no effusion or pneumothorax. Cardiomediastinal silhouette is normal. Mild mid thoracic dextroscoliosis is noted. Surgical clips in the right upper quadrant. No free air is seen below the diaphragm.", "output": "No acute cardiopulmonary process." }, { "input": "There is no consolidation, pleural effusion, or pneumothorax. Cardiomediastinal and hilar silhouettes are normal size.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. The lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest. The lungs are clear. There is no effusion or pneumothorax. The cardiomediastinal silhouette is normal. Osseous structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There increased interstitial markings seen at the bases bilaterally, as well as small bilateral pleural effusions which have increased in size. The heart is mildly enlarged. Hila appear congested. No pneumothorax.", "output": "Findings are compatible with mild pulmonary edema with small bilateral pleural effusions, increased from prior." }, { "input": "AP portable upright view of the chest. Lung volumes are low. There is mild pulmonary edema without large effusion or pneumothorax. Given the perihilar opacities, the possibility of a superimposed pneumonia is difficult to exclude. The heart is top-normal in size. Mediastinal contour is normal. Imaged osseous structures are intact.", "output": "Mild edema." }, { "input": "PA and lateral images through the chest demonstrate a left-sided PICC terminating at the mid SVC. No focal consolidation is identified. Linear opacity in the left lung demonstrates atelectatic changes. Retrocardiac fluid level consistent with known large hiatal hernia. There is no pneumothorax or pleural effusion. The patient is status post right shoulder arthroplasty.", "output": "Left-sided PICC terminating in the mid SVC." }, { "input": "PA and lateral views of the chest were obtained. There is no focal consolidation, effusion, or signs of pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. There is no free air below the right hemidiaphragm. No signs of pneumomediastinum.", "output": "No acute intrathoracic process. Specifically, no signs of pneumothorax." }, { "input": "2 serial portable semi upright AP views of the chest provided. On the initial radiographs the endotracheal tube tip is positioned 8.5 cm above the carina. After repositioning, the tip of the endotracheal tube resides 4.4 cm above the carina. Overlying EKG leads are present. Nasogastric tube is seen on the initial image only and was removed at the time of the second radiograph. Bilateral lower lung atelectasis is noted. Cardiomediastinal silhouette is grossly unremarkable. Bony structures are intact.", "output": "Appropriately positioned endotracheal tube after repositioning." }, { "input": "AP portable semi upright view of the chest. Endotracheal tube is unchanged in position with its tip positioned 3.6 cm above the carinal. An orogastric tube extends into the left upper abdomen. Bilateral pleural effusions with bibasilar atelectasis noted, new from prior.", "output": "Appropriately positioned ET and OG tubes. Small effusions and basilar atelectasis new from prior." }, { "input": "2 serial portable semi upright AP views of the chest provided. On the initial radiographs the endotracheal tube tip is positioned 8.5 cm above the carina. After repositioning, the tip of the endotracheal tube resides 4.4 cm above the carina. Overlying EKG leads are present. Nasogastric tube is seen on the initial image only and was removed at the time of the second radiograph. Bilateral lower lung atelectasis is noted. Cardiomediastinal silhouette is grossly unremarkable. Bony structures are intact.", "output": "Appropriately positioned endotracheal tube after repositioning." }, { "input": "Frontal and lateral radiographs of the chest were acquired. The lungs are hyperexpanded, with slight flattening of the hemidiaphragms and expansion of the retrosternal airspace, suggestive of chronic obstructive pulmonary disease. Minimal atelectasis is seen within the left mid-to-lower lung. The lungs are otherwise clear. The heart size is normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen. Multilevel degenerative changes of the thoracolumbar spine are noted.", "output": "1. No acute cardiac or pulmonary process. 2. Findings suggestive of chronic obstructive pulmonary disease and should be correlated to any history of smoking." }, { "input": "No significant interval change in position of left-sided chest tube. The lung volumes remain low with unchanged bibasilar linear opacities likely atelectasis. No lobar consolidation. Stable cardiomediastinal silhouette. No pleural effusion or pneumothorax present. Unchanged bony thorax. Cholecystectomy clips project over the right upper quadrant.", "output": "No significant interval change." }, { "input": "Lines and Tubes: Left-sided chest tube projects over the left lower zone. EKG leads overlie the chest and upper abdomen. Lungs: Low lung volumes with bibasilar linear atelectasis. Pleura: There is no pleural effusion or pneumothorax Mediastinum: Mild cardiomegaly and aortic knuckle calcification. Bony thorax: Unremarkable", "output": "Low lung volumes with mild bibasilar linear atelectasis, no pleural effusion or pneumothorax. Left chest tube projects over the left lower zone." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Chronic interstitial reticular opacities are similar to multiple prior studies with new superimposed airspace opacities likely representing pneumonia in bilateral lung bases, particularly in the retrocardiac area. There is likely a left pleural effusion as well. There is no pneumothorax or definite pulmonary edema or right pleural effusion. A left pectoral pacemaker projects in unchanged location with interval addition of a second coronary sinus lead. The cardiomediastinal silhouette is otherwise unchanged, partially silhouetted by diffuse parenchymal abnormalities.", "output": "Chronic interstitial process with superimposed airspace opacities likely representing pneumonia. NOTIFICATION: The findings were discussed with ___ ___, M.D. by ___ ___, M.D. on the telephone on ___ at 4:12 PM, 15 minutes after discovery of the findings." }, { "input": "Compared with the prior study an endotracheal tube has been placed which terminates 4.5 cm from the carina, directed slightly at the right tracheal wall. An enteric tube courses below the diaphragm and terminates within the duodenum. Extensive parenchymal abnormality including chronic interstitial process with superimposed parenchymal opacities likely representing pneumonia is grossly unchanged from the recent prior study. There is no pneumothorax, or right-sided pleural effusion. A probable small left pleural effusion is similar to the prior study. There is also probably a superimposed interstitial pulmonary edema. A left pectoral pacemaker and its 3 leads project in unchanged location.", "output": "1. Interval intubation and placement of an enteric tube, which appear well positioned. 2. Unchanged extensive chronic interstitial abnormality with superimposed airspace opacities likely representing pneumonia. There is also probably superimposed mild interstitial edema NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 4:14 PM, 15 minutes after discovery of the findings." }, { "input": "The lungs are well-expanded and clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "There is a subtle rounded nodular opacity projecting over both the right and left lung base which could be nipple shadows, however, recommend repeat with nipple markers to confirm and exclude underlying pulmonary nodule. Subtle bibasilar opacities more likely represent atelectasis or aspiration rather than pneumonia.", "output": "Subtle rounded nodular opacity projecting over both the right and left lung bases which could represent nipple shadows, however, recommend repeat with nipple markers to confirm and exclude underlying pulmonary nodule focal. Subtle bibasilar opacities more likely represent atelectasis or aspiration rather than pneumonia." }, { "input": "The lungs remain hyperinflated, suggesting chronic obstructive pulmonary disease. Prominent costochondral calcifications are seen. No definite focal consolidation is seen. Small nodule opacity projecting over the right lower lung on the frontal view, not substantiated on the lateral view is again seen and most likely relates to costochondral calcification. Mild basilar atelectasis/scarring is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable.", "output": "COPD. No definite acute cardiopulmonary process. Please note that CT is more sensitive in assessing for pulmonary nodules." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is detected. Heart and mediastinal contours are within normal limits. No acute fracture is detected radiographically, but the sensitivity of routine chest radiography for rib fractures is low. Right axillary round calcification is seen.", "output": "No acute findings. Sensitivity of routine chest radiography for rib fractures is low. If there is high clinical suspicion, dedicated rib series should be performed." }, { "input": "The lungs are grossly clear without evidence of focal consolidation. There is no evidence of pulmonary edema, pleural effusion, or pneumothorax. The cardiomediastinal silhouette and hilar contours are normal.", "output": "No acute cardiopulmonary process" }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. No evidence of pulmonary edema. Heart is moderately enlarged. No acute osseous abnormalities identified. No evidence of subdiaphragmatic free air.", "output": "Moderate cardiomegaly, without acute cardiopulmonary process." }, { "input": "Lung volumes are slightly low. There is no focal consolidation, pleural effusion, or pneumothorax. Left retrocardiac opacity likely represents atelectasis. The heart size is mildly enlarged. Degenerative changes are noted in the thoracic spine. Erosive changes at the left glenoid and humeral head whic appear dislocated may be old but clinical correlation suggested. Similar but perhaps less extensive changes seen at the right glenohumeral joint as well.", "output": "Slightly limited by low lung volumes. Retrocardiac opacity may represent atelectasis; however, infection cannot be entirely excluded. Changes at the glenohumeral joints- including erosive changes on both sides of the joints and probable dislocations, left worse than right. These changes may be old but please correlate clinically regarding need for further workup. The changes to the preliminary report regarding the glenohumoral findings were discussed with Dr. ___ by Dr. ___ ___ telephone at 4:20 pm." }, { "input": "Cardiomegaly unchanged. Thyroid goiter again visualized. No pulmonary edema. No airspace consolidation. Mild left lower lobe atelectasis. No pleural effusions. Marked spondylotic change of the thoracic spine as well as degenerative changes of the the glenohumeral joint bilateral.", "output": "No pulmonary edema." }, { "input": "There is a left pectoral pacemaker with the leads in satisfactory position within the right atrium and right ventricle. Linear opacities at the bilateral bases are most likely atelectasis. There is no pulmonary edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. The right hemidiaphragm is mildly elevated in comparison to the left.", "output": "Satisfactory position of the left-sided pacemaker and its leads. No pneumothorax. Basilar opacities likely atelectasis." }, { "input": "There is mild bibasilar atelectasis. No definite focal consolidation is seen. There is no pleural effusion or evidence of pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "Bibasilar atelectasis without definite focal consolidation." }, { "input": "Portable upright chest film ___ at 07:43 is submitted.", "output": "There has been interval resolution of the moderate to severe pulmonary edema with only minimal residual patchy opacity in the left mid lung. A left-sided pacemaker remains in place. There has been a median sternotomy and the heart remains stably enlarged. No large effusions. No pneumothorax." }, { "input": "Interval insertion of a right-sided internal jugular catheter with the tip in the right atrium. The ETT, and nasogastric tube are in good position. Stable appearance of the dual lead defibrillator, median sternotomy wires and epicardial pacer wire. No pneumothorax. Interval improvement in the moderate interstitial pulmonary edema. Moderate cardiomegaly with likely small bilateral pleural effusions.", "output": "Interval improvement of moderate interstitial pulmonary edema. Persistent moderate cardiomegaly." }, { "input": "Endotracheal tube terminates approximately 5 cm above the level of the carina. Enteric tube courses below the diaphragm, out of the field-of-view. Left-sided AICD, triple lead, is stable in position. The patient is status post median sternotomy and CABG. The cardiac and mediastinal silhouettes are grossly stable, with moderate cardiomegaly. There is moderate to severe pulmonary edema. A right pleural effusion is likely present. No pneumothorax is seen.", "output": "Endotracheal tube terminates approximately 5 cm above the level of the carina. Enteric tube courses below the diaphragm, out of the field-of-view. Moderate to severe pulmonary edema. Likely right pleural effusion." }, { "input": "Left chest wall triple lead pacing device is again noted. The lungs where not obscured are clear without consolidation, effusion, or edema. Moderate cardiomegaly is as noted on prior. Median sternotomy wires are intact. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "There is severe alveolar pulmonary edema, which has significantly progressed compared to the prior radiograph performed yesterday evening. There are no substantial pleural effusions or pneumothorax. Heart size remains enlarged. The left pectoral pacer is unchanged in position with leads terminating in the right atrium, right ventricle and coronary sinus. Median sternotomy wires are intact.", "output": "Severe pulmonary edema, significantly worse compared to the prior radiograph performed yesterday evening." }, { "input": "Right-sided internal jugular catheter with the tip in the right atrium. The ETT, is in good position. The first port of the nasogastric tube is in the fundus of the stomach. Stable appearance of the dual lead defibrillator, median sternotomy wires and epicardial pacer wire. No pneumothorax. Moderate interstitial pulmonary edema, has not significantly changed. Moderate cardiomegaly with likely small bilateral pleural effusions.", "output": "No significant interval change in the moderate interstitial edema and bilateral pleural effusions." }, { "input": "Moderate left and small right pleural effusions with associated compressive atelectasis are essentially unchanged. Opacity projecting over the right apex was not clearly seen on prior radiographs. There is no widening of the paratracheal stripe to suggest mediastinal hematoma. Lungs are otherwise clear. A small left apical pneumothorax is new. A right IJ central venous catheter is unchanged in position, terminating near the superior cavoatrial junction. Moderate cardiomegaly is unchanged. Visualized cardiomediastinal hilar silhouettes are unremarkable. A mitral valve replacement is noted. Median sternotomy wires are midline and intact.", "output": "1. New small left apical pneumothorax. 2. Right apical opacity raises the possibility of pleural fluid or blood. 3. Unchanged moderate left and small right pleural effusions with associated compressive atelectasis. NOTIFICATION: The findings were discussed with ___, P.A. by ___ ___, M.D. on the telephone on ___ at 4:49 PM, approximately 120 minutes after discovery of the findings." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well-expanded clear lungs. The mediastinal and hilar contours are unchanged. No pneumothorax, pleural effusion or consolidation.", "output": "No pneumothorax. No acute cardiopulmonary process." }, { "input": "Lung is well inflated and clear. Cardiomediastinal silhouette is normal. There is no pericardial, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation or pleural effusion. A tiny right apical pneumothorax has decreased since ___. Small linear atelectasis in the right mid lung. Cardiac and mediastinal silhouettes and hilar contours are stable.", "output": "Tiny right apical pneumothorax is smaller than on ___." }, { "input": "Single frontal AP chest radiograph demonstrates mild tracheal narrowing at the thoracic inlet unchanged since CT 2 days prior. The lungs are fully expanded and clear. No retrocardiac opacity. The pleural surfaces are normal without large pleural effusion or pneumothorax. The costophrenic angles are not fully included on this study. Heart size, mediastinal contour and hila are otherwise unremarkable. Visualized osseous structures are notable for a surgical screw in the left scapula.", "output": "1. Narrowing of the trachea at the level of the thoracic inlet is unchanged since CT 2 days prior. 2. No evidence of pneumothorax or pneumonia." }, { "input": "Frontal and lateral chest radiographs demonstrate low lung volumes with increased prominence of the cardiac silhouette and bronchovascular crowding. Mild pulmonary edema is improved. Opacity at the left lung base this likely unchanged, and likely represents atelectasis, although superimposed infection cannot be excluded.", "output": "1. Improved mild pulmonary edema. 2. Opacity at the left lung base is likely unchanged and may represent atelectasis, although superimposed infection cannot be excluded." }, { "input": "Endotracheal tube tip terminates approximately 5.4 cm from carina. An enteric tube tip courses below the left hemidiaphragm, through the stomach, and off the inferior borders of the film. Moderate enlargement of the cardiac silhouette is demonstrated. Left perihilar opacity is associated with left upper lobe volume loss, and is concerning for underlying malignancy. There is mild pulmonary vascular congestion, asymmetrically pronounced on the left. No large pleural effusion or pneumothorax is detected. Lungs appear hyperinflated with probable emphysematous changes in the right apex.", "output": "1. Standard positioning of the endotracheal and enteric tubes. 2. Left perihilar opacity concerning for underlying malignancy. Further assessment with chest CT is recommended, if not done previously. There appears to be associated left upper lobe volume loss. 3. Mild asymmetric pulmonary vascular congestion, more pronounced on the left." }, { "input": "There has been a interval increased density and size of the left upper lobe consolidation abutting the suprahilar region. The extent of the more diffuse and patchy opacities is unchanged and possibly represents pulmonary edema and/or multifocal pneumonia. A small right pleural effusion. No pneumothorax. The size of the cardiac silhouette is unchanged. .", "output": "Interval increased density and size of the left upper lobe consolidation. Unchanged diffuse bilateral patchy airspace opacities, possibly reflecting pulmonary edema and/or multifocal pneumonia." }, { "input": "In the interval since the prior study, a second right-sided chest tube has been placed. This appears to cross the midline and meet the left apex. There is a persistent small right apical pneumothorax. An opacity at the right lung base likely reflects a atelectasis. Subcutaneous emphysema again noted. The left lung appears grossly clear.", "output": "Persistent right apical pneumothorax. A new right chest tube appears to cross the midline to the left side of the chest and could be withdrawn 8 cm for better positioning in the right lung apex. NOTIFICATION: Findings were discussed with Dr. ___ by telephone at 14:___ approximately ___ min after discovery." }, { "input": "The lung volumes are low. There is a new moderate right and probable small left pleural effusion. Additionally, new pulmonary vascular congestion and mild pulmonary edema is present. There is no focal airspace consolidation. There is no pneumothorax. The aorta is tortuous and calcified. Calcifications are noted in the region of the mitral annulus. The cardiac silhouette is enlarged, and unchanged from the prior exam.", "output": "New mild pulmonary edema and bilateral pleural effusions. Stable moderate cardiomegaly." }, { "input": "The lungs are well inflated and clear. No focal consolidation, nodule, effusion, or pneumothorax is present. The cardiac and mediastinal contours are normal. There is no free peritoneal air.", "output": "No acute cardiopulmonary process. No free abdominal air." }, { "input": "PA and lateral views of the chest. No prior. The lungs are clear. The cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "Normal chest x-ray." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "Unremarkable chest radiographic examination." }, { "input": "Normal heart size, mediastinal and hilar contours. No focal consolidation, pleural effusion or pneumothorax. No displaced rib fracture.", "output": "Normal chest radiograph" }, { "input": "The lungs are hypoinflated and exaggerate the pulmonary vascular markings. Otherwise, the lungs are clear with no evidence of consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute fractures are identified. No free air is noted under the hemidiaphragms. Oral contrast is noted throughout the colon.", "output": "Hypoinflated lungs with no acute cardiopulmonary findings." }, { "input": "An endotracheal tube ends 4.8 cm above the carina. An enteric tube terminates below the field of view. A left-sided central venous catheter terminates at the origin of the SVC. A left-sided pigtail catheter and a left-sided chest tube are unchanged in position. Small bilateral pleural effusions, left greater than right are again seen as well as bibasilar atelectasis not significantly changed from the prior exam. Extensive left subcutaneous emphysema is minimally improved. There is no evidence of pneumothorax.", "output": "No significant change in the bilateral pleural effusions and bibasilar atelectasis. No evidence of pneumothorax." }, { "input": "Portable upright chest radiograph shows an unchanged left subclavian central venous line. The orientation of the tracheostomy is unchanged. There is interval improvement in aeration at the right lung base, with continued atelectasis at the left lung base. Parenchymal opacities in both lungs, predominantly in the upper zones, are unchanged. Left chest tube is in unchanged configuration.", "output": "Slight interval improvement in aeration of the right lung base with continued left basilar atelectasis, and unchanged support devices." }, { "input": "The orientation of the tracheostomy tube is unchanged. The heart size is stable and enlarged. Left pleural effusion appears unchanged and right parenchymal opacities have improved since the prior. Multiple minimally displaced bilateral rib fractures are again noted. No pneumothorax.", "output": "Interval improvement in parenchymal opacities, particularly at the right lung base, with continued left pleural effusion and minimally displaced bilateral rib fractures." }, { "input": "The tip of the endotracheal tube appears appropriate position approximately 3.8 cm above the carinal. An enteric tube is seen traversing the this radiograph, and extending beyond the inferior confines of this radiograph. A left-sided subclavian central venous catheter terminates in the mid portion of the SVC. A left-sided chest tube is present, terminating in the region of the left lung apex. A left-sided pigtail catheter is present, terminating at the left apex as well. There is air seen along the muscles of the left shoulder girdle. Extensive subcutaneous air is also seen on the left. Right-sided first and second rib fractures are seen, there is also suggestion of a left-sided scapular fracture, but better assessed on prior imaging. No definite pneumothorax remains, all limited by technique and overlying artifact. There is retrocardiac opacity, likely related to atelectasis, although with differential of contusion or other airspace disease.", "output": "No evidence of pneumothorax. Endotracheal tube appears appropriately positioned. Left retrocardiac opacity persists." }, { "input": "A portable frontal upright view of the chest was obtained. Cardiomediastinal silhouette is unchanged. A left subclavian line has been removed in the interval. Cardiomediastinal silhouette is unchanged. Left lower lobe atelectasis and pleural effusion persist. Previously noted right basilar opacity is more confluent. Mild edema persists. Multiple bilateral rib fractures are noted. There is no pneumothorax.", "output": "1. Right basilar airspace opacification is more confluent and compatible with pneumonia. 2. Persistent mild pulmonary edema, left basilar atelectasis and left pleural effusion." }, { "input": "There is interval increase in the amount of subcutaneous emphysema on the left. There is also increase in size and conspicuity of the left inferior pneumothorax. The left-sided chest tube is in place with the side hole projecting over of the left upper lung. A left lower lung chest tube might be needed the NG tube is slightly high with the proximal port at the GE junction. Pigtail chest tube is seen in the right lung with some residual pneumothorax seen inferiorly", "output": "Increased size of left inferior pneumothorax with chest tube in place." }, { "input": "Multiple old bilateral rib fractures are seen. Old right mid clavicular fracture is also seen. Bibasilar atelectasis is seen. There is no definite focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Multiple old bilateral rib fractures and old right clavicular fracture. No acute cardiopulmonary process." }, { "input": "LEFT SUBCLAVIAN LINE TIP IS IN MID SVC. HEART SIZE AND MEDIASTINUM ARE UNCHANGED. LEFT LOWER LOBE ATELECTASIS AND PLEURAL EFFUSION ARE UNCHANGED. A RIGHT BASAL OPACITY IS UNCHANGED MILD VASCULAR ENGORGEMENT IS UNCHANGED. LEFT PIGTAIL CATHETER HAS BEEN REMOVED. THERE IS NO PNEUMOTHORAX, LEFT RIB FRACTURES, MULTIPLE, RE-DEMONSTRATED.", "output": "LEFT SUBCLAVIAN LINE TIP IS IN MID SVC. HEART SIZE AND MEDIASTINUM ARE UNCHANGED. LEFT LOWER LOBE ATELECTASIS AND PLEURAL EFFUSION ARE UNCHANGED. A RIGHT BASAL OPACITY IS UNCHANGED MILD VASCULAR ENGORGEMENT IS UNCHANGED. LEFT PIGTAIL CATHETER HAS BEEN REMOVED. THERE IS NO PNEUMOTHORAX, LEFT RIB FRACTURES, MULTIPLE, RE-DEMONSTRATED." }, { "input": "Compared to the prior radiograph, increased severe leftward mediastinal shift and now complete left lung opacification is due to worsening left lung collapse. Right lower lung opacification, probably pneumonia, is stable. No large right pleural effusion or pneumothorax is identified. There is likely a small left pleural effusion. Multiple rib fractures, bilateral clavicle fractures and a left scapular fracture are again identified.", "output": "Severe leftward mediastinal shift and the sudden left lung opacification is due to worsening left lung collapse." }, { "input": "An ET tube is present approximately 6.2 cm above the Carina. An NG tube is present, tip extending beneath diaphragm, off the film. A left subclavian central line is present, tip over mid SVC. 2 left-sided chest tubes are present, 1 with a pigtail configuration. The cardiomediastinal silhouette is grossly unchanged. Again seen are is upper zone redistribution, interstitial edema, and mild vascular blurring, consistent with mild CHF and similar to the prior film. There is patchy opacity at both lung bases. There is also retrocardiac density, consistent with left lower lobe collapse and or consolidation. Triangular opacity at the right lung base is more pronounced and could represent subsegmental atelectasis minimally displaced left posterior sixth rib fracture again noted. No gross pneumothorax, though a subtle pneumothorax might not be apparent on this film. Prominent subcutaneous emphysema along the left chest wall an overlying pectoralis muscle. A smaller amount of subcutaneous emphysema is seen along the right chest inferiorly and in the right pectoralis muscle. Multiple bilateral rib fractures, left clavicular fracture, an left scapular fracture are again noted.", "output": "No definite pneumothorax detected, though small pneumothorax might be obscured by overlying tubing and subcutaneous emphysema. More pronounced triangular opacity at the right base --___ subsegmental atelectasis. Otherwise, doubt significant interval change." }, { "input": "An endotracheal is seen 8.4 cm above the level of the carina. A right-sided central venous catheter terminates in the upper SVC and is unchanged. Left-sided pigtail catheter and chest tube are in unchanged positions. The cardiomediastinal and hilar contours are within normal limits and stable from the prior examination. There are persistent bibasilar opacities, with subtly increased opacity on the right compared to the prior exam. There is no appreciable pneumothorax. Subcutaneous emphysema on the left is unchanged.", "output": "1. No evidence of pneumothorax. 2. Endotracheal tube is 8.4 cm above the carina. 3. Persistent bibasilar opacities, most likely represent atelectasis however infection cannot be excluded." }, { "input": "Compared to the prior radiograph performed 3 hours prior there is dramatic improvement in the left lung aeration. Left lower lobe collapse and a small pleural effusion persist. Right lower lobe pneumonia is clearing. The cardiac and mediastinal contours are stable. The tracheostomy tube is in unchanged position. Multiple fractures are again identified.", "output": "Markedly improved aeration of the left lung. Small left pleural effusion and left lower lobe collapse persists. Resolving right lower lobe pneumonia." }, { "input": "A left-sided pigtail catheter and left-sided chest tube are unchanged in appearance. A left-sided central venous catheter terminates in the upper to mid SVC and is unchanged. An enteric tube ends below the field of view. An endotracheal tube ends 5 cm above the carina. The cardiomediastinal and hilar contours are within normal limits and stable. Mild pulmonary edema has minimally decreased from the prior exam. Bibasilar opacities are again seen, minimally improved from the prior study and may represent atelectasis however infection cannot be excluded. A vertical area of lucency paralleling the left lower thoracic vertebra is unchanged and represents a small to moderate anterior, medial left pneumothorax not significantly changed in size from the prior study.", "output": "1. Persistent small to moderate anterior, medial left pneumothorax not significantly changed in size. 2. Bibasilar opacities, minimally improved from the prior study may represent atelectasis however infection cannot be excluded." }, { "input": "Right PICC is seen with tip best seen on the ___ image overlying the brachiocephalic vein, just proximal to the SVC. The lungs remain clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "Right PICC tip projecting over the brachiocephalic vein, just above the level of the SVC." }, { "input": "Examination is limited secondary to portable technique and likely motion. Right chest wall port is no longer visualized. Right PICC is seen though the tip cannot be delineated past the level of the right brachiocephalic. Lungs are grossly clear. Left humeral head anchor is noted.", "output": "Limited exam. Right PICC tip is not definitively identified. Repeat should be considered." }, { "input": "A right Port-A-Cath tip projects over the expected region of the distal SVC. The lungs are clear. No evidence of a pleural effusion, edema, consolidation, or pneumothorax. Hilar contours are within normal limits. The heart is normal in size. The mediastinum is not widened. No concerning osseous lesions on this nondedicated exam. Bilateral degenerative changes in the AC joints of the shoulders are moderate.", "output": "No focal pneumonia." }, { "input": "Since chest radiographs dated ___, there has been interval resolution of pulmonary edema. Severe cardiomegaly is unchanged. Lungs are fully expanded and clear. The pleural surfaces are normal.", "output": "Unchanged severe cardiomegaly. No radiographic evidence of pneumonia or other significant cardiopulmonary abnormalities." }, { "input": "The patient is status post CABG. Severe cardiomegaly is again noted, with mild central pulmonary vascular congestion and interstitial edema. Bibasilar opacities likely reflect atelectasis, although superimposed infection is not excluded. No evidence of pneumothorax or large pleural effusion.", "output": "1. Severe cardiomegaly and mild pulmonary vascular congestion. 2. Bibasilar opacities likely reflect atelectasis, although superimposed infection is difficult to exclude." }, { "input": "Moderate to severe cardiomegaly appears slightly increased in size compared to the previous radiograph. The patient is status post median sternotomy and CABG. There is mild pulmonary edema, worse when compared to the previous study, as well as enlargement of the vascular pedicle. Small bilateral pleural effusions are likely present. Patchy bibasilar airspace opacities likely reflect areas of atelectasis. No pneumothorax is present. There are no acute osseous abnormalities.", "output": "Mild pulmonary edema and small bilateral pleural effusions." }, { "input": "Frontal and lateral chest radiographs demonstrate multiple sternal wires and severe cardiomegaly, which appears unchanged. Increased bilateral opacities are consistent with increased vascular congestion and mild to moderate pulmonary edema. Retrocardiac opacity is likely a combination of atelectasis and edema. No definite focal consolidation is identified. There is no large pleural effusion or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "1. Vascular congestion and mild to moderate pulmonary edema. 2. No definite focal consolidation identified." }, { "input": "The heart is severely enlarged. There is moderate pulmonary edema. Obscuration of the left hemidiaphragm likely due to a combination of pleural effusion and atelectasis. There is no pneumothorax. Median sternotomy wires are noted with surgical clips projecting over the left hemithorax.", "output": "1. Moderate pulmonary edema. 2. Severe cardiomegaly. Opacity at the left lung base may be due to a combination of atelectasis and pleural effusion, although a developing consolidation cannot be excluded." }, { "input": "There is mild bibasilar atelectasis, left greater than right. There is mild prominence of interstitial markings suggesting mild pulmonary edema. Otherwise, the remainder of the lungs are clear. The aorta appears stably tortuous. There is no pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are stable with enlargement of the cardiac silhouette, likely due to prominent epicardial fat pad. No acute fractures are identified.", "output": "Minimal increase in interstitial markings may represent minimal pulmonary edema." }, { "input": "Left lower lobe atelectasis is again present. There are no focal consolidations concerning for pneumonia. There is no pneumothorax or pulmonary edema. The aorta is again tortuous. The right lung is essentially clear. No pleural effusion is present. Cardiac sized is again enlarged.", "output": "Cardiomegaly without evidence of pneumonia." }, { "input": "Streaky opacities at the left lung base most likely represents atelectasis. There is otherwise no focal consolidation. Mild pulmonary vascular congestion is noted. No pleural effusion or pneumothorax. Heart size is mildly enlarged. No acute osseous abnormalities identified.", "output": "Mild pulmonary vascular congestion." }, { "input": "The lungs are hyperexpanded with flattening of the diaphragms suggesting COPD. A geographic area lucency in the right lateral lung base may represent area of air trapping. Streaky opacities projecting over the spine on the lateral view are concerning for infection. There is no pleural effusion or pneumothorax. The pulmonary vasculature is not engorged. The cardiomediastinal and hilar contours are within normal limits. Anterior wedging of vertebral bodies at the thoracolumbar junction are age indeterminate.", "output": "Lower lobe opacity concerning for infection. Evidence of COPD." }, { "input": "Compared to prior, there is a new right lower lung opacity. Left lung is grossly clear. Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax.", "output": "New right lower lung opacity concerning for pneumonia. Followup to resolution is recommended." }, { "input": "Lung volumes are low. Heart size is normal. Mediastinal and hilar contours are unremarkable. Minimal linear opacity within the left lung base likely reflects subsegmental atelectasis. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities. Several clips are noted within the right upper quadrant of the abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest were provided. The lungs are clear bilaterally. There is no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal without signs of pneumomediastinum. The bony structures are intact. No free air below the right hemidiaphragm seen.", "output": "No acute findings in the chest." }, { "input": "The lungs are clear of focal consolidation, pleural effusion or pneumothorax. The heart size is normal. The mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The aorta is seen slightly tortuous. The mediastinal and hilar contours are otherwise unremarkable. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Dextroscoliosis of the thoracic spine is noted.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. Mild biapical pleural parenchymal scarring is noted. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear. The cardiomediastinal silhouette and hilar contours are normal. The pleural surfaces are normal without effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Severe scoliosis is redemonstrated with persistent moderate cardiomegaly. No focal consolidations concerning for pneumonia are identified. There is no pleural effusion or pneumothorax. There is mild bibasilar atelectasis. The visualized osseous structures are unremarkable. Posterior spinal fusion hardware is unchanged in appearance.", "output": "No acute intrathoracic abnormalities identified." }, { "input": "There is continued prominence of the mediastinum unchanged compared to ___, at which time it appeared to correspond with mediastinal vessels and lymph nodes. There is unchanged bibasilar atelectasis. No overt pulmonary edema. Blunting of the left costophrenic angle likely relates prominent epicardial fat pad evident on the prior CT may explain this finding.", "output": "Unchanged exam. Bibasilar atelectasis." }, { "input": "Lung volumes are low. Heart size is mildly enlarged. Mediastinal contours are somewhat widened, but this is likely due to low lung volumes and the presence of mediastinal fat. There is crowding of the bronchovascular structures. No overt pulmonary edema is noted. Minimal bibasilar streaky airspace opacities likely reflect atelectasis. No pneumothorax or pleural effusion is demonstrated. There are no acute osseous abnormalities.", "output": "Low lung volumes with bibasilar atelectasis." }, { "input": "Left-sided Port-A-Cath tip terminates in the mid SVC. The cardiac silhouette size is normal. The aorta is mildly tortuous. Mediastinal and hilar contours are otherwise unchanged. The pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is seen. Partially imaged is a right nephroureteral stent. No subdiaphragmatic free air is seen.", "output": "No acute cardiopulmonary abnormality. No subdiaphragmatic free air." }, { "input": "AP upright and lateral views of the chest are provided. A right ureteral stent is partially imaged. There is a left chest wall Port-A-Cath with tip residing in the region of the SVC, unchanged. The previously noted NG tube has been removed. There is no free air below the right hemidiaphragm. The lungs are clear bilaterally. The cardiomediastinal silhouette appears stable. No acute bony abnormalities are seen.", "output": "No acute findings, no signs of pneumoperitoneum." }, { "input": "Left chest wall port is seen with catheter tip at the RA SVC junction. The lungs are grossly clear. Blunting of left costophrenic angle may be due to small effusion. The cardiomediastinal silhouette is within normal limits. Previously seen free intraperitoneal air is not identified on this semi-erect portable film. Stent partially visualized in the right upper quadrant.", "output": "Left chest wall port with tip at the RA SVC junction." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "AP and lateral chest radiographs demonstrate clear lungs. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest are compared to previous exam from ___. Correlation is also made to chest CT from ___. The lungs remain hyperinflated and clear of focal consolidation. Calcific density projecting between the medial left clavicle and anterior left first rib is again seen and unchanged from prior CT scan. The mediastinal silhouette is within normal limits. Osseous and soft tissue structures are unchanged.", "output": "Hyperinflation without acute cardiopulmonary process." }, { "input": "An AP upright view of the chest was provided. The lungs are hyperinflated with upper lobe lucency, compatible with known underlying emphysema. There is new opacity in the right lower lung, compatible with pneumonia. No large effusion or pneumothorax is seen. Cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "Emphysema with opacity in the right lower lung compatible with pneumonia." }, { "input": "PA and lateral views of the chest. The lungs are hyperinflated but clear of consolidation. Calcified mediastinal nodes and calcifications projecting posterior to the left clavicular head and in the left midlung are unchanged. No acute osseous abnormality is detected.", "output": "Hyperinflation without acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest are provided. The lungs are hyperinflated, but appear clear. Cardiomediastinal silhouette is normal. No effusion or pneumothorax. Bony structures are intact.", "output": "COPD without superimposed pneumonia." }, { "input": "Frontal and lateral views of the chest are compared to the previous examination. There is new opacity in the right lower lobe. No pleural effusion or pneumothorax identified. Hyperinflation and a calcific densities projecting over the medial left clavicle are unchanged. The mediastinal silhouette is within normal limits. The osseous structures are unchanged.", "output": "Right lower lobe opacity is compatible with pneumonia in the correct clinical setting. Recommend follow-up after treatment to document resolution." }, { "input": "PA and lateral views of the chest demonstrate flattening of the hemidiaphragms and the parenchymal pattern consistent with severe COPD. No focal consolidation concerning for pneumonia is present. There is no pleural effusion, pulmonary edema or pneumothorax. The cardiomediastinal silhouette demonstrates prominence of the right upper mediastinal contour, which should be further evaluated with shallow oblique images. Partial resection of the posterior right fifth rib is also stable. Bilateral nipple shadows should not be confused for pulmonary nodules.", "output": "No evidence of pneumonia. Prominence of the right upper mediastinal contour should be further evaluated with shallow oblique images." }, { "input": "Frontal and lateral chest radiograph demonstrates hyperinflated lungs with flattening of the hemidiaphragms consistent with known COPD. The lungs are clear with no focal consolidation or pleural effusion. Re- demonstration of calcified mediastinal nodes and calcifications projecting posterior to left clavicular head are unchanged. Cardiomediastinal and hilar contours are within normal limits. No pulmonary edema. No pneumothorax.", "output": "Hyperinflated lungs with no pneumonia." }, { "input": "The cardiac, mediastinal and hilar contours are unchanged with the heart size within normal limits. Calcified left hilar lymph nodes as well as calcifications within the medial aspect of the left upper lung field are unchanged compatible prior granulomatous disease. Pulmonary vascularity is not engorged. The lungs are hyperinflated with relative lucency in the lung apices compatible with underlying emphysema. Previously noted right lower lobe opacity has resolved. No focal consolidation, pleural effusion or pneumothorax is identified. Scattered calcified granulomas are also noted within the lungs. Partial resection of the ___ right posterior rib is again noted. There are no acute osseous findings.", "output": "No acute cardiopulmonary abnormality. Evidence of prior granulomatous disease. Emphysema." }, { "input": "Cardiac silhouette size is normal. Mediastinal and hilar contours are unchanged, and the pulmonary vasculature is not engorged. Moderate to severe emphysema is again demonstrated within upper lobe predominance. Calcified left hilar lymph nodes and scattered calcified granulomas are again present compatible with prior granulomatous disease. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities. Amorphous calcification projecting over the left medial upper hemithorax is unchanged.", "output": "Emphysema. No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are hyperinflated, with flattening of the diaphragms, suggesting chronic obstructive pulmonary disease. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. Amorphous calcification projecting over the left upper hemithorax is stable since at least ___. Evidence of hilar calcification is again seen.", "output": "COPD without acute cardiopulmonary process." }, { "input": "As compared to the previous radiograph, the patient has developed minimal bilateral pleural effusions as well as areas of opacities in both lower lobes. Given the clinical presentation of the patient, the presence of pneumonia is likely. In addition, the cardiac silhouette is slightly enlarged as compared to the previous exam, so that mild fluid overload could be present. Defect in the posterior part of the fifth right rib, unchanged. Mild bilateral symmetrical apical thickening.", "output": "Suspicion of newly appeared bilateral lower lobe pneumonia, associated with minimal pleural effusions. At the time of dictation and observation, 1:14 p.m., on ___, the referring physician, ___. ___ was paged for notification. Findings were discussed minutes later over the telephone." }, { "input": "There has been hazy opacification at the left lung base compared to the right, which may be related to soft tissue attenuation. No definite focal consolidation concerning for pneumonia is seen. No pleural effusion or pneumothorax is present. The pulmonary vasculature is not engorged. There is a 9-mm calcified nodule in the right lung base, which likely represents a calcified granuloma. The cardiac silhouette is normal in size. The mediastinal and hilar contours are within normal limits with mild tortuosity of the thoracic aorta. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process. 9-mm calcified granuloma in the right lung base." }, { "input": "The heart size is normal. Mediastinal and hilar contours are unremarkable. Lungs are clear. Pulmonary vascularity is normal. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities are present.", "output": "Normal chest radiograph." }, { "input": "A left-sided port terminates at the cavoatrial junction. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. No free intraperitoneal air seen under the bilateral hemidiaphragms.", "output": "No acute cardiopulmonary abnormality. No free intraperitoneal air identified on this chest radiograph." }, { "input": "Frontal radiographs of the chest were acquired. The lungs are clear. The heart size is normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen.", "output": "No acute cardiac or pulmonary findings." }, { "input": "The lungs are well expanded. There are perihilar opacities and reticular opacities, consistent with mild to moderate pulmonary edema. There are no pleural effusions or pneumothorax. The cardiomediastinal silhouette demonstrates moderate to severe enlargement", "output": "Mild to moderate pulmonary edema. Cardiomegaly." }, { "input": "The cardiomediastinal silhouette is stable with mild cardiomegaly when compared to ___ study. The hila and pleura are unremarkable. No focal consolidations, pleural effusions, pulmonary edema, or pneumothorax are seen.", "output": "No evidence of pneumonia." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. Stable mild cardiomegaly. No free air below the right hemidiaphragm is seen.", "output": "No focal consolidation. Stable mild cardiomegaly. NOTIFICATION: The findings were discussed by Dr. ___ with ___ ___ on the telephoneon ___ at 12:15 PM, 3 minutes after discovery of the findings." }, { "input": "Lung volumes are low. This accentuates the size of the cardiac silhouette which is mildly to moderately enlarged. Mediastinal and hilar contours are unremarkable except for the presence of a moderate size hiatal hernia. The pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality. Moderate size hiatal hernia." }, { "input": "Lungs are clear. Moderate cardiomegaly is long standing. The right central venous catheter ends in the mid SVC. No pneumothorax, pulmonary edema, or pneumonia.", "output": "No acute cardiopulmonary process." }, { "input": "As compared to ___, new left PICC with the tip in the low SVC. Low lung volumes accentuate lung markings. No acute parenchymal consolidation. No pulmonary edema. Moderate cardiomegaly. No pneumothorax or substantial effusion.", "output": "No acute pneumonia." }, { "input": "Lung volumes remain low with platelike atelectasis at the left lung base. A left-sided PICC terminates in the proximal SVC. Knee known retrocardiac opacity is similar in degree when compared to the prior study. No new areas of consolidation are seen. No pneumothorax seen. Possible trace left pleural effusion.", "output": "No significant interval change when compared to the prior study." }, { "input": "Mediastinal surgical clips and intact median sternotomy wires are noted.The lungs are clear. Cardiac, hilar, and mediastinal contours are normal.No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are normally expanded and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "No previous images. The heart is normal in size and there is no vascular congestion, pleural effusion, or acute focal pneumonia.", "output": "No radiographic abnormality." }, { "input": "PA and lateral views through the chest demonstrates clear lungs bilaterally. The cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax identified. Osseous structures are without an acute abnormality.", "output": "No acute intrathoracic process." }, { "input": "There is a large bore right subclavian line with tip at the cavoatrial junction. The heart size is mildly enlarged. The lungs are clear without infiltrate or effusion.", "output": "No focal infiltrate." }, { "input": "Frontal and lateral radiographs of the chest were acquired. The lungs are clear. The heart size is normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen. Nipple rings are noted.", "output": "No acute cardiac or pulmonary process." }, { "input": "Single frontal view of the chest was obtained. Endotracheal tube is seen, terminating approximately 5.5 cm above the level of the carina. Enteric tube is seen coursing below the level of the diaphragm, inferior aspect not included on the image. Cardiac and mediastinal silhouettes are stable. There is prominence of the interstitial markings suggesting mild pulmonary edema, as well as prominence of the hila.", "output": "1. Endotracheal tube in appropriate position. 2. Enteric tube courses below the level of the diaphragm and inferior aspect not imaged. 3. Stable cardiomediastinal silhouette with the cardiac silhouette mildly enlarged. Mild pulmonary edema." }, { "input": "Endotracheal tube terminates 6 cm above the carina, with the head up. Left subclavian line is in the lower SVC. Enteric tube is below the diaphragm. Moderate to severe pulmonary edema persists. Moderate to large bilateral pleural effusions have increased. No no pneumothorax.", "output": "Persistent moderate-to-severe pulmonary edema with enlarging moderate to large bilateral pleural effusions" }, { "input": "PA and lateral views of the chest were provided. The heart is moderately enlarged. There is no focal consolidation, effusion, or pneumothorax. Pulmonary ground-glass opacities seen on CT are less conspicuous on radiograph. Bony structures are intact.", "output": "Cardiomegaly. Please refer to same day chest CT for further details." }, { "input": "Since the last chest radiograph performed on the same date at 12:17pm, there has been interval advancement of the dobhoff tube, which is now located just distal to the gastroesophageal junction. The lungs and cardiomediastinal silhouette are otherwise stable compared to the last radiograph. The left subclavian line is unchanged in position.", "output": "Interval advancement of the dobhoff tube, which is now located distal to the gastroesophageal junction. NOTIFICATION: Results were communicated to Dr. ___ by Dr. ___ on ___ at 4:43PM via telephone." }, { "input": "Endotracheal tube is seen, terminating approximately 2.5 cm above the carina. Enteric tube courses into the left abdomen, inferior aspect not included on the image. There are relatively low lung volumes and mild elevation of the right hemidiaphragm. Left basilar opacity, linear component likely relates atelectasis. There is more patchy left basilar retrocardiac opacity which may be due to aspiration or infection. No large pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are grossly stable. There has been interval removal of a left-sided subclavian line.", "output": "Endotracheal tube is seen, terminating approximately 2.5 cm above the carina. Enteric tube courses into the left abdomen, inferior aspect not included on the image. There are relatively low lung volumes and mild elevation of the right hemidiaphragm. Left basilar opacity, linear component likely relates atelectasis. There is more patchy left basilar retrocardiac opacity which may be due to aspiration or infection. No large pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are grossly stable. There has been interval removal of a left-sided subclavian line." }, { "input": "There has been no further improvement in the pulmonary edema pattern. Pulmonary vascular redistribution remains as well as right basilar parenchymal density. There is slight blunting of the left costophrenic sulcus. The heart is not changed in size.. The osseous structures are normal for age. Left-sided central venous catheter is unchanged in position. Barium is noted in the colon.", "output": "Partial clearing of the pulmonary edema pattern. The patient has not returned to his baseline of ___" }, { "input": "There are no significant parenchymal changes since the most recent CXR performed yesterday morning. Lung volumes are still low. Bibasilar atelectasis is unchanged in appearance. No pulmonary edema or pneumothorax. No large pleural effusions. The mediastinum, hila and heart are within normal limits. The enteric tube has been removed. ETT terminates 2.8 cm above the carina. Left IJ catheter ends at the left brachiocephalic vein-SVC confluence.", "output": "1. ETT terminates 2.8cm above the carina. Enteric tube has been removed. 2. Unchanged appearance of bibasilar atelectasis." }, { "input": "AP portable upright view of the chest. A left subclavian central venous catheter terminates at the cavoatrial junction. A nasogastric tube terminates within the stomach. There is no pneumothorax, focal consolidation, or right pleural effusion. A trace left pleural effusion is present.", "output": "Small left pleural effusion. No superimposed acute intrathoracic process." }, { "input": "There has been interval placement of a Dobbhoff tube; however, the tip is coiled within the distal esophagus. The left subclavian line is unchanged in appearance. Otherwise, there are no significant changes in the lungs or the cardiomediastinal silhouette compared to ___.", "output": "Interval placement of a Dobbhoff tube, with the tip coiled in the distal esophagus. NOTIFICATION: Results were communicated to Dr. ___ by Dr. ___ on ___ at 4:03PM, at time of discovery" }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Since the prior exam, the left PICC line has been retracted, but still terminates in the SVC. The endotracheal and enteric tubes remain in appropriate position. There is no pneumothorax. The lungs are clear. The heart is normal size. There is new slight thickening of the left paratracheal stripe at the level of mild lower thoracic spine angular kyphosis where a mild T8 compression fracture was identified on recent CT scan.", "output": "New slight thickening of the left paravertebral stripe at the level of a previously identified mild T8 vertebral body compression deformity raises concern for increasing paravertebral hematoma. Dedicated cross-sectional imaging is advised. Lines and tubes in appropriate position. Clear lungs. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 12:38 PM, 60 minutes after discovery of the findings." }, { "input": "Compared to the prior study there is no significant interval change", "output": "No change" }, { "input": "The right subclavian line is been removed. Otherwise, compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "The left-sided chest tube is been removed. There is a small left lateral pneumothorax. The ET tube and NG tube are unchanged the lungs are otherwise clear", "output": "Small left lateral pneumothorax" }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. Cardiac silhouette is moderately enlarged. Tortuosity of the descending thoracic aorta is noted. Left shoulder arthroplasty changes are noted. No acute osseous abnormalities. Hypertrophic changes are seen in the spine.", "output": "Cardiomegaly without acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax. Visualized osseous structures are grossly intact.", "output": "No evidence of pneumonia." }, { "input": "AP and lateral views of the chest. The lungs are clear without focal consolidation or effusion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "Endotracheal tube terminates 4.9 cm above the level carina. Mild bibasilar atelectasis is noted. There is no lobar consolidation, large pleural effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. Moderate scoliosis is noted within the lower thoracolumbar spine.", "output": "ETT in expected location. No acute cardiopulmonary process." }, { "input": "An endotracheal tube terminates 3.3 cm above the level of the carina. There has been interval placement of a nasogastric tube with the side hole positioned beneath the level of the diaphragm. A right-sided internal jugular central venous line is noted with the tip terminating in the mid right atrium. Multiple right upper quadrant surgical clips are noted. A subtle left retrocardiac airspace opacity is noted. There is no pneumothorax or large pleural effusion. . The cardiomediastinal silhouette is within normal limits.", "output": "1. Left retrocardiac consolidation suggestive of pneumonia versus aspiration. 2. Support lines and tubes, as above." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pneumothorax or pleural effusion. The lungs are well expanded and clear. Pulmonary vasculature is within normal limits.", "output": "No acute cardiopulmonary process. Specifically, no pneumomediastinum." }, { "input": "AP and lateral radiographs of the chest were acquired. Heterogeneous opacities at the left lung base could be atelectasis, although an infectious process in the left lower lobe cannot be excluded. The lungs are otherwise clear. There is a small-to-moderate left pleural effusion, new compared to CT from ___. The heart size is normal. The mediastinal contours are normal. There is no pneumothorax. Surgical clips are seen overlying the abdomen.", "output": "1. Left base opacity, may be due to pleural effusion and atelectasis, but underlying consolidation is note excluded." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Dextroscoliosis of the thoracic spine is noted.", "output": "No acute cardiopulmonary abnormality." }, { "input": "AP single view of the chest has been obtained with patient in sitting semi-upright position. Comparison is made with the frontal view of AP and lateral chest examination obtained two days earlier (___). Again, there is status post sternotomy and the presence of multiple surgical clips in the left-sided anterior mediastinal structures is indicative of bypass surgery. The heart size has not changed significantly. The pulmonary vasculature is not congested. An apparently postoperatively developed thin plate atelectasis on the left base remains unchanged. The right hemithorax does not demonstrate any pulmonary abnormalities at all. Skeletal structures grossly unchanged and no evidence of pneumothorax.", "output": "No change in chest appearance in comparison with preceding image obtained two days earlier." }, { "input": "Patient is status post coronary artery bypass graft surgery. The cardiac, mediastinal and hilar contours appear stable. The lungs appear clear. There are no pleural effusions or pneumothorax.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "There is relative elevation of the right hemidiaphragm. Increased opacity on the lateral view over lower spine is compatible with sclerosis of the vertebral bodies likely degenerative. Linear opacities at the right lateral costophrenic angle is likely due to scarring and atelectasis as seen on CT. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No definite acute cardiopulmonary process." }, { "input": "There are low lung volumes. Left base atelectasis without definite focal consolidation. Left base potential epicardial fat pad. No pulmonary edema is seen. The cardiac silhouette is not enlarged. Mediastinal contours are unremarkable.", "output": "Low lung volumes. No pulmonary edema. No definite focal consolidation to suggest pneumonia." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen.", "output": "No focal consolidation." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is a streaky opacity projecting over the lingula. Similarly, there is a patchy posterior opacity projecting over the lower thoracic spine, most likely in the left lower lobe. There is no pleural effusion or pneumothorax.", "output": "Patchy opacities concerning for mild bronchopneumonia in the appropriate clinical setting." }, { "input": "PA and lateral views of the chest. The lungs remain clear. There is no effusion or pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiograph demonstrates unremarkable cardiomediastinal and hilar contours. Lungs are clear. No pleural effusion or pneumothorax present.", "output": "Normal chest radiograph." }, { "input": "Frontal and lateral views of the chest were obtained. The cardiac silhouette is mildly enlarged. There is no focal consolidation, pleural effusion, evidence of pneumothorax. Mediastinal contours are stable. There may be mild central vascular engorgement/minimal pulmonary vascular congestion.", "output": "Possible mild pulmonary vascular engorgement/minimal pulmonary vascular congestion." }, { "input": "There is no pleural effusion, pneumothorax or focal airspace consolidation. The cardiac, mediastinal and hilar structures are normal and unchanged. The pulmonary vascularity is normal.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for pneumonia. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No focal consolidations concerning for pneumonia." }, { "input": "2 views of chest show that the lungs are well expanded and clear. The cardiomediastinal silhouette, hilar contours and pleural surfaces are normal. No pleural effusion or pneumothorax is present.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest were obtained demonstrating clear well expanded lungs without focal consolidation, effusion, pneumothorax. Cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest demonstrate no focal areas of consolidation. Scarring at the left lung apex is unchanged. A double contour on chest x-ray in the left lower lung represents mediastinal fat. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unchanged.", "output": "No evidence of pneumonia." }, { "input": "Single portable view of the chest. Left apical scarring is again seen and partially obscured by patient's overlying chin on the current exam. Elsewhere the lungs are clear, without focal consolidation. Cardiomediastinal silhouette is unchanged. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal silhouette is normal. The pleura are unremarkable. Previously seen right middle lobe opacity is longer present. No consolidations, pleural effusions, pulmonary edema, or pneumothorax.", "output": "Resolution of pneumonia." }, { "input": "There is a faint peribronchial opacity in the right middle lobe. The left lung is clear. Cardiomediastinal and hilar silhouettes are normal. Pleural surfaces are normal.", "output": "Right middle lobe pneumonia. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 5:01 PM, 5 minutes after discovery of the findings." }, { "input": "PA and lateral views of the chest provided demonstrate expanded lungs without focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No definite rib fractures are seen.", "output": "No acute findings in the chest. If there is strong clinical concern for injury recommend a dedicated rib series." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation, or pneumothorax. Heart size is normal. No pulmonary edema.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest with dedicated views of the rib ribs were obtained for a total of 7 images. Lung volumes are slightly low, resulting in bronchovascular crowding. There is mild bibasilar atelectasis. No focal consolidation, pleural effusion or pneumothorax. Heart size is normal. Mediastinal silhouette and hilar contours are normal allowing for lung volumes. No free air is seen under the diaphragm. No displaced rib fracture is seen. There is mild loss of thoracic vertebral body height in the mid thoracic spine of unknown chronicity. Acromioclavicular joint arthropathy is seen with calcification adjacent to the humeral head, which may represent calcific tendinopathy.", "output": "1. No focal consolidation. 2. No displaced rib fracture. 3. Loss of vertebral height in the mid thoracic spine may be degenerative, but exact chronicity is unknown. Correlate with site of patient's pain." }, { "input": "PA and lateral views of the chest. The lungs are clear without consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is slightly rotated. ETT in standard position. Enteric tube traverses the diaphragm and its tip is not seen. External respiratory tubing projects over the mediastinum and left lower hemithorax limiting evaluation. The heart size is mild-to-moderately enlarged, overall unchanged. Lung volumes are low. No focal consolidation. Small to moderate bilateral dependent pleural effusions, greater on the right. Mild-to-moderate prominence of the pulmonary vasculature with pulmonary edema. No pneumothorax.", "output": "Mild-to-moderate biventricular heart failure and/or volume overload." }, { "input": "PA and lateral views of the chest provided. Midline sternotomy wires and mediastinal clips are again noted. The lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is stable with atherosclerotic calcifications along the thoracic aorta. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral radiographs of the chest demonstrate clear lungs and normal hilar and cardiomediastinal contours. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal.", "output": "Normal radiographs of the chest." }, { "input": "Compared with the prior chest radiograph, no relevant change. The lungs are clear without focal consolidation, pleural effusion, or pneumothorax. Cardiomediastinal silhouette is within normal limits.", "output": "No pneumonia." }, { "input": "Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is no focal lung consolidation.", "output": "No evidence of pneumonia." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute disease." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lung fields are clear. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Chest radiograph dated ___. The lungs are well-expanded and clear. No focal consolidation, effusion, edema, or pneumothorax. The heart is normal in size. No mediastinal widening. No acute osseous abnormality.", "output": "Normal chest radiograph. No pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of normal size with normal cardiomediastinal contours. Lungs are clear. No pleural effusion or pneumothorax. No radiopaque foreign body.", "output": "Normal chest radiographs." }, { "input": "Right pectoral infusion port terminates at the low SVC. There is no consolidation, pleural effusion, or pneumothorax. Cardiac silhouette is top normal in size.", "output": "Right pectoral infusion port terminates at the low SVC. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 2:02 PM" }, { "input": "PA and lateral chest radiograph demonstrate no focal consolidation. Minor left base atelectasis/ scarring is noted. Cardiomediastinal and hilar contours are within normal limits. There is no pleural effusion or pneumothorax. Osseous structures demonstrates no acute abnormality.", "output": "No acute intrathoracic abnormality." }, { "input": "Supine AP views of the chest were obtained. Underlying trauma board and other overlying objects partially obscure the image. The lungs are clear bilaterally with no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. No displaced fractures are seen.", "output": "No acute intrathoracic process." }, { "input": "Extensive consolidative opacities seen involving nearly the entire left lung with air bronchograms and additional focal opacities in the right mid lung field are concerning for extensive multifocal pneumonia. Cardiac silhouette size is difficult to assess given the extensive left lung consolidation. No pleural effusion or pneumothorax is present. No pulmonary edema is demonstrated. No acute osseous abnormality is identified. Grade 3 AC separation on the left is chronic.", "output": "Extensive consolidation in the left lung with additional focal opacities in the right mid lung field concerning for multifocal pneumonia. Followup radiographs to resolution of these findings are recommended" }, { "input": "The endotracheal tube terminates in the proximal right mainstem bronchus. The right internal jugular catheter is unchanged in position and the tip is in the mid SVC. There is no pneumothorax. Otherwise, there are no significant changes compared to the prior radiograph performed earlier this morning. Again noted are diffuse bilateral patchy opacities similar in appearance compared to the prior radiograph performed earlier this morning, likely due to underlying Legionella infection.", "output": "The endotracheal tube terminates within the right mainstem bronchus. Recommend pulling it back approximately 4 cm. NOTIFICATION: Findings were telephoned to Dr. ___ by Dr. ___ on ___ at 3:06PM, at time of discovery." }, { "input": "There has been interval placement of an endotracheal tube with tip terminating approximately 6.5 cm from the carina. An orogastric tube tip and side-port are within the stomach. Remainder of the chest is unchanged with continued extensive consolidation in the left lung and more focal opacities noted within the right mid lung field. No large pleural effusion or pneumothorax is identified.", "output": "Endotracheal and orogastric tubes in standard positions. Remainder of the exam is unchanged." }, { "input": "Right IJ catheter terminates in the right atrium SVC junction. An endotracheal tube is 4 cm above the carinal. Bilateral parenchymal disease consistent with ARDS and or pneumonia has not changed. Hazy density in both lung bases suggests small bilateral effusions appear The heart is not enlarged. The osseous structures are normal for age. Monitor leads overlie the chest.", "output": "No change in the bilateral parenchymal disease consistent with a combination of Legionella and ARDS" }, { "input": "Compared to earlier the same day and allowing for differences in technique, the degree of opacification seen in both lungs appears to have progressed slightly, with more opacity now seen in the mid and upper zones on both sides. The possibility of some associated pleural fluid cannot be excluded, but much of this is likely accounted for by parenchymal opacification. The cardiac silhouette is now less well seen on both sides due to this opacification. The right paratracheal soft tissues are again noted to be prominent -- ? due to right-sided vascular engorgement. The ET tube lies approximately 5.3 cm above the carina and the right IJ central line overlies the distal SVC, both similar to the prior film.", "output": "Worsening opacification of both lungs." }, { "input": "The lungs are clear without focal opacity, pulmonary vascular congestion, pleural effusion or pneumothorax. The cardiac and mediastinal contours are stable.", "output": "No pneumonia. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 10:05 AM, 5 minutes after discovery of the findings." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "The heart size is large. The mediastinal and hilar contours are normal. The lungs show emphysematous changes. There is no pleural effusion or pneumothorax. Apical pleural thickening is noted. A compression deformity of the spine is unchanged since ___.", "output": "Cardiomegaly and emphysema, but no acute cardiopulmonary process." }, { "input": "Lung volumes are low, resulting in bronchovascular crowding. There is bibasilar atelectasis. Cardiomediastinal and hilar contours are unremarkable. No pneumothorax or pleural effusion. There is gaseous distention of loops of bowel in the upper abdomen. Mediastinum is not widened.", "output": "Bibasilar atelectasis, a nonspecific finding .could be due to diaphragm elevation because of gaseous intestinal distention, can also be seen in some instances of acute pulmonary embolism. RECOMMENDATION(S): Clinical evaluation for possibility of acute pulmonary embolism. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 8:06 AM, 1 minutes after discovery of the findings." }, { "input": "The heart size, mediastinal, and hilar contours are normal.The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.", "output": "No acute cardiopulmonary process, specifically no mediastinal widening." }, { "input": "Mild cardiomegaly is present. Calcified right lower paratracheal calcified lymph nodes suggest prior granulomatous disease. The aorta is densely calcified diffusely. Hilar contours are unremarkable. There is mild interstitial pulmonary edema with small bilateral pleural effusions. More focal opacity in the retrocardiac region likely reflects atelectasis. No pneumothorax is present. The osseous structures are diffusely demineralized.", "output": "Mild interstitial pulmonary edema and small bilateral pleural effusions. Patchy retrocardiac atelectasis. Calcified mediastinal lymph nodes suggest prior granulomatous disease." }, { "input": "Improved pulmonary edema reflected in decreased peribronchial cuffing and pulmonary vascular congestion with minimally increased cardiomegaly. Bilateral small pleural effusions and atelectatic volume loss are unchanged. Large granulomatous right peritracheal lymphadenopathy, heavily calcified right subclavian artery, and normal caliber mild ascending aortic calcification are noted.", "output": "Mild congestive heart failure improved from ___." }, { "input": "There is mild elevation of the right hemidiaphragm. There is no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal silhouette is stable.", "output": "1. No evidence of acute cardiopulmonary process. 2. Mild elevation of the right hemidiaphragm." }, { "input": "Lungs are well inflated and clear bilaterally. There is no pulmonary congestion, focal consolidation, pleural effusion, or evidence of pneumothorax. The cardiomediastinal silhouette is normal in appearance. The pleural surfaces are unremarkable. Skeletal structures are within normal limits except for multilevel degenerative changes seen along the thoracic spine.", "output": "No evidence of infection or malignancy." }, { "input": "Endotracheal tube tip is 6.4 cm from the carina. Enteric tube passes with tip into the stomach, side-port just proximal to the GE junction. The lungs are clear without consolidation, large effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. Mitral annular calcifications are noted. Old healed proximal right humerus fracture is noted.", "output": "Endotracheal tube tip 6.4 cm from the carina. Enteric tube side port in the region of the GE junction and should be advanced several cm for optimal positioning." }, { "input": "Interval repositioning of nasogastric tube with side port beyond the gastroesophageal junction. The distal tip is not visualized. The remainder of the examination is unchanged from recent chest radiograph, specifically left basilar atelectasis and pleural effusion are stable.", "output": "Repositioned nasogastric tube with side port now distal to the gastroesophageal junction. NOTIFICATION: The wet read were discussed with ___, neurosurgery, by ___, M.D. on the telephone on ___ at 11:21 AM, at the time of discovery of the findings." }, { "input": "Heart size is top normal. Mediastinal and hilar contours are similar. Lungs are hyperinflated. Streaky opacities in the lung bases may reflect atelectasis but aspiration or infection cannot be completely excluded. There is no focal consolidation, pleural effusion or pneumothorax. Pulmonary vasculature is not engorged. A percutaneous catheter balloon is seen in the left upper quadrant of the abdomen.", "output": "Streaky bibasilar airspace opacities may reflect atelectasis but infection or aspiration cannot be excluded in the correct clinical setting." }, { "input": "Portable AP upright chest radiograph ___ at 06:05 is submitted.", "output": "Lungs are hyperinflated suggestive of underlying emphysema. Endotracheal tube has its tip 4 cm above the carina. Nasogastric tube is seen coursing below the diaphragm with the tip not identified. No focal airspace consolidation is seen to suggest pneumonia. No pulmonary edema, pleural effusions or pneumothorax. Overall cardiac and mediastinal contours are unchanged." }, { "input": "Dobhoff tube with distal tip terminating in the stomach beyond the level of the gastroesophageal junction. Right PICC, unchanged. Decreased prominence of left pleural effusion and stable left basilar atelectasis.", "output": "Dobhoff tube with distal tip terminating in the stomach beyond the level of the gastroesophageal junction. NOTIFICATION: The findings were discussed with ___, neurosurgery, by ___, M.D. on the telephone on ___ at 2:54 PM, at the time of discovery of the findings." }, { "input": "The lung bases are underpenetrated, likely due to overlying soft tissue. Given this, no focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac silhouette is top-normal to mildly enlarged. There is rightward deviation of the trachea with apparent mass effect on the trachea, increased as compared to the prior study, which may be due to underlying enlargement of the thyroid gland.", "output": "No focal consolidation. Interval increase in rightward deviation of the trachea, as compared to chest radiograph from ___, suggesting interval increase in size of the thyroid gland, with increased mass effect on the trachea. This could be further assessed with non urgent thyroid ultrasound." }, { "input": "The heart size is normal. The hilar and mediastinal contours are unremarkable. Lungs are clear without evidence of focal consolidations concerning for infection. There is no pneumothorax or pleural effusion. Note is again made of mild rightward deviation of the trachea, likely secondary to patient's multinodular goiter.", "output": "No acute cardiopulmonary process identified." }, { "input": "Single frontal view of the chest was obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. There is slight deviation of the trachea to the right, which may relate to patient's known multinodular thyroid.", "output": "No focal consolidation to suggest pneumonia." }, { "input": "A single portable AP upright view of the chest was obtained. The right costophrenic angle is not fully included on the image. Given this, no large pleural effusion is seen. Right basilar opacity is not optimally assessed and could be due to atelectasis/scarring, although underlying consolidation or aspiration is not excluded. The left lung is clear. The patient is rotated slightly to the right. The cardiac silhouette is mildly enlarged. There is no overt pulmonary edema. No pneumothorax is seen.", "output": "Right costophrenic angle not fully included on the image. Suggest dedicated PA and lateral views if possible when patient able or repeat frontal view for further evaluation. Right basilar opacity, difficult to assess whether atelectasis/scarring. However, underlying consolidation due to aspiration or infection not excluded." }, { "input": "There is no lobar consolidation, pleural effusion, pneumothorax, or pulmonary edema. The descending thoracic aorta remains tortuous. The cardiomediastinal silhouette is otherwise stable. The previously described 5 mm left lung nodule is not well visualized on today's study.", "output": "No definitive pneumonia is identified. If the patient is at high risk for aspiration, recommend repeat radiograph in 12 hr." }, { "input": "Normal heart size, mediastinal and hilar contours. No pleural effusion or pneumothorax. There is a vague opacity obscuring the right heart border which is localized in the retrosternal space on the lateral view concerning for an early right middle lobe consolidation. Note is made of mild pectus excavatum.", "output": "Right middle lobe opacity concerning for early pneumonia. NOTIFICATION: The change from the preliminary read was discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 7:43 AM, 15 minutes after discovery of the findings. And an e-mail was sent to the ED QA nurses." }, { "input": "Linear opacity in the right midlung is most suggestive of atelectasis. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The aorta is mildly tortuous and calcified along the arch. The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "There is mild to moderate enlargement of the cardiac silhouette. Mediastinal contours are relatively unchanged. There is continued mild pulmonary edema, slightly worse compared to the previous exam, with patchy bibasilar opacities likely reflecting atelectasis noted 1. Additionally, as noted previously, prominent ring shadows are noted within the left upper lung field suggestive of bronchiectasis. Left apical pleural thickening is unchanged. No pleural effusion or pneumothorax is identified. Mild to moderate degenerative changes are noted within the thoracic spine.", "output": "Mild pulmonary edema. Probable bibasilar atelectasis, but aspiration or infection cannot be excluded." }, { "input": "AP and lateral chest radiographs. Pulmonary edema is mild. There is cardiomegaly. There is no pleural effusion or pneumothorax. Tortuosity of the aorta is unchanged.", "output": "Mild pulmonary edema." }, { "input": "The cardiomediastinal silhouette and hilar contours are unremarkable. Again appreciated is a region of heterogeneous opacities localized to the lingula with air bronchograms and peribronchial cuffing compatible with pneumonia. The right lung is essentially clear except for base linear atelectasis. There is no pleural effusion or pneumothorax.", "output": "Lingular pneumonia." }, { "input": "Endotracheal tube has been positioned and its tip end about 3.5 cm above the carina bifurcation. In the first image the Dobhoff tube loops in the distal esophagus, but after repositioning, despite, the tip is not included in the image, it reaches the stomach. The perihilar opacities persist with concomitant pleural fluid on the left lung base. Right lung is clear without pleural fluid.", "output": "Correct positioning of the endotracheal and Dobhoff tubes The opacities in the lingula persist, with omolateral pleural effusion" }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. Degenerative changes are partially imaged at the shoulder joints.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is present. The osseous structures are diffusely demineralized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The 2 lead pacemaker is again seen with leads projecting over the expected locations the heart is mildly enlarged there is mild increase in lung markings but no focal infiltrate or effusion", "output": "Pacemaker in good location" }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are unremarkable. There is no pneumothorax or pleural effusion. The lungs are clear. A convex density is noted along the right paraspinal region, and is of unclear etiology.", "output": "1. No pneumonia. 2. Convex opacity along right paraspinal contour just above the right hemidiaphragm. Follow up with non-emergent CT scan is recommended to exclude a posterior mediastinal abnormality. RECOMMENDATION(S): Convex opacity along right lower paraspinal region. Follow up with non-emergent CT scan is recommended to exclude a mediastinal abnormality." }, { "input": "Severe cardiomegaly is unchanged from the prior study. The mediastinal contours are similar. Mild pulmonary edema is not substantially changed from the prior study. Hilar contours are similar. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities. Splenic shadow appears absent compatible with history of sickle cell disease. Vertebral bodies have a somewhat H-shaped configuration also compatible with a history of sickle cell disease.", "output": "Severe cardiomegaly with mild pulmonary edema, similar to that seen previously." }, { "input": "Again seen are several pulmonary nodules which by radiography do not appear significantly changed. There is a known right hilar mass. A lesion of the left posterior fifth rib also appears grossly similar. No new focal opacity to suggest pneumonia is seen. No pleural effusion, pulmonary edema, or pneumothorax is present. A small amount of atelectasis or scarring is present at the right base. The cardiomediastinal silhouette is normal.", "output": "Known pulmonary nodules, right hilar mass and left-sided rib lesion. No new focal opacity to suggest superimposed acute process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Note is made of free air in the right upper quadrant, below the diaphragm. There is minimal left midlung opacity in the region of prior consolidation, likely related to scarring. No new focal consolidation or large pleural effusion is seen. Note is made of a coronary stent.", "output": "Free air under the diaphragm in the right upper quadrant, consistent with recent surgery two days prior." }, { "input": "The NG tube tip is just below the gastroesophageal junction. It should be advanced prior to use. Compared to the prior study the ET tube has been removed. There has been partial clearing of the lungs. The heart size is mildly enlarged. There is volume loss at both bases. There is a left lateral infiltrate. The bilateral effusions are much smaller. There are multiple gas-filled loops of small and large bowel likely representing an ileus.", "output": "Left lateral lung infiltrate. The NG tube tip is just below the gastroesophageal junction. It should be advanced ." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. No focal consolidations concerning for pneumonia identified. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No acute intrathoracic abnormalities identified." }, { "input": "PA and lateral views of the chest demonstrate hyperinflated, but clear, lungs. The cardiac size is top normal. The thoracic aorta is unfolded. Slight blunting of the left costophrenic angle may be due to a small amount of scarring rather than pleural effusion. Lobulation of the right hemidiaphragm is present. There is no free air.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest were provided. The heart remains top normal in size. Mediastinal contour is stable. No large consolidation, effusion or pneumothorax is seen. No overt signs of pulmonary edema. Bony structures appear stable.", "output": "No acute intrathoracic process." }, { "input": "Chest, PA and lateral. There is little interval change from the prior study. The lungs are hyperinflated but clear. Cardiac size is top-normal. The thoracic aorta is unfolded in configuration. There is no pneumothorax. There is minimal pleural scarring at the left base. Pulmonary vascularity is normal.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "ET tube terminates 4.7 cm from the carina. There are worsening bilateral upper lobe predominant opacities with indistinctness of the pulmonary vasculature compatible with pulmonary edema. The heart is top normal. The mediastinal and hilar contours are unremarkable. There is no large pleural effusion or pneumothorax.", "output": "1. ET tube 4.7 cm from the carina. 2. Worsening pulmonary edema." }, { "input": "Please note, low lung volumes limit evaluation. There is subtle opacity at the left lung base which could represent atelectasis or bronchovascular crowding. Please note however in the correct clinical setting and early pneumonia cannot be excluded. No large effusion or pneumothorax. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Subtle opacity at the left lung base is likely atelectasis, though an early pneumonia in the right clinical setting cannot be excluded. NOTIFICATION:" }, { "input": "PA and lateral views of the chest were provided. The lungs remain low. There is no definite sign of pneumonia or CHF. There is bronchovascular crowding in the lower lungs. Cardiomediastinal silhouette appears normal. Bony structures are intact.", "output": "Limited study with crowding of bronchovasculature in the lower lungs. No clear signs of pneumonia." }, { "input": "The heart size is top normal. The hilar and mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for pneumonia. There is an enteric tube which extends below the diaphragm with the tip in the body of the stomach. The visualized osseous structures are unremarkable.", "output": "Enteric tube extends below the diaphragm with the tip in the body of the stomach." }, { "input": "PA and lateral views of the chest. The lungs are clear. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities detected. No free air seen below the diaphragm.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low with secondary bibasilar atelectasis. Superiorly, the lungs are clear. The cardiomediastinal silhouette is within normal limits. Although not well assessed, there is apparent sclerosis at the humeral heads bilaterally, likely in part due to degenerative changes.", "output": "Low lung volumes without definite acute cardiopulmonary process." }, { "input": "The heart is borderline in size. There is a large hiatal hernia with an air-fluid level. Streaky associated opacities in both lung bases suggest associated atelectasis. Otherwise, the lungs appear clear. There is no pleural effusion or pneumothorax. Moderate degenerative changes are stable along the visualized thoracolumbar spine.", "output": "Large hiatal hernia with associated parenchymal opacity, probably associated atelectasis; otherwise unremarkable." }, { "input": "The lungs are clear without focal opacity, pulmonary edema, pleural effusion or pneumothorax. The cardiac and mediastinal contours are stable. No acute osseous abnormality.", "output": "No pneumonia." }, { "input": "Lung volumes are moderate. The lungs are clear. There is no pleural effusion or pneumothorax.The cardiomediastinal silhouette is unchanged.", "output": "No evidence of pneumonia." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. Interval development of bibasilar atelectasis and probable small pleural effusions. Distended loops of bowel in the imaged upper abdomen are have been more fully assessed by abdominal radiograph is performed the same date and dictated separately.", "output": "Bibasilar atelectasis and small pleural effusions. ." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are unremarkable and unchanged. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal contour is normal.", "output": "No evidence acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest were obtained. Cardiac sihouettle is mildly enlarged, slightly accentuated by low lung columes. Cardiomediastinal contours are otherwise unremarkable. Focal opacity seen in the left lower lobe, best seen on the lateral view. There is no other focal consolidation, pleural effusion, or pneumothorax. The upper abdomen and bones are grossly unremarkable.", "output": "1. Slightly enlarged cardiac silhouette accentuated by low lung volumes but component of pericardial effusion should be considered in this patient with pericarditis. Correlate with echocardiogram. 2. Left lower lobe focal opacity, potentially atelectasis although infection is possible." }, { "input": "There is a right basilar opacity which may reflect pneumonia. The heart size is normal. The mediastinal contours are normal. There is a small hiatal hernia, best seen on the lateral radiograph.", "output": "Right basilar opacity may reflect pneumonia." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable", "output": "No acute cardiopulmonary abnormalities" }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Frontal and lateral views of the chest demonstrate no intrathoracic mass to explain the patient's Horner's syndrome. The lungs are clear. There is no pleural effusion, pneumothorax or focal airspace consolidation. The cardiac and mediastinal contours are normal. There are no osseous abnormalities.", "output": "Normal Chest radiograph. No intrathoracic mass." }, { "input": "Cardiac silhouette is mildly enlarged. Main pulmonary artery is enlarged as demonstrated on prior CTA of the chest. Lungs and pleural surfaces are clear. No acute skeletal findings.", "output": "Cardiomegaly and central pulmonary artery enlargement. The patient has known cardiac chamber enlargement as well as a patent foramen ovale as reported on recent echo." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Surgical clips are again seen in the right upper quadrant.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac silhouette size remains mildly enlarged. The aorta remains tortuous. The mediastinal and hilar contours are otherwise unremarkable. The pulmonary vasculature is not engorged. The lungs are clear. No pleural effusion or pneumothorax is demonstrated. Mild degenerative changes are seen in the thoracic spine. Clips from prior cholecystectomy are demonstrated in the right upper quadrant of the abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. As compared with recent CT chest from ___, bilateral pleural effusions persist, left greater than right. There is increasing collapse of the left lower lobe. A left perihilar opacity corresponds with a left upper lobe metastatic lesions seen on recent CT. Additional scattered nodular foci within the lungs are consistent with metastatic disease better assessed on prior CT. There is no pneumothorax. No edema. Heart size appears grossly unchanged. Mediastinal contour is stable. Bony structures are intact.", "output": "Worsening left lower lobe collapse with bilateral pleural effusions again noted left greater than right. Difficult to exclude a superimposed pneumonia in the left lower lung. Scattered metastatic lesions better assessed on prior CT." }, { "input": "There is a moderate to large left pleural effusion, increased in size since the prior study. There is likely associated atelectasis. Blunting of the posterior right costophrenic angle suggests a small right pleural effusion. Pulmonary lesions, including dominant left upper lobe mass were better assessed on CT. The cardiac and mediastinal silhouettes are grossly stable in size. No pneumothorax is seen.", "output": "Moderate to large left pleural effusion and small right pleural effusion, with associated atelectasis. At least the left pleural effusion appears increased in size as compared to the prior study. Previously seen pulmonary lesions better assessed on CT." }, { "input": "The heart size is top normal. Mediastinal and hilar contours are unremarkable. Linear opacities in the lower left lower lobe are compatible with subsegmental atelectasis. No focal consolidation, pleural effusion or pneumothorax is present. There is no free air are identified under the diaphragms. No acute osseous abnormalities are visualized.", "output": "No acute cardiopulmonary abnormality. No free air under the diaphragms. Left lower lobe subsegmental atelectasis." }, { "input": "There is left-sided perihilar and mid lung opacity which is new since prior. Right lung is grossly clear. There is no edema or effusion. Cardiomediastinal silhouette is stable compared to prior CT. No acute osseous abnormalities. Surgical clips seen in the upper abdomen.", "output": "Left perihilar consolidation which could represent infection. Followup after treatment, if indicated, is suggested. If infection is not clinically suspected, CT scan should be considered to further evaluate." }, { "input": "The cardiac silhouette is within normal limits. The hilar and mediastinal contours are normal. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded, clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.No evidence of free air is seen under the diaphragm.", "output": "No acute cardiopulmonary process. No free air under the diaphragm." }, { "input": "The Dobhoff tube traverses the diaphragm into the left upper quadrant and curves rightward with the proximal portion of the tip projecting over the midline over the vertebral body. The distal end of the tip of the Dobhoff tube is cut off from the film. The Dobhoff tube is probably in the stomach. The stomach is not distended. The stylet remains within the Dobhoff tube. No pneumomediastinum. The visualized lungs are clear. The heart size is normal.", "output": "Dobhoff in stomach." }, { "input": "AP and lateral views of the chest. The lungs are clear without effusion, consolidation, or pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are normal. Elevation of the left hemidiaphragm is noted. There is no pleural effusion or pneumothorax. The lungs are well expanded with left basilar atelectasis. There is no focal consolidation concerning for pneumonia. There is no pulmonary edema.", "output": "No acute cardiopulmonary process." }, { "input": "There is no evidence for mediastinal widening. The aorta is tortuous and calcified and within expected limits for patient's age. The lung fields demonstrate no focal consolidation, pleural effusion, or pneumothorax. Heart size is within normal limits.", "output": "No radiographic evidence for acute aortic injury. Preliminary findings and recommendations were discussed with Dr. ___ by Dr. ___ by telephone at 5:25 a.m. on ___ and in person with Dr. ___ ___ Dr. ___ by Dr. ___ at 5:45 a.m. on ___. Updated findings and impression after attending radiologist review were discussed with Dr. ___ by Dr. ___ by phone at 8:55 a.m. on ___." }, { "input": "Mild cardiomegaly is stable compared to the most recent prior exam. The lung volumes are low exaggerating the hilar and mediastinal contours, which, aside from mild dilatation of the ascending aorta, better characterized on the prior CT, are unremarkable. Mild bibasilar atelectasis is persistent. There is no large pleural effusion or pneumothorax. The visualized osseous structures are unremarkable. Left-sided pacer leads terminate in appropriate position. Low lung volumes with mild bibasilar atelectasis. No evidence of a pneumothorax.", "output": "Low lung volumes with mild bibasilar atelectasis." }, { "input": "The lung fields are clear without focal consolidation, pleural effusion, or pneumothorax. Heart and mediastinal contours are within normal limits. A small locule of air seen beneath the left diaphragm on the lateral view may lies within the stomach, but is associated with very slight tenting of the diaphragm. Within the limitations of chest radiographs, no acute fracture is identified.", "output": "No acute pulmonary process identified. These findings were discussed with Dr. ___ by Dr. ___ in person at 1:15 a.m. on ___." }, { "input": "Heart size, mediastinal and hilar contours are within normal limits. Lung volumes are slightly low. Lungs are grossly clear, and there are no pleural effusions, pneumothoraces or acute skeletal findings. However, extreme left lateral ribs have been excluded from the radiograph and are not fully assessed.", "output": "No evidence of pneumonia, pleural effusion, or pneumothorax." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes. There is no pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Partially imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Lung volumes are low with increased bibasilar opacities. Retrocardiac atelectasis persists. The cardiomediastinal contours are unchanged. There is diffuse sclerosis of the bones concerning for metastatic disease, correlate with history of malignancy.", "output": "1. Bibasilar opacities, representing atelectasis although given the clinical history, aspiration is possible. 2. Diffusely sclerotic bones, concerning for metastatic disease." }, { "input": "PA and lateral views of the chest provided. There is a mildly prominent appearance of the bilateral pulmonary hilar vasculature. No frank edema. No signs of pneumonia, effusion or pneumothorax. The heart size is normal. Mediastinal contour is normal. Bony structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Possible mild central hilar congestion." }, { "input": "Moderate pulmonary edema is increased compared to ___. Cardiac silhouette is larger. There is no pneumothorax. Left lower lobe collapse is persistent. Small left pleural effusion is stable. Right internal jugular venous approach temporary pacer terminates in right ventricle. Sternotomy wires are intact. TAVR device is in expected position.", "output": "Findings consistent with worsened fluid overload." }, { "input": "A portable upright frontal chest radiograph demonstrates intact sternal wires and unchanged moderate cardiomegaly. The lungs are hyperinflated, without focal lesion or appreciable pneumothorax. A small left pleural effusion is unchanged. The visualized upper abdomen is unremarkable, without evidence of intraperitoneal free air.", "output": "1. No evidence of intraperitoneal free air. 2. Unchanged small left pleural effusion." }, { "input": "Cardiomegaly is obscured by adjacent pleuro parenchymal abnormalities. Small bilateral effusions are grossly unchanged. Retrocardiac atelectasis has improved. Multifocal opacities in the right upper lung have mildly improved. Left perihilar opacities are unchanged. There is no pneumothorax. Component of vascular congestion has improved. Right pigtail catheter has been removed. Sternal wires are aligned", "output": "Improved in component of vascular congestion" }, { "input": "Portable upright chest radiograph ___ at 09:57 is submitted.", "output": "Status post median sternotomy with stable cardiac and mediastinal postoperative contours. Persistent layering small effusions, left greater than right. Retrocardiac consolidation favoring lower lobe atelectasis, although pneumonia or aspiration should also be considered. Probable mild perihilar edema. No pneumothorax." }, { "input": "Compared to the prior radiograph from ___, there is increasing opacification of the right upper lobe, and improvement in previously seen opacity in the left upper lobe. Additionally, there is new blunting of the right hemidiaphragm, which likely indicates a small right pleural effusion. Small left pleural effusion is also noted.", "output": "1. Interval improvement in appearance of left upper lobe, with increase in opacification of the right lung, concerning for ongoing/worsening infection on the right. 2. Small bilateral pleural effusions." }, { "input": "PA and lateral views of the chest provided. Midline sternotomy wires again noted. Diffuse bilateral pulmonary opacities are concerning for multifocal pneumonia. Superimposed edema difficult to exclude. Small bilateral pleural effusions are noted. No pneumothorax. Cardiomediastinal silhouette grossly unchanged. Bony structures intact.", "output": "Diffuse pulmonary opacities concerning for multifocal pneumonia, difficult to exclude edema. Tiny bilateral pleural effusions. Followup to resolution." }, { "input": "AP view of the chest provided. Since prior chest radiograph, a right-sided pigtail pleural catheter has been inserted. There is no pneumothorax. Extent of right pleural effusion has decreased slightly. Moderate left pleural effusion is unchanged. Heterogeneous right upper lobe opacities have improved since prior study. Degree of pulmonary edema has also improved. Heart size is smaller.", "output": "No pneumothorax." }, { "input": "Lungs are well inflated and clear. The cardiac silhouette is mildly enlarged. There is no pleural effusion or pneumothorax. Visualized upper abdomen is unremarkable. Median sternotomy wires and surgical clips project over the mediastinum. Surgical clips are also seen in the upper abdomen. Calcifications of the aortic arch is noted.", "output": "No evidence of acute cardiopulmonary process. Mild cardiomegaly." }, { "input": "PA and lateral views of the chest provided. There is increased pulmonary opacity in bilateral upper lungs, right worse than the left. Small bilateral pleural effusions are again seen. Cardiac and mediastinal structures are normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Sternotomy wires are noted.", "output": "Increasing bilateral upper lung opacities, right worse than left, suggestive of pneumonia." }, { "input": "As compared to the most recent prior chest radiograph, there has been no relevant interval change. Re-demonstrated is a diffuse infiltrative pulmonary process, in addition to moderate central pulmonary vascular congestion and pulmonary edema, that has slightly progressed. There is a small left pleural effusion and probable small right pleural effusion with adjacent atelectasis. The heart remains mildly enlarged. Median sternotomy wires are intact and well-aligned.", "output": "1. Progression of a diffuse infiltrative pulmonary process, largely unchanged from ___, with some increase in pulmonary edema perhaps. 2. Mild cardiomegaly, moderate pulmonary vascular congestion/edema, and small bilateral pleural effusion with adjacent atelectasis, also unchanged." }, { "input": "Compared with ___ 11:50, there is minimal , if any, interval change. Linear lucency seen along the medial right lung likely also represents a small component pneumothorax, newly seen on this study. Otherwise, the right apical component of the pneumothorax is unchanged. Catheter at the right lung base again noted.", "output": "As above.." }, { "input": "Overall, there has been interval improvement in the moderate pulmonary edema compared to the prior exam. There has also been interval improvement in the mild cardiomegaly. Small left pleural effusion is overall unchanged compared to the prior exam. Alignment of the sternal wires is stable. There is no evidence of a pneumothorax.", "output": "Interval improvement in the moderate pulmonary edema compared to the prior exam." }, { "input": "Compared to approximately 1.5 hr earlier, no gross interval change is detected. The right lung apex pneumothorax is again seen, similar to the prior study. A catheter at the right lung base is again noted. The right PICC line tip overlies the mid/ distal SVC, probably unchanged. Cardiomediastinal silhouette and diffuse opacities are also grossly unchanged.", "output": "Right apical pneumothorax is essentially unchanged." }, { "input": "Cardiac silhouette is borderline enlarged. There is no consolidation, pleural effusion, or pneumothorax. Mediastinal and hilar silhouettes are normal size.", "output": "No findings suggestive of tuberculosis. Borderline cardiomegaly." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The ET tube is unchanged. Compared to the prior study there has been a slight interval increase in the amount of vascular plethora and hazy alveolar infiltrate. There small bilateral effusions. There continues to be volume loss in the lower lung", "output": "Increased fluid overload." }, { "input": "As compared to chest radiograph from the same day, endotracheal tube is 2 cm from the carina. Increasing bibasilar opacities left greater than right . Small left pleural effusion. Mild pulmonary vascular congestion. No pneumothorax.", "output": "ETT in good position. Mild pulmonary vascular congestion. Worsening bibasilar opacities can be worsening atelectasis or aspiration." }, { "input": "The cardiomediastinal silhouette is stable. Again noted are bibasilar opacities, slightly progressed since the most recent examination, though improved since ___. Again noted is an endotracheal tube in adequate position. There is minimal pulmonary vascular congestion, not significantly changed since prior.", "output": "Persistent bibasilar opacities, concerning for aspiration, not significantly changed since priors." }, { "input": "Cardiac size is normal. The lungs are clear. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary abnormality" }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures appear within normal limits.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Multiple right and left apical focal opacities correlate with lung parenchymal scarring seen on ___ chest CT. Severe emphysematous changes are noted in bilateral mid lung regions. There are no visible micro or macro nodules within the lung parenchyma. The hilar, cardiomediastinal, and pleural surfaces are normal. There are no acute bony abnormalities nor fracture.", "output": "1. Biapical lung parenchymal scarring correlate with findings seen on ___ chest CT. However, please refer to ___ chest CT for further characterization of these apical findings. 2. At the limited resolution of plain radiograph, there are no lung parenchymal nor skeletal lesions concerning for metastasis disease. Please refer to ___ chest CT for better evaluation of metastatic lesions. 3. Severe emphysema." }, { "input": "Multiple right and left apical focal opacities are compatible with parenchymal scarring seen on the ___ CT chest exam. Severe emphysematous changes are seen in the lungs with flattening of the diaphragm. There is no focal consolidation, pulmonary edema, or pneumothorax. The cardiomediastinal, hilar, and pleural surfaces are unchanged. Compression deformities in the lower thoracic/upper lumbar vertebral bodies are unchanged.", "output": "Redemonstrated right and left apical parenchymal scarring, better seen on the prior CT Chest from ___. No focal consolidation identified." }, { "input": "Patient is slightly rotated to the left. The lungs appear clear. The cardiomediastinal silhouette is within normal limits. Hypertrophic changes seen in the spine without acute osseous abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear and the pulmonary vasculature is normal. No pleural effusion or pneumothorax is demonstrated. Endotracheal tube terminates approximately 7.1 cm from the carina. Orogastric tube tip courses below the left diaphragm, off the inferior borders of the film. Radiopaque markers are noted projecting over the midline lower thoracic spine, which may be the distal aspects of spinal catheters.", "output": "No acute cardiopulmonary abnormality. Standard positioning of the endotracheal and orogastric tubes." }, { "input": "As seen previously, there is complete opacification of the left lower lung. The left upper lung remains aerated. There is a stable left apical cap which represents loculated pleural fluid as seen on prior CT. The right lung is slightly hyperexpanded. A nodular opacity projecting over the right lower lung measures 11 mm and likely represents a nipple shadow. If there is clinical concern for mass, a repeat view should be obtained with nipple markers. Sclerotic bone lesions are better appreciated on prior CT.", "output": "1. Stable left lower lung opacification, with loculated left pleural effusion. 2. Nodular opacity overlying the right lower lung likely represents a nipple shadow, however if confirmation of this is needed, repeat views can be obtained with a nipple marker." }, { "input": "There is increased opacification of the left hemithorax. As seen previously, the left mid-to-lower hemithorax shows complete opacification with a large pleural effusion and net volume loss including leftward shift of mediastinal structures and elevation of the left hemidiaphragm. What is new on this examination is predominantly increased vague opacification of the residual aerated portion of the left upper lung. Since pulmonary markings can still be discerned through the veil-like opacity, the appearance is suspected predominantly reflect increasing pleural effusion along the major fissure, although it is difficult to completely exclude increasing atelectasis or consolidation. The right lung remains clear with compensatory hyperinflation. Bony metastases are not well visualized on this study for the most part, although a mid thoracic vertebral body appears largely sclerotic and potentially the degree of sclerosis has increased since the prior CT.", "output": "1. Increasing opacification of the left upper hemithorax, suspected to predominantly represent increasing pleural effusion, without other significant change in pulmonary findings. 2. Sclerotic mid thoracic vertebral body; although noting that metastases to the bones are mostly not well characterized, the possibility of increased bony metastatic disease since the prior CT should be considered." }, { "input": "Frontal and lateral views of the chest re-demonstrate a large left effusion with consolidated left lower lung, with stable leftward cardiomediastinal shift. The amount of aeration in the left upper lung is similar as compared to ___, but a previously seen small hydropneumothorax is further decreased in size. The right lung is well aerated. There is no new consolidation in the right lung. Numerous sclerotic metastatic lesions in the thoracic spine are better correlated with preceding CT dated ___.", "output": "1. Overall stable appearance of near-complete opacification of the left hemithorax with pleural effusion and volume loss. 2. Diminishing small left hydropneumothorax." }, { "input": "The lungs are grossly clear besides streaky left basilar opacity which is likely atelectasis. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified. Calcification again seen in the left upper quadrant is compatible with the splenic artery aneurysm seen on prior CT.", "output": "No acute cardiopulmonary process." }, { "input": "The ETT ends approximately 4 cm proximal to the carina. The NG tube is no longer seen. Mild pulmonary vascular engorgement, but no pulmonary edema. Stable cardiomegaly and mediastinal contours. No focal consolidation, pleural effusion, or pneumothorax.", "output": "1. ETT in standard position. 2. Mild pulmonary vascular congestion." }, { "input": "Cardiomediastinal silhouette, pulmonary vasculature, and aorta are within normal limits. There is no consolidation or pleural effusion. Imaged osseous structures are unremarkable.", "output": "No acute cardiopulmonary process. No consolidation or effusion. NOTIFICATION: The findings were discussed by Dr. ___ with ___ on the telephone on ___ at 9:26 AM, at the time of discovery." }, { "input": "The inspiratory lung volumes are appropriate. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The pulmonary vasculature is not engorged and there is no overt pulmonary edema. The cardiomediastinal and hilar contours are within normal limits. The trachea is midline. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Vague scattered opacities in the lungs are concerning for multifocal pneumonia. No large effusion or pneumothorax. Cardiomediastinal silhouette is stable. Mild hilar prominence may reflect prominence of hilar nodes. Bony structures are intact.", "output": "Scattered vague opacities concerning for multifocal pneumonia with hilar prominence likely due to prominent lymph nodes. Recommend followup to resolution." }, { "input": "The heart is at the upper limits of normal size. The mediastinal and hilar contours appear within normal limits. There are no pleural effusions or pneumothorax. The lungs appear clear. Mild degenerative changes are noted along the lower thoracic spine.", "output": "No evidence of acute disease." }, { "input": "Left subclavian central venous catheter tip terminates in the lower SVC. Cardiac, mediastinal and hilar contours are unchanged, with the heart size within normal limits. Pulmonary vasculature is normal. Linear opacities in the right mid and lower lung fields, as well as the left lung base likely reflect subsegmental atelectasis. No focal consolidation, pleural effusion or pneumothorax is identified. Previously demonstrated FDG avid right lower lobe pulmonary nodule is better assessed on the recent PET-CT. Clips are noted projecting over the right hemidiaphragm. There are no acute osseous abnormalities.", "output": "Subsegmental atelectasis in the lung bases and right mid lung field. No acute cardiopulmonary abnormality otherwise identified." }, { "input": "AP single view of the chest has been obtained with patient in upright position. The heart size is within normal limits. No typical configurational abnormality is identified. Unremarkable appearance of thoracic aorta. The pulmonary vasculature is not congested. No signs of pleural effusion as the lateral pleural sinuses are free. No acute infiltrates and no evidence of pneumothorax in the apical area. Skeletal structures of the thorax grossly unremarkable. Our records do not include a previous chest examination available for comparison.", "output": "Normal chest findings as identified on single AP chest view. No evidence of infiltrate." }, { "input": "Again seen is an abandoned ICD with leads ending in the right atrium, right ventricle and left ventricle. There is moderate cardiomegaly. The lungs are clear, the cardiomediastinal silhouette is otherwise normal. There is no change from ___.", "output": "Moderate cardiomegaly. No change from ___." }, { "input": "PA and lateral views of the chest. Transvenous pacemaker leads end in the right atrium, right ventricle, and coronary sinus. One of the leads is broken proximally. Aorta is calcified and tortuous but not dilated. Lungs are clear without consolidation. Heart, mediastinal and hilar contours are normal. No pleural effusion or pneumothorax. No evidence of pulmonary vascular engorgement or pulmonary edema. Mild cardiomegaly.", "output": "No evidence of volume overload." }, { "input": "There is moderate cardiomegaly but no pulmonary edema. There is severe dextroscoliosis of thoracic spine. The costophrenic angles are slightly blunted, unchanged from ___, likely due to fibrotic changes. There is no pneumothorax.", "output": "Moderate cardiomegaly but no pulmonary edema." }, { "input": "Since the radiographs obtained 2 days prior, there has been a significant decrease in the size of the right pleural effusion, though it is still at least moderate in size and tracks up the right mediastinal border. There is atelectasis of the inferior right upper lobe with hyperexpansion of the right middle lobe. No pneumothorax. Left lung is fully expanded and clear without focal consolidation or pleural effusion. Left cardiomediastinal and hilar silhouettes are normal.", "output": "Decreased, still large right pleural effusion, unchanged associated right lower lobe atelectasis. No pneumothorax." }, { "input": "There is a large right pleural effusion, which obscures the right heart border. There is no mediastinal shift indicating underlying associated atelectasis. The mediastinal silhouette and pulmonary vasculature are unremarkable. The left lung is clear. There is no pneumothorax.", "output": "Large right pleural effusion, increased since prior." }, { "input": "Moderate right-sided pleural effusion with adjacent atelectasis has not significantly changed for differences in technique. The left lung remains clear. The cardiac silhouette is not enlarged. No pneumothorax.", "output": "Stable appearance of the moderate pleural effusion." }, { "input": "Small right pneumothorax is stable. Swan-Ganz catheter tip is in the proximal main pulmonary artery There is persistent widening of the mediastinum. No other interval changes.", "output": "Stable right pneumothorax. Persistent postoperative widening of the mediastinum" }, { "input": "The right pleural effusion is smaller than on the earlier studies. There is no pneumothorax CHF or new consolidation.", "output": "There is decrease in the right pleural effusion as compared to earlier studies. There is no significant new findings." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The left pulmonary vasculature is normal. There is a large right pleural effusion with complete atelectasis of the right middle and lower lobes. No pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Large right pleural effusion with adjacent RML/RLL atelectasis, which appears unchanged from prior chest radiograph." }, { "input": "Since ___, mild pulmonary vascular congestion, interstitial edema, and small to moderate right pleural effusion is improved, however, right lower lung atelectasis is increased. The NG tube has been removed. Small right apical pneumothorax persists. The heart size is unchanged.", "output": "1. Mild pulmonary vascular congestion, interstitial edema, small to moderate right pleural effusions are improved, and right lower lung atelectasis is increased since ___. 2. Persistence of small right apical pneumothorax." }, { "input": "Since the most recent prior study, there has been interval increase in the right pleural effusion, now large, with resultant atelectasis in the right lung. The left lung is unremarkable, and there is no left pleural effusion. There is no pneumothorax. The visualized cardiomediastinal contours are stable, with the right cardiac and lower mediastinal contours obscured by the large effusion. A new lucency projecting over the right upper mediastinum is concerning for a distended esophagus.The upper abdomen is unremarkable in appearance.", "output": "1. Interval increase in right pleural effusion, now large. 2. Esophageal distention, new." }, { "input": "There is a large right pleural effusion which is increased compared to the prior study. The left lung is clear. No left pleural effusion is seen. The right-sided cardiac and mediastinal silhouettes are difficult accurately assess due to the large pleural effusion, but the left cardiac silhouette and left-sided mediastinal contours are unremarkable.", "output": "Large right pleural effusion, increased since the prior study." }, { "input": "There is a moderate left pleural effusion. There is increased density in the retrocardiac area consistent with partial atelectasis or consolidation. The right lung is clear. The right costophrenic sulcus is blunted. Mediastinal structures are unremarkable. The bony thorax is grossly intact", "output": "Left pleural effusion. Atelectasis or consolidation in the left lower lobe." }, { "input": "The lungs are symmetrically well expanded and well aerated. No focal consolidation concerning for pneumonia, pleural effusion, or pneumothorax is detected. Biapical pleural thickening is noted on the left greater than right. The pulmonary vasculature is not engorged. The cardiac silhouette is normal in size. The mediastinal and hilar contours are within normal limits. The trachea is midline. The visualized upper abdomen demonstrates no free air beneath the right hemidiaphragm.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Lungs appear clear though volumes are somewhat low. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest. Relatively low lung volumes are seen. The lungs remain clear of consolidation, effusion or pulmonary vascular congestion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. Lung volumes are somewhat low. No convincing signs of pneumonia or CHF. A vague rounded opacity projects over the left lung base for which CT is recommended on a non-emergent basis to further assess. This opacity is only seen on the frontal projection and may represent superimposed shadows, though difficult to exclude a true pulmonary nodule. No pneumothorax or effusion. Cardiomediastinal silhouette appears normal. Bony structures are intact.", "output": "Nodular opacity in the left lower lung for which non-emergent CT is recommended to further assess." }, { "input": "There has been interval placement of a left-sided chest catheter with only minimal reexpansion of the left lung. The previously noted flattening of the left hemidiaphragm is no longer seen. Right lung remains clear. Cardiac and mediastinal silhouettes are unremarkable.", "output": "Interval placement of left-sided chest catheter with only minimal to no significant change in large left-sided pneumothorax. Previously noted flattening of the left hemidiaphragm is no longer seen." }, { "input": "PA and lateral chest radiographs again demonstrate left apical pneumothorax. It now measures 13 mm in width compared to 10 mm at 9:01 a.m. The lungs are clear. Cardiomediastinal silhouette is normal. There is no pleural effusion. There is no mediastinal shift.", "output": "Slight increase in size of left apical pneumothorax, now measuring 13 mm. Findings were discussed by Dr. ___ with Dr. ___ by phone at 2:55 p.m. on ___ at the time of interpretation." }, { "input": "PA and lateral radiograph demonstrates unremarkable mediastinal, hilar and cardiac contours. Lungs are clear. No pneumothorax evident. Minimal though less apparent left hemidiaphragm elevation again noted. Minimal blunting of the costophrenic angle is likely related to atelectasis and scarring.", "output": "No significant change." }, { "input": "Frontal and lateral views of the chest were obtained. There is a large left pneumothorax. While there is no shift of mediastinal structures, there is apparent flattening of the left hemidiaphragm and possible minimal widening of the left rib interspaces, which can be seen in tension. The right lung is clear; no pleural effusion or pneumothorax is seen. Cardiac silhouette is not enlarged. Mediastinal contours are unremarkable.", "output": "Large left pneumothorax. While no shift of the mediastinum, flattening of the left hemidiaphragm is seen and a tension component cannot be excluded. The above findings were detected at 8:14 p.m. on ___ at which point a page was placed to Dr. ___, awaiting callback at time of this dictation. Findings were discussed ___ Dr. ___, ___ taking care of the patient, on ___ at 8:25PM via telephone." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Comparison is made with the next preceding similar study of ___. The heart size is normal. No configurational abnormality is seen. Since the next preceding examination, the left-sided chest tube that terminated in the apical area has been withdrawn. No pneumothorax has developed. The previously identified minimal or residual pneumothorax in left apical area cannot be identified anymore. No new abnormalities seen. No chest wall emphysema.", "output": "Normalization of chest findings status post VATS decortication." }, { "input": "There is a small pneumothorax at the left apex. It measures 9 mm at its widest margin. The lungs are well expanded. The heart appears normal in size and configuration. Cardiomediastinal contours are unremarkable. The lungs are clear with no evidence of focal infiltrates. No pleural effusions. Bony structures are intact.", "output": "Small,9-mm, pneumothorax is seen at the left apex. NOTE: Dr. ___ was contacted by Dr. ___ at 9:45 a.m. on ___ via telephone at the time of discovery." }, { "input": "PA and lateral radiographs of the chest once again depict surgical chain sutures in the left upper lobe in unchanged position. The lungs are clear, and the hilar and cardiomediastinal contours are normal. There is no pneumothorax or pleural effusion, and the pulmonary vascularity is normal.", "output": "No evidence of pneumothorax or interval change." }, { "input": "Single AP upright portable view of the chest was obtained. A left-sided chest catheter is seen extending into the lateral left upper hemithorax. As compared to the prior study, there has been significant reexpansion of the left lung with a trace residual left apical pneumothorax remaining. There is minimal elevation of the left hemidiaphragm and left base atelectasis. Right lung is clear.", "output": "Interval expansion of the left lung with significant reduction in pneumothorax with only trace left apical pneumothorax remaining." }, { "input": "Lung volumes are stable. Stable moderate cardiomegaly. Mediastinal and hilar contours are stable. The pleural surfaces are normal. No pneumothorax. The left pacemaker is intact with leads terminating in the appropriate positions.", "output": "Stable moderate cardiomegaly without pulmonary venous congestion. No acute cardiopulmonary process." }, { "input": "Left-sided AICD is demonstrated with leads terminating in the regions of the right atrium and ventricle, unchanged. Mild to moderate cardiomegaly is similar. Mediastinal and hilar contours unchanged. There is mild upper zone vascular redistribution compatible with mild pulmonary vascular congestion. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Moderate cardiomegaly with mild pulmonary vascular congestion." }, { "input": "There is marked enlargement of the cardiac silhouette, unchanged. A left chest wall dual lead AICD is present. No focal consolidation, pleural effusion or pneumothorax identified. Mild pulmonary vascular congestion without evidence of pulmonary edema.", "output": "Mild pulmonary vascular congestion without evidence of overt pulmonary edema." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. There moderate cardiomegaly. The pacer is seen in adequate position.", "output": "No acute cardiopulmonary process. Moderate cardiomegaly." }, { "input": "PA and lateral views of the chest provided. Left chest wall pacer device is seen with leads extending into the region of the right atrium and right ventricle. The heart is mildly enlarged. The mediastinal contour is normal. Lungs are clear without focal consolidation, large effusion or pneumothorax. No signs of congestion or edema. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Top normal heart size with pacemaker in place." }, { "input": "Normal heart size, mediastinal and hilar contours. No focal consolidation, pleural effusion or pneumothorax. No displaced rib fracture.", "output": "Normal chest radiograph" }, { "input": "The heart is mildly enlarged. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. The bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "Heart size is normal. Mediastinal and hilar contours are within normal limits. The pulmonary vasculature is normal. Lungs are clear. No focal consolidation, pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Normal chest radiograph." }, { "input": "Moderate cardiomegaly with tortuosity of the thoracic aorta is unchanged from prior study. Hilar contours are unremarkable. Right lung base atelectasis and small right greater than left pleural effusion is improved compared to prior study. The lungs are hyperinflated with relatively lucent lung fields, compatible with emphysema. Lungs are otherwise clear. There is no pneumothorax.", "output": "1. Improving right lung base atelectasis with small bilateral right greater than left effusions. 2. Severe emphysema." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs remain hyperinflated, flattening of the diaphragms with an increased AP diameter consistent with chronic obstructive pulmonary disease. The cardiac silhouette remains mildly enlarged. Left apical calcification seen. Bibasilar chronic atelectasis/scarring. No new focal consolidation is seen. There is no pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are stable. Multiple compression deformities in the thoracic spine are again seen, grossly stable, but not well evaluated on this study.", "output": "No definite acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were obtained demonstrating no signs of pneumonia or CHF. No pleural effusion or pneumothorax is seen. Cardiomediastinal silhouette is stable with an unfolded thoracic aorta containing scattered atherosclerotic calcifications. Clips in the right upper quadrant noted. Bony structures appear intact.", "output": "No signs of pneumonia or other acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac silhouette is mildly enlarged. The aorta is tortuous.", "output": "Cardiomegaly. No focal consolidation to suggest pneumonia." }, { "input": "The ET tube terminates approximately 5.7 cm above the carina. There is an enteric tube which extends to the distal esophagus and must be advanced. There is mild bibasilar atelectasis. There may be a small left pleural effusion. No focal consolidations concerning for pneumonia identified. There is no pneumothorax. Deformities of the clavicles bilaterally are likely secondary to old, healed clavicular fractures.", "output": "1. ET tube terminates approximately 5.7 cm above the carina. Mild bibasilar atelectasis. 2. Enteric tube terminates in the distal esophagus and must be advanced." }, { "input": "Chest PA and lateral radiograph demonstrates unremarkable mediastinal and hilar contours. The flattened contour of the AP window indicate possible pulmonary artery or lymph node enlargement. Heart size is top normal. Mild pulmonary vascular congestion. No pleural effusion or pneumothorax evident.", "output": "Fullness in AP window due to enlarged main pulmonary artery or lymph node enlargement. Recommend comparison to prior studies. Mild vascular congestion." }, { "input": "Cardiac silhouette is enlarged but stable in size. Prominence of the central pulmonary arteries is suggestive of pulmonary arterial hypertension with increased size of pulmonary artery evident on prior CT of ___. Lungs and pleural surfaces are clear, and there are no acute skeletal findings.", "output": "No evidence of pneumonia." }, { "input": "As compared to ___, market cardiomegaly is again demonstrated accompanied by pulmonary vascular congestion. Severity of interstitial edema has decreased, and bilateral pleural effusions are no longer evident, although a small amount of fluid is present in the fissures.", "output": "Cardiomegaly and congestive heart failure, with less severe interstitial edema compared to ___." }, { "input": "The heart is enlarged, probably to a similar degree allowing for decrease in lung volumes. On this study, the main pulmonary artery contour appears larger, which could be seen with fluid overload. Multifocal opacities are seen in the context of a generalized moderate interstitial abnormality. Findings suggest pulmonary edema. Mild atelectasis is also suspected at the posterior left lung base. There are probably very small pleural effusions.", "output": "Findings most consistent with pulmonary edema. Follow-up radiographs may be helpful, however, to reassess." }, { "input": "Moderate cardiomegaly is again noted. Increased interstitial markings are seen throughout the lungs. There is no confluent consolidation or effusion. There is no acute osseous abnormality.", "output": "Cardiomegaly and interstitial edema." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. Right hemidiaphragm is mildly elevated, of uncertain chronicity No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No evidence of pneumonia. Elevated right hemidiaphragm of uncertain chronicity." }, { "input": "Heart size is normal. Symmetric mild widening of the superior mediastinum without tracheal deviation may be due to mediastinal fat or enlarged thyroid gland. The mediastinal and hilar contours are otherwise unremarkable. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Mild loss of height of a mid thoracic vertebral body is of indeterminate age. For mild degenerative changes seen in the thoracic spine.", "output": "No acute cardiopulmonary abnormality. Mild widening of the superior mediastinum which could be due to mediastinal fat or enlarged thyroid gland, and clinical correlation is recommended." }, { "input": "Interstitial opacities in the right lower lung unchanged since ___ and in right mid lung which are new is concerning for interstitial pneumonia. Mild atelectasis is present in the left lung base. Heart size, mediastinal and hilar contours are normal.", "output": "Interstitial pneumonia in right mid and lower lung." }, { "input": "PA and lateral views of the chest. Previously seen pneumonia in the right lower and mid lung are no longer apparent. The lungs are clear. The cardiac, mediastinal, and hilar contours are normal. There is no pleural effusion or pneumothorax. There is no pulmonary vascular congestion.", "output": "Resolution of previously seen pneumonia. No new consolidations." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is detected. Heart and mediastinal contours are within normal limits.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "The lungs are now clear aside from minimal atelectasis at the left lung base. There is no effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "A portable frontal chest radiograph demonstrates a normal cardiomediastinal silhouette and moderately well-aerated lungs which are without focal consolidation. Although patient positioning is suboptimal further evaluation pneumothorax or pleural effusion, neither is appreciated on this exam. The visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is a new left-sided pigtail catheter. There is a small left pneumothorax, smaller compared to the study from the prior day. The vasculature is slightly more prominent than on the prior study but there is no overt failure", "output": "New pigtail with smaller left pneumothorax" }, { "input": "Frontal lateral views of the chest demonstrates a left-sided chest tube with left pleural effusion that is best visualized apical a. There is a small left effusion that is increased in size.", "output": "Left apical pneumothorax with chest tube in place." }, { "input": "Frontal and lateral views of the chest were obtained. No enteric tube is seen on the current study. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No overt pulmonary edema is seen. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process. No enteric tube seen." }, { "input": "A nasogastric tube courses into the stomach. The cardiac, mediastinal, and hilar contours appear stable. There is mild relative elevation of the right hemidiaphragm. No pleural effusion or pneumothorax is identified. Streaky left basilar opacity suggests minor atelectasis. However, an entirely new focal opacity projecting over the right mid lung raises suspicion for pneumonia. There is no free air.", "output": "1. No free air identified. 2. New focal right mid lung opacity, concerning for pneumonia in the appropriate clinical setting. Correlation with clinical presentation is suggested. Short-term followup radiographs are also suggested to reassess." }, { "input": "The Dobbhoff tube is in the stomach with its tip curved on itself, pointing upwards. The lungs are clear. Cardiac and mediastinal silhouettes are normal", "output": "Dobbhoff tube in stomach." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Persistent homogeneous band-like area of opacification in right upper lobe anteriorly adjacent to a slightly elevated minor fissure. A similar but smaller opacity was evident on a more remote radiograph of ___ and also on ___. The appearance favors focal atelectasis over an infectious pneumonia, and may be accompanied by a small amount of fluid within the adjacent elevated fissure. Lungs are otherwise remarkable for hyperinflation and nonspecific linear scarring at the right base. Small pleural effusions versus pleural thickening are present at the posterior costophrenic angles. Heart size is normal. Aorta is diffusely tortuous without change. Bones are diffusely demineralized.", "output": "1. Persistent focal right perifissural opacity favoring an area of atelectasis over infectious pneumonia. 2. Hyperinflation of the lungs in keeping with previously provided history of COPD." }, { "input": "PA and lateral views of the chest were obtained and compared with a prior study from ___. Lungs are hyperinflated. An opacity is seen in the right upper lobe abutting the minor fissure which could represent a pneumonic consolidation and/or atelectasis. There is no large pleural effusion or pneumothorax. The cardiomediastinal silhouette appears grossly stable with an unfolded thoracic aorta. Bony structures appear intact. No displaced rib fractures are seen. Old right mid rib cage deformity is unchanged.", "output": "Focal consolidation in the right upper lobe abutting the minor fissure, may represent pneumonia or atelectasis. Otherwise, no acute findings." }, { "input": "The ET tube terminates approximately 2.5 cm above the carina. There is an enteric tube which extends below the diaphragm with the tip in the proximal stomach; however, with the side port at the gastroesophageal junction, and must be advanced. The heart size is normal. The aorta appears to be tortuous. Apparent shift of the mediastinal structures to the right may be rotational; however, there is also a component of volume loss in the right lung, with evidence of atelectasis and asymmetric elevation of the right hemidiaphragm. There is an area of increased lucency at the right lung base below the minor fissure, which could be secondary to a large bulla given patient's history of COPD or a loculated pneumothorax. The left lung appears to be clear. At the upper right lung there is a nodular opacity measuring 1.1 cm x 1.1 cm. Linear fibrotic opacities at the medial right lung base is consistent with scarring.", "output": "1. ET tube terminates appropriately above the carina of approximately 2.5 cm. 2. Nodular opacity in the upper right lung measures 1.1 cm x 1.1 cm unclear whether artifactual and possibly external to the patient or a true nodule; close attention on followup imaging is recommended, given concern for malignancy. 3. Area of hyperlucency at the right lung base may be secondary to a bulla given patient's history of COPD or a loculated pneumothorax. This is of indeterminate chronicity given absence of priors. 4. Enteric tube appears to terminate at the proximal stomach; however, the side port is in the distal esophagus, and should be advanced so that it is well within the stomach. ___ were d/w Dr. ___ at 6:___p on the day of the exam by phone by Dr. ___ ___." }, { "input": "There has been interval placement of a left internal jugular central venous catheter, terminating in the proximal SVC/SVC brachiocephalic junction, without new pneumothorax seen. The left lung is hyperinflated and relatively lucent, likely due to underlying COPD. There is a large lucency projecting over the right mid-to-lower lung which may represent a large bleb, underlying loculated pneumothorax is not excluded. Opacity at the right upper lung is again seen, which may be due to some volume loss, underlying aspiration, infection not excluded. Previously noted nodular opacity projecting over the right upper lung is no longer appreciated. No priors available for comparison. There is scarring and evidence of some volume loss on the right with some shift of the mediastinum to the right, correlate with history of prior procedure to the right hemithorax/lung. Endotracheal tube is approximately 2.5 cm at the level of the carina. The nasogastric tube is similar in appearance, with side port at the GE junction/distal esophagus and in the very proximal stomach. As suggested previously, recommend advancement so that it is well within the stomach. Cardiac and mediastinal silhouettes are similar.", "output": "Interval placement of left internal jugular catheter terminating at the SVC/brachiocephalic junction/proximal SVC without evidence of new pneumothorax. Previously noted nodular opacity projecting over the right upper lung is no longer appreciated. Otherwise, the remainder of the lung fields is similar, see above." }, { "input": "A left internal jugular central venous catheter ends in the mid SVC, unchanged. The lungs remain hyperinflation. Right mid to upper lung aeration has slightly improved. There is persistent mild bibasilar atelectasis as well as unchanged small bilateral pleural effusions. The cardiac and mediastinal contours are unchanged. Enlargement of the hila likely relates to dilation of the pulmonary arteries, similar to the prior study. There is no pneumothorax.", "output": "1. Improved right mid to upper lung aeration. 2. Small bilateral pleural effusions, unchanged. 3. Hilar enlargement is likely due to dilation of the pulmonary arteries." }, { "input": "Portable AP semi-erect chest radiograph ___ at 08:37", "output": "Left internal jugular Swan-Ganz catheter has its tip in the right pulmonary artery. Nasogastric tube is seen coursing below the diaphragm with the tip not identified. Endotracheal tube has its tip at the thoracic inlet. The distal and of a right PICC line is seen overlying the right axillary region. There continue be layering moderate bilateral pleural effusions with collapse of the left lower lobe and partial collapse of the right lower lobe. Interval improvement in the pulmonary edema. Overall cardiac and mediastinal contours are stable." }, { "input": "Portable semi supine chest radiograph ___ at 08:41 is submitted.", "output": "There are bilateral moderate to large layering pleural effusions which limit evaluation of the underlying lung parenchyma. However, there is a suggestion that there may be mild pulmonary edema. Retrocardiac consolidation likely reflects lower lobe collapse. No obvious pneumothorax, although the sensitivity to detect pneumothorax is diminished given semi-supine technique. Endotracheal tube, left internal jugular Swan-Ganz catheter, and nasogastric tube are unchanged in position, although the tip of the nasogastric tube is not included on the study." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. Again seen is right lower lobe opacity medially. Although somewhat improved from prior, there has been no intervening x-ray documenting resolution. This could be due to scarring, post-treatment changes; however, superimposed infection is not excluded. Elsewhere, the lungs are clear. There is no significant pleural effusion. The cardiomediastinal silhouette is stable. Vertically oriented surgical chain sutures again noted. Right chest wall port is no longer seen. Osseous and soft tissue structures are unremarkable. The patient is status post gastric pull-up.", "output": "Persistent right basilar, medial opacity, potentially due to scarring, post-treatment in nature; however, given acute symptoms superimposed infection is not excluded." }, { "input": "There is a subtle opacity in the left lung base which may represent a developing consolidation. The right lung is clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax. There is no free air under the diaphragm.", "output": "Subtle opacity at the left lung base which could represent a developing consolidation in the appropriate clinical setting. No free air under the diaphragm." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Lungs are clear and the pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Cardiomegaly is unchanged. There is increased retrocardiac opacity concerning for pneumonia. There is a small left pleural effusion. Right lung is clear. Mediastinal contour is grossly unremarkable. Bony structures are intact.", "output": "Retrocardiac opacity concerning for pneumonia with small left pleural effusion, new from prior. Mild cardiomegaly unchanged." }, { "input": "Since the earlier same day chest radiograph, new bilateral chest tubes have been placed, moderate left pleural effusion is improved, and small right pleural effusion is unchanged. A tiny right pneumothorax may be present but is not clearly seen. No left pneumothorax. Small pericardial effusion is unchanged with persistence of substantial cardiomegaly.", "output": "1. Moderate left pleural effusion is improved, small right pleural effusion is unchanged, and a tiny right pneumothorax may be present following placement of bilateral chest tubes earlier today." }, { "input": "The lungs are hypoinflated with crowding of vasculature. Persistent retrocardiac opacity is unchanged over multiple examinations and consistent with known hiatal hernia. No pleural effusion or pneumothorax. There is persistent mild cardiomegaly, likely accentuated due to low lung volumes. Mediastinal contour and hila are unremarkable.", "output": "1. Hypoinflated lungs. 2. Retrocardiac opacity is consistent with hiatal hernia. 3. Stable mild cardiomegaly." }, { "input": "Since ___, previously moderate bibasilar and retrocardiac atelectasis is minimally improved, and small to moderate bilateral pleural effusions, left greater than right, are unchanged. Lung volumes remain low. Moderate cardiomegaly is unchanged. No pneumothorax or pulmonary edema.", "output": "Previously moderate bibasilar retrocardiac atelectasis is minimally improved, and small to moderate bilateral pleural effusions, left greater than right, are unchanged since ___." }, { "input": "PA and lateral views of the chest provided. Lung volumes are low limiting assessment. Bibasilar opacities are noted which could represent atelectasis and/or pneumonia. Opacity at the right lung base appears slightly progressed from the prior radiograph. There is blunting of the right CP angle likely reflecting a small pleural effusion. The cardiomediastinal silhouette is stable. No pneumothorax. Crowding of bronchovascular markings at the perihilar region limits evaluation for congestion. No overt edema. Bony structures are intact.", "output": "Low lung volumes with bibasilar opacities likely reflecting atelectasis and/or pneumonia. Small right pleural effusion." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unchanged with a moderate size hiatal hernia again noted. Pulmonary vasculature is normal. A small right pleural effusion is decreased in size from the prior examination. Lungs are otherwise clear. No pneumothorax is identified.", "output": "Trace right pleural effusion, decreased from the prior study." }, { "input": "PA and lateral views of the chest provided. Retrocardiac opacity consistent with small hiatal hernia. Platelike left basal atelectasis noted. No signs of pneumonia or edema. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is unchanged. Bony structures are intact.", "output": "Small hiatal hernia again noted. Otherwise unremarkable." }, { "input": "Lung volumes are low. Heart size is normal. Mediastinal and hilar contours are unchanged with a moderate-sized hiatal hernia re- demonstrated. The pulmonary vasculature is not engorged. A trace left pleural effusion is noted with blunting of the posterior costophrenic sulcus on the lateral view. Lungs are otherwise clear. Mild degenerative changes are noted in the thoracic spine.", "output": "Trace left pleural effusion. No radiographic evidence for pneumonia. Moderate size hiatal hernia." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The heart is somewhat smaller in size compared to ___, though still mildly enlarged. Moderate left pleural effusion is larger. Small right effusion has improved. Lung volumes remain low. There is a homogeneous area of opacification within the left lower lobe, likely atelectasis. No pneumothorax or pulmonary edema.", "output": "Previously moderate left pleural effusion is larger and small right effusion has improved. Homogeneous area of opacification of the left lower lobe, likely atelectasis. Heart size is mildly enlarged, though smaller compared to ___." }, { "input": "Low lung volumes results in crowding of the bronchovascular structures. There is no evidence of focal consolidation, pleural effusion, pneumothorax, or frank pulmonary edema. The cardiomediastinal silhouette is stable. Moderate-sized hiatal hernia is unchanged.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Low lung volumes cause bronchovascular crowding. Allowing for this, there is no significant pulmonary vascular congestion or pulmonary edema. There is no pleural effusion, focal consolidation, or pneumothorax. The cardiomediastinal silhouette is stable. A moderate hiatal hernia is unchanged from multiple prior studies. The osseous structures and upper abdomen are unremarkable.", "output": "Low lung volumes causing bronchovascular crowding. No acute cardiopulmonary process." }, { "input": "The lung volumes are low; however, no focal consolidations concerning for infection are identified. There is no pleural effusion or pneumothorax. The heart size is normal. The hilar and mediastinal contours are unremarkable. There is a small hiatal hernia.", "output": "No evidence of pneumonia." }, { "input": "PA and lateral views of the chest provided. Bibasilar atelectasis persists. Tiny effusions difficult to exclude. Cardiomediastinal silhouette stable. No pneumothorax. Bony structures appear intact.", "output": "Bibasilar atelectasis unchanged with small bilateral pleural effusions." }, { "input": "The cardiomediastinal and hilar contours are unchanged. Small bilateral pleural effusions are similar in size to the prior chest radiograph on ___. Bibasilar opacities, greater on the left, appear minimally increased which may reflect atelectasis or infection. Of note there is engorgement of the azygos vein, increased from the prior examination. No pneumothorax.", "output": "Small left bilateral pleural effusion is not significantly increased from ___. Right-sided effusion may be minimally increased. Bibasilar opacities, greater on the left may reflect compressive atelectasis or infection in the appropriate setting. New engorgement of the azygos vein could reflect elevated pulmonary venous pressure or tamponade phenomenon." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. The moderate hiatal hernia is again nseen, otherwise the cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process. Hiatal hernia." }, { "input": "Frontal and lateral chest radiographs were obtained. Aside from the previously noted hiatal hernia and minimal venous engorgement, the cardiomediastinal silhouette is normal. Low lung volumes results in vascular crowding, but the lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No evidence of pneumonia." }, { "input": "Since ___, bilateral chest tubes have been removed. A tiny right apical pneumothorax is seen. No pneumothorax is seen on the left. The lung volumes remain low. Small bilateral pleural effusions, right greater than left, with some adjacent atelectasis are again seen. The heart size is unchanged.", "output": "1. Bilateral chest tubes have been removed. Tiny right apical pneumothorax is noted. 2. Note is made of small bilateral pleural effusions, right greater than left, with adjacent atelectasis." }, { "input": "Single AP upright portable view of the chest was obtained. The questionable finding of pneumothorax on the prior study is no longer appreciated and was likely due to artifact/possible skin fold. No definite pneumothorax is seen on the current study. Bilateral mid to lower lung opacities are again seen without significant interval change. There are possible trace bilateral pleural effusions. The cardiac and mediastinal silhouettes are stable.", "output": "No definite evidence of pneumothorax on the current study; finding on the prior study was likely artifactual. Persistent bilateral pulmonary opacities and possible small bilateral pleural effusions." }, { "input": "AP upright portable chest radiograph is obtained. There is persistent airspace opacity involving the mid and lower lungs bilaterally concerning for pneumonia. A component of pulmonary edema is difficult to exclude. Upper lungs are somewhat lucent which reflects known severe emphysema as seen on a prior CT from ___. No large pleural effusions are seen. Cardiomediastinal silhouette appears stable. There are prominent atherosclerotic calcifications along the course of the thoracic aorta. No pneumothorax. Bones appear intact. IVC filter is noted in the upper abdomen.", "output": "Emphysema with persistent airspace opacities involving the mid and lower lungs concerning for pneumonia with possible component of pulmonary edema." }, { "input": "Similar to multiple prior examinations, there is a superimposed accentuation of the prominent interstitial markings, presumably due to underlying interstitial lung disease. There is relative sparing of both lung apices, right more prominent than the left; however, this may be partially due to underlying emphysematous blebs. The patient's chin overlies portions of the apices. There is calcified atheromatous plaque at the arch. A large calcified lymph node is noted in the aorticopulmonary window. The cardiac silhouette is enlarged, but stable. There is a right pleural effusion, which results presumably in the blunting of the right costophrenic angle and fluid tracking within the right minor fissure. No left effusion is noted. There is no pneumothorax. Degenerative changes are seen throughout the thoracic spine.", "output": "Patchy opacities predominantly in the right lower lung and in the left mid and lower lung zones. The pattern mimics that seen on prior radiographs with slightly more confluent opacity on the current study. This may be due to asymmetric distribution of edema due to underlying emphysema or possibly multifocal pneumonia. Correlate clinically. Consider diuresis and short interval followup radiographs to help discriminate the two." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "Normal chest x-ray." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are well inflated and clear. No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable.", "output": "No acute cardiopulmonary process. Specifically, no pneumonia." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for pneumonia. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No acute intrathoracic abnormalities identified." }, { "input": "PA and lateral views of the chest were reviewed. The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. The lungs are well expanded. Crescentic scar projecting over the right hilus is again seen. Pulmonary vasculature is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion pneumothorax. The lungs are well-expanded clear without focal consolidation concerning for pneumonia. Pulmonary vasculature is within normal limits. The upper abdomen is unremarkable. Multiple wedge deformities in mid thoracic spine are again seen.", "output": "No acute cardiopulmonary process." }, { "input": "There is some mild improvement with decreased central vascular engorgement and slight decrease in cardiac silhouette. There is a small left pleural effusion and mild pulmonary vascular redistribution.", "output": "Changing appearance of mild CHF." }, { "input": "There are trace bilateral pleural effusions, improved from ___. There is no focal opacity, pulmonary edema or pneumothorax seen. The cardiac and mediastinal contours are normal. Radiopaque density in the right upper quadrant is likely secondary to prior chemoembolization.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is seen. There is mild lateral pleural thickening along the left base. There are mild degenerative changes in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are normally expanded and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart is top normal in size. The mediastinal and hilar contours are within normal limits. No focal consolidation, pleural effusion or pneumothorax is identified.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs are clear. The cardiomediastinal silhouette is normal. Osseous structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is mildly enlarged. The aorta is tortuous. Pulmonary vasculature is not engorged. Focal streaky opacities seen within the right hilar region as well as patchy opacities in the lung bases, more pronounced on the right. There is a small right pleural effusion. No pneumothorax is clearly evident. Extensive degenerative changes are noted involving both glenohumeral joints, more pronounced on the right.", "output": "Streaky right upper lobe opacity may reflect an area of infection or aspiration. Patchy bibasilar airspace opacities could reflect areas of atelectasis, though additional areas of infection or aspiration cannot be excluded. RECOMMENDATION(S): Follow-up imaging with radiographs are recommended and if there is persistence of these findings after treatment, CT is suggested." }, { "input": "Tracheostomy tip is 4 cm below the carina and is in appropriate position. NG tube extends into the proximal stomach. No interval change in moderate pulmonary edema with both interstitial and alveolar components, small bilateral pleural effusions, top normal heart size and mediastinal vein dilatation. Interval increase in heterogeneous opacity in the right lower lobe. No pneumothorax. Mediastinal and hilar contours are normal.", "output": "1. Evolving right lower lobe pneumonia suggestive of aspiration pneumonia. 2. End of NG tube is in proximal stomach. Consider advancing 3 to 5 cm to prevent additional risk of aspiration. Multiple attempts were made to contact referring physcian by Dr.___ on ___." }, { "input": "All the monitoring and supporting devices are unchanged and in standard position. As compared to prior chest x-ray, there is progression of the bilateral lung calcification. More evident on the left lung for severe and diffuse non-volume-dependent pulmonary edema. Heart size is not fully assessable for severe pulmonary edema, but is comparable to prior chest x-ray. There is probably a new bilateral pleural effusion along with atelectasis. There is no pneumothorax.", "output": "Progression of the pulmonary edema. It appears more severe, especially in the left lung. New bibasilar pleural effusion and atelectasis." }, { "input": "ET tube is 2 cm above the level of the carina and is in appropriate position. Right IJ tip is in low SVC and interval placement of left pigtail catheter projecting over the left lower lobe. Mild decrease in left pleural effusion size with no change in small right pleural effusion. Unchanged severe pulmonary edema with both an interstitial and alveolar components. No pneumothorax or new focal opacity. Mild heart enlargement with mediastinal vein dilatation. No bony abnormality.", "output": "1. No change in severe pulmonary edema. 2. Mild interval decrease in left pleural effusion status post placement of left pigtail catheter. 3. No change in small right pleural effusion." }, { "input": "The lungs are well-expanded and clear. Note is made of mild pulmonary vascular congestion, without frank edema. The previously described right upper lobe consolidation has resolved. The heart remains enlarged. The aorta is tortuous. There is no pneumothorax, pleural effusion, or consolidation. Again seen are severe degenerative changes in the bilateral shoulders, right greater than left.", "output": "1. Mild pulmonary vascular congestion. 2. No pneumonia. NOTIFICATION: Updated impression was discussed ___ ___ by Dr. ___ ___ telephone at 07:48 on ___, approximately ___ min after discovery." }, { "input": "A single frontal semi-supine view of the abdomen demonstrates an orogastric tube with the tip terminating in the stomach and the last side port at the level of the GE junction. There is a normal bowel gas pattern without evidence of ileus or obstruction. There are metallic density sugical ___ seen longitudinally traversing the midline. There is hazy opacification of visualized portion of the bilateral lungs. A central venous catheter is seen with the tip terminating in the proximal SVC, recommend correlation with dedicated chest radiograph.", "output": "Orogastric tube seen with tip terminating in the stomach and last side port at the level of the GE junction. Recommend advancement of tube by 4cm." }, { "input": "There has been no significant interval change to the appearance of the chest with mild pulmonary vascular congestion. No focal consolidation is identified. The cardiomediastinal silhouette and hilar contours are stable. There is no pleural effusion or pneumothorax. Severe degenerative changes are present at the bilateral shoulders, right greater than left.", "output": "Mild pulmonary vascular congestion. No pneumonia." }, { "input": "ET tube has been repositioned with tip ending at 1 cm from carina bifurcation. It can be pulled back by 1-2 cm. The NG tube has been pulled back with tip ending at the esophagogastric junction. It can be pushed down by 5-8 cm. Right IJ catheter is unchanged with tip ending in upper SVC. There is minimal interval change of lung opacification with mild increased of right upper lobe atelectasis, and left lung opacification for increased pulmonary edema. Heart size is not fully assessable because it is covered by pulmonary edema and bilateral pleural effusion. There is no pneumothorax.", "output": "The ET tube can be pulled back by 1-2 cm. The NG tube can be pushed down by 5-8 cm. Minimal increased bilateral pulmonary edema and atelectasis of the right upper lobe with increased pleural effusion at the left base. Findings were discussed by Dr. ___ with Dr ___ at 5.___ pm." }, { "input": "ET tube is unchanged, now with tip ending at 3.7 cm from carina bifurcation. Right IJ catheter is unchanged, with tip ending at mid SVC. NG tube is unchaged, the tip is below the diaphragm but not visualized. The opacification of the lung base is increased, for increased pulmonary edema and increased bilateral pleural effusion, more conspicuous on the right base. Cardiomediastinal silhouette is unchanged.", "output": "Increased pulmonary edema and bilateral pleural effusion especially on the right base." }, { "input": "The ET tube is unchanged with tip ending at 4 cm from carina. Right jugular catheter is unchanged with tip ending at mid SVC. NG tube is only partially visible but still in place with tip ending below the diaphragm. The pulmonary edema has increased since ___ especially in the upper lobes. The atelectasis in the right upper lobe has slightly reduced suggesting better ventilation. The consolidation at the right base has increased without clear volume reduction and is suspicious for pneumonia. The atelectasis at the left base is slightly reduced. There is no pleural effusion. Cardiomediastinal silhouette is unchanged and normal. There is no pneumothorax.", "output": "Increased pulmonary edema especially in the upper lobes with increased right base consolidation, suspicious for pneumonia. The atelectasis of the right upper lobe and left lung base are slightly improved. There is no pleural effusion." }, { "input": "Tracheostomy tube is approximately 2 cm above the level of the carina and is in appropriate position. Right IJ tip is in low SVC. NG tube extends into proximal stomach and is out of view. Mild interval increase in bilateral pleural effusions, left greater than right. Increased mild pulmonary edema with mediastinal vein dilatation and mildly enlarged heart which is slightly accentuated by low lung volumes. Linear rounded opacity in the right lower lobe is likely from atelectasis. No pneumothorax. Severe degenerative change at the right humeral head is again noted.", "output": "1. Mild increase in pulmonary edema with interval increase in small bilateral pleural effusions, left greater than right 2. Likely right lower lobe atelectasis. Consider followup chest radiographs to assess for resolution." }, { "input": "Tracheostomy site is in appropriate position. End of NG tube is in the proximal stomach. Consider advancing 3-5 cm for better sitting. No interval change in the diffuse heterogeneous bilateral opacities with mild increase in size and density of the right lower lobe focal opacity concerning for pneumonia. Stable small bilateral pleural effusions and bibasilar atelectasis. Heart size, mediastinal contour and hila are normal.", "output": "1. Mild interval increase in right lower lobe pneumonia, likely aspiration. 2. No interval change in diffuse likely infectious etiology affecting both lungs. Results were conveyed via email by Dr.___ to Dr. ___ on ___." }, { "input": "ET tube ends at 2.6 cm from carina. It can be withdrawn at least 2 cm. Right IJ catheter ends in lower SVC. Left lung base pigtail is unchanged since prior chest x-ray. As compared to yesterday, the bilateral pulmonary edema is unchanged in the right lung, but minimally improved in the left lung. There is no pleural effusion on the left, but small on the right. Cardiomediastinal silhouette is unchanged and normal.", "output": "The bilateral pulmonary edema has slightly improved to the left, but is unchanged and severe to the right. There is no pleural effusion on the left, small to the right.The ET tube should be withdrawn 2 cm." }, { "input": "A portable frontal chest radiograph demonstrates a left PICC with the tip at the cavoatrial junction, an endotracheal tube ending 3 cm above the carina, and interval placement of a nasogastric tube in the stomach. The remainder of the exam is unchanged, demonstrating mild cardiomegaly and low lung volumes.", "output": "Interval placement of a nasogastric tube, with the tip in the stomach." }, { "input": "New ET tube has tip ending at 2.3 cm from carina. Lung volume is still low, but without consolidation or nodule suspicious for pneumonia. There is no pleural effusion or pneumothorax. Heart size is accentuated by low lung volume.", "output": "New ET tube ends at 2.3 cm from carina, exam is otherwise unchanged since ___." }, { "input": "AP view of the chest. Heart size is top normal. There is a right PICC line ending in the right atrium. Lung volumes are low. There are new diffuse hazy opacities and perihilar opacities most consistent with pulmonary edema. Bibasilar opacities are seen and may represent atelectasis or pneumonia.", "output": "Increase in pulmonary edema. Bibasilar opacities may represent atelectasis or pneumonia. Lung volumes are very low. Right PICC ends in the right atrium." }, { "input": "PA and lateral views of the chest provided. A tracheobronchial stents are in place, not significantly changed in overall position as compared with recent chest radiograph. A linear metallic density again noted 2 project over the lower mediastinum. Lungs are clear. Cardiomediastinal silhouette stable. Bony structures intact.", "output": "Tracheobronchial stents in unchanged position. No superimposed acute process." }, { "input": "Increased reticular opacities bilaterally are indicative of moderate pulmonary edema. There is at least a moderate right pleural effusion and a small left pleural effusion. Heart size is top-normal. The mediastinum demonstrates vascular engorgement. No pneumothorax.", "output": "Moderate pulmonary edema with bilateral pleural effusions, right greater than left." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs demonstrate an unchanged mildly enlarged cardiomediastinal silhouette. Again seen are ill-defined reticular interstitial markings, compatible with mild pulmonary edema. Opacity projecting over the lower thoracic spine on lateral view could represent a left lower lobe pneumonia. There are likely bilateral trace pleural effusions. No pneumothorax is appreciated.", "output": "Retrocardiac opacity which could represent left lower lobe pneumonia. Likely bilateral trace pleural effusions. Mild pulmonary edema, increased compared to ___." }, { "input": "Moderate to severe enlargement of the cardiac silhouette appears unchanged. Mediastinal and hilar contours are similar. Mild pulmonary edema may be slightly worse in the interval. Minimal atelectasis is seen in the lung bases without focal consolidation. No pneumothorax is present. Percutaneous catheter projects over the left upper quadrant of the abdomen. Osseous structures are diffusely demineralized.", "output": "Moderate to severe cardiomegaly with mild pulmonary edema, slightly worse in the interval." }, { "input": "This study was made available for my interpretation, today, ___. There may be trace pleural fluid. No definite focal consolidation is seen. Slight increase in interstitial markings bilaterally may be due to mild interstitial edema. No pneumothorax is seen. The cardiac silhouette remains enlarged. The aorta is calcified and tortuous. Old left-sided posterior sixth rib fracture/ deformity is noted. The bones are diffusely osteopenic.", "output": "Possible trace pleural fluid. Cardiomegaly. Interstitial edema." }, { "input": "Prior right is no longer seen. There is right basilar opacity, new since prior. Linear left-sided opacities are likely atelectasis. There is no large effusion. Cardiac silhouette is enlarged but similar compared to prior. Atherosclerotic calcifications seen at the aortic arch. No acute osseous abnormalities.", "output": "New right basilar opacity, potentially atelectasis noting that infection is entirely possible in the proper clinical setting." }, { "input": "There are scattered bilateral reticular opacities that likely reflect a mild pulmonary edema. Atelectasis is also present at the lung bases bilaterally. No confluent consolidation, pleural effusion or pneumothorax. Heart size is moderately enlarged. Known right 8th rib fracture is better visualized on the subsequent CT.", "output": "1. Moderate cardiomegaly with mild pulmonary edema. 2. Known right 8th rib fracture is better visualized on the subsequent CT." }, { "input": "The lung volumes are somewhat low, with atelectasis in the bilateral lung bases. The heart is mildly enlarged, unchanged compared to prior studies. There is no pneumothorax, over pulmonary edema, or focal consolidation concerning for pneumonia.", "output": "Low lung volumes, bibasilar atelectasis, and stable mild cardiomegaly." }, { "input": "Rotated positioning. There is stable enlargement of the cardiac silhouette and right hilum. Linear opacity in the lingula likely reflects atelectasis. No gross pleural effusion or pneumothorax. Blunting of the posterior costophrenic angle on the left cannot be excluded, similar to prior. Bilateral percutaneous nephrostomy tubes are partially visualized.", "output": "Stable appearance of the chest compared with ___. No new area of consolidation identified. Cardiomegaly and atelectasis again noted." }, { "input": "Compared to prior, there has been no significant interval change. Prominence interstitial markings are noted in the lungs but are unchanged over multiple priors. Linear left basilar opacities likely scarring versus atelectasis. There may be trace pleural effusions as demonstrated by blunting of the posterior costophrenic angles. Mild cardiac enlargement is noted. Tubing projects over the upper abdomen bilaterally.", "output": "Interstitial edema with possible trace effusions." }, { "input": "Mild cardiomegaly and tortuosity thoracic aorta are unchanged. Mild pulmonary vascular congestion is new without overt pulmonary edema. Lungs are clear except for linear opacities in the left mid and both lower lungs suggestive of atelectasis. .", "output": "Mild pulmonary vascular congestion." }, { "input": "Moderate enlargement of the cardiac silhouette is unchanged. The mediastinal contour similar. Mild pulmonary edema is worse in the interval. Hilar contours are unchanged with prominence of the pulmonary artery suggestive of pulmonary arterial hypertension, as seen previously. Small bilateral pleural effusions are present. Atelectasis is seen in the lung bases without focal consolidation. No pneumothorax is present. Osseous structures are diffusely demineralized.", "output": "Mild pulmonary edema and trace bilateral pleural effusions, worse from the previous study." }, { "input": "AP upright and lateral views of the chest provided. Overlying EKG leads are present. There are linear densities, likely scarring, again noted in the left mid to lower lung. The heart remains moderately enlarged. No signs of congestion or edema. No focal consolidation concerning for pneumonia. No large effusion or pneumothorax. Bony structures are intact. A catheter projects over the left upper abdomen", "output": "As above." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Heart size is normal. Prominence of the ascending aorta may suggest mild ascending aortic dilatation.", "output": "1. No acute cardiopulmonary process. 2. Prominence of the ascending order may suggest mild ascending aortic dilatation, and could be further assessed with nonurgent CT chest." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "No focal opacity to suggest pneumonia is seen. No pleural effusion, pulmonary edema, or pneumothorax is present. The lungs are hyperinflated. The cardiomediastinal silhouette is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are clear. No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. No discrete solid pulmonary nodule are concerning mass. The cardiomediastinal silhouette, hila, and pleura are unremarkable.", "output": "1. No acute cardiopulmonary process. 2. No radiographic evidence of a pulmonary mass or pleural lesion." }, { "input": "Heart size is borderline enlarged. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is present. Minimal streaky atelectasis is seen in the left lower lobe. Slight loss of height anteriorly of a low thoracic vertebral body appears unchanged compared to the previous chest CT. Mild degenerative changes are seen in the imaged thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. There is a focal area of increased density at the left lower lung which is likely related to prior scarring. The lungs are otherwise clear and there is no evidence of an acute infection. There are no focal consolidations, pleural effusions or pneumothorax.", "output": "No radiographic evidence of an acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest demonstrate fully expanded and clear lungs. The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Pleural surfaces are unremarkable.", "output": "Normal chest radiograph. Specifically, no evidence of pneumonia." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There is no pleural effusions or pneumothorax. Bony structures are unremarkable. No free air is identified.", "output": "No evidence of acute cardiopulmonary disease. No free air." }, { "input": "PA and lateral views of the chest provided. Again seen is a retrocardiac rounded opacity which is most compatible with known hiatal hernia, seen on prior CT. Linear density in the left lower lung is most compatible with platelike atelectasis. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "As above." }, { "input": "Frontal and lateral views of the chest were obtained. Again seen is left base atelectasis/scarring, seen on studies dating back to ___. No definite new focal consolidation is seen. There is no pleural effusion. Cardiac and mediastinal silhouettes are stable. No pneumothorax is seen.", "output": "Subtle left base/lingular somewhat linear opacity most likely represents atelectasis/scarring. However, if the patient has been treated for underlying pneumonia since the prior study, consider chest CT for further evaluation for confirmation, as question early pneumonia has been raised in the past in this location. There is minimal pulmonary vascular congestion." }, { "input": "Heart size is mildly enlarged, unchanged. Moderate hiatal hernia is re- demonstrated. Mediastinal and hilar contours are otherwise unremarkable. Pulmonary vasculature is normal. Linear atelectasis is noted in the lung bases without focal consolidation. No pleural effusion or pneumothorax is present.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cardiac silhouette size is mildly enlarged. A moderate size hiatal hernia is re- demonstrated. Mediastinal and hilar contours are otherwise unchanged. Pulmonary vasculature is normal. Atelectasis is demonstrated both lower lobes. No focal consolidation, pleural effusion or pneumothorax is identified. Levoscoliosis of the thoracic spine with mild multilevel degenerative changes is re- demonstrated.", "output": "No acute cardiopulmonary abnormality. Moderate size hiatal hernia." }, { "input": "Platelike atelectasis in knee left lung. A retrocardiac opacity is consistent with a hiatus hernia. The trachea is central. The cardiomediastinal contour is normal. No consolidation, pleural effusion or pneumothorax seen.", "output": "No significant interval change when compared to the prior study." }, { "input": "Lower lung volumes seen on the current frontal view. Right midlung linear opacities compatible surgical chain sutures from prior wedge resection. The lungs are clear without focal consolidation worrisome for infection, edema or effusion. The cardiomediastinal silhouette is stable. Moderate hiatal hernia is again noted. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest are obtained. There is subtle opacity in the expected region of the inferior lingula, which could represent an early or resolving pneumonia. The remainder of the lungs appears clear. No pleural effusion or pneumothorax. Heart size appears normal. The aorta is slightly unfolded. Bony structures are intact.", "output": "Subtle opacity in the inferior lingula could represent an early or resolving pneumonia." }, { "input": "The lateral left base is underpenetrated due to overlying soft tissue, patient body habitus. Given this, no definite focal consolidation is seen. No large pleural effusion is seen. There are no findings suggest pneumothorax. The cardiac and mediastinal silhouettes are stable. Evidence of a hiatal hernia is again seen.", "output": "Left base atelectasis without definite focal consolidation. Hiatal hernia. No definite acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. The lungs appear essentially clear bilaterally. Evaluation is somewhat limited due to underpenetrated technique due to large body habitus. There is no large effusion or pneumothorax. There may be a small hiatal hernia. Heart size is within normal limits. The mediastinal contour is normal. No bony abnormality is seen. No free air below the right hemidiaphragm.", "output": "No acute findings. Possible hiatal hernia." }, { "input": "There is a subtle opacity overlying the left lower lobe, which may be representative of early developing pneumonia. Mild perhilar vascular engourgment might represent volume overload/minimal pulmonary edema. The cardiomediastinal silhouette is normal. Dextroscoliosis of the mid thoracic spine is again noted. No acute fracture is identified.", "output": "Subtle opacity overlying the left lower lobe may be representative of an early developing pneumonia. Haziness of the pulmonary vasculature consistent with mild pulmonary edema Findings were communicated with ED QA nurse via ___mail" }, { "input": "Cardiac silhouette size remains mildly enlarged. The aorta is slightly tortuous, as seen previously, with re- demonstration of a moderate size hiatal hernia. Pulmonary vasculature is normal. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. There are mild to moderate degenerative changes noted in the thoracic spine along with S shaped scoliosis.", "output": "No acute cardiopulmonary abnormality. Moderate size hiatal hernia." }, { "input": "The left costophrenic angle is excluded on this study. The tip of a new NG tube is not definitively visualized but appears to terminate below the diaphragm with its side hole likely above the level of the diaphragm, possibly within a hiatal hernia seen as a retrocardiac opacity. Heart size and cardiomediastinal contours are normal. Lungs are clear without focal consolidation, pleural effusion, or pneumothorax.", "output": "1. NG tube poorly visualized but likely terminates below the diaphragm with side hole above the diaphragm, possibly within a hiatal hernia. 2. No focal consolidation. The left costophrenic angle is not imaged. NOTIFICATION: The findings were discussed via telephone by Dr. ___ with Dr. ___ on ___ at 6:10 AM." }, { "input": "Heart size is normal. The aorta is tortuous. A moderate size hiatal hernia is again noted. Pulmonary vasculature is normal. There is no focal consolidation, pleural effusion or pneumothorax present. Moderate degenerative changes are again noted within the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Bibasilar atelectasis is noted. There is no lobar consolidation, pleural effusion, pneumothorax, or overt pulmonary edema. The cardiomediastinal silhouette is unchanged. A large hiatal hernia is again noted.", "output": "Bibasilar atelectasis without convincing evidence for acute cardiopulmonary process." }, { "input": "Lungs are clear. There is no effusion. Cardiomediastinal silhouette is stable. Increased density in the retrocardiac region again suggests a hiatal hernia. Hypertrophic changes are seen in the spine.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac silhouette size remains mild to moderately enlarged with a large hiatal hernia again noted. The aorta remains tortuous, and mediastinal contours similar. Hilar contours are normal. Pulmonary vasculature is not engorged. Lungs are clear apart from minimal atelectasis at the lung bases. No pleural effusion or pneumothorax is present. Degenerative changes of the imaged thoracolumbar spine are again noted with bridging osteophytes.", "output": "Large hiatal hernia. No acute cardiopulmonary process." }, { "input": "Cardiac silhouette size is top normal. Moderate size hiatal hernia is re- demonstrated. Mediastinal and hilar contours are otherwise unchanged. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is present. Moderate multilevel degenerative changes are noted in the thoracic spine. Clip is noted within the left upper quadrant of the abdomen.", "output": "No acute cardiopulmonary abnormality. Moderate size hiatal hernia." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The tortuous aorta is unchanged from chest radiograph ___. Moderate size hiatal hernia is again noted. Mild cardiomegaly is unchanged. No overt pulmonary edema is seen. No significant interval change.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. Retrocardiac opacities compatible with known hiatal hernia. There is mild left basal atelectasis. Otherwise lungs are clear. Cardiomediastinal silhouette is normal. No large effusion or pneumothorax. Bony structures appear intact. No free air below the right hemidiaphragm.", "output": "Hiatal hernia. Mild left basal atelectasis. No convincing evidence for pneumonia." }, { "input": "PA and lateral views of the chest provided. Lung volumes are low. Retrocardiac opacity is compatible with a hiatal hernia. Mild basilar atelectasis noted without convincing evidence for pneumonia or edema. No large effusion or pneumothorax is seen. A calcified granuloma projects over the right upper lung. The imaged bony structures are intact. Cardiomediastinal silhouette appears stable.", "output": "Mild basilar atelectasis and hiatal hernia. No convincing evidence for pneumonia or edema." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable. A small to moderate hiatal hernia is noted with an air-fluid level.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. There is patchy calcification along the aortic arch. The lungs appear clear. There are no pleural effusions or pneumothorax.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Left-sided Port-A-Cath tip terminates at the junction of the SVC and right atrium, unchanged. Heart size appears borderline enlarged, likely due to AP technique and lower lung volumes. A coronary artery stent is re- demonstrated. Enteric tube tip terminates in the stomach. Mediastinal and hilar contours are unremarkable. There is no pulmonary edema. No focal consolidation, pleural effusion or pneumothorax is seen. Minimal atelectasis is noted in the lung bases. There are no acute osseous abnormalities. Clips are seen in the right upper quadrant of the abdomen.", "output": "1. Left-sided Port-A-Cath tip terminates at the SVC/right atrial junction, unchanged. 2. Low lung volumes with mild atelectasis in the lung bases." }, { "input": "Small left apical pneumothorax is overall unchanged compared to the prior examination. Pigtail pleural catheter and Port-A-Cath are unchanged in position. Cardiomediastinal silhouette is stable. A small linear opacity along the periphery of the left mid/lower lung likely represents atelectasis. A small left pleural effusion is unchanged.", "output": "Persistent small left apical pneumothorax and small left pleural effusion with pigtail pleural catheter in place." }, { "input": "The right-sided PICC terminates in the mid to upper SVC. An enteric tube terminates below the field of view. The cardiomediastinal and hilar contours are within normal limits. Lung volumes are low. Right basal opacity likely represents a combination of atelectasis and possibly a trace left effusion. No pneumothorax. The right lung is clear.", "output": "Right PICC terminates in the mid to upper SVC. Left basal opacity may represent a combination of atelectasis and a trace effusion." }, { "input": "NG tube tip terminates in the stomach. Right PICC terminates in the SVC. EKG leads overlie the anterior chest.Heart size is within normal limits allowing for technique. Mediastinal and hilar contours are grossly unremarkable. There is no consolidation. Small left pleural effusion and likely left lower lobe atelectasis. There is no pneumothorax.", "output": "NG tube tip terminates in the stomach. Right PICC terminates in the SVC. Left pleural effusion with likely left lower lobe atelectasis. No pneumothorax." }, { "input": "Lungs are fully expanded and clear without consolidations or effusions. Heart size is normal and there is no pulmonary vascular congestion. Cardiomediastinal and hilar silhouettes are normal. Pleural surfaces are normal.", "output": "No radiographic evidence of pneumonia or other significant cardiopulmonary abnormalities." }, { "input": "ET tube is 1.6 cm from carina. Left internal jugular central venous catheter is in the mid SVC. Enteric tube courses into the stomach and beyond the field of view. There is no pneumothorax. The lungs are normally expanded and clear. Heart size is normal. The mediastinal hilar contours are normal. There is no pleural effusion.", "output": "ET tube 1.6 cm from the carina. New enteric tube in the stomach. Clear lungs." }, { "input": "Compared to the prior exam there has been dramatic decrease in the right pleural effusion which is now small. The Port-A-Cath is again visualized in similar position. There is a small left effusion. There is volume loss at both bases and however the aeration is improved compared to the prior exam. Pleurx catheter is seen projecting over the right lower chest. Calcified lymph nodes and intraparenchymal calcifications are again visualized.", "output": "Decreased right effusion." }, { "input": "PA and lateral views of the chest. Trace right pleural effusion is unchanged Likely small left pleural effusion. Right Port-A-Cath ends in the right atrium. Left basilar atelectasis is unchanged. Upper lungs are clear. Cardiomediastinal and hilar contours are normal. No pneumothorax.", "output": "No significant change compared to ___ at ___. No pneumothorax." }, { "input": "Frontal and lateral views of the chest were obtained. Small right apical pneumothorax is new following removal of right pleural catheter. There is additionally small right chest wall subcutaneous emphysema. Catheter of the right chest wall port, which has been accessed, terminates in the lower SVC. Several surgical clips overlie the left axilla. Right pleural effusion has increased and there is now collapse of the right middle and right lower lobes.", "output": "1. Small right apical pneumothorax following removal of right pleural catheter. 2. Increased right pleural effusion with complete atelectasis of the right middle and right lower lobes. Findings were communicated via phone call by Dr. ___ to Dr. ___ ___ on ___ at ___, 5 minutes after discovery of the findings." }, { "input": "There is a fan shaped opacity in the left upper lobe consistent with pneumonia. Moderate-sized left pleural effusion is essentially unchanged from prior study. There are no other areas of focal consolidation suspicious for infection. There is no pneumothorax. The cardiomediastinal silhouette is stable and top normal in size.", "output": "Left upper lobe pneumonia." }, { "input": "PA and lateral views of the chest provided.There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "There is no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal contour is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Single frontal view of the chest was obtained. The left lower lobe opacity is seen, worrisome for pneumonia. There is blunting of the left costophrenic angle and there may be an associated pleural effusion. The cardiac silhouette is top normal to mildly enlarged. Mediastinal contours are unremarkable. There is no pneumothorax.", "output": "Patchy left lower lobe consolidation worrisome for pneumonia with possible associated small pleural effusion." }, { "input": "Right hemodialysis catheter ends in the right atrium. Left internal jugular central venous line ends at the brachiocephalic junction. An enteric tube ends off the imaged portion of the screen. There are diffuse bilateral pulmonary opacities which have slightly progressed. Cardiac silhouette is not well assessed. No evidence of pneumothorax.", "output": "Slight increase in bilateral parenchymal opacities may represent edema; however, underlying pneumonia is not ruled out." }, { "input": "A Dobbhoff tube is visualized with its tip at the gastroesophageal junction. Right-sided central dialysis line is noted with the catheter tip at the superior cavoatrial junction. Internal jugular central venous line is noted with the tip at the origin of the SVC. Again noted at the visualized lung bases are diffuse bilateral heterogeneous pulmonary opacities as noted previously and suggestive of edema with possible concurrent pneumonia or pulmonary hemorrhage. Bilateral pleural effusions are again noted and appear relatively stable.", "output": "Dobhoff tube tip is at the gastroduodenal junction. Heterogeneous pulmonary findings suggestive of edema with possible overlying pneumonia or pulmonary hemorrhage are again noted." }, { "input": "The lungs are symmetrically well expanded and well aerated without focal consolidation concerning for pneumonia. No pleural effusion or pneumothorax is detected. The pulmonary vasculature is within normal limits. The cardiac silhouette is top normal in size but unchanged. The mediastinal and hilar contours are within normal limits. The trachea is midline. The visualized upper abdomen demonstrates a TIPS shunt, as before.", "output": "No acute cardiopulmonary process." }, { "input": "A right-sided PICC line terminates in the lower superior vena cava. The cardiac, mediastinal and hilar contours are stable. Moderate unfolding along the lower descending thoracic aorta is stable. The lungs appear clear. There are no pleural effusions or pneumothorax. Mild degenerative changes are stable along the mid thoracic spine.", "output": "PICC line terminating in the lower superior vena cava. No evidence of acute disease." }, { "input": "There is a loculated right hydropneumothorax, slightly improved since the prior exam. Mild pulmonary edema is noted. Patchy opacities in the left mid lung zone may represent asymmetric edema; however, infection is also possible. Cardiomediastinal silhouette is moderately enlarged. Median sternotomy wires are intact.", "output": "1. Small right hydropneumothorax, slightly decreased since the prior exam. 2. Opacity in the left mid lung may represent asymmetric edema; however, infection is also possible." }, { "input": "Frontal and lateral views of the chest were obtained. There is a large right-sided pleural effusion with overlying atelectasis, underlying consolidation is not excluded. There is minimal blunting of the left costophrenic angle on the frontal view, not well substantiated on the lateral view with a very trace left pleural effusions not excluded. No definite focal consolidation is seen in the left lung. The patient is status post median sternotomy. The right aspect of the cardiac silhouette is not well assessed due to the large right-sided opacity. Old-appearing rib fracture is seen approximately at the level of the right posterior sixth rib. The posterior ribs inferior to this are not well assessed due to large right-sided opacity.", "output": "Large right pleural effusion with overlying atelectasis, underlying consolidation is not excluded." }, { "input": "Interval decrease of left pleural effusion, still with band-like opacity compatible with atelectasis. Patchy opacities are still visible in the right upper lung and correlates with ground-glass opacity described in recent chest CT. Left lung is clear without pleural effusion. Heart size is mildly enlarged. There is no pneumothorax.", "output": "Interval decrease of right pleural effusion, with still residual small atelectasis. Persistent patchy opacities in the right upper lobe." }, { "input": "A right pigtail catheter is unchanged. The remnant effusion is stable. Again noted is mild pulmonary edema, although improved since the previous exam especially in the right lung. Opacity in the left mid lung may represent asymmetric edema, however this seems less likely given the improvement in edema in the right lung. The cardiac silhouette is unchanged. Median sternotomy wires are intact.", "output": "1. No change in right pleural effusion. 2. Opacity in the right midlung concerning for infection given the improvement in pulmonary edema." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded, clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.Note is made of a calcified granuloma in the right upper lung.", "output": "No acute cardiopulmonary process." }, { "input": "In comparison with prior chest radiograph from a few hours earlier, there is no significant change. Left pigtail pleural catheter remains in place without evidence of a left pneumothorax. Moderate cardiomegaly is unchanged. Moderate bilateral pleural effusions. There is pulmonary vascular congestion with pulmonary edema.", "output": "No pneumothorax." }, { "input": "There is linear opacity overlying the patient in the bilateral apices, which makes evaluation for pneumothorax difficult. However, there is likely moderate left and small right apical pneumothoraces. Again seen is left apical pigtail pleural drainage catheter, unchanged in position. There has been interval improvement of pulmonary edema. Moderate right pleural effusion with associated right lower lobe atelectasis and small left pleural effusion are mostly unchanged. The cardiac and mediastinal silhouettes are unchanged.", "output": "1. Moderate left and small right apical pneumothraces are likely. Repeat radiograph with removal of any material overlying the patient is recommended. 2. Interval improvement of pulmonary edema." }, { "input": "ET tube terminates 3.9 cm above the carina. Patient position is rotated. There is small the moderate right pleural effusion and moderate to large left pleural effusion. Mediastinal contour is obscured by bilateral pleural effusions. There is collapse of left lower lobe and atelectasis of right lung base.", "output": "ET tube terminates 3.9 cm above the carina. Moderate to large bilateral pleural effusions and compressive atelectasis of bilateral lung bases are noted." }, { "input": "PA and lateral chest radiographs demonstrate clear lungs bilaterally. There is no focal consolidation. Cardiomediastinal and hilar contours are within normal limits. There is no pleural effusion or pneumothorax identified. No evidence of pneumomediastinum or pneumoperitoneum. Visualized osseous structures demonstrate no acute focal abnormality.", "output": "No acute intrathoracic abnormality. No evidence of pneumoperitoneum or pneumomediastinum." }, { "input": "The cardiac, mediastinal and hilar contours are normal. The pulmonary vascularity is normal. The lungs are clear. No pleural effusion or pneumothorax is present. Mild dextroscoliosis of the thoracic spine is noted. Bilateral rib cage deformities appear chronic.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cardiac silhouette size is normal. Mediastinal and hilar contours are unchanged with atherosclerotic calcifications again seen throughout the aorta. Pulmonary vasculature is normal. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is demonstrated. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Aortic knob calcification is noted.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable semi-erect frontal chest radiograph demonstrates intact median sternotomy wires, and right IJ CVL tip in the upper right atrium unchanged in appearance since previous examination. Interval removal of enteric feeding tube, mediastinal drains, and endotracheal tube. Again seen is a large hiatal hernia, partially fluid-filled. The lungs are hypoinflated with bibasilar atelectasis and small bilateral pleural effusions. Persistent retrocardiac and left lower lobe opacity is noted. No pneumothorax.", "output": "1. Large hiatal hernia, partially fluid-filled. Of note patient is at increased risk for aspiration. 2. Hypoinflated lungs with bibasilar atelectasis and small stable bilateral pleural effusions. 3. Persistent retrocardiac and left lower lobe opacity is most consistent with atelectasis however differential includes pneumonia and aspiration pneumonia in the appropriate clinical setting." }, { "input": "Cardiomediastinal contours are unchanged. Cardiac size is normal. Patient has known large hiatal hernia. Bibasilar atelectasis have markedly improved. Bilateral effusions are small. There is no pneumothorax. The upper lungs are clear. Sternal wires are aligned. Patient is status post AVR", "output": "Small bilateral effusions. Marked improved bibasilar atelectasis." }, { "input": "Large hiatal hernia with large air-fluid level is seen. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. There is no pulmonary edema. The cardiac silhouette is difficult to accurately assess due to the large hiatal hernia. Mediastinal contours are unremarkable. Aortic knob is calcified.", "output": "Large hiatal hernia. Clear lungs. No pulmonary edema." }, { "input": "There is subtle opacification at the right medial base, which may represent overlapping vessels, however a pneumonia cannot be excluded. The lungs are otherwise clear. The pulmonary vascular is normal. The heart is not enlarged. There are no pleural effusions. There is no pneumothorax.", "output": "Subtle opacification at the right medial base, which may represent overlapping vessels, however a pneumonia cannot be excluded. RECOMMENDATION: PA and lateral radiographs may help to differentiate between overlapping vessels and pneumonia." }, { "input": "The lungs are hyperinflated. No focal consolidation is seen. There is no pleural effusion or pneumothorax. Chain sutures are noted overlying the left mid hemithorax. The aorta is tortuous. The cardiac silhouette is top-normal to mildly enlarged. There is prominence of the central pulmonary vasculature which may be due to central pulmonary vascular engorgement or possibly component of pulmonary arterial hypertension. No displaced fracture is identified. The bilateral humeri are partially imaged, but are seen to be high-riding, which can be seen in rotator cuff disease.", "output": "No focal consolidation to suggest pneumonia. Partially imaged high-riding bilateral humeri, may be seen with rotator cuff disease." }, { "input": "The patient is status post CABG with median sternotomy wires that appear intact and appropriately aligned. There is a left pectoral pacemaker with leads in appropriate position. Stable enlargement of the cardiomediastinal silhouette. No focal consolidations. Vascular congestion, but no overt pulmonary edema. No pneumothorax. No pleural effusion.", "output": "Vascular congestion, but no overt pulmonary edema." }, { "input": "The patient is status post aortic valve replacement and probably coronary artery bypass graft surgery. A dual-lead pacemaker/ICD device appears unchanged. The heart is moderately enlarged. The mediastinal and hilar contours appear unchanged. There is no pleural effusion or pneumothorax. The lungs appear clear. The bones are probably demineralized. Mild degenerative changes along the lower thoracic spine appear similar.", "output": "No evidence of acute disease." }, { "input": "The cardiac silhouette is prominent. The mediastinum and is not particularly enlarged. There has been removal of the right IJ central line. There is improved aeration at the lung bases. There is a small persistent left-sided pleural effusion. Calcification of the anterior longitudinal ligament of the thoracic spine is consistent with DISH. No focal consolidation or pneumothoraces are seen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Lung volumes are low. Mild bibasilar atelectasis is unchanged. No pleural effusion or pneumothorax. Hilar contours are normal. The cardiomediastinal contour is enlarged, however mildly decreased in size.", "output": "The cardiomediastinal contour is enlarged, however mildly decreased in size from ___." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unchanged, with mild unfolding of the thoracic aorta. Calcified hilar lymph nodes are again compatible prior granulomatous disease. Small hiatal hernia is again noted. The lungs are hyperinflated with flattening of the diaphragms. The pulmonary vascularity is not engorged. Patchy ill-defined nodular opacification within the region of the lingula is suggestive of small airways infectious or inflammatory process. No pleural effusion or pneumothorax is identified. Granuloma within the right lower lobe is stable. Partially imaged is fusion hardware within the lumbar spine. There are no acute osseous abnormalities.", "output": "Patchy ill-defined nodular opacities within the lingula is suggestive of a small airways infectious or inflammatory process such as aspiration. Evidence of prior granulomatous disease." }, { "input": "Again noted is tortuosity of the aorta, stable in comparison to prior study from ___. Cardiomediastinal silhouette appears stable. The lungs are clear with no evidence of a consolidation, effusion, and pneumothorax. No acute fractures identified.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. The aorta is mildly tortuous but unchanged. The mediastinal and hilar contours are stable, with unchanged calcified mediastinal and hilar lymph nodes compatible with prior granulomatous disease. The pulmonary vascularity is normal. A calcified granuloma in the right upper lobe posteriorly is unchanged. No focal consolidation, pleural effusion or pneumothorax is present. Streaky linear opacities in the lingula are unchanged, and likely reflect scarring from chronic peribronchial inflammation. Spinal posterior fusion hardware within the lower lumbar spine is partially imaged. A small hiatal hernia is re-demonstrated.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest. Calcified granuloma again seen in the right midlung. The lungs are clear of consolidation, effusion or pneumothorax. Cardiomediastinal silhouette is stable. No displaced rib fracture is identified on this nondedicated exam. Posterior fixation hardware partially visualized in the lumbar spine.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is patchy bibasilar opacities, which may represent atelectasis. There is no acute osseous abnormality.", "output": "Patchy bibasilar opacities, most consistent with atelectasis." }, { "input": "PA and lateral views of the chest ___ at 13:50 are submitted.", "output": "Interval decrease in size of small bilateral pleural effusions. Stable postoperative cardiac and mediastinal contours status post median sternotomy for CABG. No pulmonary edema or pneumothorax. Lungs are hyperinflated suggestive of underlying emphysema. Right paratracheal calcifications likely represent calcified lymphadenopathy." }, { "input": "Portable frontal chest radiograph demonstrates interval placement of a right subclavian approach central venous catheter, the tip of which is directed cephalad. An NG tube and endotracheal tube are unchanged in appearance. There is a similar appearance of bibasilar opacity, and bilateral pleural effusions. There is a similar appearance to mild pulmonary edema.", "output": "1. Interval placement of right subclavian central venous catheter, the tip of which is directed cephalad. This finding was discussed with Dr. ___ ___ the ___ Care Service at 3:40 p.m. by phone. 2. Bilateral pleural effusions with bibasilar opacities which could reflect atelectasis or pneumonia. 3. Mild pulmonary edema, unchanged." }, { "input": "The lungs are fully expanded and clear. The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax.", "output": "No radiographic evidence of pneumonia." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are unremarkable. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear.The cardiac, hilar and mediastinal contours are normal.No pleural abnormality is seen. No rib fracture.", "output": "No evidence of pneumonia or traumatic injury." }, { "input": "The patient is slightly rotated. A right pectoral Infuse-A-Port extends to the mid SVC. There is stable elevation of the right hemidiaphragm with mild right basilar subsegmental atelectasis. There is also left basilar linear atelectasis. The small to moderate right apical pneumothorax is not as readily apparent on today's exam, but still present. The heart and mediastinum are within normal limits. Metallic right upper quadrant surgical clips denote prior cholecystectomy.", "output": "Stable small to moderate right apical pneumothorax. Stable elevation of the right hemidiaphragm with stable right basilar subsegmental atelectasis." }, { "input": "When compared with the immediate prior study of ___, the right apical pneumothorax has decreased in size but is still present, now small. A small right pleural effusion is minimally increased. Atelectasis at the right base has resolved. There is no focal consolidation or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "1. Small right apical pneumothorax has decreased. 2. Small right pleural effusion has minimally increased. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 9:37 AM, 7 minutes after the discovery of the findings." }, { "input": "The study of 00:08 shows no appreciable change in the small to moderate right apical pneumothorax. However, right basilar subsegmental atelectasis and surrounding airspace opacification has increased. The heart and mediastinum are magnified by the projection. A right pectoral Infuse-A-Port is unchanged in position. Mild blunting of the left costophrenic angle may be due to a new small pleural effusion. The followup exam from ___ hr shows worsening right middle and right lower lobe airspace opacification superimposed on subsegmental atelectasis. Superimposed infection or aspiration cannot be excluded. The small to moderate right apical pneumothorax is unchanged. There is stable left retrocardiac linear atelectasis.", "output": "Stable small to moderate right apical pneumothorax. Two successive radiographs show right basilar subsegmental atelectasis with increasing airspace opacities, which may be due to superimposed infection or atelectasis. NOTIFICATION: The impression above was entered by Dr. ___ on ___ at 11:14 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "Compared to the immediate prior study of ___, the small to moderate right apical pneumothorax is unchanged. Increasing opacification of the right lung base in the absence of clinical signs of pneumonia likely represents right middle lobe collapse. There may be a small left pleural effusion. The heart is top normal in size and unchanged. The right-sided chest wall port catheter tip ends in the low SVC. There is no pulmonary edema.", "output": "1. Unchanged small to moderate right apical pneumothorax. 2. Increased right basilar opacification, likely representing right middle lobe collapse." }, { "input": "Allowing for changes in positioning, the small to moderate right apical pneumothorax may be slightly larger. Right base opacification is improved compared with earlier on the same day, making infectious etiologies very unlikely. There may be small bilateral pleural effusions. There is no focal consolidation or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "1. Allowing for changes in positioning, the small to moderate right apical pneumothorax may be slightly larger. 2. Improved right base opacification, compatible with resolving atelectasis." }, { "input": "There is a moderate to large right apical pneumothorax. The right chest wall port tip ends in the low SVC. There is mild pulmonary vascular congestion and mild cardiomegaly. There may be a small left pleural effusion. There is no focal consolidation.", "output": "1. Moderate to large right apical pneumothorax. 2. Mild pulmonary vascular congestion. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 5:09 PM, 10 minutes after the discovery of the findings." }, { "input": "The study of 00:08 shows no appreciable change in the small to moderate right apical pneumothorax. However, right basilar subsegmental atelectasis and surrounding airspace opacification has increased. The heart and mediastinum are magnified by the projection. A right pectoral Infuse-A-Port is unchanged in position. Mild blunting of the left costophrenic angle may be due to a new small pleural effusion. The followup exam from ___ hr shows worsening right middle and right lower lobe airspace opacification superimposed on subsegmental atelectasis. Superimposed infection or aspiration cannot be excluded. The small to moderate right apical pneumothorax is unchanged. There is stable left retrocardiac linear atelectasis.", "output": "Stable small to moderate right apical pneumothorax. Two successive radiographs show right basilar subsegmental atelectasis with increasing airspace opacities, which may be due to superimposed infection or atelectasis. NOTIFICATION: The impression above was entered by Dr. ___ on ___ at 11:14 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "A chest wall Port-A-Cath terminates in the mid SVC. There has been complete interval resolution of the small right apical pneumothorax seen on prior exam. The lungs are clear without focal consolidation, effusion or pneumothorax. Cardiomediastinal silhouette appears normal. The imaged osseous structures are intact.", "output": "No acute intrathoracic process. Port-A-Cath in unchanged position." }, { "input": "Chest tube has been removed. There is a persistent small left apical pneumothorax. The size and distribution of small, left pleural loculations are unchanged. Aside from chronic left lung scarring, lungs are clear. Heart size is stable. The mediastinal and hilar contours are stable. The pulmonary vasculature is normal.", "output": "1. Removal of left chest tube, with small persistent left apical pneumothorax. 2. Unchanged small, multi-loculated left pleural effusion in comparison to chest radiograph with the same date." }, { "input": "The left sided PICC ends at the low SVC. Since ___, there is re-expansion of the left lung. Small left pleural effusion is decreased in size since ___. Left loculated pleural effusion is decreased in size since ___. Interstitial thickening in the left lung consistent with patient's history of emphysema. There is no evidence of pneumothorax. Cardiomediastinal borders and hilar structures are normal.", "output": "Left-sided PICC ends at lower SVC. Compared to ___, reexpansion of left lung, decreased size of small left pleural effusion, and decreased size of left loculated pleural effusion." }, { "input": "There are relatively low lung volumes. The patient's chin partially obscures the medial lung apices. Left mid to lower lung opacity concerning for pneumonia and possible small left pleural effusion with overlying atelectasis. The right lung is clear. The cardiac silhouette is top-normal. Mediastinal contours are grossly unremarkable. Central pulmonary vascular engorgement is seen, left greater than right.", "output": "Left mid to lower lung opacity concerning for pneumonia, possible small left pleural effusion with overlying atelectasis. Central pulmonary vascular engorgement, left greater than right. Dedicated PA and lateral views would provide further assessment if/when patient able." }, { "input": "Frontal and lateral views of the chest. The lungs are hyperinflated but clear focal consolidation. Mild biapical scarring is seen, similar to prior. There is no effusion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "There is no rib fracture. If clinical symptoms persist, dedicated rib series radiographs could be obtained. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits. The aorta is tortuous. There is dextroscoliosis of the thoracic spine. Incidental note is made of cement from prior vertebroplasty.", "output": "1. No rib fracture. If clinical symptoms persist, dedicated rib series radiographs could be obtained." }, { "input": "There is mild elevation of the left hemidiaphragm with bowel beneath. There is blunting of the posterior left costophrenic angle which may be due to a trace pleural effusion with overlying atelectasis. Left basilar consolidation is not excluded. Minor lateral right basilar atelectasis is seen. No evidence of pneumothorax. The cardiac and mediastinal silhouettes are stable. Again noted is cement from prior vertebroplasty.", "output": "Mild elevation of the left hemidiaphragm. Blunting of the posterior left costophrenic angle, may be due to a trace pleural effusion with overlying atelectasis. Left basilar consolidation is not excluded" }, { "input": "Frontal and lateral views chest. The lungs are clear without consolidation, effusion, or pulmonary vascular congestion cardiomediastinal silhouette is within normal limits. Vertebroplasty changes are noted in the upper lumbar spine as on prior. No acute osseous abnormality detected.", "output": "No acute cardiopulmonary process." }, { "input": "There is blunting of the left lateral costophrenic angle which is new since prior. Lung volumes are low. Persistent elevation of left hemidiaphragm is again seen. Cardiomediastinal silhouette is unchanged. No acute osseous abnormalities identified. Vertebroplasty changes are again identified in the lumbar spine.", "output": "New small left effusion. Otherwise, no change." }, { "input": "Cardiomediastinal contours are stable. Interval improved aeration at the lung bases with near resolution of a left retrocardiac opacity. Small left pleural effusion has nearly resolved. Post vertebroplasty changes are again demonstrated in the spine.", "output": "Near resolution of left lower lobe opacity and small pleural effusion. No new findings to suggest recurrent pneumonia or congestive heart failure" }, { "input": "Lung volumes are low. Heart size is at least moderately enlarged. The mediastinal and hilar contours are unchanged. Crowding of the bronchovascular structures is demonstrated without overt pulmonary edema. Patchy opacities are noted in the lung bases, more focal in the left lung base likely reflecting areas of atelectasis. No Large pleural effusion or pneumothorax is identified. Evidence of prior kyphoplasty is seen within the upper lumbar spine.", "output": "Low lung volumes with patchy bibasilar opacities, more pronounced in the left lung base, likely atelectasis. Please note however that infection cannot be completely excluded." }, { "input": "In comparison to chest radiograph from ___, there is little change. Left lower lobe opacity is similar. The cardiomediastinal silhouette is stable. There is no pleural effusion or pneumothorax. Mild elevation of the left hemidiaphragm is unchanged. No definite displaced rib fracture seen. Changes of vertebroplasty again seen.", "output": "No displaced rib fracture seen. No significant change in the appearance of the chest compared to ___" }, { "input": "Frontal and lateral views of the chest were obtained. Low lung volumes persist. There is persistent elevation of the left hemidiaphragm with overlying mild atelectasis. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No significant interval change." }, { "input": "There is again seen nodular densities within the right mid lung field which are stable. There is cardiomegaly. There are low lung volumes with atelectasis at the lung bases. There is a left retrocardiac opacity. No pulmonary edema is seen.", "output": "As above." }, { "input": "Cardiomediastinal contours are unchanged. Small left effusion with adjacent atelectasis have minimally increased. Otherwise the lungs are clear. There is no pneumothorax or right pleural effusion. Elevation of the left hemidiaphragm is a stable. vertebroplasties are partially imaged.", "output": "Minimally increased small left effusion and adjacent atelectasis no evidence of pulmonary edema." }, { "input": "Lung volumes are low. The heart is at the upper limits of normal size or perhaps mildly enlarged, although its contours are not fully assessed given AP portable technique and low lung volumes. There is no definite pleural effusion or pneumothorax. Pulmonary vascularity is mildly prominent and indistinct, suggesting mild vascular congestion.", "output": "Findings suggesting mild vascular congestion." }, { "input": "Single portable view of the chest. Endotracheal tube tip is seen approximately 6 cm from the carina. Nasogastric tube seen with tip overlying the gastric fundus, side port not clearly delineated but potentially in the region of the GE junction. The lungs are grossly clear. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormality detected.", "output": "ET tube in appropriate position. NG tube tip in the gastric fundus, side port not seen but potentially in the region of the GE junction and could be advanced." }, { "input": "Frontal and lateral views of the chest. The lungs are clear. There is no effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormality detected.", "output": "No acute cardiopulmonary process." }, { "input": "As compared to the prior examination dated ___, there has been no significant interval change. There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The previously seen right subpulmonic pleural effusion has resolved. The lungs are clear. There is no focal consolidation or pneumothorax. The cardiac silhouette is normal. Osseous structures are unremarkable.", "output": "Resolved right pleural effusion." }, { "input": "Frontal and lateral views of the chest were obtained. There is elevation of the right hemidiaphragm versus subpulmonic effusion. Overlying right base atelectasis is seen. There is mild left base atelectasis. No left pleural effusion or consolidation is seen. The cardiac and mediastinal silhouettes are unremarkable. No evidence of pneumothorax is seen.", "output": "Elevation of the right hemidiaphragm versus subpulmonic effusion with overlying right base atelectasis." }, { "input": "The anterior lower chest is cut off from the image on the lateral view. Lung volumes are low, likely secondary to lack of full inspiration. No pulmonary edema, pleural effusion, focal consolidation, or pneumothorax. The heart is normal in size. The mediastinum is not widened. The hila are within normal limits. Multilevel degenerative changes in the thoracic spine with prominent anterior osteophytes are moderate. A prevertebral density likely represents projection artifact from the scapula, but a prevertebral lesion cannot be excluded.", "output": "1. No pneumonia. 2. Prevertebral density likely represents projection artifact from the scapula, but a prevertebral lesion cannot be excluded. RECOMMENDATION(S): Repeat lateral chest radiograph with appropriate positioning to exclude prevertebral lesion. NOTIFICATION: The impression and recommendation above was entered by Dr. ___ on ___ at 16:40 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "PA and lateral views of the chest provided. Eventration of the right hemidiaphragm again noted. The lungs appear clear without focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette appears normal. Bony structures appear intact. Prominent anterior osteophytes in the thoracic spine likely account for prevertebral opacity.", "output": "No acute findings. Prominent anterior osteophytosis in the thoracic spine likely accounts for prevertebral opacity seen on prior imaging study." }, { "input": "The lungs are clear without focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified. Calcifications in the right upper quadrant suggest cholelithiasis. There is no free intraperitoneal air.", "output": "No acute cardiopulmonary process. Probable cholelithiasis." }, { "input": "Consolidation at the right base with small amount of pleural fluid is unchanged from prior examx dating back to ___ and are likely chronic changes. Linear opacities at the left base likely represent atelectasis. There may be a small left pleural effusion. Upper lung zones are clear. There is no pneumothorax. The cardiomediastinal silhouette is unchanged.", "output": "1. Opacification at the right base with small pleural effusion is most consistent with chronic pleural changes. 2. Left basilar atelectasis and possible small pleural effusion." }, { "input": "PA and lateral views of the chest are provided. The patient's kyphotic angulation of the T-spine and rotations of the left limit the evaluation. There is a small right pleural effusion. A retrocardiac opacity could represent a hiatal hernia. The heart and mediastinal contour appear grossly unchanged. No large pneumothorax is seen. No acute fracture is evident. Vertebroplasty is present in the lower T-spine.", "output": "Small right pleural effusion. Probable hiatal hernia. Otherwise, no gross abnormality on this limited exam." }, { "input": "Frontal and lateral views of the chest were obtained. Per the radiology technologist, patient unable to raise arms for lateral image. Best films provided. There is mild blunting of the right costophrenic angle consistent with a small right pleural effusion. Trace left pleural effusion is difficult to exclude. No definite focal consolidation is seen. There is no pneumothorax. Evidence of prior vertebroplasty in the lower thoracic spine is again seen. The cardiac and mediastinal silhouettes are stable. The left humeral head again appears medially subluxed in relation to the glenoid.", "output": "Small right pleural effusion and possible trace left pleural effusion." }, { "input": "The study is limited due to patient rotation. Moderate cardiomegaly is unchanged. A large hiatal hernia is re- demonstrated. The aortic knob remains calcified. There is no pulmonary edema. Small bilateral pleural effusions, right greater than left are increased compared to the prior study. Bibasilar airspace opacities likely reflect atelectasis, but aspiration or infection is not excluded. There is no pneumothorax. The left humeral head remains chronically dislocated. Diffuse demineralization of the osseous structures is noted with evidence of prior vertebroplasty at the thoracolumbar junction.", "output": "Small bilateral pleural effusions, right greater than left, slightly increased in size compared to the previous exam. Large hiatal hernia. Bibasilar airspace opacities could reflect atelectasis but aspiration or infection cannot be excluded." }, { "input": "Portable semi-upright radiograph of the chest demonstrates complete opacification of the left hemi thorax, consistent with massive left-sided pleural effusion and left lung collapse. There is a large right-sided pleural effusion with adjacent atelectasis as well. No pneumothorax. Assessment of the cardiac silhouette is not possible secondary to pleural effusion. Moderate-sized hiatal hernia is present.", "output": "Complete opacification of the left hemi-thorax consistent with a massive left pleural effusion and left lung collapse. Large right-sided pleural effusion with adjacent atelectasis. NOTIFICATION: These findings were discussed with Dr. ___ By Dr. ___ ___ telephone at 11:22 on ___, 2 minutes after discovery." }, { "input": "Portable semi-upright radiograph of the chest demonstrates near complete opacification of the left hemi thorax with leftward mediastinal shift consistent with a massive left pleural effusion and left lung collapse. Stable moderate-large right-sided pleural effusion with compressive atelectasis. No pneumothorax. Assessment of the cardiomediastinal and hilar contours are not possible to assess secondary to large pleural effusion. Chronic left shoulder dislocation and pseudoarthrosis with clavicle again noted.", "output": "Stable near complete opacification of left hemithorax with leftward mediastinal shift, consistent with massive left pleural effusion and left lung collapse. Stable moderate-large right-sided pleural effusion with compressive atelectasis." }, { "input": "There is increased blunting of the costophrenic angles bilaterally with meniscal configuration, concerning for bilateral pleural effusions. The aerated upper lungs demonstrate prominent pulmonary vasculature without evidence for edema. Large hiatal hernia is again seen with adjacent compressive atelectasis. There are increased basilar consolidations, likely atelectasis in the setting of effusion. However, pneumonia or aspiration cannot be excluded. The aorta is tortuous and calcified. The cardiac silhouette is obscured and therefore heart size is incompletely evaluated on this study. No pneumothorax is detected. Right glenohumeral degenerative changes noted.", "output": "Bilateral pleural effusions, new or increased compared to prior, without evidence for pulmonary edema. Bibasilar consolidations most likely represent atelectasis, but aspiration or pneumonia cannot be excluded. Findings discussed with Dr. ___ by Dr. ___ by phone at 10:50 p.m. on ___ at the time of initial review of the study." }, { "input": "AP and lateral views of the chest. When compared to prior common there is new right basilar opacity compatible with pneumonia. There are persistent small bilateral pleural effusions. Cardiomegaly is unchanged. Vertebroplasty changes seen in the lower thoracic spine as on prior.", "output": "Right basilar region of consolidation compatible with pneumonia in the proper clinical setting. Recommend repeat after treatment to document resolution." }, { "input": "As compared to prior chest radiograph from ___, there has been no significant change. Again noted is a small right sided pleural effusion. There is atelectasis of the right lower lobe. The cardiac and mediastinal contours are unchanged. There is no pneumothorax. Retrocardiac opacity could represent a hiatal hernia. Vertebroplasty is present in the lower T-spine.", "output": "Small right sided pleural effusion." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is a layering pleural effusion about the right hemithorax which is probably at least moderate and possibly moderate to large in size. The left lung appears clear without pleural effusion. There is at least a moderate-sized hiatal hernia suspected along the lower mediastinum. A lower thoracic vertebroplasty has been performed. There is moderate rightward curvature centered along the mid thoracic spine. Bones appear demineralized.", "output": "Substantial pleural effusion on the right, difficult to compare to the most recent prior radiographs due to differences in technique, although the right lung is probably better aerated." }, { "input": "Frontal and lateral views of the chest were obtained. Bibasilar, right greater than left opacities are again seen, similar compared to the prior study from ___. On CT from ___, there is seen to be a large hiatal hernia extending into the right lower hemithorax with adjacent atelectasis. Suggestion of air-fluid level seen in the right lung base likely relates to this large hiatal hernia. Stable medial left base patchy opacity most likely relates to atelectasis/scarring. Cardiac and mediastinal silhouette is grossly stable as compared to ___. Slight blunting of posterior costophrenic angle makes a trace pleural effusion difficult to exclude. Evidence of prior vertebroplasty is again seen in the lower thoracic spine with a vertebral body just inferior to this compressed appears stable.", "output": "Low lung volumes. Right base opacity with air-fluid level likely corresponds to known large hiatal hernia seen on prior imaging with adjacent atelectasis. Blunting of posterior costophrenic angle makes trace effusion difficult to exclude." }, { "input": "Of AP and lateral views of the chest provided. Kyphotic positioning limits evaluation to the lung apices and lower lungs. Patient is known to have a large hiatal hernia which is evidenced by a retrocardiac opacity with gas contained within. There is associated lower lobe atelectasis as well as probable complete collapse of the right middle lobe. A small left pleural effusion is also noted. Heart size cannot be assessed. Vertebroplasty changes are noted in a lower thoracic vertebral body, unchanged. Chronic left shoulder dislocation again noted.", "output": "Large hiatal hernia with atelectasis in the lower lungs as stated, small left effusion. Chronic left glenohumeral dislocation." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Thin round calcifications are noted projecting over the left upper quadrant/lung base, not seen on the lateral view, and could reflect costochondral calcification.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lucency underlying the left hemidiaphragm may represent pneumoperitoneum or the stomach bubble. Correlation with left lateral decubitus views of the abdomen could be useful in differentiating between these 2 entities. Low lung volumes cause bronchovascular crowding and subsegmental atelectasis. There is no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal silhouette is within normal limits. Moderate acromioclavicular degenerative changes are noted bilaterally.", "output": "Lucency underlying the left hemidiaphragm may represent pneumoperitoneum or the stomach. Correlation with left lateral decubitus radiographs of the abdomen would be useful to confirm the presence of free air." }, { "input": "The lungs are hyperinflated. Increased interstitial opacities at the lung bases bilaterally in the presence of mild cardiomegaly likely represent pulmonary edema. Given the lack of prior radiographs, this could however represent underlying interstitial abnormality. There is no pleural effusion or pneumothorax. Soft tissue densities in the axilla bilaterally may represent adenopathy, however are not unusually appreciated by plain film. Correlation with physical exam is recommended.", "output": "1. Diffuse interstitial opacities at the lung bases bilaterally, in combination with mild cardiomegaly likely represent pulmonary edema. 2. Dedicated PA and lateral radiographs are recommended for better evaluation. 3. Soft tissue densities in the axilla bilaterally may represent adenopathy, and they should be correlated with physical exam." }, { "input": "A right middle lobe opacity obscures the right cardiac border. There is no pneumothorax or pleural effusion. A moderate-sized gastric air bubble is present.", "output": "Right middle lobe pneumonia." }, { "input": "The lung volumes are normal and the lungs are clear. There is no pleural effusion, pneumothorax or focal airspace consolidation. Heart is normal size. There is no pulmonary edema. Mediastinal and hilar contours are unremarkable. There is eventration of right hemidiaphragm, as before. Old left-sided rib fractures are again noted.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax. Old rib fractures on the left are again noted. Atherosclerotic calcifications of the aortic arch are present. Eventration of the right hemidiaphragm is unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "There are relatively low lung volumes. The cardiac mediastinal silhouettes are stable with the aorta calcified tortuous in the cardiac silhouette top-normal in size. No focal consolidation is seen. There is no pleural effusion or pneumothorax.", "output": "Low lung volumes without acute cardiopulmonary process." }, { "input": "Compared to the study from earlier the same day there is no significant interval change in the position of any of the support devices are tubes the lungs continue to have a diffuse alveolar infiltrate", "output": "No change" }, { "input": "Endotracheal tube ends approximately 6 cm above the carina. NGT tip projects over the stomach. There is no pneumothorax or pleural effusion. Cardiomediastinal hilar contours are normal. There are vague opacities in the lungs bilaterally. No fractures are identified.", "output": "1. Endotracheal tube in appropriate position. 2. Vague opacities in the lungs bilaterally could represent aspiration, edema, or infection." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Compared to the prior study there is no significant interval change", "output": "No change" }, { "input": "The ECMO cannula has a similar appearance compared to the prior exam the Swan-Ganz catheter tip is in the pulmonary outflow tract ET tube is in good position left IJ line tip is again seen in the mid SVC. There continues to be dense right sided alveolar infiltrate and there has been some interval increase in the dense left alveolar infiltrate. There bilateral effusions layering posteriorly that appear larger than on the study from the prior day", "output": "Slight worsening of alveolar infiltrates." }, { "input": "Endotracheal and enteric tubes remain in unchanged positions. Cardiac and mediastinal contours are within normal limits. The right lateral chest has been excluded from the field of view. There has been interval development of moderate to severe flash pulmonary edema. No large left pleural effusion or pneumothorax is seen, and the right costophrenic angle has not been imaged. No acute osseous abnormalities detected.", "output": "Moderate to severe flash pulmonary edema." }, { "input": "A retrocardiac opacity which appears to localize to the left lower lobe is noted, corresponding with patient's known left lower lobe mass. There is an associated, small, left pleural effusion, similar appearance to the patient's prior PET-CT examination. The remainder of the lung parenchyma is grossly clear, without focal consolidation, pneumothorax or pulmonary edema identified. The heart size is normal. The mediastinal and hilar contours are normal.", "output": "No radiographic evidence for acute cardiopulmonary process. Findings were conveyed by Dr. ___ to Dr. ___ ___ telephone at 11:18 on ___, 5 minutes after discovery." }, { "input": "There is no pneumothorax or focal consolidation. Left pleural effusion has increased. There are hazy opacities at the right base and left retrocardiac region, likely atelectasis. There may be small right pleural effusion. Cardiomediastinal silhouette is unchanged.", "output": "No pneumothorax. Increasing left pleural effusion and possible small right pleural effusion. Atelectasis in the right and left lower lobes." }, { "input": "AP upright and lateral views of the chest provided. Lung volumes are low. No convincing evidence for pneumonia or edema. No large effusion or pneumothorax. Cardiomediastinal silhouette appears normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Endotracheal tube in situ with the tip 42 mm proximal to the carina. Right-sided IJV CVP in situ with the tip in the mid SVC. Enteric tube in situ with its tip projecting over the fundus of the stomach. Lung volumes are low the. Cardiomegaly. Mild interval improvement in the pulmonary pulmonary edema, and associated bibasal airspace opacity. Persistent small left-sided pleural effusion.", "output": "Tubes and lines unchanged. Mild interval improvement in pulmonary edema" }, { "input": "There has been interval placement of an endotracheal tube which terminates 4 mm above the carina, in appropriate position. An NG tube has been placed which courses beyond the diaphragm and coils in the stomach with tip pointing cephalad. Low lung volumes, mild cardiomegaly, and hydrostatic pulmonary edema appear unchanged from examination earlier this morning. No pleural effusions, pneumonia, or pneumothorax.", "output": "1. Endotracheal tube in appropriate position. 2. No change in pulmonary edema since radiograph earlier this morning." }, { "input": "The ET tube is unchanged and ends at 5 cm from carina bifurcation. The NG tube is unchanged with tip ending below the diaphragm but not visualized in this chest x-ray. There is increased opacification of the lung for increased bilateral pleural effusion, more conspicuous on the right lung and with mild vascular congestion. Heart size is still mildly enlarged. Aortosclerosis.", "output": "Increased pleural effusion bilaterally, more conspicuous in the right lung with mild pulmonary congestion." }, { "input": "AP portable supine chest radiograph provided. The NG tube courses into the left upper abdomen, with its tip excluded from view. The tip of the endotracheal tube resides approximately 2.2 cm above the carina. Lung volumes are low. No large consolidation or supine evidence of pneumothorax or effusion. The heart and mediastinal contour appears grossly unremarkable. No definite bony abnormalities are seen.", "output": "Tubes and lines positioned appropriately." }, { "input": "There are increased bilateral alveolar infiltrates with pulmonary vascular re-distribution and small bilateral pleural effusions. The heart is moderately enlarged. Right-sided PICC line tip is in the mid SVC. There is volume loss in both lower lungs.", "output": "Worsened pulmonary edema." }, { "input": "Moderate cardiomegaly is persistent compared to exams dated back to ___. There is a right-sided PIC line which terminates in the mid SVC. Sternal wires appear to be intact without evidence of fracture. Small bilateral effusions are persistent. There is mild bibasilar atelectasis. There is no evidence of a pneumothorax.", "output": "Bilateral pleural effusions. Persistent mild bibasilar atelectasis." }, { "input": "The course of a right-sided PICC line is difficult to visualize but it probably terminates, as before, at the cavoatrial junction. The patient is status post sternotomy and probably coronary artery bypass graft surgery. The cardiac, mediastinal and hilar contours appear stable. Hazy opacification of each lung is consistent with pulmonary edema, probably somewhat worse than on the prior study, although increased blurring may be due to differences in technique to some extent. In particular, in the left mid lung, there is a more conspicuous opacity, but this may be due to rotation compared to the prior study. Pleural effusions are difficult to exclude. There is no pneumothorax.", "output": "Probably similar findings suggesting pulmonary edema since the recent prior study. In addition, a developing left mid lung opacity, which may indicate coinciding infection is doubted but hard to excluded. If developing infection is a possible clinical concern, then follow-up radiographs are suggested to reassess." }, { "input": "Right PICC ends in the low SVC. Postsurgical widening of the mediastinum is slowly improving. The cardiac silhouette remains moderately enlarged. Small bilateral pleural effusions greater on the right than the left are unchanged. Bibasilar opacities persist. Air is seen in the retrosternal space on the lateral view likely related to recent surgery.", "output": "Improvement in postsurgical appearance of the mediastinum with stable small pleural effusions with bibasilar opacities." }, { "input": "Right IJ central line tip in the right atrium, similar. No pneumothorax. Stable cardiopulmonary findings.", "output": "Right IJ central line in place." }, { "input": "The cardiomediastinal silhouette is normal. Interval adjustment of a right IJ CVC is seen which terminates in the right atrium. If the cavoatrial junction is the desired location recommend pulling back line approximately 2.5 cm. No pleural effusions, focal consolidations, or pneumothorax are seen.", "output": "Interval adjustment of right IJ CVC which terminates in the right atrium. RECOMMENDATION(S): Recommend pulling back right IJ catheter 2.5 cm if desired location is at the cavoatrial junction." }, { "input": "Nasogastric tube courses into the stomach. Endotracheal tube terminates 7.7 cm above the carina. Increased interstitial markings bilaterally could reflect mild pulmonary edema. No focal consolidation, pneumothorax or pleural effusion is seen. Heart is normal in size with normal cardiomediastinal contours.", "output": "Mild pulmonary edema with endotracheal tube positioned high in trachea - advancement by 3 cm advised." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is detected. Heart and mediastinal contours are stable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. Low lung volumes and bibasilar atelectasis. No evidence of pneumonia. No pulmonary vascular congestion or pulmonary edema. Heart size is accentuated by low lung volumes. Mediastinal and hilar contours are normal. No pneumothorax or pleural effusions. The right Port-A-Cath ends at the cavoatrial junction.", "output": "Low lung volumes and bibasilar atelectasis. No evidence of pneumonia." }, { "input": "Portable AP semi-upright chest radiograph was provided. Port-A-Cath again noted residing over the right mid chest with the catheter tip extending into the expected region of the superior vena cava. Lung volumes are quite low, which limits the evaluation. Bronchovascular crowding likely accounts for the left lung base opacity. No definite signs of pneumonia or CHF. No large pleural effusion or pneumothorax is seen. The imaged osseous structures appear intact.", "output": "Low lung volumes without definite signs of acute intrathoracic process." }, { "input": "A right Port-A-Cath ends in the low SVC. Severe cardiomegaly is unchanged. There is no consolidation, pulmonary edema, or pleural effusion. Mild atelectasis is present at the left base. There is no pneumothorax.", "output": "No evidence of pneumonia. Mild left basilar atelectasis." }, { "input": "AP and lateral views of the chest are compared to prior from ___. Right chest wall port is seen with catheter tip in stable position in the distal SVC. Again low lung volumes are seen. There is no large confluent consolidation and costophrenic angles are sharp. The cardiomediastinal silhouette remains stable. Osseous and soft tissue structures are grossly unremarkable, noting hypertrophic changes in the spine.", "output": "Low lung volumes, but no evidence of acute cardiopulmonary process." }, { "input": "The lungs are well-expanded and clear. The cardiomediastinal silhouette is unremarkable. The hilar and pleural surfaces are normal in appearance. There is no pleural effusion or pneumothorax. No focal opacity is identified within the lungs. There is a displaced transverse fracture through the distal aspect of the right clavicle, which is better seen on concurrent radiographs of the right shoulder. No other fractures are identified.", "output": "1. No acute cardiopulmonary process. 2. Displaced transverse fracture through the distal right clavicle." }, { "input": "The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. Mediastinal and hilar contours are unremarkable. Consolidative opacity in the right lower lobe is concerning for pneumonia. Left lung is clear. No pleural effusion or pneumothorax is identified. No acute osseous abnormalities are visualized.", "output": "Right lower lobe pneumonia. Followup radiographs after treatment are recommended to ensure resolution of these findings." }, { "input": "The lung are clear and without a focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is at the upper limits of normal. No acute fractures are identified.", "output": "No acute cardiopulmonary process." }, { "input": "Semi-upright portable AP view of the chest provided. The tip of the endotracheal tube is appropriately positioned approximately 3.4 cm above the carina. The NG tube courses into the left upper abdomen. There is retrocardiac opacity most likely representing atelectasis. The lungs appear otherwise clear. Heart and mediastinal contours are stable with mild cardiomegaly redemonstrated. No bony abnormalities are seen.", "output": "Appropriately positioned ET and NG tubes. Left lower lobe atelectasis. Mild cardiomegaly." }, { "input": "The endotracheal tube ends 3.5 cm above the level of the carina. A right internal jugular central venous catheter ends in the mid SVC. An enteric catheter courses below the level of the diaphragm, extending into the first portion of the duodenum. Dense left retrocardiac opacification is concerning for infection versus aspiration, although atelectasis could have a similar appearance. Bandlike atelectasis in the left lower lung is increased. Heterogeneous opacities at the right lung base are also increased, concerning for infection/aspiration. Mild enlargement of the cardiac silhouette is not significantly changed. There are no pleural effusions. No pneumothorax is seen.", "output": "1. Increased bilateral lower lung heterogeneous opacities, left greater than right, concerning for infection and/or aspiration. 2. Increased bandlike left lower lung atelectasis. 3. Appropriately positioned lines and tubes. Findings were discussed with Dr. ___ by Dr. ___ at 4:47 p.m. via telephone on the day of the study." }, { "input": "The endotracheal tube is appropriately positioned, ending 4 cm above the level of the carina. A right internal jugular central venous catheter ends in the low SVC. An enteric catheter courses below the level of the diaphragm and out of the field of view inferiorly. Bibasilar atelectasis, left greater than right, is slightly increased. Lung volumes are low. Mild enlargement of the cardiac silhouette is not significantly changed. Small pleural effusions are not excluded. There is no pneumothorax.", "output": "1. Low lung volumes with slight increase in bibasilar atelectasis, worse on the left. 2. Appropriately positioned lines and tubes." }, { "input": "Portable upright chest radiograph demonstrates right lower lobe airspace opacity with rounded foci of upper lobe airspace opacity. There is left lower lobe collapse. There is no pneumothorax. The cardiac silhouette remains moderately enlarged. An endotracheal tube is in place with its tip located 4.5 cm from the level of the carina. An NG tube is in place projecting over the stomach though the tip is not seen. Right IJ central venous catheter tip is located in the mid SVC.", "output": "1. Multifocal airspace opacity, most striking in the right lower lobe, little changed, and left lower lobe collapse. 2. Moderate cardiomegaly, unchanged. 3. Expected position of support devices and tubes. Findings were discussed by phone with MICU nurse ___ at 11:25am." }, { "input": "There is mild diffuse increase in interstitial markings bilaterally consistent with mild interstitial pulmonary edema. There is slight blunting of the bilateral costophrenic angles which may be due to very trace pleural effusions. The cardiac silhouette is top-normal to mildly enlarged. The aorta is slightly tortuous. There is no pneumothorax.", "output": "Interstitial edema and possible very trace bilateral pleural effusions." }, { "input": "Portable AP upright chest radiograph obtained. There is no focal consolidation, effusion, or signs of pulmonary edema. The heart and mediastinal contour appears normal. Bony structures are intact.", "output": "No acute intrathoracic process." }, { "input": "The heart is mildly enlarged. There are streaky left basilar opacities suggesting atelectasis or scarring that appears similar to the prior examination. There is no pleural effusion or pneumothorax. The bones are demineralized. There are mild degenerative changes throughout the thoracic spine. Mild compression of a thoracolumbar vertebral body appears similar. The bones are demineralized.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Frontal and lateral radiographs demonstrate stable extensive post-surgical changes of the left hemithorax with associated loss of volume. Stable scarring noted in the right lung apex. On a background of chronic lung disease and chronic bibasilar opacifications there is new prominence of the interstitium as well as Kerley B lines consistent with pulmonary edeam. Heart size is top normal and stable. No pleural effusion or pneumothorax identified.", "output": "Stable background chronic lung changes. Stable top normal heart size with evidence of volume overload consistent with provided diagnosis of right ventricular regurgitation." }, { "input": "Superimposed on chronic volume loss, parenchymal scarring, and pleural thickening in the left hemithorax, there is a persistent superimposed opacification in the left lung, which has worsened somewhat between over two days including increased volume loss. Findings in the right lung appear more chronic.", "output": "Worsening volume loss and opacification of the left lung suggesting pneumonia superimposed on chronic findings." }, { "input": "PA and lateral views of the chest show interval clearing in bilateral airspace consolidation with no increased size in spiculated common nodular pleural thickening at the right lung apex compared to ___. Marker of on Ill volume loss in the left hemithorax related to the patient's surgery for Pancoast tumor is a chronic finding and occludes upper rib resections. Bones are demineralized.", "output": "Interval clearing of bibasilar consolidation compared to ___" }, { "input": "The multifocal bilateral opacities have essentially completely resolved since ___. Left pleural effusion has also completely resolved. Residual background emphysematous changes most prominent in the right upper lung with scarring and pleural thickening as well as background post-left upper lobectomy changes with elevation of the left hemidiaphragm are unchanged compared to ___. Blunting of the left costophrenic angle reflects thickening/scarring. A calcified perihilar node is unchanged. The heart is normal in size. The descending thoracic aorta is slightly tortuous, unchanged. Dextroconvex scoliosis of thoracic spine is overall similar with similar distortion of thoracic cage. Prominent degenerative changes in the thoracic spine are also overall unchanged.", "output": "Interval resolution of pneumonia." }, { "input": "Portable AP upright view of the chest was provided. There is again noted to be post-surgical change of the left lung apex with volume loss and leftward retraction of the mediastinal structures. There is also evidence of prior left upper rib cage resection with chest wall deformity evident. The right lung is hyperinflated with upper lobe lucency, likely reflecting underlying emphysema. Coarsened interstitial markings with micronodular opacity in the right lower lung likely reflect scarring and appears stable from prior exam. The left CP angle is excluded thus limiting evaluation. No definite new consolidation in the left lung to suggest the presence of pneumonia. The heart size appears stable.", "output": "Post-surgical changes in the left upper chest, with no definite signs of pneumonia." }, { "input": "One portable AP view of the chest. Patient is post left left upper lobe resection with thoracoplasty. Top normal heart size is stable. Mediastinal and hilar contours are stable. Bibasilar opacities are unchanged. Mild pulmonary vascular congestion is also unchanged. Severe emphysematous changes are again seen. Biapical scarring is unchanged. No pleural effusion or pneumothorax.", "output": "No significant change in bibasilar opacities and pulmonary vascular congestion compared to study done yesterday." }, { "input": "Scarring of the lung parenchyma and a left chest wall deformity are stable. Hyperinflated lungs with lucency reflect known emphysema. The previously seen left retrocardiac opacity has cle resolved ared. No focal opacity. Prominent interstitial markings may indicate mild edema. There is no pleural effusion or pneumothorax. The heart size is top normal. The aortic knob is calcified in the aorta is ectatic. There is no free air beneath the right hemidiaphragm.", "output": "Mild interstitial edema superimposed on a background of severe emphysema. No signs of pneumonia or pneumothorax." }, { "input": "AP upright and lateral views of the chest were provided. The lungs are hyperinflated with chronic deformity of the left upper hemithorax and rib cage. There are opacities in the lower lungs which raise concern for pneumonia. Underlying scarring is better assessed on the prior CT. The heart size is difficult to assess, though appears grossly stable. The mediastinal contour also is grossly unchanged. Small right pleural effusion is present.", "output": "Findings concerning for pneumonia within the lower lungs." }, { "input": "Increased opacity at the left upper and lower lung concerning for multi focal pneumonia. Left basilar atelectasis and pleural effusion is present. Small right pleural effusion is also noted. Right apical scarring is unchanged. There is no pneumothorax. The cardiac and mediastinal silhouettes are unchanged. An endotracheal tube is in standard position. Enteric tube terminates in the stomach. A linear tube extending to the level of the endotracheal tube it may represent esophageal probe. The right PICC terminates in the distal SVC.", "output": "1. The endotracheal tube is in standard position. 2. Multi focal pneumonia affecting the left upper lower lungs. 3. Moderate left pleural effusion and small right pleural effusion." }, { "input": "The patient's neck is flexed to the right. The ET tube tip appears to be 0.6 cm above the carina. Right PICC tip is in the lower SVC. Side port of the NG tube is likely below the GE junction, with the tip out of view. There is moderate pulmonary edema. Moderate right and small to moderate left effusions appear similar to prior, allowing for differences in patient positioning. Retrocardiac opacity and silhouetting of the left hemidiaphragm are similar to prior. Left upper lung distortion is similar to prior. There is no pneumothorax. The cardiomediastinal silhouette is normal. Aortic calcification projecting over the heart is similar to prior. No free air below the right hemidiaphragm is seen.", "output": "1. Evaluation of ET tube location is suboptimal due to patient positioning, but appears low. 2. Right PICC and NG tube are similar to prior. 3. Moderate right and small to moderate left effusions appear similar to prior, allowing for differences in patient positioning. 4. Other findings are similar to ___." }, { "input": "Frontal and lateral views of the chest demonstrate a stable postoperative appearance of the left hemithorax status post thoracoplasty. Right apical scarring persists. Right lung base opacity partially obscuring right hemidiaphragm is new since prior exam. Ill-defined left lung base opacity is also noted. No pleural effusion is seen. There is no pulmonary edema. Emphysema predominantly involving upper lung zones is unchanged. Hilar and mediastinal silhouettes are stable. Heart size is normal. Partially imaged upper abdomen is unremarkable.", "output": "Bibasilar opacities are new since ___ exam, possibly atelectasis, aspiration, or infection in appropriate clinical setting." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "PA and lateral views of the chest. The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are grossly clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Lungs are clear. No focal consolidation, pleural effusion or pneumothorax is seen. No acute osseous abnormality is visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vascularity is normal. No pleural effusion or pneumothorax is present. The osseous structures are unremarkable.", "output": "Normal chest radiograph." }, { "input": "A single portable frontal chest radiograph was obtained. An endotracheal tube terminates appropriately above the carina. The side hole and tip of the enteric catheter are below the diaphragm. The lungs are well expanded. A triangular opacity at the right hilus/perihilar region does not obscure the right heart border. There is left base atelectasis. There is no pneumothorax or effusion. Cardiac and mediastinal contours are normal.", "output": "Right hilar/perihilar opacity may reflect combination of right lower lobe atelectasis and aspiration, although infection or contusion not excluded in appropriate clinical setting." }, { "input": "PA and lateral views of the chest provided. ET and NG tubes have been removed. There is significant improvement in aeration of the lungs with resolved pulmonary edema. There is a small residual left pleural effusion and left lower lobe atelectasis. There is right perihilar opacity which could represent atelectasis, though pneumonia is difficult to exclude in the correct clinical setting. Heart size appears grossly stable. Mediastinal contour is unremarkable. Bony structures are intact.", "output": "Significant interval improvement in aeration of the lungs with persistent right perihilar and left lower lobe opacity, likely atelectasis. Small residual left effusion." }, { "input": "PA and lateral views of the chest provided. The lungs are hyperinflated which likely reflect underlying COPD/emphysema. A nodular structure projecting adjacent to the right heart border and a left perihilar nodular structure may represent en face vasculature though given concern for malignancy, CT correlation is advised. \\ There is no focal consolidation concerning for pneumonia. There is no effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Multilevel degenerative disease is noted in the thoracic spine with large anterior spurs. No free air below the right hemidiaphragm is seen.", "output": "Right lower lung and left perihilar nodular opacities, which may represent normal vascular structures. Consider CT to further assess." }, { "input": "Cardiac silhouette is enlarged but stable in size. Enlargement of central pulmonary vessels is consistent with previously provided history of pulmonary arterial hypertension. On the frontal view, there are no focal areas of consolidation. However, diffuse increased density is present overlying the spine on the lateral view, which is limited by combination of low lung volumes and respiratory motion. Minimal basilar interstitial opacities may reflect interstitial edema and have improved since previous ___ radiograph of ___. Small bilateral pleural effusions are present as well as a small amount of fluid in the fissures. High-grade compression deformity in the mid thoracic spine is unchanged since ___.", "output": "1. Cardiomegaly and minimal interstitial edema. 2. No definite pneumonia, but basilar pneumonia cannot be fully excluded on lateral radiograph. Considering the suboptimal technique on the lateral view, repeat lateral radiograph with improved inspiratory level may be helpful to exclude basilar pneumonia if warranted clinically." }, { "input": "The heart is mildly enlarged with a left ventricular configuration. The aortic arch is partly calcified. The mediastinal and hilar contours appear unchanged. Multifocal calcified pleural plaques are again present. Superimposed is mild upper zone re-distribution of indistinct pulmonary vascularity, suggestive of pulmonary venous hypertension or slight congestion, somewhat more prominent than on the more recent of the prior examinations. There is similar mild relative elevation of the right hemidiaphragm compared to the left. There is no pleural effusion or pneumothorax.", "output": "Findings suggestive of a slight vascular congestion or pulmonary hypertension. Calcified pleural plaques, suggestive of prior asbestos exposure." }, { "input": "Frontal and lateral views of the chest were obtained. Evidence of bilateral pleural plaques are again seen. There is persistent elevation of the right hemidiaphragm. No large focal consolidation is seen. There is no large pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable.", "output": "Bilateral calcified pleural plaques again seen suggesting prior asbestos exposure. No definite new focal consolidation." }, { "input": "Numerous bilateral pleural plaques are similar to the prior study. Right pleural thickening is chronic. The cardiomediastinal silhouette is unchanged with mild cardiomegaly. Elevation of the right hemidiaphragm is chronic. There are no concerning focal airspace opacities. There is no pulmonary edema. There is no pleural effusion or pneumothorax.", "output": "1. Bilateral pleural plaques related to asbestos exposure are unchanged. 2. No evidence of pneumonia. 3. Stable Mild cardiomegaly." }, { "input": "PA and lateral chest radiographs were provided. This study was read in conjunction with the chest CT done on the same day. There is no focal consolidation, pleural effusion or pneumothorax. The right hemidiaphragm is elevated. Multiple calcified pleural plaques correspond to those seen on the chest CT. The ascending aorta is mildly dilated and tortuous. The heart is enlarged. Bones are osteopenic.", "output": "No acute cardiopulmonary process. Multiple calcified pleural plaques as seen on the recent chest CT. Cardiomegaly." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. Cardiomediastinal silhouette is normal. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Calcifications of the aortic knob are noted. The heart is normal in size. The hila are unremarkable. There is no pleural effusion or pneumothorax. The lungs are well expanded and clear without focal consolidation concerning for pneumonia. The upper abdomen is unremarkable. The visualized osseous structures are within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "No radiodense foreign body is identified. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute intrathoracic process. No radiopaque foreign body." }, { "input": "PA and lateral views of the chest provided. Midline sternotomy wires and mediastinal clips are again noted. There are small bilateral pleural effusions, similar to prior exam. No signs of edema or pneumonia. Cardiomediastinal silhouette is stable. Bony structures are intact.", "output": "Small bilateral pleural effusions, similar to prior." }, { "input": "The lungs are well expanded and clear. No pleural abnormalities are seen. The heart size is normal. The mediastinum and hilar contours are unremarkable. Chronic rib deformities are seen on the left.", "output": "No pneumonia or pulmonary edema. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the ___ ___ at 1:13PM, 45 minutes after discovery of the findings." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear. A mild to moderate wedge compression deformity along a lower thoracic vertebral body appears mildly increased since the prior examinations but chronic.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Frontal and lateral chest radiographs demonstrate unremarkable cardiomediastinal and hilar contours. Lungs are clear. No pleural effusion or pneumothorax. There is mild anterior wedging of the midthoracic vertebrae.", "output": "No acute intrathoracic process. Wedge deformity of the midthoracic vertebrae, age indeterminate." }, { "input": "Frontal and lateral views of the chest were obtained. Low lung volumes result in bronchovascular crowding. There is no focal consolidation, pleural effusion or pneumothorax. Heart size is normal. Mediastinal silhouette and hilar contours are normal. A vertebral compression deformity in the mid thoracic spine is unchanged from the prior study.", "output": "No pneumonia, edema or effusion." }, { "input": "There has been interval removal of the right-sided chest tube. Moderate to large right pleural effusion persists and appears similar. There is likely underlying compressive atelectasis given the absence of mediastinal shift. No pneumothorax is detected. The left lung appears clear. Right internal jugular catheter appears similarly positioned with tip projecting over the mid superior vena cava.", "output": "Interval removal of right-sided chest tube with persistent moderate- to large-sized right pleural effusion." }, { "input": "AP single view of the chest was obtained with patient in sitting semi-upright position. Analysis is performed in direct comparison with the next preceding similar study of ___. During the interval, right-sided thoracocentesis was performed. The massive right-sided pleural density as identified on the previous examination has decreased moderately. Still the remaining pleural effusion obliterates totally the right-sided hemidiaphragm and reaches along the right-sided lateral chest wall. After the thoracocentesis, there is no evidence of any hydropneumothorax in the right hemithorax. Left-sided pulmonary changes which include a plate atelectasis in the left lung base remain unchanged. No new abnormalities are seen.", "output": "Marked reduction of right-sided pleural effusion after thoracocentesis, no pneumothorax." }, { "input": "PA and lateral views of the chest. No prior. There is a moderate-to-large right-sided pleural effusion. There is also likely right middle and lower lobe atelectasis. Linear opacity at the left lung base suggestive of atelectasis and there is suggestion of left apical calcified granulomas, but there is no confluent consolidation or left effusion. The cardiomediastinal silhouette is within normal limits. Hypertrophic changes are seen in the spine. Surgical clips in the right upper quadrant suggest prior cholecystectomy. Osseous and soft tissue structures are otherwise unremarkable.", "output": "Moderate-to-large right-sided pleural effusion with components of middle and lower lobe atelectasis." }, { "input": "There is a new, ill-defined opacity in the right upper lung field. Differential includes small focus of pneumonia or less likely neoplasm. The ill-defined margins favor an infectious process, and it would be reasonable to treat for pneumonia with followup radiographs in 3 weeks to document resolution. If the opacity is still seen on followup radiographs, chest CT should be performed at that time. No other suspicious lesion is seen. There is no pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "New ill-defined opacity in the right upper lung field, recommend empiric pneumonia treatment with followup radiographs in 3 weeks and chest CT if no resolution. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 3:01 PM, 3 minutes after the discovery of the findings." }, { "input": "There is a pacemaker overlying the left chest with a single lead in the right ventricle. There are surgical clips seen overlying the left hilum. Heart size is stable. The mediastinal and hilar contours are stable. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No evidence of congestive heart failure." }, { "input": "PA and lateral views of the chest. A left ICD device is seen with its tip in the right ventricle. A right-sided chest tube has its tip in the medial right mid hemithorax. Subcutaneous emphysema mostly on the right including the right pectoralis muscle as well as the right and left side of the neck is unchanged. Small right apical pneumothorax is unchanged. Tiny pleural effusions are unchanged. No consolidation. The cardiac, mediastinal, and hilar contours are normal.", "output": "1. Unchanged right apical pneumothorax with chest tube in place. 2. Unchanged subcutaneous emphysema." }, { "input": "A right apical chest tube is in stable position. There is extensive air tracking along subcutaneous fascial planes bilaterally, highlighting the pectoralis on the right side extending to involve the superior mediastinum. A small-to-moderate right pneumothorax is improved now only with a mild apical pneumothorax remaining. There is no left-sided pneumothorax. There is no large pleural effusion. There are no new focal parenchymal opacities concerning for pneumonia. The cardiomediastinal and hilar contours are stable with an AICD lead in stable position. Heart size is normal. There is mild tortuosity of thoracic aorta. Pulmonary vascularity is not increased.", "output": "Improvement in a right-sided pneumothorax with only a minimal right apical pneumothorax remaining." }, { "input": "PA and lateral views of the chest. After removal of the right pleural tube, the small right apical pneumothorax remains unchanged. The extent of subcutaneous emphysema is unchanged. Small if any pleural effusion. The lungs are clear. The right hemithorax is slightly elevated and the mediastinum is slightly shifted to the right consistent with right upper and middle lobectomies. The left AICD lead ends in the right ventricle.", "output": "1. After removal of chest tube, the small right apical pneumothorax is unchanged. 2. Extent of subcutaneous emphysema is unchanged. No new abnormality is noted." }, { "input": "Frontal and lateral views of the chest were obtained. A single-lead left-sided AICD is again seen with lead extending to the expected position of the right atrium. Post-surgical changes involving the right hemithorax are again seen. Nodular pulmonary opacities seen on prior CT are better evaluated on CT. No new focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Evidence of DISH is seen along the spine.", "output": "Chronic changes involving the right hemithorax; otherwise, no acute cardiopulmonary process." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is detected. There is mild pulmonary vascular prominence with top normal heart size.", "output": "Mild pulmonary vascular prominence." }, { "input": "Lungs are clear. No large effusion or pneumothorax. Cardiomediastinal silhouette is stable. Hilar contours are unchanged. Bony structures intact. No free air below the right hemidiaphragm.", "output": "No acute findings." }, { "input": "Cardiomediastinal and hilar contours are unchanged. There is no large right pleural effusion. There is no pneumothorax. Again seen are bilateral lower lung opacities, left greater than right, not significantly changed compared to prior. Left chest port is in unchanged position with tip in the low SVC.", "output": "Similar appearance compared to most recent prior radiograph with bibasilar opacities, left greater than right. This may represent atelectasis, aspiration, or pneumonia. Clinical correlation to left lower lobe signs and symptoms is recommended. Lateral view would also be helpful for further characterization." }, { "input": "Single portable view of the chest. Endotracheal tube is now seen with tip just below the clavicular heads, likely approximately 4 cm from the carina, in appropriate position. Left-sided central venous line is unchanged. Nasogastric tube passes below the inferior field of view. Otherwise, there has been no change.", "output": "Interval placement of ET and NG tubes have" }, { "input": "ET tube ends approximately 3 cm above the carina in appropriate position. Cardiomegaly persists with mild pulmonary edema, and bilateral pleural effusions continue to be seen. A left central venous line ends appropriately in the lower SVC.", "output": "Appropriate placement of ET tube." }, { "input": "Redemonstrated is a chronic, retrocardiac opacity with adjacent left pleural effusion. Mild interstitial pulmonary edema is present. Stable, moderate cardiomegaly is noted. There is a left-sided Port-A-Cath is seen extending into the lower SVC. There is no evidence of pneumothorax. The mediastinal contours are stable. No bony abnormality is detected.", "output": "1. Interval development of mild interstitial pulmonary edema. 2. Chronic retrocardiac opacity with adjacent left pleural effusion. 3. Stable cardiomegaly." }, { "input": "Portable AP chest radiograph. The patient has been extubated in the interim and the NGT removed. Left-sided subclavian catheter tip is in stable position. The left lower lobe is chronically consolidated, presumably atelectatic (the mediastinum is anatomically located to the left). Right lower lung atelectasis is slightly improved. Mild interstitial edema and moderate cardiomegaly are also unchanged. There is no pneumothorax.", "output": "Chronic left lower lobe atelectasis and mild pulmonary edema." }, { "input": "Single frontal view of the chest. NG tube terminates in the lower esophagus. Endotracheal tube terminates 3.6 cm above the carina. Catheter of a left chest wall port, which has been accessed, terminates in the lower SVC. Patient rotation limits evaluation of the cardiomediastinal silhouette. There is asymmetric elevation of left hemidiaphragm. Retrocardiac opacity could represent atelectasis or infection. No substantial pleural effusion or pneumothorax.", "output": "Left base opacity could represent atelectasis or infection. NG tube terminates in the lower esophagus." }, { "input": "Multiple support tubes and lines are in unchanged position. Since the most recent exam from ___ at 22:10, the lung volumes are lower. There is new left lower lobe collapse with a tiny left pleural effusion. This is similar to the prior radiogrpha from ___ at 14:55. Minimal right basilar atelectasis is unchanged. There is no right pleural effusion. There is no pneumothorax. The cardiomediastinal silhouette is unchanged.", "output": "Recurrent left lower lobe collapse." }, { "input": "AP single view of the chest has been obtained with patient in semi-upright position. Analysis is performed in direct comparison with the next preceding similar study obtained five hours earlier during the same day. Patient remains intubated. Comparison with the previous study, an NG tube can now be identified, seen to pass well below the diaphragm. Chest findings remain unaltered. Subclavian central venous line on left side, atelectasis in left lower lobe area, pulmonary congestive pattern as before.", "output": "Successful placement of NG tube." }, { "input": "Heart size is normal with moderate unfolding of the thoracic aorta. Surgical clip projecting over the right hilus is unchanged, as are post-surgical changes in right lung. Cardiomediastinal silhouette and hilar contours are otherwise normal. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality. Specifically no cardiomegaly." }, { "input": "Since prior, there has been no significant interval change. The right apical hydropneumothorax as well as right pleural effusion are stable. There is mild basilar atelectasis, the left lung is otherwise clear. Cardiomediastinal and hilar contours are unchanged. Surgical clips are noted in the right hilar and mediastinal regions as well as at the right lung apex.", "output": "No interval change." }, { "input": "Frontal and lateral views of the chest. Postoperative changes of right upper lobectomy are seen with volume loss in the right hemithorax. Hydropneumothorax is again seen with fluid level rising, an expected postoperative evolution. The left lung and remaining right lung are clear. The cardiomediastinal silhouette is stable. No acute osseous abnormalities identified.", "output": "Expected evolution of postoperative changes of a right upper lobectomy without acute superimposed cardiopulmonary process." }, { "input": "AP and lateral views of the chest were obtained. Post-surgical changes are again seen. Right apical air cavity is stable to possibly minimally decreased. Right basilar opacity is seen, similar to prior, with grossly stable to possibly very minimally increased right pleural fluid. There may also be mild increase in atelectasis. Surgical clips are noted in the right hilar and mediastinal regions as well as in the right lung apex. There is mild left basilar atelectasis without new focal consolidation in the left lung. No left pleural effusion is seen.", "output": "Grossly stable examination with possible slight decrease in size of right apical air cavity, mildly increased right basilar atelectasis, and possible very slight increase in right pleural effusion." }, { "input": "The patient is status post right upper lobectomy and again seen is volume loss in the right hemi thorax. There is a right pleural effusion as well as atelectasis at the right base. The left lung appears clear. The cardiomediastinal silhouette is stable. There are no acute osseous abnormalities identified.", "output": "Moderate right pleural effusion and right basal atelectasis, increased from the prior study." }, { "input": "The lungs are well inflated and clear. There is unchanged asymmetric elevation of the right hemidiaphragm. The cardiomediastinal silhouette and hilar contours are unchanged. There is no pleural effusion or pneumothorax. Scattered surgical clips are identified at the right hilum and the right apex from prior lobectomy.", "output": "No acute cardiopulmonary process." }, { "input": "Portable AP upright view of the chest provided. There has been no significant change from the prior exam with diffuse airspace opacities, most notable in the right mid-to-lower lung. No large effusion or pneumothorax is seen. The overall cardiomediastinal silhouette appears stable. The imaged bony structures appear intact.", "output": "Stable exam from outside hospital study performed earlier today with diffuse airspace opacities concerning for pneumonia." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Calcified granuloma in the right lower lobe. The lungs are otherwise clear of airspace or interstitial opacity. The cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax. No acute or aggressive osseus changes.", "output": "Normal chest radiograph." }, { "input": "Heart size is top-normal. The aorta is tortuous. Convexity along the right paratracheal stripe may reflect tortuous vessels. Right hilar prominence may reflect underlying lymphadenopathy. Mediastinal and left hilar contours are otherwise unremarkable. No pulmonary edema is present. Increased interstitial opacities are seen in the lung bases, potentially reflective of a chronic changes. No focal consolidation, pleural effusion or pneumothorax is detected. There mild degenerative changes in the lower thoracic spine.", "output": "1. Increased interstitial opacities the lung bases, potentially reflective of chronic changes. No focal consolidation. 2. Right hilar prominence may be suggestive of underlying lymphadenopathy." }, { "input": "Left base atelectasis is seen. There is blunting of the left costophrenic angle which may be due to a trace pleural effusion. No pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. No overt pulmonary edema is seen.", "output": "Left base atelectasis. Blunting of the left costophrenic angle, trace pleural effusion not excluded. Underlying consolidation difficult to exclude. No pneumothorax seen." }, { "input": "Right internal jugular approach temporary pacing wire terminates at the level of the cardiac apex however is redundant in the right atrium and ventricle. Left lower lobe atelectasis and small left pleural effusion persist. Tortuous and calcified aortic arch is again noted.", "output": "Redundant right internal jugular approach cardiac pacing wire in terminating in the region of the right ventricle." }, { "input": "There has been interval placement of a temporary pacing lead terminating in the region of the right ventricle via a right internal jugular approach. No pneumothorax. Lung volumes remain low. Moderate enlargement of the cardiac silhouette persists. The aorta is markedly tortuous and diffusely calcified. Pulmonary vasculature is not engorged. Linear retrocardiac opacity persists, likely atelectasis, without large pleural effusion or pneumothorax.", "output": "Temporary pacing lead appears to terminate in the region of the right ventricle. No pneumothorax." }, { "input": "The lungs are clear. There is no pneumothorax or pleural effusion. The heart and mediastinum are within normal limits. Regional bones and soft tissues are unremarkable.", "output": "Clear lungs with no evidence of pneumonia." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are normal. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "AP portable upright chest radiograph provided. The lungs are well expanded and clear. No signs of pneumonia or effusion. No pneumothorax is seen. The cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "No acute abnormalities." }, { "input": "AP and lateral views of the chest. Right chest wall port is seen with catheter tip in the mid SVC. The lungs are clear of focal consolidation or effusion. The cardiac silhouette is mildly enlarged, similar to prior, with prominence of the ascending aorta seen on prior PET-CT. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "Right chest wall Port-A-Cath is seen with catheter tip extending to the mid SVC region. Hyperinflated lungs are noted with flattened diaphragms compatible with COPD. No focal consolidation, large effusion or pneumothorax is seen. There is likely mild bibasilar atelectasis. The cardiomediastinal silhouette appears stable. No acute bony abnormalities. No free air below the right hemidiaphragm.", "output": "COPD without superimposed pneumonia." }, { "input": "There are small bilateral pleural effusions with overlying atelectasis, greater on the left. No pneumothorax identified. The size of the cardiomediastinal silhouette is enlarged but unchanged. Partially evaluated gaseous distention of multiple upper abdominal bowel loops.", "output": "Small bilateral pleural effusions with overlying atelectasis, greater on the left. Incompletely evaluated gaseous distention of multiple upper abdominal bowel loops." }, { "input": "Right Port-A-Cath tip ends in the right atrium. No focal consolidation, effusion, overt edema, or pneumothorax. Linear opacity in the lingula suggestive of discoid atelectasis. . Mediastinum is not widened. No acute osseous abnormality.", "output": "No focal pneumonia." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities demonstrated.", "output": "Normal chest radiograph." }, { "input": "The lungs are well inflated and clear. The heart and mediastinal contours are normal. No focal consolidation, nodule, pneumothorax or effusion is present.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "A frontal and lateral chest radiographs demonstrate retrocardiac opacifications, unchanged compared to ___, likely representing combination of atelectasis and stable small left-sided pleural effusion. Streaky opacifications in the right lung base likely represent minimal atelectasis. Small stable right pleural effusion. There is stable enlargement of the ascending thoracic aorta, with no radiographic perceptible increase in diameter. Interval removal of right central venous sheath catheter.", "output": "Bibasilar opacifications, left greater than right, likely combination of atelectasis and stable small pleural effusions. Stable mediastinum, unable to differentiate between aorta and hematoma at this point." }, { "input": "There is interval worsening of pulmonary vascular congestion. There is mild pulmonary edema. The heart and mediastinal structures are unchanged. An endotracheal tube nasogastric tube and left internal jugular catheter remain in place. There are no concerning bone findings.", "output": "Interval worsening of vascular congestion. There is mild pulmonary edema." }, { "input": "Lung volumes remain persistently low. Left internal jugular central venous catheter tip terminates at the confluence of the brachiocephalic veins. No pneumothorax. Endotracheal tube is in standard position terminating approximately 4 cm from the carina. Enteric tube courses below the left hemidiaphragm, into the stomach and off the inferior borders of the film. Heart size is normal. Mediastinal and hilar contours are unchanged. Mild pulmonary vascular congestion is slightly improved in the interval. Patchy atelectasis is noted in the lung bases. No large pleural effusion is noted however the extreme left costophrenic angle is excluded from the field of view. No acute osseous abnormalities are detected.", "output": "1. Left internal jugular central venous catheter tip at the confluence of the brachiocephalic veins. No pneumothorax. 2. Standard positioning of the endotracheal and enteric tubes. 3. Improving mild pulmonary vascular congestion." }, { "input": "Lung volumes remain low. There is continued evidence of mild pulmonary edema mediastinal structures are unchanged. An endotracheal tube, nasogastric tube and left internal jugular catheter remain in place. There is no significant change.", "output": "No significant change." }, { "input": "Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is no focal lung consolidation.", "output": "No radiographic explanation for chest pain." }, { "input": "The lungs are clear, cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax.", "output": "No acute cardiothoracic process." }, { "input": "PA and lateral views of the chest were provided. Streaky left perihilar opacity appears similar to prior CT exam and may reflect prior radiation treatment. There is bibasilar atelectasis with a probable component of scarring. No convincing signs of pneumonia. No pleural effusion or pneumothorax. The heart size is difficult to assess appears grossly stable. Mediastinal contour is normal. No definite bony abnormalities are seen. Clips are partially imaged in the right upper quadrant.", "output": "Streaky perihilar and lower lung opacities likely reflect scarring and or atelectasis. No convincing signs of pneumonia." }, { "input": "The lungs are well inflated and clear. There is no evidence of pneumonia. There is no pleural effusion or pneumothorax. Osseous structures are intact. Again noted are surgical clips in the left upper quadrant and in the midline of the upper abdomen.", "output": "No evidence of pneumonia." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.Previously described small calcifications in the left upper lung are no longer identified.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No overt pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Endotracheal tube terminates approximately 5.6 cm above the level of the carina. Enteric tube courses below the diaphragm, inferior aspect not included on the image. The left costophrenic angle is not fully included on the image. The imaged lungs are clear. No pleural effusion or focal consolidation is seen. There is no evidence of pneumothorax.", "output": "Left costophrenic angle not fully included on the image. Given this, no acute intrathoracic process. Endotracheal tube in appropriate position." }, { "input": "The lungs are clear, the cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax.", "output": "No acute intrathoracic process." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Lungs are hyperinflated but clear. Pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is appreciated. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Pulmonary vascularity is normal and the lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. Lung volumes are low though allowing for this, there is no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. The bony structures are intact. No free air below the right hemidiaphragm. Clips in the right upper quadrant noted.", "output": "No signs of pneumonia." }, { "input": "The lungs are clear without evidence of consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. Bibasilar opacities are likely atelectasis. The cardiomediastinal silhouette is top-normal in size. The imaged upper abdomen is unremarkable. The bones are intact.", "output": "No acute cardiopulmonary process. Bibasilar atelectasis." }, { "input": "No focal consolidation, pleural effusion, or pneumothorax is seen. Heart and mediastinal contours are within normal limits.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is identified. No acute osseous abnormality is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "A single frontal AP view of the chest shows no consolidation, pulmonary edema, pleural effusion, or pneumothorax. Cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Single frontal view of the chest demonstrates low lung volumes without pleural effusion, focal consolidation or pneumothorax. The hilar and mediastinal silhouettes are unremarkable. Heart size is normal. Partially imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Moderate-to-severe cardiomegaly is similar to prior. Alveolar infiltrates at the lung bases are stable across multiple prior exams. Bilateral small to moderate pleural effusions are similar to prior. No pneumothorax. NG tube terminates below the diaphragm.", "output": "Stable bibasilar alveolar opacities. Bilateral small to moderate pleural effusions." }, { "input": "NG tube terminates in the stomach. Surgical clips overlie the right upper quadrant. The heart is severely enlarged, similar to prior, with stable cardiomediastinal contours. Bilateral pleural effusions, right greater than left, are similar to prior with stable alveolar opacity at the right base. Opacity of the left base has minimally improved, with persistent retrocardiac opacity. No pneumothorax.", "output": "Improved left base and persistent right base consolidation. Stable small bilateral pleural effusions." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is normal. Minimal atelectasis is seen in the retrocardiac region. Remainder of the lungs are clear. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Minimal retrocardiac atelectasis." }, { "input": "Low lung volumes are present. The lungs and pleural spaces are grossly clear without pneumothorax or pleural effusions. Bibasilar atelectasis is present. Heart size is normal, and mediastinal contours are grossly unchanged. There is an old left clavicular deformity present.", "output": "No acute intrathoracic process." }, { "input": "Upright AP portable view of the chest was obtained. No focal consolidation, large pleural effusion, evidence of pneumothorax is seen. There is mild central pulmonary vascular engorgement without overt pulmonary edema. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process. However, please note that there was a rounded parenchymal opacity seen on the prior study only on the lateral view, for which followup to resolution is recommended. It was not seen on the frontal view of the prior study, and should be followed up with lateral view." }, { "input": "ET tube terminates approximately 2.3 cm above the carina. The heart size is normal. The hilar and mediastinal contours are normal. There is mild bibasilar atelectasis. No focal consolidations concerning for pneumonia are identified. There is no pleural effusion. The previously noted multiple rib fractures and small pneumothorax is not well visualized on this exam.", "output": "ET tube terminates appropriately approximately 2.3 cm above the carina." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cardiac silhouette size is top normal. Mediastinal and hilar contours are within normal limits. Pulmonary vasculature is not engorged. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. No acute osseous abnormality is demonstrated. Bilateral breast prostheses are noted.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Dual lead left-sided pacer is stable in position. The patient is status post median sternotomy and cardiac valve replacements. Cardiac and mediastinal silhouettes are stable. Slight prominence of the hila is stable. No focal consolidation is seen. There is no pleural effusion or pneumothorax.", "output": "No significant interval change from ___. No acute cardiopulmonary process." }, { "input": "Portable, semi-upright radiograph of the chest demonstrates low lung volumes with resulting bronchovascular crowding. There is increased opacification of the bilateral bases to the mid lung fields, which most likely represents pulmonary edema, however underlying infection cannot be excluded. There is severe cardiomegaly, which is stable. There are small to moderate bilateral pleural effusions. There is no pneumothorax.", "output": "1. Increased opacification of the bilateral bases to the mid lung fields, which most likely represents pulmonary edema, however underlying infection cannot be excluded. 2. Stable cardiomegaly. 3. Small-to-moderate bilateral pleural effusions." }, { "input": "There are low lung volumes. The heart size is moderate to severely enlarged but unchanged. The mediastinal contours are stable. Focal opacity is noted within the right upper lung field. Additionally there is mild pulmonary vascular congestion. Streaky left basilar opacity could reflect atelectasis. No large pleural effusion or pneumothorax is identified. Left mid clavicular subacute fracture is partially obscured due to overlying catheter.", "output": "Focal right upper lung field opacity concerning for pneumonia. Mild pulmonary vascular congestion. Probable left basilar atelectasis." }, { "input": "Single portable chest radiograph demonstrates a slight interval decrease of persistent enlargement of the cardiomediastinal silhouette. There is also persistent though decreased bilateral pulmonary opacifications. The remaining opacifications are predominantly within the right lower and left upper lungs. No pneumothorax is identified. Possible small left pleural effusion present.", "output": "Decreased evidence of pulmonary edema, though there is persistent multifocal opacifications, which may represent asymetric resolving edema versus infectious process. Small left pleural effusion." }, { "input": "Frontal and lateral views of the chest were obtained. The cardiac silhouette is moderately enlarged. Perihilar opacities suggest mild pulmonary edema. However, there are additional patchy opacities in the right mid-to-lower lung which could relate to fluid overload, aspiration, or infection. No evidence of pleural effusion is seen on the left. There is persistent blunting of the right costophrenic angle, similar to prior. No pneumothorax is seen.", "output": "1. Moderate-to-severe cardiac silhouette enlargement. 2. Perihilar opacity may be due to mild pulmonary edema. However, additional patchy opacities in the right mid-to-lower lung could be due to prominent vasculature, infection, or aspiration." }, { "input": "Moderate to severe cardiomegaly appears slightly increased compared to the previous exam. Mediastinal and hilar contours are unchanged. The pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is seen. There are mild degenerative changes within the thoracic spine.", "output": "Moderate to severe cardiomegaly, slightly increased compared to previous exam. No pulmonary edema or radiographic evidence for pneumonia." }, { "input": "Increased opacities in the right lung may be concerning for aspiration or infection. Lung volumes remain low with worsening moderate bibasilar atelectasis. The heart continues to be moderately enlarged. The tip of the right PICC line is seen in the low SVC. The tracheostomy is in the appropriate position. Pleural effusions are not well ___.", "output": "1. Increased opacities in the right lung are concerning for aspiration or infection. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ ___ on the telephoneon ___ at 1:10 PM, 1 minutes after discovery of the findings." }, { "input": "The lungs are now clear besides relatively streaky right basilar opacity. There is no edema or effusion. Right basilar opacity is Moderate cardiac enlargement is slightly improved from prior. No acute osseous abnormalities. Old healed mid left clavicular fracture is again noted.", "output": "Bibasilar opacity is most likely atelectasis noting that infection is not entirely excluded." }, { "input": "Frontal portable radiographs of the chest demonstrate stable severe cardiomegaly. Mediastinal and hilar contours are stable. There is new compared to the prior study there is new pulmonary edema with more confluent opacities in the left upper lung and right lower lung which could be asymmetric edema but multifocal infectious process is possible. No large pleural effusion or pneumothorax.", "output": "Stable severe cardiomegaly with new pulmonary edema. More confluent opacities in the left upper lung and right lower lung could represent asymmetric pulmonary edema; however, infectious process is possible" }, { "input": "Right-sided PICC line has been pulled back with the tip at the cavoatrial junction. The tip of the Dobhoff is in the body of the stomach. The nasogastric tube has been removed. ET tube remains in good position. Given for differences in positioning, bibasilar opacities and associated effusions have marginally increased. Moderate cardiomegaly persists.", "output": "Tip of the Dobhoff is in the body of the stomach. Right-sided PICC now at the cavoatrial junction" }, { "input": "The heart remains moderate to severely enlarged. Mediastinal contours are stable. Mild pulmonary edema appears similar compared to the prior exam. More focal opacification in the right upper lobe may reflect asymmetric pulmonary edema, though infection cannot be completely excluded. Atelectatic changes are also seen in both lung bases. Small bilateral pleural effusions are noted. There is no pneumothorax. Left mid clavicular fracture is again seen.", "output": "Persistent mild pulmonary edema and bibasilar atelectasis. More focal opacity in the right upper lobe may reflect asymmetric pulmonary edema though infection cannot be excluded." }, { "input": "There are low lung volumes consistent with poor inspiratory effort. There is resolution of the bilateral opacities when compared to previous chest radiographs. There is no focal consolidation, pneumothorax or pleural effusion noted. Heart size continues to be severely enlarged with no pulmonary edema noted. Differential includes cardiomyopathy and pericardial effusion. The mediastinal silhouette contours are normal. There is callus formation of the left clavicular fracture with no displacement when compared with previous chest radiograph.", "output": "Resolution of the bilateral opacities with continued severe enlargement of the cardiac silhouette. Differential includes cardiomyopathy and pericardial effusion." }, { "input": "Frontal and lateral radiographs of the chest were acquired. The cardiac silhouette remains moderately enlarged, but not significantly changed compared to the most recent radiograph from ___. The mediastinal contours are otherwise normal. There is minimal right lower lobe atelectasis. The lungs are otherwise clear. Marked tracheomalacia is redemonstrated. There are no pleural effusions or pneumothorax. Deformity of the left clavicle relates to remote trauma.", "output": "1. No acute cardiac or pulmonary findings. 2. Moderate enlargement of the cardiac silhouette, unchanged. 3. Marked tracheomalacia." }, { "input": "PA and lateral views of the chest provided. Subtle linear density in the right lower lung is likely indicative of scarring. A retrocardiac bulbous opacity is most compatible with a small hiatal hernia. Lungs are clear without focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Small retrocardiac density is compatible with hiatal hernia. No signs of pneumonia or edema." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes, which accentuate the bronchovascular markings. There is no pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unchanged. Heart size is normal. There is no pulmonary edema. Retrocardiac opacity, projecting over spine on the lateral view not seen on prior. Partially imaged upper abdomen is unremarkable. Small hiatal hernia.", "output": "Retrocardiac opacity, likely atelectasis or infection in the appropriate clinical setting." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits aside from a moderate hiatal hernia projecting along the central lower mediastinum with an air-fluid level. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures are unremarkable.", "output": "No evidence of acute disease. Substantial hiatal hernia." }, { "input": "Lung volumes are normal. There is no focal consolidation, effusion, or pneumothorax. Mild tortuosity of the descending thoracic aorta is unchanged. Otherwise, mediastinal and hilar contours are stable. Heart size is normal.", "output": "No acute intrathoracic process." }, { "input": "No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process, including no evidence of pneumothorax." }, { "input": "There is no consolidation, pleural effusion, or pneumothorax. Cardiomediastinal and hilar silhouettes are normal size. Tortuous aortic contour is unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well expanded. Bilateral diffuse interstitial thickenings are compatible with pulmonary edema. There is no focal opacity. The heart is enlarged, mostly from left atrial and left ventricle contribution with splaying of the carina, left atrial appemndage prominence and verticalization of the long cardiac axis. There is a large hiatal hernia and a tortuous aorta which account for a rounded retrocardiac opacity in the lateral view. There is no pleural effusion or pneumothorax.", "output": "1. Bilateral diffuse interstitial thickening may be due to interstitial pulmonary edema in the setting of enlargement of the left cardiac chambers or may be secondary to pulmonary emphysema. 2. Large hiatal hernia." }, { "input": "The cardiac silhouette is normal in size. The hilar and mediastinal contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear unchanged. There is no pleural effusion or pneumothorax. Mild degenerative changes along the mid thoracic spine are stable.", "output": "No evidence of acute disease." }, { "input": "The lungs are well expanded and clear. Cardiac size is again noted to be borderline normal but cardiomediastinal and hilar contours are otherwise unremarkable. There is no pleural effusion or pneumothorax.", "output": "Unremarkable chest radiographic examination." }, { "input": "PA and lateral chest radiographs demonstrate no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lung volumes are low. The heart is at the upper limits of normal size. The lungs appear clear. There are no pleural effusions or pneumothorax. Mild degenerative changes are similar along the thoracic spine.", "output": "No evidence of acute disease." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of normal size with normal cardiomediastinal contours. The lungs are clear without focal or diffuse abnormality. No pleural effusion or pneumothorax. Unremarkable pulmonary vasculature. Unremarkable osseous structures. No radiopaque foreign body.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are hyperinflated. Subtle left base opacity is most likely due to atelectasis and overlying vascular structures although a subtle consolidation is not excluded in the appropriate clinical setting. There is no pleural effusion or pneumothorax. No overt pulmonary edema is seen. The cardiac silhouette is mild to moderately enlarged. The aorta is calcified and tortuous.", "output": "Hyperinflated lungs. Cardiomegaly. No pulmonary edema. Subtle opacity at the left lung base most likely due to atelectasis and/ or overlying vascular structures although early consolidation is not excluded in the appropriate clinical setting." }, { "input": "The lungs are clear besides mild left basilar atelectasis. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Portable AP upright chest radiograph obtained. Right CP angle is partially excluded. Evaluation is somewhat limited due to underpenetrated technique. The lungs are clear bilaterally. No sign of effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bones are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "Two PA and one lateral chest radiographs were obtained. The lungs are well inflated and clear. No focal consolidation, effusion, or pneumothorax is present. The cardiac and mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest demonstrate no focal consolidations. Heart size is normal. No pneumothorax or pleural effusion. Several thoracic vertebral bodies demonstrate height loss.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Cardiomediastinal silhouette and hilar contours are unremarkable. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest. The lungs are clear. The cardiomediastinal silhouette is within normal limits. Mild wedging of a few mid thoracic vertebral bodies is unchanged compared to prior. No acute osseous abnormality identified.", "output": "No acute cardiopulmonary process." }, { "input": "A nasogastric tube enters the stomach, tip not visualized. An endotracheal tube terminates at the level of the clavicles. The chin and associated soft tissues partially obscure the lung apices. Marked cardiomegaly despite the projection has increased. Lung volumes are relatively low, and retrocardiac and right basilar subsegmental atelectasis is unchanged. The lungs are grossly clear.", "output": "Nasogastric tube enters the stomach, tip not visualized." }, { "input": "There has been placement of an endotracheal tube which terminates very close to the ostium of the right mainstem bronchus and should be retracted by 2 cm right PICC line terminates in the low SVC. Enteric tube is unchanged. Left lower lobe atelectasis is moderate. Lungs are otherwise clear.", "output": "Low position of the endotracheal tube, should be retracted by 2 cm. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 10:03 AM, 2 minutes after discovery of the findings." }, { "input": "Enteric tube and right PICC are unchanged in location. Lung volumes are slightly lower. Cardiomegaly stable. No pleural effusion or pneumothorax. No new parenchymal consolidation.", "output": "Slight decrease in lung volumes, otherwise no significant change from ___ at 10:52." }, { "input": "No evidence of free air is seen beneath the diaphragms. Mild basilar atelectasis is seen. No large pleural effusion is seen, although a trace right pleural effusion be difficult to exclude. Cardiac silhouette is top-normal to mildly enlarged. Aortic knob is calcified. No focal consolidation is seen.", "output": "No evidence of free air beneath the diaphragms." }, { "input": "AP upright and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Heart size is mildly enlarged. The mediastinal and hilar contours are unremarkable. Atherosclerotic calcifications are noted in the aorta diffusely. Pulmonary vasculature is normal. Blunting of the costophrenic angles posteriorly on the lateral view suggests minimal pleural effusions bilaterally. No focal consolidation or pneumothorax is demonstrated. Mild to moderate multilevel degenerative changes are seen in the thoracic spine.", "output": "Probable minimal bilateral pleural effusions. No focal consolidation." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "There are small bilateral pleural effusions. Left perihilar opacity is most concerning for consolidation possibly from pneumonia, underlying pulmonary lesion not excluded. The cardiac silhouette is top-normal to mildly enlarged. The aorta is tortuous.", "output": "Small bilateral pleural effusions. Left perihilar opacity concerning for consolidation, less likely asymmetric pulmonary vascular congestion, underlying pulmonary lesion not excluded. Recommend follow-up to resolution to exclude an underlying pulmonary lesion." }, { "input": "Linear left basilar atelectasis is noted. Nodular densities over lung bases are most compatible with nipple shadows. Lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. Old healed left posterior rib fractures are noted. Partially visualized catheter projects over the upper abdomen.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation, pleural effusion or pneumothorax identified. The size the cardiomediastinal silhouette is within normal limits. Unchanged chronic appearing left rib fractures.", "output": "No radiographic evidence of acute cardiopulmonary disease." }, { "input": "There is moderate bilateral platelike atelectasis. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Right upper quadrant stents and upper abdominal catheter are partially imaged.", "output": "1. No pneumonia. 2. Moderate bilateral atelectasis." }, { "input": "Cardiomediastinal contours are within normal limits. Band-like atelectasis is present in the lower lobes, left greater than right, but there are no new areas of consolidation to suggest the presence of pneumonia. Healed left rib fractures are incidentally noted.", "output": "Bibasilar linear atelectasis. No evidence of pneumonia." }, { "input": "The lungs are clear besides left basilar atelectasis. The cardiac and mediastinal contours are normal, and there is no pleural effusion or pneumothorax. Percutaneous transhepatic biliary drain is partially imaged in the midline of the upper abdomen. Old healed left posterior rib fractures are noted.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Heart size is normal. Multiple old healed left rib fractures are noted.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. Right chest wall double-lumen port is seen with tip in the mid SVC. There is a 1-cm nodule projecting over the right lower lung on the frontal view, which is most likely a nipple shadow. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified noting multiple posterior left rib fractures, which appear old.", "output": "No acute cardiopulmonary process. 1-cm nodular opacity projecting over the right lower lung, potentially nipple shadow. However, given patient's history of malignancy, followup with nipple marker is suggested to confirm." }, { "input": "PA and lateral views of the chest with nipple markers demonstrate no evidence of a lung nodule or mass. Cardiomediastinal contours are within normal limits. Lungs and pleural surfaces are clear. Port-A-Catheter is unchanged in position. Healed left rib fractures are again demonstrated.", "output": "No radiographic evidence of lung nodule or mass." }, { "input": "Chest, PA and lateral. Change in shape since ___ of the large crescentic opacity in the left lower lobe, new since ___, shows it is largely atelectasis. Right lower lobe opacification is more likely atelectasis than pneumonia. Heart size is top normal. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal.", "output": "1. Heterogeneous opacity in the right lower lobe may represent atelectasis; however, infection cannot be excluded. 2. Bibasilar atelectasis could be fever souce. 3. This study does not speak to the possibility of acute pulmonary embolus." }, { "input": "Frontal and lateral views of the chest demonstrated right PIC catheter projecting over mid SVC. Low lung volumes without pleural effusions, focal consolidation or pneumothorax. Linear opacity in the left lung likely represents atelectasis. Hilar and mediastinal silhouettes are unchanged. Heart size normal. No pulmonary edema.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits and unchanged since prior examination. Again noted is a thick band of atelectasis at the left lung base with smaller atelectatic changes bilaterally. There is no new focal consolidation. No definite vascular congestion or pleural effusions. There is no pneumothorax. Multiple rib fractures are again noted along the left.", "output": "Stable atelectatic changes bilaterally with no acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. There are cholecystectomy clips in the right upper quadrant.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is a right Port-A-Cath and left subclavian with both tips in the mid SVC. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "1. Appropriately positioned right Port-A-Cath and left subclavian. 2. No evidence of pneumonia." }, { "input": "Supportive a monitoring equipment unchanged compared to the prior study. There are persistent bibasilar opacities, similar in extent when compared to the prior study. There is likely a right pleural effusion, layering posteriorly. No pneumothorax seen. No free air under the diaphragm.", "output": "No significant interval change when compared to the prior study." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "The lungs remain clear. Mediastinal structures are unchanged. Bilateral central venous catheters remain in place.", "output": "No acute change." }, { "input": "Lung volumes are unchanged compared to the prior study. A left-sided subclavian catheter terminates in the proximal SVC. A right internal jugular Port-A-Cath terminates in the mid SVC. The cardiomediastinal contour is normal. There has been progression of the bilateral basal airspace opacities. This may reflect pulmonary edema versus is infection. Given the normal heart size, the latter is considered more likely. No pleural effusion seen. An endotracheal tube is in-situ, the tip is 4.7 cm above the carina. No pneumothorax seen.", "output": "Increase in the bibasilar airspace opacities concerning for infection versus pulmonary edema." }, { "input": "Right chest subcutaneous port with catheter tip in the mid SVC is grossly unchanged in position. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. No focal consolidation, pleural effusion, or pneumothorax.", "output": "Right chest subcutaneous port with catheter tip in the mid SVC is grossly unchanged in position." }, { "input": "Cardiac size is normal. The lungs are clear. There is no pneumothorax or pleural effusion. Bilateral central catheters terminate in the mid SVC", "output": "No acute cardiopulmonary abnormality" }, { "input": "As compared to ___, the small bilateral pleural effusions have not significantly changed. The basal and retrocardiac opacities have also not significantly changed. No pulmonary interstitial edema. No pneumothorax. Unchanged size of the cardiac silhouette. Unchanged monitoring and support devices with the ETT 4 cm from the carina.", "output": "No significant interval change." }, { "input": "There is no consolidation, pleural effusion, or pneumothorax. Cardiomediastinal and hilar silhouettes are normal size. Right pectoral infusion port terminates at mid SVC.", "output": "No evidence of pneumonia." }, { "input": "An accessed right pectoral MediPort terminates in the mid SVC. The lungs are clear. The heart and mediastinum are within normal limits. Bones and soft tissues are unremarkable.", "output": "Clear lungs with no radiographic evidence of pneumonia." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are hyperinflated but clear of consolidation. Mild biapical scarring is noted. Cardiac silhouette is top-normal in size. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "A left chest tube remains in place. The previously seen tiny left apical pneumothorax is no longer identified on today's exam. A small left pleural effusion is unchanged. Left lower lobe subsegmental atelectasis is also unchanged. The right lung remains clear. Heart and mediastinum are within normal limits despite the projection. Bones and soft tissues are unremarkable.", "output": "Interval resolution of tiny left apical pneumothorax. Stable small left pleural effusion and left lower lobe subsegmental atelectasis." }, { "input": "Since prior, there is a large opacity overlying the left hemidiaphragm. There is the possibility of an elevated stomach bubble making the diagnosis of diaphragmatic rupture impossible to rule out. Otherwise, the lungs are clear. The left heart border has been silhouetted out. A small right pleural effusion is seen. Otherwise the lungs are clear. There is a compression deformity of unclear chronicity located at the mid to lower thoracic spine better characterized on CT dated ___.", "output": "Large dependent left lung opacity silhouetting the left hemidiaphragm and left heart border concerning for a pleural effusion consisting of either simple or complex fluid. Additionally, a lucency concerning for air (in the shape of a stomach bubble) is seen abutting the most nondependent aspect of the opacity, raising the remote possibility of a diaphragmatic rupture. The compression deformity in the mid to lower thoracic spine is better characterized on the CT of ___. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 1:05 PM, a few minutes after discovery of the findings." }, { "input": "Frontal and lateral chest radiographs demonstrate interval removal of right-sided PICC line. Cardiomediastinal and hilar contours are unremarkable. Faint opacity projecting over the spine in the lateral view without definite correlate on the frontal view is stable since ___ and is most likely due to atelectasis, though an early pneumonia is a less likely possibility. No pleural effusion or pneumothorax evident.", "output": "Faint opacity projecting over the spine on lateral view is unchanged since ___ and is most consistent with atelectasis, though early pneumonia cannot be excluded." }, { "input": "AP upright and lateral views of the chest provided.There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Clips are noted in the right upper quadrant.", "output": "No acute intrathoracic process." }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. There is a mildly enlarged cardiac silhouette, which can be compatible with mild cardiomegaly and/or pericardial effusion. The mediastinal silhouette is within normal limits.", "output": "Mildly enlarged cardiac silhouette. Findings can be compatible with mild cardiomegaly and/or pericardial effusion. However, even if a pericardial effusion is present, there is no evidence of hemodynamic significance." }, { "input": "PA and lateral views of the chest. There is a subtle opacity in the left lower lung sillouhetting the left heart border, possibly representing early pneumonia in the lingula. Otherwise, lungs are clear. There is no pleural effusion, or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "Possible lingular pneumonia." }, { "input": "PA and lateral views of the chest provided. There is an external artifact overlying the left neck and right mediastinum, which limits assessment of a true pneumomediastinum. Otherwise, the lungs are clear. There is no effusion or pneumothorax. The cardiomediastinal silhouette is normal. Imaged bony structures are intact. No free air below the right hemidiaphragm is seen.", "output": "1. External artifact overlying the left neck and right mediastinum, which limits assessment of true pneumomediastinum. Please repeat study if that is of concern. 2. No focal consolidation." }, { "input": "The lungs are clear without focal opacity, pulmonary edema, pleural effusion or pneumothorax. There is mild cardiac enlargement, in particular the right atrium is enlarged. The mediastinal contours are normal. There is no free air beneath the right hemidiaphragm. Central endplate compression deformities throughout the thoracic spine are of uncertain chronicity.", "output": "1. Mild cardiomegaly, particularly right atrial enlargement. 2. Central endplate compression deformities throughout the thoracic spine are of uncertain chronicity. These findings are commonly seen from infarction." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified.", "output": "Normal chest x-ray." }, { "input": "Single portable view of the chest is compared to previous exams from earlier the same day at 1:48 p.m. There are extremely low lung volumes which limits the exam. Linear opacities at the bases, more so on the left than on the right, are suggestive of subsegmental atelectasis. Superiorly, the lungs are clear. Cardiomediastinal silhouette is stable.", "output": "Extremely low lung volumes with left base atelectasis, developing consolidation not excluded in the appropriate clinical setting." }, { "input": "The lung volumes are low. The heart is normal in size. The mediastinal and hilar contours appear unchanged. There is no pleural effusion or pneumothorax. There is a persistent opacity in the left mid lung, as well as a posterior basilar component which is probably in the left lower lobe. Elsewhere, the lungs appear clear. Bony structures are unremarkable.", "output": "Persistent patchy left lower lung opacities, although improved in the posterior basilar component. Pneumonia could be considered for this appearance in the appropriate clinical setting but there has been some improvement in opacification." }, { "input": "The patient is status post median sternotomy, CABG, and aortic valve replacement. Lung volumes are low. Moderate cardiomegaly is re- demonstrated. Calcified AP window lymph node is again noted. There is mild crowding of the bronchovascular structures, with mild pulmonary vascular engorgement, similar compared to the prior study. Small bilateral pleural effusions are slightly decreased compared to the prior study. There is no pneumothorax. No acute osseous abnormalities are present.", "output": "Mild pulmonary vascular congestion and small bilateral pleural effusions, decreased from the prior study." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. The cardiac silhouette is mildly enlarged. The aorta is calcified and tortuous. Multilevel degenerative changes are again seen along the spine. No displaced fracture is seen.", "output": "Stable chest radiograph; no evidence of acute intrathoracic process." }, { "input": "Moderate bilateral pleural effusions persist, decreased on the right compared to prior, with underlying atelectasis, left greater than right. Pulmonary vascular engorgement has decreased. Visualized portions of cardiac and mediastinal contours appear stable. Median sternotomy wires appear intact.", "output": "Decreased right pleural effusion with persistent moderate bilateral pleural effusions." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral radiographs of the chest demonstrate clear lungs and normal hilar and cardiomediastinal contours. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal.", "output": "Normal radiographs of the chest." }, { "input": "", "output": "PA and lateral chest reviewed in the absence of prior chest radiographs: Normal heart lungs hila mediastinum and pleural surfaces. No evidence of intrathoracic adenopathy." }, { "input": "Evaluation is limited secondary to overlying trauma board. Within these limitations, the lungs are clear of focal consolidation, pleural effusion or pneumothorax. The heart size is normal. The mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "There are trace bilateral pleural effusions, right greater than left. No focal consolidation or pneumothorax is detected. No pulmonary edema is evident. Heart and mediastinal contours are within normal limits. There is minimal bibasilar atelectasis, left greater than right. An approximately 2 cm spiculated masslike density projects over the left mid lung. Just superior to this is a well-circumscribed 2.5 cm mass like density projecting over the left mid lung at the level of the left main pulmonary artery. There is mild focal leftward tracheal deviation.", "output": "Trace bilateral pleural effusions and bibasilar atelectasis. Mass-like densities projecting in the left mid lung, 1 of which demonstrates spiculated margins; although these could represent overlapping shadows or scarring, malignancy cannot be excluded. Non-urgent chest CT is recommended. Findings and recommendations were discussed with ___ by ___ by telephone at 15:32 on ___ after attending radiologist review." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. As before, there is a linear masslike density which projects over the left mid lung consistent with tuberculous bronchiectasis as characterized on prior chest CT from ___. There is minimal bibasilar atelectasis, right greater than left. There are no new focal consolidations. There is no pleural effusion or pneumothorax.", "output": "1. Stable density over the left mid lung, consistent with calcified tuberculous bronchiectasis as previously described on chest CT from ___. 2. No acute cardiopulmonary process." }, { "input": "AP and lateral views of the chest were obtained. The lateral view is severely limited by patient position and inability to move the left arm. Frontal view demonstrates relatively low lung volumes with bibasilar atelectasis. An area of scarring in the left upper lobe is again seen, previously described on prior chest CT from ___, as calcified tuberculous bronchiectasis. No new opacity concerning for pneumonia is identified. There is no pulmonary edema or pneumothorax. The heart size is stable.", "output": "No acute cardiopulmonary process." }, { "input": "Single view of the chest shows placement of Dobbhoff tube with tip ending in proximal gastric cavity. The tube can be advanced 3 to 5 cm. The chest findings are otherwise unchanged with moderate lung volume, small right base atelectasis and left mid lung scarring. There is no evidence of acute pneumonia or vascular congestion. No pneumothorax or pleural effusion. Cardiomediastinal silhouette is unchanged and normal.", "output": "The Dobbhoff tube can be advanced 3 to 5 cm. Findings were paged to Dr ___ by Dr ___ at 5.___ pm" }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There is no pneumothorax or pleural effusion. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "Mild streaky right base opacity could be due to atelectasis but infection or aspiration is not excluded in the appropriate clinical setting. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable and stable.", "output": "Slight streaky right base opacity could be due to atelectasis, but infection or aspiration or not excluded in the appropriate clinical setting." }, { "input": "The heart is moderately enlarged. The interstitium is prominent including Kerley B lines suggesting mild pulmonary edema. Streaky left mid lung opacities may alternatively be due to atelectasis, however. The left posterior lower lobe appears opacified, which could be seen with coinciding pneumonia or potentially atelectasis. An element of volume loss in the left lower lobe including depression of the major fissure and slight elevation of the left hemidiaphragm. A small pleural effusion is probable on the left and difficult to completely exclude on the right. Fissures are thickened. The bones are probably demineralized. There is incompletely characterized loss in height among several mid-to-lower thoracolumbar vertebral bodies including a moderate mid-to-lower thoracic compression fracture, age indeterminate, although there is no reason to think that this is likely to be recent in onset.", "output": "1. Focal opacification in the left lower lobe with volume loss. This appearance could be seen with clinically suspected pneumonia, versus atelectasis. 2. Findings also suggesting mild pulmonary edema. 3. Thoracolumbar compression deformities." }, { "input": "The left hemidiaphragm is somewhat obscured, which may be due to overlying body habitus, although atelectasis or small pleural effusion is not excluded. The right lung is clear. The cardiac and mediastinal silhouettes are unremarkable. No pneumothorax is seen. There is no overt pulmonary edema.", "output": "Obscuration of the left hemidiaphragm which may be due to overlying soft tissue, however, a small pleural effusion is not excluded. Dedicated PA and lateral views would likely be helpful for further evaluation if patient able." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "The previously seen hilar abnormality is likely tortuous and enlarged pulmonary vasculature, which may be related to underlying pulmonary hypertension. The size of the cardiac silhouette is mildly enlarged. Hyperinflation, flattened hemidiaphragms, and parenchymal scarring suggest severe underlying COPD. Chronic re-distribution of the pulmonary vasculature is noted. There is no consolidation, edema, pleural effusion, or pneumothorax. A fluid level is visible in the left breast and compatible with post-surgical changes from the recent breast surgery.", "output": "1. No acute cardiopulmonary process. 2. Severe COPD. 3. Previously seen hilar abnormality is likely tortuosity and enlargement of the pulmonary arteries, suggesting pulmonary hypertension. 4. Mild cardiomegaly. 5. Post-surgical changes in the left breast. Results were discussed with Dr. ___ at 5:10 p.m. on ___ via telephone by Dr. ___." }, { "input": "Blebs, interstitial abnormalities, and parenchymal opacities are related to patient's severe emphysema. No acute process. Moderate cardiomegaly. The endotracheal tube terminates 2.6 cm above the carina. The orogastric tube is within the stomach. There are calcifications in the aortic arch. There is no pneumothorax or pleural effusion.", "output": "1. Endotracheal tube terminates 2.6 cm above the carina and could be pulled back 1 cm for more optimal positioning. 2. Severe emphysema. 3. No acute cardiopulmonary process." }, { "input": "The cardiomediastinum has shifted left since prior radiographic examination done ___ with a left lower lobe collapse. The moderate right pleural effusion and pulmonary edema are both improved however there is residual vascular congestion. The ET tube is 4.8 cm above the carina. There is an NG tube entering the stomach, but tube goes out of view. No pneumothorax.", "output": "Interval left lower lobe collapse with mild mediastinal shift. However, improved right pleural effusion and pulmonary edema" }, { "input": "Compared to the prior study there is no significant interval change", "output": "No change" }, { "input": "Cardiac, mediastinal and hilar contours are normal. The lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities are present.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Right upper lobe airspace consolidation is concerning for pneumonia. There is subtle retrocardiac opacity which may represent left lower lobe atelectasis versus pneumonia. Lung volumes are low limiting assessment. No large effusion or pneumothorax. The heart is enlarged within left ventricular configuration. The mediastinal contour is normal. Bony structures are intact.", "output": "Right upper lobe pneumonia. Left lower lobe atelectasis versus pneumonia. Cardiomegaly." }, { "input": "AP view of the chest provided. Compared to prior study, there is a little change. Again seen is right lung opacity, more confluent in the bases, consistent with known loculated pleural effusion. There is new obscuration of left hemidiaphragm, concerning for worsening left basilar consolidation. Right-sided chest tube is in unchanged position. There is no pneumothorax.", "output": "1. Worsening left basilar consolidation. 2. Stable right loculated pleural effusion." }, { "input": "Since prior, there is increased opacity projecting over the left hemi thorax. Left chest tube is now in place. There is no pneumothorax. Opacity projecting over the right lower lung is somewhat improved. Cardiomediastinal silhouette is difficult to assess given diffuse bilateral parenchymal opacities.", "output": "Increased opacity projecting over the left lung could be due to loculated pleural effusion and underlying parenchymal opacity. Slight interval improvement in the appearance of the right lung with decreased pleural fluid but persistent parenchymal opacities." }, { "input": "Large scale consolidation has developed in the right lung in both the middle and lower lobes.", "output": "It would be distinctly unusual for extensive re-expansion edema to present at half day following and earlier post thoracentesis radiograph showing essentially clear lungs. I discussed with Dr. ___ ___ the alternative diagnoses of extensive pneumonia and pulmonary hemorrhage, for which he says there are no current clinical signs or symptoms. Careful radiographic surveillance is therefore indicated. Heart is mildly enlarged, but there is no pulmonary vascular engorgement or edema in the left lung, nor is there pneumothorax or any pleural effusion." }, { "input": "Extensive parenchymal opacities are not significantly changed from the prior exam. A left pleural chest tube is again noted with unchanged position. Allowing for slight differences in technique, there has been no significant change from the prior chest radiograph.", "output": "Extensive bilateral pulmonary opacities unchanged. Left chest tube remains in place." }, { "input": "The right lung base opacity has improved compared to ___. Same differential still applies; this could be re-expansion edema, pneumonia, or pulmonary hemorrhage. There is small left subpulmonic pleural effusion. Cardiomediastinal silhouette is within normal size and unchanged.", "output": "The right lung base opacity has improved compared to ___" }, { "input": "Frontal and lateral chest radiographs again demonstrate a pigtail catheter projecting over the left lung base. The cardiac silhouette remains mildly enlarged. The left hemidiaphragm is better visualized on today's exam, suggestive of resolution of left pleural fluid. Patchy opacities and pleural effusion on the right are unchanged. Gaseous distention of bowel loops is noted in the left upper quadrant of the visualized abdomen.", "output": "Resolution of the left pleural effusion. Unchanged patchy opacities and loculated pleural effusion on the right." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged including mild to moderate cardiomegaly. There has been mild improvement in aeration of the left lower lung although probably with a small persistent pleural effusion. On the right, several areas of dense opacification appear very similar in pattern, probably with a small pleural effusion. In addition, however, there is a more coarse appearance of interstitial change in the right mid to lower lung, as well as perhaps increased density associated with perihilar opacification.", "output": "Increased coarse interstitial opacification of the right lung mid to lower lung, worrisome for lymphangitic carcinomatosis or lymphatic congestion, which could result from hilar obstruction. Increased right hilar opacification. Differential considerations also include superimposed infection. Otherwise the examination is very similar. Chest CT may be helpful to assess for change in more specific detail if clinically indicated." }, { "input": "There is interval removal of right pigtail pleural catheter with reaccumulation of large left pleural effusion. This has Resulted in passive collapse of the left lower lung. The left upper lung is clear. Heterogeneous airspace opacities in the right lung have minimally changed. A moderate loculated right pleural effusion is probably unchanged. The cardiac silhouette is partially obscured and difficult to evaluate. There is no pneumothorax.", "output": "1. Interval removal of left pleural catheter with accumulation large left pleural effusion resulting in collapse of the left lower lung. 2. Minimally changed extensive heterogeneous opacities in the right mid/lower lung and moderate loculated right pleural effusion." }, { "input": "Single portable AP upright radiograph demonstrates near complete opacification of the right hemi thorax thought secondary to a moderate to large right pleural effusion with fluid tracking within the interlobar fissures. There is leftward shift of the mediastinum. The right hilus appears enlarged. THe left lung is grossly clear. No acute osseous abnormality is detected.", "output": "Moderate to large right pleural effusion with resultant leftward shift of mediastinal structures. Enlarged right hilus. Recommend re-evaluation with repeat chest radiograph after drainage of the pleural effusion. NOTIFICATION: Findings communicated to the ordering ED physician by ___ ___ ___ by the ED dashboard at ___:___ on ___ at the time study was reviewed." }, { "input": "AP view of the chest provided. Compared to prior study from 1 day ago, there is no significant change. Right lung and left basilar opacities are unchanged. Moderate right pleural effusion wtih apical component is also stable. Right-sided pigtail catheter is in unchanged position.", "output": "No significant change compared to prior study 1 day ago." }, { "input": "PA and lateral views of the chest are obtained. The lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax. There is subcutaneous gas in the supraclavicular region as well as at the base of neck and subtle signs of pneumomediastinum as better assessed on prior CT neck. Cardiomediastinal silhouette is otherwise unremarkable. Bony structures appear intact.", "output": "Pneumomediastinum with subcutaneous gas in the supraclavicular region. Please correlate with findings on CTA neck. No sign of pneumothorax." }, { "input": "Frontal and lateral views of the chest were obtained. There remains subtle signs of pneumomediastinum along the left aspect of the aortic arch and left upper cardiac border. However, the extent appears possibly minimally decreased compared to the prior study. Subcutaneous emphysema is again seen at the base of the neck bilaterally and bilateral supraclavicular regions as well as projecting over the right scapula. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Cardiac silhouette is not enlarged. Mediastinal and hilar contours are stable.", "output": "Persistent pneumomediastinum, possibly minimally decreased since the prior study given differences in technique. Persistent subcutaneous emphysema, as above." }, { "input": "No significant change from the prior exam. Unchanged position of the right IJ terminating in the cavoatrial junction and the right PICC line terminating in the distal SVC. Standard ETT placement. The NG tube traverses the diaphragm and ends in the approximate location of the stomach. Stable persistent and significant bibasilar atelectasis. Stable small bilateral pleural effusions. Unchanged pneumoperitoneum. No pneumothorax. Stable cardiomediastinal silhouette and hila.", "output": "No significant change. Persistent and stable significant bibasilar atelectasis." }, { "input": "New bibasilar densities are noted. A linear density at the left base is likely related to low lung volumes and atelectasis, however the density at the right base is less well-defined and more concerning for pneumonia in the proper clinical setting. There is persistent moderate distention of the colon at the splenic flexure, which is essentially unchanged dating back to ___ and may be chronic. More severely and acutely dilated loops are better evaluated on the recent abdominal radiographs of ___.There is no pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "1. New right base opacity may be due to atelectasis, however in the proper clinical setting pneumonia cannot be excluded. 2. Colonic distention is better evaluated on a recent abdominal radiographs." }, { "input": "Stable cardiomediastinal contours, with persistent apparent widening of the right mediastinal contour which appears to be due to tortuous vascular structures accentuated by patient rotation by recent CTA of ___ bibasilar atelectasis is again demonstrated, and has worsened in the right lower lobe. Small right pleural effusion has also slightly increased in size. Markedly distended loops of bowel in the upper abdomen are incompletely evaluated on this chest radiograph exam but have been assessed by a recent abdominal series. .", "output": "Bibasilar atelectasis with worsening on the right. Coexisting pneumonia in this region is not excluded radiographically. Markedly distended loops of large bowel in the upper abdomen, incompletely evaluated on this chest radiograph" }, { "input": "The patient is now extubated. Stable bilateral lower lung volumes, with expected increased bibasilar atelectasis after extubation, greater on the right compared to the left. Mild increase in pulmonary vascular congestion from the prior exam, consistent with postextubation status. No new focal consolidation, pleural effusion, or pneumothorax. Stable cardiomediastinal silhouette. Unchanged position of the right PICC line, right IJ catheter, and NG tube. No pneumoperitoneum.", "output": "Increase bibasilar atelectasis and mild the increased pulmonary vascular congestion consistent with postextubation status. Otherwise, no significant change since ___." }, { "input": "PA and lateral views of the chest provided. Mild basilar atelectasis is noted. No focal consolidation, large effusion or pneumothorax. The cardiomediastinal silhouette appears normal. Gaseous distention of the bowel in the upper abdomen noted. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Mild bibasilar atelectasis." }, { "input": "The ET tube is 4.4 cm above the carina. The right-sided PICC line tip is at the cava atrial junction. There is bilateral pleural effusions of volume loss in both lower lungs. An underlying infectious infiltrate in the lower lobes cannot be excluded. The NG tube tip is in the stomach. There is a large amount of free air within the abdomen compatible with the patient's recent surgery. Skin ___ are visualized projecting over the mid abdomen", "output": "ET tube in good position" }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or frank pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "There is again volume loss in the right hemithorax with rightward shift of mediastinal structures and prior right pneumonectomy. The left lung remains clear. There is no pleural effusion or pneumothorax on the left. Bony structures are unremarkable.", "output": "Stable appearance of the chest." }, { "input": "PA and lateral views of the chest. Again seen is opacification of the right hemithorax from prior right pneumonectomy. There is persistent shift of the mediastinum to the right with hyperexpansion of the left lung. The left lung is clear without evidence of focal consolidation, pleural effusion or pneumothorax.", "output": "Status post right pneumonectomy with no acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. Postoperative changes of right-sided pneumonectomy are seen with thoracotomy changes of the ribs, clips, and volume loss in the right hemithorax. There is secondary mediastinal shift to the right with deviation of the trachea and the left lung partially seen in the right hemithorax. The left lung is grossly clear. No effusion. No acute osseous abnormality is detected.", "output": "Expected postoperative changes of prior right pneumonectomy without acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs the chest demonstrate complete opacification of the right hemithorax. There is rightward deviation of the trachea and cardiac silhouette, consistent with known right-sided pneumonectomy. There is persistent shift of the mediastinum to the right with hyperexpansion of the left lung. The left lung is clear. There is no pneumothorax, or left-sided pleural effusion.", "output": "Status post right pneumonectomy with unchanged appearance. No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. Patient is status post right pneumonectomy with persistent complete opacification of the right hemithorax postoperative due to prior pneumonectomy. There is persistent secondary shift of the mediastinum to the right and hyperexpansion of the left lung. No focal consolidation is seen in the left lung. There is no left pleural effusion or evidence of pneumothorax.", "output": "Status post right pneumonectomy without acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. Post-operative changes of right-sided pneumonectomy are again seen with complete opacification of the right hemithorax with associated volume loss and surgical clips and changes to the bones. The left lung is clear. No acute osseous abnormality is identified.", "output": "Prior right pneumonectomy. No acute cardiopulmonary process." }, { "input": "PA and lateral images of the chest. The patient is status post right pneumonectomy, unchanged in appearance from prior exam. The left lung is well expanded and clear. Of note, the left costophrenic sulcus is not imaged on this exam, but there is no visualized left pleural effusion. There is no spare the cardiomediastinal silhouette obscured by the collapsed", "output": "No acute cardiopulmonary process is visualized; however, given the persistence of symptoms and abscence of findings on serial conventional radiographs, CT may be helpful for further evaluation of the postoperative chest." }, { "input": "The cardiomediastinal shadow is unchanged. No airspace opacification. No pneumothorax. No pulmonary edema. Mild density seen in the left costophrenic angle which may represent atelectasis or a small pleural effusion. Suture material projecting over the right hilar area. Narrowing of the subglottic trachea is probably due to recent intubation.", "output": "The cardiomediastinal shadow is unchanged. No airspace opacification. No pneumothorax. No pulmonary edema. Mild density seen in the left costophrenic angle which may represent atelectasis or a small pleural effusion. Suture material projecting over the right hilar area. Narrowing of the subglottic trachea is probably due to recent intubation." }, { "input": "A left subclavian central line ends in the upper SVC. A left pigtail catheter is unchanged in position. There is no residual pneumothorax. Bilateral moderate pleural effusions are different in distribution due to patient positioning, but there has been no appreciable change in size. The mild pulmonary edema has improved. There is no new consolidation. The cardiomediastinal silhouette is normal.", "output": "1. No residual pneumothorax. 2. Stable bilateral moderate pleural effusions. 3. Improved mild pulmonary edema." }, { "input": "A moderate to large left pneumothorax is evident. There are no signs of tension. Left subclavian central venous catheter remains in place terminating at the proximal SVC. The remainder of the exam is unchanged from the prior radiograph. Stable left base opacity.", "output": "Moderate to large eft-sided pneumothorax without signs of tension." }, { "input": "In comparison with the study of ___, the monitoring and support devices remain in place. Cardiac silhouette is within normal limits. Hazy opacification in the left hemithorax is consistent with layering pleural effusion. Smaller effusion is also seen on the right. Bibasilar atelectasis is unchanged. Engorgement of pulmonary vessels is consistent with elevated pulmonary venous pressure.", "output": "Little change." }, { "input": "ETT tip ends the 5.5 cm from the carina, which is too high with the patient's chin flexed. Enteric tube traverses the diaphragm with its tip is not seen. The stomach is nondistended. Lung volumes remain low. The lungs are clear. The heart size is normal. No pneumothorax, focal consolidation, or pleural effusion. Mediastinum and hila are within normal limits.", "output": "1. No acute intrathoracic process. 2. ETT tip is too high - should be advanced 2.5-3 cm to avoid inadvertant extubation. 3. Note that chest radiograph is sub optimal for evaluation of chest wall trauma / rib fractures. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ from the MICU on the telephone on ___ at 12:14 PM, after discovery of the findings." }, { "input": "The inspiratory lung volumes are slightly decreased but improved from the prior studies of ___. The lungs are clear without focal consolidation concerning for pneumonia, pleural effusion, or pneumothorax. Biapical pleural thickening is symmetrical. The pulmonary vasculature is not engorged, and there is no overt pulmonary edema. The cardiac silhouette is normal in size. The mediastinal and hilar contours are within normal limits allowing for slight rotation of the patient. Linear metallic densities projecting over the soft tissues of the bilateral neck appear stable over multiple prior studies.", "output": "No acute cardiopulmonary process." }, { "input": "External artifact overlies the left lung apex. Endotracheal tube terminates approximately 6.2 cm above the level of the carina. Enteric tube is seen coursing below the diaphragm, inferior aspect not included on the image. Minor left basilar atelectasis is seen without focal consolidation. No pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen.", "output": "Endotracheal tube terminates approximately 6.2 cm above the carina. Enteric tube courses below the diaphragm, inferior aspect not included on the image." }, { "input": "There is a new endotracheal tube with the tip in mid trachea, approximately 4.4 cm from the carina. Subclavian PICC line is again visualized, but the tip is at the junction of the brachiocephalic vein and superior vena cava. Again visualized is a moderate layering left pleural effusion as well as a small right pleural effusion. Left basilar atelectasis appears unchanged. The cardiomediastinal silhouette is otherwise unremarkable. There is no evidence of new consolidations, effusions, or pneumothoraces.", "output": "Endotracheal tube tip is in standard position. Otherwise, little change in comparison to prior study from earlier today." }, { "input": "Slightly low lung volumes seen with secondary crowding of the bronchovascular markings. The lungs are clear of confluent consolidation. Cardiac silhouette is mildly enlarged. No acute osseous abnormalities.", "output": "Cardiomegaly without definite acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours appear normal. The lungs are clear; the previously noted left apical opacity on prior PET-CT is not appreciated currently, CT is more sensitive. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Lung volumes are low, but there is no focal consolidation concerning for pneumonia.", "output": "Low lung volumes but no acute cardiopulmonary process." }, { "input": "Single portable view of the chest. Right-sided central venous catheter is seen with tip likely in the right atrium. Lung volumes are relatively low. There are bilateral interstitial opacities similar to prior suggesting pulmonary edema. There may be a small right-sided pleural effusion with blunting of lateral costophrenic angle. More dense retrocardiac opacity seen. Median sternotomy wires and mediastinal clips again seen. Cardiomediastinal silhouette is difficult to assess given rotation and left base opacity.", "output": "Persistent pulmonary edema. Retrocardiac opacity potentially due to a combination of atelectasis, effusion and possible consolidation." }, { "input": "Portable AP chest radiograph. Median sternotomy wires are intact. Lung volumes are low with pulmonary vascular engorgement and mild interstitial edema are stable. However, atelectasis in the right lung base is slightly worse. Pleural effusions are small. Moderate cardiomegaly is unchanged. There is no pneumothorax.", "output": "Stable mild interstitial pulmonary edema." }, { "input": "Compared to prior examination, there has been mild improvement of left-sided pleural effusion. There is otherwise no change from prior study with redemonstration of low lung volumes and associated bibasilar atelectasis. Pulmonary vasculature is normal appearing without evidence of fluid overload. There is no pneumothorax.", "output": "Mild improvement of left pleural effusion. No evidence of fluid overload." }, { "input": "The lungs are poorly expanded accounting for some vascular crowding. Bilateral hilar prominence is related to supine positioning rather than vascular engorgement. Cardiomediastinal contour is unremarkable. There is no pleural effusion or pneumothorax. The endotracheal tube ends approximately 1.5 cm above the carina but the patient's neck is seen to be in flexion. A nasogastric tube has the side port in the stomach and the tip out of view.", "output": "No evidence of acute cardiopulmonary process although assessment limited by positioning and expiratory phase radiograph. Repetition of the exam during appropriate inspiration is recommended." }, { "input": "Duo lead permanent pacemaker has been placed via left subclavian approach, with leads terminating in the right atrium and right ventricle. There is no pneumothorax. Heart size is normal. . Lungs are clear. There are possible very small bilateral pleural effusions.", "output": "Duo lead pacemaker in standard position with no evidence of pneumothorax." }, { "input": "Heart size is normal, decreased compared to the previous study. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear of focal consolidation, pleural effusion or pneumothorax. The heart is mildly enlarged. The mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. Coronary artery stent is noted. No acute osseous abnormalities. There is no free intraperitoneal air.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. Coronary artery stent is noted. There is slight angulation of the anterior left sixth rib raising possibility of fracture. Mild anterior vertebral body height loss of likely T12 not seen on prior CT.", "output": "Suspected anterior left sixth rib fracture. Dedicated views of the ribs can be performed to further clarify. Apparent anterior vertebral body height loss of T12 suspicious for a compression deformity although not particularly well evaluated. Correlate regarding possible focal tenderness and the for additional imaging." }, { "input": "Chest PA and lateral radiograph demonstrates focal opacification obscuring the left heart border, consistent with pneumonia. No recent chest radiograph provided to evaluate for interval change. No pleural effusion or pneumothorax is evident. Mediastinal, hilar and cardiac silhouettes are normal.", "output": "Focal opacification in the lingula consitent with pneumonia. Recommend continued imaging surveillance to evaluate for resolution." }, { "input": "Endotracheal tube terminates in the upper thoracic trachea, at the level of the clavicular heads, approximately 5.7 cm from the carina. Endotracheal tube terminates in the left upper quadrant, in the expected region of the stomach. Extensive airspace consolidation is noted within the left lung containing air bronchograms, consistent with pneumonia. Right lung is clear. No pneumothorax or pleural effusion. Heart size is within normal limits.", "output": "1. Appropriate position of endotracheal and enteric tubes. 2. Extensive pneumonia within the left lung." }, { "input": "The ETT is not visualized, suggesting interval removal. A right IJ catheter ends in the distal SVC. Lung volumes remain low. Left lung atelectasis is probably decreased with reduced leftward shift of the mediastinum since ___. The large region of consolidation in the left lung has markedly improved. The heart is top-normal in size, similar to to 7. No definite pleural effusion. Retrocardiac opacity is unchanged.", "output": "1. ETT not visualized. 2. Significant interval decrease in the left lung opacity and atelectasis." }, { "input": "Semi upright portable AP view the chest provided. Interval placement of a right IJ central venous catheter with its tip in the region of the low SVC. Endotracheal tube and orogastric tubes are unchanged. There is persistent consolidation in the left lung with air bronchograms consistent with pneumonia, not significantly changed from the prior exam. No pneumothorax.", "output": "As above." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Portable semi-erect chest film ___ at 04:02 is submitted.", "output": "Right internal jugular central line has its tip in the distal SVC near the cavoatrial junction. The heart appears mildly enlarged which may reflect cardiomegaly or pericardial effusion. Clinical correlation is advised. There is prominent right paratracheal and hilar soft tissue which may be vascular in etiology but raises the possibility of lymphadenopathy. Clinical correlation is advised. Lungs appear well inflated without evidence of focal airspace consolidation to suggest pneumonia or pulmonary edema. No pleural effusions or pneumothorax." }, { "input": "Single portable supine frontal chest radiograph demonstrates moderately well-expanded lungs with mild right lower lobe atelectasis. Mild right lower lobe bronchial wall thickening with associated bronchiectasis is noted No pleural effusion, although slightly limited evaluation of the left costophrenic angle. No additional focal opacity. No pneumothorax. Heart size, mediastinal contour are, and hila are unremarkable.", "output": "New mild bronchial wall thickening with associated bronchiectasis can be seen with bronchitis and or pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 3:14 PM, 5 minutes after discovery of the updated findings." }, { "input": "The patient is intubated. The endotracheal tube terminates about 7.5 cm above the carina. For more optimal positioning could be advanced by 3 to 4 cm. An orogastric tube was also placed, which terminates in the gastric cardia but with little purchase. The tube could probably be advanced by about 8 to 10 cm if gastric positioning is desired. There is no pleural effusion or pneumothorax. There is a patchy bronchovascular type of opacification pattern in the right infrahilar region. Possibilities include airway inflammation, infection or possibly aspiration.", "output": "1. Status post endotracheal intubation and placement of orogastric tube. Advancing each is suggested for more optimal positioning if clinically indicated. 2. A right infrahilar bronchovascular opacification. Re-assessment with short-term follow-up radiographs is suggested. Possibilities include airway inflammation or infection, versus possibly a small region of aspiration pneumonitis." }, { "input": "Moderate cardiomegaly is stable compared to prior studies. The lungs are well inflated, and there is no pleural effusion, pneumothorax, pulmonary edema, or focal airspace consolidation.", "output": "Stable moderate cardiomegaly. No evidence of pneumonia." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Clips are noted in the right upper quadrant of the abdomen compatible with prior cholecystectomy.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral chest radiograph demonstrate slightly low lung volumes, resulting in bronchovascular crowding. No opacity convincing for pneumonia is present. There is no pleural effusion or pneumothorax. Cardiomediastinal and hilar silhouettes are within normal limits. There is no air under the right hemidiaphragm.", "output": "No evidence of pneumonia." }, { "input": "Blunting of the right posterior costophrenic angle is new since ___. Normal heart, lungs, and mediastinal surfaces.", "output": "Blunting of the right posterior costophrenic angle may represent a trace pleural effusion or pleural thickening/scarring." }, { "input": "Mild elevation of the right hemidiaphragm is unchanged from the prior study and causes mild bronchovascular crowding of the right hilum. Allowing for differences in technique, appearance is similar to ___.", "output": "1. No definite evidence of pneumonia. 2. Unchanged mild elevation of the right hemidiaphragm." }, { "input": "Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is no focal lung consolidation.", "output": "No evidence of pneumonia. No radiographic explanation for shortness of breath." }, { "input": "Lung volumes are low. There is mild vascular congestion with peribronchiolar wall thickening. No obvious pleural effusion. No pneumothorax. The heart is probably mildly enlarged despite low lung volumes and AP projection. The patient is status post median sternotomy. Surgical clips project over the mediastinum. No acute osseous abnormality.", "output": "There is mild vascular congestion. Faint peribronchial opacities could represent atypical infection. RECOMMENDATION(S): Please correlate with clinical symptoms and close followup is recommend" }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion, or pneumothorax. Punctate hyperdensities in the right lower lung likely represent en face vessels or calcified granulomas. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Heart size is mildly enlarged with a left ventricular predominance. The aorta is unfolded. There may be a small hiatal hernia. Mediastinal and hilar contours are otherwise unremarkable. Hyperinflation of the lungs with flattening of the diaphragms may suggest underlying COPD. No focal consolidation, pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Frontal radiograph of the chest again demonstrates a Swan-Ganz catheter which is far past midline into likely segmental right pulmonary artery. It should be retracted by at least 6-7 cm for more appropriate positioning in the proximal pulmonary artery. As compared to prior study, the lung volumes remain low, accentuating the cardiac contour. The heart and mediastinum are unremarkable. Diffuse right lung opacities are slightly improved with worsened opacification of the left lung, likely equilibrating pulmonary edema. No pleural abnormality is seen.", "output": "1. Malpositioned Swan-Ganz catheter, which should be retracted by at least 6 cm for more appropriate positioning. 2. Equilibrating pulmonary edema, improved on right right and worse on the left. These findings were relayed to Dr. ___ by Dr. ___, at 9:37 a.m., three minutes after discovery." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Mildly prominent mediastinal and hilar lymph nodes are better assessed on recent prior CT. Additionally, scattered subcentimeter nodular opacities seen on prior CT are better evaluated on that study.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs. Lungs are well expanded. There is no focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette is normal. The imaged upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The cardiac, mediastinal and hilar contours appear unchanged. There is probably a trace pleural effusion on the right, but likely decreased. There is no evidence for pneumonia or parenchymal edema.", "output": "Perhaps minimal residual pleural effusion on the right, although probably decreased." }, { "input": "Cardiac mediastinal silhouette is stable. The lungs are well expanded bilaterally. There is no focal consolidation. Diffuse pulmonary vascular engorgement and small bilateral pleural effusions have increased. No pneumothorax.", "output": "Slight increase in diffuse pulmonary vascular congestion and increased small bilateral pleural effusions." }, { "input": "The lungs are clear of focal opacities concerning for an infectious process. There is hyperexpansion of the lungs consistent with chronic obstructive pulmonary disease. Cardiac silhouette is mildy enlarged. Hilar contours appear grossly unremarkable. Osteopenia of the bones is noted, but no obvious fractures.", "output": "Hyperinflated lungs, mild cardiomegaly, without acute cardiopulmonary process." }, { "input": "The patient is status post median sternotomy and transcatheter aortic valve replacement. Left-sided pacemaker device is re- demonstrated with leads terminating in the right atrium and right ventricle. Heart size remains moderately enlarged. Mediastinal contours are unchanged with diffuse atherosclerotic calcifications again noted. Mild pulmonary vascular congestion is slightly worse in the interval. Small left pleural effusion with associated atelectasis is present. Right lung remains otherwise grossly clear without new focal consolidation present. No pneumothorax is identified. Multilevel moderate degenerative changes are seen in the thoracic spine. Postsurgical changes within the left lower ribs are re- demonstrated with a bridged device again noted.", "output": "Small left pleural effusion with associated left basilar atelectasis. Mild pulmonary vascular congestion, slightly worse in the interval." }, { "input": "The left-sided two-lead cardiac pacemaker device appears intact and unchanged in position, with one tip terminating in the right atrium and the other tip terminating in the right ventricle. Median sternotomy wires, surgical clips, and cardiac valve replacements appear intact and unchanged in position. The right IJ also appears intact and unchanged in position. Since ___, the left-sided pleural effusion and adjacent compressive atelectasis have improved. Elevation of the left hemidiaphragm persists and is secondary to underlying left lung atelectasis. The lungs are otherwise clear, without focal consolidation or overt pulmonary edema. No pneumothorax. Stable moderate cardiomegaly. Stable post-procedural appearance of the mediastinum.", "output": "1. Upper open positioning of the recently placed pacemaker leads. 2. Decreased, now small left pleural effusion with adjacent atelectasis compared to ___." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax. No acute osseous abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is status post recent median sternotomy and cardiovascular surgery. Cardiomediastinal contours are stable in the post-operative setting. As compared to the recent radiograph, there has been improved atelectasis in the left mid and both lower lungs, with a residual patchy and linear foci of atelectasis remaining. Small bilateral pleural effusions are also present, but there is no evidence of pneumothorax.", "output": "Improving multifocal atelectasis. Small pleural effusions." }, { "input": "Compared to the prior exam, the right IJ line is unchanged. There is a worsened appearance of the right lung with increased right effusion, increased right lower lobe and upper lobe infiltrate. There is also hazy left-sided infiltrate, pulmonary vascular redistribution, perihilar haze, with increased cardiomegaly. There is a small left effusion.", "output": "1. Worsened CHF 2. Continued upper lobe infiltrates and new RLL infiltrate." }, { "input": "Since the prior exam, the endotracheal tube, nasogastric tube, Swan-Ganz catheter, and left chest tube have been removed. A right subclavian central venous catheter is in unchanged position with the tip in the right atrium. There is no pneumothorax. Retrocardiac volume loss has increased. Linear opacities at the bilateral bases are likely atelectasis. There is no pulmonary edema or definite pleural effusion. The cardiomediastinal silhouette is unchanged, with a postoperative appearance of the mediastinal and mild enlargement of the heart. Sternal wires and mediastinal clips are present.", "output": "1. Removal of the left chest tube. No evidence of pneumothorax. 2. Right subclavian central venous catheter with tip in the right atrium. 3. Increased retrocardiac and bibasilar atelectasis." }, { "input": "The endotracheal tube terminates 4.6 cm above the carina. A right internal jugular catheter is seen within the distal SVC. Enteric catheter is within the stomach. There has been dramatic improvement in the severe apical consolidations likely from redistribution. There is unchanged mild pulmonary edema with small bilateral pleural effusions. Cardiac silhouette is top-normal in size. Mediastinal contours are unchanged.", "output": "Marked improvement in apical pulmonary edema with residual diffuse mild edema and small pleural effusions." }, { "input": "Frontal and lateral views of the chest were performed. There is plate-like atelectasis seen at the left lung base. There is no pleural effusion, pneumothorax or focal airspace consolidation that is worrisome for pneumonia. The cardiac and mediastinal contours are normal. The hilar structures are unremarkable. Spinal orthopedic hardware is partially imaged and appears in satisfactory position.", "output": "No acute cardiopulmonary process." }, { "input": "AP portable supine view of the chest. Right IJ central venous catheter is seen with its tip extending to the low SVC. Hardware is noted in the lower thoracic spine. Bibasilar atelectasis is noted. No supine evidence for large effusion or pneumothorax.", "output": "As above." }, { "input": "The cardiomediastinal silhouette is within normal limits. Lungs are clear. Bony structures are intact.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs remain clear. The heart and mediastinal structures are unremarkable. Bony thorax is grossly intact.", "output": "No active disease." }, { "input": "AP portable upright view of the chest provided. The patient is slightly rotated to the left. There is increased opacity in the right lung base which is concerning for pneumonia. In addition, there is retrocardiac opacity, mostly in a linear configuration, which could represent atelectasis, less likely pneumonia/aspiration. A few scattered more nodular-appearing opacities are seen in the mid-to-upper lungs, at least one of which likely represents an EKG related to sternal artifact. No pneumothorax is seen. No large effusion. Overall, cardiomediastinal silhouette is stable. Bony structures appear intact.", "output": "Opacity in the right lung base concerning for pneumonia. Presumed retrocardiac atelectasis. Additional nodular opacities in the right lower lung and left upper lung could represent true pulmonary nodules and a non-emergent chest CT is recommended to further assess once the acute symptoms resolve." }, { "input": "Frontal and lateral views of the chest are compared to previous exam from ___. There are diffusely increased interstitial markings seen in the lungs bilaterally. More significant opacity seen in the retrocardiac region on the lateral view. Posterior costophrenic angles are not well seen, potentially due to effusions. The cardiac silhouette is enlarged but essentially unchanged from prior. Distended loop of bowel seen between the liver and the right hemidiaphragm. Soft tissue are otherwise unremarkable.", "output": "Findings suggestive of congestive failure. Distended loop of bowel below the right hemidiapharm for which cllinical correlation is suggested and perhaps additional abdominal imaging." }, { "input": "Interval placement of endotracheal tube with tip at the level of the clavicles. The nasogastric tube has also been placed with tip at the GE junction, should be advanced several centimeters into the stomach. Unchanged mediastinal, hilar and cardiac silhouette. Increased retrocardiac opacifications likely represents left lower lobe collapse and possibly a small left pleural effusion. Though cannot exclude developing infectious process.", "output": "1. Endotracheal tube well positioned. Nasogastric tube should be advanced several centimeters to terminate into stomach. 2. Increased retrocardiac opacity likely representing left lower lobe collapse." }, { "input": "Endotracheal tube tip 5 cm above carina. Right IJ central line tip mid SVC. Enteric tube seen to the level of junction of proximal and mid stomach. No pneumothorax. Improved left perihilar, basilar opacity. Small left pleural effusion is stable. Stable right basilar opacity, and tiny right pleural effusion. Shallow inspiration accentuates heart size. Normal pulmonary vascularity.", "output": "Improved left perihilar, basilar opacity." }, { "input": "AP portable upright view of the chest. Overlying EKG leads are present. Previously noted right IJ central venous catheter is been removed as well as the feeding tube. Retrocardiac opacity may reflect the presence of a left lower lobe pneumonia. Hila appear congested. Cardiomegaly is unchanged. Subtle opacity at the right lateral lung base may also represent a site of pneumonia. No overt signs of edema. Mediastinal contour is unchanged. Bony structures are intact.", "output": "1. Retrocardiac opacity may reflect effusion and possible pneumonia. 2. Subtle opacity in the right lateral lung base may also represent pneumonia. 3. Congestion hila without overt edema. 4. Stable cardiomegaly." }, { "input": "AP portable upright view of the chest. ET and NG tubes are again noted. The endotracheal tube tip terminates 5.4 cm above the carina. The NG tube descends along the thoracic midline though the tip is not seen. Please note on prior the NG tube tip extended to the left upper abdomen. There has been interval placement of a right IJ central venous catheter with its tip in the region of the mid SVC. There is no pneumothorax. Vague opacities in the lower lungs appear slightly increased. Hila appear congested. Prominent mediastinal contour unchanged likely technique related though not fully assessed.", "output": "Right IJ central venous catheter appropriately positioned." }, { "input": "ET tube tip lies approximately 7.7 cm above the carina, at the lower edge of the medial clavicular heads. NG tube tip overlies the left upper quadrant. A sideport, if present, does not extend beyond the GE junction. Right IJ central line tip overlies the proximal/mid SVC. Cardiomediastinal silhouette is probably unchanged, allowing for technical differences. Again seen is left lower lobe collapse and/or consolidation and obscuration of the left hemidiaphragm, slightly denser. A small left effusion would be difficult to exclude. Minimal patchy at the right low minimal minimal patchy opacity at the right lung base is also again seen, similar prior. No pneumothorax detected. Doubt overt CHF.", "output": "Left lower lobe collapse and/or consolidation, slightly more pronounced. The differential diagnosis includes a pneumonic infiltrate. Patchy opacity right cardiophrenic region again noted, similar to prior. This could represent focally prominent atelectasis, though an early pneumonic infiltrate or area of aspiration pneumonitis cannot be entirely excluded. Doubt overt CHF." }, { "input": "Endotracheal tube tip is 4.8 cm above carina. Enteric tube tip is below diaphragm, not included on the radiograph. Right IJ central line tip is in the mid SVC. No pneumothorax. Left basilar opacity is mildly worsened, mild pleural effusion is similar. Trace right pleural effusion similar. Minimal right basilar atelectasis. Pulmonary vascularity is normal. Shallow inspiration accentuates heart size.", "output": "Left basilar opacity is mildly worsened, likely atelectasis, consider pneumonitis in the appropriate clinical setting. Mild left pleural effusion." }, { "input": "Lung volumes are low. The cardiac silhouette is borderline enlarged. A retrocardiac opacity is new since the prior examination, and in the appropriate clinical context, is consistent with left lower lobe pneumonia. Left basilar opacity is chronic and similar to the examination from ___. A small pleural effusion may be present. Right infrahilar opacity is likely representative of crowding of vascular structures given low lung volumes. There is no pneumothorax.", "output": "Left lower lobe pneumonia." }, { "input": "Endotracheal tube tip terminates approximately 7 cm from the carina. An enteric tube tip is within the stomach. Lung volumes are low. Cardiac silhouette size remains moderate to severely enlarged, as seen previously. Widening of the superior mediastinal contour is likely due to a combination of low lung volumes, supine technique, and AP positioning. There is crowding of bronchovascular structures without overt pulmonary edema. Patchy opacities in the lung bases may reflect areas of atelectasis superimposed on a chronic interstitial abnormality. No large pleural effusion or pneumothorax is identified on this supine exam. Moderate degenerative changes are noted in the thoracic spine.", "output": "1. Endotracheal and enteric tubes in standard positions. 2. Low lung volumes. Patchy opacities in the lung bases likely reflect a combination of atelectasis and chronic interstitial abnormality, as seen previously." }, { "input": "The cardiac silhouette remains moderate to severely enlarged. The mediastinal contours are stably widened. There is mild pulmonary vascular congestion. A trace left pleural effusion is likely present. Retrocardiac and right basilar opacities likely reflect atelectasis. There is no pneumothorax. No acute osseous abnormalities identified.", "output": "Mild pulmonary vascular congestion and probable trace left pleural effusion. Mild bibasilar atelectasis." }, { "input": "Lung volumes are slightly low. Moderate-to-severe cardiomegaly persists. The mediastinal and hilar contours are stable. There is no pneumothorax or pleural effusion. Bibasilar consolidations may reflect atelectasis or pneumonia in the correct clinical setting. There is no pulmonary edema.", "output": "Bibasilar atelectasis or pneumonia in the correct clinical setting." }, { "input": "The heart is at the upper limits of normal size with a left ventricular configuration. There is mild unfolding and calcification along the aortic arch. There is no pleural effusion or pneumothorax. Projecting in the right infrahilar region is a nodular opacity measuring about 15 mm in diameter. Although it may represent a confluence of vascular shadows or perhaps pneumonia in the appropriate setting, the possibility of a lung nodule should be considered. The opacity is not visualized on the lateral view. Otherwise the lungs appear clear. Surgical clips project along the right upper quadrant. Small osteophytes are noted along the thoracic spine.", "output": "Right infrahilar opacification with nodular appearance. In the appropriate clinical setting, differential considerations include pneumonia, but a lung nodule should be considered and either a follow-up radiograph should be obtained in the short term after treatment if pneumonia is suspected or chest CT should be considered. Comparison to prior radiographs, if available, could also be useful. Findings and recommendations discussed with Dr. ___ by telephone while the patient was still in the emergency room." }, { "input": "No displaced rib fracture is seen. The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "No acute cardiopulmonary process. No displaced rib fracture is seen. However, the PA and lateral chest radiograph is insensitive for the detection of subtle rib fractures. If there is continued clinical concern, consider obtaining dedicated rib series." }, { "input": "Cardiac size is normal. The aorta is elongated. There is an abnormal radiolucency at the thoracic inlet / mid-line, better evaluated in concurrent CT. There is no pleural effusion or pneumothorax. The lungs are well expanded and clear without focal consolidation concerning for pneumonia. The upper abdomen is unremarkable.", "output": "Abnormal superior mediastinum better evaluated in concurrent CT." }, { "input": "Heart size has mildly increased compared with the immediate prior study and the vasculature is less well-defined suggesting volume overload without overt pulmonary edema. Trace pleural effusions are likely present bilaterally. There is no focal consolidation. Diffuse sclerosis of the visualized skeleton is compatible with known history of metastatic prostate cancer. There is no pneumothorax or displaced pathologic fracture.", "output": "1. Volume overload without overt pulmonary edema. 2. Diffuse sclerotic osseous lesions compatible with metastatic prostate cancer." }, { "input": "Compared to prior, there has been improvement of previously seen bilateral opacities. The lungs are mildly hyperinflated. There are residual linear opacities in the right mid lung, may represent impacted bronchi or atelectasis. There is no significant pleural effusion. The heart size is unchanged. The mediastinal and hilar contours are unchanged. A small sclerotic focus in the left humerus and diffuse sclerotic rib lesions likely represent metastatic foci.", "output": "1. Interval improvement of bilateral opacities with residual linear opacities in the right middle lobe. 2. Sclerotic bone lesions, likely metastatic foci." }, { "input": "Mild enlargement of cardiac silhouette is unchanged. The aorta is tortuous, and the mediastinal and hilar contours are similar compared to the previous study. Pulmonary vasculature is not engorged. Paraseptal emphysematous changes, most pronounced within the right upper lobe, are also re- demonstrated along with lung hyperinflation. Streaky opacity is noted in the right lung base. No focal consolidation, pleural effusion or pneumothorax is present. Osseous structures remain diffusely sclerotic compatible with known metastatic disease.", "output": "Right basilar streaky opacity, likely atelectasis. Early infection is not completely excluded" }, { "input": "The lungs are clear. The heart size is top normal, not significantly changed. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen.", "output": "No acute cardiac or pulmonary findings." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute osseous abnormality." }, { "input": "Single AP upright portable view of the chest was obtained. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. Through the position of the bowel, lucency under the left hemidiaphragm could relate to colon and stomach, although it is difficult to exclude free air on this study. Recommend supine and upright views of the abdomen for further evaluation.", "output": "1. Clear lungs. 2. Due to position of the bowel/stomach, lucency under the left hemidiaphragm is difficult to exclude free air. Recommend supine and upright views of the abdomen for further evaluation." }, { "input": "Lung is well inflated and clear, there is no consolidation or nodules. Cardiomediastinal silhouette is normal. There is no pneumothorax or pleural effusion. There is no evidence of subdiaphragmatic free air. Moderate air distention of the colon.", "output": "Normal chest x-ray, moderate colon air distention without subdiaphragmatic free air." }, { "input": "Frontal and lateral views of the chest demonstrate normal cardiomediastinal silhouette. The lungs are clear but slightly low in volume. There is no pneumothorax, vascular congestion, or pleural effusion.", "output": "No acute cardiopulmonary process such as pneumonia." }, { "input": "Low bilateral lung volumes. Bibasilar opacities likely reflect atelectasis. A small left pleural effusion is suspected. No pneumothorax identified. The gastric tube extends into the stomach. The size of the cardiomediastinal silhouette is within normal limits", "output": "Bibasilar atelectasis and a suspected small left pleural effusion." }, { "input": "The heart is not enlarged. The aorta is prominent with aortic knob deviating the trachea to the right. NG tube is in the stomach. The lungs are clear. No pleural effusion.", "output": "No acute process in the chest." }, { "input": "The heart is normal in size. Aortic knob is tortuous, deviating the trachea to the right. No mediastinal mass. The lungs are clear with exception of linear atelectasis in the right lower lobe. No pleural effusion or pneumothorax. NG tube is seen in the fundus of the stomach with its side hole at the GE junction region.", "output": "NG tube in the fundus of the stomach. RECOMMENDATION(S): Post the NG tube inward 4-5 cm." }, { "input": "Enteric tube seen appropriate positioned in the gastric body. Low lung volumes are noted. Bibasilar opacities are likely atelectasis. The cardiomediastinal silhouette is within normal limits.", "output": "Enteric tube within the gastric body." }, { "input": "Lungs remain hyperexpanded, and note is made of new patchy bibasilar opacities. There is blunting of bilateral costophrenic angles consistent with small bilateral pleural effusions. There is no pneumothorax or pulmonary edema. The cardiomediastinal silhouette is within normal limits. Suture anchors are noted within the right humeral head. There is a moderate hiatal hernia.", "output": "1. Bibasilar patchy opacities suggest aspiration or early pneumonia. 2. Probable small bilateral pleural effusions." }, { "input": "The lungs are clear. The cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax.", "output": "No acute cardiothoracic process." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Lungs are clear without focal opacification. No pleural effusion or pneumothorax is present. No subdiaphragmatic free air is identified.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Left-sided Port-A-Cath is again seen, terminating in the region of the proximal SVC/brachiocephalic/caval junction. Minor left basilar atelectasis is seen. No definite focal consolidation is seen. There is no large pleural effusion is although, a trace left pleural effusion would be difficult to exclude. No pulmonary edema there is seen. There is no evidence of pneumothorax. The cardiac and mediastinal silhouettes are stable.", "output": "No focal consolidation or pulmonary edema. Minor left basilar atelectasis. Trace left pleural effusion would be difficult to exclude." }, { "input": "Frontal and lateral views of the chest were obtained. A left-sided Port-A-Cath is seen with tip extending to the region of the proximal SVC. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No focal consolidation to suggest pneumonia." }, { "input": "The lung volumes are low, which somewhat limits the evaluation. Within the limitations, there is no consolidation or edema. There is no pleural effusion or pneumothorax. The mediastinal contours are normal. The heart size is at the upper limits of normal, and stable from the prior exam.", "output": "No acute cardiopulmonary process." }, { "input": "AP portable upright radiograph demonstrates an enteric tube which descends the thorax in an uncomplicated course. For proper placement within the gastric lumen, recommend advancing 3 cm. Lungs are hyperexpanded with flattening of the diaphragms suggestive of emphysema. Lungs are clear without a focal opacity convincing for pneumonia. Cardiomediastinal and hilar contours are within normal limits. No acute osseous abnormalities detected. Clips project over the mid upper abdomen. Dilated loops of small bowel are noted projecting over the upper quadrant. No air to the right hemidiaphragm is seen.", "output": "For appropriate placement of nasogastric tube within the gastric lumen, recommend advancing 3 cm. NOTIFICATION: Findings communicated to Dr. ___ ___ page at 4:51 on ___ at the time findings were discovered." }, { "input": "Frontal and lateral views of the chest demonstrate hyperexpanded lungs. The AP diameter of chest is expanded, suggestive of underlying chronic obstructive pulmonary disease. There is no focal consolidation, pleural effusions, or pneumothorax. Reticular opacities are noted in the right lung base. Hilar and mediastinal silhouettes are unchanged. Heart size is normal. Mild dextroscoliosis of the thoracic spine is seen with associated degenerative changes. Partially imaged upper abdomen is unremarkable.", "output": "Hyperexpanded lung, suggestive of chronic obstructive pulmonary disease. Right lung base opacities may represent atelectasis or infection in the appropriate clinical setting." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. Cardiomediastinal silhouette is stable given patient rotation to the left. Accentuated thoracic kyphosis is noted. Unchanged lower thoracic compression deformity is again noted.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest demonstrate hyperexpanded clear lungs. The cardiomediastinal and hilar contours are unchanged. There is no pneumothorax, pleural effusion, or focal consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral radiographs of the chest demonstrate clear lungs. There is no pneumothorax or pleural effusion. Minimal cardiomegaly is chronic. Pulmonary vascularity is normal. On the lateral view only, an anterior wedge compression fracture of a mid-to-lower thoracic vertebral body becomes apparent. No prior lateral radiographs or CTs are available to determine the age of this compression fracture.", "output": "1. No acute cardiopulmonary process. 2. Age indeterminate wedge compression fracture of a mid-to-lower thoracic vertebral body. NOTE: Findings were communicated to Dr. ___ by Dr. ___ ___ telephone on ___ at 11:16 a.m." }, { "input": "Bilateral varicoid and cylindrical bronchiectasis most severe in the right lower lobe and increased interstitial markings are better evaluated on prior chest CT dated ___ and unchanged. Bronchial wall thickening is most pronounced in the right lower lobe. Ill-defined peribronchial opacities in the left lower lobe which are new since ___, signify just a recent flare of infection. Heart size, mediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax.", "output": "Multifocal bronchiectasis, increased interstitial markings are chronic and stable since at least ___. Ill-defined peribronchial opacities in the left lower lobe, new since ___, may suggests recent flare of bronchial inflammation. Further clinical correlation is required." }, { "input": "There is continued increase in interstitial markings bilaterally, similar to the prior study consistent with multifocal bronchiectasis and chronic lung disease. On the lateral view, there may be slight increase in opacity projecting over the lower cervical spine, although this is not substantiated on the frontal view, though an infectious process cannot be entirely excluded. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are stable and unremarkable.", "output": "Grossly stable chronic changes in the lungs including chronically increased interstitial markings and multifocal bronchiectasis, subtle increase in opacity projecting over the lower thoracic spine on the lateral view, appears increased as compared to the prior study though may be related to differences in technique in inspiration, however, infectious process is not entirely excluded." }, { "input": "Frontal and lateral views of the chest are obtained. There are relatively low lung volumes. Right upper lobe consolidation is worrisome for pneumonia. The left lung is clear. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "Right upper lobe pneumonia." }, { "input": "The frontal radiograph is little changed from ___. The lateral view shows that the middle lobe is clear and there are new small regions of peribronchial opacification in one of the lung bases, overlying the spine, probably the left, and in the lingula, effectively obscured on the frontal view by scarring and a mediastinal fat pad. Upper lobe hypovascularity is probably due to emphysema, and pulmonary hypertension explains large central pulmonary arteries. Heart size is normal. There is no pleural effusion or pneumothorax.", "output": "Dr ___ ___ findings and revision of preliminary interpretation witn Dr ___ by phone at 8:15AM." }, { "input": "There are bibasilar opacities localizing to the middle lobe and lingula. While some of this could represent scarring and prominent fat pad as seen on prior chest CT, findings are slightly progressed even given differences in technique. There is also some streaky retrocardiac opacities on the lateral view which may correlate with mucous plugging seen on prior chest CT. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. Degenerative changes partially visualized at the shoulders.", "output": "More dense consolidation in the lingula and right middle lobe. Some of this may be due to the atelectasis, scarring and prominent fat pad, there is suspected superimposed acute infection given apparent progression of these changes since recent prior chest CT." }, { "input": "Opacification of the left lung base along the left heart border is due to a prominent pericardial fat pad, as seen ont he ___ CT. The lungs are otherwise free of focal consolidations, effusions or pneumothorax. No pulmonary edema. Cardiomediastinal silhouette is within normal limits.", "output": "No acute intrapulmonary process. No pulmonary edema." }, { "input": "The cardiomediastinal and hilar contours are within normal limits and stable. The pulmonary vasculature is normal. The lungs are clear. No pneumothorax or pleural effusion identified.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Obscuration of the left heart border by left upper lobe atelectasis is chronic. Lateral view shows a small region of atelectasis or pneumonia in the right middle lobe. No pleural effusion or pneumothorax is seen.", "output": "Right middle lobe pneumonia or atelectasis. NOTIFICATION: Clinical house staff or notified of the change from the initial report by Dr ___." }, { "input": "Streaky bibasilar and retrocardiac opacities appear slightly improved as compared to prior. The lungs are hyperinflated. Cardiac silhouette is unchanged. Pulmonary arteries appear enlarged. No pneumothorax.", "output": "Streaky bibasilar and retrocardiac opacities appear slightly improved as compared to prior. While these likely represent atelectasis, infection could be considered in the appropriate clinical setting." }, { "input": "There is stable mild enlargement of the cardiac silhouette. The mediastinal and hilar contours are unchanged. No focal consolidations are identified. There is a small left-sided effusion. There is no pneumothorax. The visualized osseous structures are unremarkable. There is a small, likely soft tissue prominence seen in the lateral view for which a 4-week follow up is recommended for further evaluation.", "output": "1. No acute focal consolidation suggestive of pneumonia. 2. Small prominence, likely soft tissue in origin seen on the lateral view for which a 4-week follow up is recommended." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Mild interstitial edema seen on the previous study has improved in the interval with possible minimal residual remaining. Mild enlargement of the cardiac silhouette persists. Mediastinal and hilar contours are stable. Degenerative changes are seen along the spine.", "output": "Cardiomegaly with minimal interstitial edema, improved since the prior study. No large pulmonary mass is seen, however, CT is more sensitive." }, { "input": "Frontal and lateral views of the chest demonstrate fully expanded and clear lungs. There is no pulmonary edema. Cardiomegaly is stable as is a mediastinal contours. There is no pleural effusion or pneumothorax. Right port ends in the proximal right atrium.", "output": "Stably enlarged heart, no evidence of pulmonary edema. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 10:34 AM, 5 minutes after discovery of the findings." }, { "input": "A right-sided Port-A-Cath is seen with its tip ending at the cavoatrial junction in appropriate position. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lung volumes are low, however the lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. Lungs are hyperinflated and hyperlucent suggesting COPD. There is bilateral hilar prominence which could reflect pulmonary arterial hypertension and possibly central congestion. The heart is mildly enlarged. No focal consolidation concerning for pneumonia. No effusion or pneumothorax. The mediastinal contour is stable. Bony structures are intact.", "output": "COPD with probable pulmonary arterial hypertension. Mild cardiomegaly with possible central congestion." }, { "input": "Frontal and lateral views of the chest. There are small bilateral effusions. The lungs are otherwise clear. There is no pneumothorax. Cardiomediastinal silhouette is unchanged. No displaced fracture is identified.", "output": "New small bilateral effusions. No visualized displaced fracture." }, { "input": "Pulmonary vasculature prominence has slightly increased. A left apical granuloma is unchanged. No effusions or consolidations are identified. No pneumothorax is present. Moderate cardiomegaly is unchanged. The aorta is tortuous with aortic arch calcifications. Midline sternotomy wires are intact. Mild anterior loss of height of a mid thoracic vertebral body is unchanged.", "output": "Cardiomegaly with mild pulmonary vascular congestion." }, { "input": "The lungs are hyperinflated with coarse interstitial markings, likely representing COPD. There is blunting of the bilateral costophrenic angles likely from small bilateral pleural effusions. A retrocardiac opacity is likely atelectasis. There is no pulmonary edema or pneumothorax. The mediastinal contours are normal. The heart is massively enlarged, and unchanged. Clips in the left axilla are noted.", "output": "1. Chronic changes of COPD. 2. Bilateral small pleural effusions. 3. Severe stable cardiomegaly." }, { "input": "Portable semi supine chest radiograph ___ at 15:53 is submitted for interpretation.", "output": "Endotracheal tube continues to have its tip 4 cm above the carina. The right internal jugular central line is unchanged in position. Interval removal of the right basilar pleural pigtail catheter. No pneumothorax, although the sensitivity to detect pneumothorax is diminished given semi-supine technique. There is a residual stable basilar loculated pleural effusion and persistent airspace opacity at the right base which may reflect atelectasis, although superimposed infection cannot be excluded. Although lung volumes remain low, the left lung is grossly clear. There is crowding of the pulmonary vasculature but no overt pulmonary edema is evident." }, { "input": "Lung volumes remain low. Right pleural effusion is overall unchanged. Persistent rightward shift of the mediastinum suggest component of right lung volume loss. The left lung is clear. Although the right heart border is obscured mild cardiomegaly is likely unchanged. There is no evidence of pulmonary edema. There is no pneumothorax.", "output": "1. No significant change in right pleural effusion. 2. Right lung atelectasis resulting in persistent rightward shift of the mediastinum. 3. No pulmonary edema." }, { "input": "There has been interval placement of a right-sided chest tube. There has been minimal decrease in the size of the right pleural effusion with persistent pleural fluid seen. There is persistent right middle and right lower lobe atelectasis. Lung volumes remain low on the right. No left-sided pleural effusion seen. No pneumothorax seen. The cardiomediastinal contour is unchanged compared to the prior study.", "output": "Persistent right pleural effusion following chest tube placement." }, { "input": "A right-sided chest tube is in-situ. There is a persistent moderate-sized right pleural effusion, not significantly changed when compared to the prior study. No pneumothorax seen. Right middle and right lower lobe atelectasis, superimposed infection cannot be excluded. The left lung is grossly clear.", "output": "No significant interval change when compared to the prior study." }, { "input": "Portable AP upright chest radiograph ___ at 03:36 is submitted.", "output": "Endotracheal tube and right internal jugular central line are unchanged in position. Right basilar pleural pigtail catheter remains in place with a small residual effusion. There is improving aeration in both lungs with resolving interstitial and perihilar edema. Patchy opacity at the right base likely reflects atelectasis. Overall cardiac and mediastinal contours are stable. No obvious pneumothorax." }, { "input": "Lungs are clear with no evidence of a consolidation, effusion, or pneumothorax. There is mild prominence of the vasculature but without evidence of edema. Additionally, there is mild fullness of the infrahilar right lower lobe but without a focal consolidation. Cardiomediastinal silhouette is otherwise normal. No acute fractures are identified.", "output": "No evidence of ___ acute cardiopulmonary process. There is suggestion of fullness in the infrahilar right lower lobe which may be further evaluated with ___ ___ oblique radiograph. If clinical suspicion for pneumonia is high in this immunocompromised patient, a dedicated Chest CT may also be obtained." }, { "input": "PA and lateral chest radiographs. The lungs are clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Right internal jugular central venous line is unchanged. The heart remains stably enlarged. A left-sided pleural effusion is small and has decreased in size. Bibasilar atelectasis persists. There is also a small right-sided pleural effusion.", "output": "Decreased size of left-sided pleural effusion. Stable right-sided pleural effusion and bibasilar atelectasis." }, { "input": "The lungs are clear and well expanded. No focal consolidation, mass, pleural effusion, pneumothorax, or pulmonary edema. The heart size is normal. The mediastinum is not widened. The hila are within normal limits. Visualized thoracic spine is unremarkable.", "output": "No radiographic evidence of acute or chronic tuberculosis." }, { "input": "The patient has had prior median sternotomy with CABG. A nasogastric tube terminates at the level of the GE junction. An external pacer lead remains in place. Right apical chest tube in place with small right apical pneumothorax. There is a small amount of right upper chest wall subcutaneous emphysema. The patient has had recent esophagectomy with a small amount of expected postoperative pneumopericardium and pneumoperitoneum. Band-like airspace opacities at both lung bases and at the periphery of the right lung are most likely due to atelectasis.", "output": "Bibasilar airspace opacities are most likely due to atelectasis given improvement on the subsequent radiograph. Small right apical pneumothorax with chest tube in place. Small amount of expected postoperative pneumopericardium and pneumoperitoneum." }, { "input": "AP upright and lateral views of the chest provided. Lung volumes are low limiting assessment. No overt signs of pneumonia or edema. No large effusion or pneumothorax. Bronchovascular crowding likely accounts for central prominence of bronchovascular opacities. Cardiomediastinal silhouette appears grossly unremarkable. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Limited, negative." }, { "input": "An endotracheal tube ends 3.6 cm above the carina. An orogastric tube is seen with the side port below the gastroesophageal junction and the tip out of view. Other tubes and wires are likely external to the patient. Otherwise, there are low lung volumes, accounting for some bronchovascular crowding. There is likely mild pulmonary vascular engorgment and a trace right pleural effusion. Ill-defined linear opacities in both lung bases may reflect bibasilar atelectasis. No pneumothorax is identified. Cardiomediastinal and hilar contours are unremarkable.", "output": "Low lung volumes and bibasilar opacities, possibly atelectasis, but aspiration is not excluded. Trace right pleural effusion. Endotracheal and orogastric tubes in appropriate positions." }, { "input": "There are low lung volumes. The cardiac and mediastinal silhouettes are stable. Patchy opacity is seen at the right lung base which may be due to pneumonia with possible atelectasis. Left basilar opacity is most likely due to atelectasis. Slight blunting of the right costophrenic angle suggests a trace pleural effusion and. No pneumothorax is seen. There has been interval removal of a right-sided PICC.", "output": "Low lung volumes. Patchy right basilar opacity could be due to pneumonia. Recommend followup to resolution." }, { "input": "Since earlier same-day chest radiograph, right chest tube is removed and there is a minimal small right apical pneumothorax. Subcutaneous emphysema is unchanged. The heart size is normal. Overall, the lungs are clear. Mild bibasilar atelectasis is unchanged.", "output": "Interval removal of right chest tube with probable minimal small right apical pneumothorax. Unchanged subcutaneous emphysema." }, { "input": "Since ___, small bilateral apical pneumothoraces and small bilateral pleural effusions are unchanged, and retrocardiac atelectasis is mildly increased. Lung volumes remain low with bibasilar atelectasis. Right chest tube positioning is unchanged. Substantial subcutaneous emphysema is again noted.", "output": "Small bilateral apical pneumothoraces and small bilateral pleural effusions are unchanged, and retrocardiac atelectasis mildly increased since ___" }, { "input": "Since ___, bilateral pneumothoraces, right greater than left, are appreciated. The right pneumothorax is seen 2.7 cm from the apex and extends laterally. The left pneumothorax is seen 2.2 cm from the apex. Lung volumes remain low with continued bibasilar atelectasis. Known right chest tube positioning is slightly changed. The cardiomediastinal silhouette is normal. Worsening marked subcutaneous emphysema along the right chest wall, may be due to positioning of the chest tube.", "output": "1. Interval development of bilateral pneumothoraces, right greater than left, since ___. 2. Worsening subcutaneous emphysema along the right chest wall may be due to chest tube positioning. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ ___ on the telephoneon ___ at 2:52 PM, 15 minutes after discovery of the findings." }, { "input": "A portable frontal chest radiograph demonstrates a normal cardiomediastinal silhouette and low lung volumes. There is re-expansion of the right lung, with persistent lower lung atelectasis. Marked subcutaneous emphysema along the right chest wall is noted. There is no appreciable pneumothorax. The visualized upper abdomen is unremarkable.", "output": "Interval re-expansion of the right lung, with persistent lower lobe atelectasis. Marked right chest wall subcutaneous emphysema, as before." }, { "input": "PA and lateral views of the chest. The lungs are clear without consolidation or effusion. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process, no evidence for pneumonia." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "Unremarkable chest radiographic examination." }, { "input": "Lungs well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Lower lung volumes seen on the current exam however the lungs remain clear. There is no consolidation, pneumothorax, or effusion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality. Clear lungs." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No focal consolidation. No acute cardiopulmonary process." }, { "input": "Endotracheal tube terminates approximately 3.2 cm above level the carina. Enteric tube courses below the level of the diaphragm, terminating in the left upper quadrant expected location of the stomach. There is a moderate left pneumothorax with the left chest catheter in place. Large lucency projects over the lower left hemi thorax concerning for large loculated component of pneumothorax. The mediastinum is shifted to the right. There is also widening of the rib interspaces on the left compared to the right, and flattening of the left hemidiaphragm, consistent with tension. There is diffuse opacity projecting over the right lung and to a lesser extent the left lung which may be due to massive aspiration, pulmonary hemorrhage, extensive infection. Right internal jugular central venous catheter terminates in the low SVC. The cardiac silhouette is top-normal. Mediastinal contours are unremarkable. There is extensive left chest wall subcutaneous emphysema.", "output": "Moderate left tension pneumothorax with catheter in place however, there appears to be a large loculated component projecting over the left lower hemithorax. Endotracheal and enteric tubes in appropriate position. Extensive opacity projecting over the right greater than left lungs could be due to extensive aspiration neck, pulmonary hemorrhage, infection, ARDS. Extensive left chest wall subcutaneous emphysema" }, { "input": "AP upright and lateral views of the chest provided. Lungs appear somewhat lucent and hyperinflated which is likely due to underlying emphysema. Subtle opacity at the left lung apex is noted which is indeterminate. There is also apparent shift of the trachea to the right which could in part reflect mild rotation. Given presence of emphysema, a nonemergent CT is recommended to further assess for underlying lesion. No convincing evidence for pneumonia is seen. No large effusion or pneumothorax. Cardiomediastinal silhouette appears normal. Bony structures are intact.", "output": "Emphysema with subtle left apical opacity with mild rightward shift of the trachea. Recommend nonemergent chest CT to further assess for possible underlying lesion." }, { "input": "Increased interstitial markings are noted when compared to prior. There is no confluent consolidation or large effusion. There is biapical scarring. The cardiomediastinal silhouette is stable. No acute osseous abnormalities.", "output": "Pulmonary vascular congestion. Otherwise, no change." }, { "input": "The lungs are clear without infiltrate or effusion. The bony thorax is normal. The cardiac and mediastinal silhouettes are normal", "output": "Normal chest." }, { "input": "The lungs are clear without evidence of consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. There is no free air below the hemidiaphragms.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs were provided. There is an ill-defined subtle retrocardiac opacity projecting over the lower spine concerning for infection. Dense ill-defined material projecting over the mediastinum may be external to the patient as it is not localized on the lateral view. There is no pleural effusion or pneumothorax. Heart size is mildly enlarged. The bones are intact. The imaged upper abdomen is unremarkable.", "output": "Subtle retrocardiac opacity may represent infection in the correct clinical setting." }, { "input": "AP portable upright view of the chest. Previously noted right IJ central venous catheter is been removed. Midline sternotomy wires and mediastinal clips are again noted. Multiple overlying EKG leads are present. Cardiomegaly is unchanged with left basilar opacity likely representing a pleural effusion. There is probable bibasilar atelectasis. Difficult to exclude pneumonia in the correct clinical setting. Mediastinal prominence is unchanged which may reflect recent CABG. Bony structures appear intact.", "output": "Bibasilar atelectasis and left pleural effusion." }, { "input": "Single portable view of the chest is compared to previous exam from ___. The lungs are clear of focal consolidation. Please note the left costophrenic angle is excluded from the field of view. Cardiomediastinal silhouette is within normal limits for technique. Osseous structures are unremarkable. Colonic interposition over the liver seen in the right upper quadrant.", "output": "No definite acute cardiopulmonary process." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. There is no evidence of rib fracture.", "output": "No evidence of acute intrathoracic process." }, { "input": "The lungs are relatively hyperinflated. No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal to mildly enlarged. The aorta is tortuous. There is slight prominence of the superior mediastinum which may be due to AP technique and prominent vasculature. If clinical concern for acute mediastinal or spinal process, CT is more sensitive and should be considered.", "output": "No focal consolidation to suggest pneumonia. Slight prominence of the superior mediastinum which may be due to AP technique and prominent vasculature. No prior for comparison to assess chronicity. If clinical concern for acute mediastinal or spinal process, CT is more sensitive and should be considered." }, { "input": "AP single view of the chest has been obtained with patient in upright position. There is no evidence of pneumothorax in the apical area on either left or right side. In comparison with the next preceding chest examination of ___, at that time described pulmonary abnormalities including a left lower lobe mass persists.", "output": "No evidence of pneumothorax following transbronchial biopsy intervention." }, { "input": "Frontal and lateral views of the chest are obtained. Left hilar/perihilar opacity corresponds to patient's known perihilar mass, better assessed on CT. Old-appearing rib deformities on the left may relate to prior fractures, metastatic disease not excluded, although better evaluated on CT. Extensive vascular calcification is seen projecting over the upper hemithorax bilaterally. No new focal consolidation, pleural effusion, or evidence of pneumothorax is seen.", "output": "Left perihilar opacity corresponding to known pulmonary mass again seen. Otherwise, no acute cardiopulmonary process." }, { "input": "PA and lateral chest radiograph demonstrates clear lungs bilaterally. The cardiomediastinal and hilar contours are within normal limits. There is no pneumothorax are pleural effusion. No over pulmonary team is identified. No acute osseous abnormality is seen.", "output": "No acute intrathoracic process identified." }, { "input": "Cardiomediastinal silhouette is normal. There is no focal lung consolidation. There is platelike atelectasis at the left lung base. There is no pleural effusion or pneumothorax. There is no displaced rib fracture.", "output": "No evidence of pneumonia." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest are correlated to chest CTA from ___. The lungs are clear of focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No overt pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs are clear. Previously seen small dense focus overlying the right posterior fifth rib is likely a bone island and is unchanged. There is mild cardiomegaly. The cardiac, mediastinal, and hilar contours are normal. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable view of the chest. There are hazy opacities identified at the right lung base. Cardiomediastinal silhouette is stable. No acute osseous abnormality is identified.", "output": "Right basilar opacity, potentially atelectasis, although underlying infection or aspiration is not excluded." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Mild central pulmonary vascular engorgement is seen without overt pulmonary edema. Some degenerative changes are seen along the spine.", "output": "Mild central pulmonary vascular engorgement without overt pulmonary edema. No focal consolidation." }, { "input": "There is a right-sided IJ, which terminates in the low SVC. There is a left-sided chest tube with tip projecting over the mid left lung. There has been interval extubation. Heart size is mildly enlarged, overall stable compared to the preoperative exam. There is mild fullness of the hilum bilaterally due to pulmonary vascular engorgement, however there is no evidence of pulmonary edema. No large pleural effusion is identified. There is no evidence of a pneumothorax. Note is made of gasseous distention of the stomach.", "output": "No evidence of a pneumothorax." }, { "input": "PA and lateral views of the chest were provided. The lungs are clear bilaterally. No focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "No acute findings in the chest." }, { "input": "The lungs are well inflated and clear. No consolidation, effusion, or pneumothorax is present. The heart and mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal contours are normal. Nodular opacities primarily in the upper chest, more prominent on the right than the left, are lung and pleural metastases or as shown on prior torso CT. No pneumonia or appreciable pleural effusion is present.", "output": "Lung and pleural metastases. No pneumonia or collapse." }, { "input": "PA and lateral views of the chest were obtained. Since the prior exams, there is significant interval increase in the ill-defined opacity involving the majority of right hemithorax which is concerning for disease progression. The possibility of a superimposed contusion given the history of trauma is impossible to exclude. There may be a trace right pleural effusion. There is subtle opacity at the left lung base which is new though most likely represents metastatic disease. In addition a small area of nodularity in the left upper lung is most compatible with metastatic disease. Cardiomediastinal silhouette appears stable. Bony structures appear grossly intact. No definite displaced rib fractures are identified.", "output": "Findings concerning for worsening metastatic disease in the chest." }, { "input": "ON a background of mild pulmonary edema, there are small bibasilar opacification likely a combination of atelectasis and small pleural effusions. Cardiomediastinal and hilar contours are normal. Calcifications are noted within the aortic arch. No osseous abnormality is present.", "output": "Bibasilar opacifications likely combination of atelectasis and effusion, though pneumonia is a consideration in the appropriate clinical setting." }, { "input": "2 views were obtained of the chest. Right malpositioned PICC has been removed. Bilateral small pleural effusions and accompanying atelectasis are improved from the previous examination. The remainder of the lungs are clear. The heart and mediastinal contours are stable. There is no pneumothorax.", "output": "Decreased, small bilateral pleural effusions." }, { "input": "There are bibasilar opacities with silhouetting of the hemidiaphragms consistent with moderate bilateral pleural effusions with adjacent atelectasis, increased in comparison to prior study from ___. It is worth noting that an overlying developing pneumonia cannot be excluded. The cardiac silhouette also appears enlarged in comparison to prior study suggesting heart failure. Otherwise, atherosclerotic calcifications are again noted at the aortic arch. Known sclerotic focus in the T7 vertebral body is not well evaluated on this study.", "output": "Interval increase in bibasilar opacities consistent with worsening pleural effusions with adjacent atelectasis. Cardiac silhouette also appears enlarged in comparison to prior study and the combination of these findings is suggestive of heart failure." }, { "input": "PA and lateral views of the chest were reviewed in comparison to prior study. Severe scoliosis and a spinal ___ rod is unchanged. The lungs are clear. Heart size is normal and there is no evidence of vascular congestion, pleural effusion or pneumothorax. The soft tissues are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable view of the chest was compared to previous exam from ___. Previously identified right IJ line is no longer visualized. The lungs remain clear noting right basilar atelectasis. Cardiomediastinal silhouette is within normal limits for technique. Osseous and soft tissue structures are grossly unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest are compared to previous exam from ___. Again seen is elevation of the right hemidiaphragm. The lungs remain clear of consolidation or effusion. The cardiac silhouette is within normal limits. Osseous and soft tissue structures are unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "Severe cardiomegaly appears more prominent compared to the prior examination. Cephalization of flow and the general indistinctness of the remaining pulmonary vasculature suggests congestion and mild pulmonary edema. Cardiomediastinal hilar silhouettes are normal. No focal consolidation. No definite pleural effusion. No pneumothorax.", "output": "Slight interval enlargement of the cardiac silhouette and mild pulmonary edema suggest acute on chronic heart failure." }, { "input": "Heart size is top-normal. The mediastinal and hilar contours are normal. The heart size and pulmonary vascular caliber are both top-normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. An enteric tube is in the stomach and out of view.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. There is similar to somewhat increased moderate relative elevation of the right hemidiaphragm. There is no pleural effusion or pneumothorax. Pulmonary vascularity is minimally prominent and indistinct suggesting slight congestion.", "output": "Findings suggesting minimal pulmonary congestion; otherwise, unremarkable." }, { "input": "Single portable view of the chest is compared to previous exam from earlier the same day. There is a new right IJ central line with tip in the mid SVC. Again seen is elevation of the right hemidiaphragm, similar to prior. There is no visualized pneumothorax. Cardiac silhouette is stable.", "output": "New right IJ line in appropriate position. No pneumothorax." }, { "input": "PA and lateral views of the chest provided. There is heterogeneous consolidation in the right upper lobe, with possible underlying bronchiectasis. An additional poorly defined area of consolidation in the right infrahilar region may represent an additional site of infection. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Right upper lobe pneumonia. Possible right upper lobe bronchiectasis, which could be reassessed by followup chest radiograph following antibiotic therapy. NOTIFICATION: The impression and recommendation above was entered by Dr. ___ on ___ at 11:12 into the Department of Radiology critical communications system for direct communication to the referring provider. A message was also emailed to the ED QA nurse." }, { "input": "The lateral view is slight suboptimal due the patient's overlying arm.The lungs are hyperinflated, but without focal consolidation. . No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Surgical hardware is seen at the right shoulder, not optimally evaluated.", "output": "Hyperinflated lungs. No focal consolidation." }, { "input": "Diffuse reticular opacities most pronounced at the lung bases, compatible with interstitial lung fibrosis, overall similar to prior allowing for differences in technique and patient position. No focal opacity seen. No pleural effusion or pneumothorax. The cardiac silhouette is stably enlarged. Calcification of the descending thoracic aorta is again noted. There is a cervical rib on the right.", "output": "No focal lung consolidation. Changes of interstitial lung fibrosis overall similar to prior." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable", "output": "No acute cardiopulmonary abnormalities" }, { "input": "Cardiac size is normal. Aside from retrocardiac opacities, the lungs are clear. There is no pneumothorax. There is a small left effusion. Pneumoperitoneum is again noted. Tracheostomy tube is in standard position. Right central catheter tip is in the cavoatrial junction.", "output": "Retrocardiac opacities associated with adjacent pleural effusion these could represent atelectasis or aspiration in the appropriate clinical setting Pneumoperitoneum" }, { "input": "An endotracheal tube ends 3.6 cm above the level of the carina. An enteric catheter courses below the level of the diaphragm and out of the field of view inferiorly. There is a right-sided PICC ending in the mid SVC. Mild to moderate left retrocardiac atelectasis has decreased. The lungs are otherwise clear. The heart size is normal. There is no pneumothorax. There are no pleural effusions.", "output": "Decreased left retrocardiac atelectasis. Otherwise, little interval change." }, { "input": "AP view of the chest provided. Lungs are clear. Cardiomediastinal and hilar structures are normal. Pleural surfaces are normal. There is no pneumothorax. Endotracheal tube and nasogastric tube in appropriate positions.", "output": "No acute intrathoracic process." }, { "input": "Again seen is an ET tube, tip approximately 4.3 cm above the carina, and an NG tube, tip extending beneath diaphragm off film. The cardiomediastinal silhouette is unchanged. Mild upper zone redistribution is similar to the prior study. Patchy retrocardiac opacity is more pronounced, with new obscuration of the medial left hemidiaphragm. Otherwise, no focal infiltrate. No gross effusion.", "output": "1. New obscuration of the medial left hemidiaphragm and increased retrocardiac opacity, consistent with left lower lobe collapse and/or consolidation. 2. Mild upper zone redistribution, similar to prior." }, { "input": "Heart size is top-normal. The aorta is mildly unfolded. Mediastinal and hilar contours are otherwise unremarkable. There is no pulmonary vascular congestion. Patchy opacities are noted in the lung bases, findings which may reflect atelectasis in the setting of low lung volumes. No pleural effusion or pneumothorax is demonstrated. Minimal loss of height anteriorly of a low thoracic vertebral body is of indeterminate age.", "output": "Low lung volumes with patchy opacities in the lung bases which may reflect atelectasis, though infection or aspiration cannot be excluded in the correct clinical setting. Mild anterior wedge compression deformity of a low thoracic vertebral body, of indeterminate age." }, { "input": "Portable upright chest radiograph ___ at 17:59 is submitted.", "output": "Interval removal of the endotracheal tube and nasogastric tube. The patient is status post median sternotomy with valve replacements and stably enlarged cardiac contours. There are layering bilateral effusions with associated patchy bibasilar airspace opacities suggestive of atelectasis, although pneumonia or aspiration should also be considered. No evidence of pulmonary edema. Slightly lower lung volumes with crowding of the central vasculature. No pneumothorax. Postoperative changes in the upper to mid abdomen." }, { "input": "Compared to the prior study there is a slight increase in the vascular plethora with small right effusion moderate left effusion and volume loss at both bases right IJ line with tip in the right atrium is unchanged.", "output": "Slight increase in effusions." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The heart is normal in size. The mediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Assessment is limited by patient rotation. Patient is status post median sternotomy and CABG. There is mild to moderate cardiomegaly which appears grossly unchanged. Atherosclerotic calcifications of the aorta are again noted. Pulmonary vasculature does not appear engorged. Lungs appear hyperinflated. Small bilateral pleural effusions are noted without focal consolidation. Patchy bibasilar opacities may reflect areas of atelectasis. No pneumothorax is identified. There is diffuse demineralization of the osseous structures with numerous compression deformities noted in the imaged thoracolumbar spine, many of which have developed in the interval and are of unclear chronicity.", "output": "Limited exam. Small bilateral pleural effusions with probable bibasilar atelectasis. Multiple compression fractures throughout the imaged thoracolumbar spine have developed since ___, but of unclear age." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. Heart size is top normal. The aorta is calcified and tortuous. A mid-thoracic vertebral body demonstrates loss of height. Cervical spine hardware is partially imaged.", "output": "1. Top normal heart size without radiographic evidence for acute cardiopulmonary process. 2. Mid thoracic vertebral body loss of height, age indeterminate. Clinical correlation for pain is recommended. These findings were reported to Dr. ___ by Dr. ___ by telephone at 11:20 p.m. on ___ at the time of initial review of the study." }, { "input": "Heart size is mildly enlarged. Rounded opacity at the right cardiophrenic angle could reflect a prominent epicardial fat pad. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities demonstrated.", "output": "No acute cardiopulmonary abnormality. No fractures are seen. If there is continued concern for a rib fracture, then consider a dedicated rib series. Rounded opacity at the right cardiophrenic angle could reflect a prominent epicardial fat pad, but a non urgent chest CT is suggested for further assessment." }, { "input": "AP and lateral views of the chest. No focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal and hilar contours are normal. There is no fracture identified.", "output": "No acute cardiopulmonary process. If there is a particular area of concern, dedicated views can be done for better assessment of traumatic injury." }, { "input": "PA and lateral views of the chest were obtained demonstrating clear well expanded lungs without focal consolidation, effusion, pneumothorax. Heart size is normal. Mediastinal contour is unremarkable. Bony structures are intact. There is no free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral chest radiographs. The lungs are clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The aorta is unfolded. The cardiac silhouette is top normal to mildly enlarged. No overt pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Two PA and one lateral view of the chest were obtained for review. The transvenous right ventricular/epicardial left ventricular defibrillator system. Patient has had median sternotomy. LAD coronary artery is heavily calcified. Severe cardiomegaly is chronic, recently unchanged. There is no focal consolidation to suggest pneumonia. Small bilateral pleural effusion (seen on the lateral view) is the residual of nearly resolved pulmonary edema.", "output": "Mild pulmonary edema, nearly resolved over two weeks." }, { "input": "Frontal and lateral views of the chest. There is increased pulmonary edema when compared to prior. Blunting of the posterior costophrenic angle is compatible with small effusions. There is no confluent consolidation. Moderate cardiomegaly again noted. Single-lead pacing device is identified. Median sternotomy wires are identified as well as coronary stents. No acute osseous abnormalities.", "output": "Slight increase in degree of pulmonary edema." }, { "input": "Chronic severe cardiomegaly is unchanged with stable postoperative mediastinal silhouette. Moderate pulmonary edema is minimally improved with particular note of improvement of previously noted heterogenous opacities in the right upper lobe. There is no pleural effusion or pneumothorax. Left pectoral pacer is unchanged in position.", "output": "Minimal improvement in moderate pulmonary edema with partial clearing of heterogeneous right upper lung opacity." }, { "input": "Frontal and lateral views of the chest. There is mild indistinctness of the pulmonary vasculature but without frank pulmonary edema. There is no confluent consolidation. Blunting of the posterior costophrenic angle thought to be from fat Bochdalek's hernia. Cardiac silhouette is enlarged but stable. Left chest wall single lead pacing device is again noted as well as median sternotomy wires.", "output": "Mild pulmonary vascular congestion without frank pulmonary edema." }, { "input": "Moderate cardiomegaly is unchanged from ___. There has been interval increase in pulmonary vascular congestion and all edema with worsening bilateral patchy opacities particularly in the right mid and lower lung. Progressive opacification may be from progressive edema or infection. There is no pleural effusion or pneumothorax.", "output": "Worsening vascular congestion and pulmonary edema with increased opacities especially in the right mid and lower lung which could be due to progressive edema however infection is not excluded. Results were discussed over the telephone with Dr. ___ at 11:43 on ___ at time of initial review by Dr. ___." }, { "input": "The previous right middle lobe opacity has resolved. More so on the left than the right, increased interstitial markings suggest mild pulmonary edema. There is no pleural effusion or pneumothorax. Heart remains stably enlarged with single-lead pacemaker device noted.", "output": "Mild pulmonary edema." }, { "input": "Left-sided pacemaker device is noted with lead terminating in the right ventricle and two epicardial leads are also re- demonstrated. Cardiac stents are noted, and the patient is status post median sternotomy and CABG. There is mild pulmonary vascular congestion. New right basilar opacity is concerning for pneumonia or aspiration. No left-sided consolidation is seen. There is no pleural effusion or pneumothorax. No acute osseous abnormalities are detected.", "output": "Right lower lobe opacity concerning for pneumonia or aspiration. Mild pulmonary vascular congestion." }, { "input": "The cardiac, mediastinal and hilar contours are unchanged, with the heart size appearing top normal. The pulmonary vascularity is normal. Linear opacities within both lung bases are compatible with subsegmental atelectasis. No focal consolidation, pleural effusion or pneumothorax is identified. No acute osseous abnormality is seen.", "output": "Subsegmental atelectasis in both lung bases." }, { "input": "Linear right basilar atelectasis/ scarring is minimal. Mild elevation of the left hemidiaphragm is again seen. No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "2 views of the chest were obtained. The lungs are lower in volume compared to the previous examination with increased bibasilar predominantly linear opacities consistent with atelectasis. No definite effusion is seen although trace left effusion would be difficult to entirely exclude. There is no pneumothorax. Heart is top-normal in size with normal mediastinal contours.", "output": "Bibasilar opacities are most likely atelectasis." }, { "input": "PA and lateral chest radiographs were obtained. Patchy linear opacities at both lung bases persist but are somewhat less apparent compared to the studies in the preceding week. There is no new consolidation, effusion, or pneumothorax. Cardiac, mediastinal, and hilar contours are unremarkable.", "output": "Improving bibasilar opacities, likely atelectasis." }, { "input": "Frontal and lateral views of the chest were obtained. Patchy bibasilar opacities most likely represent atelectasis, although in the appropriate clinical setting, an early infectious process is not excluded. No pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable.", "output": "Patchy somewhat linear in configuration bibasilar opacities most likely represent atelectasis, although in the appropriate clinical setting, an infectious process is not excluded." }, { "input": "Frontal and lateral views of the chest were obtained. Heart size and cardiomediastinal contours are stable. Bibasilar linear opacities are similar to prior and compatible with atelectasis or scarring. No focal consolidation, pleural effusion, or pneumothorax.", "output": "Bibasilar linear opacities are similar to prior and compatible with atelectasis or scarring." }, { "input": "There is minimal right basilar atelectasis. The lungs are otherwise clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. Pulmonary vascularity is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest demonstrate low lung volumes which accentuate normal heart size. The cardiomediastinal silhouette and hilar contours are normal. There is bibasilar atelectasis. The lungs are otherwise clear. No pleural effusion or pneumothorax. No displaced rib fracture identified.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are normally expanded. No focal airspace opacity is detected. There is perhaps minimal atelectasis at the left base, similar to the prior study. The heart is not enlarged. The mediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary abnormality." }, { "input": "PA and lateral chest radiographs demonstrate no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Posterior skin lesion is again visualized on lateral view.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well expanded and clear. There is no focal consolidation, effusion, or pneumothorax. Cardiac and mediastinal contours are normal. A 2 cm radiopaque lesion is again seen in the left back.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities demonstrated.", "output": "Normal chest radiograph." }, { "input": "Supine portable AP view of the chest is provided. The endotracheal tube tip resides approximately 5 cm above the carina. The lungs are clear. Cardiomediastinal silhouette is normal. Bony structures appear intact.", "output": "Appropriately positioned endotracheal tube." }, { "input": "Moderate hyperexpansion is chronic with relative lucency of the left lung consistent with prior left lower lobectomy. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette, including a tortuous descending aorta, which is likely related to left lower lobectomy, is stable.", "output": "Moderate chronic hyperexpansion without focal consolidation. NOTIFICATION: The findings were discussed by Dr. ___ with ___, N.P. on the telephoneon ___ at 12:06 PM, 2 minutes after discovery of the findings." }, { "input": "PA and lateral chest radiographs were provided. Lung volumes are slightly low. Opacity at the left base may be atelectasis; however infection cannot be excluded. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unchanged and notable for a tortuous aorta. The bones are intact.", "output": "Left basilar opacity which may represent atelectasis or infection." }, { "input": "Moderate cardiomegaly is unchanged compared to the prior exam. The mediastinal and hilar contours are stable, with diffuse atherosclerotic calcification of the thoracic aorta. There is no pulmonary vascular congestion. No focal consolidation, pleural effusion or pneumothorax is seen. Minimal atelectasis is noted within the right lung base. No acute osseous abnormalities detected.", "output": "No evidence of pulmonary edema." }, { "input": "Frontal and lateral views of the chest. No pleural effusion, pneumothorax or focal airspace consolidation. No free air under the diaphragm. Heart is moderately enlarged but unchanged. There is an epicardial fat pad. Mediastinum and hilar structures are unremarkable. Vascular stent is seen projecting over the left neck.", "output": "No acute cardiopulmonary process with stable moderate cardiomegaly." }, { "input": "There are low lung volumes, and crowding of normal bronchovascular structures. The cardiomediastinal silhouettes are grossly stable, possibly with mild cardiomegaly. Left lower lung opacity may represent atelectasis, however pneumonia or aspiration pneumonitis post be considered in the appropriate clinical setting. Right cardiophrenic angle opacity likely reflects crowding of normal bronchovascular structures. There is no pulmonary vascular congestion or pulmonary edema. There is no pneumothorax. Difficult to exclude a small left pleural effusion. No right pleural effusion.", "output": "Low lung volumes. Left lung opacity may represent atelectasis versus pneumonia or aspiration pneumonitis in the appropriate clinical setting. Possible small left pleural effusion." }, { "input": "Lung volumes are low bibasilar opacities which likely represent atelectasis, however could represent early infection in the appropriate clinical setting. There is no pleural effusion, or pneumothorax. Heart size and mediastinal contours are normal.", "output": "Bibasilar opacities likely reflecting atelectasis in the setting of low lung volumes, however infection could be a possibility in the appropriate clinical setting." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lung fields are clear. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable.No osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "AP and lateral chest radiograph demonstrates an enlarged heart, stable in size relative to prior examination. Central vascular prominence as well as perihilar opacities likely reflects pulmonary edema. There is no large pleural effusion. Cervical spine hardware is partially imaged. There is no pneumothorax.", "output": "Enlarged heart with interval development of mild pulmonary and interstitial edema." }, { "input": "The lungs are clear focal consolidation, effusion, or pulmonary edema. Obscuration of the right cardiophrenic angle is compatible fat pad seen on prior CT scan. Cardiac silhouette is enlarged, similar compared to prior. Lower thoracic dextroscoliosis is noted. No acute osseous abnormalities. Fractures of the pedicle screws at T1 appear are again seen.", "output": "No acute cardiopulmonary process." }, { "input": "The extent of pulmonary edema has improved compared to the prior radiograph. There are no focal consolidations. The cardiomediastinal silhouette is enlarged but stable. No pleural effusion or pneumothorax is seen. Cervical fixation hardware is partially visualized with fractures through the most inferior pedicle screws bilaterally, visualized on the C-spine CT dated ___.", "output": "1. Slightly improved pulmonary edema without focal consolidations. 2. Partially visualized cervical fixation hardware with fractures through the inferior-most pedicle screws bilaterally, unchanged from prior." }, { "input": "Single portable view of the chest. The lungs are clear. The cardiac silhouette is enlarged but stable in configuration. Osseous structure is again notable for fracture of the hardware involving the cervicothoracic posterior fixation.", "output": "Cardiomegaly without definite superimposed acute cardiopulmonary process." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax. No definite left rib abnormalities identified although conventional radiographs have low sensitivity for detection of rib abnormalities.", "output": "No acute cardiopulmonary process. If there is persistent concern, dedicated rib films may be helpful." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are clear without focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac and mediastinal silhouette is unremarkable. There is no pleural effusion or pneumothorax. Minimal opacity is suspected in the right middle lobe to explain a slightly obscured right lateral cardiac border on the frontal view.", "output": "No convincing evidence for pneumonia; suspected slight atelectasis in the right middle lobe." }, { "input": "Heart is upper limits of normal in size. Mediastinal and hilar contours are normal. Lungs and pleural surfaces are clear.", "output": "No acute cardiopulmonary radiographic abnormality." }, { "input": "Clips are seen along the left upper border of the mediastinum. There has been interval placement of a Dobbhoff tube whose tip sits in the distal portion of the stomach. The cardiomediastinal and hilar contours are normal. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process; Dobbhoff tube tip in the distal stomach." }, { "input": "New Dobbhoff tube with the tip at the first portion of the duodenum. Surgical clips are again noted in the left upper mediastinum. Otherwise, there is little change in comparison to prior study. There is continued elevation of the right hemidiaphragm with liver enlargement. Mild right basilar atelectasis as well as small right pleural effusion are again noted. Additionally, mild pulmonary edema persists. Otherwise, no new consolidations, effusions, or pneumothoraces.", "output": "1. Dobbhoff tube tip is at the first portion of the duodenum. 2. Mild pulmonary edema, small right pleural effusion, and right basilar atelectasis are stable." }, { "input": "AP upright and lateral views of the chest were obtained. A feeding tube is seen extending into the upper abdomen. Marked elevation of the right hemidiaphragm is stable. No focal consolidation, large effusion or pneumothorax is seen. Heart size appears grossly stable, though the right heart border is obscured from view. Mediastinal contour is stable. Multiple surgical clips are again noted along the right paramediastinal region. The bony structures appear intact.", "output": "Appropriately positioned feeding tube. Stable elevated right hemidiaphragm. Otherwise, no acute findings." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. Left sided paraspinal clips are again noted. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Portable chest radiograph demonstrates Dobbhoff tube with wire still in place and seen in stomach and coursing out of view. There is stable cardiomediastinal borders as well as right hemidiaphragm elevation, stable since ___, and related to perihepatic ascites identified on the ___ MRI.", "output": "Dobbhoff tube with wire still in place passes into the upper abdomen and out of view. Stable right hemidiaphragm elevation related to perihepatic fluid." }, { "input": "Dobbhoff tube with tip positioned in the mid-to-distal stomach, unlikely to be post-pyloric, as it does not pass midline. Endotracheal and nasogastric tube has been removed in the interim, . Otherwise, exam is unchanged with atelectasis noted in the right lower lung and possible small right pleural effusion.", "output": "Dobbhoff tube in the mid-to-distal stomach." }, { "input": "A Dobbhoff tube is in the post-pyloric position. The right hemidiaphragm remains stably elevated. Stable mild pulmonary vascular engorgement and mild interstitial edema persist. There is no pleural effusion or pneumothorax. There is no new consolidation. The cardiomediastinal silhouette is normal. Left mediastinal clips are unchanged.", "output": "1. No evidence of pneumonia. 2. Stable elevation of the right hemidiaphragm. 3. Stable mild pulmonary edema. Results were telephoned to ___ at 4:35 on ___ by Dr. ___." }, { "input": "Esophageal catheter courses into the left upper quadrant with tip projecting over the midline, likely within the distal stomach. Lung volumes are low with persistent elevation of the right hemidiaphragm basilar atelectasis. There has been interval improvement or resolution of the right pleural effusion. No pneumothorax is detected. Heart and mediastinal contours are stable. Mediastinal surgical clips are again noted. Biliary stent and right upper quadrant pigtail catheter are again noted. Surgical ___ project over the upper abdomen.", "output": "Orogastric tube with tip likely within the stomach." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Comparison is made with the next preceding similar study ___ ___. The heart size is unchanged and within normal limits. No configurational abnormality is identified. Unremarkable appearance of thoracic aorta. No mediastinal abnormalities are seen. The pulmonary vasculature is not congested. No signs of acute or chronic parenchymal infiltrates are seen and the lateral and posterior pleural sinuses are free. No pneumothorax in apical area. Unchanged appearance of previously described multiple surgical clips in dorsal chest wall and in left-sided para-spinal position.", "output": "Unchanged normal chest findings. Thus, no evidence of any residual pulmonary infiltrate of described pneumonia appearing at other institution." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. Paraspinal mediastinal clips are reidentified.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Right hemidiaphragm contour is markedly elevated to the level of the right hilum. The degree of right hemidiaphragm elevation has increased since ___ and was at a normal level on ___ chest radiograph. There is adjacent atelectasis at the right lung base. Heart size is normal. Left lung and pleural surfaces are clear. Surgical clips are present in the left paraspinal region. Feeding tube terminates below the diaphragm.", "output": "Worsening right diaphragmatic elevation, possibly due to known history of large volume ascites. A coexisting subpulmonic effusion cannot be excluded radiographically but there is no evidence of effusion on concurrent ultrasound exam." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for pneumonia. Unchanged appearance of the paraspinal mediastinal clips.", "output": "No acute intrathoracic abnormalities identified. No subdiaphragmatic free air." }, { "input": "There is no focal consolidation, pleural effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Multiple surgical clips are seen in the left upper hemithorax, which are unchanged. Right upper quadrant stents identified. The osseous structures are intact.", "output": "No acute cardiopulmonary process." }, { "input": "A Dobbhoff tube is seen with the tip in the stomach. Again noted is an unchanged right pleural effusion. The heart size is normal. The upper lung zones are not included in the field of view on this image.", "output": "1. Dobbhoff in proper position in the stomach. 2. Stable right pleural effusion." }, { "input": "Paraspinal clips on the left are again visualized. The lungs are clear without infiltrate. There is blunting of the left CP angle that could represent a small effusion. Heart size is slightly enlarged compared to prior. The right hemidiaphragm is not as elevated as on the prior study. The right-sided PICC line is no longer visualized.", "output": "Small left effusion." }, { "input": "Endotracheal and enteric tubes are in satisfactory position. Heart size is normal. Left lower lobe collapse and small left pleural effusion are unchanged. No evidence of pneumonia. No pneumothorax.", "output": "Stable support lines and tubes. Unchanged left lower lobe collapse and small left pleural effusion." }, { "input": "Endotracheal tube terminates 4.5 cm from the carina. Enteric tube terminates in the left upper quadrant. Heart size is normal. Left lower lobe collapse and left pleural effusion are noted the lungs are otherwise clear.", "output": "Left lower lobe collapse and small left pleural effusion." }, { "input": "Portable AP view of the chest provided. The endotracheal tube is seen with its tip residing approximately 2 cm above the carina. Lung volumes are low, and there are scattered perihilar opacities likely reflecting bronchovascular crowding and/or scattered subsegmental atelectasis. The possibility of trace aspiration is also raised. No large effusion or pneumothorax is seen. Clips reside in the right breast. Bony structures are intact.", "output": "ET tube tip positioned 2 cm above the carina. Mild perihilar opacity, likely atelectasis or bronchovascular crowding, cannot exclude trace aspiration." }, { "input": "Low lung volumes are present. This accentuates the size of cardiac silhouette which is likely within normal limits. The aorta is mildly unfolded. Mediastinal and hilar contours otherwise are unremarkable. There is no pulmonary vascular congestion. Mild bibasilar airspace opacities likely reflect atelectasis. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormalities are seen.", "output": "Low lung volumes with probable mild bibasilar atelectasis." }, { "input": "PA and lateral views of the chest were provided demonstrating no focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours are normal. A fat pad is noted along the right heart border. Bony structures are intact.", "output": "No acute findings in the chest." }, { "input": "Left base atelectasis is seen. No definite focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "In comparison to the prior study there is persistent severe pulmonary edema and large right pleural effusion. Cardiomediastinal silhouette is unchanged. There is no pneumothorax.", "output": "No substantial change compared to the prior study." }, { "input": "There has been interval, likely increase in large right-sided pleural effusion, given differences in technique. Underlying consolidation is not excluded. There are patchy opacities projecting over the left mid-to-lower lung which could be due to multifocal infection versus less likely edema. The mediastinal and cardiac silhouettes are not well assessed due to the large right-sided opacity from pleural effusion, however, the right aspect of the mediastinum and heart appear unremarkable. No large left pleural effusion is seen. There is no evidence of pneumothorax.", "output": "1. Interval increase in large right pleural effusion, underlying consolidation cannot be excluded. 2. Patchy opacities in the left mid-to-lower lung raise concern for multifocal infection, aspiration, edema felt less likely." }, { "input": "Upright AP and lateral views of the chest provided. Previously noted nasogastric tube has been removed. Mild to moderate pulmonary edema persists with small right pleural effusion. Fissure all fluid on the right likely accounts for the triangular peripheral mid lung opacity with probable adjacent scarring. The heart mediastinal contours are poorly assessed though appear grossly stable from most recent prior exam. The imaged bony structures are intact. Embolic material is seen projecting over the upper abdomen.", "output": "Essentially stable exam with right pleural effusion, partially loculated and pulmonary edema unchanged." }, { "input": "There has been interval placement of a nasoenteric tube, which terminates in the pylorus of the stomach. A right internal jugular central venous catheter terminates in the upper SVC, as before, and an endotracheal tube is in appropriate position in the mid trachea. A right pleural effusion is moderate, increased since the prior study. Bilateral hazy perihilar opacities have increased since the prior study, compatible with worsening pulmonary edema.A TIPS stent is noted in the liver.", "output": "1. Nasoenteric tube terminates in the region of the gastric pylorus. 2. Interval worsening of pulmonary edema and right pleural effusion." }, { "input": "The Dobbhoff appears to be coiled in the lower esophagus. Bilateral alveolar opacities with pulmonary edema are again seen, similar prior exam. Pleural effusions are similar to prior. The cardiomediastinal silhouette is similar to prior exam.", "output": "1. Dobbhoff coiled in the lower esophagus. 2. Unchanged appearance of pulmonary edema. NOTIFICATION: These findings were communicated to Dr. ___ at 5:34 p.m. on ___ by phone." }, { "input": "The heart appears mild to moderately enlarged. Heterogeneous opacification of the left lung appears markedly improved. Similarly, there has been improvement in opacities in the right mid-to-upper lung, probably including substantial improvement in the superior segment of the right lower lobe. Patchy opacity layering along the minor fissure suggests atelectasis. A pigtail catheter has been removed. There is recurrent opacification of the right lower hemithorax, probably reflecting pleural effusion, most likely moderate in size but difficult to quantify, as well as increasingly dense opacification of the right middle lobe suggesting atelectasis or consolidation.", "output": "Improving multifocal parenchymal opacities suggesting resolving pneumonia, but increasing dense opacification of the right lower hemithorax suggesting a combination of pleural effusion with atelectasis or potentially pneumonia." }, { "input": "A nasogastric tube terminates in the stomach. The lung volumes are low. The cardiac, mediastinal and hilar contours appear unchanged. There is similar heterogeneous opacification of each lung, greater on the right than left, with indistinct pulmonary vasculature suggesting mild to moderate pulmonary edema the main difference is an increasing pleural effusion on the right with right basilar volume loss suggesting coinciding atelectasis. A small pleural effusion is noted on the left.", "output": "Findings suggesting mild to moderate pulmonary edema with increasing right-sided pleural effusion." }, { "input": "There has been interval reaccumulation of a large, right pleural effusion with adjacent atelectasis. The right upper lobe and left lung appear grossly clear. The cardiomediastinal silhouette is stable.", "output": "Reaccumulation of a large right pleural effusion." }, { "input": "PA and lateral views of the chest were provided. There has been interval thoracentesis on the right side with significant decrease in the size of the right pleural effusion with only a small residua. Subtle consolidation in the right mid-to-lower lung could represent reexpansion pulmonary edema. Left lung appears grossly clear with probable mild left basilar atelectasis. No pneumothorax is seen.", "output": "Significant decrease in right pleural effusion with opacity in the right mid-to-low lung likely representing reexpansion pulmonary edema." }, { "input": "Severe pulmonary edema and bilateral pleural effusions, large on the right has increased compared to prior examination. Previously noted probable multifocal pneumonia in the left lung is a masked by the increased edema. Cardiomediastinal silhouette is relatively stable.", "output": "Increased severe pulmonary edema and bilateral pleural effusions, make evaluation of airspace abnormalities difficult." }, { "input": "There is a large right pleural effusion with severe compressive atelectasis and a very small amount of remaining aerated lung. Confluent diffuse airspace opacities are also present in the left lung. There is no large left effusion. No pneumothorax. Cardiac silhouette is largely obscured", "output": "1. Moderate pulmonary interstitial edema and large right pleural effusion." }, { "input": "Frontal and lateral radiographs of the chest demonstrate complete opacification of the right hemithorax consistent with a combination of pleural effusion and collapse of the right lung. There is no shift of the mediastinum. The left lung is clear. There is no pneumothorax.", "output": "Complete opacification of the right hemithorax consistent with a combination of pleural effusion and collapse of the right lung. COMMENTS: These findings were discussed with ___ (transplant nurse) by Dr. ___ ___ telephone at 3:20pm on ___, 1 hour after discovery." }, { "input": "Frontal and lateral chest radiographs again demonstrate a large right pleural effusion with associated atelectasis, not significantly changed in the last hour, but increased compared to ___ and ___. The left base infiltrate is improved compared to ___. The right base infiltrate is obscured by the pleural effusion and cannot be compared. There is no pneumothorax.", "output": "1. Increase in a large right pleural effusion since ___, with associated atelectasis. 2. Improved left base infiltrate compared to ___. The previously seen right base infiltrate cannot be compared due to overlying pleural effusion." }, { "input": "A portable frontal chest radiograph was obtained, demonstrating low lung volumes. Allowing for apical lordotic projection and lower lung volumes, there is likely no change in the moderate to large right pleural effusion and left lower lung opacities. The remainder of the exam is unchanged.", "output": "Allowing for apical lordotic projection and lower lung volumes, there is likely no change in the moderate to large right pleural effusion and left lower lung opacities." }, { "input": "AP portable upright view of the chest. A nasogastric tube terminates within the stomach, with the side hole at the gastroesophageal junction. A moderate right pleural effusion is unchanged since the ___ examination. Again seen is central pulmonary vascular congestion with moderate edema. A right PICC terminates at the cavoatrial junction. A right upper quadrant stent and midline vascular coils are again seen.", "output": "Nasogastric tube terminating within the stomach, with the side hole at the gastroesophageal junction." }, { "input": "Left PICC tip terminates in the upper SVC. Large right pleural effusion appears slightly increased in size compared to the previous exam with associated right basilar atelectasis. The cardiac, mediastinal and hilar contours appear grossly unchanged. Patchy opacity within the left mid lung field appears new and is concerning for an area of developing infection. There is no left-sided pleural effusion or pneumothorax. No acute osseous abnormalities are demonstrated.", "output": "1. Left PICC tip in the upper SVC. 2. Large right pleural effusion, slightly increased in size compared to the prior exam with associated right basilar atelectasis. 3. New ill-defined opacities within the left mid lung field concerning for infection." }, { "input": "There is interval aeration of the right lung apex from ___ with opacification of the remainder of the lung, unchanged compatible with a large right pleural effusion, minimally improved from the prior study. The left lung is grossly clear. No pneumothorax is detected. There is no left pulmonary vasculature engorgement or overt pulmonary edema. The cardiomediastinal silhouette is incompletely assessed due to opacification of the right lung. The trachea remains midline. No acute osseous abnormality is detected.", "output": "Interval aeration of the right lung apex with minimally improved large right pleural effusion compared to ___." }, { "input": "AP portable upright radiograph demonstrates interval improvement in right pleural effusion, which is now small to moderate. Left lung parenchymal opacities are unchanged, and the right apex is well aerated. There is interval worsening of the left pleural effusion, which is now small. Heart size and hilar contours are unchanged.", "output": "Interval improvement in large right pleural effusion, which is now small to moderate, with interval increase in left pleural fluid, which is now small." }, { "input": "There is a moderate right pleural effusion that has increased compared to prior exam. There is volume loss in the right lung and consolidation. There is alveolar infiltrate in the left lower lung. There is a small left effusion. There is mild pulmonary vascular redistribution.", "output": "Bilateral infiltrates right greater than left with bilateral effusions right greater than left." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Right chest tube now appears closer to the apex of the right hemi thorax. Right pneumothorax and effusion are not significantly changed from ___. Mild left retrocardiac opacity may represent atelectasis. No focal consolidation. TIPS shunt and evidence of gastric variceal embolization are seen.", "output": "1. Right pneumothorax and effusion are not significantly changed from ___. 2. Right chest tube now appears closer to the apex of the right hemi thorax." }, { "input": "A chest tube remains in place with a small right apical pneumothorax. There is also a moderate-sized pleural effusion on the right. Allowing for slight differences in positioning and decreased lung volumes, the extent of fluid is not clearly changed. There is probably some degree of atelectasis at the right lung base, as before, although findings are not specific on radiography. A TIPS shunt projecting over the right upper quadrant shows some narrowing along the mid portion of the stent, similar to the prior findings, and again noted are vascular coils projecting over the epigastric region to the left of midline as well as patchy calcification in the left upper quadrant. The left lung remains clear with noting a very small pleural effusion only on the left.", "output": "Decreased lung volumes, but other prior probably no significant change." }, { "input": "Compared to the prior study, the right PleurX catheter is not visualized, and there is interval decrease in the right pleural effusion. Bilateral parenchymal opacities have improved and the lungs are better aerated, although still worse on the left compared to the right. The heart size is difficult to assess due to obscuration of the cardiac border.", "output": "Interval decrease in the right pleural effusion with not visualized right pleural catheter." }, { "input": "Of note, the patient has been suffering from hepatic hydrothorax secondary to liver cirrhosis with two recent thoracentesis on ___ and ___. Compared to our prior radiograph on ___, there is a large right-sided pleural effusion with associated right lower lobe atelectasis. Patchy airspace and interstitial opacities are noted throughout the left lung, suggestive of pulmonary edema, significantly worse from ___. There is no left-sided pleural effusion. There is no evidence of subdiaphragmatic free air. Old right lower lateral right fractures are noted.", "output": "Large right-sided pleural effusion and worsening pulmonary edema in the left lung." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal mediastinum and heart size. A moderate right pleural effusion has decreased since yesterday, with interval improvement in the right middle lobe consolidation. An opacity in the superior right lower lobe is improved, and given this rapid improvement likely represented atelectasis or major aspiration which is now resolved. There is no convincing evidence of pneumonia. The left lung is unchanged, and there is no left pleural effusion. No pneumothorax is seen.", "output": "1. Interval decrease in the right pleural effusion and improvement in the right middle lobe consolidation. 2. Improvement of a superior right lower lobe opacity, which likely represented atelectasis or major aspiration, without convincing evidence of pneumonia." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Partially imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "There is no pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal silhouette is normal. Minimal opacity at right lung base is probably atelectasis and less likely an early focus of pneumonia.", "output": "Minimal right basilar opacity, favoring atelectasis over focal pneumonia." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Right humeral head anchor noted.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Coronary artery stent is noted. Lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities are detected. No definite focal rib lesion is noted.", "output": "No acute cardiopulmonary abnormality. No focal osseous abnormality identified." }, { "input": "The cardiomediastinal silhouettes are normal. The bilateral hila are unremarkable. The lungs are clear. There is no pulmonary vascular congestion. There is no pleural effusion or pneumothorax.", "output": "Unremarkable chest radiograph. No acute cardiopulmonary process." }, { "input": "Lungs are well expanded clear. Mediastinal contour, hila, and cardiac silhouette are normal. The aorta is tortuous. No pneumothorax or pleural effusion. Left fifth posterior rib fractures appears chronic.", "output": "Chronic left fifth rib fracture. No evidence of acute fracture within the limits of plain radiography." }, { "input": "The posterior costophrenic sulci are blunted with a meniscoid effect suggesting small pleural effusions which are likely bilateral, although more definitively demonstrated on the right side. The pulmonary vascularity is mildly prominent suggesting slight pulmonary congestion. Vague opacities in the left lower lobe are better seen on the lateral view. Atelectasis or pneumonia could be considered for this appearance. There is no pneumothorax. Mild cardiac enlargement is similar allowing for differences in technique.", "output": "Small pleural effusions and left lower lobe opacity, greater than right. Mildly prominent vascularity suggesting slight congestion. Atelectasis or potentially pneumonia could be considered in the appropriate clinical setting regarding focal left lower lobe opacification." }, { "input": "PA and lateral views of the chest provided. Airspace consolidation is noted in the left lower lobe concerning for pneumonia. Right lung is clear. Cardiomediastinal silhouette appears unremarkable. No pneumothorax. A small left pleural effusion is likely present. Bony structures are intact.", "output": "Left lower lobe pneumonia. Please refer to subsequent CTA chest for further details." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute disease." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Prominent anterior spurs noted throughout the mid to lower T-spine. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Lung volumes are lower. Retrocardiac opacity is likely atelectasis. The heart is top-normal in size, unchanged. The mediastinum is not widened. No edema no pleural effusion, pneumothorax, or focal consolidation.", "output": "No focal pneumonia. Atelectasis and low lung volumes." }, { "input": "Slight rotation of the patient limits assessment, with obscuration of the right heart border due to superimposition with the spine. The lungs are hyperinflated, with flattening of the diaphragm and attenuation of the peripheral vessels compatible with emphysema. There are no focal opacities concerning for pneumonia. Linear opacities in the left lung base were present on ___ and likely represent scarring. Mild cardiomegaly is redemonstrated with significant contribution from the left atrium. There is no pleural effusion or pneumothorax. A bicameral pacemaker is redemonstrated with the leads ending in appropriate position.", "output": "Hyperinflated lungs. No evidence of pneumonia." }, { "input": "The lungs well expanded. Mild bibasilar atelectasis is again noted, similar to prior exam. The lungs are otherwise clear. There is no pleural effusion or pneumothorax. Cardiomediastinal silhouette is unremarkable. A pacemaker is seen overlying left chest with leads in expected location. No evidence of acute traumatic chest injury.", "output": "No acute cardiopulmonary process. No evidence of acute traumatic chest injury. If concern for rib fracture persists, dedicated rib radiographs can be obtained." }, { "input": "The lungs are well expanded with stable bibasilar atelectasis. A left dual lead pacemaker is unchanged. No pneumothorax or pleural effusion.", "output": "No evidence of pneumonia." }, { "input": "Assessment is slightly limited by patient rotation. Left-sided pacemaker device is again noted with leads terminating in the right atrium right ventricle. Heart size appears within normal limits. Mediastinal and hilar contours are unchanged with mild atherosclerotic calcifications noted in the aortic arch. Pulmonary vasculature is not engorged. Subsegmental atelectasis is seen in the lung bases. No focal consolidation, pleural effusion or pneumothorax is detected. There are no acute osseous abnormality is visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "A dual lead pacemaker/ICD device appears unchanged with leads terminating in the right atrium and ventricle, respectively. The cardiac, mediastinal, and hilar contours appear stable. The extreme right costophrenic sulcus is partly excluded, but there is no evidence for pleural effusion or pneumothorax. Streaky opacity in the left lower lung suggests minor atelectasis, probably unchanged. Otherwise, the lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "A left-sided pectoral pacer and dual leads are in expected position. The cardiomediastinal and hilar contours are within normal limits. The lungs are minimally hyperexpanded but clear. No focal consolidation, pleural effusion or pneumothorax is seen.", "output": "No evidence of pneumonia." }, { "input": "PA and lateral views of the chest provided. The lungs are mildly hyperexpanded. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No pneumonia." }, { "input": "Frontal and lateral views of the chest. Multiple scattered nodular and patchy opacities have increased since the prior exam, possibly representing enlarging pulmonary nodules or infection. Right medial lung base opacity is most consistent with infection. Blunting of the left costophrenic angle could represent pleural thickening or a small pleural effusion. Heart size and cardiomediastinal contours are normal. Thoracic spinal fusion hardware is in stable position with pedicle screws and laminar hooks. Severe compression deformity of a mid-thoracic spine vertebral body is similar to prior.", "output": "Increase in size and number of multiple scattered and patchy opacities, as well as new medial right lung base opacity, consistent enlarging pulmonary nodules and concern for underlying infection." }, { "input": "Frontal and lateral views of the chest are obtained. Bilateral spinal rods are seen. Left basilar atelectasis/scarring is seen. There is slight blunting of the left costophrenic angle, which may be due to a very trace pleural effusion. Scattered patchy opacities are seen in the right lower lung, some of which may be due to pulmonary nodules, but appear greater in extent as compared to the prior CT and may be due to areas of underlying infection or worsening disease. No pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. The cardiac and mediastinal silhouettes are unremarkable. There is stable severe compression of the mid thoracic vertebral bodies.", "output": "Areas of patchy right lower lung opacity appear increased, could be due to pulmonary nodules with areas of infection or progression of disease. Possible very trace left pleural effusion." }, { "input": "There is a subtle increase of opacities on the right side which is confirmed on the lateral view. Cardiac silhouette is normal in size. There is no pleural effusion or pneumothorax.", "output": "Subtle increase in right sided opacities concerning for a pneumonia in the correct clinical setting. Findings emailed to ED QA nurses at 8:03 AM." }, { "input": "Heart size is normal. Atherosclerotic calcifications are noted at the aortic knob. Mediastinal and hilar contours are unchanged. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is present. Scarring is seen within the lung apices. Calcified granuloma in the right lung base is present. Moderate multilevel degenerative changes are seen in the thoracic spine.", "output": "No acute cardiopulmonary abnormality. Specifically, no evidence of aspiration." }, { "input": "Frontal and lateral chest radiographdemonstrates a right porta cath tip in the mid SVC. The lungs are mildly hypoinflated with crowding of vasculature. No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable.", "output": "1. Right porta cath tip in the mid SVC 2. No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were performed. The lungs are clear. There is no pleural effusion, pneumothorax or focal airspace consolidation. The cardiac and mediastinal contours are normal. The hilar and pleural structures are normal. The imaged upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax. Visualized osseous structures are grossly intact.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs are fully expanded and clear. No pleural abnormalities. Heart size is normal. Cardiomediastinal and hilar silhouettes are normal.", "output": "No significant cardiopulmonary abnormality." }, { "input": "Lung volumes are low leading to crowding of the bronchovascular structures. Mild bibasilar atelectasis is noted. There is no lobar consolidation, pleural effusion, pneumothorax, or pulmonary edema identified. Mild cardiomegaly is noted.", "output": "Low lung volumes, mild cardiomegaly, and bibasilar atelectasis." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. Although this study is limited for assessment of osseous structures, no bony abnormalities are identified.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are moderately well inflated and clear. No pleural effusions. Cardiomediastinal silhouette is within normal range. There is diffuse mild demineralization with multilevel degenerative changes of the thoracic spine.", "output": "No acute cardiopulmonary process identified." }, { "input": "Cardiomediastinal contours are normal. Lungs are clear. There are possible very small pleural effusions bilaterally. A large amount of free intraperitoneal air is evident and is likely explained by the patient's recent surgery one day earlier.", "output": "1. No acute cardiopulmonary process. 2. Large amount of free intraperitoneal air, likely due to recent pelvic surgery. Clinical correlation suggested." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lung volumes are low with bibasilar atelectasis. No pulmonary edema is seen. Heart size is top normal. Aortic calcification is noted. Deformity of the left humeral head is partially imaged.", "output": "Low lung volumes without evidence for acute process." }, { "input": "As compared to chest radiograph from earlier today, significant interval decrease in right pleural effusion with right lower lobe re-expansion edema. The left lung is relatively clear. No interstitial edema. Mild to moderate cardiomegaly. No pneumothorax.", "output": "Interval significant decrease in right-sided pleural effusion with right lower lobe re-expansion edema. No pneumothorax." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Comparison is made with the next preceding similar study of ___. PA and lateral chest views with patient in upright position demonstrate mild enlargement of the cardiac silhouette without typical configurational abnormality. Unremarkable appearance of thoracic aorta. The pulmonary vasculature demonstrates an upper zone redistribution pattern, but there is no evidence of interstitial or alveolar edema. The previously identified bilateral pleural effusions have regressed markedly. There remains a mild degree of right-sided pleural effusion obliterating the lateral half of the diaphragmatic contour and filling the lateral pleural sinus. This extends into the posterior pleural sinus. On the other hand, evidence of left-sided pleural effusion has disappeared completely with clear delineation of the diaphragmatic contour and sharp delineation of both lateral and posterior pleural sinuses which indicates absence of any remaining fluid. No new acute pulmonary parenchymal infiltrates can be identified, and the apical areas do not show any pneumothorax. Skeletal structures of the thorax are quite unremarkable.", "output": "Marked regression of pleural effusions with small right-sided pleural effusion remaining. Also, the enlargement of the cardiac silhouette has regressed markedly." }, { "input": "There has been interval reaccumulation of the right pleural effusion, now moderate. The left pleural effusion is stable. There is no pneumothorax. There is no new focal consolidation concerning for pneumonia. The patient is rotated to the right, which may account for the apparent increased widening of the upper mediastinum, consistent with central vascular engorgement. The right internal jugular line is present with tip in stable position.", "output": "Reaccumulation of right pleural effusion with stable left pleural effusion and central vascular engorgement." }, { "input": "AP portable view of the chest. The cardiac silhouette has decreased in size. Moderate right pleural effusion is unchanged and small left pleural effusion is unchanged. Interval development of mild pulmonary vascular congestion.", "output": "Decrease in size of cardiac silhouette, consistent with prior pericardiocentesis. Bilateral pleural effusions, moderate on the right and small on left are not significantly changed. Interval development of mild pulmonary vascular congestion." }, { "input": "AP single view of the chest has been obtained with patient in semi-upright position. Comparison is made with the next preceding similar study dated ___. Previously described cardiac enlargement appears unchanged. The same holds for the previously described right internal jugular approach central venous line terminating in the lower SVC. Successful right-sided thoracocentesis has resulted in elimination of right-sided basal effusion, now with clear visibility of diaphragmatic contours. The pulmonary vasculature in the right hemithorax does not appear congested, and there is no evidence of a post-procedure pneumothorax in the apical area. On the left side, the previously described pleural effusion obscuring the diaphragmatic structures remains rather unchanged. No new pulmonary parenchymal infiltrates are seen.", "output": "Successful thoracocentesis with removal of pleural effusion in right hemithorax and absence of post-interventional pneumothorax. Estimate of pleural effusion based on single view observation is between 750 to ___ mL." }, { "input": "As compared to ___, a moderate right pleural effusion with adjacent substantial right mid and lower lung opacification is new. Compared to more recent CT chest of ___, the pleural effusion has increased in size, and note is again made of a small loculated component anteriorly. . Right heart border is obscured by the effusion, but cardiomediastinal contours are otherwise stable from the", "output": "Moderate, partially loculated right pleural effusion has increased in size since ___ chest CT." }, { "input": "Severe enlargement of the cardiac silhouette is present which is partially attributable to the presence of a moderate pericardial effusion. The aorta is tortuous. There is no pulmonary vascular congestion. There are bilateral pleural effusions, small to moderate on the right and small on the left. Bibasilar atelectasis is also seen, more pronounced within the right lung base. There is no pneumothorax. No acute osseous abnormalities are seen.", "output": "Bilateral pleural effusions, small to moderate on the right and small on the left with bibasilar atelectasis. Moderate size pericardial effusion, better assessed on the chest CT obtained earlier in the day." }, { "input": "Hardware seen in the left clavicle. Chest tube has been removed. There are multiple left rib fractures again seen. Atelectasis in lungs bilaterally is unchanged. No pneumothorax. No pleural effusion. Cardiomediastinal and hilar contours are normal.", "output": "No pneumothorax identified. Multiple rib fractures on the left and bilateral atelectasis." }, { "input": "ET tube has been removed. The enteric tube ends in the stomach. A left-sided chest tube is in place. Multiple left-sided rib fractures are again seen. There is decrease in bilateral parenchymal opacities, likely a combination of atelectasis and possibly aspiration. No evidence of pneumothorax. No pleural effusion. The cardiomediastinal and hilar contours are stable.", "output": "Decrease in parenchymal opacities bilaterally, likely representing atelectasis with possible aspiration." }, { "input": "PA and lateral images of the chest. Lungs well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Chest PA and lateral radiograph demonstrates decreased size of the left upper lobe opacity possibly due to resolution of hemorrhage, now measuring 2.8 in the craniocaudal dimension compared to 3.5 cm on prior study. There is persisitent if not increased streaky retrocardiac opacities, possibly related to aspiration. No definitive opacification concerning for pneumonia. Minimal left costophrenic angle blunting, likely represents small left pleural effusion. No osseous abnormalities identified.", "output": "Interval decrease in size of left upper lobe opacity, possibly reflecting resolution of prior hemorrhage. Likely small left pleural effusion." }, { "input": "There is still an area of increased density in the left upper lobe projecting over the anterior aspect of the second rib measuring approximately 2.9 x 2.2 cm, improved from ___. The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax.", "output": "Improving left upper lung zone consolidation compared to ___." }, { "input": "Moderate hyperexpansion of the lungs has increased compared with prior studies, suggestive of small airways disease. There is no suspicious mass, focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "1. No suspicious nodules or masses. 2. Moderate hyperexpansion has increased." }, { "input": "2 views were obtained of the chest. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The heart is normal in size with normal cardiomediastinal contours.", "output": "No acute intrathoracic process." }, { "input": "The heart size is normal. The mediastinal and hilar contours are within normal limits. Lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are identified.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral chest radiographs demonstrate no relative changes when compared to prior radiograph. Unchanged bilateral pleural effusions with subsequent areas of atelectasis. There is moderate cardiomegaly with stable appearing mediastinal contour. Sternal wires and mediastinal postoperative clips are noted in unchanged in position. There are no new parenchymal opacities. There is no pulmonary edema. No pneumothorax.", "output": "No significant interval changes." }, { "input": "Frontal and lateral chest radiographs demonstrate stable mediastinal and hilar contours. The lungs appear largely unchanged with minimally increased density within the right lower lobe. There are unchanged bilateral pleural effusions with areas of atelectasis. Sternotomy wires are intact. There is no pneumothorax. No overt pulmonary edema.", "output": "Minimal change in density within the right lower lobe. Unchanged bilateral pleural effusions with areas of atelectasis." }, { "input": "PA and lateral views of the chest were provided. Midline sternotomy wires are noted. The lungs appear somewhat hyperinflated with upper lobe lucency, suggestive of underlying emphysema. There is mild pulmonary interstitial edema. Trace fluid tracks along the fissural planes. No pneumothorax is seen. Cardiomediastinal silhouette appears normal. Bony structures appear intact.", "output": "Mild interstitial edema and trace pleural effusion." }, { "input": "Cardiac silhouette size is normal. The aortic knob is calcified. The mediastinal and hilar contours are within normal limits. Pulmonary vasculature is not engorged. Lungs are clear without focal consolidation. There is continued blunting the right costophrenic angle, likely pleural thickening, unchanged. No pleural effusion or pneumothorax is present. Anterior wedge compression deformity of L2 vertebral body is unchanged.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Again seen are median sternotomy wires with mitral valve replacement in place. Heart size is top normal. Cardiomediastinal silhouette and hilar contours are stable with tortuosity of the thoracic aorta noted. There has been interval resolution of the right-sided pleural effusion and improvement in the small left pleural effusion. Patchy atelectasis in the left lung base persists. There is no pneumothorax. Previously seen retrosternal lucency has resolved and was likely post-operative gas.", "output": "Resolution of previously noted right pleural effusion, and decreased size of trace left pleural effusion. Mild left basilar atelectasis." }, { "input": "Portable upright chest radiograph was obtained. The lungs are somewhat low in volume with a trace pleural effusion and atelectasis. The left lateral pleural thickening, previously described, appears to have resolved. Left rib deformities are noted. Multiple ___ are seen in place of 2 sternal wires projected intervally removed.", "output": "Perhaps trace left pleural effusion and atelectasis. No pneumothorax." }, { "input": "The heart is mildly enlarged. There is tortuosity of the descending aorta. Sternotomy wires and mitral valve replacements are noted. There is increased opacities at the lung bases bilaterally which likely reflect atelectasis. No large pleural effusion or pneumothorax is identified. Note is made of bilateral rib deformities.", "output": "Bibasilar opacities likely reflect atelectasis." }, { "input": "The patient is status post median sternotomy and multiple midline skin ___ are noted within the anterior chest. The heart size is normal. The aorta is mildly tortuous but unchanged. There is no pulmonary vascular congestion. Streaky opacities in the left lung base likely reflect atelectasis with a trivial left pleural effusion. There has been interval improvement in the aeration of the right lung base with minimal residual atelectasis noted. No new areas of focal consolidation are seen. No pneumothorax is identified. Old bilateral rib fractures are noted. Mild loss of height of a low thoracic vertebral body is unchanged.", "output": "Mild bibasilar atelectasis with trace left pleural effusion. No new areas of focal consolidation identified." }, { "input": "Frontal and lateral chest radiographs were obtained. There is interval improvement in bilateral pleural effusions and associated bibasilar atelectasis. There is an apparently new retrosternal lucency, which is difficult to assess due to suboptimal positioning on the lateral view. No focal consolidation, pneumothorax, or pulmonary edema is seen. Postoperative cardiomediastinal silhouette and hilar contours are stable.", "output": "1. Interval improvement in bilateral pleural effusions and adjacent atelectasis. 2. Retrosternal lucency, possibly related to postoperative gas collection versus pre-existing bullae. Repeat lateral CXR with improved positioning may be helpful for initial further evaluation." }, { "input": "PA and lateral radiographs of the chest demonstrate clear lungs. The cardiac, hilar, mediastinal contours are normal. No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "There is stable scarring in the right upper lobe, and bilateral severe emphysematous changes.There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "1. Stable changes of severe emphysema. 2. No evidence of acute cardiopulmonary process." }, { "input": "No focal opacity to suggest pneumonia is seen. No pleural effusion, pulmonary edema, or pneumothorax is present. The heart, mediastinal and pleural surface contours are normal.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Cardiomegaly is moderate to severe. There is mild interstitial pulmonary edema. Tiny bilateral pleural effusions noted. No evidence of pneumonia. No pneumothorax. Hilar congestion is noted. Mediastinal contour is normal. Bony structures are intact. Dish related changes of the T-spine noted.", "output": "Cardiomegaly with interstitial pulmonary edema and tiny bilateral pleural effusions." }, { "input": "The lungs are clear of focal consolidation, pleural effusion or pneumothorax. The heart size is normal. The aorta is tortuous and the heart demonstrates left ventricular configuration. The mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. Old healed mid right clavicular and lateral sixth and seventh rib fractures are chronic.", "output": "No acute cardiopulmonary process." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Lungs are clear. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormality is visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided demonstrate slight coarsening of reticular interstitial markings predominantly in the right upper lobe which could represent fibrosis in patient with strong smoking history. There is relative opacity projecting over the right mid lung at the level of two posterior rib deformities which are unchanged. There is no definite sign of pneumonia or mass lesion. No effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "No definite sign of pneumonia or mass lesion. Areas of scarring in the right upper lung, likely represent fibrosis. Given the patient's extensive smoking history and symptomatology, a non-emergent CT of the chest may be performed to further assess as clinically warranted." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well expanded and clear. There is no focal scarring in the right upper lobe is unchanged. Posterior rib deformities are stable. There is no consolidation effusion or pneumothorax. Cardiac and mediastinal contours are normal. There is no pneumoperitoneum.", "output": "No acute cardiopulmonary process. No free air." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes, which accentuate bronchovascular markings. There is no pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. Mild interstitial pulmonary edema is likely. Right-sided remote rib fractures are redemonstrated. The imaged upper abdomen is unremarkable.", "output": "Low lung volumes and likely mild interstitial pulmonary edema." }, { "input": "Since the prior study, lung volumes have decreased, accentuating the cardiac contour and pulmonary vasculature. Diffuse interstitial abnormality may represent edema or underlying interstitial lung disease. Chronic, healed right rib fractures are again seen. No pleural effusion or pneumothorax.", "output": "Low lung volumes with diffuse interstitial abnormality, reflecting edema versus underlying interstitial lung disease. No evidence of pneumonia." }, { "input": "Frontal lateral radiographs of the chest demonstrate normal heart size and mediastinal contours. No focal consolidation, pleural effusion or pneumothorax. Multiple old healed right rib fractures, but no acute displaced rib fracture. Mild anterior wedging of a mid thoracic vertebral body.", "output": "No acute displaced rib fracture." }, { "input": "PA and lateral views of the chest provided. Lungs appear clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is stable. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No evidence of pneumonia." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. The lungs are well-expanded. There is no focal consolidation concerning for pneumonia. Pulmonary vascularity is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided demonstrate clear well-expanded lungs without focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours are normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "Heart size and cardiomediastinal contours are normal. Lungs are clear without focal consolidation, pleural effusion, or pneumothorax.", "output": "Normal chest radiographs." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities seen.", "output": "Normal chest radiograph." }, { "input": "Cardiac, mediastinal and hilar contours are normal. The lungs are clear and the pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest were acquired. The lungs are clear. The heart size is normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen.", "output": "No acute cardiac or pulmonary process." }, { "input": "Patient is rotated to the left on the current exam. Opacity projecting posterior to the heart on the lateral view cannot be definitively localize on the frontal. It may be in part due to crossing the vessels and descending thoracic aorta although a component of parenchymal opacity is possible. No acute osseous abnormality identified.", "output": "Limited exam due to positioning. Opacity on the lateral view seen posterior to the heart which could be overlapping shadows. Underlying component of parenchymal opacity from atelectasis is possible, infection is not excluded." }, { "input": "Lung volumes are low. Heart size is mild to moderately enlarged. The aorta appears tortuous. The hilar contours are normal. Mild streaky atelectasis is noted in the lung bases. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Mild streaky bibasilar atelectasis." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No evidence of pneumonia." }, { "input": "The inspiratory lung volumes are decreased from the prior study with resultant accentuation of the cardiac mediastinal silhouette, which is likely unchanged. The thoracic aorta is moderately tortuous. A known large hiatal hernia is unchanged. There is no large focal consolidation, pleural effusion or pneumothorax. No acute osseous abnormality is detected. There is scoliosis and hypertrophic changes of the spine.", "output": "Decreased lung volumes without acute cardiopulmonary process. Unchanged large hiatal hernia." }, { "input": "Increased opacities in left upper lobe correspond to the findings on the CT from the same day and are compatible with pneumonia. The right lung is clear. Cardiac size is normal. There is no pleural effusion, pulmonary edema or pneumothorax.", "output": "Left upper lobe pneumonia. Findings discussed with ___ at 12:45 a.m. via telephone." }, { "input": "PA and lateral views of the chest provided. Lungs are hyperexpanded with flattened diaphragms and increased retrosternal lucency, findings consistent with chronic pulmonary disease such as chronic bronchitis. There is no focal consolidation. There is no pulmonary edema or pleural effusion. Heart size is normal. Mediastinal, hilar, cardiac contours are normal.", "output": "Findings suggestive of chronic bronchitis." }, { "input": "There is hyperinflation, likely from emphysema. There is no consolidation, pulmonary edema, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Hyperinflation. No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. There is no pulmonary edema. No displaced fracture is identified.", "output": "No acute cardiopulmonary process." }, { "input": "No significant interval change. A right chest wall Port-A-Cath tip terminates in the right atrium. The lungs are clear. No focal consolidation, edema, effusion, or pneumothorax. The heart is top-normal in size. The mediastinum is not widened. No acute osseous abnormality.", "output": "No acute cardiopulmonary process on radiograph." }, { "input": "There is a right chest wall port catheter which terminates in the right atrium. The lungs are clear and the heart size and mediastinal contours are normal. There is no pleural effusion or pneumothorax. The osseous structures are intact. No subdiaphragmatic free air.", "output": "No acute cardiopulmonary process." }, { "input": "A right Port-A-Cath ends in the proximal right atrium. The lungs are clear without focal opacity, pulmonary edema, pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal.", "output": "Clear lungs." }, { "input": "Patient is status post median sternotomy and CABG. A shin is seen. There is no pneumothorax or pleural effusion. The cardiac silhouette remains mildly enlarged. Mediastinal contours are stable. No displaced rib fracture is seen, however, these radiographs has low sensitivity for the detection of such.", "output": "No definite acute cardiopulmonary process." }, { "input": "Median sternotomy wires are intact. Mild cardiomegaly may be minimally increased. Mediastinal and hilar contours are normal. The lungs are hyperinflated but clear. There is no pulmonary edema. There is no pleural effusion or pneumothorax. Degenerative changes in the thoracic spine are re- demonstrated.", "output": "1. Mild hyperexpansion of the lungs without evidence of pneumonia. 2. Stable to slightly increased mild cardiomegaly." }, { "input": "Patient is status post median sternotomy and aortic valve replacement. Heart size is mildly enlarged but unchanged. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is identified. Linear opacity within the right middle lobe likely reflects scarring, not substantially changed from the prior CT. No acute osseous abnormality is detected. There are moderate degenerative changes within the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "A hazy opacification is present in the right middle lobe obscuring the right heart border consistent with a pneumonia. There is no pulmonary edema, pleural effusion, or pneumothorax. The size of the cardiac silhouette is at the upper limits of normal. Sternal wires are intact.", "output": "Right middle lobe pneumonia. Recommend repeat chest radiograph after treatment in four to six weeks to ensure resolution. Results were discussed with Dr. ___ at 3:30 p.m. on ___ via telephone by Dr. ___." }, { "input": "Frontal and lateral radiographs of the chest show interval resolution of right middle lobe opacification from ___ with residual bronchial thickening. The inspiratory lung volumes are appropriate. The lungs are clear without pleural effusion, pneumothorax or new focal consolidation. The pulmonary vasculature is not engorged. The cardiac silhouette is top normal in size. The mediastinal and hilar contours are within normal limits. The patient is status post median sternotomy with intact wires.", "output": "Resolution of right middle lobe pneumonia from ___." }, { "input": "There is increased opacity in the right perihilar region. The right cardiac margin is not clearly identified on the frontal view. While this may be partially due to rotation, given subtle increased opacity on the lateral view projecting over the cardiac silhouette underlying right middle lobe consolidation is likely present. Elsewhere, the lungs are clear. Median sternotomy wires are intact. Cardiomediastinal silhouette is otherwise unremarkable. No acute osseous abnormalities.", "output": "Right middle lobe opacity which could be in part due to scarring given prior findings although superimposed infection would certainly be possible." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Upright AP and lateral radiographs of the chest demonstrate decreased inspiratory lung volumes. The lungs are clear without focal consolidation, pleural effusion, or pneumothorax. The cardiac silhouette is normal in size. The mediastinal and hilar contours are within normal limits. The thoracic aorta is unfolded and tortuous. The pulmonary vasculature is not engorged.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were obtained. No focal consolidation, large effusion, or pneumothorax is seen. Cardiomediastinal silhouette is normal. No gross bony deformities are seen.", "output": "No acute injury." }, { "input": "A portable supine frontal chest radiograph again demonstrates an endotracheal tube terminating approximately 2.2 cm from the carina. An enteric tube is unchanged in position, terminating in the stomach. Lung volumes remain low, with exaggeration of the cardiac silhouette. The right hemidiaphragm is not as well seen, likely related to atelectasis. MILD EDEMA HAS IMPROVED SINCE ___:11. No obvious focal consolidation, pleural effusion, or pneumothorax is identified. There may be minimal edema in the bilateral upper lung zones.", "output": "Persistently low lung volumes, with increased atelectasis in the right lower lung. IMPROVED MILD EDEMA." }, { "input": "Lung volumes are low without pleural effusion, focal consolidation, or pneumothorax. Heart and mediastinal contours are unchanged.", "output": "Low lung volumes without evidence for acute process." }, { "input": "Heart size is mildly enlarged. The mediastinal and hilar contours are unremarkable. Pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is identified. Multilevel moderate hypertrophic changes are seen throughout the imaged thoracolumbar spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. Extensive airspace consolidation is noted bilaterally. On the left, consolidation aid involves the lingula and on the right there is predominately involvement of the right upper lobe and possibly right middle lobe. Findings are compatible with pneumonia. There is a small left pleural effusion. Cardiomediastinal silhouette appears grossly unchanged. Difficult to exclude a component of edema/ congestion. No pneumothorax. Bony structures are intact.", "output": "Multifocal pneumonia. Small left effusion. Difficult to exclude a component of mild edema/ congestion." }, { "input": "Slight pectus deformity obscures the right heart border. The lungs are otherwise clear. There is no pleural effusion or pneumothorax. Cardiomediastinal silhouette is normal.", "output": "No evidence of acute cardiopulmonary pathology." }, { "input": "A single portable AP semi-upright view of the chest was obtained. The endotracheal tube terminates approximately 1.6 cm above the carina with the patient's neck flexed and should be pulled back by approximately 1 cm for optimal placement. NG tube is subdiaphragmatic. Heart is normal size and cardiomediastinal contours are unremarkable. Lung volumes are low and mild basilar atelectasis is noted. Lungs are otherwise clear. There is no pleural effusion or pneumothorax.", "output": "Endotracheal tube is too low and should be pulled back by 1 cm for optimal placement." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is demonstrated. Multiple clips are seen within the upper abdomen on the lateral view.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. Bony structures appear normal.", "output": "No evidence of acute disease." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Low lung volumes are seen. There is secondary crowding of the bronchovascular markings and bibasilar opacities which are most likely atelectasis. There is no effusion or overt pulmonary edema. Cardiac silhouette appears enlarged but also likely accentuated by low lung volumes and not likely change. No acute osseous abnormalities identified.", "output": "Low lung volumes with probable bibasilar atelectasis. Infection cannot be entirely excluded." }, { "input": "A central venous catheter terminates in the right atrium. The cardiac, mediastinal and hilar contours appear stable. On the frontal view only there is patchy opacity at the medial left lung base suggesting atelectasis; developing pneumonia is possible, however.", "output": "Vague opacity at the left base, atelectasis versus pneumonia; correlation with pulmonary symptoms is recommended, if any. Short-term follow-up radiographs may be helpful if there is clinical concern for developing infectious process." }, { "input": "No focal consolidation, pleural effusion or pneumothorax is seen. There is no overt pulmonary edema. The heart is normal in size given AP technique. The mediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Linear bibasilar atelectasis is seen without evidence of focal consolidation. There is no pleural effusion or pneumothorax. The heart is mildly enlarged with normal mediastinal contours.", "output": "Bibasilar atelectasis without evidence of pneumonia. Enlarged cardiac silhouette, appears increased in size since the prior study." }, { "input": "Enlarged cardiac silhouette is due to a known pericardial effusion and is overall unchanged compared to the prior exam. The hilar and mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for pneumonia. There is no large pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No acute intrathoracic abnormalities." }, { "input": "The heart size is mildly enlarged, stable compared to the exam from ___. The hilar and mediastinal contours are normal. No focal consolidations, pleural effusions, or pneumothoraces are seen. The visualized osseous structures are unremarkable.", "output": "No acute abnormalities identified to explain patient's cough and fever." }, { "input": "PA and lateral chest radiographs were obtained. There is volume loss at the left lung base with area of focal opacity, likely due to atelectasis. The cardiac silhouette is moderately enlarged. Hilar and mediastinal contours are stable. There is no pleural effusion or pneumothorax.", "output": "Left lung base atelectasis, pneumonia cannot be excluded in the appropriate clinical setting." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Normal chest radiograph." }, { "input": "There are trace bilateral pleural effusions. Pulmonary vascular congestion. Mild left mid lung and right base opacities are seen which could be due to multifocal infection versus component of vascular congestion. No pneumothorax is seen. Cardiac silhouette is top-normal in size. Aortic knob is calcified. Degenerative changes along the spine.", "output": "Trace bilateral pleural effusions. Pulmonary vascular congestion. Mild left mid lung and right base opacities could be due to multifocal infection versus related to vascular congestion." }, { "input": "Supine portable AP view the chest provided. Lung volumes are low limiting assessment. In this patient with a known right diaphragmatic eventration, a double density at the right lower lung is reflective of this. There is bibasilar atelectasis without large pleural effusion. Heart size is difficult to assess. Mediastinal contour appears grossly unremarkable. No convincing signs of overt edema or pneumonia when interpreted in conjunction with same-day CT abdomen pelvis.", "output": "Bibasilar atelectasis. Right hemidiaphragmatic eventration. No overt signs of edema or pneumonia." }, { "input": "As compared to the previous radiograph, mild improvement in the pulmonary edema. Low lung volumes. Moderate cardiomegaly. Worsening bibasilar atelectasis with persistent bilateral small pleural effusions. . No pneumothorax.", "output": "Mild interval improvement in the interstitial pulmonary edema. Worsening bibasilar atelectasis." }, { "input": "Lung volumes are persistently low. This accentuates the size of the cardiac silhouette which appears at least moderately enlarged but unchanged. Widening of the mediastinal contour is likely reflective of the low inspiratory lung volumes and is similar to the prior study. Mediastinal and hilar contours are otherwise unremarkable. There is crowding of the bronchovascular structures without overt pulmonary edema. Patchy opacities in the lung bases likely reflect areas of atelectasis though infection is not completely excluded. No large pleural effusion or pneumothorax is identified. Marked degenerative changes are again noted throughout the imaged thoracolumbar spine without a definite acute abnormality.", "output": "Low lung volumes with patchy opacities at the lung bases, likely atelectasis. Infection however is not completely excluded." }, { "input": "AP and lateral views of the chest. Again low lung volumes are seen with crowding of the bronchovascular markings. There is no evidence of confluent consolidation or effusion. No overt pulmonary edema is identified. The cardiomediastinal silhouette is prominent, but likely accentuated due to AP technique and low inspiratory volumes. It is unchanged from prior. No acute osseous abnormality is detected.", "output": "No definite acute cardiopulmonary process based on this exam with low lung volumes." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. In addition to multifocal linear opacities in the left mid and both lower lungs, and more confluent area of opacification is present in the right infrahilar region. . No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Marked scoliosis is noted.", "output": "Multifocal opacities in the left mid and bilateral lower lobes are likely due to atelectasis in the recent postoperative setting. Coexisting aspiration or pneumonia in the right infrahilar region is not excluded." }, { "input": "Low lung volumes are noted again noted. Streaky bibasilar opacities are likely atelectasis. There is no effusion or overt pulmonary edema. Cardiomediastinal silhouette is within normal limits. Tortuosity of the descending thoracic aorta is again noted. No acute osseous abnormalities. Compression deformity of a mid to lower thoracic vertebral body is unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "There are relatively low lung volumes, which accentuate the bronchovascular markings. Given this, there may be minimal vascular congestion No focal consolidation to suggest pneumonia is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable.", "output": "Low lung volumes present with of vascular markings. Given this, there may be minimal vascular congestion. No focal consolidation." }, { "input": "The heart appears mildly enlarged. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable.", "output": "Mild cardiomegaly. No evidence of acute cardiopulmonary disease." }, { "input": "The lungs are clear of focal consolidation, pleural effusion or pneumothorax. The heart size is normal. The mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs remain hyperinflated suggestive of underlying COPD. Heart size is normal. The aorta remains tortuous with scattered calcifications. Calcified left upper lobe granuloma and calcified right mediastinal lymph node suggests prior granulomatous disease. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Persistent blunting of the right costophrenic sulcus likely reflects chronic pleural thickening or scarring. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral chest radiographs were provided. Opacity overlying the right hilus is consistent with known mass and lymphadenopathy. There is no pleural effusion or pneumothorax. Linear opacity at the left base is likely atelectasis. The cardiomediastinal silhouette is normal.", "output": "Opacity overlying the right hilus is consistent with known mass and hilar lymphadenopathy. Atelectasis in the left base." }, { "input": "Portable single frontal chest radiograph was obtained. The previous right upper lobe parenchymal opacities are not well seen and are replaced by an area of linear atelectasis. No pleural effusion or pneumothorax is seen. The cardiomediastinal silhouette is normal. There is persistent right hilus enlargement, consistent with known hilar mass and adenopathy.", "output": "1. No pneumothorax appreciated. Right upper lobe atelectasis. 2. Known right hilar lung mass with central lymphadenopathy." }, { "input": "The heart is moderately enlarged. There is moderate pulmonary vascular congestion and pulmonary edema. Small bilateral pleural effusions are present. There is no pneumothorax.", "output": "Moderate cardiomegaly, vascular congestion, pulmonary edema, and pleural effusions consistent with decompensated heart failure. A superimposed pneumonia is difficult to exclude in the appropriate clinical setting." }, { "input": "Compared the previous film there is improvement since ___ the with the heart being less enlarged. The pulmonary vessels less engorged and clearance of the bilateral pulmonary edematous opacities.", "output": "Improved pulmonary edema with residual cardiomegaly and mild there vascular congestion" }, { "input": "Frontal and lateral radiographs of the chest demonstrate clear lungs. Cardiomediastinal contour is normal. Persistent mild blunting of the right costophrenic angle reflects pleural scar. No pneumothorax is seen.", "output": "Persistent right basilar pleural scar with clear lungs." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Cardiac and mediastinal silhouettes are stable and unremarkable. Slight upper paratracheal opacity likely represents prominence of vascular structures and without change since the prior study and without indentation on the trachea. Evidence of DISH is seen along the thoracic spine. In addition, degenerative changes are also seen along the thoracic spine.", "output": "No acute cardiopulmonary process. No evidence of free air beneath the diaphragms." }, { "input": "A nasogastric tube has been placed which makes a single coil within the stomach. The cardiac, mediastinal, and hilar contours appear unchanged, allowing for differences in technique. The heart is at the upper limits of normal size. The lung volumes appear low. The lungs appear clear. There is no pleural effusion or pneumothorax. No free air is demonstrated. Degenerative changes involve each shoulder. The right acromiohumeral interval appears narrowed which can be seen with rotator cuff pathology, and suture anchors in the left humeral head suggest prior rotator cuff repair, also present before.", "output": "No evidence of acute disease. Nasogastric tube terminating in the stomach. No evidence for free air." }, { "input": "Upper lobe predominant ill-defined lung opacities which demonstrated on prior CT and are compatible with changes sarcoidosis. There is no focal lung consolidation concerning for pneumonia. There is no pleural effusion or pneumothorax. Cardiomediastinal silhouette is stable. Partially imaged anterior cervical spine spinal fusion hardware.", "output": "Upper lobe predominant ill-defined lung opacities as demonstrated on prior chest CT, consistent with known sarcoidosis. No focal consolidation." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is focal increased opacity in the left retrocardiac area. There is no pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are normal. No acute fractures are identified.", "output": "Focal increased opacity in the left retrocardiac region which may represent an early pneumonia in the proper clinical setting." }, { "input": "There are new bilateral pleural effusions, right greater than left with right lower lobe volume loss. A small infiltrate right lower lobe can't be excluded.", "output": "Increased bilateral pleural effusions. The findings were discussed with Dr. ___ at 21:05 on ___ via telephone by Dr. ___." }, { "input": "AP portable upright view of the chest. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process" }, { "input": "The lungs are clear.The cardiac, hilar and mediastinal contours are normal.No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. Midline sternotomy wires and mediastinal clips are noted. The heart is moderately enlarged and there is pulmonary edema with a small right and a moderate left pleural effusion. Associated left lower lobe atelectasis is likely present, though cannot exclude pneumonia. Bony structures appear grossly intact. Vascular calcifications along the thoracic aorta noted. No free air below the right hemidiaphragm. Calcifications projecting over the right upper quadrant likely reflect costal cartilage calcification.", "output": "Pulmonary edema with bilateral effusions and moderate cardiomegaly." }, { "input": "The heart size is normal. The hilar mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for pneumonia. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No acute intrathoracic abnormalities identified." }, { "input": "The heart is mildly enlarged in the thoracic aorta is tortuous. Lungs are clear. There is no pleural effusion or pneumothorax. No displaced fractures are seen.", "output": "No acute intrathoracic abnormality." }, { "input": "The heart size is top normal. The mediastinal and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.Mild aortic arch calcifications are present.", "output": "No acute cardiopulmonary process. The heart is top normal in size." }, { "input": "Low lung volumes bilaterally are unchanged since ___. Markedly limited evaluation of lung bases with bilateral basilar heterogeneous opacities representing atelectasis or possible pneumonia. No new focal opacity. Cardiac silhouette is obscured by the elevated diaphragms. Lung apices are obscured by patient's chin positioning limiting assessment for apical pneumothorax. Moderate degenerative disease of the left shoulder. Additional visualized bones are unremarkable.", "output": "1. Unchanged low lung volumes. 2. Markedly limited evaluation of lung bases with bilateral basilar opacities is likely basilar atelectasis however may represent pneumonia in the appropriate clinical setting." }, { "input": "Compared to chest radiograph one hour prior there is a new endotracheal tube with tip 3.2 cm above the level of the carina in appropriate position. NG tube is seen projecting along the course of the left main bronchus with tip in the left upper quadrant. The NG tube is likely following the course of the esophagus and entering the stomach when compared to course of GI tract on prior CT from ___. Low lung volumes with bibasilar atelectasis again noted. Cardiac silhouette cannot be assessed given elevated diaphragmatic surface and low lung volumes. No significant interval change in lung parenchyma. No pneumothorax. Limited assessment of the bones is unremarkable.", "output": "1. ET tube in appropriate position. 2. NG tube is likely in the stomach when compared to the course of the esophagus and stomach on prior CT from ___. Results were conveyed by telephone by Dr. ___ to Dr. ___ at 11:50 a.m. on ___ within five minutes of observation of findings." }, { "input": "Single portable view of the chest is compared with previous exam of ___. Low lung volumes are again noted however they appear grossly clear of confluent consolidation or pulmonary vascular congestion. Rounded lucency in the retrocardiac region is suggestive of possible hiatal hernia, similar to prior exam.", "output": "Low lung volumes without definite acute cardiopulmonary process." }, { "input": "Lung volumes are low. This causes crowding of the bronchovascular structures. Mediastinal contour is unchanged and a left-sided intrathoracic stomach is again demonstrated. Heart size is difficult to assess given the presence of the intrathoracic stomach. 2.8-cm left hilar mass containing calcifications is re- demonstrated, similar in size compared to the previous study . Patchy opacities in the lung bases may reflect atelectasis though infection is not excluded. Additionally, a trace right pleural effusion may be present. There is no overt pulmonary edema. No pneumothorax is seen. Multilevel degenerative changes are noted in the thoracic spine.", "output": "1. Low lung volumes with bibasilar opacities likely atelectasis, though infection is not excluded. A trace right pleural effusion may also be present. 2. No interval change in appearance of the left hilar mass." }, { "input": "Single portable AP of the chest provided. There has been re-positioning of the nasogastric tube which resides in the expected position of the stomach. This patient is known to have a hiatal hernia. The endotracheal tube appears somewhat low in position, residing at the carina which likely is exaggerated due to the patient's chin positioned down. Lung volumes remain low.", "output": "Re-positioning of NG tube with tip likely residing within the stomach in this patient with a known hiatal hernia. Low-lying endotracheal tube. Consider retraction by 1 to 2 cm for more optimal positioning." }, { "input": "PA and lateral chest radiographs were obtained. Comparison is made to prior radiograph dated ___. Triangular retrocardiac density is localized on the lateral film to correspond with the anterior aspect of the left lower lobe abutting the major fissure, in the appropriate clinical setting, this may reflect pneumonia. Cardiomediastinal contours appear within normal limits. There is no pleural effusion or pneumothorax.", "output": "Left lower lobe consolidation. In the appropriate clinical setting, this may reflect pneumonia" }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are hyper inflated. The nodular density in the left upper lobe has cleared. Increased markings are present particularly in the left base, a new finding. . The left basilar disease appears more prominent than previously. There is no pleural effusion. The mediastinum is normal. The heart size is normal. The osseous structures are normal for age.", "output": "The nodular density in the left upper lobe has cleared, but there is now new left infrahilar left lower lobe parenchymal disease likely pneumonia or atelectasis. Followup recommended." }, { "input": "The lungs are clear of focal consolidation, pleural effusion or pneumothorax. The heart size is normal. The mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest are obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The hilar contours are stable. Cardiac and mediastinal silhouettes are stable.", "output": "No acute intrathoracic process." }, { "input": "There are extensive patchy opacities projecting over the right lung, worse at the right mid-to-lower lung but also involving the right upper lung and to a lesser extent at the left mid to lower lung, worrisome for multifocal pneumonia. This is new since ___. No large pleural effusion is seen. There is no pneumothorax. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Findings worrisome for multifocal pneumonia. Recommend followup to resolution." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Lungs are well-expanded. Nodular opacification is seen in the left mid lung laterally. Given the resolution of the previously seen pneumonia in the right lung, this nodular opacification is concerning for recurrence of pneumonia. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "Nodular opacification in the left mid lung laterally. Given the resolution of the previously seen pneumonia in the right lung, this nodular opacification is concerning for recurrence of pneumonia. NOTIFICATION: These findings were communicated via the radiology critical results dashboard at 6:00 p.m. on ___." }, { "input": "PA and lateral views of the chest demonstrate the lungs are well expanded and clear. The cardiomediastinal silhouette is unremarkable. No focal opacity, pleural effusion, pulmonary edema or pneumothorax is present. No obvious rib fracture or displacement is identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are hyperinflated, with biapical scarring and relative flattening of the bilateral hemidiaphragms. There is no pneumothorax, pleural effusion, or overt pulmonary edema. The cardiomediastinal silhouette is unremarkable. There is no subdiaphragmatic free air. There is mild narrowing of the trachea at the level of the aortic arch, not significantly changed compared to prior studies.", "output": "1. No subdiaphragmatic free air or acute cardiopulmonary pathology. 2. Emphysema and biapical scarring, likely from prior infection." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. The lungs are mildly hyperinflated but clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is mild left base atelectasis. No focal consolidation is seen. There is no large pleural effusion. No pneumothorax is seen. Minimal biapical pleural parenchymal thickening is seen. The aorta is somewhat tortuous. The cardiac silhouette is not enlarged. No evidence of free air is seen beneath the diaphragms.", "output": "Minimal left base atelectasis. No focal consolidation. No evidence of free air beneath the diaphragms." }, { "input": "The toe the low lung volumes, which accentuate the bronchovascular markings. No focal consolidation is seen. There is no pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are stable given differences in lung volume. No overt pulmonary edema is seen. Prominent anterior bridging osteophyte is seen in the mid to lower thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. Slightly lower lung volume is seen on current exam. The lungs are clear of confluent consolidation or effusion. The cardiomediastinal silhouette is within normal limits. The osseous and soft tissue structures are again notable for multiple right lateral rib fractures as well as a left lower lateral rib fracture as on prior. No pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The Dobhoff tube terminates in the mid esophgaus and has turned, pointing in cephalad direction. Lungs are otherwise clear.", "output": "Malpositioned Dobhoff tube as above. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 4:48 PM, 10 minutes after discovery of the findings." }, { "input": "The lungs are clear of focal consolidation, pleural effusion or pneumothorax. The heart size is normal. The mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "The inspiratory lung volumes are appropriate. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The pulmonary vasculature is not engorged. The cardiomediastinal and hilar contours are within normal limits. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "Since the prior radiograph, there has been interval intubation with the endotracheal tube approximately 2 cm from the carina. The orogastric tube terminates in the stomach. There is significant cardiomegaly and calcification of the aortic arch and descending thoracic aorta. Pulmonary vascular congestion and interstitial abnormality, particularly at the right lung base, has progressed since the prior chest radiograph. No strong evidence for pneumonia.", "output": "Satisfactory positioning of the endotracheal tube and orogastric tube, with interval increase in pulmonary vascular congestion since the prior radiograph, but no strong evidence for pneumonia." }, { "input": "Low lung volumes are again noted. There is been interval improvement of the previously noted pulmonary edema which is now mild. There is no new consolidation. Cardiomediastinal silhouette is stable. There is no large effusion.", "output": "Interval improvement of previously seen pulmonary edema." }, { "input": "The heart is mildly enlarged with a left ventricular configuration. The aortic arch is calcified. The right hemidiaphragm is mildly elevated relative to the left. Lung parenchyma shows mild interstitial prominence including cuffed airways but is otherwise clear without focal opacification. There is no definite pleural effusion or pneumothorax.", "output": "Mildly prominent interstitium which may indicate airway inflammation or mild pulmonary congestion, but no focal opacification to suggest pneumonia." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Apart from a calcified granuloma in the left lung base, the lungs are clear. No pleural effusion, focal consolidation or pulmonary edema is present. Multiple old right-sided rib fractures are re- demonstrated.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The heart is at the upper limits of normal size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures are unremarkable. There is no free air.", "output": "No evidence of acute disease." }, { "input": "Cardiomediastinal silhouette is within normal limits. Right hemidiaphragm is mildly elevated. Lungs are clear. There is no pleural effusion or pneumothorax. A cluster of multiple high-density material, each measuring up to 13 mm, projecting over the right mid abdomen posteriorly may reflect retained contrast within colonic diverticula. There is diffuse demineralization of the osseous structures with a compression deformity of a vertebral body at the thoracolumbar junction. Deformity of the midshaft of the left clavicle may reflect a remote fracture.", "output": "No acute intrathoracic process. Age indeterminate compression fracture at the thoracolumbar junction." }, { "input": "Increase in pulmonary edema is seen bilaterally when compared to previous chest radiograph. New opacity in the left mid-lung is seen, and no pleural effusion is seen. Right central venous line is in appropriate position in lower SVC.", "output": "Increase in pulmonary edema. New left mid-lung opacity may be increasing edema or new developing pneumonia." }, { "input": "The lungs are well expanded. In the lateral view, there is a rounded opacity in the upper anterior mediastinum, which is thought to be inferior to an external clip in the right mid lung, between the posterior ribs six and seven. There is some opacification of the right cardiophrenic angle which may represent a prominent epicardial fat pad. No other focal opacities are identified. The cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "1. Rounded opacity in the anterior upper mediastinum seen in the lateral view as well as an ill-defined opacity between the posterior portion of the right sixth and seventh rib as described above may represent focal consolidation or nodule. Further assessment with chest CT is recommended. 2. Ill-defined opacification of the right cardiophrenic angle is also assessed in the lateral view and likely represents a prominent epicardial fat pad." }, { "input": "13 mm nodular density in the right upper lobe has been previously imaged on CT chest of ___ with followup recommendations. Lung volumes are low with mild bibasilar atelectasis. However, there is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Bibasilar atelectasis. Stable 13 mm right upper lobe nodule described on recent CT." }, { "input": "Severe pulmonary edema has worsened. The cardiac silhouette is enlarged, and no pleural effusions are seen. Previous right central venous line has been removed. Focal consolidation can not be excluded.", "output": "Increase in pulmonary edema." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Prominent bridging osteophyte seen in the lower thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "Ill-defined opacity projects over the left heart border. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. A central line terminates in the mid SVC. The tip of the endotracheal tube is approximately cm from the carina. An enteric tube is seen below the diaphragm and likely in the distal stomach.", "output": "1. Ill-defined opacity in the left lower lung, may reflect aspiration or asymmetric edema. 2. ET tube tip approximately 6 cm from the carina. Enteric tube in the distal stomach. Central line in mid SVC." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of top normal size, similar to prior, with normal cardiomediastinal borders. The vascular pedicle and mediastinum are not widened. The lungs are clear without focal or diffuse abnormality. No pleural effusion or pneumothorax. Osseous structures are unremarkable. A new electronic device overlying the left hemithorax is compatible with a vagal nerve stimulator. Surgical clips overlie the right thyroid bed.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs. Small left pleural effusion is new. The heart remains mildly enlarged, but there is no evidence of pulmonary edema. There is no pneumothorax.", "output": "New small left pleural effusion. NOTIFICATION: Findings were relayed by Dr. ___ to Dr. ___ ___ by phone at 13:07 on ___ (approximately ___ min after discovery)." }, { "input": "There is no evidence of focal consolidation, pneumothorax, or frank pulmonary edema. Increased interstitial markers are stable from the prior exam, likely age related. A small left pleural effusion is noted. Moderate cardiomegaly is stable. The descending thoracic aorta is calcified but otherwise unremarkable.", "output": "Stable moderate cardiomegaly and small left pleural effusion." }, { "input": "The lungs are hyperexpanded consistent with chronic pulmonary disease. Compared to the prior chest radiograph of ___, there is a new left lower lobe opacity. Mild cardiomegaly and aortic calcifications persist. The right lung is clear. There is no pleural effusion or pneumothorax.", "output": "New left lower lobe opacity could represent atelectasis, however, in the correct clinical setting this could represent pneumonia." }, { "input": "A small left pleural effusion is new since ___. Diffuse coarsening of the interstitium is most prominent in the right lower lobe. Otherwise, the lungs are clear without focal opacity, overt pulmonary edema or pneumothorax. The aortic knob is calcified. Moderate cardiomegaly is stable.", "output": "1. A small left pleural effusion is new since ___. 2. Diffuse coarsening of the interstitium, most predominant in the right lower lobe could represent interstitial edema or chronic interstitial disease." }, { "input": "Single portable upright radiograph demonstrates a mild to moderately enlarged heart similar in appearance to prior study dated ___. No evidence of overt pulmonary edema. Lungs are hyperinflated. There is no focal consolidation to suggest pneumonia. No large pleural effusion or pneumothorax is identified.", "output": "Stable cardiomegaly without overt pulmonary edema. Hyperinflated lungs." }, { "input": "There are new focal airspace opacities in the right lung base, with corresponding increased density in the lower lobe on the lateral view, concerning for right lower lobe pneumonia, possibly aspiration. A small-to-moderate left pleural effusion is unchanged from ___. Hyperinflation of the lungs is redemonstrated. No pneumothorax is detected. The pulmonary vasculature is not engorged and there is no overt pulmonary edema. There is exaggerated kyphosis of the thoracic spine. A well-circumscribed density projecting within a mid thoracic vertebral body likely corresponds to a bone island. Multilevel degenerative changes are present in the visualized spine.", "output": "1. New focal opacities in the right lung base concerning for right lower lobe pneumonia, possibly aspiration pneumonia. 2. Unchanged small-to-moderate left pleural effusion from ___." }, { "input": "The cardiomediastinal silhouette is stable consistent with moderate to severe global cardiomegaly. There is a heavily calcified thoracic aorta. The hila are within normal limits. Diffuse pulmonary interstitial prominence is suggestive of sequelae of chronic pulmonary edema, mild on the current study. There is no large pleural effusion. There is no pneumothorax. There is diffuse subjective osseous demineralization. Vascular calcifications are seen at the base of the neck.", "output": "1. Moderate to severe global cardiomegaly. Mild pulmonary interstitial edema. 2. No focal lung consolidation." }, { "input": "The lungs are hyperinflated. There is diffuse patchy opacification of both lungs, slightly worse compared to ___ and likely due to mild pulmonary edema. The small left pleural effusion shows minimal improvement from the prior scan. Additionally, there is a small spiculated nodule in the left mid-lung that could reflect a round opacification overlying a mid-thoracic vertebral body. Stable cardiomegaly. Calcification of the aortic arch. No other acute osseous abnormalities.", "output": "1. Slight improvement of small left-sided pleural effusion 2. Small left pulmonary nodule with spiculated appearance. Recommend further evaluation with a CT scan. NOTIFICATION: Findings were telephoned to Dr. ___ by Dr. ___ on ___ at 2:59PM, approximately 15 minutes after discovery." }, { "input": "Since the chest radiographs obtained ___, the small left pleural effusion has decreased in size. Tiny right pleural effusion small if any. Moderate to severe cardiomegaly is unchanged without pulmonary vascular congestion or pulmonary edema. Lungs are fully expanded and clear without consolidations. Aortic knob is heavily calcified. Cardiomediastinal and hilar silhouettes are otherwise normal.", "output": "No radiographic evidence of pneumonia or other significant acute cardiopulmonary abnormalities." }, { "input": "Heart size is mild to moderately enlarged. The aorta is diffusely calcified. The mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Lungs are hyperinflated without focal consolidation. There may be a trace left pleural effusion and posteriorly on the lateral view. Small amount of fluid is also seen along the fissures. There is no pneumothorax.", "output": "Minimal, if any,small left pleural effusion. No focal consolidation to suggest pneumonia." }, { "input": "Since the prior study performed on ___, the right lower lobe pneumonia has resolved. No new consolidation, pleural effusion or pneumothorax. Mild interstitial pulmonary edema is new. Mild to moderate cardiomegaly. There is no subdiaphragmatic free air. No acute osseous abnormalities are identified.", "output": "1. No focal pneumonia. Interval resolution of prior right lower lobe pneumonia. 2. Mild interstitial pulmonary edema and mild cardiomegaly." }, { "input": "There is severe cardiomegaly. As compared to prior chest radiograph, there has been interval increase of a small-to-moderate left pleural effusion. There is hyperinflation of the upper lung lobes, unchanged from prior examinations. There is no pulmonary edema. There are no focal consolidations concerning for pneumonia. There is evidence of kyphosis.", "output": "1. Interval increase of small-to-moderate left pleural effusion. 2. No definite acute focal pneumonia." }, { "input": "There is no consolidation, pleural effusion or pneumothorax. No pulmonary edema. Cardiomediastinal contours are normal. No acute osseous abnormalities identified. No subdiaphragmatic free air.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. Increased interstitial markings are seen when compared to prior suggestive of edema. Trace bilateral effusions again noted. There is no new consolidation. Cardiomediastinal silhouette is unchanged. Median sternotomy wires and mediastinal clips again seen. Moderate hiatal hernia is again noted. Surgical clips in the right upper quadrant. No acute osseous abnormality is detected.", "output": "Findings again suggestive of mild pulmonary edema." }, { "input": "The patient is status post median sternotomy and thymectomy, with multiple tiny surgical clips seen in the anterior mediastinum and sternotomy wires seen well aligned. There is evidence of pulmonary vascular congestion with interstitial edema and vascular redistribution to the upper zones. Associated small, bilateral pleural effusions are noted. No pneumothorax or focal consolidation is identified. There is a mild, stable cardiomegaly. The mediastinal contours are normal. A hiatal hernia is noted.", "output": "Pulmonary vascular congestion with upper zone vascular redistribution, mild interstitial edema, and bilateral small pleural effusions." }, { "input": "Bilateral DBS devices project over the upper lungs. Where seen, the lungs are clear. Hiatal hernia is noted, moderate in size. The cardiomediastinal silhouette is otherwise within normal limits. Atherosclerotic calcifications and median sternotomy wires are noted. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes. There is no pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Several surgical clips project over right upper abdomen, which is otherwise unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Again seen is moderate cardiomegaly, with prominence of the cardiomediastinal silhouette. The dual lead pacemaker is again noted, with lead tips over the right atrium and right ventricle. Mild interstitial edema is again seen, slightly more pronounced. There is new hazy opacity at the right lung base, which could represent a combination of pleural fluid and/or underlying collapse and/or consolidation. The left costophrenic sulcus is clear.", "output": "1. Cardiomegaly. 2. Interstitial edema, possibly slightly more pronounced than on ___. 3. New hazy opacity at right lung base. This is not fully characterized, but could represent a combination of pleural fluid and underlying collapse and/or consolidation." }, { "input": "Heart size is mildly enlarged. There is no focal lung consolidation. There are small bilateral pleural effusions. There is mild interstitial edema. There is no pneumothorax. Known rib fractures are better evaluated on prior CT.", "output": "Mild interstitial edema and small bilateral pleural effusions." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. There is no pulmonary edema. The heart is normal in size, and the mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The pulmonary vasculature is essentially normal. The cardiac silhouette is top normal in size. The mediastinal and hilar contours are within normal limits. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "No acute focal consolidation, pleural effusion or pneumothorax. The pulmonary vasculature is essentially normal. The cardiac silhouette is top normal in size. The mediastinal and hilar contours are within normal limits. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "Vague opacity is identified at the right lung base on the frontal view. It is better seen on 1 of the 2 lateral views than on the other. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "Vague right basilar opacity, potentially atelectasis although infection is not excluded." }, { "input": "The lungs are clear, without focal consolidation, effusion or pneumothorax. The heart size is normal. The mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well expanded. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Comparison is made with the next preceding similar study of ___. The heart size is unchanged, the configuration demonstrating a prominence of the left ventricular contour, but no other significant abnormalities are present. Thoracic aorta unremarkable. The pulmonary vasculature is not congested. There is no evidence of a small amount of right-sided pleural effusion blunting the right lateral pleural sinus and extending posteriorly as identified on the lateral view. Some linear parenchymal densities on the right lung base are consistent with plate atelectases. No conclusive evidence for pleural effusion in left hemithorax. No other new parenchymal infiltrates are present. No pneumothorax is seen in the apical area. Position of previously described orthopedic hardware in upper lumbar spine, unchanged. Moderate gas distention of large bowel is noted.", "output": "Development of right-sided pleural effusion since the next preceding study of ___. As this patient has a history of ovarian carcinoma, the possibility of metastatic process must be considered." }, { "input": "The right-sided pleural effusion is once again seen, increased in size since the prior examination. The remainder of the lungs remain clear of any focal opacities or consolidations. Cardiomediastinal silhouette is unchanged in size. Linear parenchymal densities at the right lung base are consistent with plate atelectasis. Position of the previously described orthopedic hardware is unchanged. Multiple air fluid levels are seen within the abdomen as well as dilation of small bowel. This is unchanged from the prior study, but clinical correlation is recommended as this may be due to persistent small bowel obstruction or substantial ileus.", "output": "1. Increased in size of right pleural effusion as compared to ___ study. 2. Multiple air fluid levels and dilat ion of the small bowel as described above raising concern for substantial ileus or bowel obstruction; clinical correlation is recommended." }, { "input": "Right-sided temporary pacer wire with the tip in the right ventricle. No pneumothorax. The appearance of the lungs of not significantly changed with left basal atelectasis and small effusion. No significant interstitial edema. Mild cardiomegaly.", "output": "Right-sided temporary pacer tip in the right ventricle. No pneumothorax." }, { "input": "The lungs are hyperinflated. Known left upper lobe pulmonary nodule is not clearly delineated. There is subtle opacity at the lung base medially which also seen posteriorly on the lateral view. Elsewhere, no focal consolidation identified. Cardiomediastinal silhouette is within normal limits. Known left hilar adenopathy better seen by prior CT.", "output": "Hyperinflation with subtle bibasilar opacities seen medially. These could represent infection in the proper clinical setting. Known left upper lobe pulmonary nodule and left hilar adenopathy better seen on prior PET-CT." }, { "input": "The cardiomediastinal shadow is normal. Right-sided PICC line in situ with the tip at the mid to distal SVC. Pulmonary overinflation. Mild coarsening of the bronchovascular markings. Nodular airspace consolidation with associated bronchograms seen in the medial basal segment of the right lower lobe. No pleural effusion. No pulmonary edema.", "output": "Nodular airspace consolidation with associated air bronchograms/bronchiectasis seen in the medial basal segment of the right lower lobe. This was also noted on previous imaging. Pulmonary hyperinflation and mild coarsening of the bronchovascular markings: COPD should be excluded." }, { "input": "There are streaky opacities in the lower lungs, most suggestive of minor atelectasis. Otherwise, the lung fields appear clear. The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. Bony structures are unremarkable. Surgical clips project along the right upper quadrant. There is no free air.", "output": "Predominantly streaky opacities in the lower lobes, most suggestive of atelectasis. No evidence for free air." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax or pleural effusion. There are mild degenerative changes in the thoracic spine", "output": "No acute cardiopulmonary abnormalities" }, { "input": "There is a new left lower lobe infiltrate seen best on the lateral exam in in the retrocardiac region. The heart is mildly enlarged and there is mild-to-moderate central pulmonary vascular congestion and interstitial edema. Small bilateral effusions are noted, left greater than right, with adjacent atelectasis. The upper lungs are grossly clear.", "output": "New left lower lobe infiltrate compatible with pneumonia" }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest were obtained. The patient is rotated slightly to the right. There are likely small bilateral pleural effusions. There is prominence of the central pulmonary vasculature. Mild interstitial edema is seen as well as indistinctness of the hila. Cardiac and mediastinal silhouettes are grossly stable. Degenerative changes are again seen along the spine. There are aortic calcifications.", "output": "Findings suggestive of volume overload with likely small bilateral pleural effusions as well as interstitial edema and prominence of the central vasculature." }, { "input": "The inspiratory lung volumes are appropriate. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The pulmonary vasculature is not engorged. The mediastinum is prominent due to unfolding of the thoracic aorta. The cardiac and hilar contours are within normal limits. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process. Unfolded thoracic aorta." }, { "input": "No focal consolidation is seen and there is no pleural effusion or pneumothorax. Cardiac silhouette is top-normal. Mediastinal contours unremarkable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac silhouette size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is within normal limits. Patchy ill-defined nodular opacities are seen within the left perihilar region. The right lung is clear. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities are present.", "output": "Ill-defined nodular opacities in the left perihilar region are suspicious for early infection." }, { "input": "Compared with prior radiographs performed on the same day on ___ at 05:11, there has been interval increase in bilateral pneumothorax. Again seen is pneumomediastinum. There is no pleural effusion. Cardiomediastinal silhouette is unchanged. ET tube and NG tube are unchanged in position. Right central venous catheter terminates at the superior caval atrial junction.", "output": "Interval worsening of bilateral pneumothorax. Pneumomediastinum, similar to prior. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ ___ on the telephoneon ___ at 4:04 PM, 15 minutes after discovery of the findings." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "There is increased size of the left pneumothorax which is seen both laterally and medially. This is superimposed on the diffuse lung disease previously described. There is increased subcutaneous emphysema. Bilateral chest tubes, left central line, ET tube, and NG tube are unchanged At the time of dictating this study followup films had already been obtained", "output": "Moderate left pneumothorax, increased compared to prior." }, { "input": "As compared to chest radiograph from 1 day prior, widespread reticular opacities have increased. . No significant pleural effusions. The cardiomediastinal contours are stable. Cardiac size is normal. Right-sided Port-A-Cath with the tip in the right atrium", "output": "Worsening, widespread interstitial opacities can be worsening pulmonary edema. The differential includes atypical infection including viral or PCP given the history of immunocompromise." }, { "input": "Compared with prior radiographs performed on same day on ___ at ___:11, there is worsening of pneumomediastinum. Bilateral pneumothoraces extending to the deep regions of the costophrenic sulci are slightly increased from prior. There is continued widespread subcutaneous emphysema, similar to prior. Bilateral chest tubes are stable in appearance. ETT, NG tube and right IJ catheter are unchanged in position.", "output": "Increase in pneumomediastinum and slight increase in bilateral pneumothoraces." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. Previously noted right paramediastinal mass is no longer visualized on the current study. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Portable semi-erect chest radiograph ___ 05:06 is submitted.", "output": "Endotracheal tube, right internal jugular Port-A-Cath, bilateral chest tubes and nasogastric tube are unchanged in position. Stable bilateral diffuse parenchymal abnormality and extensive subcutaneous emphysema and pneumomediastinum does not appear to be significantly changed." }, { "input": "Small right pneumothorax stable, small left pneumothorax slightly larger. Bilateral pleural drains unchanged in their respective positions. Subcutaneous emphysema in the neck is decreasing, small pneumomediastinum persists, improved since earlier in the week. ET tube in standard placement. Esophageal drainage tube ends in the upper portion of a nondistended stomach. Right central venous infusion port catheter ends close to the superior cavoatrial junction. Heart size normal.", "output": "Slight increase in small left pneumothorax. Small right pneumothorax is stable." }, { "input": "PA and lateral views of the chest. Mild cardiomegaly is stable. There are bibasilar opacities, stable, likely reflecting chronic atelectasis/aspiration. There are aortic knob calcifications. The mediastinal and hilar contours are normal. No large pleural effusion. No pneumothorax.", "output": "Stable bibasilar opacities, likely the sequela of chronic aspiration and atelectasis." }, { "input": "Compared with chest radiograph performed earlier on same day, there has been interval placement of the ET tube, which terminates 5 cm above the carina. An enteric tube is difficult to follow throughout the entire chest, but terminates below the level of the diaphragm in the stomach. There is left basilar atelectasis. Left perihilar and right basilar opacities are increased from prior and likely represent asymmetric edema or aspiration. Cardiomediastinal silhouette is stable.", "output": "1. ET tube is appropriately positioned, terminating approximately 5 cm above the carina. 2. An enteric tube terminates in the stomach. 3. Interval increase in left perihilar and right basilar opacities likely representing asymmetric edema or aspiration." }, { "input": "Endotracheal tube tip terminates approximately 4.6 cm from the carina. An enteric tube is noted within the distal esophagus, though the tip is not well visualized. Lung volumes are low. Heart size is mildly enlarged. The aorta is tortuous. Crowding of bronchovascular structures is present with mild pulmonary vascular congestion. Bibasilar airspace opacities may reflect areas of atelectasis. Numerous clips are seen in the right neck. No acute osseous abnormalities detected.", "output": "1. Standard positioning of the endotracheal tube. 2. Enteric tube courses into the distal esophagus, however the tip is not well visualized on this exam. Dedicated radiographs of the upper abdomen are recommended to better assess the location of the tip of the enteric tube. 3. Low lung volumes with bibasilar patchy opacities, likely atelectasis. Infection or aspiration is not excluded in the correct clinical setting. 4. Probable mild pulmonary vascular congestion." }, { "input": "The lungs are clear of consolidation. Linear left basilar opacity is most likely atelectasis versus scarring. The cardiomediastinal silhouette is within normal limits. Median sternotomy wires are again noted. There is no free air below the diaphragm.", "output": "No acute cardiopulmonary process. No free intraperitoneal air." }, { "input": "Sternotomy wires appear intact and appropriately positioned. Stable enlargement of the cardiomediastinal silhouette. No focal consolidations. No pulmonary edema. No pleural effusion. No pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The patient is status post median sternotomy with three intact median sternotomy wires demonstrated. Mild enlargement of the cardiac silhouette is unchanged. The mediastinal and hilar contours are stable. Pulmonary vascularity is normal. Linear opacities within the lingula are compatible with areas of scarring. No focal consolidation, pleural effusion or pneumothorax is present. There is no pulmonary vascular congestion. Clips are seen within the upper abdomen just to the right of midline.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified. Surgical clips project over the upper abdomen anteriorly.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Port-A-Cath over the right chest wall is again seen with catheter extending into the region of the mid SVC. In this patient with known pulmonary nodules better seen on the a recent CT exam, nodules are poorly visualized on radiograph. There is a small right pleural effusion which appears unchanged from the recent CT exam. No evidence of superimposed pneumonia or edema. Cardiomediastinal silhouette is stable. The imaged bony structures are intact.", "output": "1. No acute findings. 2. Small right pleural effusion stable from recent PET-CT. 3. Pulmonary nodules better assessed on recent PET-CT." }, { "input": "A Port-A-Cath is in place, with tip over distal SVC. There is background hyperinflation, consistent with COPD. The cardiomediastinal silhouette is not enlarged. Mild aortic calcification noted. There is slight blunting of the right cardiophrenic angle, consistent with a small amount of pleural fluid or thickening. On the lateral view, there is suggestion of focal nodular density in the lower lobe posteriorly on 1 side. Additional patchy density projects over the cardiac silhouette. Indistinct opacities are seen laterally in both right and left lower zones. These small opacities likely correspond to opacities seen on the ___ chest CT. No CHF or large consolidation is identified. Oral contrast is noted within the bowel.", "output": "1. Port-A-Cath tip over distal SVC. 2. Bibasilar focal opacities, likely corresponding to opacity seen on an outside the ___ chest CT. Correlation with clinical history is requested for further assessment. 3. Small right effusion." }, { "input": "Cardiac silhouette size is top normal. Mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Small bilateral pleural effusions are new in the interval with associated atelectasis in the lung bases. No pneumothorax. No acute osseous abnormalities demonstrated.", "output": "Small bilateral pleural effusions with bilateral lower atelectasis." }, { "input": "PA and lateral views of the chest. The lungs are clear. There is no consolidation or pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified.", "output": "Normal chest x-ray." }, { "input": "There is again seen a right-sided dialysis catheter whose distal tip projects over the lower SVC versus cavoatrial junction. This is likely in unchanged position and the appearance of a more distal location of the tip likely reflects decreased lung volumes in comparison to prior radiograph. There has been interval removal of endotracheal tube, as well as removal of previously seen NG tube. The cardio mediastinal contours are grossly unchanged. There is no evidence of pneumothorax. There has been interval increase in opacification of the lower portion of the right upper lobe which may represent developing pulmonary edema, infection, or atelectasis. There is again redemonstrated a loculated left pleural effusion without significant interval change. Also again seen is a small right sided pleural effusion.", "output": "1. Increased opacification of the lower portion of the right upper lobe which may represent developing pulmonary edema, infection, or atelectasis. 2. Stable appearance of left loculated pleural effusion and small right pleural effusion." }, { "input": "AP portable upright view of the chest. Endotracheal tube extends into the right mainstem bronchus. Nasogastric tube tip is seen just beyond the GE junction. Dialysis catheter with right IJ insertion extends to the level of the cavoatrial junction. Bilateral pleural effusions are noted, small to moderate in overall size with airspace consolidation in the mid to lower lungs concerning for pneumonia. No large pneumothorax is seen. Bony structures appear grossly intact.", "output": "No acute intrathoracic process" }, { "input": "There has been interval retraction of the endotracheal tube with its tip now residing 3.2 cm above the carinal. Otherwise, no change.", "output": "Appropriately positioned endotracheal tube." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. There is no free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Lungs are clear of consolidation, effusion or vascular congestion. Biapical scarring is again noted. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Cardiomediastinal silhouette and hilar contours are normal. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "Normal chest radiograph; specifically, no evidence of pneumonia or lung nodules." }, { "input": "Minor basilar atelectasis is seen without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is visualized. No acute osseous abnormalities seen.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No evidence of metastatic disease. No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are mildly hyperinflated. No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. Heart and mediastinal contours are within normal limits.", "output": "No radiographic evidence for pneumonia." }, { "input": "As compared to the previous image, third above catheter has been advanced. The course of the catheter is unremarkable, the tip is not included on the image and, thus, located be low the gastroesophageal junction. The right PICC line is unchanged. No pneumothorax.", "output": "As compared to the previous image, third above catheter has been advanced. The course of the catheter is unremarkable, the tip is not included on the image and, thus, located be low the gastroesophageal junction. The right PICC line is unchanged. No pneumothorax." }, { "input": "Endotracheal tube ends 4.6 cm above the carina. Increasing, large right pleural effusion. Stable, small left pleural effusion. Normal heart size and distended azygos vein. Normal hilar contours. New, interstitial edema on the left.", "output": "Increasing, large right pleural effusion and stable, small left pleural effusion with new interstitial edema on the left." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unchanged with a large hiatal hernia containing an air-fluid level again noted. Pulmonary vasculature is not engorged. Lungs are hyperinflated with mild emphysematous changes again noted within the upper lobes. No focal consolidation, pleural effusion or pneumothorax is present. Multiple compression deformities within the thoracic spine are unchanged.", "output": "Large hiatal hernia. No acute cardiopulmonary abnormality otherwise demonstrated." }, { "input": "Mildly increased pulmonary vascularity, new. Large esophageal hiatal hernia, similar. Strands of atelectasis in the lingula, right middle lobe, similar. .", "output": "Increased pulmonary vascularity." }, { "input": "AP portable upright view of the chest. A prominent retrocardiac opacity corresponds with known hiatal hernia. Lung volumes are low with mild bibasilar atelectasis. The cardiac silhouette appears unchanged. Mediastinal contour is within normal limits. There is no convincing evidence of pneumonia, edema, large effusion or pneumothorax. The imaged osseous structures are intact. No free air below the right hemidiaphragm.", "output": "Large hiatal hernia. Mild bibasilar atelectasis, otherwise unremarkable exam." }, { "input": "The cardiac silhouette is mildly to severely enlarged, however this is likely accentuated by a large hiatal hernia with air-fluid level seen on the lateral view. The posterior chest is partially obscured by external artifact on the lateral view. Given this, no large pleural effusion is seen. There is no definite focal consolidation or pneumothorax. Mediastinal contours are unremarkable.", "output": "Large hiatal hernia. Large cardiac silhouette, may be exaggerated by large hiatal hernia." }, { "input": "Lung volumes are slightly low, resulting in bronchovascular crowding. Cardiomediastinal and hilar contours are stable. Note is made of a large hiatal hernia. There is no pleural effusion, pneumothorax, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The heart is at the upper limits of normal size. Patchy calcification is noted along the aortic arch. There is no pleural effusion or pneumothorax. The lungs appear clear. Small anterior osteophytes are present along the mid thoracic spine.", "output": "No evidence of acute disease." }, { "input": "Heart size is mildly enlarged with tortuosity of the thoracic aortic arch. Hilar contours are unremarkable. Lungs are clear. No pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are well aerated and clear. Heart size and mediastinal contours are normal. There is no pleural effusion or pneumothorax. Osseous structures are notable for chronic left clavicular fracture.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest provided. Lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "There are diffuse bilateral airspace opacities. No pneumothorax or large pleural effusion. The cardiac silhouette is mild-to-moderately enlarged.", "output": "Diffuse bilateral airspace opacities. Given patient history, most consistent with pulmonary edema. Other etiologies and differential diagnosis include widespread infection and pulmonary hemorrhage. Correlate clinically and recommend repeat radiograph after diuresis to assess for underlying consolidation. Enlarged cardiac silhouette." }, { "input": "Shallow inspiration. Few linear bibasilar opacities, likely atelectasis. Pneumonitis less likely. Chest otherwise normal", "output": "Few linear bibasilar opacities, likely atelectasis ; pneumonitis is less likely" }, { "input": "Left lower lobe consolidation is worrisome for pneumonia. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Left lower lobe consolidation worrisome for pneumonia." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lungs are low in volume but clear. There is no pleural effusion or pneumothorax. The heart is normal in size and cardiomediastinal contours. No displaced rib fractures are identified.", "output": "No acute intrathoracic process." }, { "input": "Left basilar linear atelectasis is unchanged. The lungs are otherwise clear. There is no pneumothorax. The heart and mediastinum are within normal limits. An old healed left rib fracture is again noted. No acute rib fractures are identified. Multilevel spinal degenerative changes are stable.", "output": "No acute rib fracture identified. Old healed left rib fracture. No pneumothorax. Stable left basilar linear atelectasis with otherwise clear lungs." }, { "input": "AP portable upright views of the chest were obtained. Lungs are clear bilaterally with no focal consolidation, effusion or pneumothorax. There is no evidence of CHF. Cardiomediastinal silhouette is normal. Bony structures appear intact. There is no subdiaphragmatic free air.", "output": "No acute intrathoracic process." }, { "input": "There is patchy left base opacity worrisome for left lower lobe pneumonia. The right lung is likely clear. A small focal opacity in the right medial lung base on the AP view, most likely represents vascular structure though additional site of consolidation is not excluded. Trace left pleural effusion is seen. The cardiac silhouette is mildly enlarged. The aorta is somewhat tortuous.", "output": "Left lower lobe pneumonia. Possible additional small focus of infection in the right lung versus vascular structure." }, { "input": "No focal consolidation is seen. There may be a trace left pleural effusion. Prominence of the azygos vein is stable as compared to chest CT from ___. A central venous line courses superiorly from the IVC and terminates at the cavoatrial junction/ distal SVC. The cardiac and mediastinal silhouettes are stable. No overt pulmonary edema is seen.", "output": "Possible trace left pleural effusion. Central venous line courses superiorly in the IVC and terminates at the cavoatrial junction/ distal SVC, possibly somewhat high in position." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. Calcifications of the tracheobronchial tree is unchanged. There is no pleural effusion or pneumothorax. A central venous line is again partially visualized projecting over the mid SVC, previously at the distal SVC. A stent is again seen projecting over the left lower lobe.", "output": "1. No acute cardiopulmonary process. 2. Central venous line now projects over the mid SVC, previously at the distal SVC." }, { "input": "Right chest tube has been removed. There is a small right apical pneumothorax, measuring up to 1.5 cm. There is no left pneumothorax. There is no effusion. Stable elevation of right hemidiaphragm. No new opacity to suggest pneumonia. Stable hilar and mediastinal contours, without pulmonary vascular congestion or edema.", "output": "Small right apical pneumothorax following chest tube removal. These findings were communicated to ___ at 9:30 a.m. on ___ by Dr. ___." }, { "input": "Since the prior examination, there has been interval filling of the residual apical cavity with fluid and no evidence of residual pneumothorax. There are changes related to right upper lobectomy with volume loss and diaphragmatic elevation. The remainder of the right hemithorax is well aerated. The left hemithorax is well aerated. There are no focal opacities concerning for pneumonia. There are no pleural effusions or pneumothorax. The cardiomediastinal and hilar contours are normal. Pulmonary vascularity is normal.", "output": "Expected changes status post right upper lobectomy with fluid demonstrated within the lobectomy site. No evidence of pneumothorax or acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear stable. There are no pleural effusions or pneumothorax. There is small-to-moderate hiatal hernia with an air-fluid level which is better depicted on the frontal views. The osseous structures are unremarkable.", "output": "No definite evidence of acute disease. Suspected small to moderate hiatal hernia." }, { "input": "Two portable views of the chest are compared to previous exams from ___ and ___. The lungs are clear of confluent consolidation or evidence of large effusion. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No definite acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Ill-defined interstitial and nodular opacities are noted diffusely, more so on the right, concerning for infection. No pleural effusion or pneumothorax is present. There are moderate multilevel degenerative changes seen in the thoracic spine.", "output": "Diffuse ill-defined opacities, more pronounced on the right. Findings are concerning for multifocal infection, and atypical organisms should be considered." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unchanged. Streaky bibasilar opacities likely reflect atelectasis. Pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is seen. Moderate degenerative changes are noted within the imaged thoracic spine.", "output": "Streaky bibasilar opacities, potentially reflective of atelectasis." }, { "input": "The heart size is within normal limits. The mediastinal contours are unremarkable. The lungs are hyperexpanded but clear. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs are clear besides mild right basilar atelectasis. Cardiomediastinal silhouette is stable. No acute osseous abnormalities. Prior right-sided dual-lumen central venous catheter is no longer visualized.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal silhouette is normal. Right central venous catheter ends in the right atrium, unchanged. Again seen, is prominence of the pulmonary vascular markings and minimal bibasilar opacities, similar in appearance to ___. There is no pleural effusion or pneumothorax.", "output": "Mild pulmonary vascular congestion, similar to ___. No focal consolidation." }, { "input": "Mild to moderate bilateral pleural effusions noted. Mild increase in size of cardiac silhouette. Mild increase in right pulmonary vasculature. No pneumothorax or focal consolidation is noted. Mediastinal contours are normal. No bony abnormality is detected.", "output": "New pulmonary effusions bilaterally, increased cardiac silhouette and vasculature markings suggestive of congestive heart failure." }, { "input": "Sternotomy wires are intact. Right IJ sheath is in the upper SVC. Interval increase in moderate-sized left pleural effusion with left lower lobe collapse and left sided mediastinal shift. Small right-sided subpulmonic effusion and mild right lower lobe atelectasis. No pneumothorax, new focal opacity, or pulmonary edema. Heart size is top normal. No bony abnormality.", "output": "1. Left lower lobe collapse with interval increase in moderate-sized left pleural effusion. 2. Small right subpulmonic effusion and mild right lower lobe atelectasis. Results were conveyed via telephone to ___, NP by Dr.___ on ___ at 1PM within 15 minutes of observation of findings." }, { "input": "Frontal and lateral views of the chest. The heart is of normal size with stable hilar contours. Subtle patchy opacity in the anterior right upper lobe is new since ___. Previously seen left lung opacities have resolved. No pleural effusion or pneumothorax. A moderate-sized hiatal hernia is similar to prior. Pulmonary vascular markings are normal. No radiopaque foreign body.", "output": "New right upper lobe patchy opacity, compatible with an early focus of pneumonia in the correct clinical setting. Recommend follow up CXR in 4 weeks to document resolution following appropriate therapy. Findings were discussed via phone call by ___ with Dr. ___ on ___ at ___ PM." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. There is mild upper zone redistribution and indistinctness of pulmonary vascularity suggesting borderline congestion, although not striking. As seen previously, the left costophrenic sulcus appears effaced with patchy streaky opacities at the lung bases, but without substantial change suggesting a more chronic form of basilar atelectasis. A moderate hiatal hernia, seen on the prior CT is not visible on this study. There is no pleural effusion or pneumothorax. Bones appear demineralized. There are mild similar degenerative changes throughout the thoracic spine.", "output": "Borderline findings suggesting vascular congestion. Patchy basilar opacities, but with little if any change and more suggestive of chronic atelectasis or scarring than acute pneumonia, although it is difficult to completely exclude an ongoing infectious process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest. The lungs are clear. Cardiomediastinal silhouette is normal. Osseous structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. Heart and mediastinal contours are within normal limits. There is no evidence for free intraperitoneal air.", "output": "No radiographic evidence for acute cardiopulmonary process or free intraperitoneal air." }, { "input": "The patient is status post sternotomy. The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. Streaky opacity in the medial right middle lobe suggests minor atelectasis. The bones appear within normal limits.", "output": "No evidence of acute disease." }, { "input": "The lateral view is suboptimal due to the patient's overlying arm. Given this, the lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No acute intrathoracic process." }, { "input": "AP upright and lateral views of the chest were provided. Lungs are clear without focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette appears normal. On the lateral view, a compression deformity is seen at the thoracolumbar junction, new from the ___ exam though appears chronic. Bilateral AC joint arthropathy is noted.", "output": "No consolidation to suggest pneumonia. Chronic appearance of a vertebral body compression at the thoracolumbar junction." }, { "input": "Cardiac silhouette size is top normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Minimal streaky opacities in the lung bases likely reflect atelectasis. No focal consolidation, pleural effusion or pneumothorax is identified. No acute osseous abnormality is detected.", "output": "Minimal atelectasis at the lung bases without focal consolidation to suggest pneumonia" }, { "input": "There is mild pulmonary edema and small bilateral pleural effusions. More focal consolidation identified at the right lung base. Moderate to severe enlargement of the cardiac silhouette is seen. There is no prior exam to evaluate for interval change. No acute osseous abnormalities, hypertrophic changes noted in the spine.", "output": "Mild pulmonary edema and bilateral pleural effusions. More focal region of opacity at the right lung base could represent superimposed infection. Enlarged cardiac silhouette likely due to cardiomegaly noting that pericardial effusion would also be possible." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest were acquired. The lungs are clear. The heart size is normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen.", "output": "No acute intrathoracic process." }, { "input": "No cardiomegaly. Normal configuration of the hila. No airspace consolidation. No suspicious pulmonary nodules or masses. No pleural effusions. No pneumothorax. Spondylotic changes of the thoracic spine.", "output": "No residual airspace opacification." }, { "input": "A weighted esophageal catheter terminates in the region of the gastroesophageal junction. A right PICC terminates in the mid superior vena cava, which appears retracted compared to prior. Retrocardiac density likely corresponds to known left lower lobe consolidation, better seen on today's CT. No pleural effusion or pneumothorax is seen. No pulmonary edema is evident on this view. The main pulmonary artery is enlarged, as seen on CT.", "output": "1. Left lower lobe consolidation, better evaluated on CT. 2. Weighted enteric catheter with tip in the region of the gastroesophageal junction. Subsequent radiographs demonstrate interval repositioning of the enteric catheter." }, { "input": "There is no significant change compared to prior radiograph with redemonstration of a mild pulmonary vascular congestion and interstitial edema. Right chest juxtahilar opacity is unchanged from the prior study. A right-sided PICC terminates at the level of the mid SVC. A nasointestinal tube is positioned with the tip out of the field of view however terminates in at least the ___ portion of the duodenum. There is no pleural effusion or pneumothorax.", "output": "1. Right PICC at the mid SVC. 2. Nasointestinal tube tip is out of view but terminates at least at the level of the ___ portion of duodenum. 3. Unchanged mild interstitial edema and right juxtahilar opacities." }, { "input": "An AP upright radiograph of the chest is provided. There is a heterogeneous opacity in the right lower lobe. The lungs are otherwise clear. Mild cardiomegaly is a chronic finding. Otherwise, the hilar and cardiomediastinal contours are normal. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal.", "output": "1. Right lower lobe pneumonia. 2. Chronic mild cardiomegaly." }, { "input": "Initial chest radiograph demonstrates a feeding tube coiling within the distal esophagus with its tip projecting over the expected location of the cervical esophagus. Subsequent imaging demonstrates repositioning of the feeding tube. The feeding tube courses below the diaphragm and its tip terminates in the gastric fundus. The cardiomediastinal and hilar contours are stable. Lung volumes remain low with bibasilar atelectasis.", "output": "Feeding tube terminates in the gastric fundus. These findings were discussed with ___ ___ by ___ via telephone on ___ at 11:40 a.m., at the time of discovery." }, { "input": "Moderate pulmonary edema has resolved. There is blunting of the posterior right costophrenic angle which may reflect atelectasis or a small effusion. The cardiac silhouette remains mildly enlarged. There is no pleural effusion or pneumothorax. The mediastinum and hilar contours are unremarkable.", "output": "Resolution of pulmonary edema with atelectasis versus a tiny effusion in the posterior right lower hemithorax." }, { "input": "Study is slightly limited due to the patient's chin obscuring assessment of the lung apices. Additionally, the patient is mildly rotated. Heart size is mildly enlarged but unchanged. The mediastinal and hilar contours are similar. There is mild pulmonary vascular congestion. Patchy opacities in the lung bases could reflect atelectasis but infection cannot be excluded. No large pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Mild pulmonary vascular congestion. Bibasilar airspace opacities could reflect atelectasis but infection cannot be excluded." }, { "input": "There is mild enlargement of cardiac silhouette. The mediastinal and hilar contours are unchanged. Mild pulmonary vascular congestion persists. There are streaky opacities in the lung bases which may reflect atelectasis. No focal consolidation, pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Mild pulmonary vascular congestion and mild bibasilar atelectasis." }, { "input": "Right-sided PICC line ends in the mid SVC. The enteric catheter traverses past the diaphragm; however, coiling is noted within the throat region. Consolidation in the left lobe is seen and is described in further detail in other imaging reports. No pleural effusion or pneumothorax is noted. The cardiac silhouette and mediastinal contours are unchanged from previous radiographs. No definite bony abnormalities are noted.", "output": "Left lung consolidation is seen, and coiling of the enteric catheter is noted in the throat." }, { "input": "The patient is status post median sternotomy. A right lower lobe opacity reflects a fat containing Bochdalek's hernia as seen on the reference chest CT. There are bibasilar opacities, possibly reflecting atelectasis. No pleural effusion or overt pulmonary edema is noted. The heart is normal in size, and the thoracic aorta is enlarged as noted on the prior chest CT.", "output": "Bibasilar opacities likely reflect atelectasis. No pulmonary effusion." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are normal. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax. No overt traumatic findings.", "output": "Normal chest radiograph. No overt traumatic findings." }, { "input": "Frontal and lateral radiographs of the chest demonstrate normal heart size. The cardiomediastinal silhouette and hilar contours are normal. The lungs are clear. No pleural effusion or pneumothorax. No displaced rib fracture identified.", "output": "Normal chest radiograph." }, { "input": "PA and lateral views of the chest provided. Midline sternotomy wires are again noted. There is persistent opacity at the right lung base with volume loss which likely represents atelectasis and small effusion. The left lung and right upper lung remain well aerated. Bony structures are intact.", "output": "Stable exam with right lower lung atelectasis and small effusion." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs were obtained. A right chest Port-A-Cath terminates in the cavoatrial junction. The lungs are fully expanded and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "No evidence of consolidation in the left upper lobe. No acute cardiopulmonary process. Findings were communicated with ___ by Dr.___ at 4:10pm on ___." }, { "input": "Lungs are well expanded and clear bilaterally with no evidence of focal consolidation, mass lesions or pleural effusion. There is no pneumothorax. The aorta is slightly tortuous; otherwise, the cardiomediastinal silhouette is within normal limits. The pleural surfaces are unremarkable.", "output": "No evidence of metastatic disease." }, { "input": "Assessment is limited by patient positioning and rotation. Heart size appears mildly enlarged. Mediastinal contours are grossly unremarkable. There is no overt pulmonary edema, nor is there a pleural effusion or pneumothorax. Lung volumes are low. There appear to be patchy opacities in the lung bases which are nonspecific, and may be reflective of infection or aspiration. No acute osseous abnormality is detected.", "output": "Limited exam. Probable patchy opacities in the lung bases which are nonspecific, potentially reflective of infection or aspiration in the correct clinical setting. Consider repeat PA and lateral views of the chest when the patient is able to be positioned for these exams" }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Lung volumes are borderline low, but there is no focal consolidation concerning for pneumonia. Visualized portion the upper abdomen is unremarkable.", "output": "No pneumonia or other acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest provided. Lung volumes are low limiting evaluation. There is subtle lower lung opacity which is most compatible with atelectasis though difficult to exclude a very early pneumonia. No large effusion or pneumothorax. No signs of congestion or edema. Cardiomediastinal silhouette is stable. Bony structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Mild bibasal opacities in the setting of low lung lung volumes likely reflects atelectasis. Difficult to exclude an early pneumonia." }, { "input": "PA and lateral views of the chest. There are trace bilateral pleural effusions. The lungs are clear of focal consolidation. The cardiomediastinal silhouette is within normal limits. There is no visualized pneumomediastinum. Hypertrophic changes are seen in the spine without acute osseous abnormality. No free air seen below the diaphragm.", "output": "Trace bilateral effusions otherwise, no acute cardiopulmonary process." }, { "input": "The lung volumes are low. There is vascular congestion and mild pulmonary edema. There is no focal opacity, pleural effusion, or pneumothorax. The mediastinal silhouette is normal. The heart is mildly enlarged.", "output": "Mild pulmonary edema." }, { "input": "Lung volumes are decreased. The cardiac silhouette is mildly enlarged. There are calcifications involving the aortic knob. The hilar and mediastinal contours are otherwise normal. There is no focal consolidation, large pleural effusion or pneumothorax. There is no overt pulmonary edema.", "output": "Low lung volumes. No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Lungs are hyperinflated with severe emphysema noted. No focal consolidation concerning for pneumonia. No large effusion or pneumothorax. Cardiomediastinal silhouette appears grossly within normal limits. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Hyperinflated lungs with severe emphysema. No convincing evidence for pneumonia. Please note, evaluation is limited for small pulmonary nodules and given background severe emphysema, consider nonemergent chest CT to further evaluate." }, { "input": "The lungs are clear with no evidence of a consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Atherosclerotic calcifications are noted at the aortic arch. No acute fractures identified.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest demonstrate low lung volumes with top normal heart size. A pulse generator is present in the left chest wall, with pacing leads terminating in the right atrium and right ventricle. There is no pneumothorax, pleural effusion, pulmonary edema, or focal airspace opacity. Mild pleural thickening or scarring is noted on the right.", "output": "Top normal heart size. No acute cardiopulmonary process." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac, mediastinal and hilar contours are within normal limits. The pulmonary vasculature is normal. No focal consolidation or pneumothorax is present. Patchy opacities in the lung bases likely reflect areas of atelectasis. Minimal blunting of the costophrenic angles posteriorly suggests the presence of trace bilateral pleural effusions. Mild to moderate degenerative changes are noted in the thoracic spine. Clips from prior cholecystectomy are seen in the right upper quadrant of the abdomen.", "output": "Patchy opacities in the lung bases, likely atelectasis, with probable trace bilateral pleural effusions." }, { "input": "Heart size is normal with mild unfolding of the thoracic aorta. Cardiomediastinal silhouette and hilar contours are otherwise unremarkable. Lungs are mildly hyperinflated but clear. Pleural surfaces are clear without effusion or pneumothorax. Hyperdensities in the right upper quadrant are likely surgical clips.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Streaky opacities at the left base likely reflect atelectasis. There is no pleural effusion or pneumothorax. Surgical clips are re- demonstrated in the right upper quadrant of the abdomen.", "output": "Streaky opacities at the base of the left lung likely reflect atelectasis however consider infection in the appropriate setting." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well inflated and clear. No focal consolidation, effusion, or pneumothorax is present. An mild left convex contour in the AP window is unchanged since ___ and likely represents a vascular contour rather than adenopathy.", "output": "No acute cardiopulmonary process. Stable mild convex contour in the AP window. This is almost certainly a normal vascular contour. Repeat shallow oblique chest radiographs are suggested for confirmation." }, { "input": "An azygos lobe is incidentally noted. No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation is seen peer there is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. No evidence of free air is seen beneath the diaphragms.", "output": "No acute cardiopulmonary process." }, { "input": "A right IJ central line is present, tip overlying distal SVC at the cavoatrial junction. No pneumothorax is detected. The patient is status post sternotomy. There is prominence of the cardiac mediastinal silhouette, which is not significantly changed. Patchy opacity at both lung bases, at least some of which is accounted for by atelectasis. Blunting of the left costophrenic angle is consistent with a small effusion. There is minimal upper zone redistribution, but no overt CHF. Tiny metallic density again noted the left upper lung, question surgical clip. The lateral view shows an oblong opacity in the posterior segment of a lower lobe on one side. This is new compared with a CT dated ___.", "output": "1. Patchy opacity at both bases, similar, though slightly different in configuration, compared with ___. 2. Oblong opacity in the lower lobe posteriorly, new compared with ___ CT scan. The differential diagnosis includes a pneumonic infiltrate. Rounded atelectasis and loculated fluid are considered less likely. NOTIFICATION: The ordering clinician ___ was paged by Dr. ___ by phone at 16:56 and 18:24 on ___ and discussed with her by phone at 18:47 the same day." }, { "input": "Since the prior exam, the right chest tube has been removed. No pneumothorax is identified. The lung volumes have slightly improved, though there is persistent retrocardiac atelectasis. There is no new opacity or pulmonary edema. Probable small bilateral pleural effusions are present. The cardiomediastinal silhouette is unchanged with an expected post-operative appearance. A right internal jugular central venous catheter is present with the tip in the low SVC.", "output": "Status post right chest tube removal. No evidence of a pneumothorax." }, { "input": "Low lung volumes are present. This accentuates the size of the cardiac silhouette which is at least mildly enlarged. The aorta is unfolded. Mediastinal and hilar contours are unremarkable. There is crowding of the bronchovascular structures without overt pulmonary edema. Streaky and linear opacities in the lung bases likely reflect areas of atelectasis. No pleural effusion, focal consolidation or pneumothorax is visualized. No acute osseous abnormality is identified.", "output": "Low lung volumes with bibasilar atelectasis." }, { "input": "Lung volumes are low with bronchovascular crowding. There is mild pulmonary vascular congestion and slight indistinctness of the pulmonary vasculature suggesting mild edema. The heart size is difficult to fully assess in the setting of low lung volumes and is AP view and is probably normal in size. No pleural effusion or pneumothorax. The mediastinum is not widened. No evidence of fractures on this nondedicated exam.", "output": "1. Low lung volumes and minimal bronchovascular crowding and edema. 2. No focal pneumonia or pneumothorax." }, { "input": "An endotracheal tube terminates adjacent to the carina, possibly just extending into the proximal right main stem bronchus. An orogastric tube courses below the diaphragm, the tip is not included in this examination. Lung volumes are somewhat decreased. Increased opacity at the left lower lung could reflect a combination of atelectasis and pleural effusion. However, in the appropriate clinical setting, aspiration should be considered. The cardiomediastinal and hilar contours are within normal limits.", "output": "1. Endotracheal tube terminates adjacent to the carina. Recommend pulling back at least 4 cm to ensure adequate positioning. 2. Increased opacity at the left lung base could reflect a combination of pleural effusion and volume loss. In the appropriate clinical setting, however, aspiration should also be considered. Findings discussed with Dr. ___ by ___ the telephone on ___ at 05:45, ___ min after discovery. Additional findings discussed with Dr. ___ by ___ the telephone on ___ at 07:50 AM." }, { "input": "PA frontal and lateral chest radiograph demonstrates interval removal of endotracheal and nasogastric tube. Lungs are well expanded and clear bilaterally. Previously seen streaky linear opacities at the left base most consistent with atelectasis. There is no focal consolidation. There is no pleural effusion or pneumothorax. Cardiomediastinal contour is remarkable for a tortuous aorta. Heart size is normal. No pulmonary edema. The mediastinal and hilar contours remain stable.", "output": "No pneumonia." }, { "input": "Opacity seen in at the left base laterally which may be due to atelectasis. Elsewhere, the lungs are clear given relatively low lung volumes. Cardiac silhouette is top-normal based on technique. Tortuosity of the descending thoracic aorta is noted. Radiopaque densities project over the left upper quadrant, incompletely assessed.", "output": "No definite acute cardiopulmonary process." }, { "input": "Portable semi-upright radiograph of the chest demonstrates low lung volumes with resultant bronchovascular crowding. There is stable mild cardiomegaly. Left-sided pacemaker with atrial and right ventricular leads is present. There is no pleural effusion, pneumothorax, or consolidation.", "output": "Stable mild cardiomegaly without evidence of pneumonia." }, { "input": "Low lung volumes. There is subtle opacification at the right lung base which may represent atelectasis, however an early developing pneumonia is a consideration. Otherwise, the lungs are clear. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Subtle opacification at the right lung base, which may represent atelectasis, however an early developing pneumonia is a consideration." }, { "input": "The lungs are well inflated and clear. No focal consolidations. No pulmonary edema. Stable appearance of the cardiomediastinal silhouette. No pleural effusion. No pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal silhouette is within normal limits. Previously seen right lung base airspace opacity has improved, likely attributable to atelectasis.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The cardiomediastinal contours are within normal limits. The bilateral hila are unremarkable. The lungs are clear without focal consolidation. There is no evidence of pulmonary vascular congestion. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Right chest wall AICD is noted with leads extending to the region of the right atrium and right ventricle. Lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Right internal jugular central venous catheter tip terminates in the mid SVC. No pneumothorax. Remainder of the examination is unchanged from the prior study performed approximately 2 hr earlier.", "output": "Right internal jugular central venous catheter tip in the mid SVC. No pneumothorax." }, { "input": "A portable frontal chest radiograph again demonstrates a right chest wall AICD/ pacer device with leads overlying the right atrium and ventricle. The cardiac silhouette is accentuated by mildly low lung volumes and technique, again appearing mildly enlarged. There is no appreciable focal consolidation, pleural effusion, or pneumothorax. Pulmonary vasculature is not engorged. The visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest are obtained. Midline sternotomy wires and mediastinal clips are again noted. A chest tube previously seen in the right lung base has been removed. A pigtail catheter is partially imaged in the right upper abdomen. Bilateral pleural effusions are again noted without significant change since the prior exam. Upper lobe lucency is compatible with known emphysema. Cardiomediastinal silhouette is stable. Bony structures appear intact.", "output": "Stable small bilateral pleural effusions. Interval removal of right basal chest tube." }, { "input": "Chest PA and lateral radiographs demonstrate unremarkable mediastinal, hilar, and cardiac contours. There is slight increase in a small right-sided pleural effusion but without evidence of overt pulmonary edema. Faint opacification noted within the medial aspect of the right upper lobe as well as in the lateral aspect of the left upper lobe, correlate with patient's known pulmonary masses. No focal opacification concerning for pneumonia identified. There is a right-sided Port-A-Cath with tip terminating at the cavoatrial junction and a newly evident pigtail drain in the right upper abdominal quadrant. Sternotomy sutures are midline and intact.", "output": "Minimal increase in small right pleural effusion. No evidence for pulmonary edema. Faint right upper lobe opacifications correspond with known masses." }, { "input": "The right chest tube has been removed. A Pleurx catheter is not definitely seen. There is no pneumothorax. A moderate right and small left pleural effusion are unchanged. Bibasilar atelectasis is also stable. There are no new consolidations. The subcutaneous air overlying the right neck is stable. Sternal wires and mediastinal clips are intact.", "output": "1. No pneumothorax. 2. Stable moderate right and small left pleural effusions." }, { "input": "There is a large right pleural effusion with associated compressive atelectasis at the right lung base; the effusion has substantially increased. A small left pleural effusion is also present. There is minimal left basilar atelectasis. Heart size is top normal. The mediastinal contours are normal. The patient is status post midline sternotomy and CABG. There is no pneumothorax. A catheter overlies the right upper quadrant of the abdomen.", "output": "1. Large right and small left pleural effusions. 2. Moderate right and mild left opacities, which are not specific but could be seen with associated compressive basilar atelectasis." }, { "input": "There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. There is mild bilateral apical thickening, more prominent on the left.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest were obtained demonstrating clear well-expanded lungs without signs of pneumonia or CHF. Bilateral nodular opacities in the lower lungs are likely nipple shadows. No pleural effusion or pneumothorax. Heart and mediastinal contours appear normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No signs of pneumonia or CHF." }, { "input": "A frontal and lateral view of the chest confirms that the left PICC ends in the mid-distal SVC. There is no pneumothorax. The cardiomediastinal and hilar contours are normal. The lungs are clear. There is no pleural effusion.", "output": "Left PICC ends in the mid-distal SVC. No pneumothorax." }, { "input": "AP upright and lateral views of the chest provided. Mild hilar congestion and interstitial edema likely reflect mild congestion. The heart is mildly enlarged. No definite consolidation, effusion or pneumothorax. Mediastinal contour stable. Bony structures intact.", "output": "Cardiomegaly with mild pulmonary edema." }, { "input": "Streaky left retrocardiac opacity most likely represents atelectasis. There is otherwise no focal consolidation, pleural effusion or pneumothorax. Heart size is mildly enlarged. Atherosclerotic calcifications are noted in the aortic arch. There is no evidence of acute fracture. There is bilateral glenohumeral and acromioclavicular joint osteoarthritis.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest are obtained. There is left base linear atelectasis/scarring. Chronic left-sided pleural opacity/thickening is again seen. There is no new focal consolidation, large pleural effusion, or evidence of pneumothorax. The cardiac and mediastinal silhouettes are stable. There has been interval removal of a left-sided PICC.", "output": "Interval removal of a left-sided PICC. Otherwise, no significant interval change." }, { "input": "Relatively low lung volumes are again noted with secondary crowding of the bronchovascular markings. Right PICC is seen with tip projecting over the lower SVC, better seen on the lateral projection. There is no definite consolidation or effusion there is apparent enlargement of the cardiac silhouette which is likely accentuated by low lung volumes and AP technique, unchanged.", "output": "No definite acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. A right upper extremity PICC line is in place with the catheter extending into the mid SVC region though the tip is not clearly visualized. Otherwise no change. No consolidation concerning for pneumonia.", "output": "As above." }, { "input": "Single portable semi erect radiograph through the chest demonstrates obscuration of the left hemidiaphragm concerning for consolidation. Cardiomediastinal and hilar contours are similar in appearance to prior study dated ___. No large pleural effusion is identified. Focal area of lateral pleural thickening at the level of the left chest wall is similar in appearance.", "output": "Consolidation within the left lower lobe concerning for pneumonia." }, { "input": "The lung volumes are low. In comparison to prior study, missing short segment of the right posterior fifth rib, left acromioclavicular joint osteoarthritis, and bilateral glenohumeral joint arthritis are again seen; however, there is increased lucency and thinning of the posterior seventh rib when compared to most recent ___ chest radiograph that may represent worsening osteoporosis given patient's debilitated and wheelchair-bound state. There are no sclerotic bone lesions noted. There is mild cardiomegaly with mild pulmonary vascular congestion and cephalization of pulmonary vessels without overt pulmonary edema. Bibasilar subsegmental atelectasis are also noted. No pneumothorax seen. Old fracture of the right fifth posterior rib unchanged from prior chest radiograph.", "output": "1. Mild cardiomegaly, fluid overload, without overt pulmonary edema. 2. Stable osteoarthritis of the bilateral glenohumeral joint, severe left acromioclavicular joint osteoarthritis, increased lucency of the ribs(particularly the right seventh posterior rib) that may represent worsening osteoporosis in a debilitated and wheelchair-bound patient. RECOMMENDATION(S): Recommend CT scan if there is clinical suspicion for malignancy or pathological fractures. NOTIFICATION: Discussed findings with ordering physician ___. ___ pager ___ via telephone conversation, on ___ at 15:20, 1 hour after discovery of the findings." }, { "input": "The heart is mildly enlarged. The mediastinal and hilar contours appear unchanged. There is similar patchy opacification at the left lung base, probably involving the left lower lobe with left lateral pleural thickening. A smooth defect along the course of the right posterior fifth rib appears unchanged. The right lung remains clear aside from patchy unchanged right infrahilar opacity, again suggesting minor atelectasis or scarring. There is no pleural effusion or pneumothorax. No definite evidence of pneumonia.", "output": "Stable chronic-appearing findings including left basilar scarring and pleural thickening; no definite evidence of pneumonia." }, { "input": "Lungs are slightly hyperinflated. There is no consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette is normal. No acute osseous abnormalities identified. Multiple remote right-sided rib fractures are again noted.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is no focal lung consolidation. Irregularity of the posterior sixth rib, likely represents a fracture, correlate for site of patient's pain.", "output": "Fracture of the posterior sixth rib." }, { "input": "Lungs are fully expanded and clear. No pleural abnormalities. Mild cardiomegaly is unchanged. No pulmonary vascular congestion or edema. Cardiomediastinal and hilar silhouettes are normal.", "output": "No evidence of acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, large effusion or pneumothorax. No signs of congestion or edema. Cardiomediastinal silhouette is normal. Overlying EKG leads are present. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. Left chest wall AICD again noted with single lead extending into the region of the right ventricle. A prosthetic cardiac valve and midline sternotomy wires are noted. The heart is enlarged in the interval. The aorta appears unfolded. There are small bilateral pleural effusions. Hilar engorgement is noted with mild interstitial pulmonary edema. No focal consolidation to suggest pneumonia. No pneumothorax.", "output": "Cardiomegaly, new from prior with hilar congestion and mild interstitial edema. Small bilateral pleural effusions." }, { "input": "The lungs are clear without consolidation or pneumothorax. Blunting of the left posterior costophrenic angle raises possibility of small effusion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified. Surgical clip projects over the left upper quadrant.", "output": "Possible small left pleural effusion. Otherwise unremarkable chest x-ray." }, { "input": "2 supine portable views of the chest demonstrate interval placement of a right internal jugular central venous catheter, which terminates at the cavoatrial junction. There is no pneumothorax. There is elevation of the right hemidiaphragm, and relatively low lung volumes, and right basilar atelectasis. The heart size is top normal and the mediastinum is likely within normal limits, allowing for supine portable technique, although hilar prominence suggests underlying fluid overload. Relatively asymmetric opacification in the left apex compared to the right, is possibly due to non-cardiogenic edema. No large pleural effusion is present and no consolidation concerning for pneumonia is seen.", "output": "Right internal jugular central venous catheter in appropriate position. No pneumothorax or focal pneumonia. Left apical haziness could represent a component of non-cardiogenic edema, in addition to underlying fluid overload and right basilar atelectasis. The above findings were communicated to Dr. ___ by Dr. ___ ___ telephone at 9:14 am, after attending review." }, { "input": "Single portable chest radiograph was provided. Endotracheal tube is 6.2 cm above the carina. Nasogastric tube courses below the diaphragm into the stomach. A right internal jugular central line terminates in the lower SVC. There is no focal consolidation, pleural effusion or pneumothorax. The cardiac silhouette is enlarged but unchanged.", "output": "Endotracheal tube may be advanced 2 cm for better positioning." }, { "input": "Mild opacities at the left lower lung base are likely atelectasis. No substantial pleural effusion. No pneumothorax. No focal consolidations or opacities concerning for an infectious process. Cardiomediastinal silhouette and hilar contours are normal.", "output": "No overt evidence of pneumonia. Probable left basilar atelectasis." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs which are clear. There is no focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "Normal chest radiograph." }, { "input": "The lungs are hypoinflated with crowding of vasculature and bibasilar atelectasis. No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable.", "output": "Hypoinflated lungs with bibasilar atelectasis. No pneumonia." }, { "input": "The lungs are clear and the lung volumes are normal. There is no pleural effusion, pneumothorax or focal airspace consolidation. The heart is normal size. There is no evidence for pulmonary edema. The mediastinal and hilar contours are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There are low lung volumes and mild left base atelectasis. Left base opacity has decreased as compared to the prior study. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable.", "output": "Low lung volumes and mild left base atelectasis. Left base opacity is significantly decreased compared to prior." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and fairly well-aerated lungs. There is no focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is status post right upper lobe wedge resection. There is resultant mild elevation of the right hemidiaphragm as well as mild shift of the trachea to the right. The heart size is normal. The hilar and mediastinal contours are stable. No focal consolidations concerning for pneumonia is identified. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No pneumonia." }, { "input": "The lungs are poorly inflated. Retrocardiac patchy opacity seen on the lateral view, not substantiated on the frontal view is likely due to atelectasis, but developing consolidation is not entirely excluded in the appropriate clinical setting. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. No displaced fracture is seen.", "output": "Low lung volumes. Retrocardiac patchy opacity seen on the lateral view, not substantiated on the frontal view is likely due to atelectasis/bronchovascular crowding, but developing consolidation is not entirely excluded in the appropriate clinical setting." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear without focal consolidation. S-shaped scoliosis of the thoracolumbar spine is again noted. The cardiomediastinal silhouette and hilar contours are stable. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Again noted is scoliosis of the thoracic spine and tortuosity of the descending thoracic aorta. The lungs are clear and the cardiac, hilar, and mediastinal contours are normal. No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Other than a small focus of linear atelectasis at the left lung base, the lungs are fully expanded and clear. No pleural abnormalities. Heart size is normal. Cardiomediastinal and hilar silhouettes are normal. No radiographic evidence of rib fractures. There are mild degenerative changes of the thoracic spine.", "output": "No radiographic evidence of rib fractures or acute bony abnormalities." }, { "input": "Frontal and lateral views of the chest were obtained. There are relatively low lung volumes which accentuate the bronchovascular markings. However, given this, no focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Slight prominence of the central pulmonary vascular structures likely relates to low lung volumes. The cardiac silhouette is top normal. Mediastinal contours are unremarkable. There is no evidence of free air beneath the diaphragms.", "output": "No evidence of free air beneath the diaphragm. No focal consolidation." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. The bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "As compared to ___, mediastinal drains, chest tube, nasogastric tube and endotracheal tube have been removed. Hazy opacity throughout the right lung has improved. Increasing basal atelectasis with bilateral effusions, small right moderate left. No interstitial edema. Possible tiny apical right pneumothorax.", "output": "Possible tiny apical right pneumothorax." }, { "input": "A right internal jugular catheter terminates in the distal SVC. Platelike atelectasis in the right lung base. There has been interval improvement in aeration of the left lung base with reduced atelectasis and likely a small residual effusion. No pneumothorax seen. Previous median sternotomy and coronary artery bypass clips seen.", "output": "Interval decrease in the degree of atelectasis of the left lung base. Probable small residual left pleural effusion." }, { "input": "PA and lateral views of the chest were compared to previous exam from ___. Linear opacity at the lung bases is most suggestive of atelectasis. There is, however, somewhat patchy but still linear opacity in the right upper lung on the frontal exam, not clearly located on the lateral. The lungs are otherwise clear. There is no effusion. Cardiomediastinal silhouette is within normal limits as are the osseous and soft tissue structures.", "output": "Patchy but somewhat linear opacity in the right upper lung, this could be due to atelectasis; however, early, developing infiltrate is also possible. Clinical correlation suggested." }, { "input": "Bibasilar opacities and a possible left upper lobe opacity are all concerning for pneumonia. There is no evidence of effusion or pulmonary edema. The cardiomediastinal silhouette and hilar contours are grossly normal. There is no pneumothorax.", "output": "Bibasilar opacities as well as a left upper lobe opacity concerning for pneumonia. These findings were communicated to Dr. ___ by telephoned at 11:58 on ___ by Dr. ___." }, { "input": "The cardiac, mediastinal and hilar contours are normal. The lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear, cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax.", "output": "No evidence of pneumonia." }, { "input": "There is streaky retrocardiac opacity which is most likely atelectasis. Left mid lung linear opacity also likely atelectasis versus scarring. Lungs are otherwise clear without confluent consolidation or effusion. The cardiomediastinal silhouette is stable. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are within normal limits. The pulmonary vasculature is not engorged. Linear opacities within the lung bases bilaterally are compatible with areas of subsegmental atelectasis. Remainder of the lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Mild subsegmental bibasilar atelectasis. No evidence for congestive heart failure." }, { "input": "AP upright and lateral views of the chest provided. Hazy consolidation is seen within the right lower lung which is concerning for pneumonia. Mild left mid and lower lung atelectasis is present. The upper lungs appear relatively well aerated. The hila are slightly prominent which could reflect reactive nodal prominence. Cardiomediastinal silhouette is stable. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Findings concerning for right lower lung pneumonia." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well-expanded clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "No pneumonia." }, { "input": "PA and lateral views of the chest were obtained. The lungs are clear. There is no consolidation, pleural effusion or pneumothorax. The cardiac, mediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary abnormality. These findings were discussed with Dr. ___ at 2:15 p.m. on ___ by telephone." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear except for unchanged linear scarring in the mid and lower lungs. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart is borderline in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable.", "output": "Heart at the upper limits of normal size. No evidence of acute cardiopulmonary disease." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of top normal size with stable cardiomediastinal contours. The right lung base linear opacity is similar to multiple prior examinations, compatible with chronic mucoid impaction. Known right lower lobe nodule is not clearly visualized on this exam. Small right pleural effusion is present, similar to prior. No radiopaque foreign body. Multilevel thoracic spine degenerative changes.", "output": "Right lower lung linear opacity, similar to prior and likely reflects chronic mucoid impaction. Small right pleural effusion is also similar to prior." }, { "input": "PA and lateral chest radiograph demonstrates improved aeration of the right lower lobe. No focal opacity convincing for pneumonia is identified. Mild blunting of the right phrenic angle may reflect trace pleural effusion. Cardiac size appears overall stable. Again identified is an azygos lobe.", "output": "These findings were communicated to the ordering physician ___. ___ by Dr. ___ ___ telephone at 15:01 on ___." }, { "input": "The heart is top normal in size. The hilar and mediastinal contours are normal. Patient is status post right lower lobectomy with postsurgical changes. An area of increased opacification in the right lung base likely represents scar formation and appears unchanged from prior examination. Otherwise, the lungs are clear. There are no pleural effusions, pneumothorax, focal consolidations or pulmonary edema. Degenerative changes are noted along the lower thoracic spine.", "output": "Postsurgical changes at the right lung compatible with prior right lower lobectomy and scar formation. No signs of superimposed pneumonia." }, { "input": "Postsurgical changes with persistent scarring at the right base are stable from prior exams. A small right pleural effusion is unchanged. There is no left pleural effusion. There is no pneumonia, pulmonary edema, or pneumothorax. The aorta is tortuous and calcified. The cardiomediastinal silhouette is otherwise normal.", "output": "Stable post-surgical changes in the right lung with a persistent small right pleural effusion. No acute cardiopulmonary process." }, { "input": "It'll changes are seen in the right lung following lobectomy. The left lung appears clear. The cardiac size is mildly enlarged. The aorta appears tortuous with calcifications. There is no pneumothorax, pulmonary edema, or pneumonia. Degenerative changes are seen in the thoracic spine.", "output": "Postsurgical changes following right lobectomy. No evidence of pneumonia or pulmonary edema." }, { "input": "AP upright portable chest radiograph is obtained. Patient is status post right lower lobectomy with post-surgical changes again noted at the right lung base. There is no definite sign of pneumonia or CHF. No large effusion or pneumothorax. Known emphysema is evidence by relative upper lobe lucency. Cardiomediastinal silhouette is stable. Bony structures appear intact.", "output": "Post-surgical changes at the right lung base compatible with prior right lower lobectomy. No signs of superimposed pneumonia." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Comparison is made with the next preceding similar study of ___. Cardiovascular, mediastinal structures are unchanged. No pulmonary vascular congestion is present. The previously identified small amount of pleural densities on the right lower base persists. In comparison with the next preceding study suggests that the amount of fluid has increased mildly. No other new pulmonary abnormalities are seen, and no new parenchymal lesions are identified. The left hemithorax remains unchanged. No pneumothorax has developed in the apical area.", "output": "Mild increase of postoperative right-sided pleural effusion in this patient status post VATS procedure." }, { "input": "Lungs remain hyperinflated. The heart size remains within normal limits. Mediastinal and hilar contours are unchanged. New consolidative opacities are seen within the left upper lobe as well as both lung bases compatible with multifocal pneumonia. Mild pulmonary vascular engorgement is also demonstrated. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Multifocal pneumonia. Followup radiographs are recommended after treatment to ensure resolution of this finding." }, { "input": "Frontal and lateral views of the chest demonstrate top normal heart size. The mediastinal and hilar contours are normal. The lungs are clear. There is no pneumothorax, vascular congestion, or pleural effusion.", "output": "No acute cardiopulmonary process." }, { "input": "Normal cardiomediastinal and hilar contours. Clear lungs. Normal pleural surfaces.", "output": "No radiographic evidence of cardiomegaly or coarctation." }, { "input": "PA and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette. There is no focal consolidation, pleural effusion, or pneumothorax. A convex, linear opacity in the right lung base is stable from ___ and may represent an area of scarring. The pulmonary vasculature is normal.", "output": "No cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded, clear lungs. The cardiomediastinal and hilar contours are unchanged. There is no pneumothorax, consolidation, or pleural effusion.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Streaky opacities at the lung bases on the frontal view may reflect minimal subsegmental atelectasis. There is no focal consolidation worrisome for pneumonia, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The lateral view of the chest is suboptimal due to overlying external artifact. Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "Lateral view of the chest is suboptimal due to overlying external artifact. Otherwise, no evidence of acute cardiopulmonary process." }, { "input": "Left subclavian dual lumen central venous catheter terminates in the right atrium. There is a large opacity in the right mid and lower lung with air bronchograms and associated moderate pleural effusion. There is also small pleural effusion at the left base. Heart size is normal. The mediastinal and hilar contours are unremarkable. There is no pneumothorax. There is S-shaped curvature of the thoracolumbar spine.", "output": "Large area of opacity in the right mid and lower lung with associated pleural effusion worrisome for aspiration/pneumonia." }, { "input": "There are moderate left greater than right pleural effusions. Increased interstitial markings are seen throughout the lungs. The cardiac silhouette is enlarged. Degenerative changes are noted at the shoulders bilaterally. No acute osseous abnormalities.", "output": "Congestive failure with moderate left greater than right effusions and pulmonary edema." }, { "input": "Again seen is a left-sided dialysis catheter extending to the region of the cavoatrial junction. Allowing for differences in positioning, the cardiomediastinal silhouette is probably unchanged. There is background hyperinflation. On the current exam, the upper zone vessels appear slightly prominent bilaterally. There is new atelectasis at the left lung base and minimal atelectasis at the right lung base. No frank consolidation or gross effusion is identified. Minimal blunting of left costophrenic angle is likely present.", "output": "Mild prominence of the upper zone vessels, without overt CHF. Minimal atelectasis at the left base. No definite focal infiltrate and no frank consolidation identified." }, { "input": "AP portable upright view of the chest. Overlying EKG leads present. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process" }, { "input": "PA and lateral radiographs of the chest were acquired. Lung volumes are slightly low. There is chronic elevation of the right hemidiaphragm. The lungs are clear aside from minimal right basilar atelectasis. Heart size is within normal limits. Mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen.", "output": "No acute cardiac or pulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of normal size with unremarkable cardiomediastinal contours. Lung volumes are low and small right atelectasis is present. Lungs are otherwise clear without focal or diffuse abnormality. No pleural effusion or pneumothorax is identified. The catheter of a right chest wall port, which has been accessed, terminates in the right atrium. The osseous structures are unremarkable.", "output": "Low lung volumes with atelectasis. No pleural effusion." }, { "input": "Single portable view of the chest is compared to previous exam from ___. Right chest wall port is seen with catheter tip at the RA-SVC junction. Low lung volumes are again noted. Retrocardiac opacity may be due to atelectasis. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are grossly unremarkable. There is no visualized free air below the diaphragm on this portable examination.", "output": "No definite acute cardiopulmonary process. No definite free intraperitoneal air based on this portable exam." }, { "input": "Overall, there has been no significant interval change from the most recent prior study of ___. Right perihilar opacity persists, corresponding to soft tissue concerning for recurrent malignancy on prior CTA of the chest. Linear opacities in the right lung apex with opacification of the right paratracheal stripe may represent right upper lobe collapse and/or radiation changes. There is no significant pleural effusion or pneumothorax. The cardiac silhouette is incompletely evaluated due to low lung volumes. The mediastinal contours are prominent, related in part to unfolding of the thoracic aorta and right lung opacities. The cardiomediastinal silhouette appears stable from the prior study.", "output": "Overall, stable appearance of the chest with right perihilar and upper lobe opacities reflecting radiation fibrosis and/or tumor recurrence. Possible small left lower lobe pneumonia." }, { "input": "Single portable view of the chest. When compared to prior there has been no significant interval change. Right ___ and ___ opacities are unchanged. The elsewhere, the lungs are grossly clear and there is no evidence of pulmonary vascular congestion. Cardiomediastinal silhouette is unchanged as are the osseous and soft tissue structures.", "output": "No significant interval change." }, { "input": "Compared to most recent prior study, there has been no major interval change. Right perihilar and right upper lung opacity persists. There is persistent elevation of the right hemidiaphragm. No new consolidation, pleural effusion, or pneumothorax is detected. Heart and mediastinal contours are stable; cardiac silhouette is incompletely evaluated due to low lung volumes.", "output": "No radiographic evidence for acute change." }, { "input": "Lung volumes are low. The cardiac, mediastinal and hilar contours are within normal limits. Lungs are clear. No pleural effusion or pneumothorax is identified. No acute osseous abnormalities are detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is right basilar opacity which silhouettes the right hemi diaphragm which appears focally elevated, potentially with underlying eventration. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "Right basilar opacity silhouetting the hemidiaphragm which could be atelectasis or scarring, to be correlated clinically to exclude infection." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Large esophageal hiatal hernia. Small pleural effusions, similar. Increased left basilar atelectasis or infiltrate. Mild interstitial prominence, stable. Patchy right upper lung capacity, stable. Remainder normal.", "output": "Increased left basilar atelectasis or infiltrate. Otherwise stable" }, { "input": "Frontal and lateral views of the chest were obtained. This study was made available for my interpretation, today, ___, at 10:00 a.m. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable. There may be minimal basilar atelectasis/scarring without significant interval change. Some degenerative changes are seen along the spine. No overt pulmonary edema is seen.", "output": "No significant interval change. No acute cardiopulmonary process." }, { "input": "Heart is mildly enlarged. The cardiac, mediastinal and hilar contours appear stable. There is a small new pleural effusion on the left and probably a trace one on the right. A mild interstitial abnormality involves the lower lungs but more suggestive of vascular congestion than pneumonia.", "output": "Findings suggests mild vascular congestion. Small new pleural effusion on the left." }, { "input": "Minor basilar atelectasis is seen without definite focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Minor basilar atelectasis without definite focal consolidation. No pleural effusion seen." }, { "input": "The heart size is normal. Mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vascularity is normal. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs and pleural spaces are clear without evidence of pneumothorax or pleural effusions. Cardiomediastinal silhouette is within normal limits. There is no evidence of pneumoperitoneum and osseous structures are unchanged.", "output": "No evidence of acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest. Lower lung volumes are seen on the current exam, particularly on the frontal view. Relatively linear left basilar opacity is likely due to atelectasis as it is not seen on the lateral view. Elsewhere, the lungs are clear. There is no effusion or pulmonary vascular congestion. Degree of cardiomegaly is unchanged, given lower inspiratory volumes. No acute osseous abnormality is identified. Gaseous distention of the colon seen below the left hemidiaphragm.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest are provided. The lungs are clear bilaterally. The heart is top normal in size. The aorta is unfolded. No pleural effusion or pneumothorax. Bony structures are intact.", "output": "No acute findings in the chest." }, { "input": "The cardiac silhouette is moderately enlarged with tortuosity of the thoracic aorta unchanged from prior study. Hilar contours are unremarkable. Lungs are clear. There is no evidence of pulmonary vascular congestion, interstitial edema or fibrotic change. There is no pleural effusion or pneumothorax.", "output": "Moderate cardiac enlargement without evidence of fluid overload. No acute intrathoracic abnormality." }, { "input": "Frontal and lateral views of the chest were obtained. Right superior mediastinal widening is similar to ___ and corresponds to tortuous vessels as seen on prior CT. The heart size is normal. Bilateral lungs are clear without focal or diffuse abnormality. An apparent calcified nodule overlying the right lower lung corresponds to a right breast calcification seen on prior CT. A moderate-to-large sized hiatal hernia is again identified as a retrocardiac opacity. The osseous structures are unremarkable. No radiopaque foreign bodies are present.", "output": "No acute cardiopulmonary process. Moderate-to-large hiatal hernia." }, { "input": "There are low lung volumes. Indistinctness and prominence of the hila suggest vascular engorgement and congestion. No definite focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "Low lung volumes and vascular engorgement/congestion." }, { "input": "Evaluation of the later radiograph is severely limited by patient's arm position. Within this limitation, the cardiomediastinal and hilar contours are unremarkable. Lungs are clear. No pleural effusion or pneumothorax identified. Substantially assymetrically increased soft tissue opacification on the left with suggestion of subcutaneous gas and possible air fluid level on the lateral view.", "output": "No acute intrathoracic process. Assymetry of breast soft tissue with possible subcutaneous gas and air fluid level noted on lateral view may relate to recent surgery. Please correlate with patient symptom and surgical history." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. A metallic BB overlies the left chest wall near the 2 left-sided rib fractures, which are better evaluated on the dedicated rib series from ___ at 13:05.", "output": "No acute cardiopulmonary process. Rib fractures, better evaluated on the rib series." }, { "input": "There is no evidence for free intraperitoneal air under the diaphragms. The lung fields demonstrate no focal consolidation, pleural effusion, or pneumothorax. Lung volumes are low. Linear density projecting over the lateral left mid lung may represent atelectasis or scarring. Aortic calcifications are present.", "output": "No free intraperitoneal air." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Lungs are clear. No pleural effusion or pneumothorax is present. The pulmonary vasculature appears normal. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality. Chest CTA is recommended for further assessment given the concern for pulmonary embolism." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours appear normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No signs of pneumonia or other acute intrathoracic process." }, { "input": "The heart size is normal. The hilar and mediastinal contours are within normal limits. There is no pneumothorax, focal consolidation, or pleural effusion.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process. No radiographic evidence of interstitial lung disease." }, { "input": "Portable AP upright chest radiograph obtained. Clips are noted in the upper abdomen. Two epicardial pacing wires are present. The right CP angle is excluded partially. Lungs appear clear without signs of CHF or pneumonia. No large effusion or pneumothorax seen. Heart size is normal. Mediastinal contour is unremarkable. Bony structures are intact.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well expanded. Biapical scarring is unchanged. There is no focal consolidation, effusion or pneumothorax. Moderate cardiomegaly is stable. Multilevel thoracic spine degenerative changes are unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is mildly enlarged, unchanged. The mediastinal and hilar contours are similar. The pulmonary vasculature is not engorged. Biapical scarring is unchanged, and the lungs are without focal consolidation. No pleural effusion or pneumothorax is seen. Minimal patchy atelectasis is noted in the lung bases. There is no subdiaphragmatic free air. Moderate multilevel degenerative changes are seen in the thoracic spine.", "output": "No acute cardiopulmonary abnormality. No subdiaphragmatic free air." }, { "input": "The cardiomediastinal silhouette is moderately enlarged. Mild bibasilar atelectatic changes, but the lungs are without a focal consolidation, effusion, or pneumothorax. No acute fractures are identified.", "output": "Moderate cardiomegaly with no acute cardiopulmonary process identified." }, { "input": "Mild to moderate enlargement of the cardiac silhouette is unchanged. Mediastinal and hilar contours are within normal limits. Pulmonary vascularity is normal. Biapical scarring is re- demonstrated. There is no focal consolidation, pleural effusion or pneumothorax. Streaky left basilar opacity is likely reflective of atelectasis. There are multilevel degenerative changes in the thoracic spine.", "output": "Mild left basilar atelectasis." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. No signs of pneumomediastinum. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Focal eventration of the right hemidiaphragm is noted.", "output": "No acute intrathoracic process." }, { "input": "Cardiomediastinal and hilar silhouettes are normal. Asymmetric opacity of the left lower lobe may be due to atelectasis, but given the clinical history, superimposed infection is considered. No pleural effusion or pneumothorax.", "output": "1. Left basilar opacity may be due to atelectasis, but superimposed infection is also possible given the patient's clinical history. 2. No evidence of lung hyperinflation. NOTIFICATION: The above findings were communicated via telephone by Dr. ___ to Dr. ___ at 06:19 on ___, ___ min after discovery." }, { "input": "Lung volumes are low. The cardiomediastinal and hilar contours are within normal limits. The lung fields are clear. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable.", "output": "No acute cardiopulmonary abnormality." }, { "input": "AP and lateral views of the chest. The lungs are clear. There is no pneumothorax. Cardiomediastinal silhouette is normal. No displaced rib fractures identified.", "output": "No acute cardiopulmonary process. No displaced rib fracture identified however dedicated rib series with BB marker in region of site of pain may be helpful." }, { "input": "AP upright and lateral views of the chest were obtained. The lungs are clear, though low lung volumes somewhat limit the evaluation. There is no pleural effusion or pneumothorax. Cardiomediastinal silhouette is stable and there are atherosclerotic calcification along the aortic knob. There is tortuosity of the thoracic aorta. Bony structures appear intact. Old left rib cage deformities are again noted.", "output": "No acute findings in the chest." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. No focal consolidations concerning for pneumonia are identified. Widespread lung metastases are better evaluated on the prior chest CT from ___. Only scattered pumonary metastases are noted on this exam. There is no pleural effusion or pneumothorax.", "output": "1. No focal consolidations concerning for pneumonia are identified. 2. Widespread lung metastases are better evaluated on the CT of the chest from ___." }, { "input": "Lungs are hyperinflated. There is no focal consolidation to suggest pneumonia. Calcified granulomatous nodular opacities are again seen, and are unchanged from prior. There is increased density in the extreme right medial apex, that was present previously, but is more conspicuous on today's exam. Pleural thickening in this region is unchanged. Cardiomediastinal and hilar contours are unchanged. There is no pleural effusion or pneumothorax.", "output": "1. Increased radiodensity in the extreme right apex, which may represent scarring, but is more conspicuous compared to prior radiographs, a CT chest can be obtained for further evaluation. 2. No evidence of pneumonia. NOTIFICATION: Findings were emailed to the ED QA nurses by Dr. ___ on ___ at 17:00, on the day of the study. With" }, { "input": "No focal consolidation is seen. There is minor linear left base atelectasis/ scarring. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The tip of the enteric to terminates in the gastric fundus, but the sidehole is seen at the level of the gastroesophageal junction. A right-sided Port-A-Cath terminates at the cavoatrial junction. There is no evidence of pneumonia, pleural effusion or pneumothorax. Known pulmonary metastases are better evaluated on the recent chest CT dated ___. Cardiomediastinal silhouette is within normal limits.", "output": "1. Enteric tube terminates in the gastric fundus, with the sidehole remaining at the level of the gastroesophageal junction. 2. Known pulmonary metastases are better evaluated on recent CT chest." }, { "input": "Single supine AP portable view of the chest was obtained. Underlying trauma board and other external artifact partially obscure the view. An endotracheal tube is seen, terminating approximately 3.8 cm above the level of the carina. Nasogastric tube is seen coursing below the level of the diaphragm and terminating in the expected location of the stomach. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No acute intrathoracic process. Endotracheal and nasogastric tubes in appropriate position." }, { "input": "PA and lateral views of the chest. No prior. The lungs are clear. The cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views chest. No pleural effusion, pneumothorax or focal airspace consolidation. Cardiac size and mediastinal contours are normal. Hilar structures unremarkable. There is no radiopaque foreign object.", "output": "No acute cardiopulmonary process." }, { "input": "Of the is post median sternotomy and CABG. Dense mitral annular calcifications are again noted. Mild cardiomegaly with the left ventricular predominance is re- demonstrated. The aorta is unfolded with atherosclerotic calcifications noted at the aortic knob. Pulmonary vasculature is mildly engorged, but improved compared to the previous radiograph. No focal consolidation, pleural effusion or pneumothorax is seen. The lungs are hyperinflated. Dense vascular calcifications are noted within the left upper quadrant of the abdomen. Extensive degenerative changes are noted involving both shoulders.", "output": "Mild pulmonary vascular engorgement, improved compared to previous chest radiograph." }, { "input": "Left-sided pacemaker device is re- demonstrated with leads in unchanged positions. Heart size remains mild to moderately enlarged. Dense mitral annular calcifications are again noted. Mediastinal and hilar contours are unchanged with diffuse atherosclerotic calcifications seen in the thoracic aorta. Pulmonary vasculature is not definitively engorged. Minimal atelectasis is seen in the lung bases without focal consolidation. No pleural effusion or pneumothorax is present. Moderate multilevel degenerative changes are again seen in the thoracic spine. Clips are noted in the right upper quadrant of the abdomen. Degenerative changes of the right acromioclavicular and glenohumeral joints are re- demonstrated with probable chronic anterior dislocation of the right glenohumeral joint.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The patient is status post median sternotomy, CABG, and left-sided pacer placement with leads terminating in the region of the right atrium and right ventricle. Dense mitral annular calcifications are again noted. Mild enlargement of the cardiac silhouette is unchanged. Diffuse atherosclerotic calcifications of the thoracic aorta are noted. The mediastinal and hilar contours are grossly unchanged. No pulmonary edema is demonstrated. There is no focal consolidation, pleural effusion or pneumothorax. Mild multilevel degenerative changes are noted throughout the thoracic spine. Rounded calcifications in the left upper quadrant of the abdomen correspond to known aneurysms of the splenic artery.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. Midline sternotomy wires, mediastinal clips and dual lead pacemaker appear unchanged. A right upper extremity PICC line is again seen which appears intervally advanced, with its tip now extending into the cavoatrial junction possibly entering the right atrium. Patient is rotated to her left. There is pulmonary edema which is similar to prior exam. Small bilateral pleural effusions are likely present. Mitral annular calcification noted. Cardiomediastinal silhouette stable. No pneumothorax. Bony structures are grossly intact with chronic degeneration of the right shoulder partially noted.", "output": "1. Pulmonary edema with small pleural effusions. 2. PICC line tip at the cavoatrial junction or within the right atrium. Consider slight retraction." }, { "input": "Portable AP upright radiograph is obtained. Multiple pulmonary nodules are better assessed on previously obtained chest CT. The patient is status post transbronchial biopsy of one of these nodules without pneumothorax. No focal consolidation or pleural effusion. The heart is top normal in size with post-surgical changes and coronary bypass graft. Dual-lead pacer is in unchanged position. Extensive degenerative changes are seen at the shoulders as before.", "output": "No evidence of pneumothorax. Pulmonary nodules better assessed on previous chest CT." }, { "input": "AP upright and lateral views of the chest provided. Patient is leftward rotated somewhat limiting assessment. Midline sternotomy wires, mediastinal clips, and a left chest wall pacer device with leads extending to the region of the right atrium and right ventricle appear unchanged. There is curvilinear coarse calcification projecting over the heart as on prior compatible with mitral annular calcifications. The lungs appear clear without focal consolidation, large effusion or pneumothorax. The cardiomediastinal silhouette appears unchanged. No acute osseous abnormalities. Chronic severe degenerative disease at both shoulders is again noted. Dense vascular calcification projecting over the upper abdomen also noted.", "output": "As above." }, { "input": "The heart is normal in size. There is a slight prominence of the main pulmonary artery contour of uncertain significance, perhaps artifactual. Otherwise, the mediastinal and hilar contours are unremarkable. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures are unremarkable.", "output": "Minimal prominence of the main pulmonary artery contour, but probably within normal limits; otherwise unremarkable." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are well expanded. They appear somewhat hyperinflated which may relate to good inspiratory effort. No focal consolidation, pleural effusion, or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "No focal consolidation." }, { "input": "Lordotic and slightly rotated positioning. Possibility of background hyperinflation/COPD cannot be excluded. The heart is not enlarged. There is slight prominence of the ascending aorta and scattered aortic calcifications. The descending aorta is grossly unremarkable. Within the limits of plain film radiography, no hilar or mediastinal lymphadenopathy is detected. No CHF, focal infiltrate, effusion, or pneumothorax is identified. Minimal bibasilar atelectasis is likely present. Focal calcification overlying the left neck is suggestive of carotid artery calcification.", "output": "1. Possible background changes of hyperinflation/COPD. Clinical correlation and, if clinically indicated, a lateral view could help further assessment. 2. No acute pulmonary process identified. 3. Mild prominence of the ascending aorta, disproportionate to the descending aorta. In the appropriate clinical setting, this can be associated with hypertension or aortic stenosis. 4. Probable left carotid artery calcification." }, { "input": "As compared to 1 day prior, Dobhoff tube has been advanced with the tip in the pylorus region. The lungs are clear. The cardiomediastinal contours are unremarkable. No pleural effusions or pneumothorax.", "output": "No acute cardiopulmonary process. Dobhoff tube in the region of the pylorus now." }, { "input": "The enteric tube is not clearly identified below the level of the carina though there is the suggestion that it does is far as the gastroesophageal junction. Cardiac size is normal. The lungs are clear. There is no pneumothorax or pleural effusion.", "output": "Recommend conventional radiographs to document position of the esophageal drainage tube. RECOMMENDATION(S): PA and lateral views for better visualization of the esophageal drainage tube. ." }, { "input": "Frontal and lateral views of the chest. Heart size and cardiomediastinal contours are normal. Lungs are clear without focal consolidation, pleural effusion, or pneumothorax.", "output": "Normal chest radiographs." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "There is somewhat patchy, somewhat consolidative opacity in the medial right lower lobe. There is mild bibasilar atelectasis. There is no effusion or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Bibasilar opacities likely atelectasis noting that infection or aspiration are not excluded. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 10:32 AM, 5 minutes after discovery of the findings." }, { "input": "Compared to the previous exam there is a increase the and pulmonary vascular congestion and haziness over both the lungs particularly in the lower lung fields with increased consolidation in the right lower lobe. The findings are extensive and compatible with a fluid overload.", "output": "Fluid overload both lungs." }, { "input": "Right IJ central line tip near cavoatrial junction. There is small left pleural effusion, more apparent compared prior. There is new left lower lobe consolidation, likely atelectasis, consider infection if clinically appropriate. Mildly improved right lower lung capacity. No definite right pleural effusion. Normal heart size, pulmonary vascularity. No pneumothorax.", "output": "There is small left pleural effusion. Left basilar consolidation, likely atelectasis, consider infection if clinically appropriate. Improved right basilar opacity." }, { "input": "A right internal jugular line has been placed with its tip in the mid SVC. Much improvement to of the bilateral lower lobe opacities. Heart is normal in size. there is no pneumothorax or pleural effusion.", "output": "Right IJ in SVC." }, { "input": "The lungs are fully expanded and clear. The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Visualized osseous structures are normal.", "output": "Normal chest radiograph." }, { "input": "Moderate pulmonary vascular congestion with moderate associated pulmonary interstitial edema and mild cardiomegaly are new since ___. There is no pleural effusion, pneumothorax, or focal consolidation.", "output": "Mild congestive heart failure." }, { "input": "The lungs are clear without focal opacity, pulmonary edema, pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal. There is no free air beneath the right hemidiaphragm.", "output": "Normal chest radiograph." }, { "input": "AP portable supine view of the chest. Lungs appear clear. No supine evidence for effusion or pneumothorax. Cardiomediastinal silhouette appears normal. No acute osseous abnormality seen.", "output": "No acute findings." }, { "input": "Lung volumes are low with secondary crowding of the bronchovascular markings. No definite superimposed edema. There is no focal consolidation or effusion. Enlarged cardiac silhouette is unchanged given differences in technique on the current exam. Hypertrophic changes noted in the spine.", "output": "Cardiomegaly without acute cardiopulmonary process." }, { "input": "Low lung volumes accentuate likely mildly enlarged cardiac silhouette. Retrocardiac opacity may reflect some combination of effusion, atelectasis, aspiration or infection. There is moderate pulmonary edema. Likely small right pleural effusion.", "output": "1. Likely congestive heart failure with cardiomegaly, effusions and moderate pulmonary edema. 2. Retrocardiac opacity likely reflects atelectasis though aspiration or infection are possible." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. There is no pulmonary edema. The heart is normal in size, and the mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No signs of pneumonia." }, { "input": "Frontal and lateral views of the chest demonstrate normal cardiomediastinal silhouette allowing for low lung volumes. There is no pneumothorax, vascular congestion, or large effusion. There may be trace subsegmental atelectasis in the left base.", "output": "No evidence of pneumonia. Trace subsegmental atelectasis in the left base." }, { "input": "There are opacities at the bilateral lung bases with air bronchograms concerning for aspiration/pneumonia. There is also a small right and likely trace left pleural effusion. The cardiac silhouette is markedly enlarged. There is mild pulmonary vascular congestion. No pneumothorax is seen.", "output": "1. Bibasilar opacities concerning for infection/ aspiration. Recommend treating to full resolution. If these opacities do not resolve, CT chest is recommended for further evaluation to exclude underlying neoplasm. 2. Small right and likely trace left pleural effusions. 3. Severe cardiomegaly, unchanged." }, { "input": "Lung volumes are slightly decreased but the lungs are clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is enlarged, similar prior exams.", "output": "No acute cardiopulmonary process. Unchanged exam from prior." }, { "input": "Heart size is top normal with mild tortuosity of the thoracic aorta. Hilar contours are unremarkable. Pleural surfaces are clear without effusion or pneumothorax. Opacities in the posterior left lower lobe are suggestive of atelectasis.", "output": "Left basilar opacities suggesting atelectasis. No potential nodules are visualized on this study, possibly due to decreased lung volumes, but please note the prior recommendation to follow-up with a PA view using nipple markers." }, { "input": "The lungs are normally expanded and clear. Opacity at the left base seen ___ is resolved. The heart size is normal. The mediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. No subdiaphragmatic free air seen. Surgical clips project over the right upper quadrant.", "output": "1. No acute cardiopulmonary abnormality. 2. No evidence of subdiaphragmatic free air." }, { "input": "The heart continues to be moderately enlarged. There is pulmonary vascular redistribution and hazy vascularity with patchy alveolar infiltrate, lower lobe greater than upper lobe.", "output": "Worsened fluid status. An underlying infectious infiltrate particularly in the lower lobes cannot be excluded." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Frontal and lateral views chest were performed. The lung volumes are low, resulting in vascular crowding. There is no pleural effusion, pneumothorax or focal airspace consolidation. Bibasilar atelectasis is appreciated. The cardiac silhouette remains top normal in size. The aorta is enlarged. The hilar contours are normal. There are no acute osseous abnormalities seen.", "output": "No acute cardiopulmonary process with an enlarged aorta." }, { "input": "Moderate cardiomegaly is increased compared to the previous chest radiograph, partially accentuated by slightly low lung volumes. The aorta remains tortuous. There is minimal pulmonary vascular congestion without overt pulmonary edema. Subsegmental atelectasis is seen within the right middle and lower lobes. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Moderate cardiomegaly, increased in size from the prior study. Mild pulmonary vascular congestion without overt pulmonary edema. Right basilar atelectasis." }, { "input": "Right PICC terminates at the cavoatrial junction. Elevation the right hemidiaphragm is chronic. Right mid lung and left lung base atelectasis are similar to before. Pleural effusion are small, if any. There is no pneumothorax. Moderately enlarged cardiomediastinal silhouette is unchanged. Aortic contour is tortuous.", "output": "Unchanged bilateral atelectasis and cardiomegaly." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette appears normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "As compared to the prior examination dated ___, there has been no significant interval change. There is no evidence of focal consolidation, pleural effusion, pneumothorax, or frank pulmonary edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities are detected.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Heart size is normal with a left ventricular predominance. Mediastinal and hilar contours are unremarkable. Lungs are clear. No focal consolidation, pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Moderate multilevel degenerative changes are noted in the thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are unremarkable. The pulmonary vasculature is normal. Mild asymmetric opacity is noted in the right apex. Remainder of theLungs are clear without focal consolidation. No pleural effusion or pneumothorax is identified. No acute osseous abnormalities demonstrated.", "output": "Mild asymmetric opacity in the right apex could reflect an area of infection." }, { "input": "PA and lateral views of the chest were provided. Multiple clips in the left axilla with asymmetric size of the left breast noted. The lungs are clear without focal consolidation, effusion, or pneumothorax. Tiny clips are also noted projecting over the left breast soft tissues. The cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Surgical changes in the left breast/axilla. No evidence of pneumonia." }, { "input": "PA and lateral views of the chest demonstrate left axillary vascular clips from prior axillary dissection, as well as left breast clips, unchanged from prior study. The lungs are well expanded and clear bilaterally, with no evidence of pneumothorax, pleural effusion, pulmonary edema, or focal airspace consolidation. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and two lateral chest radiographs were obtained. The lungs are clear and well inflated. No effusion, consolidation, or pneumothorax is present. The cardiomediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is not engorged. Apart from atelectasis in the lung bases, lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. No acute osseous abnormality is visualized.", "output": "Minimal bibasilar atelectasis. Otherwise no acute cardiopulmonary abnormality." }, { "input": "PA and lateral chest radiograph demonstrate clear lungs bilaterally. Cardiomediastinal and hilar contours are within normal limits. There is no pneumothorax or pleural effusion. No evidence of pulmonary edema. No displaced rib fracture is identified.", "output": "No displaced rib fractures identified. If indicated, dedicated rib films with radiopaque marker at the site of clinical concert can be considered. No pneumothorax." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of normal size with normal cardiomediastinal contours. Lung volumes are low, exaggerating bronchovascular markings. Small atelectasis is seen at the bilateral lung bases. No focal pulmonary consolidation, pneumothorax, or pleural effusion. Osseous structures are unremarkable. No radiopaque foreign body.", "output": "Atelectasis. No pulmonary consolidation." }, { "input": "PA and lateral views of the chest provided. Subtle opacity seen projecting over the right lung base which could represent a small area of atelectasis or in the right clinical setting early pneumonia. Otherwise the lungs are clear. No effusion or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Small focal opacity projecting over the right lung base could represent atelectasis versus early pneumonia." }, { "input": "There is a slightly tortuous thoracic aorta. The cardiac silhouette is within normal limits. The bilateral hila are normal. There is an elevated right hemidiaphragm, with slight interval increase in comparison to scout view from ___ CT, likely secondary to hepatomegaly. There are no focal lung consolidations. There is no pulmonary vascular congestion. There are no pneumothoraces or effusions.", "output": "Slight interval increase in moderate elevation of right diaphragm in comparison to prior CT, likely secondary to hepatic enlargement. NOTIFICATION: The above findings were discussed over the phone by Dr. ___ with Dr. ___, on ___ at 10:15, approximately 5 minutes after review." }, { "input": "Frontal upright and lateral chest radiographs demonstrate well-expanded lungs. Cardiomediastinal contours are normal. Lungs are clear, without focal consolidation. There is no pleural effusion and no pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The lung volumes are low. The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. There is mild rightward convex curvature centered at the thoracolumbar junction.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "AP portable view of the chest. There are bilateral mainly central parenchymal opacities consistent with moderate pulmonary edema. There are likely small bilateral pleural effusions. The heart size is normal. Again seen is a densely calcified thoracic aorta. There is no pneumothorax.", "output": "Moderate pulmonary edema. Likely small bilateral pleural effusions." }, { "input": "Frontal and lateral radiographs of the chest show a persistent peripheral ill-defined opacity projecting over the right mid lung, which is not appreciably changed from the preceding radiograph of ___ but new from the prior CT of ___. No focal consolidation, pleural effusion, or pneumothorax is present. The pulmonary vasculature is not engorged. The thoracic aorta is calcified throughout its course with extensive calcification of the bilateral carotid arteries as well. The cardiac silhouette is top normal in size. The mediastinal and hilar contours are within normal limits and unchanged from the preceding radiograph. Degenerative changes are noted in the thoracic spine.", "output": "Persistent pulmonary nodule of the right mid lung. A followup CT is recommended for further evaluation to exclude malignancy." }, { "input": "The lungs are well expanded and clear. There is no focal consolidation, effusion or pneumothorax. Extensive calcifications of the thoracic aorta and its branches are unchanged. A left subclavian stent is in stable position. Mild cardiomegaly is stable. A previously seen right mid lung pulmonary nodule is not appreciated on this exam.", "output": "No acute cardiopulmonary process." }, { "input": "Right chest wall single lead pacing device is again noted. There is moderate cardiomegaly which is unchanged. The lungs are clear without focal consolidation, effusion, or edema. No acute osseous abnormalities.", "output": "Cardiomegaly without superimposed acute cardiopulmonary process." }, { "input": "The heart is borderline in size. The aorta is moderately tortuous. The lungs appear clear. There are no pleural effusions or pneumothorax. Small osteophytes are present anteriorly along the mid thoracic spine.", "output": "No evidence of acute cardiopulmonary disease. Mild cardiomegaly and tortuosity of the aorta." }, { "input": "Frontal and lateral radiographs of the chest demonstrate mild pulmonary congestion. The hilar contours are unchanged. The heart is mildly enlarged. There is no pneumothorax, pleural effusion, or consolidation. The patient is status post placement of a single lead pacemaker, with the lead projecting over the expected location of the right ventricle.", "output": "1. No pneumothorax. 2. Mild pulmonary vascular congestion." }, { "input": "Right-sided pacemaker device is noted with lead terminating in the right ventricle. Moderate cardiomegaly is re- demonstrated. The mediastinal and hilar contours are similar. The pulmonary vasculature is minimally engorged. There are mild patchy opacities in the lung bases likely reflective of atelectasis. A trace left pleural effusion may be present. No pneumothorax is detected. No acute osseous abnormality is visualized.", "output": "Minimal pulmonary vascular congestion and possible trace left pleural effusion. Mild bibasilar atelectasis." }, { "input": "The lungs are clear. MILD CARDIOMEGALY AND PULMONARY VASCULAR CONGESTION HAVE INCREASED SINCE ___, CONSISTENT WITH MILD CARDIAC DECOMPENSATION, ALTHOUGH THERE IS NO EDEMA OR PLEURAL EFFUSION. . The hilar and mediastinal contours are otherwise normal. There is no pneumothorax. There is no pleural effusion.", "output": "EARLY CARDIAC DECOMPENSATION." }, { "input": "Since the prior exam, the mild pulmonary edema has resolved. The lungs are clear without consolidation or edema. There is no definite pleural effusion. No pneumothorax is identified. The mediastinal contours are normal other than atherosclerotic calcifications along the aortic arch. The heart is moderately enlarged, and similar to the prior exam. A right-sided cardiac device with a single lead terminating in the right ventricle is unchanged.", "output": "Unchanged moderate cardiomegaly. No acute cardiopulmonary process." }, { "input": "Right-sided pacemaker device is noted with single lead terminating in the right ventricle. Moderate cardiomegaly is re- demonstrated, unchanged. The aorta is mildly tortuous. Mild pulmonary edema is new in the interval. There are likely trace bilateral pleural effusions. No focal consolidation or pneumothorax is present. Mild degenerative changes are seen in the thoracic spine.", "output": "Mild pulmonary edema and probable trace bilateral pleural effusions" }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No pneumothorax." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are unremarkable. Right-sided pleural effusion has resolved. Lungs are clear. Pleural surfaces are clear without large effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Significant interval decrease in right-sided pleural effusion which is now small. The lungs are clear. The cardiomediastinal contours are unremarkable. No pneumothorax.", "output": "Significant interval decrease in pleural effusion which is now very small." }, { "input": "The right pleural effusion has decreased in size since the prior exam and is now small. There is no left pleural effusion. The lungs are clear. There is no pneumothorax. Bones and soft tissues are normal. Contrast from a recently performed CT scan opacifies the partially imaged colon.", "output": "Decreased right pleural effusion which is now small. Clear lungs." }, { "input": "In comparison to the chest radiograph obtained 1 day prior, there has been an increase in pulmonary edema and an increase in the small right pleural effusion with associated right lower lobe atelectasis. Heart size top-normal. Cardiomediastinal silhouette otherwise unchanged. A right-sided IJ central venous catheter terminates in the mid SVC. .", "output": "Mild pulmonary edema with an increased, small, right pleural effusion and associated atelectasis. Right lower lobe pneumonia less likely." }, { "input": "Single portable chest radiograph demonstrates interval placement of right subclavian line terminating at the cavoatrial junction. No pneumothorax or pleural effusion identified. Otherwise, the examination is unchanged. There is redemonstration of vague opacification projecting over the left hemithorax with no clear anatomical relationship and may represent increased soft tissue density due to patient's positioning.", "output": "New right subclavian venous line without pneumothorax or pleural effusion. Stable opacification projecting over the left hemithorax of unclear etiology, possibly increased due to patient positioning." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs which are clear. There is no pleural effusion or pneumothorax.", "output": "Normal chest radiograph without recurrence of pleural effusion." }, { "input": "PA and lateral views of the chest were obtained. The heart is normal size. Increased opacification at the right base and distortion of the right cardiac border likely relate to moderate-sized right pleural effusion and adjacent atelectasis. Lungs are otherwise clear. There is no left effusion. No pneumothorax.", "output": "Moderate right pleural effusion and adjacent atelectasis." }, { "input": "The lungs are clear without consolidation or edema. Persistent small right pleural effusion is noted. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "Persistent small right pleural effusion. No superimposed acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is a small pleural effusion on the right, although none is found on the left. In addition there is a somewhat rounded subpleural opacity seen on the lateral view posteriorly in the posterior right costophrenic sulcus. Bony structures are unremarkable.", "output": "Small suspected right pleural effusion versus scarring, but including a small rounded posterior density, atelectasis versus infection. Follow-up radiographs are recommended to show resolution and exclude a developing mass, although less likely. Recommendation discussed with Dr. ___ on ___." }, { "input": "No definite focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are grossly stable.", "output": "No definite focal consolidation to suggest pneumonia." }, { "input": "Cardiomediastinal silhouette is within normal limits. Lungs are clear. There is no pleural effusion or pneumothorax. Bones are grossly unremarkable.", "output": "No acute intrathoracic abnormality." }, { "input": "Lung volumes are similar when compared to the prior study. The trachea is central. The cardiomediastinal contour is unchanged. The previously demonstrated moderate right pleural effusion has decreased, there is however small residual pleural effusion. No left-sided pleural effusion seen. No lobar consolidation or pneumothorax seen. No free air seen under the diaphragm.", "output": "Small right pleural effusion, decreased when compared to the prior study." }, { "input": "Lungs are well aerated and grossly clear. There is no focal consolidation, pulmonary edema, or pneumothorax. Subtle right residual pleural effusion is noted. The cardiomediastinal silhouette and hilar contours are stable.", "output": "No evidence of acute cardiopulmonary process. Decreased right pleural effusion." }, { "input": "Single portable chest radiograph demonstrates mild pulmonary vasculature engorgement possibly reflecting an element of mild fluid overload. Otherwise, the cardiomediastinal and hilar contours are unremarkable. There is slight asymmetric increased opacifiction projecting over the left lower hemithorax, not clearly anatomical or intraparenchymal and may be due to overlying soft tissue or technique. No pleural effusion or pneumothorax identified. Increased density projecting below the left hemidiaphragm likely relates to significant splenomegaly evident on ___ CT. No osseous abnormality identified.", "output": "Mild pulmonary vascular engorgement, likely reflecting element of fluid overload. Slight asymmetric increased opacifiction projecting over the left lower hemithorax, not clearly anatomical or intraparenchymal and may be due to overlying soft tissue or technique. If continued concern, could be further assessed with frontal and lateral radiograph." }, { "input": "The endotracheal tube tip projects 9 mm above the carina. An NG tube courses below the left hemidiaphragm and out of view. There is new mild cardiomegaly with diffuse pulmonary opacities. No pleural effusions or pneumothorax.", "output": "1. Low-lying endotracheal tube. Please retract by at least 2-3 cm for more optimal positioning. 2. Diffuse bilateral pulmonary opacities are likely due to pulmonary edema. However, superimposed infection is not excluded. NOTIFICATION: The above findings and recommendation were communicated via telephone by Dr. ___ to Dr. ___ at 17:30 on ___, ___ min after discovery." }, { "input": "The patient is rotated which limits assessment. There is stable cardiomediastinal contours. No focal consolidation, pleural effusion or pneumothorax. Unchanged compression deformity of a mid thoracic vertebral body.", "output": "Stable appearance of the chest with no acute process." }, { "input": "Old right humeral fracture is partially imaged. No focal consolidation is seen. There is no pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are stable.", "output": "Old right humeral fracture is partially imaged. No focal consolidation is seen. There is no pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are stable." }, { "input": "AP portable upright view of the chest. The endotracheal tube is seen with its tip located 7.4 cm above the carinal. Advancement by approximately 3-4 cm may achieve a more optimal position. NG tube courses inferiorly though its tip is excluded from view. Both CP angles are excluded. Lungs appear grossly clear. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "Endotracheal tube positioned high in the trachea. Recommend advancement." }, { "input": "The heart is normal in size. The mediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. The lungs appear clear. The right lower mediastinum has a bulging contour which may be associated with an abnormality of the right atrium.", "output": "1. No evidence of acute disease. 2. Bulging right atrial contour; this appearance is not necessarily abnormal but follow-up echocardiogram should be considered in addition to correlation with clinical history." }, { "input": "PA and lateral views of the chest were provided demonstrating no focal consolidation, effusion or pneumothorax. The heart and mediastinal contours are normal. The imaged osseous structures are intact. There is no free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "AP upright and lateral views of the chest are provided. The lungs appear clear. The heart is borderline enlarged. Mediastinal contour is normal. No effusion or pneumothorax. Bony structures are intact.", "output": "Borderline cardiomegaly. Otherwise, normal." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. A small hiatal hernia is noted. The imaged upper abdomen is unremarkable. The bones are intact.", "output": "Small hiatal hernia. No acute findings." }, { "input": "AP and lateral views of the chest are compared to prior chest CT from ___. Low lung volumes are seen. The lungs, however, are clear of consolidation or effusion. There is the suggestion of a small hiatal hernia based on the frontal exam, similar in configuration compared to prior given rightward deviation of the right paraspinal line. Osseous and soft tissue structures are unremarkable.", "output": "No definite acute cardiopulmonary process. No free air below the diaphragm." }, { "input": "PA and lateral views of the chest. The lungs are clear. Cardiac silhouette is top normal. No acute osseous abnormality detected.", "output": "No acute cardiopulmonary process." }, { "input": "Patient is rotated to the left. There is persistent marked elevation of the right hemidiaphragm and chronic blunting of the costophrenic angles. Subtle left mid lung opacity is stable since at least ___. Cardiac and mediastinal silhouettes are stable. Surgical clips seen in the right upper quadrant.", "output": "No significant interval change." }, { "input": "The heart is mild-to-moderately enlarged, as before. The aortic arch is calcified. There is similar marked relative elevation of the right hemidiaphragm compared to the left side. There are mild interstitial changes which suggest slight fluid overload or pulmonary congestion. Particularly evident on the lateral view are posterior opacities along the elevated right hemidiaphragm which are suggestive of associated atelectasis. It is difficult to exclude trace pleural effusions. There is no pneumothorax. Surgical clips project over the right upper quadrant. Multiple air-fluid levels are seen within bowel including the colon but without dilatation. Vague opacity in the left mid lung appears unchanged and suggests minor atelectasis or scarring. There is mild rightward convex curvature along the thoracic spine. The bones may be demineralized to some degree.", "output": "1. Findings suggesting mild vascular congestion. 2. Patchy left mid lower lung opacities that appear unchanged and suggest minor atelectasis or scarring. 3. Similar severe elevation of the right hemidiaphragm. 4. Air-fluid levels in bowel of the upper abdomen, a non-specific pattern." }, { "input": "There is persistent marked elevation of the right hemidiaphragm with overlying atelectasis. Left mid lung opacity in a relative linear configuration is seen which may be due to atelectasis however, consolidation due to infection not excluded. No large pleural effusion is seen. Cardiac and mediastinal silhouettes are stable. Subtle increased interstitial markings is stable to possibly slightly decreased as compared to the prior study.", "output": "There is persistent marked elevation of the right hemidiaphragm with overlying atelectasis. Left mid lung opacity in a relative linear configuration is seen which may be due to atelectasis however, consolidation due to infection not excluded. No large pleural effusion is seen. Cardiac and mediastinal silhouettes are stable. Subtle increased interstitial markings is stable to possibly slightly decreased as compared to the prior study." }, { "input": "AP upright and lateral views of the chest provided. Chronic elevation of the right hemidiaphragm is again noted. Clips project over the right upper quadrant. There is a stable appearance of the chest with scattered reticular and ground-glass opacities which appear grossly unchanged from a prior CT from ___ suggesting a chronic inflammatory process. No large effusion or pneumothorax. An IVC filter projects over the upper abdomen. No pneumothorax. Bony structures demineralized and intact.", "output": "Stable appearance of the chest as compared with a prior CT from ___ with scattered ground-glass and reticular opacities likely reflecting a chronic inflammatory process." }, { "input": "Low lung volumes with marked elevation of the right hemidiaphragm is stable with bibasilar opacities consistent with atelectasis. Unchanged diffuse hazy opacity is again seen with vague prominence of the interstitium. No focal consolidation or pneumothorax. Similar appearance of mild blunting of the costophrenic angles. The heart size and cardiomediastinal contours are stable.", "output": "Stable appearance of the chest with diffuse hazy opacity and prominence of interstitial markings, raising potential concern for pulmonary edema versus a chronic inflammatory process. No focal consolidation." }, { "input": "Chest, PA and lateral. No acute fracture is identified. Persistent elevation of the right hemidiaphragm is chronic. Linear opacity in the left mid lung zone is unchanged. There is a small left pleural effusion. Mild pulmonary vascular congestion is noted. There is no pneumothorax. Mediastinal contours are normal. There are surgical clips in the right upper quadrant of the abdomen.", "output": "1. Mild pulmonary vascular congestion and small left pleural effusion. 2. Stable elevation of the right hemidiaphragm and linear scarring in the left mid lung zone." }, { "input": "There is persistent elevation of the right hemidiaphragm with adjacent atelectasis. Diffuse intersitial opacities have decreased since the last study, correlating with improving interstitial lung disease. An opacity in the left mid lung zone correlates to an area of intersitial abnormality on the chest CT obtained on the same day and is stable since the prior evaluation in ___. No pleural effusion. Patient is status post cholecystectomy.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "There is no significant change in appearance of the thorax compared with prior radiograph from ___. There is persistent marked elevation of the right hemidiaphragm with overlying atelectasis. Left mid lung opacity in a relative linear configuration is seen, unchanged from prior radiograph. This opacity was also seen on prior chest CT's dating back to ___. There is no pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are stable.", "output": "Persistent marked elevation of the right hemidiaphragm with overlying atelectasis. Stable left mid zone opacity may represent scarring versus a focus of organizing pneumonia given long-term stability." }, { "input": "Persistent elevation of the right hemidiaphragm is again noted. Subtle left midlung opacity is unchanged dating back to ___ and may be due to scarring. There is no effusion or new consolidation. Cardiomediastinal silhouette is stable. Atherosclerotic calcifications are seen at the arch. Surgical clips noted in the right upper quadrant as well as an IVC filter seen on the lateral view.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. Prior effusions are no longer seen. The cardiac silhouette is top-normal. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. There are small bilateral effusions which are new since prior. The lungs are clear without consolidation or pulmonary vascular congestion. There is mild cardiomegaly which has developed since prior exam. No acute osseous abnormality is identified.", "output": "Small bilateral effusions and mild cardiomegaly. No focal consolidation." }, { "input": "PA and lateral views of the chest. The lungs are clear. There is no effusion or pulmonary vascular congestion. The cardiomediastinal silhouette is normal. Osseous and soft tissue structures demonstrate no acute abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "There are relatively low lung volumes. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest. Lung volumes are low. There is stable appearance of mild enlargement of the cardiac silhouette which is new from older prior. Likely small left pleural effusion is unchanged with associated atelectasis. No significant right pleural effusion. Slighlyt increased interstitial markings seen without frank pulmonary edema. No focal consolidation or pneumothorax.", "output": "Mild cardiomegaly, which is new since ___, and small left pleural effusion. Pulmonary vascular congestion." }, { "input": "Bilateral chest tubes are directed superiorly. An endotracheal tube is 8 cm above the carina and should be advanced for proper positioning. Enteric tube terminates within the stomach. A right subclavian catheter terminates in the upper SVC. There is a small right apical pneumothorax and probable small left pneumothorax. There is no pleural effusion. There is collapse of the left lower lobe. Capping of the left apex may represent pleural fluid or extrapleural hematoma. Multiple right rib fractures and bilateral scapular fractures are better seen on the trauma CT torso.", "output": "1. Small bilateral pneumothoraces. 2. ET tube terminates 8 cm above the carina and could be advanced several cm for optimal positioning. 3. Multiple right rib fractures and bilateral scapular fractures again seen. 4. Left apical cap, which could reflect pleural fluid or extrapleural hematoma. Correlation with outside CT findings recommended. Findings #1 and #2 were discussed with Dr. ___ by Dr. ___ at 11:36 on ___ via telephone." }, { "input": "A left subclavian catheter terminates in the mid SVC. An endotracheal tube and enteric tube have been removed in the interim. A left pleural effusion has decreased in size from prior, now small, with improved aeration at the left lung base. There is worsened mild pulmonary edema. The lungs are clear. There is no pneumothorax or focal airspace consolidation. The cardiac and mediastinal contours are unchanged. Multiple displaced scapular and rib fractures are again identified.", "output": "Improved small left pleural effusion with worsened mild pulmonary edema." }, { "input": "Small bilateral pleural effusions are suspected. Mild to moderate cardiomegaly appears unchanged. The mediastinal and hilar contours, including prominence of the main pulmonary artery contour, appear stable. Patchy left basilar opacification is not entirely specific but most suggestive of minor atelectasis. Bones are unremarkable.", "output": "Small suspected bilateral pleural effusions and patchy left basilar opacification, most likely due to atelectasis." }, { "input": "PA and lateral views of the chest. No prior. Indistinct pulmonary vascular markings seen throughout. Increased hazy bibasilar opacities are in part due to overlying gynecomastia; however, prominent interstitial markings are likely in part accountable for this finding. There is no confluent consolidation or large effusion. Cardiac silhouette is enlarged. Osseous and soft tissue structures are unremarkable. Free air is seen below the diaphragm.", "output": "Indistinct pulmonary vascular markings seen throughout suggestive of pulmonary vascular congestion. Cardiomegaly. No free air below the diaphragm. No other large confluent consolidation." }, { "input": "Frontal and lateral views of the chest are compared to previous exam from ___ and ___. The lungs are clear of confluent consolidation or effusion. Indistinct pulmonary vascular markings are seen centrally suggesting pulmonary vascular congestion. Cardiac silhouette is enlarged but stable in configuration. Osseous and soft tissue structures are unremarkable.", "output": "No confluent consolidation. Findings suggestive of pulmonary vascular congestion and stable cardiomegaly." }, { "input": "Single portable view of the chest. Prior right PICC is no longer visualized. Lower lung volumes are seen on the current exam. The lungs remain clear of besides mild retrocardiac opacity. The cardiomediastinal silhouette is stable. Degenerative changes are seen at the shoulders.", "output": "Retrocardiac opacity, potentially atelectasis, infection is not excluded. Consider repeat with PA and lateral." }, { "input": "AP and lateral views of the chest. Bibasilar atelectasis is mild. No pleural effusion or pneumothorax. Moderate cardiomegaly, severe pulmonary artery dilatation and moderate pulmonary vascular congestion are similar.", "output": "Mild basilar atelectasis. Chronic moderate cardiomegaly and probable pulmonary hypertension. Recurrent cardiac decompensation." }, { "input": "Frontal and lateral views of the chest. Prior right IJ line is no longer visualized. There are new bibasilar regions of consolidation. Indistinct pulmonary vascular markings seen more superiorly. The cardiac silhouette is enlarged but stable in configuration. There is vertebral body height loss of a mid thoracic vertebral body and severe height loss in a lumbar vertebral body which based on frontal projection were likely present on ___. No acute osseous abnormality identified.", "output": "Bibasilar regions of consolidation compatible with infection in the proper clinical setting. Superimposed component of vascular congestion." }, { "input": "The heart is mild-to-moderately enlarged. Upper mediastinal contours are stable. Lung volumes are low and there is bibasilar atelectasis, but no focal consolidation, pleural effusion, or pneumothorax. Compression deformity in the mid thoracic spine is similar to prior. Pneumobilia in the right upper quadrant is incidentally noted.", "output": "Stable cardiomegaly. Low lung volumes with bibasilar atelectasis." }, { "input": "Single portable supine AP image of the chest. The right IJ central line has been pulled back in the interval, but still terminates in the right atrium. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is stable.", "output": "1. Right IJ central line terminates in the right atrium. Pullback of 5 cm could be performed to have the tip located in the superior cavoatrial junction, if desired. 2. No acute cardiopulmonary process." }, { "input": "Single portable supine AP image of the chest. The right IJ central line has been pulled back in the interval and now terminates in the superior direction junction. The lungs are well expanded. There has been interval mild increased cephalization of the pulmonary vessels, which may be partly or wholly due to supine positioning, making it difficult to evaluate for pulmonary edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is stable.", "output": "1. Right IJ central line terminates in the superior cavoatrial junction. 2. Interval mild increased cephalization of the pulmonary vessels, which may be partly or wholly due to supine positioning, making it difficult to evaluate for pulmonary edema." }, { "input": "The heart appears borderline in size. The aorta is tortuous with patchy calcification. The cardiac, mediastinal and hilar contours appear stable. The lungs appear clear. There are no pleural effusions or pneumothorax. A mild compression deformity of the T6 vertebral body appears unchanged. A severe compression deformity of L1 (vertebra plana) appears unchanged with stable alignment abnormality. The bones appear demineralized.", "output": "No evidence of acute disease. Stable compression fractures." }, { "input": "The lung volumes are low. Mild fullness in the right hila may indicate early developing infection in the correct clinical setting. Opacity of the left base stable over multiple prior studies and most likely represents atelectasis. Moderate cardiomegaly is stable. No pneumothorax or pleural effusion.", "output": "Mild fullness in the right hila may indicate early developing infection in the correct clinical setting." }, { "input": "Single portable upright AP image of the chest. The right IJ central line terminates in the right atrium. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unchanged from prior exam.", "output": "1. Right IJ central line terminates in right atrium. Pullback of 5-6 cm could be performed to have the tip located in the superior cavoatrial junction, if desired. No pneumothorax. 2. No acute cardiopulmonary process. little cephalization ? edema supine positioning is repsonsible in part for distenstion ___ ___ ___ vasculatrue makes it difficult to eval for pulm edema - just last one this way." }, { "input": "AP upright portable view of the chest was obtained. There are small bilateral pleural effusions with overlying atelectasis. No definite focal consolidation is seen. There is no pneumothorax. The aorta is calcified and tortuous. The cardiac silhouette is mildly enlarged.", "output": "Small bilateral pleural effusions with persistent mild enlargement of the cardiac silhouette." }, { "input": "AP and lateral chest radiograph demonstrate mild cardiomegaly. Interval worsening of patchy and linear bibasilar opacity. There are small bilateral pleural effusions. Again demonstrated is pneumobilia within the right upper quadrant. A right internal jugular central line is identified its tip terminating in the right atrium. About the insertion site of the catheter, there is subcutaneous air noted. The trachea appears to be mildly displaced to the right compatible with known left sided thyroid nodule as demonstrated on CT dated ___.", "output": "Worsening bibasilar opacities, which may be due to atelectasis, with or without coexisting pneumonia." }, { "input": "Single portable view of the chest. The lungs are clear. There is no left effusion or pulmonary vascular congestion. Cardiac silhouette is enlarged but stable in configuration. No acute osseous abnormality detected.", "output": "Cardiomegaly without acute cardiopulmonary process." }, { "input": "There is a new retrocardiac opacity. A right IJ has been removed. Small bilateral pleural effusions are seen. Cardiomediastinal silhouette is unchanged compared to prior.", "output": "New retrocardiac opacity concerning for pneumonia in the appropriate clinical setting. NOTIFICATION: The findings were relayed by text page by Dr. ___ with Dr. ___ on the telephone on ___ at 12:15 PM, 1 minutes after discovery of the findings. In addition, the impression will be put in the critical dashboard. The impression above was entered by Dr. ___ on ___ at 12:16 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "Single portable semi upright AP image of the chest. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unchanged from prior exam with prominence of the right pulmonary artery again noted. The apparent enlargement of the aorta is due to adjacent atelectasis, as seen on recent CT.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs are normally expanded. There is no focal airspace opacity to suggest pneumonia. The heart is mildly enlarged, but unchanged. The mediastinal and hilar contours are stable with tortuosity of the aorta and mild prominence of the pulmonary artery, better seen on prior CT of the chest. Small bilateral pleural effusions persist. There is no pneumothorax. Compression deformity of T6 is unchanged.", "output": "Stable small bilateral pleural effusions and mildly enlarged cardiac silhouette similar to prior." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. Mid thoracic dextroscoliosis is noted.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Thoracolumbar scoliosis is noted.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. No pleural effusion, pulmonary edema, or pneumothorax is present. The heart size is normal. No osseous abnormality is seen.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "AP upright and lateral chest radiographs were obtained. The lungs are well expanded and clear without pleural effusion or pneumothorax. The heart is top-normal in size with normal cardiomediastinal and hilar contours.", "output": "No acute intrathoracic process." }, { "input": "The heart size is normal. Mediastinal and hilar contours are unremarkable except for mild atherosclerotic calcifications of the aortic knob. The lungs are clear with the exception of subsegmental atelectasis in the right lung base. No focal consolidation, pleural effusion or pneumothorax is visualized. Mild loss of height of two adjacent vertebral bodies at the thoracolumbar junction compatible with compression deformities are age indeterminate.", "output": "No acute cardiopulmonary abnormality. Mild compression deformities of 2 adjacent vertebral bodies at the thoracolumbar junction, age indeterminate." }, { "input": "AP single view of the chest has been obtained with patient in sitting semi-upright position. Comparison is made with the next preceding available portable chest examination of ___. Evidence of previous thoracotomy probably related to bypass surgery similar as on previous examination. Heart size not conclusively enlarged on this portable chest examination. There is no evidence of pulmonary vascular congestion, and no acute parenchymal infiltrates can be identified. The lateral pleural sinuses are free. The drooping head obscures portions of the apical area, but there is no suspicion for any significant pneumothorax.", "output": "Status post bypass surgery, but no signs of pulmonary congestion or acute infiltrates on this pre-operative chest examination." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for pneumonia. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No acute intrathoracic abnormalities identified." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities demonstrated.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are mildly hyperinflated with mild flattening of the hemidiaphragms. Left midlung linear atelectasis is present. The lungs are otherwise clear. The heart and mediastinum are within normal limits. There is no pneumothorax.", "output": "Left midlung linear atelectasis with otherwise clear hyperinflated lungs." }, { "input": "Left hilar fullness related to prominent pulmonary artery with rotation from scoliosis. Bilateral linear scars in the mid left lung and both lower lung regions. Cystic structure in the left lower lobe as seen on CT. Heart size and mediastinal contour are normal.", "output": "1. Left hilar fullness is likely related to prominent pulmonary artery accentuated by slight rotation from mild scoliosis. 2. Cystic structure in left lower lobe as seen on CT on ___. 3. Bilateral linear scarring in the left mid lung and both lower lung regions. Results were conveyed via telephone to Dr. ___ by Dr. ___ on ___ at 11:50 a.m. within 10 minutes of the results." }, { "input": "Cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. The right basilar opacity is much improved on the current study. Mild plate-like atelectasis in the left mid lung and lower lung are still present. Paucity of vasculature in the apices is indicative of emphysematous changes. An ill-defined opacity persists at the right apex which was not present in ___.", "output": "1. Improved right basilar opacity. 2. Persistent ill-defined opacity in the right apex, which is concerning for malignancy. Chest CT is recommended for further evaluation. Dr. ___ ___ these results with Dr. ___ at 4:01 pm on ___ via telephone." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are unremarkable. There is redemonstration of right lung base consolidation with air bronchograms slightly progressed compared to prior study. Retrocardiac opacities have improved and are likely atelectatic. Small right effusion is unchanged. There is redemonstration of significant emphysema, particularly with increased biapical lucency. There is no pneumothorax.", "output": "Worsening of right base consolidation worrisome for pneumonia or aspiration with associated small right effusion." }, { "input": "Chest, portable. There is subtle opacity in the left lower lung. The lungs are otherwise clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal.", "output": "Subtle opacity in the left lower lung may represent atelectasis, but early pneumonia cannot be fully excluded. Consider obtaining lateral film and/or close interval followup if there is high clinical suspicion for pulmonary infection." }, { "input": "Interval removal of endotracheal tube and nasogastric tube. Heart size is normal. Upper lobe predominant emphysema is present, as well as a large thin-walled cystic structure within the left retrocardiac region, which may be due to a bulla or pneumatocele. This was previously imaged on abdominal CT of ___ and appears relatively similar allowing for technical differences. Worsening heterogeneous opacities are present in the right lower lobe, and there are also poorly defined nodular opacities in the right lung apex. A focal patchy opacity is also present in the left retrocardiac area. These findings are nonspecific, but could reflect evolving multifocal pneumonia or multifocal aspiration in the appropriate clinical setting. Linear atelectasis is present in both the left mid and right lower lung. Additional right lower lung septal lines may due to asymmetrical edema in the setting of small right pleural effusion and peribronchial cuffing.", "output": "Multifocal lung opacities, possibly due to multifocal aspiration and mild edema. When the patient's condition permits, standard PA and lateral chest radiographs are recommended for more complete evaluation of the chest, especially to reevaluate nodular opacities in the right apex." }, { "input": "The lungs are clear. Cardiac silhouette is normal in size. No pleural effusion or pneumothorax.", "output": "Normal chest x-ray." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA lateral images of the chest. The lungs are well expanded clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well-expanded and clear. No focal consolidation, effusion, edema, or pneumothorax. The heart is top-normal in size, unchanged. Mediastinal contours are unchanged without mediastinal widening. Multilevel degenerative changes of the thoracic spine are mild.", "output": "No focal pneumonia." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "There has been slight interval increase in the moderate degree of interstitial and pulmonary alveolar edema. The cardiomediastinal silhouette is unchanged. There is likely a small left pleural effusion. No pneumothorax is identified.", "output": "Slight interval progression of moderate interstitial and pulmonary alveolar edema." }, { "input": "Heart size is normal. Mediastinal and hilar contours are within normal limits. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "There is redemonstration of a pigtail drainage catheter at the right lung base with adjacent right infrahilar opacity, similar in appearance to prior study. Persistent widespread parenchymal consolidations are slightly increased in density, compatible with worsening edema. Small right effusion is unchanged. There is no pneumothorax. Esophageal stent is unchanged and appears patent.", "output": "Unchanged appearance of right infrahilar consolidation with adjacent pigtail drainage catheter. Mildly progressed pulmonary edema." }, { "input": "A left PICC terminates in the low SVC. A right pigtail catheter terminates in the right pleural space at the site of the known esophagopleural fistula. Density projecting over the right cardiac border may correspond to Amplatz plug. There is no pneumothorax. Esophageal stent has been removed. The previously noted air-fluid level in the right lower lobe is no longer visualized. The left lung is clear. Cardiomediastinal silhouette is normal. G-tube is in place.", "output": "No evidence of pneumothorax. Improvement in right paramediastinal air collection status post amplatz plug." }, { "input": "Two views were obtained of the chest. Right basilar pleural pigtail catheter has been removed. A meniscus/air fluid level at the right lower lung identifies an air-fluid collection in the medial right pleural space which is likely smaller than on the previous examination given improved visualization of the right heart border, though this may also be due to air within the collection. Right lung parenchymal opacities are similarly slightly improved. Trace pleural effusion is present on the left. The heart and mediastinal contours are left PICC an esophageal stent are unchanged.", "output": "Unchanged to slight interval decrease in now air-fluid collection in the medial right pleural space and decrease of right basal parenchymal opacities with trace left pleural effusion." }, { "input": "Frontal upright and lateral chest radiographs demonstrate well-expanded lungs. The cardiomediastinal contour is normal. The heart is normal in size. Streaky opacities at the right lung base are improved compared to the prior examination and likely reflect atelectasis. Again seen is high-density material projecting over the lower right chest, unchanged compared to the prior study. There is no free air under the diaphragm and no pneumothorax.", "output": "No evidence of free air under the diaphragm." }, { "input": "Re-demonstrated is a moderate biventricular cardiomegaly, without pulmonary edema. Cardiomegaly has slightly progressed since ___. There is no pleural effusion, no focal consolidation or pneumothorax.", "output": "Moderate biventricular cardiomegaly without pulmonary edema." }, { "input": "The cardiac and mediastinal silhouettes are stable with persistent enlargement of the cardiac silhouette. There is very minimal central pulmonary vascular congestion without overt pulmonary edema. There is possible slight blunting of the posterior costophrenic angles and very trace pleural effusions are difficult to exclude. There is no focal consolidation or pneumothorax.", "output": "Stable cardiac silhouette. Minimal central pulmonary vascular congestion without overt pulmonary edema. Slight blunting of the posterior costophrenic angles, trace effusion not entirely excluded." }, { "input": "Redemonstrated is marked dilatation of the ascending and descending thoracic aorta. Moderate cardiomegaly is stable compared to the prior exam. There is no evidence of a pneumothorax or a large pleural effusion. Diffuse reticular interstitial abnormalities suggestive of fibrotic lung disease are seen predominantly at the lung bases bilaterally. No pneumothorax is identified. There may be slight interval improvement of mild pulmonary edema.", "output": "1. Slight interval improvement of mild pulmonary edema. 2. Fibrotic lung disease, which may be secondary to NSIP. 3. Dilatation of the thoracic aorta." }, { "input": "There is no consolidation, pleural effusion, or pneumothorax. Cardiac silhouette is mildly enlarged. Lung volume is low. Bilateral peribronchial cuffing is identified, most notably in the right upper lobe.", "output": "Peribronchial cuffing is suggestive of bronchitis. No radiographic evidence of pneumonia. Cardiac silhouette is mildly enlarged." }, { "input": "In comparison with the study of ___, there are areas of increased opacification in the left upper and lower lung zones. Right lung is relatively clear, and there is no evidence of vascular congestion.", "output": "Multifocal pneumonia. This information was telephoned to Dr. ___." }, { "input": "Cavitary consolidation in the apical posterior segment of the left upper lobe and smaller lesions in the lingula, right middle or lower lobe, and anterior segment of the right upper lobe are all little changed since ___. No pleural effusion, pneumothorax, or pulmonary edema is seen. Heart and mediastinal contours are within normal limits.", "output": "Left upper lobe consolidation, and smaller lesions, likely multifocal pneumonia, unchanged over three weeks." }, { "input": "Frontal and lateral radiographs of the chest were acquired. The lungs are clear. Mild elevation of the right hemidiaphragm is not significantly changed. The heart size is normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen. The imaged osseous structures are grossly unremarkable.", "output": "1. No acute cardiac or pulmonary process. 2. No definite acute fracture." }, { "input": "The lungs are clear. The left costophrenic angle is excluded from the field of view. The cardiomediastinal silhouette is normal. No acute osseous abnormalities. No free intraperitoneal air identified.", "output": "No acute cardiopulmonary process, no free intraperitoneal air." }, { "input": "PA and lateral views of the chest provided. The lungs are clear without signs of pneumonia or CHF. No pleural effusion or pneumothorax is seen. Cardiomediastinal silhouette is normal. Bony structures are intact. A mild dextroscoliosis of the spine at the TL junction noted. No free air below the right hemidiaphragm.", "output": "No pneumonia or other acute intrathoracic process." }, { "input": "There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. Cardiomediastinal silhouette is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "There is a left-sided port which terminates in the cavo-atrial junction. There is a tubular structure inferior to the port, not seen on the lateral radiograph and is likely external to the patient. No focal consolidation concerning for pneumonia is identified. There is no pleural effusion or pneumothorax.", "output": "Left-sided port with the tip terminating in the cavoatrial junction." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Minimal anterior osteophyte formation is again noted along the upper thoracic spine.", "output": "No evidence of acute disease." }, { "input": "Lungs are hypoinflated, accounting for vascular crowding. There are no focal opacities bilaterally. Cardiomediastinal and hilar contours are unremarkable. Some aortic tortuosity is noted. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute intrathoracic process." }, { "input": "The heart is mildly enlarged. The mediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. The lungs appear clear. The osseous structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "PA and lateral views of the chest were obtained. Linear scar versus atelectasis is again noted in the left mid lung. No focal consolidation to suggest the presence of pneumonia. No pleural effusion or pneumothorax is seen. Heart and mediastinal contour appear stable. Bony structures are intact. No free air below the right hemidiaphragm. Mild degenerative spurring in the mid and lower thoracic spine.", "output": "No acute intrathoracic process." }, { "input": "A left anterior chest wall implanted dual-lead pacer is in standard position. Heart size is normal with tortuosity of the aortic arch. Hilar contours are unremarkable. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax. No fracture is identified.", "output": "No acute cardiopulmonary abnormality. No definite fracture is identified, though dedicated rib series may be helpful if there is focality on exam." }, { "input": "The lungs are clear. Cardiomediastinal silhouette and hilar contours are unremarkable. No pleural effusion or pneumothorax.", "output": "No evidence of acute intrathoracic process." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. The lungs remain clear. Cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Pulmonary vascularity is normal. Lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormality is seen.", "output": "Normal chest radiograph." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Partially imaged is tubular high density projecting over the left abdomen at the lower aspect of the image, unclear whether ingested content or external to the patient.", "output": "No acute cardiopulmonary process. No focal consolidation." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of normal size with normal cardiomediastinal contours. Lungs are clear without focal or diffuse abnormality. The pulmonary vasculature is unremarkable. No pneumothorax or pleural effusion. Osseous structures are unremarkable. No radiopaque foreign bodies.", "output": "No acute cardiopulmonary process." }, { "input": "Known numerous small pulmonary nodules measuring up to 3 mm are better delineated on dedicated Chest CT from ___. The lungs are clear with no evidence of a consolidation, effusion, or pneumothorax. Cardiac and mediastinal silhouettes are normal. No acute fractures are identified.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal contours are normal. No infiltrate is seen on the frontal film. However on the lateral images there is a streaky area of increased opacity seen inferiorly. It is unclear if this represents a small area of volume loss. Is not confirmed on the frontal film.", "output": "Volume loss versus small infiltrate only seen on the lateral film" }, { "input": "The lungs are now clear. The cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications noted at the aortic arch. Hypertrophic changes are seen the spine.", "output": "No acute cardiopulmonary process." }, { "input": "A new enteric tube has been place with tip relying the distal stomach. ET tube is seen in standard position. Cardiomediastinal and hilar contours are stable with mild cardiomegaly. Opacification at the right lung base may perhaps be slightly improved compared to the prior study, indicating perhaps lessened volume loss and decreased pleural effusion at the left base. There is no right pleural effusion. There is no pneumothorax. Pulmonary vasculature is within normal limits.", "output": "Interval placement of NG tube with tip in the stomach. Improvement in left retrocardiac opacity." }, { "input": "The endotracheal tube ends 4 cm above the carina. An NG tube ends below the gastroesophageal junction with the tip out of view. Compared with prior exam, the right lung shows diffuse, mostly basal alveolar opacities, hilar engorgement and upper vascular redistribution suggestive of cardiac decompensation. A small right sided effusion is worsened from prior. In the left, there is nearly total opacification of the lung base with obscuration of the heart border and hemidiaphragm. The degree of opacification of the left lung base is conspicuously worse compared to the right lung base, suggesting underlying severe atelectasis in combination with the pulmonary edema and worsened left sided effusions. Atherosclerotic calcifications of the aortic knob are present. Cardiomegaly cannot be clearly assessed due to obscuration of the left heart border.", "output": "1. Acute pulmonary edema with associated worsening of pleural effusions. 2. Opacification of the left lung base suggests severe atelectasis underlying the pulmonary edema, likely due to bronchial occlusion by secretions." }, { "input": "ET tube and enteric tube are in standard position with tip of enteric tube off the film. Left subclavian line is in standard position with tip terminating in the upper SVC. There is no pneumothorax. Vascular congestion bordering on pulmonary edema of the right lung is seen. Left retrocardiac opacity is mostly atelectasis with resultant volume loss and mild leftward shift of the mediastinum. Calcifications of the aortic knob are noted.", "output": "Worsening vascular congestion of the right lung. Persistent left basilar atelectasis." }, { "input": "There is a new dual-lead pacemaker/ICD device with leads terminating in the right atrium and ventricle, respectively. Otherwise, there has been no significant change. There is no pneumothorax. There is no evidence for pneumonia.", "output": "Status post placement of two-lead pacemaker/ICD device." }, { "input": "Again seen dual lead left-sided pacemaker is similar in position.The cardiac and mediastinal silhouettes are stable. No definite focal consolidation is seen. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "In comparison to the chest radiographs obtained ___, no significant changes are appreciated. Lungs are fully expanded and clear without consolidations or suspicious pulmonary nodules. No pleural abnormalities. Severe cardiomegaly is unchanged. No pulmonary vascular congestion or pulmonary edema. Cardiomediastinal hilar silhouettes otherwise normal. There is partial opacification of the thoracic anterior longitudinal ligament. In the mid thoracic spine, there is either disruption of this ossified ligament or incompletely joined bridging syndesmophytes.", "output": "No radiographic evidence of pneumonia or other acute cardiopulmonary abnormalities." }, { "input": "Left pectoral pacer leads terminate in the right atrium and right ventricle, as expected. Lungs are clear of consolidation, effusion or pneumothorax. No pulmonary edema. Mild cardiomegaly is unchanged. Mediastinal contours are normal.", "output": "No evidence of acute intrathoracic process." }, { "input": "A frontal semi-upright view of the chest was obtained portably. Bilateral diffuse opacities have increased from ___ at 6:55 p.m. Given the short interval increase, there may be a component of pulmonary edema but supervening infection cannot be excluded. Heart size is unchanged.", "output": "Findings likely represent moderate pulmonary edema. Superimposed infection cannot be excluded. Recommend repeat radiograph after treatment." }, { "input": "The lungs are well-expanded and clear. The cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion, pneumothorax, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are normally expanded and clear without pneumothorax. The cardiomediastinal silhouette and hilar contours are normal. There is no pleural effusion.", "output": "No acute cardiopulmonary abnormality. No pneumothorax." }, { "input": "Very shallow inspiration, similar compared the prior radiograph. New bilateral perihilar opacities, worsened bibasilar opacities, consider atelectasis, edema, pneumonitis cannot be excluded. Significant gastric distention.", "output": "New bilateral perihilar opacities, worsened bibasilar opacities, consider atelectasis, edema, pneumonitis cannot be excluded." }, { "input": "Patchy of bibasilar opacities are present, greater on the left, which may reflect pneumonia in the proper clinical context. There is no pleural effusion or pneumothorax identified. The size the cardiomediastinal silhouette is within normal limits. The tip of the left PICC line projects over the left brachiocephalic/ SVC confluence.", "output": "Patchy bibasilar opacities, greater on the left which may reflect pneumonia in the proper clinical context. The tip of the left PICC line projects over the left brachiocephalic/SVC confluence." }, { "input": "Extremely low lung volumes. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Bibasilar atelectasis. Lungs are otherwise clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Low lung volumes without definite acute cardiopulmonary process." }, { "input": "Substantial worsening of pulmonary edema with increased perihilar opacities, alveolar edema, increased cardiomediastinal silhouette and air bronchograms. Worsening of bilateral large pleural effusions. Moderate-to-severe bibasilar compressive atelectasis, right greater than left. There is some tracheal displacement to the right however this is likely due to mild malrotation of the patient. The osseous structures are stable.", "output": "Worsening of severe pulmonary edema likely secondary to CHF." }, { "input": "Sequential images of the chest and left upper quadrant demonstrate advancement of a feeding tube into the stomach. The tip of the endotracheal tube projects over the mid thoracic trachea. A left PICC line extends to the cavoatrial junction. Low bilateral lung volumes with unchanged pulmonary vascular congestion and bilateral pleural effusions. No pneumothorax identified. The appearance of the cardiomediastinal silhouette is unchanged.", "output": "Interval advancement of the feeding tube into the gastric body. Low bilateral lung volumes with unchanged pulmonary vascular congestion, pleural effusions and overlying atelectasis." }, { "input": "Pleural effusions small if any. Heart size normal.", "output": "Compared to chest radiographs ___ through ___. Bibasilar opacification variable since ___ is more pronounced today than before. This has been documented as lower lobe atelectasis. Widespread peribronchial opacification in the mid and upper lung zones has been relatively constant. The left perihilar component looks like pneumonia and the remainder is mild edema. Overall lung abnormalities do not look sufficient to explain respiratory failure particularly if the atelectasis were corrected. Cardiopulmonary support devices in standard placements." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Slightly limited study due to underpenetration. Heart size is top-normal. Mediastinal contour is preserved. Central pulmonary vascular prominence without interstitial edema. Lungs are clear. The pleural surfaces are clear without effusion or pneumothorax.", "output": "Mild pulmonary vascular prominence without interstitial edema. No pneumonia." }, { "input": "PA and lateral views of the chest provided. The lungs appear clear without focal consolidation, large effusion or pneumothorax. The overall configuration of the cardiomediastinal silhouette is unchanged with relative prominence of the main pulmonary artery contour. No pneumothorax or effusion. No signs of congestion or edema. Bony structures are intact. No free air below the right hemidiaphragm. Tiny clips are noted in the lower neck.", "output": "No acute findings." }, { "input": "When compared to earlier exam, there has been no significant interval change. The lungs are grossly clear. Increased opacity at the lung bases likely due to overlying soft tissue as there is no finding on prior chest CT. Cardiomediastinal silhouette is stable. No acute osseous abnormalities.", "output": "No significant interval change, no acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and moderately well-aerated lungs which are without focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is top normal. The mediastinal and hilar contours are unchanged. The pulmonary vascularity is normal. Minimal linear opacities in the left mid lung are compatible subsegmental atelectasis. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities. Clips are again noted within the neck compatible with prior thyroidectomy.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest were provided. There is an abnormal appearance of the right pulmonary hilum, which could reflect technique/rotation versus overlying soft tissue. No abnormality is detected on the lateral projection. No pneumothorax or effusion is seen. Heart size cannot be assessed. Mediastinal contour appears grossly stable. Bony structures are intact.", "output": "Abnormal prominence of the right pulmonary hilum is likely technique due to rotation. Consider repeat study to clarify. Otherwise, unremarkable." }, { "input": "Heart size is top normal to mildly enlarged. Mediastinal silhouette and hilar contours are unremarkable and unchanged since at least ___. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear without consolidation, effusion, or edema. The cardiomediastinal silhouette is stable noting mild cardiomegaly. No acute osseous abnormalities. Surgical clips in the upper abdomen are noted on the lateral view.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest provided.Underpenetration limits assessment. Allowing for this, the lungs are clear. There is no pleural effusion or pneumothorax. Mild congestion difficult to exclude. There is no frank edema. Cardiomediastinal silhouette is unchanged. Bony structures are intact.", "output": "No signs of pneumonia. No overt edema though mild congestion difficult to exclude in the correct clinical setting." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded, clear lungs. There is stable linear scarring in the left mid to low lung. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs remain clear. Cardiomediastinal silhouette is normal. No acute osseous abnormality seen. Surgical clips in the upper abdomen raise possibility of prior cholecystectomy. Surgical clips also seen within the neck.", "output": "No acute cardiopulmonary process." }, { "input": "The right breast mimics an opacification of the right hemithorax. On the lateral views, there are no suspicious pulmonary consolidations. The cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax.", "output": "No acute cardiothoracic process." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is stable from prior exam.", "output": "No acute cardiopulmonary process." }, { "input": "There are relatively low lung volumes. Left mid lung linear atelectasis/scarring is again seen. Prominence of the pulmonary vasculature may be exaggerated by low lung volumes however, a degree of vascular congestion may be present. No large pleural effusion is seen. There is no evidence of pneumothorax. The cardiac and mediastinal silhouettes are stable.", "output": "Prominence of the pulmonary vasculature may be exaggerated by low lung volumes however, a degree of vascular congestion may be present." }, { "input": "Evaluation of lung bases are limited due to overlying dense breast tissue. No consolidation is identified in the upper lungs. There is no pneumothorax or large pleural effusion. Cardiac silhouette is upper limits of normal in size.", "output": "Evaluation of lung bases is limited due to overlying dense breast tissue. No radiographic evidence of pneumonia is identified within this limitation. Consider obtaining standard PA and lateral view radiographs for better evaluation of the lung bases. RECOMMENDATION(S): Consider obtaining standard PA and lateral view radiographs for better evaluation of the lung bases." }, { "input": "As compared to the prior radiographic examination dated ___, there has been no significant interval change. Lung volumes remain low, leading to crowding of the bronchovascular structures. There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. Mild to moderate cardiomegaly and enlarged bilateral pulmonary arteries are noted, better evaluated on the patient's prior CT torso dated ___.", "output": "1. No evidence for acute cardiopulmonary process. 2. Chronic findings of mild-moderate cardiomegaly and enlargement of the bilateral pulmonary arteries, suggesting underlying pulmonary hypertension." }, { "input": "PA and lateral views of the chest are provided. There is ill-defined opacity in the right mid-to-lower lung with a small right pleural effusion which could reflect pneumonia in the correct clinical setting. Please note, no prior studies are available and comparison with prior studies would aid to assess acuity of this finding. There is a tiny left pleural effusion. The heart and mediastinal contours appear normal. Bony structures are intact.", "output": "Small right and tiny left effusion. Poorly defined opacity in the right mid-to-lower lung may represent pneumonia in the correct clinical setting. Please note, prior studies would be helpful for comparison to assess the acuity of this finding." }, { "input": "A portable semi-upright radiograph of the chest demonstrates interval increase in left-sided pleural effusion and adjacent atelectasis and new small right-sided pleural effusion with adjacent atelectasis. Stable appearing biapical scarring and multiple calcified granulomas in the left upper lung. Cardiomediastinal and hilar contours are unchanged. There is no pneumothorax. Endotracheal tube ends 4 cm from the carina. No pneumomediastinum.", "output": "No free air." }, { "input": "Single AP portable view of the chest was obtained. An enteric tube is seen coursing to the left of midline into the medial left lower hemithorax and does not traverse below the diaphragm. The tube is in inappropriate position and its presence is may be within a left lower lobe airway versus within a tortuous distal esophagus. Recommend removal and replacement. Endotracheal tube is seen, terminating approximately 3.2 cm above the level of the carina. It is difficult to exclude trace pleural effusion, although no large pleural effusion is seen. There is left basilar atelectasis. There is prominent biapical scarring. Ovoid calcific structures project over the left upper hemithorax which may represent calcified granulomas or other calcification. The cardiac silhouette is not enlarged. The aortic knob is calcified.", "output": "Inappropriate position of enteric tube. Recommend removal and replacement. This finding was discussed with Dr. ___ at 3:15 p.m. on ___ via telephone, ___ minutes after discovery." }, { "input": "Lung volumes are low accentuating the cardiac silhouette and pulmonary vasculature. Heart size is normal. Cardiomediastinal silhouette is normal. There is central pulmonary vascular predominance with cephalization and trace interstitial edema. Fissural fluid is noted on the lateral views. No pneumothorax.", "output": "Mild interstitial pulmonary edema with trace bilateral pleural effusions. No consolidation to suggest pneumonia." }, { "input": "AP view of the chest provided. Compared to prior study, there is no significant change. Bibasilar opacities are again seen, likely pneumonia, unchanged since prior study. There are no large pleural effusions. Endotracheal tube is in appropriate position. New nasogastric tube is seen coursing towards the stomach and out of view.", "output": "1. Stable bibasilar opacities, concerning for pneumonia. 2. New nasogastric tube in appropriate position." }, { "input": "AP portable upright view of the chest. Endotracheal tube resides approximately 4.5 cm above the carinal. Upper lung lucency suggests pneumonia. There is opacity in the lower lungs, right greater than left concerning for pneumonia. Heart size appears normal. Mediastinal contour is unremarkable. Prominence of the pulmonary hilar vasculature may reflect pulmonary hypertension. Bony structures appear intact.", "output": "Lower lung pneumonia. Emphysema. ET tube positioned appropriately." }, { "input": "Prior median sternotomy and CABG. Sternotomy wires are intact and in similar alignment. No acute focal consolidation or pulmonary edema. Mild to moderate cardiomegaly. The thoracic aorta is heavily calcified and mildly ectatic. No pleural effusions or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is top normal in size. The mediastinal and hilar contours are within normal limits. There is calcification of the aortic arch. The lungs are well expanded and clear. There are no focal consolidations, pulmonary edema, pleural effusions, or pneumothorax. Sternotomy wires and mediastinal surgical clips are intact.", "output": "No radiographic evidence of an acute cardiopulmonary process. These findings were discussed with Dr. ___ by Dr. ___ via telephone on ___ at 4:40 p.m., at the time of discovery." }, { "input": "Portable AP upright chest radiograph was obtained. Lungs are clear bilaterally. Patient rotated to the right. No large effusion or pneumothorax. Cardiomediastinal silhouette normal. No bony abnormalities.", "output": "No acute findings." }, { "input": "Slightly limited evaluation due to patient positioning. The lungs are well inflated. Lower lobe opacity best seen on lateral projection is consistent with a hiatal hernia. The lungs are clear. No pleural effusion or pneumothorax. Stable mild cardiomegaly noted. Mild calcification of the aortic arch is present. Mediastinal contour and hila are unremarkable. Limited evaluation of the osseous structures are notable for dextroscoliosis with apex at the mid thoracic spine.", "output": "1. Lower lobe opacity best seen on lateral projection is consistent with hiatal hernia. 2. Stable mild cardiomegaly." }, { "input": "As compared to the prior study dated ___, there has been minimal interval change. There is no evidence of focal consolidation, pleural effusion, pneumothorax, or frank pulmonary edema. Minimal retrocardiac atelectasis is noted. The cardiomediastinal silhouette is within normal limits. Calcifications are seen at the aortic arch. Dextroscoliosis is noted, centered at the mid thoracic spine. No acute osseous abnormalities are detected.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Assessment is slightly limited by patient rotation. Cardiac silhouette size remains mildly enlarged. A moderate size hiatal hernia is again noted. The aorta remains tortuous. Hilar contours are grossly unremarkable. Pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is detected. The osseous structures are diffusely demineralized with mild loss of height of several mid and lower thoracic vertebral bodies, grossly unchanged from the prior exam.", "output": "Slightly limited examination. No acute cardiopulmonary process. Moderate size hiatal hernia." }, { "input": "PA and lateral views of the chest. The lungs are clear. Surgical chain sutures overlying the right upper lung. Cardiomediastinal silhouette is within normal limits. Left chest wall electronic device is seen. There is no prior to evaluate for change in position. Osseous structures are unremarkable. Surgical clips seen in the right upper quadrant.", "output": "Electronic device projects over left chest wall, however there is no prior to evaluate for interval change in position." }, { "input": "PA lateral images of the chest. Lungs well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "2 views were obtained of the chest. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The heart is normal in size with normal mediastinal and hilar contours. Subtle irregularity in the anterior sternum could reflect prior injury and stable since ___. Old rib fractures noted.", "output": "No acute intrathoracic process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. No focal consolidation, pleural effusion, or pneumothorax. Widening of the left acromioclavicular joint is difficult to compare because of patient rotation, but it was also present on prior radiograph ___ ___. Left diaphragmatic contour abnormality posteriorly on the lateral view, has not changed since ___ but is a change from ___. Old rib fractures bilaterally.", "output": "1. Widening of the left acromioclavicular joint has been present since at least ___. Dedicated AC views may be performed if the patient has pain at this location. 2. Round contour of posterior left hemidiaphragm is similar to ___ but increased since ___. This probably represents focal herniated fat from a diaphragmatic defect. However, if clinically warranted, CT chest may be performed to differentiate herniated fat from a localized fibrous lesion of the pleura." }, { "input": "The cardiomediastinal contours are unchanged. There is no concerning focal consolidation. There is no pleural effusion or pneumothorax. Compression deformity of mid thoracic vertebral body is unchanged since ___.", "output": "1. No acute cardiopulmonary process. 2. Chronic mid thoracic compression deformity." }, { "input": "The lungs are well expanded without focal opacities. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. No rib fractures are identified. Degenerative changes of both AC joints are present. Mild dextroscoliosis centered in the mid thoracic spine is seen. There is a compression deformity in a mid thoracic vertebra, better seen in the lateral view, with an horizontally oriented band of sclerosis which is new compared with ___. The vertebra measures 16 mm of height in the mid body compared with 20 mm of height for the two adjacent vertebrae.", "output": "1. No evidence of acute cardiopulmonary process. 2. Compression deformity of a mid thoracic vertebra is new from ___. An horizontally oriented band of sclerosis suggests chronicity. Correlation with clinical history of trauma is recommended." }, { "input": "The NG tube is coiled in the esophagus with the loop near the GE junction and the tip in the upper thoracic esophagus. Lung volumes are lower compared to the prior study and there is bibasilar atelectasis, left greater than right. Heart size is normal. Mediastinal and hilar contours are normal. There is no large pneumothorax. A small left pleural effusion is presumed.", "output": "1. The NG tube is coiled in the esophagus. On the followup chest radiograph of ___ at 05:24 available at the time of this dictation the NG tube is shown to have been repositioned appropriately. 2. Probable small left pleural effusion." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is seen. Clips in the right upper quadrant of the abdomen indicate prior cholecystectomy. No acute osseous abnormality is visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart appears mildly enlarged. The mediastinal and hilar contours are unremarkable. Trace pleural effusions are detectable bilaterally on the lateral view along the posterior costophrenic sulci. The lungs appear clear. There is no pneumothorax.", "output": "Cardiomegaly and trace pleural effusions; otherwise unremarkable." }, { "input": "There is moderate cardiomegaly and moderate vascular congestion. There is no pneumothorax and no lung consolidation to suggest pneumonia.", "output": "Moderate cardiomegaly and moderate vascular congestion." }, { "input": "Moderate cardiomegaly has increased from ___ study. Mild vascular congestion and pulmonary edema is seen. A round left lower lobe nodule is seen on PA and lateral imaging, not seen on ___ study, which requires follow-up imaging for further characterization.", "output": "1. Moderate cardiomegaly with mild vascular congestion and pulmonary edema. 2. Round 2.8 cm left lower lobe nodule that requires follow-up imaging for further characterization. RECOMMENDATION(S): Recommend follow up CT chest for further characterization of left lower lobe nodule. NOTIFICATION: The impression and recommendation above was entered by Dr. ___ on ___ at 17:14 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "There are relatively low lung volumes, which accentuate the bronchovascular markings. Patchy medial right base opacity may represent atelectasis and overlapping structures, but consolidation is not excluded in the appropriate clinical setting. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "There are relatively low lung volumes, which accentuate the bronchovascular markings. Patchy medial right base opacity may represent atelectasis and overlapping structures, but consolidation is not excluded in the appropriate clinical setting. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable." }, { "input": "Normal heart size, mediastinal and hilar contours. No focal consolidation, pleural effusion or pneumothorax.", "output": "No acute process." }, { "input": "Heart size remains moderately enlarged, similar compared to the previous exam. The mediastinal and hilar contours are stable, and there is no pulmonary vascular congestion. Mild elevation of the left hemidiaphragm is unchanged, and a patchy opacity in the left lower lobe appears similar compared to the prior exam. A small left pleural effusion may be present. No pneumothorax is identified. There are multilevel degenerative changes in the thoracic spine.", "output": "Patchy opacity in the left lower lobe, similar compared to the prior study, and could reflect an area of atelectasis. A small left pleural effusion may be present." }, { "input": "Heart size is mildly enlarged. The mediastinal and hilar contours are unchanged with diffuse atherosclerotic calcifications of the aorta noted. The pulmonary vasculature is not engorged. Elevation of the left hemidiaphragm is similar with mild bibasilar atelectasis noted. No focal consolidation, pleural effusion or pneumothorax is present. Moderate degenerative changes are seen in the thoracic spine.", "output": "Mild bibasilar atelectasis. Otherwise, no acute cardiopulmonary abnormality." }, { "input": "The heart is mildly enlarged, unchanged. There is tortuosity of the descending aorta. The mediastinal and hilar contours are otherwise unremarkable. There is elevation of the left hemidiaphragm and note is made of marked gaseous distention of small bowel in the left upper quadrant. There is mild atelectasis at the left lung base. There is no focal consolidation, definite pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process. No evidence of free air. Marked gaseous distention of small bowel in the left upper quadrant for which clinical correlation is recommended. Findings discussed with Dr. ___ by ___ via telephone on ___ at 2:27 PM, time of discovery." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographdemonstrates well expanded and clear lungs.No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable. Limited assessment of the upper abdomen is within normal limits.", "output": "Normal chest radiograph. No pneumonia." }, { "input": "PA and lateral images of the chest. There is an opacity at the right hilum which may represent lymphadenopathy, mass, or a parenchymal process overlying normal vascular structures. There is opacity the right lung base that may represent atelectasis but is suspicious for pneumonia or aspiration in the right clinical setting. There is no pleural effusion or pneumothorax. Cardiomediastinal silhouette is unremarkable.", "output": "1. Opacity at the right hilum which may represent lymphadenopathy, mass, or parenchymal process overlying normal vascular structures. CT is recommended for further evaluation. 2. Opacity in the right lung base which may represent atelectasis but it is suspicious for pneumonia or aspiration in the right clinical setting. These findings were communicated to Dr. ___ at 10:14 a.m. on ___ by phone." }, { "input": "Frontal AP and lateral views of the chest were obtained. The lungs are well expanded and clear without focal consolidation, pleural effusion or pneumothorax. Heart size is normal. The mediastinal silhouette and hilar contours are normal. Mild degenerative change is seen in the thoracic spine.", "output": "No pneumonia, edema or effusion." }, { "input": "PA and lateral chest radiograph demonstrates clear lungs bilaterally. Cardiomediastinal silhouette is within normal limits. Hilar contour is normal. There is no pleural effusion, pneumothorax, or evidence of pulmonary edema. There are degenerative changes of the thoracic spine.", "output": "No acute intrathoracic abnormality." }, { "input": "On the frontal view, there is faint opacity projecting over the left lung base which does not silhouette the left cardiac margin. On the lateral view there is increased opacity projecting over the spine anteriorly. While this finding can be seen in the setting of degenerative spine changes, it is more conspicuous when compared to previous exam from ___. Cardiomediastinal silhouette is within normal limits. Hypertrophic changes are noted in the spine.", "output": "Faint opacity at the left lung base which could represent pneumonia in the proper clinical setting. RECOMMENDATIONS: Repeat after treatment suggested to document resolution." }, { "input": "PA and lateral chest radiograph demonstrates clear lungs bilaterally. Cardiomediastinal and hilar contours are within normal limits as is pulmonary vasculature. There is no pneumothorax or pleural effusion. No evidence of pulmonary edema. There is no air under the right hemidiaphragm.", "output": "No opacity convincing for pneumonia." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.", "output": "No focal consolidation concerning for pneumonia." }, { "input": "A left axillary pacemaker generator and two intact pacing leads are in standard position. Again seen are small punctate calcifications in the mid left lung that are unchanged since ___. The lungs are otherwise clear. The cardiomediastinal silhouette and hilar contours are normal. The pleural surfaces are normal without effusion or pneumothorax.", "output": "No evidence of complications status post pacemaker placement." }, { "input": "The heart size is top normal. Aorta appears unfolded. The lungs are clear without evidence of focal consolidations, pleural effusions, or pneumothoraces. The visualized osseous structures are unremarkable.", "output": "No evidence of pneumonia." }, { "input": "AP upright and lateral views of the chest were provided. Large body habitus limits evaluation. Allowing for this, the lungs appear clear without focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours appear normal. Bony structures appear intact.", "output": "No definite signs of pneumonia, somewhat limited study due to large body habitus." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. Again, low lung volumes are seen. Linear opacity in the right mid lung suggestive of atelectasis. There is no consolidation or effusion. Cardiomediastinal silhouette is within normal limits. Anterior wedge deformities of the mid-to-lower thoracic vertebral bodies is unchanged from T-spine films from ___. Osseous and soft tissue structures are otherwise unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Compared with prior radiographs on ___, there is a large convex mediastinal opacity centered at the aortic-pulmonary window, possibly representing a postop mediastinal hematoma or medial loculated fluid collection. Pulmonary edema, bibasilar consolidations, and moderate left and small right pleural effusions have improved. Median sternotomy wires and right axillary clips are stable in appearance.", "output": "1. Large convexity of left mediastinal border adjacent to the aortic knob, which may represent a postoperative mediastinal hematoma or medial loculated pleural fluid collection. This could be more fully characterized by CT if warranted clinically. 2. Interval slight improvement in pulmonary edema, bibasilar consolidations, and moderate left and small right pleural effusions." }, { "input": "The lung volumes are low bilaterally. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unchanged. Healed fractures are noted in the right chest wall laterally. Partially visualized cervical and thoracic spinal fusion hardware are unchanged in alignment and grossly intact.", "output": "No acute cardiopulmonary process and no evidence of pneumonia." }, { "input": "Lung volumes are slightly low. Opacity in the right mid lung seen on ___ has resolved. There has been some interval redistribution of pleural effusions which are likely overall unchanged, moderate on the left and small on the right. Bilateral interstitial opacities are improving. Heart size is normal. The mediastinal and hilar contours are stable. There is no pneumothorax. Right Port-A-Cath is in stable position.", "output": "Some interval redistribution of pleural effusions which are likely overall unchanged, moderate on the left and small on the right." }, { "input": "Redemonstrated is diffuse bilateral reticular nodular interstitial abnormalities that are fairly similar to the prior examination. Previously seen moderate right pleural effusion has decreased in size and the right lung is better aerated. A small left pleural effusion is unchanged. Port-A-Cath terminates in the lower SVC as before.", "output": "1. Interval decreased right pleural effusion. 2. Persistent diffuse reticulonodular interstitial densities." }, { "input": "Since ___, there has been re-accumulation of left pleural effusion with minimal atelectasis at the left base. Small right pleural effusion is similar to ___. The heart size is top normal. Mediastinal and hilar contours are unchanged. Right PICC terminates in mid to low SVC. A pleural catheter is right of midline. No pneumothorax is seen.", "output": "Reaccumulation of moderate left pleural effusion. Stable small right pleural effusion." }, { "input": "New left-sided PleurX catheter has a medial course. Right sided Port-A-Cath remains in the right atrium. Right-sided pleural catheter is medial superior coarse unchanged in appearance. New opacification in the right lower lung may reflect pleural fluid versus airspace consolidation. Small right-sided pleural effusion. Mild cardiomegaly unchanged. No pneumothorax.", "output": "New left-sided PleurX catheter. No pneumothorax. New opacification in the right lower chest may reflect pleural fluid or airspace consolidation. A lateral view would be helpful to help localize this abnormality." }, { "input": "Support Devices: The catheter of the right subclavian infusion port terminates at the cavoatrial junction. There is a mild increase in interstitial lung markings, which is stable from the prior study. There is no focal airspace consolidation. There is no pneumothorax or pleural effusion. Pulmonary vascular markings are normal.", "output": "No focal airspace consolidation to suggest pneumonia." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded lungs. Mild increase in interstitial markings, right greater than left, relate to interstitial lung disease, and are similar to recent prior CT. Tiny bilateral pleural effusions are present. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax or consolidation. Right-sided Port-A-Cath dens at the cavoatrial junction.", "output": "Mild increase in interstitial markings, right greater than left, relate to interstitial lung disease. Tiny bilateral pleural effusions." }, { "input": "Cardiomediastinal silhouette is normal. There is no overt pulmonary edema. There are patchy bibasilar opacities. There is no pleural effusion or pneumothorax. There is no acute osseous abnormality.", "output": "Patchy bibasilar opacities, which could represent atelectasis however in the correct clinical setting pneumonia or aspiration should be considered." }, { "input": "The lungs are clear without focal consolidation, effusion or overt edema. Cardiomediastinal silhouette is within normal limits. Median sternotomy wires and mediastinal clips are noted. There are atherosclerotic calcifications at the aortic arch. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. Status post CABG with intact median sternotomy wires and multiple mediastinal clips. Heart size and cardiomediastinal contours are normal. The lungs are clear without focal consolidation, pleural effusion, or pneumothorax. No evidence of free air beneath the diaphragms is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The inspiratory lung volumes are appropriate. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The pulmonary vasculature is not engorged. The cardiomediastinal and hilar contours are within normal limits. There is calcification of the aortic knob. No acute osseous abnormality is detected. The patient is status post median sternotomy with multiple intact appearing wires and mediastinal surgical clips consistent with CABG surgery.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral images of the chest were obtained. There is interval improvement in the right pleural effusion. There is increased prominence of the hila. Calcified lymph nodes are again seen in the perihilar regions. Reticular thickening is increased in the right upper lobe suggestive of new interstitial edema. There is increased perihilar opacitiy, which could represent vascular engorgement versus increased lymphadenopathy. The subpleural opacity in the left upper lobe appears unchanged since prior imaging. There is no pneumothorax. Cardiac silhouette is unchanged. Visualized osseous structures are unremarkable.", "output": "Improving right pleural effusion. Worsening interstitial edema. Increase in perihilar opacity likely due to vascular engorgement or lymph node enlargement. These findings were communicated to ___ at 3:15 p.m." }, { "input": "Two frontal images of the chest demonstrate well-expanded lungs. Bilateral pleural effusions are seen. Previously described scattered densities are again noted bilaterally in the lungs. There is no evidence of pneumothorax or other biopsy complication. The cardiomediastinal silhouette is unchanged. Visualized osseous structures are unremarkable. Comparison is also made to CTA from ___.", "output": "Improved bilateral pleural effusions. No complication status post biopsy. Otherwise, unchanged chest radiograph." }, { "input": "Pneumoperitoneum is new compared to the prior exam. The heart size is top normal. The mediastinal and hilar contours are unchanged, with multiple calcified lymph nodes again demonstrated within the mediastinum and hilar regions. Numerous nodules are seen within both lungs, 1 of which is cavitating and located within the left upper lobe, as demonstrated on the prior chest CT. No pneumothorax or pleural effusion is noted. Increased interstitial markings within the lung bases may reflect mild pulmonary edema. No acute osseous abnormalities are detected. Cervical spinal fusion hardware is partially imaged.", "output": "1. New pneumoperitoneum. This finding was discussed by Dr. ___ with Dr. ___ at 21:00, ___ by phone. 2. Diffuse pulmonary metastases, better assessed on prior chest CT. 3. Increased interstitial markings at the lung bases likely suggestive of mild volume overload." }, { "input": "Lung volumes are low. The heart size is normal. Re- demonstrated are numerous calcified mediastinal and hilar lymph nodes. The mediastinal and hilar contours otherwise are unchanged. Ill-defined nodular opacities are scattered within the left lung and are better demonstrated on the prior CT, not significantly changed in the interval. No pleural effusion or pneumothorax is present. Subtle increase in interstitial markings within the right lung base likely reflects lymphangitic spread of tumor, as demonstrated on the prior CT. Previously seen compression deformity of the T11 vertebral body as well sclerotic lesion within T12 is better assessed on the recent CT.", "output": "No significant interval change compared to the prior CT. No new areas of opacification within the lungs." }, { "input": "Single AP upright portable view of the chest was obtained. Patient is status post median sternotomy. There is stable mild-to-moderate enlargement of the cardiac silhouette. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. There is mild central pulmonary vascular engorgement. Minimal left base atelectasis may be present.", "output": "Mild central pulmonary vascular engorgement without overt pulmonary edema. Mild-to-moderate enlargement of the cardiac silhouette again seen." }, { "input": "PA and lateral chest radiographs were provided. The lungs are well expanded. There is no focal consolidation, pleural effusion, or pneumothorax. Cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "The inspiratory lung volumes are appropriate. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The pulmonary vasculature is not engorged. The cardiomediastinal and hilar contours are within normal limits. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "Single frontal view of the chest. Heart size and mediastinal contours are normal. Medial right lung base and retrocardiac opacities are new and consistent with multifocal pneumonia. A spiculated nodule in the left upper lobe is similar to prior. Other known nodules were better evaluated on prior CT. Indistinct appearance of the left hemidiaphragm suggests the presence of a small pleural effusion. No pneumothorax.", "output": "Symmetric right base and retrocardiac opacities may represent either atelectasis or pneumonia." }, { "input": "The heart size is top normal. Mediastinal and hilar contours are unchanged with tortuosity of the thoracic aorta again noted. Low lung volumes cause mild crowding of the bronchovascular structures, though no overt pulmonary edema is seen. Patchy bibasilar airspace opacities most likely reflect atelectasis but infection is not completely excluded. No pleural effusion or pneumothorax is clearly noted. There are no acute osseous abnormalities.", "output": "Low lung volumes with patchy bibasilar opacities likely reflective of atelectasis. Infection however is not completely excluded." }, { "input": "AP upright and lateral views of the chest were provided. The lungs are clear without focal consolidation, effusion, or pneumothorax. The heart is mildly enlarged with a left ventricular configuration. Mediastinal contours are normal aside from aortic calcifications. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. There is minimal posterior basilar atelectasis. The aorta remains tortuous. The cardiac silhouette is top normal. There is no overt pulmonary edema.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs demonstrate improved lung volumes relative to prior examination. An enteric tube descends the thorax in an uncomplicated course, its tip not well visualized though appears to course below the level of the hemidiaphragm. A right PICC terminates at or just below the superior vena cava. Cardiomediastinal and hilar borders are within normal limits. A retrocardiac opacity is new relative to prior examination for which infection is difficult to exclude. Bibasilar atelectasis is most pronounced within the left lower lobe. There is a small pleural effusion. There is no pneumothorax or evidence of pulmonary edema.", "output": "New retrocardiac opacity for which infection cannot be excluded. A small left pleural effusion is associated with atelectasis." }, { "input": "Portable AP chest radiograph demonstrates the left PICC is directed towards the lateral wall of the SVC. Median sternotomy wires are again noted. Lung volumes are low. However there is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No pneumonia." }, { "input": "PA and lateral chest radiographs were obtained. A small right and moderate left pleural effusion have increased since ___ when they were small. There is no consolidation or pneumothorax. Bibasilar septal lines indicate mild interstital edema. There are no abnormal cardiac or mediastinal contours. A left-sided PICC line tip terminates in the mid SVC. Median sternotomy wires are intact.", "output": "Moderate left and small right pleural effusions have progressed since ___. Mild interstitial edema." }, { "input": "The patient is status post median sternotomy with mediastinal clips noted. Heart size is normal. The aorta is mildly tortuous but unchanged. Mediastinal and hilar contours are unremarkable. Right PICC tip terminates within the SVC/right atrial junction. No pleural effusion or pneumothorax is seen. Minimal patchy bibasilar opacities are present. There is no free air under the diaphragms. No acute osseous abnormalities are seen.", "output": "Mild bibasilar patchy opacities likely reflective of atelectasis, though aspiration or early infection are not completely excluded." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. Upper lobe lucency and splaying of bronchovasculature is concerning for underlying emphysema. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process" }, { "input": "Heart size, mediastinal and hilar contours are normal. Lungs and pleural surfaces are clear. Mild curvature of the spine is noted.", "output": "No radiographic evidence of pulmonary vasculitis." }, { "input": "Right internal jugular central venous catheter tip terminates in the region of the mid SVC. Heart size is normal. Atherosclerotic calcifications are noted within the aortic arch and descending thoracic aorta. Calcified mediastinal lymph nodes are present suggestive of prior granulomatous disease. Hilar contours are normal. No focal consolidation, pleural effusion or pneumothorax is identified. No pulmonary edema is visualized. 18 mm nodular opacification overlying the right mid lung field appears to contain a central area of calcification and may reflect a hamartoma. No acute osseous abnormality is detected.", "output": "1. Right internal jugular central venous catheter tip in the mid SVC. No pneumothorax. 2. 18 mm nodular opacity in the right mid lung field for which comparison with prior imaging is suggested or consider chest CT for further assessment. RECOMMENDATION(S): Comparison with previous chest imaging is recommended. If none are available, consider non-emergent chest CT for further assessment." }, { "input": "The patient is rotated, limiting assessment. The mediastinum is normal in size and contour. The cardiac silhouette is normal in size. The hila are unremarkable. There is no pneumothorax lungs are expanded and clear without focal consolidation. Gaseous distention of multiple bowel loops is noted in the upper abdomen.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Mild prominence of the left hilum is stable. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No acute cardiopulmonary process. No displaced rib fracture seen, however, if clinical concern is high, dedicated rib series or CT is more sensitive." }, { "input": "The lungs are hyperinflated. There is no focal parenchymal opacity. There is tenting of the left hemidiaphragm as well as leftward displacement of the mediastinum likely due to postradiation retraction. No pleural effusion or pneumothorax is present.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. There are patchy regions of consolidation identified in the right lower lobe. Elsewhere the lungs are clear. The cardiomediastinal silhouette is within normal limits. Breast tissue expanders are seen bilaterally, new on the right compared to prior.", "output": "Right lower lobe region of consolidation compatible with pneumonia in the proper clinical setting." }, { "input": "Heart size is top normal. Mediastinal and hilar contours are unremarkable. Lungs are clear. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cardiac, mediastinal and hilar contours are unchanged, with the heart size within normal limits. Evidence of volume loss in the right lung from prior right lower lobectomy and right middle lobe segmentectomy are re- demonstrated with slight rightward shift of mediastinal structures and elevation the right hemidiaphragm. A small right pleural effusion may be slightly increased compared to the previous exam. There is no pulmonary vascular congestion. Streaky opacities are noted within the right upper lobe and left lung base, which appear to have slightly increased compared to the previous exam. No pneumothorax is identified. There are no acute osseous abnormalities. The bones are diffusely demineralized.", "output": "Slight interval increase in small right pleural effusion. Patchy opacities in the right upper lobe and left lung base may reflect areas of developing infection." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged, allowing for differences in technique. A vague peripheral opacity projecting over the right lung apex also appears unchanged. Streaky opacities in the right lower lobe are most consistent with minor atelectasis. There is no pleural effusion or pneumothorax.", "output": "Right basilar opacity suggesting minor atelectasis. No convincing evidence for pneumonia or congestive heart failure." }, { "input": "Frontal and lateral views of the chest were obtained. There is persistent elevation of the right hemidiaphragm with blunting of the right costophrenic angle due to prior lung resection. Better seen on the prior study, there are chain sutures projecting over the right lower hemithorax. The patient has known pulmonary nodules and bronchiectasis throughout the lungs, better seen on prior CT. Biapical pleural thickening is again seen. The cardiac and mediastinal silhouettes are stable, as are the hilar contours. Overall, there has been no significant interval change since the prior study.", "output": "No significant interval change since the prior study. Chronic changes as above." }, { "input": "AP and lateral views of the chest demonstrate clear lungs. Cardiac silhouette is stable. No pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Again, there are low lung volumes. The patient's chin overlies the right apex. Given the above, the again areas of bilateral mid to lower lung atelectasis bilaterally. No discrete focal consolidation is seen. There is no pleural effusion or pneumothorax. Projecting over the left upper lobe again seen is a 6 mm calcific nodule most likely presenting a calcified granuloma. A few smaller rounded calcified nodules are seen projecting over the right lung, stable, also likely representing calcified granulomas. Cardiac and mediastinal silhouettes are stable.", "output": "Several areas of likely atelectasis in the mid to lower lung the lungs bilaterally, evolving infection is not excluded in the appropriate clinical setting." }, { "input": "Lung volumes are low. Bibasilar linear opacities likely represent atelectasis. There is mild pulmonary vascular prominence, which may be exaggerated by low lung volumes. Likely calcified nodule seen in the left upper lung. Heart and mediastinal contours are difficult to evaluate in the setting of low lung volumes. No pleural effusion or pneumothorax is detected.", "output": "Low lung volumes with bibasilar atelectasis. Underlying infection is not completely excluded." }, { "input": "Cardiomediastinal contours are stable in appearance with tortuosity of the thoracic aorta and left ventricular configuration of the heart. Lungs and pleural surfaces are clear. No acute skeletal abnormalities are detected on this limited portable study.", "output": "No evidence of pneumonia or pneumothorax to account for right-sided chest pain." }, { "input": "The lungs are clear. Cardiac silhouette is enlarged but stable. The aorta is tortuous. There is no evidence of pleural effusion, pneumonia, pulmonary edema. A right-sided PICC line terminates in the low SVC.", "output": "No evidence of acute cardiopulmonary process. PICC line ends in the low SVC." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable. An orthopedic screw is seen to project over the left shoulder.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are clear. There is no large pleural effusion or pneumothorax. There is no subdiaphragmatic free air.", "output": "No acute cardiopulmonary process and no subdiaphragmatic free air." }, { "input": "The lungs are well expanded and clear. There is no pleural fluid or pneumothorax. The heart is normal in size with slightly tortuous aortic contours.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest demonstrate low lung volumes without pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. No rib fracture is identified. Compression deformity of the L1 vertebral body is age indeterminate.", "output": "1. No rib fracture is identified. In the setting of high clinical suspicion for a rib fracture, dedicated rib series may be obtained. No pneumothorax. 2. Mild compression deforminty of the L1 vertebral body, age indeterminate." }, { "input": "PA and lateral chest radiographs are provided. There is no focal consolidation, pleural effusion, or pneumothorax. There is mild lower lobe atelectasis. Cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation is seen. There is slight blunting of the left posterior costophrenic angle which may be due to pleural thickening; however, a small pleural effusion is not excluded. There is no pneumothorax. There is no overt pulmonary edema. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Slight blunting of the posterior left costophrenic angle may be due to pleural thickening or a trace pleural effusion." }, { "input": "The lungs are clear without infiltrate or effusion. The trachea ___ mediastinal silhouettes are normal. There continues to be mild elevation right hemidiaphragm.", "output": "No infiltrate or effusion." }, { "input": "Right internal jugular central venous catheter has been pulled back to the confluence of the right subclavian and right internal jugular veins. The heart remains moderately enlarged. There is a replaced aortic valve. The mediastinal and hilar contours is stable. Small bilateral pleural effusions are unchanged. There is no frank pulmonary edema. Mild bibasilar opacities have worsened. There is no pneumothorax.", "output": "1. Right IJ central venous catheter has been pulled back to the confluence of the right subclavian and right internal jugular veins. 2. Worsened bibasilar opacities could reflect atelectasis or aspiration. 3. Small bilateral pleural effusions are unchanged." }, { "input": "Cardiomediastinal silhouette and hilar contours are stable. An endotracheal tube is in appropriate position with the tip terminating 4 cm cranial to the carina. A right subclavian approach central venous catheter is in place with the tip terminating at the cavoatrial junction. Moderate-to-severe pulmonary edema is unchanged with moderate bilateral pleural effusions. A persistent focus of asymmetric density in the right upper lung is slightly worse compared to ___.", "output": "1. Unchanged moderate-to-severe pulmonary edema with moderate bilateral pleural effusions. 2. Slight increase in asymmetric right upper lung opacities are likely asymmetric edema; however, concurrent infection is not excluded in the appropriate clinical setting." }, { "input": "The heart continues to be moderately enlarged and there is pulmonary vascular redistribution. There are bilateral lower lobe infiltrates with associated volume loss. There are small bilateral effusions.", "output": "Compared to the prior study that fluid overload and lower lobe volume loss appears slightly worse." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Pulmonary edema and mediastinal vascular engorgement is worse compared to radiograph obtained approximately 6 hours earlier. Mild cardiomegaly has also worsened. Dobbhoff tube is noted with weighted tip within the expected region of the stomach. There is no pneumothorax.", "output": "Pulmonary edema, mediastinal vascular engorgement and cardiomegaly have progressed since radiograph obtained 6 hours earlier." }, { "input": "There is hazy opacification at the left base, which is likely atelectasis, although underlying infection cannot be excluded. There is no edema, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Anterior cervical spinal fusion hardware is present, although only partially evaluated on these images.", "output": "Hazy opacification at the left base is likely atelecatasis, although an underlying pneumonia cannot be excluded." }, { "input": "Frontal and lateral views of the chest. Heart size and cardiomediastinal contours are normal. Small linear bibasilar opacities are consistent with atelectasis. Blunting of the right costophrenic angle appears chronic. No focal consolidation, pleural effusion, or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable semi upright frontal chest radiograph demonstrates interval placement of an enteric feeding tube coursing mid line with side port at the level of the diaphragms and tip within the stomach. Moderately well inflated lungs with persistent linear atelectasis. No pneumothorax. Again seen is linear scarring in the lungs and pleural scarring, similar to previous examination. Stable small left pleural effusion with scarring. No new focal opacity. Heart size, mediastinal contour, and hila are unremarkable. Limited assessment of the osseous structures are within normal limits and upper abdomen demonstrates pneumobilia as seen on previous CT.", "output": "1. Enteric feeding tube with side port at level of the diaphragm and tip within the stomach. Consider advancing 3-5 cm for better positioning. 2. Stable chest, with linear atelectasis, scarring, and small left pleural effusion. No evidence of pneumonia. 3. Persistent pneumobilia, as seen on CT from ___." }, { "input": "There has been interval placement of a nasogastric tube which extends into the stomach. However, the NG tube port sites at the GE junction. There is no pneumothorax or pneumomediastinum. Small right pleural thickening is unchanged. Bilateral linear atelectasis versus scarring is again noted, unchanged. The regional bones and soft tissues are unremarkable.", "output": "The side port of the NG tube at the GE junction. Advancement by 4-5 cm is recommended. Otherwise, no significant interval change. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 12:42 PM, 10 minutes after discovery of the findings." }, { "input": "PA and lateral views of the chest were obtained. The heart is normal size and cardiomediastinal contour is stable. Linear scarring in the lungs and pleural scarring resulting in the elevation of the right lung base laterally is unchanged. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute intrathoracic process." }, { "input": "Frontal AP upright and lateral views of the chest were obtained. Bilateral and diffuse increased interstitial markings likely represents mild interstitial edema. More focal opacity at the right lung base is probably atelectasis. Small bilateral pleural effusions are better seen on CT. Scarring in the right mid lung is unchanged from ___. There is no pneumothorax. The heart size is top normal. There are aortic knob calcifications. No acute osseous abnormality is identified.", "output": "Findings compatible with mild interstitial edema. Repeat radiograph could be performed after treatment to evaluate for underlying pneumonia." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. There is a nodular density projecting over the left cardiac silhouette and the anterior left sixth rib measuring 6 mm. Density of this nodule suggests that it is calcified. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Right PICC tip terminates in the lower SVC. Lung volumes are low. Heart size is accentuated as a result of low lung volumes, and is likely borderline enlarged. The aorta is unfolded. There is no pulmonary edema. Streaky bibasilar airspace opacities could reflect atelectasis though infection, particularly in the right lung base, is difficult to exclude. Blunting of left costophrenic sulcus is similar compared to the prior exam, and likely attributable to mild pleural thickening. No focal consolidation is identified. There is no pneumothorax. No large pleural effusion is identified. No acute osseous abnormality is seen.", "output": "Low lung volumes limits assessment of the lung bases. Streaky bibasilar airspace opacities could reflect atelectasis, but infection is difficult to exclude. Recommend repeat radiographs with improved inspiratory effort (when patient is able to) for further assessment." }, { "input": "Portable AP upright chest radiograph demonstrates a left PICC with the tip in the superior SVC. There is a small left pleural effusion, and no right pleural effusion is seen. The lungs are clear and the cardiac and mediastinal contours are normal. No pneumothorax.", "output": "Small left pleural effusion with unchanged position of left PICC. No pneumothorax." }, { "input": "There are mild new opacities overlying the right mid lung which may represent an infectious process in this immunocompromised patient. Known 5 mm right lower lobe pulmonary nodules not well evaluated on this study. Mild right basilar atelectasis is noted. The left lung is clear. Cardiac and mediastinal silhouettes are normal.", "output": "1. Mild new opacities overlying the right midlung which may represent an infectious process in this immune compromised patient. Further characterization may be obtained with CT. 2. Known 5-mm right lower lobe nodule is not well identified on this study." }, { "input": "Cardiac size is top normal. Right PICC tip is in the cavoatrial junction as before. Persistent right lower lobe opacity could be atelectasis but superimposed infection cannot be excluded, otherwise the lungs are clear. There is no pneumothorax or pleural effusion. Blunting of the left CP angle is unchanged", "output": "Persistent opacity in the right lower lobe is likely atelectasis but superimposed infection cannot be excluded." }, { "input": "Frontal and lateral radiographs of the chest demonstrate clear lungs with left basilar atelectasis, unchanged. The nodular density seen in the right middle lung field on the prior radiograph is again noted. No pleural abnormality is noted and the cardiomediastinal contours are unchanged.", "output": "Recommend shallow obliques with nipple markers for evaluation of the abnormality in the right middle lung. These findings were entered into radiology reporting dashboard by Dr. ___ ___ ___." }, { "input": "Frontal and lateral radiographs of the chest demonstrate lungs. There is mild blunting of the left costophrenic angle, which likely represents atelectasis, and is unchanged. There is a subtle opacity in the right middle lung field which may represent a composite shadow, however underlying parenchymal abnormality cannot be excluded. The cardiac and mediastinal contours are unchanged from the prior radiograph. No pneumothorax or pleural effusion is seen.", "output": "No acute cardiopulmonary process. Cannot exclude underlying nodule in the right middle lung field subtle opacity. Recommend repeat radiograph for further evaluation." }, { "input": "An enteric tube terminates in the region of the stomach, likely the pylorus. Of note, the tube does not appear kinked on these images. The cardiomediastinal and hilar contours are within normal limits. The lungs are clear without focal consolidation, pleural effusion or pneumothorax.", "output": "Enteric tube terminates within the region of the stomach. No evidence of kinking on these radiographs." }, { "input": "Since ___, small right pleural effusion and right basilar atelectasis is increased. The heart size is normal. Previously noted right PICC line has been removed. Mid leftward tracheal deviation is due to enlarged right thyroid lobe.", "output": "Small right pleural effusion and right basilar atelectasis is increased since ___." }, { "input": "PA and lateral views of the chest provided. Elevated right hemidiaphragm again noted. There is persistent right hilar and perihilar atelectasis. Left lung is clear. No convincing evidence for pneumonia. Cardiomediastinal silhouette is normal. No pneumothorax. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Persistent atelectasis in the right hilar/ perihilar region." }, { "input": "Lung volumes remain low on the right status post removal of the chest tube with a small residual right pleural effusion. Small left-sided pleural effusion also seen. No definite pneumothorax seen. There is a small amount of subcutaneous air tracking in the neck. Left lung appears clear. The cardiomediastinal contour is unchanged compared to the preoperative study.", "output": "Small bilateral pleural effusions, larger right. No definite pneumothorax seen." }, { "input": "Portable AP upright chest radiograph ___ at 16:19 is submitted.", "output": "Bibasilar linear opacities favor scarring, post inflammatory change, or atelectasis especially as the right hemidiaphragm is tented and elevated consistent with volume loss. No developing focal airspace consolidation is seen to suggest pneumonia, although outside CT dated ___ does demonstrate patchy areas of ground-glass opacity in the left upper lobe and a more consolidative process in the right posterior medial lower lobe which was felt to represent atelectasis, neither of which were well seen on plain radiography. There is a right lateral and basilar pleural effusion which is unchanged. Overall cardiac and mediastinal contours are stable. No pneumothorax or pulmonary edema." }, { "input": "There is a feeding tube which extends below the level the diaphragms but is looped over the mid abdomen. There is increased elevation of the right hemidiaphragm. Minimal bibasilar atelectasis is present. No pneumothorax or pleural effusion. The size of the cardiomediastinal silhouette is within normal limits.", "output": "A feeding tube is looped and projects over the mid abdomen. Elevation of the right hemidiaphragm. Bibasilar atelectasis." }, { "input": "There low bilateral lung volumes. No pleural effusion, focal consolidation or pneumothorax identified. Mild unchanged atelectasis/ scarring in the right mid lung zone. The size of the cardiomediastinal silhouette is within normal limits.", "output": "No radiographic evidence of acute cardiopulmonary disease." }, { "input": "Minimal pneumomediastinum distributed along the aortic knob is consistent with the recent pericardiocentesis. Normal heart size is unchanged since ___. Left mid and lower lung opacity, which is combination of loculated pleural effusion, atelectasis and/or consolidation, has minimally improved since ___. Mild-to-moderate right pleural effusion is appreciated on chest CT dated ___ is not really redemonstrated on the chest radiograph and for its evaluation, please refer to the dedicated chest CT. No evidence of pneumothorax.", "output": "1. Lower lung opacity, which is a combination of loculated effusion, atelectasis and/or consolidation, is minimally better since ___. 2. Minimal pneumomediastinum is consistent with recent pericardiocentesis. 3. Mild-to-moderate right pleural effusion appreciated on chest CT dated ___ is not really appreciated on the chest radiograph." }, { "input": "Since the most recent prior radiograph, the left pigtail catheter has been removed. There is no significant change. Again seen are changes s/p VATS and decortication with slight elevation of the left hemidiaphragm. Aeration is improved at the left base. Opacities in the left upper lung zone persist. There are bilateral pleural effusions, greater on the left which is unchanged. Loculated left effusion with internal air-fluid level is unchanged. Cardiomediastinal silhouette is stable.", "output": "Removal of left pigtail catheter. Stable appearance of bilateral pleural effusions, post-surgical changes, and left lung opacities." }, { "input": "An ill-defined, large opacity in the left upper-mid lung is concerning for pneumonia. Larger and more dense opacity in the left lower lung is likely a combination of moderate effusion and atelectasis and/or consolidation. Right lung is clear. Pleural effusion if any is minimal on the right side.", "output": "Large left upper-mid lung consolidation, in view of clinical history is worrisome for pneumonia. More homogeneous and dense left lower lung opacity is combination of effusion and atelectasis and/or consolidation." }, { "input": "There has been interval intubation with the endotracheal tube terminating approximately 3.7 cm from the chronic. An enteric tube tip and side-port terminates within the stomach. Heart size is normal. Mediastinal and hilar contours are unremarkable. Ill-defined small nodular opacities are demonstrated within both lung bases. Hazy opacity within the left hemi thorax suggest a layering pleural effusion. No large pneumothorax is identified. There are no acute osseous abnormalities.", "output": "1. Standard positioning of endotracheal and enteric tubes. 2. Bibasilar ill-defined small nodular opacities, worrisome for infection or aspiration. Metastatic disease is not excluded. 3. Hazy opacity in the left hemi thorax, likely a layering left pleural effusion." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low. The lungs are clear. Mediastinal contour, hila, and cardiac silhouette are normal. There is no pneumothorax or pleural effusion. No osseous abnormality within the limits of plain radiography.", "output": "No evidence of traumatic injury within the limits of plain radiography." }, { "input": "Frontal and lateral views of the chest were obtained. There is confluent, left greater than right, pulmonary fibrosis which is most prominent in the left upper lobe. Findings have progressed since ___ with increased left upper lobe heterogeneous pulmonary markings. There is new tenting of the left hemidiaphragm, suggesting left lung volume loss. Bilateral loculated pleural effusions have increased, now moderate in size with increased left upper lung subpleural opacity. Heart size is stable. Left PICC has been removed.", "output": "Confluent, left greater than right, pulmonary fibrosis, progressed since ___ with increased left upper lobe heterogeneous pulmonary markings. Findings are consistent with worsening fibrotic disease with probable superimposed infection or, less likely, pulmonary edema. Increased loculated pleural effusion, now moderate in size, especially on the left." }, { "input": "Frontal and lateral views of the chest are compared to previous chest x-ray from ___ and subsequent chest CT from ___. Again seen are increased reticular markings at the periphery of the lungs superiorly which are unchanged and better characterized by CT chest performed the same day. There is no superimposed acute consolidation. There are small bilateral pleural effusions. Cardiomediastinal silhouette is unchanged. Multiple healing left rib fractures are seen. There are multiple compression deformities in the lower thoracic and upper lumbar spine as seen on prior chest x-ray from ___.", "output": "No definite acute cardiopulmonary process." }, { "input": "Left PICC tip terminates in the lower SVC. Lung volumes are low. Cardiac and mediastinal contours are unchanged, and there are continued multifocal opacities within the left upper and lower lung fields as well as within the right upper lung field, findings concerning for pneumonia. Additionally, bilateral pleural effusions, small to moderate in size appear unchanged. Crowding of the bronchovascular structures persists. Underlying emphysematous changes are most pronounced within the lung apices. Diffuse gaseous distention of abdominal bowel loops are seen within the upper abdomen. Diffuse demineralization of the osseous structures is present with unchanged compression deformities within the lower thoracic spine. Remote left sided rib fractures are again seen.", "output": "Persistent multifocal airspace opacities, most pronounced within the left upper lung field, on a background of emphysema, concerning for multifocal pneumonia. Similar bilateral small to moderate sized pleural effusions. Marked gaseous distention of loops of bowel within the upper abdomen." }, { "input": "The cardiac, mediastinal, and hilar contours appear unchanged. There is probably a small persistent pleural effusion on the left, but with increased superimposed opacification projecting along the posterior costophrenic angle. Fissures are thickened and there is a generalized mild prominence of the interstitium, suggesting interstitial changes, although mild vascular congestion is possible. Irregular pulmonary architecture, particularly in the upper lungs, is suggestive of emphysema. Multifocal left-sided rib deformities appear unchanged as well as scarring at the left lung apex.", "output": "1. Increased left posterior basilar opacification including persistent small pleural effusion. 2. Mild interstitial abnormality, which may reflect emphysema and mild chronic interstitial disease, although mild superimposed vascular congestion could be considered in the appropriate setting." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is irregularity of the posterior left fourth rib but no fractures seen in this region on torso CT scan. There is loss of vertebral body height at L1.", "output": "Compression fracture of L1." }, { "input": "Upright AP and lateral views of the chest provided. The heart is enlarged, increased from prior with hilar engorgement and interstitial edema noted. A small right pleural effusion. No large left effusion. No pneumothorax. Bony structures appear demineralized though intact.", "output": "Mild pulmonary edema with cardiomegaly. Tiny right pleural effusion also noted." }, { "input": "Portable AP chest radiograph demonstrates the endotracheal tube has been removed. The right IJ catheter is in stable position. Right PICC tip is in the right axillary vein. Massive cardiomegaly and small bilateral pleural effusions, greater on the left are unchanged. However, there is no pulmonary edema. Retrocardiac atelectasis is noted. There is no pneumothorax.", "output": "Severe cardiomegaly without evidence of pulmonary edema, unchanged from ___." }, { "input": "There is stable enlargement of the cardiac silhouette. No focal consolidation, pleural effusion or pneumothorax.", "output": "Stable enlargement of the cardiac silhouette. No pneumonia" }, { "input": "The cardiac, mediastinal and hilar contours are normal. Pulmonary vascularity is normal. Lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are detected.", "output": "Normal chest radiograph." }, { "input": "PA and lateral views of the chest provided. Mild cardiomegaly is noted with hilar congestion without overt edema. Mild left basal atelectasis. No convincing evidence for pneumonia. No large effusion or pneumothorax. Mediastinal contour appears normal though there is mild calcification at the aortic knob. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "As above." }, { "input": "PA and lateral views of the chest were provided demonstrating no focal consolidation, effusion, or pneumothorax. The heart is top normal in size. Mediastinal contour is normal. Bony structures intact.", "output": "No signs of pneumonia. Borderline cardiomegaly." }, { "input": "Upright frontal chest/abdominal radiograph demonstrates a Dobbhoff tube ending in the left upper quadrant. The curvature of the Dobbhoff tube suggests that it is within the fourth portion of the duodenum. There is a right central venous catheter line ending in the right atrium. The bowel gas pattern is unremarkable. There is retrocardiac opacity in the left lung base, perhaps in large part an effusion.", "output": "The curvature of the Dobbhoff tube suggests that its tip is within the fourth portion of the duodenum. A radiograph could be considered after injection of contrast into the tube for definite confirmation of tip location." }, { "input": "AP and lateral chest radiographs were provided. The patient is rotated to the right. The lung volumes are low. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is stable. The bones are intact. The diaphragms are elevated, likely due to large volume ascites. Again seen is a hiatal hernia.", "output": "Low lung volumes, no acute process" }, { "input": "There are low lung volumes with bibasilar atelectasis. Elevation of the left hemidiaphragm is not changed from CT abdomen of ___. A small hiatal hernia is also unchanged. No focal consolidation, pleural effusion or pneumothorax is present. Normal cardiomediastinal silhouette.", "output": "No focal consolidation." }, { "input": "A left-sided PICC line terminates in the mid SVC. Lung volumes are low which causes vascular crowding as well as bibasilar atelectasis. An exaggeration of the cardiac size. No pleural effusion, pneumothorax or focal consolidation worrisome for pneumonia. NG tube terminates in the duodenum.", "output": "Left-sided PICC is in the mid SVC." }, { "input": "Previously visualized right apical pneumothorax is not appreciated on today's radiograph. Multiple right-sided rib fractures are noted, but better visualized on prior CT. Slightly more prominent opacification of the right lung base, likely related to atelectasis. Small right pleural effusion unchanged. Cardiomediastinal silhouette within normal limits.", "output": "Interval resolution of tiny right apical pneumothorax." }, { "input": "Lung volumes are relatively low, similar to prior. There mild pulmonary edema, slightly worse when compared to prior. Left chest wall pacing device is again noted. Degree of cardiac enlargement unchanged. There are trace bilateral pleural effusions.", "output": "Mild pulmonary edema with trace bilateral effusions." }, { "input": "Patient is status post median sternotomy and CABG. A left-sided AICD device is noted with leads in unchanged positions. Abandoned leads are also noted projecting over the left chest wall. Mild to moderate enlargement of the cardiac silhouette is re- demonstrated. Atherosclerotic calcifications are noted within the aorta which remains mildly tortuous. Mild pulmonary edema is slightly worse in the interval. There are trace bilateral pleural effusions. Streaky atelectasis is noted in the lung bases bilaterally. Assessment of the lung apices medially is obscured by the patient's chin projecting over this area. There are moderate multilevel degenerative changes in the thoracic spine.", "output": "Mild pulmonary edema, worse in the interval, with trace bilateral pleural effusions." }, { "input": "Triple lead left-sided AICD is stable in position. The cardiac and mediastinal silhouettes are stable. There is minimal interstitial edema. No pleural effusion or pneumothorax is seen. There is no lobar consolidation. The cardiac and mediastinal silhouettes are stable.", "output": "Minimal interstitial edema. No lobar consolidation." }, { "input": "Compared to the prior study the pulmonary edema is worsened. The heart is moderately enlarged. There is pulmonary vascular redistribution with hazy alveolar infiltrate right greater than left. Dual lead pacemaker is unchanged. The ET tube is 2.7 cm above the carina. The NG tube tip is in the stomach. There are small bilateral infiltrates.", "output": "Worsened pulmonary edema" }, { "input": "Status post median sternotomy with intact and aligned sternotomy wires. A left pectoral AICD remains in place. Increased bilateral interstitial opacities are most likely due to worsening pulmonary edema. Small bilateral pleural effusions are unchanged. Moderate cardiomegaly despite the projection is also stable. There is no pneumothorax.", "output": "Slight interval increase in moderate pulmonary edema. Stable small bilateral pleural effusions. Stable moderate cardiomegaly." }, { "input": "There are mildly improved interstitial markings in the right lower lung. Diffuse interstitial changes corresponding to prior CT, are unchanged. Pulmonary vascular prominence and top normal heart size are unchanged from ___. The AICD is in stable position.", "output": "Improved right lower lung vascular congestion, otherwise unchanged chest radiograph from ___. The results were discussed with Dr. ___ by phone at 4:21 p.m." }, { "input": "Mild cardiomegaly is overall stable compared to the prior exam. The lungs are mildly hyperinflated. There may be small bilateral pleural effusions. No focal consolidation concerning for pneumonia is identified. A left-sided AICD is unchanged in position compared to the prior exam. The visualized osseous structures are unremarkable.", "output": "1. No acute intrathoracic abnormalities identified. 2. Mildly hyperinflated lungs, consistent with patient's COPD." }, { "input": "Lung volumes are persistently low. Moderate to severe pulmonary edema has changed in distribution, but not in overall severity. Mild cardiomegaly is also stable. Bilateral pleural effusions have increased. No focal consolidation concerning for pneumonia. There are 2 coiled leads around the left ICD pacemaker. There is a presumably orphaned right ventricular ICD lead, with intact continuous right atrium and right ventricle leads. The appearance is unchanged since the radiograph from ___. Intact median sternotomy wires and mediastinal clips are unchanged.", "output": "1. Increased bilateral pleural effusions, with redistribution of the moderate to severe pulmonary edema. 2. No evidence of pneumonia." }, { "input": "PA and lateral views of the chest reviewed. Cardiomediastinal and hilar contours are stable. Left axillary pacemaker defibrillator is present with leads terminating in right atrium and right ventricle as expected. There is no pleural effusion or pneumothorax. Lungs are well expanded and clear. Apparent bilateral hazy opacities seen on ly on the fronatl view are likley due to overlying soft tissue and are unchanged from prior. There is no pulmonary edema.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest are obtained. Left-sided AICD is again seen, leads unchanged in position. Patient is status post median sternotomy and CABG. There is mild pulmonary vascular congestion. More confluent opacity at the right lung base, similar to prior, could represent overlying vasculature, although underlying consolidation is not excluded in the appropriate clinical setting. Recommend followup to resolution. No large pleural effusion or pneumothorax is seen. Cardiac silhouette is top normal. The cardiac and mediastinal contours are stable.", "output": "Mild pulmonary vascular congestion. More confluent opacity at the right lung base may be due to overlying vessels, although underlying consolidation cannot be excluded in the appropriate clinical setting. Recommend followup to resolution." }, { "input": "Portable semi-erect chest film ___ at 23:08 is submitted.", "output": "The left-sided pacer remains in place. Patient is status post median sternotomy with stable cardiac and mediastinal contours. Overall, interval improvement but persistent mild to moderate pulmonary and interstitial edema. No pneumothorax. No large effusions." }, { "input": "The cardiac silhouette is borderline enlarged. Pulmonary edema has resolved. No focal consolidation is seen. There is no definite pleural effusion or pneumothorax. A dual lead ICD/pacemaker is in stable position.", "output": "1. Significant improvement of pulmonary edema since the prior examination. 2. No acute intrathoracic abnormality." }, { "input": "A left-sided pacer/ICD is seen with its leads terminating in the right atrium and right ventricle, unchanged locations. The heart is enlarged. The hilar and mediastinal contours are within normal limits. Lung volumes are low. There is no focal consolidation, pleural effusion or pneumothorax. There is no overt pulmonary edema. Mild bibasilar scarring is noted, as seen on prior chest CT. There are mild degenerative changes of the thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "Portable AP chest film ___ at 14:35 is submitted.", "output": "Left-sided pacer device remains in place. Patient is status post median sternotomy with stable postoperative cardiac and mediastinal contours. Bilateral interstitial opacities are likely not significantly changed given lower lung volumes and likely reflect mild to moderate interstitial edema. No large effusions. No pneumothorax." }, { "input": "Frontal and lateral views of the chest demonstrate unchanged small bilateral pleural effusions. The heart size is large, and there has been an interval increase in interstitial markings consistent with mild pulmonary edema. A left-sided pacer/ICD is noted with leads terminating in the right atrium and right ventricle. There is no pneumothorax or consolidation. There are mild degenerative changes within the thoracic spine.", "output": "Mild pulmonary edema." }, { "input": "Left chest wall pacing device is again noted. There is pulmonary vascular congestion which has progressed since prior. Small bilateral pleural effusions are noted. There is right basilar opacity potentially atelectasis. The cardiomediastinal silhouette remains stable. No acute osseous abnormalities identified.", "output": "Pulmonary edema slightly worse compared to prior with small effusions. Right basilar opacity potentially atelectasis, correlate clinically regarding possibility of superimposed infection." }, { "input": "Minimally increased interstitial markings in the lung bases likely represent mild interstitial pulmonary edema. There is no focal consolidation, pleural effusion, or pneumothorax. The left pectoral pacemaker and its leads project in unchanged location. Hyperinflation suggesting underlying COPD is unchanged. The cardiomediastinal silhouette, including mild cardiomegaly, is unchanged.", "output": "Probable mild pulmonary edema. No focal consolidation." }, { "input": "Transvenous pacer has been removed and replaced by a permanent pacemaker, with leads in the right atrium and right ventricle. The right ventricular lead has a more superior course than typical, and is more superiorly located than the recent temporary transvenous pacing lead. There is no evidence of pneumothorax. The heart is upper limits of normal in size. Large hiatal hernia is demonstrated with adjacent atelectasis. Small pleural effusions are present bilaterally.", "output": "Permanent pacemaker in place, with superior course of right ventricular lead as described. Dr. ___ was telephoned to discuss this finding at 8:55 a.m. on ___ at the time of discovery." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided demonstrate clear well-expanded lungs without focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures are intact. Right shoulder prosthesis is partially imaged.", "output": "No acute traumatic injuries seen." }, { "input": "PA and lateral chest radiographs are provided. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal. The imaged upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Lungs are well-expanded and clear without focal consolidation concerning for pneumonia. Pulmonary vasculature is within normal limits. There is no pneumoperitoneum. An acute fracture of left posterolateral rib 9 is noted.", "output": "Acute fracture of left posterolateral rib 9. No pneumothorax." }, { "input": "Patient is status post median sternotomy and CABG. Heart size is mildly enlarged. Prominence of the hila bilaterally is unchanged and is concerning for pulmonary arterial hypertension. There is mild pulmonary vascular congestion without overt pulmonary edema. Lungs are hyperinflated with mild emphysematous changes again noted. No focal consolidation, pleural effusion or pneumothorax is detected. Vascular calcifications are noted projecting over both lung apices.", "output": "Mild cardiomegaly with mild pulmonary vascular congestion." }, { "input": "The lungs are clear. No pleural effusion or pneumothorax. The cardiopericardial silhouette is borderline enlarged. A dual lead pacemaker is seen with leads in appropriate position. There is cortical irregularity of the left lower lateral ribs, likely chronic fractures.", "output": "No significant intrathoracic abnormality. Reviewed with Dr. ___." }, { "input": "PA and lateral views of the chest were obtained demonstrating clear well expanded lungs without focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours are normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest are obtained. A right arm PICC line is seen with its tip located in the expected position of the right brachiocephalic vein. There is a segment of coiled distal tubing, which may extend into the right IJ. The lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. There is no free air below the right hemidiaphragm.", "output": "No acute intrathoracic process. Right arm PICC line with distal segment partially coiled though tip in the expected position of the right brachiocephalic vein." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Mild degenerative changes are noted in the thoracic spine. Biliary stent is seen in the right upper quadrant of the abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Compared to prior, there is improvement of the diffuse airspace disease. Right upper and lower lobe opacities are likely residual pulmonary edema. No appreciable pleural effusion is seen. There is mild decrease in cardiomegaly, and the mediastinal and hilar contours. There has been interval removal of Swan-Ganz catheter. No pneumothorax is seen. Biapical thickening is unchanged.", "output": "Interval improvement of pulmonary edema. Remaining right upper and lower lobe ulna edema." }, { "input": "Cardiac silhouette is mild to moderately enlarged. The aorta is calcified and tortuous. Slight increased interstitial markings bilaterally raise concern for mild interstitial edema. There is also blunting of the left costophrenic angle posteriorly concerning for small pleural effusion. It is difficult to exclude trace right pleural effusion. No pneumothorax is seen.", "output": "Cardiomegaly, mild interstitial edema, and small left and possible trace right pleural effusions suggest component of CHF." }, { "input": "Underlying trauma board and other external artifact partially obscure the view. Endotracheal tube terminates approximately 3.7 cm above the level of the carina. There are low lung volumes. Medial right basilar opacity may relate to overlap of vascular structures versus consolidation. There is no pleural effusion or evidence of pneumothorax. The cardiac silhouette is top-normal to mildly enlarged. Mediastinal contours are unremarkable.", "output": "Underlying trauma board and other external artifact partially obscure the view. Endotracheal tube terminates approximately 3.7 cm above the level of the carina. There are low lung volumes. Medial right basilar opacity may relate to overlap of vascular structures versus consolidation. There is no pleural effusion or evidence of pneumothorax. The cardiac silhouette is top-normal to mildly enlarged. Mediastinal contours are unremarkable." }, { "input": "Lungs are clear. No focal consolidation, large effusion or pneumothorax. Cardiomediastinal silhouette appears stable with unchanged hilar prominence. No bony abnormalities.", "output": "No acute intrathoracic process." }, { "input": "Again there is a large right hydropneumothorax, which in comparison with prior exam is similar or just slightly improved. There is persistent collapse of the right lung. The chest tube is in unchanged position. The left lung is clear. The cardiomediastinal silhouette is normal.", "output": "Similar or very slightly improved appearance of the large right hydropneumothorax with persistent collapse of the right lung." }, { "input": "There is interval opacification of the right hemi thorax the left lung remains clear except for mild prominence of the bronchovascular markings. The left cardial mediastinal silhouette is unchanged. A radiopaque tube is projected over the lower right hemi thorax as before.", "output": "0pacification of the right hemi thorax consistent with continued accumulation of fluid in the right chest cavity." }, { "input": "AP and lateral views of the chest. There is complete opacification of the right hemithorax with left-sided mediastinal shift. The left lung is grossly clear. Cardiac silhouette cannot be assessed due to silhouetting on the right. No acute osseous abnormalities.", "output": "Complete whiteout of the right hemithorax with leftward mediastinal shift indicating some component of pleural effusion. Consider CT scan to further evaluate." }, { "input": "When compared to prior, there is no significant interval change. Again seen is a right hydropneumothorax which is similar compared to prior. Right lung atelectasis has slightly improved compared to prior. Endobronchial valves are seen adjacent to the hilum. The left lung is clear.", "output": "Persistent large right hydropneumothorax with atelectasis of the right lung somewhat improved since ___" }, { "input": "There is opacification of the right hemithorax as before. Bronchovascular markings are prominent on the left, as on the earlier study. Density at the left lung base appears somewhat increased. Mediastinal structures are unchanged. A chest tube remains in place on the right.", "output": "Interval increase in left basilar density which in the reflect developing parenchymal consolidation. No other change." }, { "input": "There is no appreciable interval change in complete whiteout of the right hemithorax despite the presence of a right sided chest tube. There is new mild pulmonary edema involving the left lung. The trachea and mediastinal structures are not significantly displaced. A moderate layering left pleural effusion has increased. The heart and mediastinum cannot be accurately assessed.", "output": "No appreciable interval change in complete opacification of the left hemithorax, which is due to a combination of post obstructive collapse and large pleural effusion. New mild pulmonary edema. Increased moderate layering left pleural effusion." }, { "input": "Again, there is a large right hydropneumothorax. Overall, the size appears slightly decreased from prior exam with an associated mild increase in expansion of the right lung. The right-sided chest tube is unchanged. The left lung is clear. The cardiomediastinal silhouette is normal.", "output": "Slight interval decrease in size of the large right hydropneumothorax." }, { "input": "Lungs well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is top normal in size.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are slightly reduced. Heart size is mildly enlarged. The aorta is unfolded. The mediastinal and hilar contours are otherwise unremarkable. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. There is mild loss of height of the T12 vertebral body which is unchanged.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process. No significant interval change." }, { "input": "Compared with earlier the same day, the right IJ line which had been seen as coiled over the right heart has been removed. A right IJ sheath or catheter is present, tip over mid/ distal SVC. There is a right subclavian PICC line, with tip over distal SVC. No pneumothorax is detected . Apparent ET tube, with tip approximately 5.0 cm above the carina. NG tube present, tip extending beneath diaphragm, off film. The side port also extends beneath the GE junction. Cardiomediastinal silhouette is unchanged. No overt CHF. Some patchy opacity in the retrocardiac region is similar to the prior film. There is minimal subsegmental atelectasis at the left greater than right lung bases. The lungs are out otherwise grossly clear. No effusions identified. The right hemidiaphragm is slightly elevated, unchanged. Apparent artifactual ___ line along the right mediastinum and right heart border. Again seen are multiple drains and tubes over the right upper abdomen, with surgical ___, best correlated with details of the or relevant procedural history.", "output": "1. Interval removal of previously seen coiled right IJ line. Lines and tubes currently nominal in appearance. 2. No pneumothorax detected. 3. Otherwise, I doubt significant interval change. 4. Left lower lobe collapse and/or consolidation with air bronchograms is similar to the film obtained earlier today." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal and the lungs are clear. No focal consolidation, pleural effusion or pneumothorax is present. No displaced rib fracture is visualized.", "output": "No acute cardiopulmonary abnormality. No displaced rib fracture identified. If there is continued concern for a rib fracture, consider a dedicated rib series." }, { "input": "Lungs are well expanded and clear. There is no pneumothorax or pleural effusion. Cardiomediastinal silhouette is unremarkable. Visualized osseous structures are unremarkable. Radiopaque surgical material is noted in the right upper quadrant.", "output": "Unremarkable chest radiograph with no evidence of acute pulmonary or cardiac process." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. The lungs are clear of focal consolidation or effusion. Increased opacity in the retrocardiac region on the frontal and lateral raises the possibility of a hiatal hernia. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Surgical clips project over the left upper quadrant of the abdomen as well as in the midline of the epigastrium.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "There is no evidence for lobar consolidation, pleural effusion, pneumothorax, or overt pulmonary edema. The cardiomediastinal silhouette is unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs are clear. There is no effusion or pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormality detected.", "output": "Normal chest x-ray." }, { "input": "PA and lateral views of the chest demonstrate no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal. There are atherosclerotic calcifications at the aortic knob. Apparent post-surgical hardware is visualized in the mid-thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. The mediastinal silhouette and hilar contours are normal. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities demonstrated.", "output": "No acute cardiopulmonary process." }, { "input": "Compared to the prior film, the Swan-Ganz catheter and mediastinal drain have been removed. Again seen is sternotomy, with mild prominence the cardiomediastinal silhouette, unchanged. Also again seen is left lower lobe collapse and/or consolidation, similar to the prior film. Minimal atelectasis right base is also similar. There is upper zone redistribution, without overt CHF. Minimal blunting of left costophrenic angle is more pronounced on the current film.", "output": "1. Small left effusion is newly visible. 2. Interval removal of Swan-Ganz catheter and mediastinal drain. 3. Otherwise, I doubt significant interval change. 4. Left lower lobe collapse and/or consolidation is similar to the prior film. No new area of opacity to suggest new superimposed pneumonia is detected." }, { "input": "Compared to the prior study there is no significant interval change in the location of the Swan-Ganz catheter. The ET tube has been removed. Mediastinal drains are still present. There is volume loss at both bases, left greater than right. But the aeration in the lower lobes is improved compared to the study from the prior day", "output": "Slight improved appearance to the lung" }, { "input": "The lungs are well-expanded. The heart is top-normal in size. There is no pneumothorax or large pleural effusion. Prominence of the pulmonary vascular markings, with mild peribronchial cuffing is noted. No focal consolidation worrisome for pneumonia is present.", "output": "Mild pulmonary edema." }, { "input": "The inspiratory lung volumes are appropriate. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The pulmonary vasculature is not engorged. The cardiac silhouette is mildly enlarged, which is unchanged from ___. Prominence of the right supracardiac mediastinal contour is likely due to enlargement of the ascending aorta, which is also stable. The hilar contours are within normal limits. No acute osseous abnormality is detected.", "output": "1. No acute cardiopulmonary process. 2. Stable mild cardiomegaly and enlargement of the ascending aorta, unchanged from ___." }, { "input": "PA and lateral views of the chest provided. Overlying EKG leads are present. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral chest radiographs were obtained. There is interval improvement in the previous opacities in the right upper and mid lung zones. A small area of opacification remains in the right upper lobe. There is now a hyperlucent zone at the right lung base, but no evidence of pneumothorax. A small right pleural effusion has developed with associated compressive basilar atelectasis. The left lung is fully expanded and clear. Cardiomediastinal silhouette and hilar contours are stable. A Dobbhoff tube terminates in the first part of the duodenum. It is looped twice in the fundus of the stomach.", "output": "1. Interval improvement in right upper and mid lung zone opacities, with a small area of opacification remaining. 2. Hyperlucent zone at right lung base but no pneumothorax. 3. New small right pleural effusion with basilar atelectasis." }, { "input": "There is a new Dobbhoff tube which appears to terminate in the first part of the duodenum. The heart size is normal. There has been interval worsening of the consolidations overlying the right mid and lower lung zones. There is a stable small left pleural effusion, however slight interval worsening of the mild bibasilar atelecatsis and small right pleural effusion. Note is made of slight interval worsening of the pulmonary vascular congestion. The visualized osseous structures are unremarkable.", "output": "1. Dobbhoff tube tip terminates likely in the first part of the duodenum. 2. Interval increase in consolidations overlying the mid and upper right lung segments, concerning for pneumonia." }, { "input": "No interval change in the dobbhoff tube which loops once in the fundus and ends in the first part of the duodenum. Interval filling of the hyperlucent area in the right lung base, as seen on this single AP chest view. No additional significant change. Stable small right pleural effusion. No new focal opacity, pneumothorax, pulmonary edema or left pleural effusion. Heart size, mediastinal contours and hila are normal. No bony abnormality.", "output": "1. Interval filling of right hyperlucent area. 2. No pneumonia." }, { "input": "AP upright and lateral views the chest provided demonstrate cardiomegaly without signs of congestion or edema. No large effusion or pneumothorax. No convincing evidence for pneumonia. A pectus excavatum deformity of the sternum is noted. Degenerative spurring is noted in the thoracic spine.", "output": "Cardiomegaly, no signs of pneumonia." }, { "input": "Lung volumes are low. There is increased right pleural effusion, persistent right lower lobe atelectasis, and new right middle lobe atelectasis. Pulmonary vascular congestion and pulmonary edema have improved minimally. Mediastinal widening is consistent with elevated central venous pressures. Stable moderate cardiomegaly. There is no pneumothorax. The right IJ central venous catheter terminates at the distal SVC. There is an enteric tube extending into the stomach with distal tip not visualized. The ET tube is positioned at the thoracic inlet 6 cm above the carina. For more secure positioning, the ET tube could be advanced 2cm.", "output": "1. Increased right pleural effusion and right basal atelectasis. 2. Minimal improvement, pulmonary vascular congestion and edema. 3. The ET tube is positioned at the thoracic inlet. For more secure positioning, the ET tube could be advanced 2cm." }, { "input": "Lung volumes are unchanged compared to the prior study. The trachea is central. An nasogastric tube terminates in the stomach. The cardiomediastinal contour is unchanged. There is persistent mild bibasilar atelectasis, there may be small bilateral pleural effusions. No consolidation seen. Mild pulmonary vascular congestion persists.", "output": "Nasogastric tube terminates in the stomach. Otherwise, no significant interval change when compared to the prior study." }, { "input": "The patient has been intubated since the prior study, the tip of the endotracheal tube is 4 cm above the level the carina. A nasogastric tube is in-situ, the tip is in the stomach. There is bibasilar atelectasis, similar in degree compared to the prior study. Even allowing for the projection, the heart appears enlarged and there is haziness of the pulmonary vasculature consistent with mild pulmonary vascular congestion. No consolidation or pneumothorax seen.", "output": "The endotracheal tube is in appropriate position. Otherwise, no significant interval change when compared to the prior study." }, { "input": "An endotracheal and nasogastric tube are unchanged in appearance compared to the prior study. There has been interval placement of a right internal jugular catheter. No pneumothorax seen. No pleural effusion seen. There is persistent left basilar atelectasis. Otherwise, there has been no significant interval change.", "output": "The right internal jugular catheter terminates in the distal SVC." }, { "input": "There are diffuse bilateral parenchymal opacities most confluent on the right perihilar region but seen bilaterally and throughout the lungs with some peripheral sparing on the right. There is no effusion. There is mild enlargement cardiac silhouette as well as apparent enlargement of the main pulmonary artery. No acute osseous abnormalities.", "output": "Diffuse bilateral parenchymal opacities throughout the lungs which could represent multifocal or atypical infection although edema is possible. Mild enlargement of cardiac silhouette potentially due to underlying cardiomegaly although pericardial effusion is possible. Probable enlargement of main pulmonary artery as well which can be seen in setting of pulmonary hypertension." }, { "input": "PA and lateral views of the chest provided. The trachea is midline. There is no evidence of pneumomediastinum. No radiopaque foreign body is seen. Lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Subcentimeter rounded calcified opacity projecting over the left upper lung may represent a calcified granuloma. No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac silhouette is top-normal. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process 2" }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax. Incidental note is made of an azygos fissure.", "output": "No acute cardiopulmonary process." }, { "input": "An ET tube is in place terminating approximately 5 cm from the carina. An NG tube courses into the stomach. The cardiac size is normal. There is no pneumothorax. There is large retrocardiac opacity as well as a right lower lobe opacity concerning for aspiration or pneumonia in the correct clinical setting. There is cephalization of vessels indicating fluid overload.", "output": "1. Appropriate positioning of support devices 2. Bibasilar opacities compatible with pneumonia or aspiration 3. Mild fluid overload" }, { "input": "The lateral view it is slight suboptimal due to external artifact projecting over the posterior chest. There are relatively low lung volumes. No definite focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac silhouette is top-normal to mildly enlarged. There may be minimal vascular congestion.", "output": "Possible minimal pulmonary vascular congestion. No focal consolidation." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. Clips are demonstrated in the right upper quadrant of the abdomen.", "output": "No acute cardiopulmonary process." }, { "input": "The right-sided mediastinal mass is again visualized. Right chest tube is been removed. There is a small right inferior pneumothorax. There is an 8 mm opacity that projects over the left first rib anteriorly. This was not present on the prior studies and is felt to be bony in the etiology. The left lung is clear", "output": "New small right inferior pneumothorax" }, { "input": "A right chest port terminates in the mid SVC. The cardiomediastinal contours are remarkable for unchanged prominence of the right mediastinal contour corresponding to a known anterior mediastinal soft tissue abnormality on prior PET-CT of ___. The lungs are clear. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Interval removal of the left PICC. Right hilar mass is smaller. No cardiomegaly. Fully expanded, clear lungs. No definite osseous abnormalities.", "output": "Decrease in size of right hilar mass." }, { "input": "A portable frontal chest radiograph again demonstrates cardiomegaly. Bilateral opacities are consistent with pulmonary edema, increased compared to prior exam. No definite focal consolidation is identified, although an infectious process superimposed on the underlying edema cannot be excluded. There is likely a right pleural effusion. No pneumothorax is seen.", "output": "1. Worsened pulmonary edema. 2. Right pleural effusion. NOTIFICATION: These findings were discussed via telephone by Dr. ___ ___ with Dr. ___ at ___ on ___." }, { "input": "One portable semi-upright AP view of the chest. The mediastinal contours are widened, likely exaggerated by the portable technique of the film. The right hilum is full, concerning for possible mass. No definite focal consolidations are seen. No large pleural effusion or pneumothorax.", "output": "Right hilar opacity and mediastinal widening concerning for possible mass. Recommend CT for further assessment. No definite focal consolidation. These findings were discussed with Dr. ___ at 8:20am on ___ by telephone." }, { "input": "Lung volumes are low. There is minimal bibasilar atelectasis and/or scarring. Widening of the mediastinum is not significantly changed, nor is fullness of the right hilum. The heart size is normal. There are no pleural effusions. No pneumothorax is seen.", "output": "1. No acute cardiac or pulmonary process. 2. Unchanged fullness of the right hilum, raising concern for an underlying mass. Evaluation with CT was previously recommended on the radiograph report from ___." }, { "input": "Frontal and lateral views of the chest are obtained. There is lingular consolidation, worrisome for pneumonia. The right lung is clear. No pleural effusion or pneumothorax is seen. The cardiac silhouette is not enlarged. The mediastinal and hilar contours are unremarkable.", "output": "Lingular consolidation with possible involvement of the inferior left upper lobe, worrisome for pneumonia." }, { "input": "The lung volumes are low. No focal opacity, pulmonary edema, pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal.", "output": "Clear lungs. Normal heart size." }, { "input": "Frontal and lateral radiographs of the chest were acquired. The lungs are clear. The heart size is normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen.", "output": "No acute cardiac or pulmonary process." }, { "input": "There increased areas of patchy opacity in both lower lungs with ill definition of the left hemidiaphragm compatible with volume loss/ infiltrate/effusion. the appearance of the PICC line is unchanged", "output": "Given history of probable aspiration the findings could be due to aspiration pneumonia or infectious process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation effusion or pneumothorax. Overlying EKG leads are present somewhat limiting evaluation. The cardiomediastinal silhouette is normal. The imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "There are subtle bilateral peribronchial opacities, which are new since the CXR dated ___. Lateral view also demonstrates a linear opacity projecting over the heart, suggesting a middle lobe process. Lung bases on CT abdomen ___ are clear. No pleural effusions or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. The right port is unchanged in position and terminates at the cavoatrial junction.", "output": "New bilateral peribronchial opacities, concerning for infectious process particularly in an immunocompromised patient. Recommend CT Chest for further evaluation. If any concern for pulmonary embolism, obtain CTA Chest instead. NOTIFICATION: Findings telephoned to ___, NP, by Dr. ___ on ___ at 3:55PM, approximately 5 minutes after discovery." }, { "input": "Heart size, mediastinal and hilar contours are normal. Lungs and pleural surfaces are clear, and there is no acute skeletal abnormality.", "output": "No radiographic evidence of pneumonia. Please note that the subtle lung abnormalities on recent CT may be below the resolution of conventional chest radiographs." }, { "input": "Right-sided Port-A-Cath tip terminates in the high right atrium. Heart size is normal. Cardiomediastinal silhouette and hilar contours are normal. Increased density at the left lung base is compatible with pneumonia. Lungs are otherwise clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "Increased left lung base density on frontal view without lateral correlate suspicious for left lower lobe pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 4:26 PM, 20 minutes after discovery of the findings." }, { "input": "A Port-A-Cath terminates in the lower superior vena cava. The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "There is increased opacity in the left lower lobe overlying the lower thoracic spine, which is suspicious for left lower lobe pneumonia. There is no pleural effusion, or pneumothorax. Cardiomediastinal and hilar silhouettes are normal size.Right pectoral infusion port terminates at cavoatrial junction.", "output": "Possible left lower lobe pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 11:03 AM." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for pneumonia. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No acute intrathoracic abnormalities identified." }, { "input": "Faint ground-glass opacities in the left upper lobe and lingula noted on CT are not clearly demonstrated on the radiograph. Otherwise, the lungs are clear. Cardiac and mediastinal silhouettes are normal. No acute fractures identified.", "output": "Ground-glass opacities noted in the left upper lobe and lingula on CT from ___ are better delineated on that CT. Otherwise, no interval change." }, { "input": "PA and lateral views of the chest. The lungs are clear. The cardiomediastinal silhouette is normal. No osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "A right Port-A-Cath ends in the low superior vena cava. The lungs are clear without focal opacity, pulmonary edema, pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal. There is no free air beneath the right hemidiaphragm.", "output": "No acute cardiopulmonary process. NOTIFICATION: Wet read called to ___ by ___ at ___ ___." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. The lungs are clear. Cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs are hyperinflated with emphysematous changes again noted, most pronounced in the lung apices. Cardiac, mediastinal and hilar contours are unchanged without evidence for pulmonary edema. Known esophageal malignancy is better assessed on the prior CT. Streaky opacities in the lung bases may reflect aspiration, atelectasis or infection. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities identified.", "output": "Bibasilar patchy opacities could reflect aspiration, atelectasis or infection. Severe emphysema. Known esophageal malignancy better assessed on prior CT." }, { "input": "Frontal lateral radiographs demonstrate well aerated, somewhat hyperinflated lungs which are clear. A left hilar mass is unchanged. There are tiny bilateral pleural effusions. No pneumothorax is visualized.", "output": "1. No evidence of pneumonia or pneumothorax. Tiny bilateral pleural effusions. 2. Unchanged left hilar mass. These findings were communicated via telephone by Dr. ___ with Dr. ___ at ___ on ___." }, { "input": "The lungs are hyperinflated and clear. Severe emphysematous changes are noted. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Patient is slightly rotated. There is mild right lower lobe atelectasis. No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable. Limited assessment of the osseous structures is notable for mild leftward curvature of the thoracic spine.", "output": "1. No acute cardiopulmonary process. 2. Mild leftward curvature of thoracic spine may be positional however is suspicious for scoliosis. 3. Although no fracture is seen, conventional chest radiographs are not appropriate for detection or characterization of chest cage lesions. Any focal findings should be clearly marked and imaged with either bone detail views or CT scanning (performed subsequently)." }, { "input": "Cardiac silhouette size is top normal. The aorta remains unfolded. Mediastinal contour remains unchanged. New focal consolidative opacity is seen in the left lower lobe concerning for pneumonia. Linear opacities in the right mid lung and lung base are unchanged, likely reflective of areas of scarring. Emphysematous changes are again noted with bilateral pleural parenchymal scarring in the lung apices. There is no pulmonary vascular congestion, pleural effusion or pneumothorax. No acute osseous abnormality is detected.", "output": "Left lower lobe pneumonia. RECOMMENDATION(S):Followup radiographs after treatment are recommended to ensure resolution of this finding." }, { "input": "Relatively linear left mid to lower lung opacity is again seen, potentially scarring from prior infection. Linear right mid lung opacities are likely atelectasis versus scarring is well. Biapical scarring is also noted. The lungs are without new consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac silhouette is mildly enlarged. The mediastinal silhouette and hilar contours are unremarkable. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Patchy right lower lobe opacity is new and accompanied by mild bronchial wall thickening. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Left subclavian catheter is unchanged in position.", "output": "Findings concerning for early pneumonia in the right lower lobe." }, { "input": "Mild enlargement of the cardiac silhouette is present. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. Clips are noted within the upper abdomen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. A subtle patchy left basilar retrocardiac opacity is seen, nonspecific, could be due to atelectasis, although a pneumonia is not excluded in the appropriate clinical setting. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are stable and unremarkable. Old right-sided rib deformity at approximately the right lateral eighth rib is noted.", "output": "Patchy left basilar retrocardiac opacity could be due to atelectasis or pneumonia." }, { "input": "No consolidation. Left hilar and mediastinal regions have normal postoperative appearance unchanged from prior. No pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No pneumonia. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 11:21 AM, 5 minutes after discovery of the findings." }, { "input": "The right lung is clear. Post-surgical changes are noted in the left lung with elevation of the left hemidiaphragm and rightward deviation of normally midline structures as expected after completion left upper lobectomy. Tiny left pleural effusion may be present. Cardiac silhouette is unremarkable.", "output": "Tiny left pleural effusion with expected post-surgical appearance to the left lung." }, { "input": "New right-sided Port-A-Cath tip ends at mid SVC. Both lungs are clear. There is no pleural effusion or pneumothorax. Surgical clips are seen over left lower chest, probably from prior breast surgery. Heart size, mediastinal and hilar contours are normal.", "output": "New right-sided Port-A-Cath tip is at mid SVC. No pneumothorax or pleural effusion." }, { "input": "There are minor bibasilar atelectatic changes, greater on the right than the left. Otherwise, the lungs are without a focal consolidation or effusion. There is no pneumothorax. Right chest wall port appears stable with catheter tip at the mid SVC. Surgical clips are noted in the left chest anteriorly.", "output": "Bibasilar atelectasis, right greater than left. If clinical suspicion for an acute infection is high, a dedicated chest CT is recommended for further characterization." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. Right chest wall port is again seen with catheter tip in the mid SVC. The lungs are clear of focal consolidation. Cardiomediastinal silhouette is within normal limits. Surgical clips are seen within the left chest anteriorly. Osseous and soft tissue structures are otherwise unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are hyper expanded. Heart size is within normal limits.Mediastinal and hilar contours are unremarkable. There is no evidence for pulmonary edema, pulmonary consolidation, pleural effusion, or pneumothorax. There is been interval removal of the right-sided port. Surgical clips are again noted in the left anterior chest.", "output": "No acute cardiopulmonary abnormalities. No evidence of prior or active TB." }, { "input": "The heart size is normal. The hilar and mediastinal contours are unremarkable. The lungs are clear without evidence of focal consolidations, pleural effusions or pneumothoraces. The visualized osseous structures are unremarkable.", "output": "No acute abnormalities identified." }, { "input": "The lungs are well expanded, and clear. The pleural surfaces are normal without pneumothorax. The cardiac silhouette is top normal in size, the mediastinal contours are normal.", "output": "No acute chest abnormality." }, { "input": "Low lung volumes accentuate heart size which is top-normal, unchanged dating back to ___. Increased opacity at the right base that may be related to atelectasis from low lung volumes; however, consolidation is also possible. No pleural effusion or pneumothorax.", "output": "1. Top normal heart size unchanged from ___. 2. Increased opacity at the right lung base may be atelectasis from low lung volumes; however, early pneumonia is also possible. Recommend oblique views to further evaluate. NOTIFICATION: Telephone notification to Dr. ___, ___ primary care doctor, ___ ___. ___ at 10:55 on ___." }, { "input": "The heart is at the upper limits of normal size. The mediastinal and hilar contours appear within normal limits. Patchy right infrahilar opacity has remained the same and so is probably due to minor atelectasis or scarring. Otherwise, the lungs appear clear. There are no pleural effusions or pneumothorax. Slight degenerative changes are similar along the thoracic spine.", "output": "No evidence of acute disease." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vascularity is is normal. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Clips are noted within the upper abdomen. No free air is seen under the diaphragms.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. Bony structures appear intact.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. A dual lumen right-sided central venous catheter is seen terminating in the right atrium. Since the prior study, there has been interval development of a small-to-moderate right pleural effusion with overlying atelectasis. The left lung is clear. No pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "Interval development of small-to-moderate right pleural effusion with overlying atelectasis." }, { "input": "Frontal and lateral views of the chest were obtained. Left-sided hemodialysis catheter terminates in the right atrium. Heart size is normal and cardiomediastinal contours are stable. Right-sided pleural effusion has decreased, now small to moderate in size. Pulmonary vascular marking are prominent, consistent with mild edema. Linear opacities in the right lung base are most consistent with atelectasis. No pneumothorax.", "output": "Decreased size of right pleural effusion, now small to moderate in size, with adjacent atelectasis. Mild pulmonary edema." }, { "input": "AP single view of the chest has been obtained with patient in sitting semi-upright position. Analysis is performed in comparison with the next preceding similar study of ___. On AP frontal view, appearance of previously described HD catheter unchanged. Heart size not increased. The right-sided pleural effusion appears to have increased again and is now resulting in diffuse basal haze overlying the right lower lobe structures as the fluid apparently is layering in the posterior pleural compartments. There is no evidence of new discrete local pulmonary parenchymal infiltrates which can be identified on this single AP portable chest view. Had a lateral view been repeated similar as ordered on yesterday's examination, the increasing degree of right-sided pleural effusion could have been assessed more appropriately and a possible pneumonia been eliminated with greater assurance.", "output": "Increased pleural effusion on right side, no evidence of new acute infiltrate seen on single AP chest view." }, { "input": "Single frontal view of the chest was obtained. New NG tube terminates below the diaphragm. Large-bore right central catheter has been removed. Right pleural effusion has increased, now moderate to large, and has apparent loculated components at the right base and major fissure. New mild pulmonary edema. Upper lobe predominant emphysema is unchanged. Heart size is normal.", "output": "1. Increased partially loculated right pleural effusion, now moderate to large in size. 2. New NG tube terminates below the diaphragm." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear unchanged including mild unfolding of the thoracic aorta. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "PA and lateral views of the chest provided. Heart appears top-normal in size. Mediastinum appears normal. Lungs are clear without focal consolidation, large effusion or pneumothorax. No signs of congestion or edema. Imaged bony structures are intact. No free air below the right hemidiaphragm.", "output": "Mild cardiomegaly without signs of edema." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiomediastinal silhouette is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac silhouette is borderline enlarged. The mediastinal and hilar contours are stable and unremarkable. There is no pleural effusion or pneumothorax. The lungs are clear besides left lower lung atelectasis. No subdiaphragmatic free air is noted.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. The lungs appear clear bilaterally without definite signs of pneumonia or overt CHF. The heart size is top normal. The mediastinal contour is normal. No large effusion or pneumothorax is seen. The bony structures appear intact.", "output": "No signs of fluid overload." }, { "input": "The heart is borderline in size. The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Frontal and lateral views of the chest. There are bibasilar opacities, slightly asymmetric and more conspicuous on the right than on the left. This may be due to chronic underlying lung disease as seen on prior chest CT and has not significantly changed. Superiorly the comment the lungs are clear. Cardiomediastinal silhouette is unchanged and within normal limits. Median sternotomy wires again seen. No acute osseous abnormality detected.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest were acquired. The patient is status post midline sternotomy and CABG. The lungs are clear. The heart size is at the upper limits of normal, unchanged. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen. Multilevel degenerative changes of the thoracolumbar spine are noted.", "output": "No acute cardiac or pulmonary process." }, { "input": "There is a retrocardiac opacity silhouetting the medial hemidiaphragm which may be due to atelectasis. The lungs are otherwise clear without focal opacity, pulmonary edema, pleural effusion or pneumothorax. Cardiomegaly is mild. The aorta is tortuous. Mid thoracic vertebral body height loss is noted, age indeterminate.", "output": "Mild cardiomegaly. Retrocardiac opacity, potentially atelectasis noting infection cannot be excluded. Mid thoracic compression deformities, age indeterminate." }, { "input": "PA and lateral views of the chest provided. Lungs are hyperinflated with flattened diaphragms suggesting COPD. Lungs are clear without focal consolidation, large effusion or pneumothorax. Cardiomediastinal silhouette appears normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "COPD, no superimposed pneumonia." }, { "input": "Lungs are hyperinflated but clear. The cardiomediastinal silhouette and hilar contours are stable. There is no pleural effusion or pneumothorax. Two rounded opacities projecting over the lung bases are likely nipple shadows.", "output": "Findings consistent with COPD without acute process." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are well expanded and clear without focal consolidation, pleural effusion or pneumothorax. Heart size is normal. Mediastinal silhouette and hilar contours are normal. There is no air under the diaphragm. No osseous abnormality is identified.", "output": "Normal chest radiographs." }, { "input": "Single portable supine frontal view chest. Lung volumes low compared to prior exams, with mild bronchovascular crowding. The lungs are otherwise clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are normal. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal opacity, pulmonary edema, pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal. There is no free air beneath the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lung fields are clear. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable.", "output": "Normal chest radiograph" }, { "input": "When compared to prior, there has been no significant interval change. The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "Normal chest x-ray." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are unremarkable. The lungs are grossly clear. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "AP upright portable view of the chest was obtained. There are dual-lead left-sided pacer device with lead extending in the expected position of the right atrium and right ventricle. Midline tracheostomy is seen. There is a right subclavian central venous catheter, distal aspect not well appreciated due to the overlapping structures, but likely terminating at the cavoatrial junction/proximal right atrium. What appears to be a weighted enteric tube is seen coursing into the left upper quadrant in the expected location of the proximal stomach. The patient is status post median sternotomy and CABG. There are small-to-moderate bilateral pleural effusions with overlying atelectasis. No pneumothorax is seen. Subtle haziness of the left mid lung zone may relate to layering pleural effusion. However, ground-glass opacity, with subtle infectious process is not excluded. There appears to be a left-sided PICC, distal aspect not well seen, but likely terminating in the proximal SVC.", "output": "Lines and tubes as above. Bilateral pleural effusions with overlying atelectasis. Subtle ground-glass opacity projecting over the left mid lung may be due to layering pleural effusion; however, infectious process not entirely excluded. Attention at followup." }, { "input": "The cardio mediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is no focal consolidation. Views of the upper abdomen are unremarkable.", "output": "No evidence of pneumonia." }, { "input": "No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable. No overt pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable. There is no widening of the mediastinum. No pulmonary edema is seen. No displaced fracture is identified.", "output": "No acute cardiopulmonary process. The mediastinum is not widened." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Cardiac silhouette size is normal.", "output": "No acute cardiopulmonary process. Cardiac silhouette size is normal." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. The lungs are clear of consolidation or pneumothorax. There is mild blunting of one of the posterior costophrenic angles, potentially due to trace effusion, likely on the right. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "Trace probable right pleural effusion without other acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. No pleural effusion, focal consolidation or pneumothorax. No pulmonary edema. Partially imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. Heart size is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are seen.", "output": "No acute cardiopulmonary abnormality present." }, { "input": "Possible minimal left base atelectasis without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is mild relative elevation of the left hemidiaphragm with streaky basilar opacification suggesting atelectasis, overall with volume loss, but an infectious process could be considered, particularly regarding a patchy left lower lobe opacity on the lateral view. There is no pleural effusion or pneumothorax. The cardiac, mediastinal and hilar contours appear within normal limits.", "output": "Patchy left lower lobe opacity. This may be consistent with pneumonia, but atelectasis could also be considered as the etiology, in the appropriate clinical setting." }, { "input": "AP and lateral views of the chest. There is mild indistinctness of the pulmonary vasculature more pronounced than prior portable film from ___. The lungs are clear of confluent consolidation or large effusion. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "Mild pulmonary vascular congestion. No focal consolidation." }, { "input": "Single portable view of the chest. Endotracheal, enteric, and chest tubes are no longer seen. Right IJ central line is unchanged. Low lung volumes seen on the current exam. The lungs however are grossly clear. There is no visualized pneumothorax. Postoperative changes of median sternotomy again noted.", "output": "Interval removal of the bilateral chest tubes. No visualized pneumothorax." }, { "input": "AP and lateral views of the chest were reviewed. Median sternotomy wires and CABG clips are unchanged. The heart size is normal. The mediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. Again seen is left basilar atelectasis, recurrent over multiple prior studies. There is no focal consolidation concerning for pneumonia. Pulmonary vasculature is within normal limits.", "output": "Left basilar atelectasis, which has been present intermittently over multiple prior studies, raising the question of left diaphragm paralysis. No pneumonia." }, { "input": "The patient is status post median sternotomy and CABG. Heart size remains normal. Mediastinal and hilar contours are unchanged. The pulmonary vascularity is normal. Elevation left hemidiaphragm is stable. Retrocardiac opacity is nonspecific and could reflect atelectasis, pneumonia or aspiration. No large pleural effusion or pneumothorax is identified. There are mild degenerative changes in the thoracic spine.", "output": "Elevated left hemidiaphragm with adjacent retrocardiac opacity likely reflecting atelectasis though infection or aspiration cannot be excluded." }, { "input": "Frontal and lateral radiographs were acquired of the chest. As before, the patient is status post midline sternotomy and CABG. Elevation of the left hemidiaphragm is increased compared to the prior study from ___. Streaky left lower lung opacities are likely atelectases, although could be aspiration or pneumonia in the appropriate clinical setting. There are no definite pleural effusions. No pneumothorax is seen. The heart size is normal. The mediastinal contours are normal. There are multilevel flowing anterior osteophytes, suggestive of DISH.", "output": "Increased elevation of the left hemidiaphragm, likely partially accounting for the decreased breath sounds on physical exam. Adjacent left lower lobe opacities could be atelectasis, although aspiration or pneumonia could be considered in the appropriate clinical setting." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is within normal limits. Median sternotomy wires and mediastinal clips are noted. Hypertrophic changes are seen in the spine.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs were obtained. Heart is top normal size and cardiomediastinal contours are unremarkable. Lungs are slightly low in volume but clear. No focal area of consolidation to suggest acute pneumonia. No pleural effusions and no pneumothorax. Osteophytes are noted along the spine.", "output": "No focal consolidation to suggest acute pneumonia; however, in an immunocompromised patient, CT scan is indicated if there is high suspicion for infection." }, { "input": "PA and lateral views of the chest. The lungs are clear, there is no effusion or pulmonary vascular congestion. Cardiomediastinal silhouette is unchanged. Hypertrophic changes again noted in the spine. Degenerative changes noted at the right acromioclavicular joint.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Subtle patchy retrocardiac airspace consolidation is noted compatible with left lower lobe pneumonia. No large effusion or pneumothorax is seen. The right lung appears largely clear. Cardiomediastinal silhouette appears normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Findings compatible with left lower lobe pneumonia." }, { "input": "AP and lateral radiographs obtained. Examination is limited by motion and body habitus. Within this limitation, cardiomediastinal and hilar contours are unchanged. Dense calcifications are noted within the aortic arch. Limited assessment of the lung bases due to body habitus on the frontal view. There is no definite opacification evident on the motion-degraded lateral views. No pleural effusion or pneumothorax is present. A wedge deformity of the mid thoracic, age indeterminate.", "output": "Limited assessment given body habitus and motion. No definite lung opacification identified. No pleural effusion. Age-indeterminate mid thoracic compression deformity." }, { "input": "Single frontal semi-erect AP portable view of the chest was obtained. There are prominent bilateral predominantly perihilar opacities which may be due to severe pulmonary edema/ARDS, possible multifocal infection. There is blunting of the costophrenic angles and small pleural effusions are not excluded. The cardiac silhouette is likely top normal to mildly enlarged, although not well assessed due to right lung base opacities. Aortic knob is calcified. No evidence of pneumothorax is seen.", "output": "Extensive perihilar opacities raise concern for severe pulmonary edema/ARDS, possible multifocal infection. Blunting of the costophrenic angles, small pleural effusions not excluded." }, { "input": "Left chest wall pacing device is noted. The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. Median sternotomy wires and mediastinal clips are noted. Degenerative changes noted at the acromioclavicular joints bilaterally.", "output": "No acute cardiopulmonary process." }, { "input": "Left-sided IJV CVP in situ with the tip in the proximal to mid SVC. Pulmonary hyperinflation with emphysematous changes seen in the upper lung zones. The heart size is normal. Marked bibasilar (right more than left) airspace consolidation again visualized which shows mild progression compared to prior imaging. Findings are concerning for aspiration pneumonia.", "output": "Mild progression of the multi focal pneumonia" }, { "input": "There has been interval placement of a left internal jugular central venous catheter which terminates in the mid SVC without evidence of pneumothorax. The lungs are hyperinflated, consistent with chronic obstructive pulmonary disease. Relative lucency over the upper chest consistent with pulmonary emphysema. Re- demonstrated are bibasilar, right greater than left, consolidations worrisome for multifocal pneumonia and/ or aspiration. The right base consolidation appears slightly more consolidated as compared to 3 hr prior. No large pleural effusion is seen. There is no evidence of pneumothorax. Cardiac and mediastinal silhouettes are stable.", "output": "Left internal jugular central venous catheter terminates in the mid SVC without evidence of pneumothorax. Right greater than left bibasilar consolidations, slightly more consolidative on the right, worrisome for multifocal pneumonia and/ or aspiration. Re- demonstrated pulmonary emphysema. ." }, { "input": "2 views were obtained of the chest. The lungs are low in volume with basilar atelectasis. There is no pleural effusion, focal consolidation or pneumothorax. The heart is unchanged in size with normal cardiomediastinal contours.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest demonstrate low lung volumes with persistent mild bibasilar atelectasis. There is no evidence of focal opacity, pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable and the heart size is stable.", "output": "No acute cardiopulmonary process." }, { "input": "Comparison is made to prior study from ___. The right IJ central line has been removed. The heart size is normal. Lungs are clear. Bony structures are intact.", "output": "No signs for acute cardiopulmonary process." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process. Results were discussed with ___, Dr. ___ ___, at 10:45 a.m. on ___ via telephone by Dr. ___ at the time the findings were discovered." }, { "input": "Normal heart size, mediastinal and hilar contours. No focal consolidation, pleural effusion or pneumothorax.", "output": "Normal chest radiograph" }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "Frontal and lateral views of the chest were obtained. No new focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. There is no overt pulmonary edema.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. A curvilinear density projecting over right breast, may relate to calcifications associated with the breast prosthesis, unchanged since prior.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs are well expanded bilaterally. There is a focal subtle opacity in the right upper lung zone, seen best on the frontal view and may represent pneumonia. Otherwise, lungs are clear bilaterally with no other areas of focal consolidation, no pleural effusion, no masses or lesions. There is no pneumothorax. The cardiomediastinal silhouette is normal. The pleural surfaces are unremarkable.", "output": "Right upper lung zone focal opacity, which may represent pneumonia." }, { "input": "A single view of the chest demonstrates low volumes, but no focal opacities to suggest pneumonia. There is bibasilar atelectasis. Enlarged cardiomediastinal contour reflects low lung volumes. Breast prostheses are noted. There is no pneumothorax or pleural effusion.", "output": "Low lung volumes, but no evidence of pneumonia." }, { "input": "PA and lateral views of the chest provided. Improved lung volumes compared with prior exam with mild residual left basal atelectasis. No pulmonary edema, pneumothorax or large effusion. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Mild left basilar atelectasis." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "No prior studies for comparison. The heart size is normal. The lungs are clear. There is no focal consolidation, pleural effusions or signs for overt pulmonary edema. Bony structures are intact.", "output": "No signs for acute cardiopulmonary process." }, { "input": "Multiple known pulmonary metastases are better evaluated on prior CT. Cardiomediastinal silhouette is unchanged. There is no focal lung consolidation. Pleural effusion is small, if any.", "output": "No significant interval change in the appearance of the chest. No pulmonary metastases better evaluated on prior dedicated chest CT." }, { "input": "There are low lung volumes. The cardiomediastinal silhouettes are stable and within normal limits. Aortic arch calcifications are again seen. The bilateral hila are unremarkable. Pulmonary vascular congestion has improved in comparison to ___. The lungs are clear. There is a small right pleural effusion with adjacent basilar atelectasis. There is no left effusion. There is no pneumothorax.", "output": "Low lung volumes. Small right pleural effusion with adjacent basilar atelectasis. No focal lung consolidation." }, { "input": "The patient has multiple known pulmonary metastases, which are better assessed on the recent CT chest performed ___. Streaky left retrocardiac opacities likely represent atelectasis, although pneumonia is difficult to exclude in the appropriate clinical setting. No other consolidation. No pleural effusion or pneumothorax. Thoracic aorta is tortuous. Heart size is normal. There is no subdiaphragmatic free air.", "output": "1. Left retrocardiac opacity may represent atelectasis or pneumonia. 2. Known pulmonary metastases." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unchanged with atherosclerotic calcifications of the aortic knob noted. There is mild pulmonary vascular congestion. Low lung volumes are noted. Patchy opacities in the lung bases may be due to the atelectasis in the setting of low lung volumes though infection or aspiration cannot be completely excluded. Small right pleural effusion is decreased in size compared to the previous study. No pneumothorax is identified.", "output": "Low lung volumes with patchy bibasilar opacities, potentially atelectasis but infection or aspiration is not excluded. Mild pulmonary vascular congestion. Trace right pleural effusion, decreased in size compared to the previous study." }, { "input": "The lung volumes are normal. Normal size of the cardiac silhouette. Normal hilar and mediastinal structures. No pneumonia, no pulmonary edema. No pleural effusions.", "output": "Normal chest radiograph without evidence of pneumonia." }, { "input": "PA and lateral views of the chest provided. Vague reticular opacities are noted primarily in the mid to lower lungs which could reflect an atypical infection. No lobar consolidation, effusion or pneumothorax. No overt signs of edema. Bony structures are intact. Heart and mediastinal contours appear normal.", "output": "Subtle reticular opacities in the lower lungs may represent an atypical pneumonia. Please correlate clinically." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. There is no free air below the diaphragm.", "output": "No evidence of pneumonia." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Some degenerative changes are seen along the spine.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "An endotracheal tube ends 3.5 cm above the carina with the chin extended. It should be re-evaluated when the head and neck or in neutral position which would advance the tip of the tube. The esophageal drainage tube is coiled in the upper stomach. The lung fields are clear. Cardiomegaly is mild. There is no pneumothorax or pleural abnormality.", "output": "Has currently positioned, the endotracheal tube could advance too close to the carina when the head and neck are neutral position." }, { "input": "The patient is intubated, the endotracheal tube terminates approximately 4 cm above the level the carina. A nasogastric tube terminates in the stomach. There are persistent predominately bibasal parenchymal opacities, a more prominent of the right lung base than the left. No pleural effusion or pneumothorax seen.", "output": "Persistent bibasal parenchymal opacities." }, { "input": "Compared to prior, lung volumes are similar. However, there are denser appearing opacities in the right base, concerning for worsening basilar atelectasis or pneumonia. There is persistent left basilar atelectasis. Left pleural effusion is small if any. Heart is top normal and unchanged from prior. No pneumothorax is seen. ETT and NG tubes are in standard position and unchanged from prior.", "output": "Worsening right basilar atelectasis or pneumonia." }, { "input": "Compared to ___ at 12:27, the lung volumes have slightly decreased, accentuating the heart size and interstitial opacities. Right paracardial opacity is again seen, not significantly changed from prior. The left lower lobe atelectasis or pneumonia appears slightly denser, likely due to lower lung volume. ET tube is seen approximately 4.5 cm from the carina. The enteric tube likely terminates and mid stomach. The enlarged appearance of the mediastinum is unchanged.", "output": "No significant change." }, { "input": "No previous images. The cardiac silhouette is within normal limits, and lungs are clear without vascular congestion or pleural effusions.", "output": "No evidence of acute pneumonia." }, { "input": "No focal consolidation is seen. There is minimal basilar atelectasis. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. Mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. The lungs are clear without focal opacity, pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal. No acute osseous abnormality is seen.", "output": "Normal chest radiograph." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are clear without focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process. No displaced fractures seen." }, { "input": "Diffusely increased interstitial markings are slightly decreased in conspicuity compared with the prior study. There is mild cardiomegaly. There is no pleural effusion, focal consolidation, or pneumothorax. There is no displaced rib fracture.", "output": "1. Slightly decreased conspicuity of the diffusely increased interstitial markings, potentially attributable to interval resolution of mild pulmonary edema superimposed on the unchanged chronic interstitial lung disease. 2. No displaced rib fracture." }, { "input": "PA and lateral views of the chest provided. No focal consolidation is seen concerning for pneumonia. No large effusion or pneumothorax. Coarsened lung markings noted diffusely raising concern for underlying fibrosis. Cardiomediastinal silhouette is stable and normal. Bony structures are intact.", "output": "No pneumonia. Findings concerning for interstitial lung disease." }, { "input": "Frontal and lateral views of the chest. Lung volumes are low, exaggerating heart size and mediastinal width. Interstitial markings appear diffusely increased. No focal consolidation, pleural effusion, or pneumothorax.", "output": "Mild chronic interstitial lung disease without focal consolidation." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Heart is mildly enlarged but stable in size. Pulmonary vascularity is normal. Left hemidiaphragm remains mildly elevated with adjacent linear area of atelectasis or scarring. No focal areas of consolidation have developed to suggest an acute pneumonia, and there are no pleural effusions.", "output": "Elevated left hemidiaphragm with adjacent left basilar scar or atelectasis." }, { "input": "Portable AP upright chest radiograph is obtained. Lung volumes are low, though the imaged portion of the lungs appears clear. The heart size cannot be assessed. No large effusion or definite signs of pneumothorax. Mediastinal contour appears unremarkable. Bony structures are intact.", "output": "No definite signs of aspiration or pneumonia." }, { "input": "Endotracheal tube is seen with tip approximately 1.3 cm from the carina. Mild asymmetrical left basilar opacity is identified. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities detected.", "output": "Endotracheal tube approximately 1.3 cm from the carina. Asymmetric left basilar opacity potentially atelectasis, although aspiration or infection is possible" }, { "input": "Single AP view of the chest demonstrates relatively low lung volumes. The cardiac silhouette is slightly prominent, but this is likely due to AP portable technique. No focal opacity is identified within the lungs and there is no evidence of pneumothorax, pleural effusion or pulmonary edema.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. There may be minimal left perihilar scarring/atelectasis. The cardiac silhouette is top normal. Mediastinal and hilar contours are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Normal heart size, mediastinal and hilar contours. No focal consolidation, pleural effusion or pneumothorax.", "output": "Normal chest radiograph" }, { "input": "PA and lateral views the chest were provided. The lungs are clear without focal consolidation effusion or pneumothorax. The cardiomediastinal silhouette is normal. The imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Large left pleural effusion is smaller since the study two hours prior following recent thoracentesis. There is a small left apical pneumothorax. The heart is partially obscured; however, there is moderate cardiomegaly. Opacities in the right infrahilar region may reflect atelectasis. 2.4 cm nodular opacity projecting over the ___ anterior interspace may relate to the costochondral junction. The aortic knob is calcified.", "output": "1. Moderate left pleural effusion is smaller. 2. Small left apical pneumothorax is new. 3. 2.4 cm left apical nodular opacity may relate to the costochondral junction and can be re-assessed on follow-up chest radiograph. CT should be obtained if the finding persists. These results were telephoned to ___, MD by ___, MD at 5:05 a.m., ___, five minutes after discovery." }, { "input": "Cardiac silhouette size remains moderately enlarged. Mediastinal contour is unremarkable. There is a persistent moderate left pleural effusion with associated left basilar opacity likely reflective of atelectasis. Increased patchy opacity within the right lung base is also likely reflective of atelectasis. No overt pulmonary edema is demonstrated. There is no pneumothorax.", "output": "Persistent moderate left pleural effusion with left basilar opacity likely reflective of atelectasis. Increased atelectasis within the right lung base." }, { "input": "A left-sided pigtail catheter has been placed in the interval from the prior study with some improved aeration. Kinking in 2 locations of this catheter is. Extensive left-sided disease remains", "output": "Interval improvement in aeration. Kinking of the catheter is suggested orthogonal radiographs may help" }, { "input": "The previously identified left apical pneumothorax is not clearly identified noting limitation due to patient rotation to the left. Otherwise, there has been no significant interval change. Retrocardiac opacity is again noted. Streaky right basilar opacities persist. Cardiomediastinal silhouette has not changed. Degenerative changes seen at the shoulders.", "output": "Previously noted left apical pneumothorax is not clearly delineated on the current exam noting suboptimal positioning limiting evaluation." }, { "input": "A moderate left pleural effusion is unchanged, and left lower lobe collabse obscuring the left hemidiaphragm, and limiting assessment of the cardiac size. The right lung is well expanded and grossly clear, with no focal consolidation, pleural effusion, or pulmonary edema. There is no pneumothorax. Dense atherosclerotic calcifications in the aortic arch are again seen.", "output": "Moderate left pleural effusion is unchanged. Right lung is grossly clear." }, { "input": "Left flexible chest tube remains in the left hemi-thorax. Moderate left pleural effusion appears slightly decreased. Cardiomediastinal silhouette is shifted to the left, but is unchanged. Right basilar atelectasis is mostly unchanged. No pneumothorax is seen.", "output": "Small decrease in moderate-sized left pleural effusion. No pneumothorax ." }, { "input": "A moderate size left pleural effusion appears slightly increased in size compared to the prior radiograph, with a component appearing to be loculated laterally. Opacification within the left lung base may reflect compressive atelectasis though infection is not completely excluded. Assessment of the cardiac silhouette size is difficult given the presence of the left pleural effusion. The aortic knob is calcified. Hazy opacification with in the right lung base may be due to overlying soft tissue. There is no pneumothorax or pulmonary edema. No acute osseous abnormality is seen.", "output": "Moderate size left pleural effusion, slightly larger than on the prior study. Left basilar opacification likely reflects compressive atelectasis, but infection cannot be completely excluded." }, { "input": "In comparison to the most recent prior radiograph, there is increasing right-sided pleural effusion along with right-sided platelike atelectasis. There is also increasing opacities near the right middle lobe concerning for a superimposed infectious process. On the left, there continues to be a pleural effusion and atelectasis, and again pneumonia cannot be ruled out in this area. Cardiomegaly remains. No vascular engorgement is also noted on today's film.", "output": "1. Vascular engorgement 2. Right basilar atelectasis and small effusion 3. Left atelectasis and moderate size effusion" }, { "input": "Again seen is near complete opacification of the left hemithorax, likely secondary to known loculated pleural effusions as seen on prior chest CT. The cardiomediastinal silhouette is shifted to the left, likely reflecting volume loss. Calcifications are seen along the aortic knob. Patchy streaky opacities at the right lung base are likely reflective of atelectasis, with minimal blunting of the right costophrenic angle which could be secondary to a small amount of pleural fluid.", "output": "1. Stable near complete opacification of the left hemithorax. 2. Leftward shift of cardiomediastinal structures, secondary to lung collapse." }, { "input": "There has been interval decrease in size of large left pleural effusion. Status post thoracentesis. No pneumothorax is identified. The right hemi thorax remains grossly clear, and there is persistent obscuration of the left hemidiaphragm and left heart border, likely due to atelectasis and some remaining pleural effusion.", "output": "Interval decrease in size in left pleural effusion following thoracentesis. No evidence of pneumothorax." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. There is no pulmonary edema. The heart is normal in size, and the mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "No new focal consolidation is seen. Stable 6 mm rounded opacity projecting over the right mid-to-lower lung may relate to a vessel or costochondral calcification. No large pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. There is no overt pulmonary edema.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs are clear. The cardiomediastinal silhouette is within normal limits. S-shaped lower thoracic upper lumbar scoliosis is identified. Osseous and soft tissue structures are otherwise unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. Degenerative change at the right acromioclavicular joint.", "output": "No acute cardiopulmonary process." }, { "input": "Left-sided pacemaker device with leads terminating in the right atrium and right ventricle is again noted. Heart size is normal. Aortic knob is mildly calcified. Mediastinal and hilar contours are unchanged. Upper lobe predominant emphysema is again noted. Streaky bibasilar airspace opacities likely reflect atelectasis. No pleural effusion, pulmonary vascular congestion, or pneumothorax is identified. There are mild degenerative changes in the thoracic spine.", "output": "Emphysema. Mild bibasilar atelectasis." }, { "input": "Upright AP and lateral views of the chest demonstrate a left chest wall pulse generator, with pacing wires terminating in the right atrium and right ventricle, unchanged from the prior study. The lung volumes are somewhat low, with background emphysema and interstitial prominence, similar compared to prior studies; however, there are new left perihilar opacities which are concerning for infection. No pleural effusion or pneumothorax is detected. The cardiomediastinal silhouette is unremarkable.", "output": "Left perihilar opacities, new since the prior study are concerning for pneumonia. Followup radiographs after treatment are recommended." }, { "input": "AP upright and lateral views of the chest provided. Dual lead pacemaker appears unchanged in position with leads extending to the region of the right atrium and right ventricle. There is severe emphysema, better assessed on prior CT, with acute pulmonary edema evidenced by pulmonary hilar congestion and ___ B-lines. No large effusion. No focal consolidation. There may be a tiny right pleural effusion. No pneumothorax is seen.", "output": "Emphysema with superimposed pulmonary edema." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Analysis is performed in direct comparison with the next preceding similar study of ___. Comparison suggests mild regression of heart size and thymus, simultaneously lesser marked perivascular haze in the pulmonary circulation compatible with dehydration in patient previously suffering from fluid overload. The previously identified local suspicious hazy densities in the right mid lung field and lower lobe area as well as left upper lobe area have all regressed and suggest improvement of the previously identified multifocal densities suspicious to constitute exacerbation of the patient's chronic COPD status. No new parenchymal abnormalities are seen. The lateral and posterior pleural sinuses remain free as they were before.", "output": "Improvement of previously diagnosed exacerbation of COPD, patient with multiple focal parenchymal infiltrates. The present chest findings are similar to what was noted on a more remote examination of ___." }, { "input": "Single portable chest radiograph demonstrates hyperexpansion of lungs with relative lucency of the upper lung zones, consistent with chronic lung disease. There is a persistent asymmetric increased opacity in the right lung base, similar across multiple prior studies and possibly representing combination of scarring and atelectasis. No new focal opacifications evident. No pleural effusion or pneumothorax identified. Mediastinal and hilar contours are unremarkable. Heart size is top normal. Stable positioning of dual-chamber pacemaker noted. No osseous abnormality is present.", "output": "No acute intrathoracic process. Stable linear right lower lung opacifications, unchanged across multiple prior studies on background of chronic lung disease." }, { "input": "PA upright and lateral chest radiograph demonstrates no focal consolidation. There is severe emphysema. As seen on prior study dated ___, a transvenous right atrial and right ventricular pacer is identified in unchanged position. There persists vascular engorgement as well as lobulation of the left hilus for which adenopathy cannot be excluded. No large pleural effusion is identified. No acute osseous abnormality. Aortic arch calcifications incidentally noted.", "output": "Vascular engorgement stable since prior examination. Prominent left hilus, present on prior examination suspicious for adenopathy. A non-urgent dedicated CT for further evaluation should be obtained for further evaluation. Updated impression and recommendation was reported to Dr. ___ by Dr. ___ ___ telephone at 9:25 on ___." }, { "input": "Frontal and lateral views of the chest demonstrate irregular opacity punctuated with small lucencies possibly representing dilated bronchi. This could represent asymmetric edema versus infection, and could potentially represent entities such as bronchioloalveolar carcinoma. There may also be additional opacities in the right middle and left infrahilar lungs. There is no pneumothorax or pleural effusion. There is appearance of severe emphysema. Mild cardiomegaly is unchanged. Mediastinal and hilar contours are within normal limits. A left pectoral dual-channel pacer/AICD appears stable in location with leads terminating in the right atrium and right ventricle. Upper thoracic lordosis is unchanged.", "output": "Findings concerning for multifocal pneumonia. Recommend treatment and followup to resolution. emphysema chk after edma rx mild cardiomegaly" }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are unremarkable. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Portable AP upright chest radiograph obtained. A subtle vague opacity in the left lower lung is seen adjacent to the left heart border which could represent tiny focus of pneumonia, though due to low lung volumes, evaluation is somewhat limited. Otherwise, the lungs are clear. No signs of pulmonary edema or effusion. No pneumothorax. Heart and mediastinal contours are normal. Bony structures are intact.", "output": "Subtle opacity at the left lung base adjacent to the left heart border, question early pneumonia. Consider repeat radiographs with dedicated PA and lateral views with more optimized inspiratory effort to better assess." }, { "input": "Patchy opacities at the bases bilaterally likely represent atelectasis. No definite consolidations. No pulmonary edema. Cardiomediastinal silhouette is within normal limits. No pleural effusion or pneumothorax.", "output": "No definite evidence of pneumonia." }, { "input": "Low lung volumes accentuates heart size and pulmonary vasculature. Stable bibasilar basilar infiltrate / atelectasis. A calcified aortic arch is noted. A peripherally calcified oval structure is seen in the right upper quadrant in keeping with porcelain gallbladder. Degenerative changes are seen in the glenohumeral and acromioclavicular joints bilaterally.", "output": "No evidence of pulmonary edema." }, { "input": "AP of the chest demonstrates normal lung volumes without pleural effusion, focal consolidation or pneumothorax. The hilar and mediastinal silhouettes are unchanged. Heart size is top normal. No pulmonary edema.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Two views of the chest were obtained. These demonstrate low lung volumes with no focal consolidation concerning for infective process. Cardiomediastinal and hilar contours are within normal limits. No evidence of pulmonary edema. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "Lungs are well expanded. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. Imaged upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Endotracheal tube now terminates 3.3 cm above the carina, in appropriate position. Enteric tube has been withdrawn slightly, terminating at the gastroesophageal junction. Recommend advancement so that it is well within the stomach. Interval placement of right IJ central venous catheter terminates in the mid to lower SVC without evidence of pneumothorax. Otherwise no significant interval change in the appearance of the lung fields. Cardiac and mediastinal silhouettes are stable.", "output": "Endotracheal tube terminates 3.3 cm above the carina, in appropriate position. Enteric tube has been withdrawn slightly, terminating at the gastroesophageal junction. Recommend advancement so that it is well within the stomach. Interval placement of right IJ central venous catheter terminates in the mid to lower SVC without evidence of pneumothorax." }, { "input": "Endotracheal tube terminates approximate 9 mm above the carina. Recommend withdrawal by approximately 1.5-2 cm for more optimal positioning. Enteric tube courses below the diaphragm, terminating in the expected location of the proximal stomach. Right greater than left perihilar opacities could be due to pulmonary edema versus aspiration, infectious process not excluded. No large pleural effusion is seen. There is subtle suggestion of linear calcification at the right diaphragm which could represent pleural calcification.", "output": "Endotracheal tube terminates approximate 9 mm above the carina. Recommend withdrawal by approximately 1.5-2 cm for more optimal positioning. Enteric tube courses below the diaphragm, terminating in the expected location of the proximal stomach. Right greater than left perihilar opacities could be due to pulmonary edema versus aspiration, infectious process not excluded. No large pleural effusion is seen." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "While the bilateral predominantly basilar diffuse opacities, right greater than left, may be contributed to by some vascular congestion, this is still worrisome for bilateral pneumonia. Bilateral small pleural effusions are probable. The tip of the ETT is seen 5.5 cm above the carina. A feeding tube is seen in the stomach continues out of view. The tip of a right IJ catheter is seen in the mid to lower SVC. The tip of an esophageal temperature probe is noted in the standard position. The heart size is unchanged. No pneumothorax. There is a calcified pleural plaque in the right lung base, compatible with prior asbestos exposure.", "output": "1. Bilateral predominantly basilar diffuse opacities, right greater than left, while likely partially due to increasing vascular congestion and atelectasis, are still worrisome for bilateral pneumonia. 2. All support devices are in standard position. NOTIFICATION: The findings were discussed with ___ Surgery ___ ___, M.D. by ___, M.D. on the telephone on ___ at 5:03 PM, 20 minutes after discovery of the findings." }, { "input": "The heart is mildly enlarged with a left ventricular configuration. Streaky left mid lung opacities suggest minor unchanged atelectasis or scarring. Otherwise, the lungs appear clear. There are no pleural effusions or pneumothorax.", "output": "No evidence of acute disease." }, { "input": "Mild enlargement of the cardiac silhouette is relatively unchanged. The mediastinal and hilar contours are unremarkable. There is no focal consolidation, pleural effusion or pneumothorax. Linear opacity within the anterior aspect of the upper lobe, possibly in the left upper lobe, is best seen on lateral view, and is compatible with subsegmental atelectasis. While there may be mild pulmonary vascular congestion, no overt pulmonary edema is seen. Mild degenerative changes of the thoracic spine are visualized. Clips are seen within the upper abdomen on the lateral view.", "output": "Mild pulmonary vascular congestion. Subsegmental atelectasis within likely the left upper lobe." }, { "input": "The cardiac silhouette size is mildly enlarged but unchanged. The mediastinal and hilar contours are stable. Pulmonary vasculature is normal. Subsegmental atelectasis is demonstrated within the left lung base. No focal consolidation, pleural effusion or pneumothorax is demonstrated. Mild degenerative changes are noted in the thoracic spine. Clips are demonstrated within the upper abdomen compatible with prior cholecystectomy.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Portable supine chest radiograph demonstrates an endotracheal tube, its tip which projects approximately 2.9 cm above the level of the carina. An enteric tube descends the thorax in uncomplicated course, its tip below the level of the diaphragm though out of the field-of-view. Lungs demonstrate emphysematous changes and are hyperexpanded. There is no focal consolidation identified. Cardiomediastinal and hilar contours are within normal limits. Several bilateral chronic appearing rib fractures are noted. There is no pneumothorax or pleural effusion.", "output": "Emphysematous changes. Supportive devices appear appropriately positioned." }, { "input": "No change in the position of the BiV-ICD leads, which terminate in the right atrium, right ventricle, and epicardial vein of the left ventricle. Since the radiograph from the prior day, there has been no significant change. Unchanged bilateral pleural plaques, left clavicular old fracture, old left rib fractures, and bilateral apical caps are noted. No pneumothorax or new effusion.", "output": "Bi-V ICD leads terminate in the right atrium, right ventricle, and left ventricle. No pneumothorax." }, { "input": "A right chest wall pulse generator is in place, with unchanged position of 3 pacer/defibrillator leads. Mediastinal clips and median sternotomy wires are present, with fracture of the superior most 2 wires. The heart is mildly enlarged. Moderate bilateral pleural effusions are noted, with peribronchial cuffing, and pulmonary vasculature bilaterally, compatible with mild pulmonary edema. There is no pneumothorax or focal consolidation. There are most likely post-radiation changes see along the mediastinum bilaterally", "output": "Moderate bilateral pleural effusions and mild pulmonary edema." }, { "input": "Heart size is normal. Mediastinal and hilar contours are within normal limits and unchanged. The aortic knob is calcified. There are emphysematous changes again noted, severe in extent. 8 mm nodular opacity projecting over the left lung apex is new compared to the prior study, but could reflect the end of the left 1st rib or a summation of shadows. No focal consolidation, pleural effusion or pneumothorax is present. Blunting of the costophrenic angle on the left posteriorly likely is due to chronic pleural thickening. No acute osseous abnormalities are present. Cholecystectomy clips are seen in the right upper quadrant the abdomen.", "output": "1. Severe emphysema without acute abnormality. 2. 8 mm nodular opacity within the left lung apex. Shallow oblique views are recommended to assess if this is a true nodule versus a summation of shadows or rib end." }, { "input": "A series of images over a period of 5 minutes are presented, initial images showing the NG tube at the gastroesophageal junction, images taken at a later time show NG tube extending into the stomach and pointing towards the pylorus. The ET tube and right subclavian catheter remain in unchanged satisfactory position. Otherwise, there is no significant change compared to the most recent prior radiographs with stably hyperinflated lungs and normal cardiomediastinal silhouette. No pleural effusion or pneumothorax. Images of the abdomen show multiple lines which may be external to the patient or within the abdominal wound.", "output": "NG tube ending in the stomach including the side ports. Otherwise, no significant change." }, { "input": "Two views of the chest demonstrate clear lungs without effusion, or pneumothorax. The cardiac silhouette is normal in size, the mediastinal contours are normal.", "output": "No acute chest pathology." }, { "input": "Normal heart size, mediastinal and hilar contours. No focal consolidation, pleural effusion or pneumothorax. Suture anchor in the right shoulder is unchanged.", "output": "Normal chest radiograph NOTIFICATION: Message left with wet read by Dr. ___ with Dr. ___ office on the telephone on ___ at 4:29 PM, 10 minutes after review." }, { "input": "The heart is normal in size. The hilar and mediastinal contours are unremarkable. The lungs are well expanded and clear. There is no evidence of pneumothorax or pleural effusion. The visualized osseous structures are unremarkable.", "output": "No acute abnormalities identified to explain the patient's persistent cough. No rib fractures identified." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The heart is normal in size. Normal cardiomediastinal silhouette.", "output": "No acute intrathoracic process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Right-sided Port-A-Cath tip terminates at the junction of the SVC and right atrium. Lung volumes remain low. Heart size is moderately enlarged, unchanged. Mediastinal and hilar contours are similar. Crowding of bronchovascular structures due to low lung volumes is present without overt pulmonary edema. Patchy opacity in the right lung base is slightly worse compared to the previous chest radiograph. The left lung is clear. No pneumothorax or large pleural effusion is identified.", "output": "Increased patchy opacification in the right lung base could reflect worsening atelectasis however infection is not excluded in the correct clinical setting." }, { "input": "Endotracheal tube terminates approximately 7 cm from the carina. Right-sided Port-A-Cath tip terminates in the mid SVC. Low lung volumes are present. Heart size appears moderately enlarged. The aortic knob is distinct with atherosclerotic calcifications noted. Widening of the superior mediastinal contour may be reflect underlying lymphadenopathy. Patchy and linear opacities in the lung bases likely reflect areas of atelectasis. There may be a small right pleural effusion, though no large pneumothorax is identified on this supine exam. No displaced fracture is visualized.", "output": "1. Low lung volumes with bibasilar patchy and linear opacities, likely atelectasis. Please note that aspiration or infection cannot be excluded. Possible trace right pleural effusion. 2. Endotracheal tube in standard position. 3. Widened superior mediastinal contour suspicious for mediastinal lymphadenopathy." }, { "input": "A dual lumen Port-A-Cath is in-situ, the tip is in the mid to distal SVC. Lung volumes are slightly low resulting crowding of the bronchovascular structures and mild prominence. No consolidation, pneumothorax or pleural effusion seen. The visualized bony structures are unremarkable in appearance.", "output": "No significant interval change when compared to the prior study." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "There is a persistent opacity at the right lung base likely a combination a pleural effusion atelectasis however, in the absence of a lateral view, pneumonia cannot be excluded in the appropriate clinical setting. There is a small left pleural effusion. Stable moderate pulmonary vascular congestion. Mild cardiomegaly is stable. Mediastinal widening is stable. Right Port-A-Cath terminates in the low SVC. There is no pneumothorax.", "output": "Persistent opacity at the right lung base likely combination pleural effusion and atelectasis however, in the absence of a lateral view, pneumonia cannot be excluded in the appropriate clinical setting." }, { "input": "Suboptimal and prior tree effort. The trachea is central. The cardiomediastinal contour is unchanged compared to the prior study. A dual lumen port terminates in the mid SVC. No consolidation, pneumothorax or pleural effusions seen. The visualized bony structures are unremarkable in appearance.", "output": "No acute cardiopulmonary process seen." }, { "input": "Since ___, increased small to moderate bilateral pleural effusions, right greater than left, with increased small to moderate bibasilar atelectasis are seen. Lung volumes remain low. There is new mild pulmonary edema. Moderate cardiomegaly is unchanged. No pneumothorax. Tip of the endotracheal tube is seen 4.8 cm above the carina. Right Port-A-Cath placement is unchanged. New feeding tube is seen in the region of the stomach in continues out of view.", "output": "1. Increased small to moderate bilateral pleural effusions, right greater the left, with increased bibasilar atelectasis and new mild pulmonary edema since ___. 2. Support devices are in the appropriate position. NOTIFICATION: The findings were discussed by Dr. ___ with RN ___ ___ on the telephoneon ___ at 12:13 PM, 5 minutes after discovery of the findings." }, { "input": "There is interval decrease in the right effusion which is now small. There continues to be dense retrocardiac opacification compatible with volume loss/infiltrate/ effusion. There is some residual volume loss/ infiltrate the right lower lung. There is mild pulmonary vascular redistribution. The heart continues to be moderately enlarged. The ET tube NG tube and right-sided central line are unchanged", "output": "Decreased right effusion" }, { "input": "Endotracheal tube tip projects over the low trachea approximately 2.5 cm above the carina. An esophageal catheter traverses below the diaphragm with tip projecting over the left upper quadrant, likely within the stomach. There is a small left pleural effusion. Patchy opacity at right cardiophrenic angle and vertical stranding at left base medially most likely represents atelectasis or scarring. No focal consolidation or pneumothorax is detected on this single view. Heart size is top normal. Aortic tortuosity is seen with otherwise normal mediastinal contours.", "output": "1. Endotracheal tube tip projecting over the low trachea. 2. Small left pleural effusion. 3. Bibasilar atelectasis or scarring. Attention to right cardiophrenic angle opacity is recommended to exclude early infiltrate." }, { "input": "A right hemodialysis catheter ends in the atrium. Mild cardiomegaly is unchanged. A pigtail catheter is stable. The moderate right and small left pleural effusion are unchanged. Bibasilar atelectasis has slightly improved. There is no new consolidation or pneumothorax.", "output": "1. Stable moderate right and small left pleural effusions. 2. Improvement in bibasilar atelectasis." }, { "input": "The cardiac, mediastinal and hilar contours are unremarkable. The pulmonary vasculature is normal. Calcified granuloma is seen within the right mid lung field. Lungs are otherwise clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are detected. Clips are noted within the upper abdomen on the lateral view.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or pneumothorax is seen. The cardiac silhouette is mildly enlarged. The aorta is calcified. No overt pulmonary edema is seen.", "output": "Mild enlargement of the cardiac silhouette without overt pulmonary edema." }, { "input": "The lung volumes are low. The heart is at the upper limits of normal size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There is no pleural effusion or pneumothorax. Slight osteophyte formation is noted along the anterior margin of much of the thoracic spine. Surgical clips project over the upper spine.", "output": "No evidence of acute disease." }, { "input": "Low lung volumes are again noted. Bibasilar opacities which are more conspicuous on the frontal view which demonstrates the lower lung volumes. These are likely atelectasis. Superiorly, the lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "Bibasilar opacities which are most likely due to atelectasis in the setting of low lung volumes. No definite evidence of infarction." }, { "input": "The lungs are hyperinflated, suggestive of emphysema. An ill defined right infrahilar opacity abutting the right cardiac sillhouette without obscuring it is not seen in the lateral view. No other focal opacities are identified. Biapical pleuro-parenchymal scarring is present. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. No rib fractures are seen.", "output": "1. Right infrahilar opacity is not clearly seen in the lateral view and may represent a focus of consolidation such as atelectasis/pneumonia versus summation of structures. Correlate clinically. 2. No evidence of rib fractures. Of note, this study has suboptimal sensitivity for the detection of rib fractures and dedicated rib series or chest CT are more sensitive." }, { "input": "Pain status post median sternotomy and CABG. Several fractured wires are again seen. The cardiac silhouette remains top-normal to mildly enlarged. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Patient is status post median sternotomy and CABG with multiple fractured sternotomy wires again demonstrated, better seen on the prior CT. Heart size remains mildly enlarged. Mediastinal and hilar contours are normal. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is identified. Biliary stent is seen within the upper abdomen on the lateral view. No acute osseous abnormalities present.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Patient is status post median sternotomy and cardiac valve replacement.The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac silhouette is mild to moderately enlarged. No pulmonary edema is seen. Mediastinal contours are unremarkable.", "output": "Cardiomegaly. No pulmonary edema." }, { "input": "AP semi upright and lateral views of the chest provided. Midline sternotomy wires again noted, the majority of which are extensively fragmented, unchanged. There is no focal consolidation concerning for pneumonia. No large effusion or pneumothorax. No signs of congestion or edema. There is a linear density in the left mid lung which could represent a focus of scarring or atelectasis. Chronic left rib deformities are again noted. No free air below the right hemidiaphragm. Clips in the right upper quadrant noted.", "output": "As above." }, { "input": "Frontal and lateral views of the chest demonstrate multiple fractured sternal wires, unchanged from ___. New from ___, is a posteriorly displaced sternal wire fragment at approximately the mid sternal level. There is no focal consolidation. The cardiomediastinal and hilar contours are stable. There is no pneumothorax or a pleural effusion.", "output": "No interval change to multiple fractured sternal wires. Recommend chest CT to localize a posteriorly displaced wire fragment of the superior third sternal wire. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 3:15 PM, 40 minutes after discovery of the findings." }, { "input": "Frontal and lateral chest radiographs again demonstrate multiple disrupted sternal wires, unchanged from prior radiograph. Again seen is moderate cardiomegaly. The lungs are clear and there is no pleural effusion or pneumothorax.", "output": "1. No evidence of pneumonia. 2. Moderate cardiomegaly and multiple disrupted sternal wires, unchanged from prior radiograph. A preliminary read was provided by Dr. ___ to the office of Dr. ___. A message was left with ___ at ___ on ___." }, { "input": "The lungs are clear. There is no consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. Multiple fractured median sternotomy wires are again noted. No acute osseous abnormalities, old healed left anterior rib fractures are noted. Surgical clips in the right upper quadrant suggest prior cholecystectomy.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is rotated slightly to the left. The patient is status post median sternotomy and CABG with several sternotomy wires again seen to be fractured. Cardiac and mediastinal silhouettes are stable. Multiple old anterior lateral left-sided rib deformities are again seen. No focal consolidation. No large pleural effusion. No evidence of pneumothorax.", "output": "No significant interval change given differences in patient position." }, { "input": "PA and lateral views of the chest. There is no focal consolidation. There is no pleural effusion or pneumothorax. The heart is mildly enlarged. The mediastinal contours are normal. The median sternotomy wires are again seen, three of which are fractured. The wire located third from the top has a fracture fragment oriented posteriorly. The mediastinal clips are stable.", "output": "1. No acute cardiopulmonary process. 2. Three fractured median sternotomy wires. The wire located third from the top has a fracture fragment oriented posteriorly." }, { "input": "Frontal and lateral views of the chest were obtained. The patient is status post median sternotomy. Again, several of the sternal wires are fractured. No definite focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable.", "output": "No significant interval change." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear and well expanded without effusion or focal consolidation. No acute rib fractures are seen. Several fractured sternotomy wires are unchanged.", "output": "No evidence of pleural effusion or focal consolidation. NOTIFICATION: The above findings were communicated via telephone by Dr. ___ to Dr. ___ at 15:59 on ___, ___ min after discovery." }, { "input": "PA and lateral views of the chest were obtained demonstrating clear well expanded lungs without focal consolidation, effusion, pneumothorax. The heart and mediastinal contours appear normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "There is pulmonary vascular congestion with early mild pulmonary edema. Heart size is enlarged. There is a tiny left pleural effusion. No focal consolidation or pneumothorax is seen. Aortic calcifications are present.", "output": "Cardiomegaly with early pulmonary edema, likely secondary to congestive heart failure." }, { "input": "Cardiac, mediastinal and hilar contours are normal. The lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is seen. There is no evidence of pneumomediastinum. There are no acute osseous abnormalities. No radiopaque foreign body is identified.", "output": "No acute cardiopulmonary abnormality. No radiopaque foreign body is seen, and no evidence for pneumomediastinum." }, { "input": "There has been interval removal of right-sided chest tube. The previously seen right apical pneumothorax is reduced in size. There are stable moderately low lung volumes with pleural effusion, essentially unchanged. There is stable cardiomegaly. Swan-Ganz catheter now terminates within the right main pulmonary artery. Endotracheal tube is again seen in place, unchanged in position no less than 3 cm from the carina.", "output": "Interval removal of right chest tube with reduction in previously seen right apical pneumothorax. Remainder of exam is essentially unchanged." }, { "input": "There is redemonstration of the enlarged cardiac silhouette, possibly related to cardiomegaly, though as previously mentioned pericardial effusion IS not excluded. There is increased prominence of the interstitial markings, particularly in the perihilar distribution, likely due to increased pulmonary edema. A moderately sized left pleural effusion is identical in appearance to chest radiogrpah performed 3 days earlier, though less apparent on intervening radiogrpah, likely due to positioning. Retrocardiac opacity likely represents a combination of effusion and atelectasis, though infectious process cannot be excluded. There has been interval removal of the endotracheal tube. The central venous catheter terminates in the mid superior vena cava. No pneumothorax evident. Sternotomy sutures are midline and intact. No osseous abnormalities identified.", "output": "Worsening pulmonary edema. Moderate-sized left pleural effusion, unchanged compared to ___. Interval removal of endotracheal tube." }, { "input": "AP upright portable chest radiograph obtained. The heart is moderately enlarged. No pleural effusion or pneumothorax. No definite signs of pneumonia. No overt signs of CHF. There is mild prominence of the aortic knob, but this is likely due to tortuosity with faint atherosclerotic calcifications noted. Bony structures are intact.", "output": "Cardiomegaly with unfolded thoracic aorta likely accounting for prominence of the mediastinum. Please refer to subsequent CTA for further details." }, { "input": "There has been interval removal of the left-sided chest tube with no development of pneumothorax observed. Also seen has been removal of the aortic balloon and catheter from the ascending aorta. There has been slight interval improvement in the left upper lobe opacity. Otherwise, study is largely unchanged from prior. Swan-Ganz catheter is seen, unchanged in position. Endotracheal tube is seen unchanged in position approximately 5 cm from the carina. Cardiomediastinal silhouette is stable.", "output": "Successful removal of chest tube and aortic pump balloon with no resulting pneumothorax." }, { "input": "There is increasing left-sided opacification involving the mid to lower lung, probably reflecting increased pleural effusion with associated parenchymal opacity, which is most often due to atelectasis although not specific. There is also a small new right-sided pleural effusion. Pulmonary vascularity is slightly prominent in the upper lungs, suggesting pulmonary venous hypertension, although without frank congestive heart failure. The patient is status post sternotomy and the heart appears again enlarged.", "output": "Increasing opacification of the left hemithorax, probably reflecting an increasing pleural effusion." }, { "input": "Portable upright view of the chest demonstrates right PIC catheter tip projecting over mid SVC. Swan-Ganz catheter is positioned at the pulmonary outflow tract. The heart remains markedly enlarged. Perihilar vascular congestion. Costophrenic angles are minimally blunted, suggestive of possible trace pleural effusions. No pneumothorax.", "output": "In comparison to ___ exam, there is no significant change in severe cardiomegaly and possible trace bilateral pleural effusions." }, { "input": "Severe cardiomegaly is chronic; however, there is no evidence of pulmonary edema. There is mild pulmonary vascular congestion. There are small bilateral pleural effusions. There is an area of increased opacity in the right lower lobe concerning for pneumonia. There is no evidence of pneumothorax. Patient is status post median sternotomy and coronary bypass grafting. There is a left-sided PIC line which appears to terminate in the left brachiocephalic vein, overall unchanged in position compared to the prior exam. Note is made of an aortic stent.", "output": "1. New focal consolidation in the right lower lobe concerning for pneumonia. 2. Mild pulmonary vascular congestion." }, { "input": "PA and lateral views of the chest were provided. A left upper extremity PICC line is seen with its tip residing in the upper SVC region. Midline sternotomy wires and mediastinal clips are again noted. The heart remains markedly enlarged. There is no focal consolidation, or convincing signs of congestive heart failure. There is trace right pleural effusion noted. No pneumothorax is present. The bony structures are intact. An aortic stent is partially imaged in the upper abdomen.", "output": "Massive cardiomegaly unchanged. Trace right pleural effusion. PICC line unchanged in position." }, { "input": "Frontal and lateral radiographs of the chest show a moderate left pleural effusion obscuring the left hemidiaphragm which is probably unchanged from the supine radiograph of ___ with the meniscus better visualized on today's upright exam. A small to moderate right pleural effusion is also probably unchanged from the prior radiograph. Associated bibasilar compressive atelectasis is stable. No pneumothorax is present. A right internal jugular central venous catheter has been removed since the prior radiograph. The patient is status post median sternotomy with wires intact. Cardiac silhouette cannot be assessed. The mediastinal contours are within normal limits with calcified aortic knob and deviation of the trachea to the right. A stent is unchanged in position in the midline corresponding to the upper abdominal aorta. Generalized loss of height and kyphosis is noted in the thoracic spine.", "output": "Stable moderate left pleural effusion and small to moderate right pleural effusion compared to supine radiograph from ___." }, { "input": "A moderate left pleural effusion is markedly increased compared to ___. There is associated compressive atelectasis at the left lung base, underlying consolidation can not be excluded. Ill-defined opacities in the right lower lung are slightly increased compared to the ___ radiograph, consistent with either atelectasis or possibly an infectious process. There may be a tiny right pleural effusion. The cardiac silhouette size is difficult to assess given the left pleural effusion, although moderate-to-severe enlargement does not seem significantly changed. The mediastinal contours are stable. There is no pneumothorax. The patient is status post midline sternotomy and CABG. Aortic calcifications are noted.", "output": "1. Increased moderate left pleural effusion with overlying atelectasis, underlying consolidation can not be excluded. Possibly small right pleural effusion. 2. Right lower lobe atelectasis versus infection. Clinical correlation is recommended. Pertinent findings were discussed with Dr. ___ by Dr. ___ at 1:08 p.m. via telephone on the day of the study." }, { "input": "A single portable frontal radiograph of the chest was acquired. There is redemonstration of intact sternotomy wires as well as surgical clips scattered throughout the lower thorax, unchanged. The previously seen vascular stent projecting over the mid abdomen is only partially imaged on today's study. Moderate enlargement of the cardiac silhouette is increased compared to the prior study. There is a dense retrocardiac opacification, increased, possibly secondary to atelectasis, although infection and/or aspiration could have an identical appearance. Small bilateral pleural effusions are not significantly changed. There is persistent pulmonary vascular congestion without frank interstitial edema. There is no pneumothorax. The mediastinal contours are unchanged.", "output": "1. Increased bibasilar retrocardiac dense opacification, possibly secondary to atelectasis, although an infectious process could appear similar. Clinical correlation recommended. 2. Unchanged small bilateral pleural effusions. 3. Findings suggesting mild pulmonary vascular congestion." }, { "input": "ET tube terminates 6 cm above the carina. Right internal jugular central venous catheter tip projects over mid SVC. Sternotomy wires are intact. Multiple surgical clips project over cardiac silhouette. Left lung base consolidation is unchanged. Left costophrenic angle is obscured, suggestive of small pleural effusion, decreased since prior. There is no pneumothorax. Hilar and mediastinal silhouettes are unchanged. Mild-to-moderate cardiomegaly persists. Perihilar vascular congestion is noted.", "output": "Persistent left lung base consolidation, likely atelectasis. Left pleural effusion has decreased in size since ___." }, { "input": "A single portable radiograph of the chest was acquired. There has been interval placement of a right internal jugular central venous catheter, ending in the mid-to-low SVC. There is no pneumothorax. A moderate left pleural effusion persists. A small right pleural effusion remains possible. Ill-defined opacities at the right lung base are not significantly changed and could be atelectasis or pneumonia. Left basilar compressive atelectasis is again seen. The cardiac and mediastinal contours are unchanged.", "output": "Interval placement of a right internal jugular catheter with its tip in the mid-to-low SVC. No evidence of pneumothorax. Otherwise, no interval change." }, { "input": "PA and lateral views of the chest were provided demonstrating pneumomediastinum as well as subcutaneous emphysema extending into the right and left upper chest wall. Overall findings appear stable from prior exam. There is no pneumothorax, effusion, or signs of pneumonia. The heart size is normal. Bony structures are intact.", "output": "Pneumomediastinum and subcutaneous emphysema in the upper chest wall. Findings could reflect small airways injury. No pneumothorax or pneumonia." }, { "input": "Cardiac silhouette size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is a small area of increased opacity in the left lower lobe. This is new compared to prior an could represent some scarring this occurred in the interval or small early infiltrate. Otherwise the lungs are clear", "output": "Small infiltrate and left lower lobe" }, { "input": "A subtle medial right basilar opacity is seen which may be due to atelectasis, although an infectious process is not excluded. Left lung is clear. There is no pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are unremarkable.", "output": "Subtle medial right basilar opacity may be due to atelectasis and overlap of vascular structures, although an early infectious process is not excluded in the appropriate clinical setting, however, felt less likely." }, { "input": "Patchy lingular opacity is most likely due to atelectasis although early infectious process is not excluded in the appropriate clinical setting. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal. Mediastinal contours are unremarkable.", "output": "Subtle patchy lingular opacity most likely due to atelectasis, less likely early consolidation." }, { "input": "Overall, there is no significant change since ___. There is persistent pulmonary vascular engorgement without frank interstitial pulmonary edema. There are large bilateral layering pleural effusions and associated bibasilar opacification, compatible with atelectasis. There are no new focally occurring opacities concerning for pneumonia. There is no evidence of pneumothorax. The cardiomediastinal and hilar contours are stable, demonstrating tortuosity of the thoracic aorta. The heart is within upper limits of normal in size.", "output": "Stable examination since ___ with bilateral large layering pleural effusions redemonstrated." }, { "input": "", "output": "Small bilateral pleural effusions with associated atelectasis, similar to the prior week's radiograph. ______________________________________________________________________________ FINAL REPORT HISTORY: ___-year-old male status post exploratory laparotomy and ___ patch for perforated pyloric ulcer. This has been complicated by intra-abdominal abscesses that were drained by IR on ___; now with fever, altered mental status, and abdominal pain. STUDY: PA and lateral upright chest radiographs. COMPARISON: ___. FINDINGS: A pigtail catheter sits in the right upper quadrant of the abdomen. The cardiomediastinal contours are normal and unchanged. Bibasilar opacities reflect components of atelectasis and pleural effusion which is seen tracking up along the major fissures on the lateral view. There is no pneumothorax. There is no subdiaphragmatic free air. IMPRESSION: Small bilateral pleural effusions with associated atelectasis, similar to the prior week's radiograph." }, { "input": "The cardiac, mediastinal, and hilar contours appear stable. The heart is normal in size. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute disease." }, { "input": "Heart size is top normal. The mediastinal contour is normal. Right hilar prominence is stable and consistent with known lymphadenopathy seen on prior CT. Mild edema is stable. Small to moderate right pleural effusion is larger than the left. No focal consolidation or pneumothorax is seen. Emphysema is severe.", "output": "1. Mild edema is stable. 2. Small to moderate right pleural effusion is larger than the left." }, { "input": "AP upright and lateral views of the chest were provided. Patient is known to have underlying emphysema accounting for hyperinflation and upper lobe lucency. There are ill-defined peribronchovascular opacities in the lower lungs concerning for pneumonia, perhaps slightly progressed from the prior CT chest. No large effusion or pneumothorax is seen. The heart and mediastinal contour appears stable. Clips are noted in the left upper abdomen. Bones appear intact.", "output": "Emphysema with irregular peribronchovascular opacity in the lower lungs, slightly increased from prior CT exam from 2 days ago, likely reflect worsening pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. There is persistent blunting of the right costophrenic angle and a small pleural effusion with overlying atelectasis. Patchy right medial base opacity appears new since the CT from ___, infectious process may be present. No evidence of pneumothorax is seen. There is mild vascular congestion.", "output": "Blunting of the right costophrenic angle with small pleural effusion. medial basilar opacities could relate to infectious process. Prominence of the right hilum likely relates to lymphadenopathy seen on prior CT." }, { "input": "A portable frontal chest radiograph demonstrates interval increase in the heart size, which is consistent with cardiomegaly and/or pericardial effusion. There is mild, if any, pulmonary edema. Bilateral pleural effusions are small to moderate in size, with associated bibasilar atelectasis. There is no pneumothorax.", "output": "1. Increased heart size, consistent with cardiomegaly and/or pericardial effusion. 2. Mild, if any, pulmonary edema. 3. Bilateral small to moderate pleural effusions with associated bibasilar atelectasis. These findings were communicated via telephone by Dr. ___ to Dr. ___ at ___ on ___." }, { "input": "AP portable upright view of the chest. No free air is seen below the right hemidiaphragm. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process. No signs of pneumoperitoneum." }, { "input": "The lungs are clear. There is no effusion, consolidation, or pneumothorax. The cardiomediastinal silhouette is normal. There is no visualized pneumomediastinum. No acute osseous abnormalities identified. No free air below the diaphragm.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no evidence of pneumomediastinum, pneumothorax or pneumoperitoneum. There is no focal consolidation, effusion, or signs of edema. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process. No evidence of pneumomediastinum, pneumothorax or pneumoperitoneum." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear without focal opacities, pleural effusion or pneumothorax. The cardiac and mediastinal contours are stable.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs remain relatively hyperinflated, suggesting chronic obstructive pulmonary disease. Platelike right base atelectasis is seen. There are subtle scattered areas of opacity projecting over the lateral left upper to mid lung, and possibly to a lesser extent over the right lung, which may be related patient's known metastatic disease, but underlying infection is not excluded. There is slight blunting of the costophrenic angles and trace pleural effusions may be present. The cardiac silhouette is top-normal. The mediastinal contours are stable.", "output": "Bilateral nodular opacities may relate to patient's known at metastatic disease, however, findings appear worse as compared to ___ which may be due to progression of disease, however, superimposed infectious process is not excluded. Probable trace bilateral pleural effusions." }, { "input": "2 views were obtained of the chest. The lungs are well expanded with a left lower lobe opacities which may reflect developing infectious process. There is no pleural effusion or pneumothorax. The heart and mediastinal contours are unremarkable.", "output": "Early or developing left lower lobe pneumonia." }, { "input": "Single frontal view of the chest. The heart size and cardiomediastinal contours are normal. No focal consolidation, pleural effusion, or pneumothorax. Sternotomy wires are intact. Leads of a right chest wall pacer terminate over the right atrium and ventricle.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac silhouette is top normal. Mediastinal contours are unremarkable.", "output": "No definite acute cardiopulmonary process." }, { "input": "The lungs are well-expanded and clear. No consolidation, effusion common pneumothorax. The heart is normal in size. The mediastinum is not widened. The hilar contours are within normal limits. No acute osseous abnormality. Multi-level degenerative changes including prominent anterior osteophytes are noted in the thoracic spine with probable diffuse idiopathic skeletal hyperostosis.", "output": "1. No acute intrathoracic process. 2. Diffuse idiopathic skeletal hyperostosis." }, { "input": "AP portable upright view of the chest. Overlying EKG leads are present. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process" }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are unremarkable. No definite focal consolidation is seen. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "There is no consolidation, pleural effusion, or pneumothorax. Cardiomediastinal and hilar silhouettes are normal size.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal.", "output": "Normal radiographs of the chest." }, { "input": "The heart size is normal. The aortic knob is calcified. The mediastinal and hilar contours are normal. Scarring within the lung apices is present. Remainder of the lungs are clear. No focal consolidation, pleural effusion or pneumothorax is present. The pulmonary vascularity is normal.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest. No prior. The lungs are clear of consolidation, effusion, or pneumothorax. The mediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. The lungs are hyperinflated without discrete focal lesion or signs of pneumonia or CHF. There is a vague density at the right infrahilar region which likely corresponds with a chest wall density as seen on the lateral view. Please correlate for chest wall palpable abnormalities. Cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "1. ague opacity projecting over the right infrahilar region likely corresponds with a chest wall contour abnormality (seen on lateral view) for which clinical correlation is advised. Given the history of metastatic cancer if there is concern for metastatic disease in the chest, a CT is recommended to further assess. 2. Hyperinflated lungs likely reflect COPD." }, { "input": "The cardiomediastinal and hilar contours are unremarkable. Lungs are clear. No pleural effusion or pneumothorax.", "output": "Normal chest radiograph." }, { "input": "AP upright and lateral views of the chest provided. Lung volumes are slightly diminished from prior. Allowing for this, there is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. The bony structures are intact. There is no free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "PA and lateral views of the chest. The lungs are clear, were not obscured by overlying cardiac leads and wires. The cardiomediastinal silhouette is normal. Slight mid thoracic dextroscoliosis is identified. Osseous structures demonstrate no acute abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. The lungs appear clear, with hyperinflation and upper lobe pleural parenchymal scarring. No effusion or pneumothorax is seen. The heart size remains normal. Thoracic aortic atherosclerotic calcification again noted. Bones appear intact. Clips are noted in the mid abdomen.", "output": "No acute findings." }, { "input": "Compared with ___, the chest tubes have been removed. No pneumothorax is detected. Possible small focus of subcutaneous emphysema adjacent to the left mid clavicle -- has there been recent intervention in this location. Again seen is a right IJ central line, tip overlying the mid/distal SVC. Also again seen is cardiomegaly with sternotomy wires, similar to prior. No overt CHF. Bibasilar atelectasis again noted. Degree of retrocardiac opacity could be very slightly increased. Minimal blunting of left costophrenic angle is again noted.", "output": "Interval removal of chest tubes. No pneumothorax detected. Equivocal focal small focus of subcutaneous emphysema in the left supraclavicular region. Bibasilar atelectasis and minimal blunting of left costophrenic angle, similar to prior." }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or frank pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. There are relatively low lung volumes. There is mild bibasilar atelectasis. There is slight blunting of the posterior left costophrenic angle which may be due to small Bochdalek's hernia seen on torso CT from ___. No large pleural effusion is seen. There is no evidence of pneumothorax. Mild lingular atelectasis is seen. The cardiac and mediastinal silhouettes are stable with the aorta calcified and tortuous and the cardiac silhouette top normal. No overt pulmonary edema is seen.", "output": "Mild lingular atelectasis. Otherwise, no acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. There is bibasilar atelectasis. Blunting of posterior costophrenic angles may be due to atelectasis, although a trace pleural effusion cannot be excluded. Cardiac and mediastinal silhouettes are stable.", "output": "Bibasilar atelectasis. Trace blunting of bilateral posterior costophrenic angles could be due to atelectasis or pleural thickening, although trace effusions cannot be excluded." }, { "input": "PA and lateral chest radiographs were provided. There is no focal consolidation, pleural effusion or pneumothorax. There is minimal atelectasis of the right middle lobe. The cardiomediastinal silhouette is stable. The bones are intact.", "output": "No acute cardiopulmonary process." }, { "input": "Near resolution of small pleural effusions and bibasilar atelectasis. There is mild linear bibasilar atelectasis. The heart is top-normal in size, unchanged. Thoracic aortic calcifications are unchanged. No pneumothorax. Degenerative changes in the thoracic spine are noted. No definite fracture.", "output": "1. Near resolution of small pleural effusions and bibasilar atelectasis. 2. No pneumothorax. 3. No evidence of a fracture." }, { "input": "AP and lateral views of the chest were performed with patient positioned upright. There is no definite evidence for pneumonia or CHF. Mild linear atelectasis in the left lower lung is noted. Cardiomediastinal silhouette is grossly unremarkable allowing for slight patient rotation as well as an unfolded thoracic aorta. Bony structures are intact.", "output": "No evidence of pneumonia." }, { "input": "The lungs are clear of focal consolidation, pleural effusion or pneumothorax. The heart size is top normal. The mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top normal. There is no overt pulmonary edema. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "No pneumothorax is seen. ICD is seen with leads terminating in the right atrium and right ventricle. The visualized lung parenchyma is without consolidation. There is no definite pleural effusion. The stomach bubble and left hemidiaphragm appear more elevated than the previous examination with associated shifting of the right heart border laterally.", "output": "1. No pneumothorax with ICD leads terminating in their expected location, the right atrium and right ventricle. 2. Rightward deviation of the right heart border with associated increased left hemidiaphragm elevation and enlarged stomach bubble." }, { "input": "Diffuse pulmonary opacities appear similar compared to ___. Differential still includes severe pulmonary edema, ARDS, or pneumonia. Cardiomediastinal silhouette is normal size and unchanged. ET tube terminates 4.5 cm above the carina. Left PICC, and NG tubes remain in same position. Deformity of the right humeral neck is unchanged.", "output": "Diffuse pulmonary opacities appear similar compared to ___. Differential still includes severe pulmonary edema, ARDS, or pneumonia." }, { "input": "AP upright and lateral views of the chest provided. Mild bibasilar atelectasis is noted. Otherwise, the lungs appear clear. Suture material is seen overlying the right mid lung. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Mild bibasilar atelectasis. No convincing signs of pneumonia." }, { "input": "The ET tube terminates 4.5 cm above the carina. Left PICC line terminates in mid SVC. Transesophageal to of terminates in the stomach. Diffuse interstitial pulmonary abnormality is worse compared to ___, especially in the right lung. Finding is concerning for worsening infectious process or exacerbation of interstitial lung disease. Pleural effusion is minimal, if any. Right proximal humeral deformity is unchanged.", "output": "Diffuse interstitial pulmonary abnormality is worse compared to ___, especially in the right lung, concerning for worsening infectious process or exacerbation of interstitial lung disease. RECOMMENDATION(S): The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 12:17 PM." }, { "input": "Again seen is a left sided PICC line with tip over distal SVC. No pneumothorax detected Lordotic positioning. There are low inspiratory volumes. The cardiomediastinal silhouette is unchanged. There is bibasilar patchy opacity. Compared to ___, this is slightly more pronounced on the left, though similar on the right. No CHF or effusion. Unusual notching seen in the proximal right humerus, only partially imaged on this film --___ there history of old healed fracture ?", "output": "1. Bibasilar patchy opacities, more pronounced on the left side compared with ___. While this is compatible with atelectasis, in the appropriate clinical setting, an early infiltrate would be difficult to exclude. 2. ? Old healed right proximal humeral fracture. Please see comment above." }, { "input": "Overlying EKG leads are present. Lower lung opacities are predominantly linear and likely represent atelectasis though difficult to exclude an early pneumonia. No definite signs of congestion or edema. Mild cardiomegaly is noted. Mediastinal contour is normal. There are no acute osseous abnormalities.", "output": "Lower lung opacities likely atelectasis, difficult to exclude an early component of pneumonia. Mild cardiomegaly." }, { "input": "Heart size is top-normal in size. Mediastinal and hilar contours are unchanged. Pulmonary vasculature is not engorged. Patchy opacities in the lung bases likely reflect areas of atelectasis. No pleural effusion, focal consolidation or pneumothorax is present. No acute osseous abnormalities detected.", "output": "Patchy bibasilar airspace opacities, likely atelectasis. Infection cannot be excluded in the correct clinical setting." }, { "input": "Mild linear left base atelectasis is seen. There is no focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Compared to the prior study, subsegmental atelectasis at both bases is significantly increased. The possibility of associated early infiltrates cannot be excluded, though no frank consolidation is seen. The cardiomediastinal silhouette is unchanged. There is mild vascular plethora, without overt CHF. No effusion.", "output": "Increased streaky opacities at both bases are most suggestive of increased bibasilar atelectasis. The possibility of early infectious infiltrates is considered less likely, but cannot be entirely excluded. Mild upper zone redistribution again seen. Doubt overt CHF." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. An 8 x 4 mm rectangular opacity in the right hilus projects over the setting pulmonary artery and is of uncertain etiology. The imaged upper abdomen is unremarkable. The bones are intact.", "output": "1. No acute cardiopulmonary process. 2. 8 x 4 mm rectangular dense opacity over the right hilus for which repeat imaging with shallow oblique films is recommended. NOTIFICATION: These findings were discussed with Dr. ___ by Dr. ___ ___ telephone at 09:25 on ___" }, { "input": "Heart size is normal. Mediastinal and hilar contours are unchanged. Pulmonary vascularity is normal. Minimal streaky left basilar opacity likely reflects atelectasis. No focal consolidation, pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Minimal left basilar atelectasis." }, { "input": "The left hemidiaphragm is elevated. There is bibasilar atelectasis. At the left base, there is blunting of the costophrenic angle and the possibility of early hazy opacity cannot be excluded. There is mild upper zone redistribution, without overt CHF. No gross effusion or pneumothorax detected. Possible mild cardiomegaly. Right IJ central line tip lies in the region of the cavoatrial junction.", "output": "Upper zone redistribution. Early hazy opacity left base cannot be excluded. Probable small left effusion." }, { "input": "There are relatively low lung volumes. Fullness and indistinctness of the hila suggests pulmonary vascular congestion. No discrete focal consolidation is seen. There is no pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are stable.", "output": "Moderate vascular congestion." }, { "input": "The right lateral costophrenic angle is now clear. There is a small left subpulmonic pleural effusion. Bilateral interstitial edema appears more prominent from the prior exam. Moderate cardiomegaly is stable. No pneumothorax or definite focal consolidation. There is diffuse osteopenia and multilevel degenerative changes with anterior osteophytes in loss of intervertebral disc height in the visualized thoracic spine, overall similar to the prior exam.", "output": "1. Interval increased interstitial edema. 2. Small left subpulmonic effusion. 3. Stable moderate cardiomegaly." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Portable supine chest radiograph ___ at 10:42 is submitted.", "output": "Interval removal of right internal jugular central line. The tracheostomy tube remains in satisfactory position. There is persistent retrocardiac consolidation which may reflect lobar atelectasis. There are likely bilateral layering pleural effusions and there has been interval appearance of mild pulmonary edema. The heart remains enlarged." }, { "input": "There is persistent moderate to severe cardiomegaly. There is mild pulmonary edema. Opacity at the right lung base on the frontal view may be due to atelectasis. There is no significant effusion. Degenerative changes are noted in the spine.", "output": "Cardiomegaly with mild pulmonary edema." }, { "input": "Tracheostomy tube tip terminates approximately 7 cm from the carina. Right PICC tip terminates in the upper SVC. Moderate to severe enlargement of the cardiac silhouette is present. The aorta is diffusely calcified and tortuous. Moderate to severe pulmonary edema is noted along with layering bilateral pleural effusions. More focal opacities in the lung bases may reflect areas of atelectasis, however infection or aspiration cannot be excluded. No pneumothorax is present. There are no acute osseous abnormalities.", "output": "1. Tracheostomy tube in standard position. 2. Moderate to severe cardiomegaly with moderate to severe pulmonary edema, layering bilateral pleural effusions, and probable bibasilar atelectasis. Infection or aspiration at the lung bases cannot be excluded." }, { "input": "Portable semi-erect chest radiograph ___ at 10:54 is submitted.", "output": "Endotracheal tube has its tip 4 cm above the carina. A nasogastric tube is seen coursing below the diaphragm with the tip not identified. Right internal jugular central line has its tip in the distal SVC. The heart remains stably enlarged which may reflect cardiomegaly, although pericardial effusion should also be considered. Mediastinal contours are unchanged. Interval decrease in size of a right pleural effusion. Persistent retrocardiac consolidation may reflect partial lower lobe atelectasis, although superimposed infection cannot be excluded. Interval appearance of mild perihilar edema. No obvious pneumothorax." }, { "input": "Moderate pulmonary edema is noted. The cardiac silhouette is enlarged. The mediastinal silhouette and hilar contours are normal. No pleural effusion or pneumothorax is present.", "output": "Cardiomegaly with moderate pulmonary edema." }, { "input": "PA and lateral views of the chest. There is no focal consolidation. Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "A portable semi supine frontal chest radiograph again demonstrates and a left approach central venous catheter, which crosses midline and then heads superiorly, with the tip again likely within the right brachiocephalic vein. The azygos vein is also a consideration. The remainder of the exam is unchanged, with cardiomegaly and pulmonary edema.", "output": "Status post replacement of a left approach central venous catheter, which again crosses midline and head superiorly. The tip may be in the right brachiocephalic vein versus azygos vein." }, { "input": "There are low lung volumes. The heart is moderately enlarged but unchanged. The aorta is tortuous and diffusely calcified. There is crowding of the bronchovascular structures, with probable mild pulmonary vascular congestion. Small bilateral pleural effusions are noted, with a small amount of fluid in the minor fissure on the right. There are patchy bibasilar opacities most likely reflective of atelectasis. No pneumothorax is present. Compression deformity of the T11 vertebral body is unchanged compared to the prior MRI.", "output": "Mild pulmonary vascular congestion and small bilateral pleural effusions. Probable bibasilar atelectasis." }, { "input": "AP portable semi upright view of the chest. Patient's position limits evaluation. The lungs appear grossly clear aside from mild basilar atelectasis. The heart appears moderately enlarged though unchanged. The mediastinal contour cannot be assessed. Bony structures appear grossly intact with kyphotic angulation of the T-spine.", "output": "Limited exam with mild basilar atelectasis and kyphosis of the T-spine." }, { "input": "AP upright portable chest radiograph obtained. Lung volumes are low and the patient is rotated to the right, which limits the evaluation. There is bibasilar atelectasis with probable small bilateral pleural effusions. The heart appears enlarged, though this could be in part magnified due to technique. Possibility of pneumonia at the lung bases cannot be excluded, though atelectasis is favored. No pneumothorax is seen. Mediastinal contour is difficult to assess. No bony abnormalities.", "output": "Bibasilar atelectasis, difficult to exclude an early pneumonia. Small bilateral pleural effusions redemonstrated." }, { "input": "A portable supine frontal chest radiograph demonstrates interval placement of a left central venous catheter, which crosses midline and courses superiorly, terminating either within the brachiocephalic or the right subclavian or internal jugular veins near their confluence. The remainder of the exam is unchanged, including cardiomegaly and diffuse pulmonary opacity suggestive of edema.", "output": "Interval placement of a left central venous catheter, which terminates either within the brachiocephalic or the right subclavian or internal jugular vein near the confluence." }, { "input": "The patient is slightly rotated to the right, with a somewhat lordotic view which limits evaluation slightly. Heart size is likely mildly enlarged and otherwise mediastinal contour is likely unchanged from ___ given rotation. Lung volumes are low with demonstration of linear atelectasis in the right mid lung field. The lungs are otherwise grossly clear. There is no large pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Compared with the prior study on ___, there has been no significant change. The tip of the ET tube is located approximately 6 cm from the carina. Again seen is a left retrocardiac opacity, likely lower lobe volume loss and pleural effusion. However, superimposed pneumonia is considered in the appropriate clinical setting. There is elevation of the right hemidiaphragmatic contour or with mild atelectatic changes and a probable small effusion.", "output": "1. ET tube is located approximately 6 cm above the carina. Otherwise, no significant change since the prior radiograph on ___." }, { "input": "AP portable view of the chest. Pleural thickening, possibly calcified, which blunts the right costophrenic sulcus with mild right hemidiaphragm elevation is unchanged. There is a new small left pleural effusion. There is mild cardiomegaly and cephalization of vessels consistent with mild pulmonary vascular congestion. No definite consolidation suggestive of pneumonia. No pneumothorax.", "output": "New small left pleural effusion. New mild pulmonary vascular congestion. No definite signs of pneumonia. Biasilar atelectasis." }, { "input": "A frontal upright view of the chest was obtained portably. The patient is rotated. There is no focal consolidation, pleural effusion or pneumothorax. Blunting of the costophrenic sulci bilaterally is unchanged from ___. Scarring at the right base is unchanged. The cardiac and mediastinal silhouettes are stable. There is no free air under the diaphragm. No acute osseous abnormality is identified.", "output": "No acute intrathoracic process. No change from ___." }, { "input": "Single AP view of the chest provided. Left central venous catheter ends at the mid SVC. Patient is status post tracheostomy. Consolidations at the lung bases, bilaterally are mildly worsened from chest radiograph ___. Additionally, there is moderate atelectasis at the right lung base. No pneumothorax. Right basilar pleural effusion and atelectasis is unchanged. Hilar contours are normal. Cardiomediastinal contours are unchanged.", "output": "Bilateral, lower lobe pneumonia is mildly worsened from ___." }, { "input": "Patient is rotated. The left costophrenic angle not fully included on the image. Midline tracheostomy tube is seen. The right hemidiaphragm remains elevated and there is persistent blunting of the right costophrenic angle. Right base atelectasis/scarring is seen. Overall, the right lung is again seen to be volume than the left. No definite focal consolidation is seen on the left. The cardiac and mediastinal silhouettes are grossly stable. The bones are diffusely osteopenic.", "output": "Patient rotated. Left costophrenic angle not fully included on the image. Midline tracheostomy tube. Right hemi diaphragm remains elevated and there is persistent blunting of the right costophrenic angle. Right base atelectasis/ scarring again seen; right base opacity is increased as compared to the prior study which could be due to increased atelectasis, however, underlying consolidation is difficult to exclude." }, { "input": "There is leftward rotation of the patient current radiograph. Tracheostomy tube is again seen in grossly appropriate position. Allowing for differences in technique, the cardiomediastinal silhouettes are stable. There are low lung volumes and a sub-optimal inspiratory effort. Right lower lung and retrocardiac opacities likely represent basilar atelectasis, however, pneumonia cannot be excluded in the correct clinical setting. Small bilateral pleural effusions are likely still present. Central hilar prominence may represent mild pulmonary vascular congestion without evidence of frank pulmonary edema. There is no pneumothorax.", "output": "1. Probable bibasilar atelectasis and small bilateral pleural effusions, however, left lower lobe pneumonia cannot be excluded in the correct clinical setting. 2. Mild pulmonary vascular congestion without frank pulmonary edema." }, { "input": "A tracheostomy tube and left internal jugular central venous catheter are unchanged. Since the prior exam, there has been increased pulmonary vascular congestion and new mild pulmonary edema. The bilateral opacities are grossly unchanged, and better characterized on the recent CT of the chest. Small bilateral pleural effusions are stable. There is no pneumothorax. Enlargement of the cardiomediastinal silhouette is unchanged.", "output": "Interval development of new mild pulmonary edema. Otherwise no significant change, including stable bilateral opacities and pleural effusions." }, { "input": "AP portable upright view of the chest. Tracheostomy tube projects over the superior mediastinum with an overlying oxygen mask in place. There is again noted to be mild elevation of the right hemidiaphragm. Mild pleural thickening along the lateral aspect of the right lung is again noted. There is mild basilar atelectasis noted bilaterally. No convincing signs of pneumonia or edema. No large effusion or pneumothorax is seen. The cardiomediastinal silhouette appears stable. No acute bony injuries.", "output": "Overall no change. No definite signs of pneumonia." }, { "input": "AP portable upright view of the chest. There has been interval placement of a left IJ central venous catheter with its tip projecting over the expected region of the mid SVC. Otherwise no change.", "output": "Right IJ positioned appropriately." }, { "input": "A portable frontal semi-erect chest radiograph demonstrates a tracheostomy in appropriate position. Lung volumes are low. The cardiomediastinal silhouette is unchanged. Consolidation seen in ___ is improved, with streaky opacities likely atelectasis. A small right pleural effusion is unchanged. No definite focal consolidation is identified. There is no pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No definite focal consolidation. Streaky right base opacity is likely atelectasis, possibly related to a small right pleural effusion, unchanged." }, { "input": "Low lung volumes are present. The cardiac silhouette size is borderline enlarged. However this is likely accentuated due to low lung volumes. The mediastinal contour is relatively similar compared to the previous exam. There is mild cephalization of the pulmonary vascular markings due to supine positioning, but no pulmonary edema is seen. Patchy opacities in the lung bases most likely reflect atelectasis. Blunting of the costophrenic sulci bilaterally is chronic, and appears to relate to chronic pleural thickening. No pneumothorax is identified. There are no acute osseous abnormalities detected. Excreted contrast from recent CT scan is noted within the right collecting system.", "output": "Low lung volumes with bibasilar atelectasis. Chronic bilateral pleural thickening." }, { "input": "Since the prior exam, the patient has been extubated, and a tracheostomy tube has been placed. A left-sided PICC line is unchanged, terminating at the superior cavoatrial junction. Small to moderate bilateral pleural effusions with associated bibasilar atelectasis are unchanged. There is no pneumothorax. The cardiomediastinal silhouette cannot be accurately assessed.", "output": "Status post extubation with no significant interval change in small to moderate bilateral pleural effusions with associated bibasilar atelectasis. Infection at either lung base cannot be excluded." }, { "input": "The endotracheal tube terminates 7.2 cm above the carina. A left IJ central venous catheter terminates at the mid SVC. The heart is mildly enlarged, unchanged from prior examinations. There is a persistent left retrocardiac opacity which remains stable, either reflecting atelectasis or underlying consolidation. Small left pleural effusion is unchanged. There is continued elevation of the right hemidiaphragm with adjacent compressive atelectasis.", "output": "Unchanged persistent left retrocardiac opacity, which may reflect atelectasis or small consolidation. Small left pleural effusion. Persistent right elevated right hemidiaphragm with adjacent atelectasis." }, { "input": "Compare with ___ at 11:18 (earlier the same day), there has been interval improvement in the appearance of the right lung. The area of dense thickening seen along the expected course of the minor fissure is significantly improved, though it remains partially visible, suggesting interval re-expansion of portions of the right lung. Patchy opacity however remains visible in the aerated portions of the right lung. The right hemidiaphragm remains elevated, with blunting of the right costophrenic angle, and a small amount of pleural thickening along the right chest wall on the lung apex. The right paratracheal soft tissue density remains thickened. As before, the cardiomediastinal silhouette remains midline and appears overall unchanged. The right hilum, as before, is obscured by surrounding opacities. Also, as before, left lung remains grossly clear, without CHF focal consolidation or effusion. Minimal atelectasis is now noted.", "output": "Interval improvement in the degree of aeration of the right lung. Background patchy opacities remain visible throughout much of the aerated portion of the right lung. The most likely differential are pneumonic infiltrates, extensive aspiration, or asymmetric CHF, but other etiologies cannot be excluded. The left lung remains grossly clear, with minimal atelectasis at the base." }, { "input": "There is increased opacity at the right lung base. Some of this could be due to elevation of the right hemidiaphragm although subpulmonic effusion is possible. Patchy adjacent consolidation is also noted. Left lung is grossly clear noting motion which obscures fine detail. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "Right basilar opacity which could a component of sub pulmonic effusion or elevated right hemidiaphragm. Adjacent parenchymal opacities which could represent a combination of atelectasis, aspiration and/or infection." }, { "input": "An endotracheal tube has been placed that terminates approximately 3 cm above the carina. A orogastric tube passes into the stomach, its distal course not imaged. Lung volumes are low. The cardiac, mediastinal and hilar contours appear unchanged. There is persistent mild elevation of the right hemidiaphragm with effacement of the right costophrenic sulcus and mild pleural thickening, apparently chronic in nature. Likewise, blunting of the left costophrenic sulcus appears unchanged. There is no pneumothorax.", "output": "Status post endotracheal intubation. Stable appearance of the chest." }, { "input": "Portable AP semi-upright views of the chest were obtained. Cardiomediastinal silhouette is unchanged. Chronic bibasilar opacities more severe on the right have slightly increased, likely representing worsening atelectasis; however, underlying consolidation is not excluded. Lungs are otherwise clear. Small bilateral pleural effusions are unchanged. No pneumothorax.", "output": "Slightly increased opacification at the right base is probably related to worsening atelectasis as chronically seen in that region; however, developing consolidation cannot be excluded." }, { "input": "Compared to the prior study the right hemidiaphragm continues to be elevated with either scarring or effusion. In addition there is an area of atelectasis versus infiltrate that is increased compared to the study from 2 days prior. The left lobe is clear.", "output": "Worsened appearance of the right lower lobe. It is unclear if this is volume loss or infectious infiltrate." }, { "input": "Tracheostomy tube in place. Volume loss in the right lung. New right mid and lower lung opacities noted, concerning for pneumonia. The left lung is clear.", "output": "Left lung consolidation concerning for pneumonia. ." }, { "input": "The patient is rotated distorting the appearance of the right thoracic cage. Tracheostomy tube is in standard position. Right lower hemithorax opacity with silhouetting of the right heart border is consistent with a combination of a small pleural effusion, atelectasis, and residual but improved consolidation from infection. No pneumothorax. Asymmetric edema and pulmonary vascular engorgement on the prior exam in the right lung has markedly improved. No frank pulmonary edema. Pulmonary vascular engorgement is now more symmetric and minimal.", "output": "1. Persistent but markedly improved pneumonia. 2. Small right pleural effusion and atelectasis. 3. Improved edema and bronchovascular engorgement, now minimal in more symmetric." }, { "input": "PA and lateral views of the chest provided. Tracheostomy tube again noted projecting over the superior mediastinum. There is a left IJ access central venous catheter with its tip terminating in the low SVC, unchanged. There is persistent elevation of the right hemidiaphragm with right basal atelectasis as on prior. Lungs are otherwise clear. No convincing signs of pneumonia. Cardiomediastinal silhouette is unchanged. Bony structures are intact.", "output": "No convincing evidence for pneumonia." }, { "input": "Rotated positioning. Again seen is the tracheostomy tube. Compared with ___, there is new patchy opacity at the base of the right upper zone and at the right lung base, with less pronounced patchy opacity extending toward the right lung apex. There is pleural fluid and/or thickening in the right costophrenic angle and extending along the right chest wall, that is similar to the prior study. In addition, there is new thickening of the right minor fissure which could represent pleural fluid extending along the minor fissure. As before, the right hemidiaphragm is likely elevated. Allowing for rotation, the mediastinum remains grossly midline. The mediastinum appears prominent, though this is likely accentuated by low inspiratory volumes and rotation. Heart size is at the upper limits of normal. In the left lung, there is minimal upper zone redistribution and minimal atelectasis linear atelectasis/scarring at the left lung base. The extreme left costophrenic angle is excluded from the film, but no gross left effusion is identified. There is background osteopenia. Incidental note is made of severe left glenohumeral osteoarthritis.", "output": "New patchy opacity in much of the right lung, most pronounced at the base of the right upper lobe and at the right base. Although non-specific, the appearance is concerning for multifocal pneumonic infiltrate. Asymmetric CHF could have a similar appearance, but is considered unlikely given the absence of significant findings in the left lung. New thickened appearance of the right minor fissure suggests fluoro fluid layering along the minor fissure." }, { "input": "The endotracheal tube tip is 4 cm above the carina. The left PICC line terminates in the right atrium, and if desired, would need to be withdrawn at least 3.5 cm to be positioned in the low SVC. No pneumothorax. There are moderate bilateral pleural effusions, obscuring the heart borders. The right effusion may be loculated, as fluid is not distributed diffusely and posteriorly and lung on this supine view. Substantial left lower lobe atelectasis with leftward shift of the mediastinum is unchanged.", "output": "1. Moderate bilateral pleural effusions, possibly loculated on the right. 2. Unchanged left lower lobe atelectasis. 3. Left PICC line terminates in the right atrium and would need to be withdrawn at least 3.5 cm be position in the low SVC, if desired." }, { "input": "The tracheostomy is again noted. The overall appearance is quite similar, though slight differences are present on both sides. On the right, there is slight difference in distribution of right lung opacities. In particular, the previous seen dense platelike opacity in the right mid/lower zone is no longer visualized and may have resolved. The small right pleural effusion is similar in appearance. In the left lung, there is upper zone redistribution. Patchy retrocardiac opacity is slightly more pronounced with new partial obscuration left hemidiaphragm and suggested left lower lobe air bronchograms. On the left, mild upper zone redistribution and slight vascular plethora.", "output": "Suspected very slight improvement in opacities in the right infrahilar region. Slight worsening of collapse/consolidation at the left lung base. On the left, mild upper zone redistribution and slight vascular plethora." }, { "input": "Persisting chronic right basilar atelectasis, and possible small pleural effusion appear unchanged compared to prior studies. Pleural thickening on the right is unchanged. Retrocardiac opacity on the left has worsened since the prior study, and is worrisome for pneumonia or aspiration in the appropriate clinical setting. There is no overt pulmonary edema. There is no pneumothorax. The heart size is stable.", "output": "Right bibasilar atelectasis and possible small effusion stable. Worsening retrocardiac left basilar opacity, concerning for aspiration or pneumonia in the appropriate clinical setting" }, { "input": "Retrocardiac opacities are increased from prior study, likely reflect atelectasis. No large pleural effusion or pneumothorax. The heart is moderately enlarged. The mediastinum and hila are unchanged. The descending aorta is slightly tortuous, unchanged. General increased dense appearance of the bones in the thorax are unchanged from the prior exam. Mild biapical pleural thickening is unchanged. Eventration of the right hemidiaphragm is similar the prior exam. There appears to be right rib fractures", "output": "Retrocardiac opacities are likely atelectases, superimposed infection cannot be excluded please correlate clinical symptoms. ." }, { "input": "Left-sided dual-chamber pacemaker device is re- demonstrated with leads terminating in the right atrium right ventricle. The patient is status post right upper lobectomy with expected fluid overlying the right apex. Cardiac, mediastinal and hilar contours are unchanged. Patchy opacities within the right perihilar region, right lung base, and left lung base are unchanged from the exam earlier today, but not clearly evident on the prior CT exam from ___. There is no pulmonary edema. Small bilateral pleural effusions are noted. No pneumothorax is identified.", "output": "No interval change compared to the prior study from approximately 15 hours earlier. Continued right perihilar and bibasilar patchy opacities which may reflect areas of infection. Small bilateral pleural effusions." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Compared to the prior study there is increased volume loss/ infiltrate in the right. Lung volumes continue to be low and there is pulmonary vascular redistribution.", "output": "Increased volume loss/ infiltrate in the right lower lobe" }, { "input": "AP upright and lateral views of the chest were provided. There is moderate pulmonary edema noted, similar to prior exam from earlier this year. No large effusions are seen. The heart remains moderately enlarged. The mediastinal contour is stable. Bony structures are intact. No free air below the right hemidiaphragm. Trace fluid along the fissures noted.", "output": "Moderate degree of pulmonary edema." }, { "input": "The ET tube ends 3 cm from the carina. The right internal jugular central venous catheter ends in the mid-to-low SVC. NG tube is out of view. Compared to chest radiograph from ___, the diffuse bilateral parenchymal opacities have worsened. There are now increased opacities at the right upper lung and more opacities including the right mid lung. Compared to radiograph from ___, there is no significant change. The cardiac, mediastinal, and hilar contours are stable. No large pleural effusion. No pneumothorax.", "output": "1. Compared to ___, there is worsening diffuse parenchymal opacities. Compared to ___, there is no significant change. 2. Lines and tubes are in appropriate position." }, { "input": "There are bilateral interstitial opacities, greater at the lung bases, consistent with moderate pulmonary edema. The previously reported right upper lobe spiculated opacity is again noted and better evaluated on prior FDG tumor imaging study. Diffuse emphysematous changes are again noted throughout the lungs. The heart remains moderately enlarged. Mediastinal contours are stable.", "output": "1. Moderate pulmonary edema with moderate cardiomegaly. 2. Right upper lobe spiculated opacity again noted and better delineated on prior FDG Tumor Imaging study." }, { "input": "Moderate-to-severe cardiomegaly and mild widening of the mediastinum is chronic and unchanged since at least ___. Scattered parenchymal opacities particularly at the lung bases as well as spiculated areas of probable scarring in the lung apices are unchanged since ___. There is no clear superimposed opacity. There is no pleural effusion or pneumothorax.", "output": "Scattered areas of increased parenchymal opacity are likely chronic and unchanged since ___ without suggestion of superimposed process." }, { "input": "AP and lateral images of the chest. The lungs well expanded. Prominent interstitial markings are seen, predominantly in the bases. This may be due to chronic underlying lung disease, but the presence of cardiomegaly suggests it may be a component of mild pulmonary. No pleural effusion or pneumothorax is seen.", "output": "Probable mild pulmonary edema. Cardiomegaly." }, { "input": "The cardiac silhouette is moderately enlarged. There is no pleural effusion. There are increased interstitial markings bilaterally, suggesting moderate pulmonary edema, increased from the prior study and/or chronic thromboembolic pulmonary disease seen on prior CT from ___. Right upper lobe nodularity better assessed on CT.", "output": "Persistent moderate enlargement of the cardiac silhouette. Increased interstitial markings bilaterally suggesting moderate pulmonary edema, increased from the prior study, and/or chronic thromboembolic pulmonary disease as seen on prior CT." }, { "input": "Bilateral multifocal lung opacities reflecting pneumonia which are worse in the left lung are unchanged in distribution and severity since prior chest radiograph from ___. Presumed small bilateral pleural effusions are unchanged. Heart size is normal. Mediastinal and hilar contours are unchanged.", "output": "Bilateral multifocal lung opacities reflecting multifocal pneumonia are unchanged in severity and distribution." }, { "input": "The airspace opacities in the left lung and in the right lower lobe which were new on were new on ___ radiograph have minimally improved over last 10 hours. These acute and newly developed opacities between ___ and ___ could reflect asymmetric pulmonary edema or acute pneumonitis. Conclusion should be drawn in conjunction with clinical history. Top normal heart size is normal. The mediastinal and hilar contours are unremarkable.", "output": "Bilateral airspace opacities in the left lung and the right lower lobe, new since ___ reflecting pulmonary edema or pneumonitis, have minimally improved." }, { "input": "Severe cardiomegaly with tortuosity of the aorta is unchanged from prior study. Hilar contours are unremarkable. Again appreciated are moderate increased interstitial lung markings with lower zone predominance, similar to prior examination given difference of technique. There is no focal consolidation. There is no pleural effusion or pneumothorax.", "output": "Similar appearance of moderately increased interstitial lung markings suggestive of pulmonary fibrosis." }, { "input": "There are extensive heterogeneous opacities throughout the entire left lung and right lower lung. The right mid and upper lung is essentially clear. The heart size is within normal limits. The mediastinal contours are normal. There are no definite pleural effusions. No pneumothorax.", "output": "Diffuse bilateral airspace opacities with sparing of the right mid/upper lung would be a somewhat unusual pattern for asymmetric pulmonary edema and it is thought to be concerning for a multifocal infectious process." }, { "input": "Frontal and lateral views of the chest were performed. The heart is mild to moderately enlarged, unchanged. Prominent and asymmetric interstitial opacities appear improved from the most recent study but similar to ___. A worsened appearance of the chest from ___ is worrisome for progressive and severe fibrosis, however, a component of acute reaction to drug use cannot be excluded. The azygous vein is not enalarged and there are no pleural effusions to think this worsening is primarily related to volume overload. The mediastinal and hilar structures are normal. There are no acute osseous abnormalities.", "output": "Prominent interstitial opacities which appear worse from ___ are thought to reflect a path to severe fibrosis, however, this could partially be explained by an acute reaction from recent drug use. No convincing evidence for volume overload." }, { "input": "Portable chest radiograph demonstrates unremarkable mediastinal contours. There is stable mildly enlarged cardiac silhouette. There has been interval increase in diffuse alveolar opacities with a basilar predomince, left greater than right with loss of left hemidiaphragm silhouette. Given multiple prior studies demonstrating rapid increase and decrease of opacification and previously provided history of cocaine use, findings suggest acute non-cardiac pulmonary edema versus pulmonary toxicity.", "output": "Increased asymmetric predominantly basilar diffuse airspace opacifications likely represent acute non-cardiac edema vs pulmonary toxicity from inhaled substance." }, { "input": "Severe bilateral diffuse parenchymal opacities are noted and appear similar to that seen previously in ___. Cardiomediastinal silhouette remains stable. No acute fractures are identified.", "output": "Diffuse bilateral severe parenchymal opacities, similar to that seen previously in ___ with multifocal pneumonia. These findings are more consistent with multifocal pneumonia, supperimposed pulmonary edema is possible." }, { "input": "The heart and mediastinal contours are largely obscured by diffuse pulmonary opacities. The costophrenic angles appear sharp likely signifying no pleural effusion and there is no pneumothorax.", "output": "Widespread pulmonary opacities, the differential for which includes edema, multifocal pneumonia, or crack lung." }, { "input": "AP upright view of the chest was provided. There is interval increase in airspace consolidation is noted diffusely and bilaterally. Findings are concerning for multifocal pneumonia, though a component of edema is difficult to exclude. Cardiomediastinal silhouette is stable. Bony structures are intact.", "output": "Worsening pneumonia." }, { "input": "The cardiac silhouette remains enlarged. Bibasilar predominant opacities seen on the prior study persists, but appear improved in the interval. Right upper lobe pulmonary nodule seen on CT from ___ was better assessed on CT. Mediastinal contours are stable. No pleural effusion or pneumothorax.", "output": "The cardiac silhouette remains enlarged. Bibasilar predominant opacities seen on the prior study persists, but appear improved in the interval. Right upper lobe pulmonary nodule seen on CT from ___ was better assessed on CT. Mediastinal contours are stable. No pleural effusion or pneumothorax." }, { "input": "In comparison to previous radiograph, diffuse lung opacities have somewhat decreased with some residual opacities predominently in the lower lobes. No pleural effusion or pneumothorax is present. Right upper lobe linear opacity is unchanged from prior. Stable mild cardiomegaly.", "output": "Interval improvement in diffuse bilateral opacities. No new consolidation." }, { "input": "One semi-erect AP portable view of the chest. Right internal jugular line ends in the mid to low SVC. Endotracheal tube ends 3 cm from the carina. The diffuse parenchymal opacities with minimal sparing of only the mid right lung are unchanged. No pneumothorax. NG tube in the stomach.", "output": "No significant change in diffuse parenchymal opacities with minimal sparing in the right mid lung." }, { "input": "The heart is again mild-to-moderately enlarged.There is new confluent opacification in the left upper lobe, particularly near the apex with lesser involvement elsewhere. To a lesser degree, there is also new right apical opacification. A right lower lung opacity is similar to improved, however. The lungs are hyperinflated. There is no pleural effusion or pneumothorax. Bony structures are unremarkable.", "output": "Much more extensive lung opacification than seen on the prior study including confluent left apical opacification with a distribution that is not typical for pulmonary edema. An infectious process could be considered, but the process is widespread but heterogenous, with a strikingly peripheral distribution in the left upper lobe which could be seen with an eosinophilic pneumonia, which has been described as a manifestation of cocaine-related lung disease. A coinciding component of pulmonary edema is also possible." }, { "input": "Since the prior radiograph, there has been interval increase in heart size and mediastinal venous congestion. Pulmonary veins the interstitium are also congested. No pleural effusion or pneumothorax.", "output": "Moderate pulmonary edema with no pleural effusion." }, { "input": "Heart appears to be enlarged as previously seen. There is increased pulmonary vascular congestion, more prominently on the left. There is also slight widening of the upper mediastinum on the right, possibly indicating engorgement of the azygous vein. Although no consolidation is noted, the pattern of pulmonary congestion makes it difficult to exclude an overlying developing infilterate. No pleural effusions and no pneumothorax.", "output": "Increased pulmonary vascular congestion, overlying developing infiltrate cannot be ruled out." }, { "input": "There are diffuse airspace opacities spanning nearly the totality of both lungs, with some sparing of an ill-defined region in the right upper lung. The cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "Bilateral opacities occupying nearly the totality of the lungs consistent with acute pulmonary edema. Diffuse reactive inflammatory process such as pneumonitis or infection cannot be excluded." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes. Diffuse bilateral consolidate opacities with have recurred since prior exam, but are in different distribution. There is no pleural effusion or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is top normal.", "output": "Diffuse bilateral consolidative opacities have recurred in different distribution since prior exams, likely due to interval environmental exposures." }, { "input": "Heart size remains moderate to severely enlarged. The mediastinal and hilar contours are unchanged with superior mediastinal widening compatible with underlying lymphadenopathy. There is mild pulmonary edema, not substantially changed in the interval. Hazy opacities within the lung bases are re- demonstrated, and better assessed on the recent CT. Known spiculated nodule in the right upper lobe is better assessed on the previous CT. No focal consolidation, pleural effusion or pneumothorax is present. The lungs remain hyperinflated. No acute osseous abnormality is detected.", "output": "1. Mild pulmonary edema, not sugstantially changed in the interval. 2. Mild hazy opacities in the lung bases, better assessed on the previous CT exams, and potentially reflective of chronic thromboembolic disease. 3. Unchanged mediastinal lymphadenopathy and cardiomegaly. 4. Known right upper lobe spiculated nodule is better assessed on the previous CT." }, { "input": "As compared to the prior examination, there is improved aeration bilaterally. However, there remains some hazy opacification, greater at the bases, likely representing pulmonary edema and predominantly a mild to moderate interstitial abnormality. No significant pleural effusion is present. A small amount of pleural fluid is noted along the right major fissure. No pneumothorax is seen. There is mild cardiomegaly.", "output": "Mild to moderate predominantly interstitial opacification, less severe than before, but suggesting persistent or recurrent pulmonary abnormality; although not specific, it could be seen with pulmonary edema among other causes." }, { "input": "Endotracheal tube terminates approximately 4.1 cm above the level of the carina. Enteric tube courses below the diaphragm, in the field of view. Left-sided subclavian central venous catheter is stable in position. There has been interval increase in left infrahilar opacity. Right base opacity persists. External leads overlie the right upper lung, making evaluation in this region suboptimal. No pleural effusion or pneumothorax seen. Enlargement of the cardiomediastinal silhouette is stable.", "output": "Persistent bibasilar opacities with interval increase in left infrahilar opacity concerning for worsening pneumonia with possible a component of underlying edema. Right upper lung is not optimally assessed due to overlying external leads." }, { "input": "There is mild cardiomegaly, stable. The mediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. The lungs are well-expanded. Prominent interstitial markings are again noted, similar to prior, and suggestive of moderate pulmonary edema. Underlying chronic interstitial changes are also possible, especially given the persistence of this finding. There is no focal consolidation concerning for pneumonia.", "output": "Mild cardiomegaly with stable interstitial prominence, which may moderate pulmonary edema or chronic changes. No focal consolidation concerning for pneumonia." }, { "input": "Frontal and lateral radiographs of the chest show dramatic improvement and near resolution of previously seen extensive bilateral parenchymal opacities from ___. No pleural effusion or pneumothorax is present. The pulmonary vasculature is not engorged. The cardiac silhouette is top normal in size. The mediastinal and hilar contours are within normal limits. A right-sided PICC line is unchanged in position with the tip terminating in the mid SVC.", "output": "1. Dramatically improved appearance of crack cocaine lung injury from ___. 2. Stable borderline cardiomegaly." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. The heart is mild to moderately enlarged but unchanged. Fissures are minimally thickened. There is no pleural effusion or pneumothorax. A diffuse moderate interstitial abnormality appears very similar to the prior studies. No superimposed acute focal abnormality is identified. There has been no definite change.", "output": "Similar moderate diffuse interstitial abnormality. Findings could be seen with recurring or persistent pulmonary edema, which seems mostly likely, although an underlying interstitial abnormality could also be considered." }, { "input": "The inspiratory lung volumes are appropriate. The pulmonary vasculature is engorged. There is predominantly bibasilar increased interstitial opacities consistent with dependent pulmonary edema, which is improved from ___. There is no pleural effusion or pneumothorax. The cardiac silhouette is top normal in size. The mediastinum remains prominent but stable, likely reflecting venous congestion. The hilar contours are within normal limits. No acute osseous abnormality is detected.", "output": "Mild to moderate pulmonary vascular congestion/interstitial edema without pleural effusion, improved from ___." }, { "input": "Cardiac silhouette remains enlarged, unchanged from prior exam. Global heterogeneous opacities with a peripheral predilection are worse compared to ___ with an appearance suggestive of eosinophilic pneumonia. There is no pneumothorax.", "output": "Worsening bilateral peripheral opacities with a distribution suggestive of eosinophilic pneumonia." }, { "input": "Single frontal view of the chest demonstrates interval placement of ET tube with tip terminating 2.7 cm above the carina. Compared to 1 day prior, there is massive progressive worsening of widespread pulmonary opacities and near complete white-out of bilateral lungs with relative sparing of the right upper lobe. There is new obscuration of the cardiac silhouette as well as a bilateral diaphragmatic contours allowing for which, cardiomegaly is likely unchanged. Bilateral effusions may be present. There is no pneumothorax. The airway remains midline. Note is made of an airdistended stomach.", "output": "1. ET tube with tip terminating 2.7 cm above the carina. 2. Marked rapid progression of pulmonary disease with now diffuse dense opacification of bilateral lungs and mild sparing of the right upper lobe, overall appearance suggestive of ARDS. 3. Moderate air distended stomach. NGT placement should be considered. Findings discussed with Dr. ___ ___ phone at approximately 1pm on ___." }, { "input": "In comparison to prior chest radiograph from ___, there is stable enlargement of the cardiac silhouette, compatible with mild to moderate cardiomegaly. Diffuse airspace and reticular interstitial opacities with a bilateral lower lobe predominance likely reflect chronic parenchymal inflammation, and were better characterized on prior chest CT from ___. There is likely mild pulmonary edema superimposed. There is no evidence of focal lung consolidation. There is no pleural effusion or pneumothorax.", "output": "1. Stable mild to moderate cardiomegaly and mild pulmonary edema. 2. Stable lower lobe predominant airspace and reticular interstitial opacities, possibly reflecting chronic lung disease. No superimposed focal lung consolidation." }, { "input": "The heart is mild-to-moderately enlarged. The mediastinal and hilar contours appear unchanged. There is no pleural effusion or pneumothorax. There are persistent reticular opacities with hazy background opacity within in the mid-to-lower lungs or perhaps recurring opacity that is relatively confluent more in the right lower lobe than elsewhere. Much of this appearance is suggestive of vascular congestion including indistinct upper zone redistribution of pulmonary vascularity and thickening of fissures. A patchy focal right upper lobe opacity appears unchanged and is most suggestive of a form of prior scarring.", "output": "Findings which are most suggestive of pulmonary edema, although more confluent in the right lower lobe than elsewhere. In the setting of high clinical suspicion for pneumonia, the possibility this represents a developing focal pneumonia as a second diagnosis could be considered in the appropriate setting." }, { "input": "Frontal and lateral views of the chest were obtained. The previously seen diffuse lung opacities have significantly decreased in the interval with possible residua seen in the bilateral lower lobes. No large pleural effusion is seen. There is no pneumothorax. The cardiac silhouette remains enlarged. Subtle peripheral right upper lobe linear opacity may relate to scarring.", "output": "Significant interval decrease in previously seen bilateral pulmonary opacities with some opacity remaining in the bilateral lower lung fields." }, { "input": "The heart remains mild-to-moderately enlarged. The mediastinal and hilar contours are stable. Redemonstrated are hazy opacifications bilaterally with a basilar predominance, which may slightly be worse in the interval. No new focal consolidation, pleural effusion or pneumothorax is identified. There are no acute osseous abnormalities.", "output": "Diffuse hazy opacifications in the lungs, most pronounced at the lung bases, compatible with a chronic interstitial lung disease. As findings may be slightly increased compared to the prior exam, a superimposed infectious process or exacerbation of the patient's underlying chronic interstitial lung disease cannot be excluded." }, { "input": "Frontal and lateral views of the chest. When compared to multiple prior exams, there has been no significant interval change and interstitial opacities most notably at the lung bases. More spiculated opacity in the right upper lung is also seen. When compared to remote priors this has not significantly changed and is most suggestive of a chronic process. There is no definite superimposed consolidation. There is no effusion. Moderate cardiomegaly is again seen and unchanged. No acute osseous abnormality detected.", "output": "Chronic parenchymal changes which have persisted and have not significantly changed since ___ and are likely chronic. No definite superimposed process." }, { "input": "Heart size is moderately enlarged. Mediastinal and hilar contours are similar. Mild pulmonary edema is not substantially changed in the interval. No pleural effusion, focal consolidation or pneumothorax is visualized. There are no acute osseous abnormalities.", "output": "Mild pulmonary edema and moderate cardiomegaly, unchanged." }, { "input": "Frontal and lateral chest radiographs demonstrate stable severe cardiomegaly. Mediastinal and hilar contours are unremarkable without evidence of vascular congestion to suggest overload. There is redemonstration of the bibasilar somewhat reticular opacifications which have been present to varying degrees since initial presentation to ___ in ___. Compared to next preceding radiograph, ___, there is mild interval improvement. Findings are better assessed on a CTA chest performed ___ at which point they were attributed to chronic lung changes thought to be sequelae of illicit drug use such as scarring, hemorrhage or chronic organized pneumonia. No definite new focal opacification is identified. There is redemonstration of the rounded lesion in the right upper lobe which appears stable since ___ and non-FDG avid on PET-CT performed ___. Stability and lack of radiotracer uptake suggest this is an area of scarring. No pleural effusion or pneumothorax evident. No osseous abnormality identified.", "output": "Relatively stable if not slightly improved bibasilar opacifications present since ___ and though to reflect chronic inflammatory changes reactive to illicit drug use. No definite new focal opacification identified. Right upper lobe nodule, unchanged since ___ and non-FDG avid as of ___." }, { "input": "Single AP upright portable view of the chest was obtained. Again seen is prominence of the interstitial markings particularly in the mid-to-lower lungs similar to prior in this patient with suggestion of pulmonary fibrosis possibly slightly improved as compared to the prior study. The patient's reported right upper lobe spiculated opacity seen on prior PET-CT from ___ was better evaluated on that study. The cardiac silhouette remains enlarged. Mediastinal contours are stable.", "output": "1. Stable cardiomegaly. 2. Stable to possibly slightly improved interstitial lung disease. No acute cardiopulmonary process. 3. Right upper lobe spiculated opacity seen on prior CT better evaluated on CT." }, { "input": "PA and lateral views of the chest demonstrate the lungs are well expanded with minimal interstitial prominence, which may be artifactual. Otherwise, the lungs are clear with no pulmonary edema, pleural effusion, pneumothorax or focal consolidation. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Streaky bibasilar opacities likely represent atelectasis. Since the prior radiograph of ___ is slightly progressed particularly at the right lung base. No consolidation or pleural effusion. Heart size and mediastinal contours are normal.", "output": "Mild increase in right basilar atelectasis since ___. No evidence consolidation. No pleural effusion." }, { "input": "Heart size is mildly enlarged but unchanged. The mediastinal and hilar contours are within normal limits. Pulmonary vasculature is not engorged. Small bilateral pleural effusions are noted along with patchy opacities in the lung bases, likely atelectasis. No pneumothorax is visualized. There are mild multilevel degenerative changes demonstrated in the thoracic spine and severe degenerative changes are also seen involving both shoulders.", "output": "Small bilateral pleural effusions with probable bibasilar atelectasis." }, { "input": "The heart is moderately enlarged but stable from the prior examination in ___. The aorta is tortuous. Mediastinal and hilar contours are within normal limits. The pulmonary vasculature is not engorged. Very small bilateral pleural effusions are demonstrated and stable from the prior examination. Linear opacities at the lung bases most likely reflect atelectasis. There is no pneumothorax. No focal consolidation is identified.", "output": "Very small bilateral pleural effusions and bibasilar atelectasis. Stable cardiomegaly." }, { "input": "PA and lateral views of the chest were compared to previous exam from ___. Better inspiratory effort seen on the current exam. Faint linear bibasilar opacities, however, seen only on the frontal. There is no effusion. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "Linear bibasilar opacities suggestive of atelectasis. Otherwise, no acute cardiopulmonary process." }, { "input": "There is mild right base atelectasis. No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable and unremarkable. Slight prominence of the right hilum on the frontal view is stable since at least ___.", "output": "No acute cardiopulmonary process." }, { "input": "Chest PA and lateral radiograph demonstrates unremarkable mediastinal and hilar contours. Stable mild-to-moderate cardiomegaly. Significant decrease in right pleural effusion with near resolution. Stable right upper lobe opacification with surgical clip and evidence of associated volume loss correlating with known mass treated with cyberknife.", "output": "No pulmonary edema. Significantly improved, nearly resolved, right pleural effusion. Stable right upper lobe mass and postreatment volume loss." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are clear without focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "THERE IS RIGHT BASILAR OPACITY WORRISOME FOR PNEUMONIA. UNDERLYING PLEURAL EFFUSION AND ATELECTASIS MAY ALSO BE PRESENT. . NO FOCAL CONSOLIDATION IS SEEN ON THE LEFT. THERE IS SLIGHT PROMINENCE OF THE LEFT HILUM AND THERE APPEARS TO BE PERIBRONCHIAL THICKENING. NO LARGE LEFT PLEURAL EFFUSION. NO PNEUMOTHORAX. THE CARDIAC SILHOUETTE IS TOP-NORMAL CONTOURS ARE UNREMARKABLE.", "output": "RIGHT BASILAR OPACITY WORRISOME FOR PNEUMONIA. UNDERLYING PLEURAL EFFUSION AND ATELECTASIS MAY ALSO BE PRESENT. PERIHILAR PERIBRONCHIAL THICKENING. RECOMMEND FOLLOWUP TO RESOLUTION." }, { "input": "Cardiomegaly and mediastinal contours are stable. Multiple bilateral calcified pleural plaques are similar to prior. Blunting of the left costophrenic angle is similar to prior, possibly a small pleural effusion or pleural thickening. No focal consolidation or pneumothorax.", "output": "No focal consolidation." }, { "input": "Frontal and lateral views of the chest are compared to previous exam from ___. Right-sided central line is seen with catheter tip at the RA-SVC junction. Mildly increased interstitial markings are seen throughout the lungs bilaterally, increased from prior exam. Superimposed linear bibasilar opacities are suggestive of atelectasis. There is no large effusion. Cardiac silhouette is enlarged but not significantly changed. Osseous and soft tissue structures are unremarkable.", "output": "Mildly increased interstitial markings compared to previous exam suggesting mild pulmonary vascular congestion. Linear bibasilar opacities which have the appearance of atelectasis however clinical correlation is suggested regarding possibility of early pneumonia." }, { "input": "Moderate cardiomegaly is stable. The lungs are clear. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary abnormality" }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "The lungs are clear. There is no focal consolidation or effusion. The cardiac silhouette is enlarged but stable in configuration. Atherosclerotic calcifications noted at the aortic arch. No acute osseous abnormalities.", "output": "Cardiomegaly without acute cardiopulmonary process." }, { "input": "Single AP upright portable view of the chest was obtained. There are multiple bilateral patchy pulmonary opacities worrisome for multifocal pneumonia. Trace blunting of the right costophrenic angle could be due to a trace right pleural effusion. No pneumothorax is seen. The cardiac silhouette remains mildly enlarged. Mediastinal contours are stable and the aortic knob is calcified.", "output": "Patchy bilateral pulmonary opacities, most prominently in the mid-to-lower lung zones, worrisome for multifocal pneumonia. A component of superimposed pulmonary edema may be present. Recommend followup to resolution." }, { "input": "No focal consolidation, pleural effusion, or pneumothorax is seen. Mild interstitial abnormality is likely chronic. Heart and mediastinal contours are within normal limits.", "output": "Mild interstitial abnormality, which is likely chronic, without radiographic evidence for acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest demonstrate improvement in a left hydro pneumothorax ,with air-fluid level in the left apex, following left upper lobectomy. The fluid component is increasing relative to the aerated component, as expected. There has been interval resolution of the small remaining amount of subcutaneous air. Appearance of the right lung is unchanged compared to the prior study.", "output": "Improving left hydro pneumothorax following left upper lobectomy." }, { "input": "Since the prior study, there has been interval thoracentesis, with removal of fluid from a left apical hydro pneumothorax. The aerated portion of the pneumothorax remains, unchanged in size compared to the prior study. The appearance of the right hemi thorax is stable. The cardio mediastinal silhouette is also unchanged.", "output": "Expected appearance status post thoracentesis with removal of fluid from a left apical hydro pneumothorax." }, { "input": "AP portable upright view of the chest. Patient remains intubated with the tip of the endotracheal tube located approximately 2.8 cm above the carina. An NG tube is been placed which terminates in the left upper abdomen. Patient's rotation limits evaluation. Lungs appear grossly clear.", "output": "ET and NG tubes in place." }, { "input": "The lungs are clear. Slight hyperinflation as evidenced by flattened diaphragms. Cardiac silhouette is normal in size. There is no pleural effusion, pneumothorax, or pneumonia.", "output": "No evidence of acute cardiopulmonary process. Mild hyperexpansion." }, { "input": "Best seen on the lateral views increased opacity projecting over the lung bases, likely localizing to the right on the frontal view. Elsewhere, the lungs are clear. Cardiomediastinal silhouette is stable noting moderate cardiomegaly. Left chest wall dual lead pacing device is again noted. No acute osseous abnormality. Vertebroplasty changes are identified in the lower thoracic spine, new since ___.", "output": "Basilar opacity, likely localizing to the right, which would be compatible with pneumonia in the proper clinical setting." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. There is tortuosity of the descending aorta. The lungs are hyper expanded and there is flattening of the diaphragms, likely related to chronic lung disease. There is an area of increased opacity at the right lung base which is concerning for an infectious process. There is no pneumothorax or pleural effusion.", "output": "Increased opacity at right lung base concerning for pneumonia. Short interval followup is recommended after treatment to document resolution." }, { "input": "Hyperinflation. Tortuous, calcified thoracic aorta. Heart size within normal. Trace right pleural effusion. The previously demonstrated right lung base opacity is slightly less prominent on the current study, likely atelectasis.", "output": "Hazy right base opacity is less conspicuous than prior study, and likely represents atelectasis rather than developing pneumonia." }, { "input": "The lungs are hyperexpanded with flattening of diaphragms, consistent with emphysema. Opacities in the right lung base are consistent with pneumonia. No pneumothorax or pleural effusion. Heart size is normal and mediastinal contours, including tortuosity of the aorta, are stable.", "output": "Right lung base opacities likely reflect focal scar or atelectasis but FOLLOW UP PA and lateral CXR is recommended when clinically feasible to exclude focal/early pneumonia." }, { "input": "", "output": "Severe emphysema; right cardiophrenic angle opacity equivocal for pneumonia. ______________________________________________________________________________ FINAL REPORT HISTORY: ___-year-old male with fever, chills, and failure to thrive. STUDY: PA and lateral chest radiograph. COMPARISON: ___. FINDINGS: The cardiomediastinal and hilar contours are within normal limits and unchanged from prior exam. Lucent lungs as well as flattening of the hemidiaphragms are compatible with severe emphysema. A subtle opacity exists at the right cardiophrenic angle but no correlate on the lateral view is present. There is no pleural effusion or pneumothorax. IMPRESSION: Severe emphysema; right cardiophrenic angle opacity equivocal for pneumonia. Findings discussed with ___ at 15:40 on ___ by ___ over the phone." }, { "input": "The lungs are hyperinflated. Mild biapical scarring is noted. There is a focal opacity projecting on the lateral view overlying the spine likely localizing to the right base on the frontal view, unchanged from prior. This correlates with an area of scarring seen on prior CT. There is no focal consolidation worrisome for infection. Cardiac silhouette is within normal limits tortuosity of the abdominal aorta is again noted.", "output": "Hyperinflation without superimposed acute cardiopulmonary process." }, { "input": "Cardiac silhouette size is normal. Mediastinal and hilar contours are within normal limits. Lungs are clear. Pulmonary vasculature is not engorged. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Consecutive lateral left fifth through at least eighth rib fractures are again seen. Adjacent hematoma is likely unchanged. Small left pleural effusion and left basilar atelectasis are unchanged. No pneumothorax. Heart size is top-normal. Cardiomediastinal and hilar silhouettes are unremarkable.", "output": "Unchanged left rib fractures and adjacent hematoma." }, { "input": "Right lung is essentially clear. Slightly increased density along the periphery and base of the left lung is likely due to the pleural-based hematoma seen on the concurrent chest CT. No effusion or pneumothorax. Mild cardiomegaly. Mediastinal contours are normal. Acute fractures of the left fifth through ninth ribs are displaced.", "output": "Increased density over the periphery and base of the left lung is likely due to the pleural or extrapleural hematoma resulting from multiple left-sided rib fractures." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well-expanded clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion, pneumothorax or consolidation.", "output": "Normal chest. No evidence of TB or sarcoid." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Moderate degenerative change involves the left acromioclavicular joint. Visualized bony structures are otherwise unremarkable.", "output": "No evidence of injury." }, { "input": "Portable upright chest radiograph ___ at 09:51 is submitted.", "output": "Overall cardiac and mediastinal contours are stable. Lungs appear well inflated without evidence of focal airspace consolidation to suggest pneumonia. No pulmonary edema, pleural effusions or pneumothorax. Aorta is somewhat unfolded and tortuous." }, { "input": "Mild cardiomegaly is re- demonstrated. The mediastinal and hilar contours are unchanged. The pulmonary vasculature is normal. Lungs are clear. No focal consolidation, pleural effusion or pneumothorax is present. Clips are seen within the right upper quadrant of the abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Moderate cardiomegaly is re- demonstrated. The mediastinal and hilar contours are unchanged. There is mild bibasilar atelectasis. No pulmonary edema, pleural effusion, or pneumothorax. No focal consolidations are noted.", "output": "No acute cardiopulmonary process." }, { "input": "Portable upright chest radiograph ___ at 06:43 is submitted.", "output": "The cardiac and mediastinal contours appear stably enlarged with particular prominence of the right hilum which could be all vascular although lymphadenopathy should also be considered. The pulmonary edema has resolved, although there is mild cephalization of the vasculature consistent with pulmonary venous hypertension. Patchy retrocardiac opacity could reflect atelectasis in the setting of a layering effusion, although pneumonia or aspiration should also be considered. No pneumothorax." }, { "input": "The cardiac silhouette is enlarged. The pulmonary vasculature is engorged and indistinct. Mild peribronchial cuffing is noted. No definite focal consolidation is identified. Small left pleural effusion is present.", "output": "Pulmonary vascular congestion and minimal interstitial pulmonary edema. Otherwise stable examination." }, { "input": "AP portable upright view of the chest. There is increased pulmonary edema. Small bilateral pleural effusions likely present. Overall cardiomediastinal silhouette is unchanged. Bony structures are intact.", "output": "Worsening edema." }, { "input": "PA and lateral views of the chest provided. Surgical clips in the right upper quadrant noted. There is no focal consolidation, effusion, or pneumothorax heart size appears top-normal. The aorta is slightly unfolded. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "As above." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Triple lead left-sided pacer device is again seen with leads unchanged in position, extending to the expected positions of the right atrium, right ventricle, and coronary sinus.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen. Nipple jewelry is incidentally noted.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are normal. The lungs are clear. An azygous fissure is incidentally noted. There is no pneumothorax or pleural effusion. The visualized bones are unremarkable.", "output": "No acute intrathoracic process." }, { "input": "The cardiomediastinal shadow is normal. No pleuropulmonary disease. Azygos fissure. No sinister bony lesions.", "output": "Essentially normal chest radiograph." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Multiple rounded calcifications are noted projecting superior to the right mid clavicle, unchanged, potentially phleboliths.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiac silhouette is largely unremarkable for technique. No significant abnormalities are seen of the pulmonary vasculature. There is no definite peribronchial cuffing. Mild right-sided basilar opacity. An opacity is seen at the left lung base, with indistinctness of the left costophrenic angle. This may represent basilar atelectasis, though difficult to exclude a developing pneumonia. Soft tissue calcifications are noted in the right supraclavicular region. There is mild dextroscoliosis of the thoracic spine.", "output": "Bibasilar atelectasis with associated volume loss. Difficult to exclude a developing pneumonia in the correct clinical setting. Consider dedicated PA and lateral views to better assess." }, { "input": "The heart is not enlarged. Cardiomediastinal contours are within normal limits. No CHF, focal infiltrate or effusion is identified. No pneumothorax is detected. No free air seen beneath the diaphragms . No rib fracture is identified on these lung technique films. Limited assessment of the thoracic spine is grossly unremarkable.", "output": "No acute pulmonary process identified. No pneumothorax detected. If there is high concern for an occult pneumothorax, than frontal chest x-ray obtained with the patient at end-expiration of the respiratory cycle could help for further assessment." }, { "input": "Lungs are clear. Cardiac silhouette is normal in size. Mediastinal contours unremarkable. There is no pleural effusion, pneumothorax or pulmonary edema. There is no free air.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest demonstrate hyperexpanded and clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. The lateral view is suboptimal due to the patient's overlying arm. Given this, there is subtle patchy left base retrocardiac opacity, best seen on the frontal view, which could be due to atelectasis; however, underlying consolidation due to aspiration and/or pneumonia is not excluded. There is minimal elevation of the right hemidiaphragm. The patient is status post median sternotomy. The aorta is calcified and tortuous. The cardiac silhouette is top normal to mildly enlarge. No overt pulmonary edema is seen. No large pleural effusion or pneumothorax. Degenerative changes are seen at the right shoulder, the right humeral head is high-riding, which can be seen in rotator cuff disease.", "output": "Lateral view is suboptimal due to the patient's overlying arm. Subtle patchy left base opacity could be due to atelectasis, although underlying consolidation due to aspiration or pneumonia may be present." }, { "input": "Low lung volumes are seen with crowding of the bronchovascular markings. Within the limitation, there is no confluent consolidation or effusion. Cardiac silhouette is accentuated by low lung volumes but is likely within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac silhouette size is normal. The mediastinal and hilar contours are unremarkable. Patchy ill-defined opacities are present in both lung bases, more pronounced on the left, concerning for multifocal pneumonia. No pleural effusion or pneumothorax is detected. There is no pulmonary vascular engorgement. No acute osseous abnormalities seen.", "output": "Patchy bibasilar airspace opacities concerning for multifocal pneumonia." }, { "input": "The cardiomediastinal silhouette is unremarkable. Central pulmonary vasculature is congested, with indistinctness of the pulmonary vasculature overall. Patchy bilateral opacities are noted, worse at the right base. Bilateral pleural effusions are present.", "output": "Findings consistent with pulmonary edema. Infection is not excluded." }, { "input": "The heart is normal in size. The aorta is moderately tortuous with patchy calcification. A perihilar opacity on the left does not appear particularly mass-like and would typically be more suggestive of pneumonia, involving the lingula and posterior basilar left lower lobe. There is a small pleural effusion on the right and a very small one on the left. Streaky opacities in the right hemithorax suggest chronic scarring. There is no pneumothorax. The bones appear demineralized. No fracture is identified.", "output": "Left perihilar opacity that does not appear particularly mass-like, most suggestive of pneumonia based on imaging, although other etiologies such as atelectasis, chronic scarring or even aspiration could be considered, depending on clinical circumstances, if clinical findings do not suggest pneumonia. In any case follow-up radiographs are recommended within eigth weeks in order to show resolution and exclude the much less likely possibility of neoplasm. If available, correlation with prior radiographs would also be useful." }, { "input": "There is a new, moderate, right-sided pleural effusion, as well as an increased left-sided pleural effusion. There is associated atelectasis bilaterally. There is no evidence of pulmonary vascular congestion. The mediastinal contour is normal.", "output": "1. New moderate right pleural effusion. 2. Interval increase in moderate left pleural effusion." }, { "input": "PA and lateral views of the chest provided. Volume loss is again noted within the right hemithorax with traction bronchiectasis noted in the upper lobes, right greater than left. Patient status post partial resection in the right upper lobe. Pleural thickening likely accounts for blunted CP angles bilaterally though small pleural effusions difficult to exclude. Upward retracted hila unchanged. Overall cardiomediastinal silhouette unchanged. Overall appearance of the chest is minimally changed from numerous prior studies.", "output": "Chronic scarring with superior retraction of the hila and pleural thickening. Small pleural effusions difficult to exclude." }, { "input": "Frontal and lateral chest radiographs demonstrate clear lungs without pulmonary edema or focal opacity. Patient has likely undergone thoracic surgery, given the surgical material seen in the right apex. A widened paratracheal stripe suggests possible lymphadenopathy. The heart is normal in size. There are bilateral pleural effusions, left greater than right. No pneumothorax is present.", "output": "1. Bilateral pleural effusions, left greater than right. 2. A widened paratracheal stripe suggests possible lymphadenopathy. CT is recommended for further evaluation. These findings were entered onto the critical communications dashboard by Dr. ___ at ___ on ___." }, { "input": "There has been interval increase in the left pneumothorax with increased lucency in the left costophrenic angle. The remainder of the exam is unchanged.", "output": "Interval increase in the left sided pneumothorax. These findings were communicated via telephone by ___, MD, to ___, NP, at ___ on ___, 10 minutes after discovery." }, { "input": "When compared to most recent exam, there has been no significant interval change besides the removal of left-sided chest tube seen on prior. Left basilar opacity suggests small residual effusion. Right perihilar opacity is unchanged as well as surgical chain sutures at right upper lung. Cardiomediastinal silhouette is stable. No acute osseous abnormality is identified.", "output": "Persistent left basilar opacity suggestive of residual effusion. No definite interval change since prior." }, { "input": "The left-sided pneumothorax is unchanged compared to the most recent study. The remainder of the exam is unchanged.", "output": "No significant change in the left pneumothorax compared to the most recent exam. These findings were discussed via telephone by ___, MD, with ___ ___, NP, at ___ on ___, upon discovery." }, { "input": "There has been interval development of a moderate left apical pneumothorax. The left pleural effusion is significantly decreased compared to prior radiograph. The remainder of the exam, including a widened peritracheal stripe and postsurgical changes of the right apex, are unchanged.", "output": "1. Interval development of a moderate left apical pneumothorax. 2. The left pleural effusion is significantly decreased." }, { "input": "Frontal and lateral radiographs of the chest demonstrate low lung volumes which results in bronchovascular crowding. There is bibasilar atelectasis. Moderate cardiomegaly. No pneumothorax or pleural effusion.", "output": "1. Bibasilar atelectasis. 2. Moderate cardiomegaly." }, { "input": "There is interval development of partially circumscribed increased density in the posterior aspect of the right lower lobe. The left lung is clear. The heart mediastinal structures are appearance. The bony thorax is grossly intact.", "output": "Increased density in the right lower lobe consistent." }, { "input": "Indistinctness of the left heart border with left mid and lower lung airspace opacity has progressed slightly compared with the recent prior study. The right mid and lower lung airspace opacification has improved. There is no pleural effusion, pulmonary edema, or pneumothorax. Enlargement of the cardiomediastinal silhouette is unchanged. Mild biapical pleural thickening is stable.", "output": "Slight interval increase in the extent of the left lung consolidation with slight decrease in the right lower lung airspace opacity." }, { "input": "Compared with ___, there are new opacities in the left mid and lower lung, mostly in the lingula. There are additional opacities in the right mid lung. There is a small left pleural effusion. The heart is enlarged.", "output": "1. Multifocal pneumonia. 2. Small left pleural effusion." }, { "input": "The appearance of the chest is similar to 2 days prior with opacities in the left mid to lower lung including the lingula and the right mid to lower lung, worrisome for multifocal pneumonia. Subtle opacity previously seen in the right upper to mid lung is less well seen on the prior study and may have decreased in extent. Trace pleural effusion is difficult to exclude. Mild biapical pleural thickening is re- demonstrated. The cardiac and mediastinal silhouettes are stable.", "output": "Possible slight improvement in focal right upper to mid lung opacity seen on the prior study. Otherwise, no significant interval change in findings worrisome for multifocal pneumonia. Persistent enlargement of the cardiac silhouette." }, { "input": "Frontal and lateral views of the chest were obtained. Moderate cardiomegaly with mediastinal widening is unchanged. Lung volumes are low. Mild pulmonary edema is worsened since the prior exam. Bilateral lower lobe lung opacities, larger on the left, have increased and likely represent a combination of atelectasis, consolidation, and effusion. No pneumothorax. No acute osseous changes identified.", "output": "Cardiomegaly and mild pulmonary edema with bibasilar opacities, consistent with a combination of atelectasis, consolidation, and effusion." }, { "input": "The patient is rotated ___ and the lung volumes are low, both of which extremely limit interpretation. Further evaluation is limited by overlying soft tissue. There is a probable small right pleural effusion, best appreciated on the lateral view. Overlying opacities are likely atelectasis and superimposed soft tissue. A more focal opacity at the right medial base could represent pneumonia in the correct setting. There is no pneumothorax. The widened appearance of the mediastinum is secondary to mediastinal lipomatosis as demonstrated on the prior CT. The heart size is mildly enlarged. There is no evidence for pulmonary edema.", "output": "1. Probable small right pleural effusion. 2. More focal opacity at the right medial base could represent pneumonia in the correct clinical setting." }, { "input": "This exam is suboptimal due to underpenetration from patient's body habitus. Endotracheal tube terminates 4.9 cm above the carina. Large cardiomediastinal silhouette is again seen. Lung volumes remain low. Vascular structures are dilated consistent with volume overload. Evaluation of increased densities of the lung bases bilaterally is particularly suboptimal and it is impossible to determine how much is due to atelectasis versus recent aspiration or pulmonary edema. Small pleural effusions are present at best. No large pneumothorax.", "output": "1. ET tube is in adequate position, 4.9 cm above the carina. 2. Limited evaluation of increased densities at lung bases, difficult to determine how much is related to atelectasis, recent aspiration or pulmonary edema." }, { "input": "The heart size remains moderate to severely enlarged. The mediastinal contours remain widened, due to mediastinal lipomatosis. There is mild pulmonary vascular engorgement, similar compared to the previous exam, and a probable small right pleural effusion. No pneumothorax is identified. Bibasilar airspace opacities likely reflect atelectasis. There are multilevel degenerative changes in the imaged thoracic spine.", "output": "Mild pulmonary vascular engorgement and small right pleural effusion. Bibasilar airspace opacities likely reflect atelectasis but infection or aspiration cannot be completely excluded." }, { "input": "There are low lung volumes, which accentuate the cardiomediastinal contours and bronchovascular structures. There are bilateral patchy lower lobe opacities. There is no pneumothorax. The mediastinal and hilar contours are unchanged with widening of the cardiomediastinal silhouette, related to known mediastinal lipomatosis. There are degenerative changes along the lower thoracic spine.", "output": "1. Bilateral patchy lower lobe opacities, which could represent atelectasis, aspiration or pneumonia. In the setting of low lung volumes, characterization is limited and a repeat chest radiograph with increased inspiratory level may be helpful in this regard. 2. Stable, widened cardiomediastinal silhouette related to known mediastinal lipomatosis." }, { "input": "The lung volumes are low, accentuating the bronchovascular structures. There is vascular congestion and mild pulmonary edema, slightly worse than in the prior exam. Bibasilar consolidations are not significantly changed from the prior exam, and likely represent atelectasis. The mediastinal and hilar contours are widened. The cardiac silhouette is enlarged. This is stable from prior exams.", "output": "1. Mild vascular congestion and pulmonary edema. 2. Low lung volumes with probable bibasilar atelectasis. 3. Stable appearance of the enlarged cardiomediastinal silhouette." }, { "input": "The study is somewhat limited due to underpenetration. Cardiac silhouette size remains moderately enlarged, primarily due to the presence of prominent epicardial fat. Widening of the superior mediastinum is also unchanged and attributable to mediastinal lipomatosis. Crowding of the bronchovascular structures is noted, with mild vascular congestion, similar to the prior chest radiograph. Lung volumes are low with mild patchy bibasilar airspace opacities, likely atelectasis. No focal consolidation, pleural effusion or pneumothorax is present. There are mild degenerative changes in the thoracic spine.", "output": "Mild pulmonary vascular congestion. Low lung volumes with probable bibasilar atelectasis." }, { "input": "Lung volumes are decreased compared to the prior exam, which causes crowding of the bronchovascular structures. Minimal pulmonary vascular congestion may be present, but no overt pulmonary edema is present. Moderate cardiomegaly persists. The mediastinal and hilar contours are unchanged with apparent widening of the superior mediastinum likely attributable to mediastinal lipomatosis. No pneumothorax or pleural effusion is detected. Assessment of the lung bases is limited due to low lung volumes, with minimal patchy opacities likely reflective of atelectasis. No focal consolidation is demonstrated. There are mild degenerative changes in the thoracic spine.", "output": "Low lung volumes with probable bibasilar atelectasis." }, { "input": "PA and lateral chest views have been obtained with patient in upright position. Comparison is made with the next preceding similar study of ___. Mild-to-moderate cardiac enlargement as before, no change in configuration. The thoracic aorta is stable. No new mediastinal abnormalities. The pulmonary vasculature is not congested. No signs of acute or chronic parenchymal infiltrates have developed and the lateral and posterior pleural sinuses remain free. No pneumothorax in the apical area.", "output": "Stable chest findings, no evidence of new acute processes." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. There is no pulmonary edema. The heart is normal in size, and the mediastinal contours are normal. No pneumoperitoneum is seen. Surgical clips noted in the right upper quadrant.", "output": "No acute cardiopulmonary process." }, { "input": "A spinal stimulator device projects over the left hemithorax, as before. The cardiac, mediastinal and hilar contours appear unchanged. There is no pleural effusion or pneumothorax. Streaky right basilar opacity suggests a small focus of atelectasis or scarring. There is no evidence for pneumonia or congestive heart failure. A prior healed fracture is noted along the distal right clavicle.", "output": "No evidence of acute disease." }, { "input": "Again seen is a spinal stimulator device that projects over the left hemithorax. There is no focal infiltrate or effusion. The right hemidiaphragm is minimally elevated. There is mild pulmonary vascular redistribution and mild cardiomegaly, increased compared to prior.", "output": "Mild Fluid overload." }, { "input": "No definite focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiograph demonstrates clear lungs bilaterally. Cardiomediastinal and hilar contours are within normal limits. There is no pleural effusion or pneumothorax. Visualized osseous structures are without an acute abnormality.", "output": "No evidence of pneumonia." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is detected. Heart and mediastinal contours are stable with mild cardiomegaly. Single-lead cardiac pacemaker appears similarly positioned. Hardware overlies the left upper outer chest, limiting evaluation of the underlying lung parenchyma.", "output": "No radiographic evidence for acute cardiopulmonary process with stable pacemaker positioning." }, { "input": "There is no consolidation, pleural effusion, or pneumothorax. There is no pulmonary edema. Mild cardiomegaly is unchanged. Left pectoral defibrillator with its lead terminating in the right ventricle is unchanged in position.", "output": "No pneumothorax. No notable interval change. Stable mild cardiomegaly." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are unremarkable. Again seen is subtle opacity at the left lung base, not significantly changed since prior examination, which likely represents the pectoralis muscle. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic process." }, { "input": "Lung volumes are normal. No focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities are identified. However, note that a chest radiograph is not sensitive for detection of chest wall trauma.", "output": "No acute cardiopulmonary process. If there is concern for rib fractures, dedicated rib series in the area of focal tenderness should be performed." }, { "input": "Subtle increased opacity at the left lung base may represent pneumonia in correct clinical setting. No pneumothorax or pleural effusion is identified. Cardiomediastinal and hilar silhouettes are normal size.", "output": "Subtle increased opacity at the left lung base may represent pneumonia in correct clinical setting. RECOMMENDATION(S): Short-term followup radiographs may be helpful" }, { "input": "The lungs are well expanded and clear. Hila and cardiomediastinal contours and pleural surfaces are normal.", "output": "Normal chest radiograph." }, { "input": "A curved opacity projecting over the right lung, presumably outside of the patient, limits optimal evaluation of this area. Slightly low lung volumes are similar to ___. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Left lung parenchymal opacities are improved from ___. No pleural effusion or pneumothorax.", "output": "1. No acute deterioration or pneumothorax. 2. Left lung parenchymal opacities are improved from ___." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Known lingular consolidation is re-demonstrated. No new areas of consolidation, pulmonary edema or a pneumothorax. No pleural effusions. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "1. No acute intrapulmonary process. 2. Known lingular consolidation is re-demonstrated." }, { "input": "There is a large focal opacity centered in the left lung lingula. The opacity appears larger than on a chest x-ray from ___, but is in keeping with findings on a chest CT scout film from ___. Compared to the previous chest x-ray, there is new linear atelectasis in the right mid zone and a new small right pleural effusion, with a small amount of associated parenchymal opacity. Heart size is grossly unchanged, without frank cardiomegaly. The lungs are otherwise grossly clear, without other focal opacities, CHF or left-sided effusion. No pneumothorax detected. Aside from mild degenerative changes in the thoracic spine. Bony structures are grossly unremarkable.", "output": "1. Large opacity in the left lingula consistent with known masslike consolidationsseen on previous x-rays and CTs, but with interval enlargement compared with ___ chest x-ray. The most likely differential is a progressive organizing pneumonia or aggressive fungal infection. Neoplasm could also account for this appearance, but is considered less likely given relatively rapid progression. The patient has apparently undergone transbronchial biopsy of this lesion. Please see biopsy results for further assessment. 2. New small right pleural effusion with small area of focal opacity adjacent to it. This is new compared with the ___ radiograph and appears to progressed slightly compared with the ___ CT scan. Attention to this area on followup films is recommended to exclude developing new focus of infiltrate or progressive effusion." }, { "input": "The lungs are clear. Heart size and mediastinal contours are normal. There is no pleural effusion or pneumothorax. Osseous structures are intact.", "output": "Normal chest radiographs" }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is status post intubation with ET tube terminating at the level of the clavicles. However, a newly placed nasogastric tube is malpositioned, coiling in the lower esophagus. There are new left cervical skin and a stable small amount of right supraclavicular soft tissue subcutaneous emphysema. There is no pneumothorax. The lungs are clear. The heart and mediastinum are within normal limits. The followup radiograph of 20:58 shows removal of the nasogastric tube. The ET tube is unchanged in position. There is no other significant interval change.", "output": "Initially malpositioned nasogastric tube coiled in the lower esophagus was removed on the subsequent radiograph of 20:58 hrs. ET tube in satisfactory position. Clear lungs. Small right supraclavicular subcutaneous emphysema." }, { "input": "The patient is status post intubation with ET tube terminating at the level of the clavicles. However, a newly placed nasogastric tube is malpositioned, coiling in the lower esophagus. There are new left cervical skin and a stable small amount of right supraclavicular soft tissue subcutaneous emphysema. There is no pneumothorax. The lungs are clear. The heart and mediastinum are within normal limits. The followup radiograph of 20:58 shows removal of the nasogastric tube. The ET tube is unchanged in position. There is no other significant interval change.", "output": "Initially malpositioned nasogastric tube coiled in the lower esophagus was removed on the subsequent radiograph of 20:58 hrs. ET tube in satisfactory position. Clear lungs. Small right supraclavicular subcutaneous emphysema." }, { "input": "Frontal and lateral views of the chest were obtained. There are relatively low lung volumes. A subtle left base retrocardiac opacity most likely represents atelectasis and confluence of vessels; however, an early infectious process is not excluded in the appropriate clinical setting. The right lung is clear. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen.", "output": "Subtle patchy posterior left lower lobe opacity, most likely represents atelectasis and overlap of vascular structures, although infection is not excluded in the appropriate clinical setting." }, { "input": "PA and lateral views of the chest are provided. Cervical fusion hardware is again seen as well as clips in the flank region. The lungs are clear. No free air below the right hemidiaphragm. No pneumothorax or pleural effusion. Cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "No acute findings, specifically with no signs of pneumoperitoneum." }, { "input": "Single portable view of the chest is compared to previous exam from ___. The lungs are clear of focal consolidation, large effusion or pulmonary vascular congestion. Cardiomediastinal silhouette is unchanged. Mid thoracic dextroscoliosis and hypertrophic changes again seen in the spine. Chronic deformities seen at the right humeral head and glenoid, similar to prior exam.", "output": "No acute cardiopulmonary process." }, { "input": "The right costophrenic angle is not fully included on the image. Given this, no large pleural effusion is seen. There is no focal consolidation or evidence of pneumothorax. Eventration of the right hemidiaphragm is again seen. Right paratracheal opacity without indentation of the adjacent trachea is stable since scout radiograph image from ___ and is consistent with combination of vascular structures and mediastinal fat. The cardiac silhouette is not enlarged.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well-expanded. Increased opacities in the left lower lobe could reflect aspiration or early pneumonia in the appropriate clinical situation. The right lung is clear. The heart is normal in size. Mediastinal contours are unchanged with probably a tortuous descending thoracic aorta. No pneumothorax, edema, or pleural effusion. Multilevel degenerative changes in the thoracic spine are mild. Right old clavicular fracture.", "output": "Left lower lobe opacities may reflect aspiration and/or early pneumonia in the appropriate clinical situation." }, { "input": "There are bibasilar opacities concerning for aspiration/ infection. The cardiomediastinal silhouette and hilar contours are stable. There is no pleural effusion or pneumothorax. There is a healed right mid clavicular fracture.", "output": "Bibasilar opacities concerning for aspiration pneumonitis versus atelectasis." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. No focal consolidation or pneumothorax is seen. Mild elevation of the right hemidiaphragm, of unknown chronicity, could be due to the presence of a subpulmonic effusion or subdiaphragmatic/hepatic process. No left-sided pleural effusion is identified. No acute osseous abnormalities seen.", "output": "Mildly elevated right hemidiaphragm of unknown chronicity, could be due to the presence of a subpulmonic effusion or subdiaphragmatic/hepatic process. Clinical correlation is recommended and consider CT for further assessment." }, { "input": "PA and lateral chest radiographs demonstrate clear lungs. There is no pleural effusion, pneumothorax, or pulmonary vascular congestion. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "The ETT is slightly too high and terminates approximately 8 cm above the carina. There is an NG tube coursing below the diaphragm with the tip in the stomach. There is mild bibasilar atelectasis. The lungs are otherwise clear. The pulmonary vasculature is normal. The cardiomediastinal silhouette is normal. There is no pleural effusion. There is no pneumothorax.", "output": "1. ETT too high, terminating approximately 8 cm above the carina. 2. Mild bibasilar atelectasis. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 9:27 AM, 2 minutes after discovery of the findings." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or edema. There is chronic blunting of the right lateral costophrenic angle, likely scarring. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No focal consolidation." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size remains mildly enlarged. Mediastinal and hilar contours are unremarkable. Low lung volumes cause crowding of the bronchovascular structures but no overt pulmonary edema is demonstrated. No focal consolidation, pleural effusion or pneumothorax is visualized. Multiple clips as well as a bullet are seen within the posterior aspect of the right upper quadrant pain, unchanged. No acute osseous abnormalities are demonstrated.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Exam is limited due to technical factors. The lungs are grossly clear without consolidation large effusion or overt edema. The cardiomediastinal silhouette is grossly within normal limits. Left lateral rib fracture appears be old.", "output": "No definite acute cardiopulmonary process based on this limited exam." }, { "input": "The cardiomediastinal silhouette is unremarkable, and unchanged allowing for rotation. The lung fields are clear. Surgical hardware at the left proximal humerus is without evidence of complication.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest were provided. The lungs appear clear bilaterally without focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours are normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "There is a large left-sided pleural effusion, not significantly changed since ___, though increased since ___. A right sided port terminates in the upper SVC, stable. The cardiomediastinal silhouette and pulmonary vasculature are stable and unremarkable.", "output": "Persistent, large left-sided pleural effusion." }, { "input": "There is moderate to large left-sided pleural effusion. Opacity at the right lung base laterally could be due to subpulmonic effusion and potential atelectasis. Lungs are otherwise clear. Right chest wall port catheter tip projects over the SVC. Cardiac silhouette cannot be assessed due to silhouetting on the left. Left axillary surgical clips are identified. No acute osseous abnormalities.", "output": "Moderate to large left pleural effusion." }, { "input": "Port-A-Cath catheter tip terminates at the mid SVC. The left PleurX is in similar position. No pneumothorax. Small right-sided pleural effusion has decreased. Small left pleural effusion is unchanged. Retrocardiac opacity and right basilar opacity have both improved. No pulmonary edema or acute focal consolidation. Mild cardiomegaly.", "output": "Interval decrease in right pleural effusion and likely adjacent atelectasis. Improved aeration of the left lung as well." }, { "input": "Stable right-sided Port-A-Cath in the mid SVC. Left PleurX catheter also in similar configuration. Interval decrease in left-sided pleural effusion which is now small. Lingular and retrocardiac opacity have also decreased. Moderate right-sided pleural effusion and basal opacity have slightly increased.", "output": "Interval decrease of left-sided pleural effusion. No pneumothorax." }, { "input": "The right Port-A-Cath tip projects over the mid to low SVC, unchanged. The left PleurX catheter projects over the lower left hemithorax, unchanged. Numerous surgical clips projecting over the left chest wall are also unchanged. There has been further interval decrease in the size of left pleural effusion with minimal residual fluid. Left lobe linear atelectasis persists. A small right pleural effusion has increased in size since the prior exam with associated relaxation atelectasis. No pneumothorax. Heart size is unchanged.", "output": "1. Trace left pleural fluid. 2. Small right pleural effusion and atelectasis, increased since ___." }, { "input": "There is no significant change in a left-sided pleural effusion compared with prior radiographs on ___.There is no new focal consolidation. No pneumothorax is seen. A right Port-A-Cath is stable in position. The cardiac and mediastinal silhouettes are unremarkable. Left axillary surgical clips are present.", "output": "No significant change in left-sided pleural effusion." }, { "input": "In comparison to the most recent examination, there is no significant change in the left-sided pleural effusion. A left-sided PleurX catheter remains at the left lung base. Left basilar opacity is stable. Right basilar opacity is improved. Again seen is a right sided Port-A-Cath with the tip terminating in the mid SVC. Surgical clips are seen in the left chest wall.", "output": "No significant change in left-sided pleural effusion." }, { "input": "Lung volumes are low. A right-sided chest for terminates in the mid to lower SVC. Again noted are bilateral small pleural effusions, grossly similar to the prior examinations. Bibasilar opacities have improved since comparison radiographs. There is bibasilar atelectasis, more pronounced on the left. No definite rib fracture is identified. If there is persistent concern for bony abnormality, dedicated rib films can be obtained.", "output": "Bibasilar atelectasis and small pleural effusions." }, { "input": "Frontal and lateral chest radiograph demonstrates well expanded and clear lungs. There is no focal consolidation or pleural effusion. No pneumothorax. The cardiomediastinal and hilar contours are within normal limits.", "output": "No pneumonia. These findings were communicated to Dr. ___ secretary by Dr. ___ ___ telephone at 15:05 on ___ immediately upon review of the radiographs." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is detected. No acute osseous abnormalities are visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Lungs are well-expanded without focal consolidation concerning for pneumonia. The upper abdomen is unremarkable. Mild degenerative changes are seen in thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.", "output": "No focal consolidation concerning for pneumonia." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. The lungs are well-expanded and clear without focal consolidation concerning for pneumonia. Pulmonary vasculature is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided demonstrating no focal consolidation, effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures are intact. There is no free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "The lungs are clear. Cardiac silhouette is normal in size. No pleural effusion, pneumothorax or pulmonary edema.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process. No radiographic evidence of active tuberculosis." }, { "input": "Frontal and lateral views of the chest are obtained. There are relatively low lung volumes. No focal consolidation, pleural effusion, or pneumothorax is seen. The aorta is slightly tortuous. The cardiac silhouette is not enlarged.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest are provided. The lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. There is a mildly levoscoliosis of the T-spine.", "output": "No acute traumatic injuries." }, { "input": "The lungs are well expanded and clear. There is stable cardiomegaly. There is no pneumothorax or pleural effusion. There is DJD at both shoulders.", "output": "No acute cardiopulmonary process." }, { "input": "Moderate cardiomegaly is unchanged. Lung volumes are decreased. No focal consolidation, large pleural effusion or pneumothorax identified.", "output": "Stable moderate cardiomegaly in the setting of lower lung volumes. No acute cardiopulmonary process identified." }, { "input": "AP portable upright and lateral views of the chest were provided. The heart remains mildly enlarged. There is no focal consolidation to suggest the presence of pneumonia. No overt edema. No effusion or pneumothorax.", "output": "Stable exam." }, { "input": "AP upright and lateral views of the chest provided.Underpenetrated technique limits evaluation. Allowing for this, there is no convincing evidence for pneumonia or CHF. No large effusions or pneumothorax. The cardiomediastinal silhouette is top normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Limited, negative." }, { "input": "PA and lateral views of the chest obtained ___ lung volumes. There is no pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Partially imaged upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "AP single view of the chest has been obtained with patient in semi-upright position. Comparison is made with the next preceding similar study obtained 7 hours earlier during the same day. On this single frontal view examination the imaged field was directed more to the lower chest apparently requested. This was the major concern of a localized small pneumothorax. The apical area of the thorax is not included in the image field. Thus, it is unclear whether the patient has been extubated or if the EGT has been pulled back to the neck region. Previously described NG tube remains in position. The upper left-sided chest tube again points towards the apical area, but the ultimate tip is cut off. The lower positioned chest tube terminating at the level of the diaphragm remains in unchanged position and the low loculated small pneumothorax cavity has not changed in size significantly. The right hemithorax remains unchanged.", "output": "Stable chest findings, no evidence of major pneumothorax." }, { "input": "Heart size is normal with trace unfolding of the aorta. Aortic knob calcifications are mild. Cardiomediastinal silhouette and hilar contours are normal. Lungs are clear. Pleural surfaces are clear without effusion pneumothorax.", "output": "1. No acute cardiopulmonary abnormality. 2. Previously characterized bibasilar nodules are better evaluated by CT, not evident on radiography." }, { "input": "AP single view of the chest has been obtained with patient in semi-upright position. Analysis is performed in direct comparison with the next preceding similar study of ___. Position of previously described right-sided subclavian central venous line and left-sided PICC is unchanged. As before, there is mediastinal shift towards the left hemithorax which now is completely opacified, demonstrating complete loss of aeration of the left lung. This finding occurring in combination with left-sided mediastinal shift is highly suggestive of central airway obstruction which is probably accomplished by mucus plugs. There is no evidence of new pulmonary infiltrates in the right lung; however, the vascular pattern suggests some degree of congestion with possible mild increase of pleural effusion, now partially obliterating the diaphragmatic contours.", "output": "Complete opacification of left-sided hemithorax in the presence of mediastinal shift towards the left. Clearing of central airways recommended. Referring physician, ___ was paged at 4:45 p.m." }, { "input": "Single frontal view of the chest was obtained. The right costophrenic angle is excluded on this study. There is new right mid lung opacity. There is also new extensive retrocardiac opacity in the left lower lobe and patchy left mid lung opacity likely within the lingula. A pleural effusion is suspected on the left. No pneumothorax. Osseous structures are unremarkable. There is calcification of the aortic knob. No radiopaque foreign body.", "output": "New multifocal opacities worrisome for pneumonia with a suspected small left-sided pleural effusion." }, { "input": "Lungs are well expanded and clear. There are no lung opacities concerning for pneumonia. Left hemidiaphragm is mildly elevated. Heart size, mediastinal and hilar contours are normal. Mild-to-moderate sized hiatal hernia is present. No pleural effusion.", "output": "No acute cardiopulmonary process. No pneumonia." }, { "input": "A PICC line has been removed. The cardiac, mediastinal and hilar contours appear unchanged. The right lung remains clear. There is again mild relative elevation of the left hemidiaphragm with patchy opacification most suggestive of atelectasis, although somewhat improved. There is no pleural effusion or pneumothorax. Prior healed fractures involve the right posterolateral sixth and seventh ribs. The bones are probably demineralized.", "output": "No evidence of acute disease. Persistent volume loss and atelectasis in the left lower lung, but most recently somewhat improved." }, { "input": "Portable supine AP chest radiograph obtained. Evaluation limited due to patient rotation to the left. There is left basal opacity which could represent effusion and possibly atelectasis/pneumonia. The right lung appears clear. A PICC line is seen in the right arm tip extending to the level of the low SVC. Aortic atherosclerosis is noted. Bony structures are intact.", "output": "Limited exam with left basal opacity, increased from prior, concerning for effusion with probable consolidation which may represent worsening pneumonia." }, { "input": "The lung volumes are low. Allowing for rotation, low lung volumes and AP portable technique, the cardiac, mediastinal, and hilar contours appear unchanged, including suspected mild cardiomegaly. The aortic arch is calcified. There is patchy left basilar opacity suggestive of minor atelectasis, but otherwise the lungs appear clear. Although difficult to entirely exclude, there is no definite evidence for pleural effusion.", "output": "Limited examination without definite evidence for acute disease. Noting the limitations of this study, if pulmonary symptoms were to persist or worsen, a short-term followup radiographs should be considered, preferably with standard PA and lateral technique, if possible to reassess the significance, if any, of vague left basilar opacity." }, { "input": "A right infrahilar opacity has increased from ___, but is similar compared to ___. Unchanged small bilateral pleural effusions and fluid in the major fissures, more on the left than on the right. The cardiomediastinal silhouette is normal aside from aortic arch calcifications. A right central line has been removed in the interval.", "output": "Since ___, worsening right infrahilar opacity." }, { "input": "Portable chest radiograph demonstrates minimally improved aeration of the previously completely collapsed left lower lobe. Remainder of the left and right lungs are clear. No pneumothorax is evident. A small left pleural effusion is likely. A right-sided PICC line terminates in the distal SVC.", "output": "Persistent though improved left lower lobe collapse with a small left pleural effusion." }, { "input": "No focal consolidation, pleural effusion or pneumothorax is seen. Opacity in the right medial lung base is attributed to the pectum excavatum.", "output": "No acute process." }, { "input": "No focal consolidation, pleural effusion or pneumothorax is seen. Heart and mediastinal contours are within normal limits. There is minimal dextroconvex thoracic scoliosis and pectus excavatum.", "output": "No acute findings. Discussed with ___ by Dr. ___ in person at 3:30 a.m. on ___ at the time of initial review of the study." }, { "input": "The heart is normal in size. The aorta is calcified and tortuous. There is no pleural effusion or pneumothorax. A nodular opacity projecting over the left lower lung suggests a nipple shadow rather than a true pulmonary nodule. Vague opacity is noted in the basilar right lower lobe in both views. Bony structures are unremarkable.", "output": "1. Vague right lower lobe opacity, probably atelectasis, although pneumonia is not excluded. 2. Vague nodular focus projecting over the left lower lung, probably a nipple shadow, with a pulmonary nodule less likely. An additional PA view with nipple markers is recommended to assess further." }, { "input": "The lungs are clear, cardiomediastinal silhouette and hila are normal. The pulmonary arteries are slightly prominent or granulomatous lymph node calcifications causing sligthly prominent hila. There is no pleural effusion and no pneumothorax.", "output": "No acute cardiothoracic process." }, { "input": "There are small-to-moderate sized bilateral pleural effusions and associated basilar opacities, larger on the left than the right. These opacities may represent compressive atelectasis, though a component of infection is difficult to completely exclude. Additionally, there is mild vascular congestion. No pneumothorax is identified. The mediastinal contours are unchanged, and normal. Atherosclerotic calcifications are noted along the aortic arch. The heart is moderately enlarged. It appears slightly increased in size since the prior exam. Otherwise, there has been little change.", "output": "1. Small-to-moderate sized bilateral pleural effusions. 2. Bibasilar consolidations, larger on the left from the right, which may represent compressive atelectasis, though a component of infection cannot be completely excluded. 3. Mild vascular congestion. 4. Cardiomegaly." }, { "input": "A new right internal jugular sheath terminates near the confluence of the internal jugular and subclavian veins. A left subclavian catheter terminates in the lower SVC. An endotracheal tube is 2 cm above the carina. An orogastric tube courses along the esophagus and terminates out of the field of view, likely within the stomach. The lungs are better expanded, which results in an improved appearance of both the mediastinum and cardiac silhouette. There is prominence of the central vasculature with mild pulmonary edema. There is no pleural effusion. The previously seen rounded opacity at the right lung base is no longer visualized. There is no pneumothorax or focal airspace consolidation. There is no free air seen on this semi erect radiograph.", "output": "Improved appearance of the cardiac mediastinal contours with mild pulmonary edema." }, { "input": "Despite the history of extubation, an endotracheal tube is present and terminates 1.7 cm above the carina. An enteric tube ends in the esophagus and would need to be advanced at least 10cm to move all the sideports into the stomach. A left subclavian catheter tip terminates in the mid superior vena cava. Orthopedic hardware and a vascular abdominal stent are noted. The lung volumes are low which results in crowding of the bronchovascular structures. There is prominence of the central vasculature without overt evidence for pulmonary edema. A rounded opacity is seen at the right lung base and is new. There is no pleural effusion or pneumothorax. The cardiac size in normal. Apparent widening of the mediastinum is unchanged. Dilated air-filled loops of large bowel below the diaphragm. No free air seen on this supine only view.", "output": "1. ETT should be pulled back 2-3 cm for better positioning. 2. Advancement of the enteric tube by at least 10 cm is recommended for positioning within the stomach. 3. Air-filled loops of dilated bowel, no free air seen on this supine view. 4. Right lower lung rounded opacity which may reflect metastatic disease, pulmonary infarction or atelectasis. This could be further evaluated with cross-sectional imaging or repeat radiograph at full inspiration. These findings were discussed with Dr. ___ by Dr. ___ at 11:33 AM on ___ the time of discovery." }, { "input": "Heart size is top normal with mild unfolding of the thoracic aorta. Hilar contours are unremarkable. There is minimal widening of the superior mediastinum, unchanged from prior study and likely represents vascular structures or mediastinal fat. Lungs are clear. There is no pleural effusion or pneumothorax. The osseous structures are grossly unremarkable.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of normal size with stable cardiomediastinal contours. Scattered parenchymal opacities are better characterized on CT likely reflect atypical infection. Bilateral pleural effusions are moderate in size, similar to ___, though increased since ___. No pneumothorax. Sternotomy wires are intact. Mediastinal clips and coronary artery stents are similar to prior.", "output": "Moderate-sized bilateral pleural effusions, similar to ___. Scattered opacities, better characterized on same-day CT, likely represent pneumonia." }, { "input": "Left-sided chest tubes have been removed since yesterday. A right-sided internal jugular catheter remains at the cavoatrial junction. No pneumothorax is identified. Lung volumes are low. Right hilar opacity has increased since 7:50 a.m. Sternal wires are intact. Moderate cardiomegaly is unchanged.", "output": "No pneumothorax, status post left-sided chest tube removal. Increased right hilar opacity reflects some combination of increasing atelectasis and pulmonary edema." }, { "input": "PA and lateral chest views were obtained with patient in upright position. There is status post sternotomy and evidence of previous bypass surgery. Moderate cardiac enlargement is present. Thoracic aorta is of ordinary ___ but shows rather extensive calcifications in the wall at the level of the arch. Pulmonary vasculature does not show any upper zone redistribution, interstitial alveolar edema, but bilateral moderate amounts of pleural effusions are still present and blunt the lateral and posterior pleural sinuses. There is no evidence of new discrete pulmonary parenchymal infiltrates of pneumonic nature. No pneumothorax is present in the apical area on the frontal view. When comparison is made with the next preceding portable chest examination of ___, the at that time observed perivascular haze has regressed.", "output": "Improving and lesser marked pulmonary congestion but still remaining bilateral pleural effusions and the presence of moderate cardiac enlargement in patient status post sternotomy and bypass surgery. Further dehydration measures are recommended and followup examination may be helpful." }, { "input": "Comparison is made to the prior study from ___. There is a right IJ central venous line with the distal lead tip at the cavoatrial junction. There are low lung volumes with crowding of the pulmonary vascular markings at the bases. Small bilateral pleural effusions are seen. There is some atelectasis at the right base. There is mild interstitial prominence without overt pulmonary edema. There is a right small apical pneumothorax. This is slightly decreased in size when compared to the prior chest radiograph from ___ at 7:48 a.m. The left side demonstrates no pneumothorax.", "output": "1. Persistent right apical pneumothorax which is small in size. 2. Bilateral pleural effusions. 3. Atelectasis at the right lung base." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of top normal size with stable cardiomediastinal contours. The pulmonary vasculature is indistinct, compatible with mild edema. Bilateral effusions have increased, now moderate in size, with adjacent compressive atelectasis. No pneumothorax. Sternotomy wires are intact. Mediastinal clips and coronary artery stent are similar in position.", "output": "Mild pulmonary edema with increased bilateral pleural effusions, now moderate in size. Findings were communicated via phone call by ___ to ___ on ___ at 13:25 p.m." }, { "input": "The cardiomediastinal contours are within normal limits. The bilateral hila are unremarkable. The lungs are clear without focal consolidation. There is no evidence of pulmonary vascular congestion. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are mildly hyperexpanded, but clear without pleural effusion, focal consolidation, or pneumothorax.The aorta is tortuous.", "output": "No focal consolidation concerning for pneumonia." }, { "input": "The lungs are well expanded. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is remarkable for left ventricular configuration of the heart and a tortuous thoracic aorta.", "output": "No acute cardiopulmonary process" }, { "input": "An opacity overlying the spine on the lateral radiograph is concerning for a right lower lobe pneumonia. There is no pleural effusion, pulmonary edema or pneumothorax. The heart size is normal. The mediastinal contours are normal.", "output": "Opacity seen on the lateral radiograph concerning for a right lobe pneumonia. NOTIFICATION: Findings were emailed to the ED QA nurse by Dr. ___ on ___ at 9:17 AM after impression change." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Single frontal radiograph of the chest demonstrates the lungs are well expanded, with no evidence of focal pneumonia, pulmonary edema, pleural effusion, or pneumothorax. Minimal biapical scarring is again noted. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. The patient is status post median sternotomy. Dual-lead left-sided pacer device is again seen, with one lead extending to the expected position of the right atrium. The second lead which extends more inferior is not well evaluated due to underpenetration. There are relatively low lung volumes. The cardiac enlargement persists, although appears minimally less prominent as compared to the prior study. No definite pleural effusion is seen. There is minimal central pulmonary vascular congestion. Evidence of DISH is seen along the spine.", "output": "Continued enlargement of the cardiac silhouette with mild vascular congestion." }, { "input": "PA and lateral views of the chest provided. ___ is again noted with leads extending to the region the right atrium right ventricle. Midline sternotomy wires and mediastinal clips again noted. Lung volumes are low limiting assessment. There is mild cardiomegaly with hilar congestion and probable mild interstitial edema. No large effusion or pneumothorax. No convincing signs of pneumonia. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Mild cardiomegaly with congestion and mild edema." }, { "input": "There is a new right-sided pigtail catheter with interval decrease in the right pleural effusion. There continues to be left pleural effusion of volume loss at the bases.", "output": "New right chest tube" }, { "input": "There is volume loss in the right lung with right basilar atelectasis. With a small right pleural effusion cannot be excluded. A right internal jugular catheter terminates in the mid to distal SVC. An endotracheal tube terminates approximately 3.6 cm above the level the carina. A nasogastric tube terminates with the tip just beyond the gastroesophageal junction, this could be advanced several cm for better seating within the stomach. No consolidation or pneumothorax seen.", "output": "As above." }, { "input": "right-sided pigtail catheter is again visualized. There are small bilateral pleural effusions left greater than right. There is hazy alveolar infiltrate left greater than right which have increased compared to the prior study. There is pulmonary vascular redistribution. . There is no pneumothorax.", "output": "Increased alveolar infiltrates bilaterally. This may be due to pulmonary edema but underlying infection cannot be excluded" }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Hilar contours are unremarkable. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Portable AP upright chest radiograph ___ at at 18:13 is submitted.", "output": "Right basilar pleural catheter remains in place. Patchy opacities at both bases likely reflect atelectasis, although pneumonia cannot be entirely excluded. No pneumothorax is seen. A linear opacity at the right apex is felt to be related to something external to the patient as it crosses outside of the hemithorax. Overall cardiac and mediastinal contours are stable. No pulmonary edema. Crowding of the vasculature in the setting of low lung volumes." }, { "input": "Re- demonstrated blunting of the right costophrenic angle which could be due to effusion or scarring given the mild elevation the right hemidiaphragm. Cardiomediastinal silhouette is within normal limits. There is no focal consolidation.", "output": "Chronic blunting of the right costophrenic angle may represent a small effusion and/or scarring. Underlying infection cannot be excluded." }, { "input": "Right lower lobe opacity may reflect a combination of pleural effusion, atelectasis, and probable concurrent pneumonia given the provided history of sepsis. The left lung is clear. No pneumothorax or large effusion. The heart is normal in size. No acute osseous abnormality. Distended air-filled loops of bowel in the right upper quadrant are non-specific.", "output": "1. Right pleural effusion. Correlate with clinical assessment and consider cross sectional imaging and fluid sampling to evaluate etiology if clinically indicated. 2. Concurrent right lower lobe pneumonia cannot be excluded and is certainly possible given the provided history of sepsis. 3. Non-specific gaseous distension of partially imaged bowel in the right upper quadrant. Correlate with clinical assessment and consider dedicated abdominal imaging to further evaluate for acute process, particularly in the setting of a right pleural effusion. RECOMMENDATION(S): Correlate clinical assessment for etiology of right pleural effusion and consider dedicated cross-section chest and abdominal imaging to further evaluate as above. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 8:28 AM, 60 minutes after discovery of the findings." }, { "input": "Portable upright chest radiograph ___ at 09:08 is submitted.", "output": "A right basilar pigtail pleural catheter remains in place. There is a questionable tiny lucency near the right apex which could reflect a very tiny pneumothorax or possibly loculated air or focal pleural fat as no definite pleural line is seen extending from this lucency. Clinical correlation is recommended. Residual patchy opacity at the right base likely reflects atelectasis. Improved aeration at the left base. No pulmonary edema. Overall cardiac and mediastinal contours are stable given differences in patient rotation." }, { "input": "There has been interval removal of the right-sided pigtail drainage catheter. No pneumothorax. A small to moderate right pleural effusion remains, decreased from ___. Residual right lower lobe opacity is likely due to atelectasis. Mediastinal contours and cardiac borders are normal. A lateral left upper lobe nodule was better characterized on recent chest CT, which also demonstrated multiple other pulmonary nodules.", "output": "No pneumothorax. Small 2 moderate right pleural effusion decreased from ___ ___." }, { "input": "When compared to previous exam, there has been no significant interval change. Elevation the right hemidiaphragm is again noted. Blunting of the right lateral costophrenic angle could be due to pleural based scarring. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No significant interval change. Right lateral pleural based scarring. No definite superimposed acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. There is mild calcification of the aortic knob. The lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax. The trachea is somewaht deviated to the left likely due to an enlarged thyroid gland.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs are clear without evidence of consolidation. There is no pneumothorax. There is slight blunting of the left costophrenic angle seen on the lateral view that may represent pleural thickening. The cardiac, mediastinal, and hilar contours are normal. There is no pulmonary vascular congestion.", "output": "No consolidation. Essentially normal radiographic examination of the chest." }, { "input": "The lungs are clear of airspace or interstitial opacity. The cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax. Healing mild deformity of the body of the sternum with callus formation in keeping with recent fracture. No mediastinal hematoma or significant depression of the sternum.", "output": "Healing deformity of the mid body of the sternum. No significant depression." }, { "input": "The lungs are clear. Cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications are noted at the aortic arch. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Semi-upright portable AP view of the chest was provided. Lung volumes are low with probable mild bibasilar atelectasis. There is no definite pneumothorax or large effusion. Cardiomediastinal silhouette appears stable. No displaced rib fracture is seen.", "output": "No acute traumatic injury." }, { "input": "Frontal and lateral radiographs the chest demonstrate well expanded, clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. The cardiac and mediastinal silhouettes are unremarkable. Pulmonary vasculature is not engorged. Multilevel degenerative changes of the thoracic spine noted.", "output": "No acute intrathoracic process." }, { "input": "There is minimal opacity in the left lower lung which is stable from multiple prior studies, and likely represents scarring or atelectasis. The lungs are otherwise clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are remarkable for a tortuous thoracic aorta, unchanged. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No radiographic findings to suggest the diagnosis of sarcoidosis." }, { "input": "The inspiratory lung volumes are appropriate. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The horizontal linear opacity in the right lung base is unchanged from the prior study and may represent scarring or abnormal branching of a vessel. The pulmonary vasculature is not engorged and there is no overt pulmonary edema. The cardiac silhouette is normal in size. The mediastinal and hilar contours are within normal limits. The trachea is midline. The visualized upper abdomen is unremarkable. Degenerative change of the right acromioclavicular joint is noted.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are normal. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process; specifically, no evidence of pneumonia. Findings were discussed with ___ at 16:30 on ___ by ___ with phone." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest were compared to previous exam from ___. Right chest dual-lumen port is again seen with catheter tip in the mid SVC. Clip seen within the left upper lobe with associated linear opacity. There has, however, been interval resolution of previously identified parenchymal opacities in the left upper lung. There is no new region of consolidation or pleural effusion. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "Interval resolution of the parenchymal opacity in the left upper lung when compared to prior. No definite acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. The heart size and cardiomediastinal contours are normal. Cephalization of vessels is consistent with pulmonary vascular congestion. No focal consolidation, pleural effusion, or pneumothorax. Catheter of the right chest wall port terminates in the lower SVC. A fiducial marker overlies the left mid lung.", "output": "Pulmonary vascular congestion. No focal consolidation." }, { "input": "Lungs are clear. Cardiomediastinal silhouette and hilar contours are unremarkable. Patient has a right-sided Port-A-Cath as well as a fiducial seed marker within the left upper lobe with associated unchanged linear opacity. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest shows low lung volume, without consolidation or nodules. There is no pleural effusion or pneumothorax. Cardiomediastinal silhouette is normal. There is no vascular congestion or pulmonary edema. Spinal fixation hardware is at the level of the cervical spine.", "output": "No sign of pulmonary edema or acute cardiopulmonary processes." }, { "input": "Frontal and lateral views of the chest. The lungs are clear and well expanded without focal opacity, pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal. Cervical spine hardware is noted.", "output": "No acute intrathoracic process." }, { "input": "The lungs are mildly hypoinflated and clear. No pleural effusion or pneumothorax. Heart is top-normal in size, likely accentuated due to low lung volumes. Mediastinal contour and hila are unremarkable.", "output": "Normal chest x-ray. No pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. Dual-lumen right-sided central venous dialysis catheter is seen, terminating at the cavoatrial junction. The cardiac silhouette remains markedly enlarged. There is right base plate-like atelectasis. Previously seen left lower lobe consolidation has essentially resolved in the interval. Mild linear left mid lung atelectasis/scarring is seen. The aorta is calcified and tortuous. Hilar contours are stable to possibly mildly engorged. No pleural effusion or evidence of pneumothorax is seen.", "output": "1. Right-sided central venous dialysis catheter terminates at the cavoatrial junction. If atrial position is desired, should be advanced approximately 2 cm. Persistent marked enlargement of the cardiac silhouette. 2. Right base plate-like atelectasis and mild left mid lung linear atelectasis/scarring. Previously seen left lower lobe consolidation has essentially resolved in the interval." }, { "input": "Portable upright film demonstrates improved aeration in the left lower lung. The previous lucencies likely represented a skin fold. No pneumothorax is identified. However, there continues to be increased opacity in the left upper lung likely representing a small infiltrate. The right lung is clear. Right IJ line tip is in the distal SVC", "output": "1. No pneumothorax 2. Small left upper lobe infiltrate." }, { "input": "A dialysis catheter terminates at the cavoatrial junction. The heart is moderately enlarged as before. The mediastinal and hilar contours appear unchanged. Aside from a patchy left basilar opacity suggesting minor atelectasis, the lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "The heart size is enlarged, but there is no mediastinal widening. The lungs demonstrate bibasilar atelectasis as well as plate atelectasis. Trace pleural effusion is present bilaterally. There is no pneumothorax. The pulmonary vasculature appears mildly engorged.", "output": "Increased cardiomegaly with mild engorgement of pulmonary vessels and basilar atelectasis and trace pleural effusion. Findings may represent early failure." }, { "input": "The mid to lower left lung is opacified suggesting a large pleural effusion and extensive atelectasis, including likely left lower lobe collapse secondary to compressive atelectasis. There is a small right pleural effusion. There is no pneumothorax. There is a mild interstitial abnormality. The cardiac silhouette has enlarged considerably from ___.", "output": "Large left-sided pleural effusion and extensive atelectasis involving the lingula and left lower lobe. Findings suggesting mild vascular congestion. NOTIFICATION: Preliminary findings were communicated to Dr. ___ by Dr. ___, in person on ___ at 9:45 AM, 5 minute(s) after discovery." }, { "input": "Portable AP chest radiograph demonstrates mild cardiomegaly, pulmonary vascular congestion, and interstitial edema. However, the right upper lobe is disproportionately consolidated suggestive of pneumonia. There was a smaller consolidation in the same lobe in ___, so either the pneumonia is recurrent or the abnormality is the 'pneumonia' form of bronchioloalveolar cell lung cancer. Another alterhative is asymmetric edema if patient has marked mitral regurgitation. Probable small left pleural effusion. There is no pneumothorax. Moderate hiatus hernia is chronic.", "output": "1. Moderate pulmonary edema. 2. Probable right upper lobe pneumonia, alternatively asymmetric edema if patient has marked mitral regurgitation, or bronchioloalveolar carcinoma progressed sinde ___." }, { "input": "Single frontal view of the chest was obtained. Heterogeneous opacification of the right lung is increased with increased involvement of the right lower lung. Right upper lobe involvement appears stable. Pulmonary edema is slightly improved. Left pleural effusion has decreased in size. No pneumothorax. Mild cardiomegaly is unchanged. Moderate hiatal hernia is chronic. No radiopaque foreign body.", "output": "1. Increased heterogeneous opacity of the right lower lung with unchanged involvement of the right upper lung likely reflects worsening infection or pulmonary hemorrhage. 2. Improved pulmonary edema with decreased size of left pleural effusion." }, { "input": "Compared to the study from the prior day, there has been some interval mild improvement in the patchy alveolar infiltrate on the right; however, there is persistent alveolar edema. The heart size continues to be mildly enlarged. There is a mildly tortuous aorta.", "output": "Mild improvement in fluid overload but still persistent." }, { "input": "Right pleural effusion has increased and is now moderate in severity. Right upper lobe consolidation has increased with new right lower lobe consolidation. Heart size is persistently mildly enlarged. Aortic tortuosity persists. No pneumothorax is seen", "output": "Increased right pleural effusion and right lung consolidations, which could represent pneumonia or asymmetric edema. Findings discussed with ___ by ___ by telephone at 11:39 a.m. on ___ after attending radiologist review." }, { "input": "There is no pneumothorax. Increased right base opacity could represent post-bronchoscopy hemorrhage, residual lavage fluid, or possibly right middle lobe pneumonia.There is no pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "Increased opacification of the right base could be hemorrhage, residual lavage fluid, or possibly right middle lobe pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ ___ on the telephone on ___ at 11:20 AM, 11 minutes after the discovery of the findings." }, { "input": "Lungs are clear. Opacity at the left cardiophrenic angle is compatible with a fat pad. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. Anterior and posterior cervical fixation hardware is noted. IVC filter is partially visualized in the abdomen.", "output": "No acute cardiopulmonary process." }, { "input": "No definite focal consolidation is seen. There is minor left base atelectasis. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable. Re- demonstrated is partially imaged cervical spine hardware. No evidence of free air is seen beneath the diaphragm.", "output": "No acute cardiopulmonary process. No evidence of free air beneath the diaphragm." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. There is no pulmonary edema. The heart is normal in size, and the mediastinal contours are normal. Cervical spinal hardware is partially visualized", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are normal. Opacity at the left cardiophrenic angle is unchanged from most recent prior, then described as an epicardial fat pad. There is no focal consolidation, effusion, or pneumothorax. There is no central vascular congestion or overt pulmonary edema. Mediastinal and hilar contours are normal. Heart size is normal. Anterior and posterior cervical fixation hardware is noted.", "output": "No evidence of pneumonia." }, { "input": "PA and lateral views of the chest provided. Partially visualized hardware in the cervical spine noted. Lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is stable with top-normal heart size. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. An IVC filter is partially visualized in the upper abdomen.", "output": "No acute findings." }, { "input": "The cardiac, mediastinal and hilar contours are normal. The pulmonary vascularity is normal. The lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are hyperinflated. There is no focal consolidation, pleural effusion or pneumothorax. Irregularity of the posterior ___ right rib is likely secondary to trauma.", "output": "Hyperinflated lungs, no acute cardiopulmonary process." }, { "input": "The heart size is within normal limits. The mediastinal and hilar contours are normal. There is a stable appearance of the flattened right hemidiaphragm compatible with pleural-parenchymal scarring. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs are well expanded. Platelike opacities overlying the right lower lobe and spine are suggestive of atelectasis, less prominent than on ___. Mediastinal contour, hila, and cardiac silhouette are normal. No pneumothorax or pleural effusion.", "output": "No pneumonia." }, { "input": "PA and lateral views of the chest provided. Faint bibasal atelectasis noted. No convincing evidence for pneumonia or edema. Cardiomediastinal silhouette is normal. In particular, the mediastinum appears normal in caliber. Several chronic right rib cage deformities are again noted. No acute bony abnormality is seen. No free air below the right hemidiaphragm.", "output": "No acute findings. Normal mediastinal contour." }, { "input": "Again seen is a right subclavian PICC line, tip over distal SVC. Allowing for technical differences, the cardiomediastinal silhouette is probably unchanged. The previously identified nodular densities are less pronounced than on the prior study, though faint residua are visible. Bibasilar opacities -- ? atelectasis -- prior again seen, last pronounced. No new nodular density, frank consolidation, or effusion is identified. Probable tiny calcified granuloma adjacent to the lower right trachea, unchanged.", "output": "As above" }, { "input": "Frontal and lateral views of chest were obtained. The heart size and cardiomediastinal contours are normal. Right base linear opacities are chronic and compatible with atelectasis or scarring. Slight elevation of the lateral aspect of the apparent right hemidiaphragm is compatible with a tiny pleural effusion. No focal consolidation or pneumothorax. Chronic right ___ rib fracture is unchanged.", "output": "Chronic right base atelectasis or scarring. Possible tiny right pleural effusion." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. The lungs are mildly hyperinflated, otherwise no focal consolidations concerning for pneumonia are identified. Irregularity of the posterior ___ right rib is likely secondary to a prior trauma. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormalities identified." }, { "input": "Frontal and lateral radiographs of the chest demonstrate mild atelectasis at the right base. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation. Old healed right rib fracture.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs demonstrate no focal consolidation, pleural effusion, or pneumothorax. Healed right eighth rib fracture is again noted. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiograph demonstrates linear opacity at the right lower lobe suggestive of atelectasis. Lungs demonstrate no focal opacity convincing for pneumonia. Cardiomediastinal and hilar contours are unremarkable. Lungs are hyperexpanded suggestive of emphysematous changes. Deformity of the eighth right rib posteriorly appears to be secondary to prior injury.", "output": "Hyperexpanded lungs with flattening of the bilateral diaphragms suggestive of emphysema. No focal opacity convincing for pneumonia." }, { "input": "There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Old right rib deformities are again seen. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear without focal consolidation. There is linear atelectasis in the bilateral lung bases, new, but no definitive consolidation seen. Potentially left lower lobe consolidation is a possibility. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Multiple old healed right rib fractures are again noted. Lower thoracic compression deformities may be slightly worsened, however evaluation is slightly limited due to overlying atelectasis.", "output": "1. New bibasilar areas of atelectasis, with potentially present left lower lobe consolidation. 2. Lower thoracic compression deformities may be slightly worsened, however evaluation is slightly limited due to overlying atelectasis. Dedicated thoracic spine radiographs could be performed if patient is symptomatic. 3. Old rib fractures. NOTIFICATION: Findings and recommendation were emailed to the ED QA nurses." }, { "input": "AP upright and lateral views of the chest provided. Lung volumes are low. Bronchovascular crowding limits assessment for mild pulmonary edema. There is no large effusion or pneumothorax. No focal consolidation concerning for pneumonia. The heart size appears top-normal likely due to technique. Chronic right posterior rib deformities again seen. No free air below the right hemidiaphragm.", "output": "Low lung volumes with possible mild pulmonary edema." }, { "input": "Multiple old right-sided rib deformities are again seen. No definite new focal consolidation is seen. There is basilar and mid lung minor atelectasis/scarring. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well-expanded, with minimal atelectasis or scarring in the right lung base. There is no pleural effusion comp pulmonary edema, pneumothorax, or focal airspace consolidation. Irregularity of the posterior eighth rib is again seen, unchanged since the prior study.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear aside from minimal bibasilar atelectasis, right greater than left. The cardiac and mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen. The bony thorax is grossly intact.", "output": "1. No acute cardiac or pulmonary process. 2. No evidence of a rib fracture. If clinical concern persists, a dedicated rib series with appropriately placed skin markers could be obtained." }, { "input": "PA and lateral views of the chest were provided. The lungs are hyperinflated with upper lobe lucency and splaying of bronchovasculature compatible with emphysema. No large consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is stable. Bony structures are intact.", "output": "Emphysema without definite signs of superimposed pneumonia." }, { "input": "Heart size, mediastinal, and hilar contours are normal. Lungs are hyperinflated, however clear without pleural effusion, focal consolidation, or pneumothorax.", "output": "No acute cardiopulmonary process. Hyperinflated lungs." }, { "input": "Heart size is mildly enlarged but unchanged. The mediastinal and hilar contours are similar. Pulmonary vasculature is not engorged. Linear and patchy opacities in the right upper lobe and lung bases likely reflect areas of atelectasis in the setting of low lung volumes. No focal consolidation, pleural effusion or pneumothorax is present.", "output": "Low lung volumes with atelectasis in the lung bases and right upper lobe, without focal consolidation to suggest pneumonia." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. Lung volumes are low. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of pneumonia." }, { "input": "Compared to ___, lung volumes remain slightly low. There is consolidation at the lung bases, right greater than left, representing atelectasis, aspiration or pneumonia. No pleural effusion. No pneumothorax. Heart size is normal and unchanged.", "output": "Bibasilar opacities, right greater than left, which may represent atelectasis, aspiration or pneumonia." }, { "input": "No focal consolidation is seen. There may be minimal pulmonary vascular congestion without overt pulmonary edema. No pleural effusion or pneumothorax is seen. Cardiac silhouette is top-normal.", "output": "Possible minimal pulmonary vascular congestion." }, { "input": "PA and lateral views of the chest were provided. There is no focal consolidation, pneumothorax, or pleural effusion. The cardiomediastinal silhouette is unremarkable. There are no suspicious osseous lesions.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is status post median sternotomy with aortic valve replacement. A small right pleural effusion has decreased. The lungs are clear. The rounded contour of the right hilus is stable dating back to ___, and may be due to vasculature. There is stable mild cardiomegaly. There is no pneumothorax.", "output": "Decreased small right pleural effusion. Stable mild cardiomegaly. Clear lungs." }, { "input": "There is a new moderate right-sided pleural effusion, likely with superimposed comparison atelectasis. There is a small left pleural effusion. There is no focal consolidation, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is stably enlarged. Median sternotomy wires and a prosthetic aortic valve are noted.", "output": "New moderate right-sided pleural effusion and small left pleural effusion." }, { "input": "Compared to prior exam, the right lung volume is slightly decreased in slight increase in right mediastinal shift. The right hemidiaphragm is not as well visualized indicating a worsening right pleural effusion and worsened lower lobe atelectasis. There is an unchanged small left pleural effusion. No evidence of pulmonary vascular congestion or pulmonary edema. The cardiomediastinal contours are enlarged but stable without significant pulmonary vascular congestion. Stable calcification of the aortic arch. Median sternotomy wires are intact.", "output": "Worsened right pleural effusion and atelectasis. Unchanged small left pleural effusion. Stable moderate cardiomegaly without significant pulmonary vascular congestion." }, { "input": "Severe cardiomegaly, tortuous aorta, right pleural effusion and large area of atelectasis in the right middle lobe and right lower lobe are unchanged. Minimal interstitial edema is unchanged. Moderate degenerative changes in the thoracic spine are noted. There is increase in the AP in diameter of the chest. Patient is status post valve replacement. Sternal wires are aligned. There is no evident pneumothorax", "output": "Minimal interstitial edema. No change in cardiomegaly right pleural effusion and adjacent atelectasis" }, { "input": "There is re- demonstration of a mediastinal drain to the left of the trachea. There is an unchanged right chest tube. Residual oral contrast seen in the hepatic flexure and descending colon. Opacity along the right mediastinum is consistent with recent surgical history. Right lower lung platelike atelectasis is unchanged. There is no evidence of pneumothorax, pneumomediastinum, or consolidation. There is no evidence of pleural effusion.", "output": "1. Stable postsurgical changes. 2. No evidence of pneumothorax, pneumomediastinum, or pleural effusion. 3. Unchanged right mid and lower lung atelectasis." }, { "input": "Single AP view of the chest provided. Right chest tube is in stable position. No pneumothorax. Moderate right pleural effusion and moderate atelectasis of the right middle and lower lobe is unchanged. Mild platelike atelectasis at the left lung base is unchanged. Postsurgical changes are stable.", "output": "Postsurgical changes are stable. Moderate atelectasis at the right lung base and midlung are unchanged. No significant changes from the previous examination." }, { "input": "Right-sided Port-A-Cath tip terminates the mid SVC. Patient is status post esophagectomy and gastric pull-through, with the mediastinal contour appearing unchanged. Cardiac and hilar contours are within normal limits. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. Clips are seen in the right upper quadrant of the abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There are low inspiratory volumes. Note is made of a drain overlying the superior mediastinum and a line --___ PICC line -- overlying the right atrium. No pneumothorax detected. Cardiomediastinal silhouette is prominent, but unchanged. The right hemi diaphragm is elevated and there is probably a small to moderate right effusion, with underlying collapse and/or consolidation. There is platelike atelectasis in the right mid lung inferiorly. No CHF, other evidence of consolidation, or left-sided effusion identified.", "output": "Doubt significant interval change." }, { "input": "Portable erect chest radiograph ___ at 03:42 is submitted.", "output": "There is worsening bilateral pulmonary edema with associated layering bilateral effusions and bibasilar consolidation likely reflecting compressive atelectasis, left greater than right. Heart remains enlarged status post median sternotomy for CABG. A nasogastric tube is seen coursing below the diaphragm with the tip not identified. No pneumothorax. Right subclavian PICC line now has its tip in the axillary region." }, { "input": "Since the prior chest radiograph, there has been interval repositioning of the right PICC, and the loop has since resolved. However, the tip remains at the distal right subclavian and appears to be heading superiorly towards the right internal jugular vein. Repositioning is advised. There has otherwise been no relevant change. Stable mild pulmonary edema, bibasilar atelectasis and pleural effusions. No pneumothorax.", "output": "Right PICC tip is in the right subclavian, heading superiorly towards the right internal jugular vein." }, { "input": "Portable semi-erect chest radiograph ___ at 07:41 is submitted.", "output": "Interval exchange with placement of a dual lumen left internal jugular central line which has its most distal tip in the distal SVC. Right subclavian PICC line unchanged in position. Tracheostomy tube in satisfactory position. Status post median sternotomy for CABG with stable postoperative cardiac and mediastinal contours. Small layering bilateral effusions with associated left basilar atelectasis. Interval appearance of mild interstitial edema. No pneumothorax." }, { "input": "PA and lateral views were reviewed. The cardiomediastinal and hilar contours are stable. There is no pleural effusion or pneumothorax. The lungs are well expanded. Vague density in the lateral left mid lung field without a clear correlate on the lateral view may be due to overlapping structures, but evolving consolidation is not excluded.", "output": "Vague left mid lung zone opacity only appreciated on the frontal view which may be due to overlapping structures, but evolving consolidation is not excluded." }, { "input": "Streaky bibasilar opacities are more notable on the left, and are suggestive of atelectasis, although aspiration or pneumonia can not be entirely excluded. No pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is unchanged in appearance.", "output": "Bibasilar opacities favoring atelectasis, although pneumonia or aspiration cannot be entirely excluded." }, { "input": "An endotracheal tube is in satisfactory position. An enteric tube courses below the diaphragm with the tip out of the field of view. A vascular stent on the right is unchanged. There continues to be interval improvement in the diffuse interstitial opacities. There is no new opacity. There is no pulmonary edema, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Continued improvement in the resolving pneumonia. No new opacity." }, { "input": "ETT in standard position. The enteric tube traverses the diaphragm into the left upper quadrant wires tip is not seen. Incompletely visualized hemodialysis catheter tip projects image the lower right mediastinum. Vascular stents end-to-end project over in the right medial upper hemithorax. Lung volumes remain low but have slightly improved compared to the prior exam. Residual lower lung worse on the streaky opacities most likely reflect atelectasis. No left pleural effusion. No pneumothorax. No edema. Heart size is normal.", "output": "Persistent bibasilar atelectasis and lower lung volumes, slightly improved in the interim." }, { "input": "Frontal and lateral upright radiographs of the chest were obtained. The vascular stent in the superior vena cava is unchanged in appearance. Top normal heart size and mediastinal contours are unchanged. Mild tortuosity of the thoracic aorta is stable. No focal consolidation, pleural effusion or pneumothorax. An oval ___ x 8 mm opacity projects over the ___ right posterior rib unchanged dating back to at least ___ corresponding to a sclerotic lesion in the 7th rib on CT, likely a bone island.", "output": "No evidence of pneumonia" }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Vascular stent is noted within the SVC in unchanged position. Pulmonary vasculature is normal. Patchy opacities in the left upper and lower lung fields are nonspecific and may reflect areas of infection. No pleural effusion or pneumothorax is present. No acute osseous abnormalities present. Moderate degenerative changes are noted in the lower thoracic spine. Bone island in the right seventh rib posteriorly is unchanged.", "output": "Focal patchy opacities in the left upper and lower lung fields may reflect areas of atelectasis though infection is not completely excluded." }, { "input": "AP view of the chest. The enteric tube ends off the inferior portion of the image. The endotracheal tube is in appropriate position, 4.4 cm from the carina. Right brachiocephalic/SVC stent is unchanged in position. Bilateral parenchymal opacities are again seen, slighly decreased on the left. Possibly trace pleural effusions. No pneumothorax. Cardiomediastinal and hilar contours are normal.", "output": "Enteric tube ends off the inferior portion of the image. Slight improvement in parenchymal opacities on the left, but bilateral parenchymal opacities persist." }, { "input": "SVC stent in similar position. The lungs are clear. The cardiomediastinal silhouette is unremarkable. No interstitial edema or pleural effusions. No pneumothorax. Sclerotic bony lesion involving the seventh right rib posterior laterally is stable since ___ and is likely a bone island, documented on prior CT thorax ___.", "output": "No acute cardiopulmonary process." }, { "input": "ETT in standard position. Overlapping vascular stents projecting over the right upper medial hemithorax are unchanged. Enteric tube tip and sideport projecting over the expected region of the stomach in left upper quadrant. Hemodialysis catheter tip projects over the lower right mediastinum, unchanged. Lung volumes remain low. Bilateral lower lobe streaky linear opacities are most consistent with atelectasis, increased from prior exam, now with indistinct left hemidiaphragm and descending aorta borders. No pneumothorax, edema or effusion. The heart size normal.", "output": "Interval decreased lung volumes and increased atelectasis." }, { "input": "Redemonstration of vascular stents about the right superior mediastinum is noted. No pneumothorax or pleural effusions are seen. No focal consolidations are seen to suggest an acute infectious process. Heart size is within normal limits. Mild degenerative changes are seen within the thoracic spine.", "output": "No acute intrathoracic process." }, { "input": "Portable semi-erect chest radiograph ___ at 04:03 is submitted.", "output": "Feeding tube courses below the diaphragm and the tip is not identified. The endotracheal tube continues to have its tip 4 cm above the carina. The right brachiocephalic SVC stent and ascending right ventricular cannula are both unchanged in position. Right upper lobe patchy opacity and fainter developing opacities at both lung bases are concerning for multifocal pneumonia. The left upper and mid lung remains clear. No pulmonary edema. Overall cardiac and mediastinal contours are stable." }, { "input": "There is no pneumothorax. A metallic stent projecting over the upper SVC is unchanged. An ovoid density projecting at the level of the right seventh rib is a small bone island. Small bilateral pleural effusions are unchanged. There is mild pulmonary vascular congestion without frank pulmonary edema. The cardiomediastinal silhouette is stable. There is no focal consolidation. NG tube projects over the left upper quadrant.", "output": "1. No pneumothorax. 2. Mild pulmonary vascular congestion without frank pulmonary edema. 3. Small bilateral pleural effusions." }, { "input": "There is a triangular retrocardiac opacity, which likely represent left lower lobe atelectasis. The right lung is clear. There is no evidence for pulmonary edema, pneumothorax or pneumonia. The heart is top-normal in size. The mediastinum and hilar contours are unremarkable. SVC vascular stent seen. Tracheostomy tube appears unchanged in position. A large bore catheter is seen in the expected location of the IVC, unchanged from prior. Percutaneous gastrostomy tube appears unchanged.", "output": "New left lower lobe atelectasis." }, { "input": "ETT tip projects approximately 3.5 cm from the carina with the neck in flexion. Enteric tube tip and side-port project over the expected region of the stomach in the left upper quadrant. Vascular stent projects over the right medial upper hemithorax, unchanged. Hemodialysis catheter tip projects over the lower mediastinum. Lung volumes are lower compared to the prior exam. Bilateral lower lung streaky opacities may reflect atelectasis but have increased from the prior exam and are concerning for developing bilateral aspiration. No effusion or pneumothorax. The heart size is normal. Mediastinal silhouette is unchanged. Aortic knob calcifications are noted mediastinal drain is unchanged.", "output": "1. Newly placed enteric tube projects over the expected region of the stomach. 2. Increased lower lung opacities are concerning for bilateral aspiration. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephoneon ___ at 9:54 AM, 10 minutes after discovery of the findings." }, { "input": "No implanted Port-A-Cath is seen. Again seen is a metallic stent within the SVC. Previously noted tracheostomy tube is not clearly visualized. There is a focal narrowing in the upper trachea again noted. A linear peripheral opacity projecting over the right upper lung is likely a small scar. Lungs are clear. No new focal consolidation, pleural effusion, or pneumothorax. Cardiomediastinal silhouette is unchanged.", "output": "1. No evidence of a left-sided Port-A-Cath. 2. No acute cardiopulmonary process." }, { "input": "AP portable upright chest radiograph provided. Lung volumes are low and underpenetrated technique limits evaluation. Allowing for this, no convincing signs of pneumonia or CHF. No large effusion or pneumothorax is seen. The cardiomediastinal silhouette appears stable. Bony structures are intact.", "output": "No convincing signs of pneumonia on this limited portable radiograph." }, { "input": "The lung volumes are low. Basilar atelectasis is not significantly changed from the prior exam. There is no focal consolidation to suggest pneumonia. There is no pulmonary edema, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal. A right-sided PICC is present with tip in the upper right atrium.", "output": "1. Low lung volumes with bibasilar atelectasis. No evidence of pneumonia. 2. Right PICC with the tip in the upper right atrium." }, { "input": "Compared to the previous chest radiograph, the right-sided PICC line has been removed. Low lung volumes are again seen, and no focal consolidation, pleural effusion or pulmonary edema is seen. Atelectasis is seen at the lung bases, and the cardiac and mediastinal contours are normal.", "output": "No focal consolidation to suggest pneumonia is seen." }, { "input": "Evaluation is limited due to patient position. The lungs are clear of focal consolidation, pleural effusion or pneumothorax. The heart is normal in size. The upper mediastinum is wide with enlargement of the aortic knob also noted. There is no pulmonary edema.", "output": "Widened upper mediastinum and enlarged appearance of the aortic knob. Recommend repeat upright chest radiographs. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 8:16 AM, 10 minutes after discovery of the findings." }, { "input": "Cardiac silhouette size is top normal. The aorta is mildly unfolded. The previously noted widening of the superior mediastinal contour has essentially resolved, likely due to low lung volumes. Pulmonary vasculature is normal. Hilar contours are normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality. Slight unfolding of thoracic aorta without superior mediastinal widening." }, { "input": "The mediastinal structures appear unremarkable. There is no cardiomegaly. The visualized lung fields are clear without evidence of focal consolidation. There has been interval development of a small/ minimal left-sided pleural effusion. No evidence of pneumothorax.", "output": "Interval development of small/minimal left-sided pleural effusion. Otherwise no evidence of acute cardiopulmonary process. NOTIFICATION: The above findings were discussed over the phone by Dr. ___ with Dr. ___ on ___ at 15:41." }, { "input": "There is minimal left base atelectasis. Otherwise, the lungs are clear without focal consolidation. No large pleural effusion is seen. There is no pneumothorax. Aortic knob calcification is seen. Otherwise, the cardiac and mediastinal silhouettes are unremarkable.", "output": "Minimal left base atelectasis. Otherwise, no acute cardiopulmonary process." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. There has been no change from the prior radiograph.", "output": "Normal chest radiograph without evidence of pneumonia." }, { "input": "The heart size is normal. Mediastinal can't hilar contours are unremarkable. Lungs are clear and the pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities present.", "output": "No acute cardiopulmonary abnormality." }, { "input": "ICD is in place with a single lead terminating in the right ventricle. There is no visible pneumothorax. Heart size is normal. Prominence of main pulmonary artery contour corresponds to an enlarged pulmonary artery on outside CTA of the chest ___ ___, suggesting the possibility of pulmonary arterial hypertension. Lungs are clear except for linear atelectasis at the left base. Note is made of an apparent coronary artery stent. There is no pleural effusion or acute skeletal finding.", "output": "Single-lead ICD terminates in right ventricle with no evidence of pneumothorax." }, { "input": "Lung volumes are low. The heart size is moderately enlarged. The aorta is tortuous and diffusely calcified. There is crowding of the bronchovascular structures but no overt pulmonary edema is seen. Streaky left basilar opacity likely reflects atelectasis. Right apical calcifications are unchanged. No large pleural effusion or pneumothorax is identified. Diffuse demineralization of the osseous structures is noted.", "output": "Low lung volumes with minimal left basilar atelectasis." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. No focal consolidations concerning for pneumonia are identified. There is no pleural effusion or pneumothorax.", "output": "No focal consolidations concerning for pneumonia identified." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Surgical clips are present in the chest wall bilaterally.", "output": "No radiographic evidence of pneumonia." }, { "input": "Again seen is stable lingular atelectasis. There is no focal consolidation, pleural effusion, or pneumothorax. The heart size is normal. Atherosclerotic calcifications are noted in the aortic arch. The cardiomediastinal silhouette is within normal limits.", "output": "No evidence of pneumonia." }, { "input": "A small amount of left basilar linear atelectasis is stable from the prior radiograph. There is no evidence of pneumonia or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. Calcification of the aortic arch is noted.", "output": "Stable mild left basilar atelectasis." }, { "input": "PA and lateral views of the chest provided. Lungs are hyperinflated, but clear. Pulmonary vasculature is normal. Cardiomediastinal and hilar contours are normal. There are no pleural effusions.", "output": "No acute intrathoracic process." }, { "input": "The heart size and mediastinal contours are stable. No focal consolidation, pleural effusion or pneumothorax is present. Atelectasis at the left base is unchanged.", "output": "No evidence of pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 4:32 PM, 2 minutes after discovery of the findings." }, { "input": "PA and lateral chest radiographs. The lungs are clear with the exception of mild atelectasis in the left lung base. There is no pleural effusion or pneumothorax. The cardiac, hilar, and mediastinal contours are unremarkable.", "output": "No acute cardiopulmonary process. No evidence of hilar lymphadenopathy." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs which are clear. An opacity in the right upper lobe represents a calcified granuloma. There is no pleural effusion or pneumothorax.", "output": "Right upper lobe calcified granuloma. Otherwise normal chest radiograph." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Portable single frontal chest radiograph was obtained. The Dobbhoff tube is looped in the mid esophagus and courses superiorly with the tip terminating in the pharynx. TLung volumes remain low. There is persistent moderate enlargement of the cardiac silhouette with pulmonary vascular congestion.", "output": "A mal-positioned Dobbhoff tube coiled in the mid esophagus and courses superiorly ending in the oropharynx. Findings were communicated with Dr. ___ by Dr.___ at time of observation at 4:42p.m. on ___." }, { "input": "The lungs are well-expanded and clear. The heart is normal in size. The mediastinal contour, hila, and pleura are normal. There is no focal consolidation, pneumothorax, pleural effusion, or pulmonary edema.", "output": "Normal chest radiograph, including no focal consolidation to suggest pneumonia, no pleural effusion, and evidence of pleural disease." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.", "output": "No focal consolidation concerning for pneumonia." }, { "input": "Moderate cardiomegaly is unchanged. Bibasilar atelectasis and small bilateral pleural effusions are stable as well as unchanged pulmonary vascular congestion. The ETT terminates in the midtrachea. There is interval placement of a feeding tube with a side-port that is below the EG junction and a tip that extends beyond the lower margin of the image.", "output": "Feeding tube placement with the side port below the EG junction." }, { "input": "There is re- demonstration of bilateral moderate pulmonary edema that appears unchanged compared to ___ study. Again there are bilateral upper lobe nodular opacities that is suggestive of disseminated infection with septic emboli. Stable mild cardiomegaly. There may be bilateral small pleural effusions.", "output": "Re- demonstration of bilateral moderate pulmonary edema and upper lobe nodular opacities that are stable from ___ study." }, { "input": "Low bilateral lung volumes. No focal consolidation, pleural effusion or pneumothorax identified. There is mild unchanged vascular crowding, likely secondary to the low lung volumes. The size and appearance of the cardiomediastinal silhouette is unchanged.", "output": "No significant interval change since the prior examination." }, { "input": "Cardiac silhouette size is normal. Atherosclerotic calcifications are demonstrated at the aortic knob. Mediastinal and hilar contours are normal. Lungs are hyperinflated with attenuation of vascular markings towards the apices suggestive of mild emphysema. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormalities seen.", "output": "No acute cardiopulmonary abnormality. Mild emphysema." }, { "input": "A newly placed dual-lead left pectoral pacemaker sends leads to the right atrium and right ventricle. There is no pneumothorax. The lungs are clear. The heart and mediastinum are within normal limits. Multilevel spinal degenerative changes are stable.", "output": "Newly placed left pectoral dual-lead pacemaker sends leads to the right atrium and right ventricle. No pneumothorax. Clear lungs." }, { "input": "Heart size is mildly enlarged, unchanged. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is appreciated. Multiple old bilateral rib fractures are present. There are mild degenerative changes seen in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart appears mildly enlarged. The mediastinal and hilar contours appear unchanged. There are no pleural effusions or pneumothorax. The lungs appear clear. Multiple remodeled bilateral rib fractures appear unchanged.", "output": "No evidence of acute disease." }, { "input": "PA and lateral views of the chest provided. Lung volumes are somewhat low. And external device projects over the lung apices and superior mediastinum somewhat limiting assessment. The lungs appear clear though volumes are low. Cardiomediastinal silhouette is normal. No acute bony injuries. Please note, sternum is grossly unremarkable on the lateral projection.", "output": "As above." }, { "input": "PA AND LATERAL VIEWS OF THE CHEST. There is stable elevation of the right hemidiaphragm. There is no focal consolidation. There is no pleural effusion. No pneumothorax. The cardiomediastinal contours are normal.", "output": "Stable elevation of the right hemidiaphragm. No acute cardiopulmonary process." }, { "input": "Left-sided central venous catheter has been removed. The heart size is normal. The mediastinal and hilar contours are unchanged. Evidence of volume loss in the right lung with elevation of the right hemidiaphragm and collapse of the right middle lobe appear chronic. Linear opacities within the right lung base likely reflect right lower lobe subsegmental atelectasis. Left lung is clear. No pleural effusion is identified. The pulmonary vascularity is not engorged, and there is no pneumothorax. No acute osseous abnormality is identified. Partially seen is anterior cervical fusion hardware.", "output": "Chronic right middle lobe collapse with adjacent right lower lobe subsegmental atelectasis." }, { "input": "AP and lateral views of the chest were performed Elevation of the right hemidiaphragm is again noted. Vague linear densities in the left mid to lower lung could reflect atelectasis. No convincing evidence of pneumonia. No effusion or pneumothorax. Overall cardiomediastinal silhouette appears stable. Bony structures appear intact.", "output": "No acute findings. Mild left basilar atelectasis." }, { "input": "Single portable view of the chest is compared to previous exam from ___. Again, there is elevation of the right hemidiaphragm. Blunting of the right lateral costophrenic angle may be due to atelectasis versus small effusion. Left lung is clear, noting that the costophrenic angle is excluded from the field of view. There is no pneumothorax. Cardiomediastinal silhouette is within normal limits. New left-sided central catheter is seen; however, the tip projects over the upper mediastinum on the left. Anterior cervical fixation hardware is identified.", "output": "Left-sided central catheter with tip projecting over the upper mediastinum on the left. The exact location of which is indeterminate on this study; however, please see subsequent CT scan for additional detail." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Analysis is performed in direct comparison with the next preceding chest examination of ___. The heart size remains normal. No configurational abnormality is identified. Unchanged appearance of thoracic aorta which is mildly widened with prominent aortic arch, but no local contour abnormalities or advanced wall calcifications are present. The pulmonary vasculature is not congested. Similar as on previous examination, the pulmonary vasculature demonstrates an irregular peripheral pattern, coinciding with some flattened diaphragms consistent with COPD. Acute parenchymal infiltrates are not seen. The next previous examination (___), plate atelectasis in the right lower lobe and middle lobe area have disappeared. Unchanged appearance of left-sided rib resection (#6).", "output": "Stable chest findings consistent with COPD, but no acute pulmonary infiltrates." }, { "input": "Portable frontal chest radiograph demonstrates a largely stable appearance of numerous pleural metastases, right greater than left. There is no definite effusion, there is no pneumothorax. The heart remains markedly enlarged. The mediastinal contours are notable for thickening of the right paratracheal stripe, which is likely vascular. The pulmonary vasculature is normal. There is minimal atelectasis which is stable in appearance in the left lower lung.", "output": "1. Largely stable appearance of pleural based metastasis. 2. Marked cardiac enlargement, not significantly changed compared with prior. 3. Minimal bibasilar atelectasis, stable." }, { "input": "The heart is at the upper limits of normal size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax.", "output": "No evidence of acute disease." }, { "input": "Upright AP and lateral radiographs of the chest. FINDINGS: There is slight blunting of the right costophrenic sulcus, which may represent combination of atelectasis and very small pleural effusion. Also, at the lateral aspect of the right hemidiaphragm is apparent slight focal concavity or lobulation of the diaphragm, which may represent adjacent airspace opacity or normal contour of the diaphragm.", "output": "Small right pleural effusion with question of possible peripheral right lower lobe opacity, which may represent infection in the right clinical setting." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures notable for right convex scoliosis of the thoracic spine. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "AP and lateral views of the chest. The lungs are clear without focal consolidation, effusion or pulmonary vascular congestion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. The lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax. There is a retrocardiac opacity containing air likely representing a hiatal hernia, which was better assessed on the prior CT chest. The cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Hiatal hernia redemonstrated. No signs of pneumonia or other acute intrathoracic process." }, { "input": "Single portable radiograph of the chest demonstrates interval placement of a nasogastric tube which is seen projecting below the diaphragm, out of the field of view. The remainder of the examination is unchanged compared to the prior radiograph. Bilateral alveolar densities are again seen and similar in appearance. A right-sided pacemaker is unchanged with leads in the right atrium and right ventricle. The monitoring and support devices are also unchanged.", "output": "Interval placement of nasogastric tube which projects past the diaphragm, out of field of view." }, { "input": "The patient is status post tracheostomy. A dual-lead pacemaker/ICD device appears unchanged. Dialysis catheter again terminates at the cavoatrial junction. Cardiac, mediastinal and hilar contours appear unchanged. There is increased heterogeneous opacification predominantly involving the central parts of each lung. In addition, there are small pleural effusion suspected bilaterally.", "output": "Increased heterogeneous pulmonary opacities; differential considerations include fluid overload, pneumonia, aspiration, or combination." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal contours are within normal limits. The lungs are hyperinflated, consistent with known diagnosis of COPD. Increased pulmonary markings likely reflect chronic changes. There is upper lobe scarring with tenting of the hila bilaterally. There is no focal consolidation or pneumothorax. Posterior basal opacity, seen best on the lateral view, is unchanged and could represent a small pleural effusion or a Bochdalek hernia.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are hyperinflated compatible with COPD. Heart size is normal. Enlargement of the hila bilaterally likely reflects pulmonary arterial hypertension. There is no pulmonary vascular engorgement. Mediastinal contours are unremarkable. Bullous changes with scarring is seen within the lung apices. Linear opacities within the right mid lung field and left lung base also may reflect chronic changes. Calcified granuloma in the right middle lobe is present. No focal consolidation, pleural effusion or pneumothorax is seen. There is diffuse demineralization the osseous structures.", "output": "COPD. Chronic changes within the lung apices, right mid lung field and left lung base. No focal consolidation concerning for pneumonia. Likely pulmonary arterial hypertension." }, { "input": "The lungs are hyperinflated with flattening of the diaphragms, suggesting chronic obstructive pulmonary disease. There is slight blunting of the bilateral costophrenic angles, which may be due to pleural thickening although very trace pleural effusions are not excluded. Bibasilar atelectasis is seen, without definite focal consolidation. Relative lucency at the upper lungs likely relates to pulmonary emphysema. The cardiac and mediastinal silhouettes are stable.", "output": "COPD and findings suggesting pulmonary emphysema. Slight blunting of the bilateral costophrenic angles may be due to pleural thickening, although trace effusions are not excluded. Bibasilar opacities most likely represent atelectasis; however, an early infectious process is not excluded in the appropriate clinical setting." }, { "input": "The lungs are relatively hyperinflated, which can be seen with COPD. No focal consolidation is seen. . No pleural effusion or pneumothorax is seen. The cardiac silhouette is not enlarged. Slight prominence of the hila bilaterally may be due to central pulmonary vascular engorgement although underlying lymphadenopathy is not entirely excluded. Multi-level degenerative changes along the spine.", "output": "Slight prominence of the hila bilaterally may be due to central pulmonary vascular engorgement although underlying lymphadenopathy is not excluded. If this is of clinical concern, follow-up chest CT would provide further evaluation. Hyperinflated lungs without focal consolidation." }, { "input": "Endotracheal tube has been withdrawn with tip now in standard position, terminating approximately 4.6 cm from the carina. Enteric tube tip remains within the stomach. Lung volumes remain persistently low. Patchy and linear opacities are noted in the lung bases compatible with atelectasis. No focal consolidation, pleural effusion or pneumothorax is present.", "output": "Endotracheal tube tip now terminating in standard position." }, { "input": "The endotracheal tube appears high, located 5 cm above the carina, above the level of the clavicle. This may be related to the position of the neck. The tip of the nasogastric tube is at the level of the pylorus/first portion of duodenum. There is improved aeration of the lungs when compared to the prior. The veil like, hazy opacities have also improved when compared to the prior. No acute consolidation or interstitial edema. No large pleural effusions or pneumothorax. No displaced rib fractures are seen.", "output": "The ETT appears high, which may be related to patient's neck positioning. Improved aeration of the atelectasis when compared to the prior." }, { "input": "Overlying trauma board slightly limits assessment. A right mainstem bronchial intubation is present with the tip of the endotracheal tube at the proximal right mainstem bronchus. Enteric tube tip terminates within the stomach. Lung volumes are low. Heart size is mildly enlarged. Widening of the mediastinum may reflect low lung volumes and supine positioning. Crowding of the bronchovascular markings is noted, likely due to low lung volumes. There appears to be hazy ill-defined opacities within both lungs, more so on the left. No large pleural effusion or pneumothorax is present. No displaced fractures are visualized.", "output": "1. Right mainstem bronchial intubation. 2. Enteric tube within the stomach. 3. Low lung volumes. Hazy opacities in both lungs, more so on the left, may reflect areas of atelectasis though contusion or aspiration is not excluded." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures are intact. No free air is seen below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "A left Port-A-Cath is unchanged in position with the tip terminating in the proximal right atrium. The lungs are symmetrically well expanded and well aerated without focal consolidation, concerning for pneumonia, pleural effusion or pneumothorax. The pulmonary vasculature is not engorged. The cardiomediastinal and hilar contours are within normal limits. No acute osseous abnormality is detected.", "output": "No focal consolidation concerning for pneumonia." }, { "input": "2 portable supine views of the chest demonstrate low lung volumes, crowding the hilar structures, with no evidence of overt pulmonary edema. There is no pneumothorax, pleural effusion or focal consolidation concerning for pneumonia. Multiple right-sided healed rib fractures were present previously in ___. Calcifications projecting over the left heart are unchanged, likely of the mitral annulus. The heart is normal in size, allowing for portable supine technique. The mediastinal contours are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Faint opacities in the lung bases are likely due to atelectasis. There are no other focal airspace opacities to suggest infection. The lungs are well expanded. The heart is at the upper limits of normal as on the previous study. The mediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. The aorta is calcified and tortuous.", "output": "Mild bibasilar atelectasis without evidence to suggest pneumonia." }, { "input": "Since prior exam, the left pigtail chest tube has been removed. There is no pneumothorax. There is minimal bibasilar atelectasis. The lungs are otherwise clear. There is no overt pulmonary edema or pleural effusion. The cardiomediastinal silhouette has an expected postoperative appearance. Sternal wires are intact.", "output": "Status post left chest tube removal. No pneumothorax." }, { "input": "Since the prior exam, the right-sided chest tube has been removed. There is no pneumothorax. A left-sided pigtail catheter is unchanged. A 1 cm left apical pneumothorax is again noted. A right internal jugular central venous catheter is unchanged. There is minimal left basilar atelectasis, unchanged from the prior exam. The lungs are otherwise clear. There is no pleural effusion. The cardiomediastinal silhouette is normal.", "output": "1. Status post removal of the right-sided chest tube. No evidence of a right pneumothorax. 2. Unchanged small left apical pneumothorax." }, { "input": "AP view of the chest. A Swan-Ganz catheter ends in the main pulmonary artery. There are two mediastinal drains and one right-sided pleural drain seen. The endotracheal tube is in appropriate position. An enteric tube ends in the stomach. There is a moderate-to-large left pneumothorax. No significant mediastinal shift. Heart size is normal. No pleural effusion. Slight increase in pulmonary vascular congestion on the right.", "output": "New moderate left pneumothorax. No evidence of mediastinal shift. These findings were discussed with ___ by Dr. ___ at 3:29 p.m. on ___ by telephone." }, { "input": "The thoracic aorta is mildly tortuous; otherwise, the cardiomediastinal silhouettes are within normal limits. The bilateral hila are unremarkable. The lungs are clear. There is no pulmonary vascular congestion. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary process. No evidence of pneumonia." }, { "input": "Redemonstrated is left mid-upper lung scarring, with associated superior retraction of the left hilum. There is a vague opacification noted over the left mid lung, which may be consistent with a developing consolidation There is no pleural effusion, pneumothorax, or overt pulmonary edema. The heart is normal in size. The mediastinal contours are otherwise normal. Redemonstrated is a lower thoracic vertebral body compression deformity.", "output": "Vague opacification seen in the left mid lung, concerning for an developing pneumonia. Findings were conveyed by Dr. ___ to Dr. ___ ___ telephone at 11:33 am ___ ___, at the time of discovery." }, { "input": "AP portable supine view of the chest. Midline sternotomy wires and a prosthetic cardiac valve noted. There is a left chest wall pacer device with 2 leads extending to the region of the right atrium and right ventricle unchanged. The heart remains moderately mildly enlarged. Right hemidiaphragm is elevated. Mild bibasilar atelectasis noted. No signs of pneumonia or CHF. No pneumothorax. Bony structures are intact.", "output": "Mild cardiomegaly. Bibasilar atelectasis." }, { "input": "Minimal retrocardiac opacity is only seen on frontal projection and most consistent with atelectasis. The lungs are otherwise well inflated and clear with a stable 5 mm left lower lobe calcified granuloma, unchanged since ___. No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable.", "output": "1. Stable 5 mm left lower lobe calcified granuloma 2. Minimal retrocardiac atelectasis. No evidence of pneumonia." }, { "input": "There is no evidence of a focal consolidation. Small, bilateral pleural effusions are new from the prior examination. No pneumothorax or pulmonary edema is identified. The cardiomediastinal silhouette is unremarkable in appearance. No bony abnormality is detected.", "output": "No discrete lobar consoldiation. Small bilateral pleural effusions." }, { "input": "Right PICC terminates in the lower SVC. The previously layering left pleural effusion is now more dependent, likely due to patient positioning. Linear air-fluid level in the left lung base is concerning for hydropneumothorax. No new parenchymal opacity is appreciated.", "output": "As radiography is not sensitive for pulmonary for, no definite pulmonary infarct is seen. Linear air-fluid level at the left lung base is concerning for hydropneumothorax. NOTIFICATION: Dr. ___ was paged by Dr. ___ at 1226PM on ___." }, { "input": "A right PICC ends in the mid SVC. Compared to the prior study there are new patchy bibasilar opacities with increase in left pleural effusion. The heart size and mediastinal contours are stable. No right pleural effusion or pneumothorax.", "output": "New bibasilar patchy opacities could reflect aspiration, infection or edema. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 3:22 PM, 15 minutes after discovery of the findings." }, { "input": "There is retrocardiac and left basilar opacity silhouetting the hemidiaphragm. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. Right-sided PICC seen with tip in the mid SVC. Catheter also projects over the left upper quadrant. No acute osseous abnormality is identified.", "output": "Left basilar opacity likely due to an effusion with underlying atelectasis, although infection is possible." }, { "input": "Portable AP upright chest radiograph was provided. A nephrostomy tube is partially visualized in the left upper abdomen. The left hemidiaphragm is again noted. There is no focal consolidation, large effusion or pneumothorax seen. The cardiomediastinal silhouette appears normal. A PICC line enters the left arm and its tip is seen in the mid SVC region. Mediastinal contour is normal. Bony structures are intact.", "output": "No acute intrathoracic process. PICC line appropriately positioned." }, { "input": "The ET tube is seen in adequate position 5 cm above the carina. The right PICC is again seen to terminate in the mid SVC. NGT terminates in the stomach. The lungs well expanded. A retrocardiac opacity is seen, consistent with atelectatic lung and pleural effusion seen on recent CT. There is no right pleural effusion. The cardiomediastinal silhouette is mildly enlarged.", "output": "1. ETT, right PICC, and NGT in standard positions. 2. Retrocardiac opacity, consistent with atelectatic lung and pleural effusion seen on recent CT." }, { "input": "A right PICC ens in the low SVC. The moderate left pleural effusion is likely unchanged allowing for differences in technique with associated atelectasis. Pulmonary vascular congestion has improved. A small right pleural effusion is unchanged. Heart size and mediastinal contours are normal. No pneumothorax.", "output": "Stable moderate left and small right pleural effusions with associated atelectasis. Interval improvement in pulmonary vascular congestion. No focal consolidation." }, { "input": "Cardiomediastinal silhouette and hilar contours are unremarkable. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax. Upper enteric tube terminates in the proximal stomach; however, the side port appears within the lower esophageal segment and should be advanced by at least 10 cm.", "output": "1. No acute cardiopulmonary abnormality. 2. NG tube in the proximal stomach, however, with side port in the lower third of the esophagus and should be advanced by 10 cm." }, { "input": "Portable frontal radiograph of the chest demonstrates the ET tube ending 2.5 cm above the carina. A esophageal probe is noted in the upper esophagus. The right PICC is in unchanged position. An NG tube within the stomach. There is overall worsening of lower lobe opacities which are now becoming more confluent and involving the left upper lobe. Small bilateral pleural effusions are possible. Stable heart size and mediastinal contours. No pneumothorax.", "output": "Tubes and lines in satisfactory position. Overall worsening of lower lobe opacities with new upper lobe opacities could reflect aspiration or superimposed edema. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 3:22 PM, 5 minutes after discovery of the findings." }, { "input": "No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac silhouette size is normal. Mediastinal and hilar contours are normal. Pulmonary vasculature is not engorged. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. Hyperdensities seen below the left hemidiaphragm. Surgical clips are noted in the right axilla.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There no pleural effusions or pneumothorax. Projecting over the lateral left mid lung is a small nodular focus of high density consistent with a calcification, measuring about 5 mm in diameter, consistent with either a parenchymal granuloma or perhaps a bone island within the anterior left fifth rib. Otherwise the lung fields appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Bilateral, predominantly dependent opacities with air bronchograms reflect edema, mild to moderate, but improved from the prior exam. Concurrent infectious process cannot be excluded in the appropriate clinical situation, particularly in right lower lobe. Mild central pulmonary vascular congestion is similar the prior exam. No pleural effusion. Mild cardiomegaly is unchanged. Aortic knob calcifications are mild, unchanged. Dual lead cardiac pacing may care device appears intact and unchanged in position. Slight elevation in eventration of the right hemidiaphragm overall similar.", "output": "Persistent mild-to-moderate edema in the setting of mild cardiomegaly, overall improved since ___ with concurrent pneumonia, predominantly in right lower lobe." }, { "input": "Linear opacities at the left lung base are new since ___. There is no pleural effusion or pneumothorax. The cardiac and mediastinal contours are stable.", "output": "Linear opacities at the left lung base are new since ___ and most likely represent atelectasis however underlying infection can not be excluded." }, { "input": "Since ___, there has been interval improvement in increased interstitial markings bilaterally with prominence of the interstitial markings remaining, but to a lesser degree, may be due to very gradually improving process, as suggests an on prior chest CT from ___ ; possibly very gradually improving infectious with possible underlying cryptogenic organizing pneumonia. However, since the prior CT from ___, today there appears to be increased blunting of the right costophrenic angle raising concern for a small right pleural effusion and possible pleural thickening. No left pleural effusion is seen. There is no evidence of pneumothorax. Cardiac and mediastinal silhouettes are stable.", "output": "Increased interstitial markings bilaterally, right slightly greater than left, which overall appear improved as compared to prior chest radiograph from ___, as suggested on prior chest CT from ___, findings may relate to a very gradually improving infectious process with possible underlying cryptogenic organizing pneumonia. New blunting of the right costophrenic angle raises concern for a small right pleural effusion and possible pleural thickening." }, { "input": "Right PICC line tip low SVC. Feeding tube tip below diaphragm, not included on the radiograph. Surgical clips upper abdomen. Stable left lower lobe consolidation. Increased pulmonary vascularity, similar. Worsened perihilar opacities, interstitial prominence, from edema. Worsened left pleural effusion. Right pleural effusion, probably similar. Distended partially seen bowel loop upper abdomen.", "output": "Worsened left pleural effusion. Worsened pulmonary edema." }, { "input": "Right-sided dual lumen central venous catheter terminates at the SVC /right atrial junction. Low lung volumes are present. The heart size is normal but accentuated by the low lung volumes. The aorta remains tortuous. There is crowding of the bronchovascular structures. Mild pulmonary vascular congestion is likely present. Patchy airspace opacities in the lung bases likely reflect atelectasis though infection cannot be excluded. No pleural effusion or pneumothorax is identified. There are no acute osseous abnormalities.", "output": "1. Mild pulmonary vascular congestion. 2. Low lung volumes with patchy bibasilar airspace opacities likely reflecting atelectasis." }, { "input": "Left internal jugular central venous catheter tip terminates within the proximal left brachiocephalic vein near the confluence of the brachiocephalic veins. No pneumothorax is detected. Mild pulmonary vascular congestion persists. Streaky bibasilar airspace opacities are also again demonstrated, likely atelectasis. Remainder of the chest is unchanged.", "output": "Left internal jugular central venous catheter tip terminates in the proximal left brachiocephalic vein, near the confluence of the brachiocephalic veins. No pneumothorax." }, { "input": "Lateral displacement of left lung base apex reflects subpulmonic disposition of effusion that could be same size as prior. Small left pleural effusion. Decrease in pulmonary edema with clear right upper lobe and left lung. Stable mild enlargement of cardiac silhouette with dilated mediastinal vein. No pneumothorax.", "output": "1. Subpulmonic disposition of right effusion, likely unchanged in size. 2. Stable mild enlargement of cardiac silhouette may relate to dilated mediastinal veins; however, unclear if small pericardial effusion present. 3. Improvement in pulmonary edema." }, { "input": "There are 2 tubes projecting over the expected course of an NG tube. The each have the tip in the stomach. The remainder the appearance of the lungs unchanged", "output": "No change." }, { "input": "AP single view of the chest has been obtained with patient in semi-upright position. Comparison is made with the next preceding similar study obtained one day earlier. During the interval, the right-sided chest tube has been removed. No remaining pneumothorax can be identified. Previously identified NG tube remains. No new pulmonary abnormalities are seen, and the lateral pleural sinuses remain free.", "output": "No pneumothorax following chest tube removal." }, { "input": "Single AP upright portable chest radiograph demonstrates clear lungs bilaterally. Cardiomediastinal and hilar contours appear within normal limits. There is no pneumothorax or large pleural effusion. No overt pulmonary edema. No air under the right hemidiaphragm is identified. Osseous structures demonstrate no acute abnormality.", "output": "No acute intrathoracic abnormality." }, { "input": "AP and lateral views of the chest. Enteric tube is no longer visualized. Subcutaneous gas overlying the right chest wall has resolved. Surgical ___ present. The lungs are clear of consolidation. There is probable small right pleural effusion. There is no visualized pneumothorax. The cardiomediastinal silhouette is within normal limits and unchanged. Surgical clips project over the upper abdomen as on prior.", "output": "Probable small right pleural effusion. Otherwise no definite acute cardiopulmonary process." }, { "input": "Compared to the prior study there is increase in the bilateral lower lobe alveolar infiltrates. The heart size continues to be moderately enlarged. The NG tube tip is in the stomach. The PICC line tip is at the cavoatrial junction. There is mild pulmonary vascular recent redistribution.", "output": "Worsened bilateral lower lobe infiltrates. It is unclear if this is due to pulmonary edema or infectious etiology." }, { "input": "Increased interstitial markings are seen in the lungs bilaterally, more conspicuous on the right than the left as seen on prior. There are small bilateral pleural effusions. The cardiomediastinal silhouette is stable, top-normal in size. Atherosclerotic calcifications are noted at the aortic arch. No acute osseous abnormalities.", "output": "Increased interstitial markings throughout the lungs bilaterally, similar when compared to prior and small bilateral pleural effusions. Findings may represent pulmonary edema although atypical infection can have a similar appearance." }, { "input": "Endotracheal tube terminates approximately 2.5 cm above the carina. Enteric tube courses below the diaphragm, into the expected location of the proximal stomach. Extensive bilateral pulmonary opacities persist. Left costophrenic angle is not fully included. No pneumothorax is seen. Cardiac and mediastinal silhouettes are stable.", "output": "Endotracheal tube terminates approximate 2.5 cm above the carina. Enteric tube courses below the diaphragm, into the expected location of the proximal stomach. Extensive bilateral pulmonary opacities persist." }, { "input": "Portable AP upright chest radiograph obtained. Lung volumes are low somewhat limiting evaluation. Allowing for this, there is no definite sign of pneumonia or overt CHF. No large effusion or pneumothorax is seen. Heart size is likely normal given technique. Mediastinal contours are unremarkable. Previously noted left IJ central venous catheter has been removed. Bony structures are intact.", "output": "Limited, negative." }, { "input": "Increased bilateral perihilar opacities concerning for pulmonary edema superimposed on chronic lung disease. No large pleural effusion is seen although trace pleural effusion would be difficult to exclude. No pneumothorax is seen. The cardiac silhouette is top-normal. Partially imaged gaseous distension of bowel in the upper abdomen.", "output": "Increased bilateral perihilar opacities concerning for pulmonary edema superimposed on chronic lung disease. Partially imaged gaseous distension of bowel in the upper abdomen." }, { "input": "Portable AP chest radiograph. Right-sided chest tube and NGT are in stable position. Lung volumes are low with minimal bibasilar atelectasis. The cardiomediastinal silhouette is normal. There is no pneumothorax.", "output": "No pneumothorax." }, { "input": "The film is labeled supine, but the gravity marker shows a more erect position. There is increased opacity in the right chest with some pulmonary vascular re-distribution. This likely represents alveolar edema that is asymmetric. This is markedly worse compared to the prior study. The left IJ line has been removed. The left lung is clear. The heart is upper limits normal in size. There is no free air.", "output": "Asymmetric pulmonary edema." }, { "input": "Right PICC line tip in the low SVC. Enteric tube tip is in the mid stomach. There are bilateral pleural effusions, which have mildly increased since prior exam. There is left lower lobe consolidation, which is stable. Increased heart size, pulmonary vascularity. There are bilateral central, basilar pulmonary opacities, favor edema, consider pneumonitis, less likely ARDS. Surgical clips in the upper abdomen.", "output": "Bilateral pleural effusions. Increased pulmonary vascularity. Perihilar opacities, favor edema ; consider pneumonitis if clinically appropriate. Stable left lower lobe consolidation." }, { "input": "Feeding tube tip in the proximal stomach. Right PICC line tip in the low SVC. Stable left lower lobe consolidation. Increased heart size, pulmonary vascularity, similar. Interstitial prominence, likely edema, improved. Mild area of right midlung opacity has improved. Decreased right basilar opacity. Decreased left and probably stable right pleural effusion. Surgical clips upper abdomen.", "output": "Interval improvement in pulmonary edema and left pleural effusion. Mildly improved right mid lung, basilar opacity." }, { "input": "Frontal and lateral views of the chest demonstrate interval increased suggestion of peribronchial cuffing in the right greater than left infrahilar region particularly on frontal view, less conspicuous in the lateral view, raising question of interval development of pneumonia although atelectasis could potentially explain the findings. There is no pneumothorax or pleural effusion. Cardiomediastinal silhouette is within normal limits and thoracic aortic tortuosity is unchanged.", "output": "Patchy right infrahilar opacity, concerning for bronchopneumonia." }, { "input": "Endotracheal tube tip in good position. Enteric tube tip below diaphragm in the proximal stomach, side port near gastroesophageal junction, should be advanced 5 cm. Surgical clips upper abdomen. Stable opacification left lower lobe, likely atelectasis. . Bilateral perihilar, right basilar opacities, likely pulmonary edema, stable. Stable bilateral pleural effusions.", "output": "Enteric tube tip in the proximal stomach, side port near gastro esophageal junction, should be advanced. Stable cardiopulmonary findings." }, { "input": "Compared to the prior study there is increase in the alveolar edema with bilateral pleural effusions, dense consolidation in both lower lungs right greater than left, pulmonary vascular redistribution, and hazy alveolar infiltrate. The ET tube and NG tube are unchanged", "output": "Worsened appearance to the lungs." }, { "input": "Single frontal view of the chest was obtained. The right costophrenic angle is not fully included on the image. There are minor areas of left base linear atelectasis. No focal consolidation is seen. There is no large pleural effusion or evidence of pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. Old right-sided rib fractures involving the posterolateral right fifth and sixth ribs are noted.", "output": "Right costophrenic angle not fully included on the image. Minor left base atelectasis. Otherwise, no acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There no pleural effusions or pneumothorax.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Linear sclerosis in the left first rib may correspond to a healing prior fracture. No acute fracture is detected on these views. Lung volumes are slightly low. Subtle opacity projecting over the right mid lung may represent bronchiectasis. No pleural effusion or pneumothorax is detected. Heart size is top normal. Aortic calcifications are seen. Note is made of calcification of the anterior longitudinal ligament, consistent with DISH.", "output": "1. Healing left first rib fracture without evidence for acute fracture. However, dedicated rib series is more sensitive for rib fractures. 2. Right middle lobe bronchiectasis." }, { "input": "Patient's physical condition required examination in sitting semi-upright position using AP single chest view. Comparison is made with the next preceding AP and lateral chest examination of ___. Mild cardiac enlargement, similar as before. No evidence of acute pulmonary vascular congestion and the lateral pleural sinuses remain free. The on previous examination identified basal plate atelectasis cleared up and there is presently no evidence of any remaining acute parenchymal abnormality short of the crowded basal pulmonary vasculature related to patient's poor inspirational effort. No pneumothorax in the apical area.", "output": "Disappearance of previously noted bilateral basal plate atelectasis. No evidence of new acute pulmonary parenchymal infiltrates on this AP single view chest examination." }, { "input": "Lung volumes are low. There are streaky opacities in the right mid lung and left base, which likely represent atelectasis. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is unchanged.", "output": "Bibasilar atelectasis and low lung volumes. Otherwise no acute process." }, { "input": "Right internal jugular approach large bore central venous catheter tip terminates in the high right atrium. Heart size is top normal. Postoperative mediastinal contours unchanged with median sternotomy wires intact. Central pulmonary vasculature is mildly prominent but without frank interstitial edema. Lungs are otherwise clear. Mediastinal and hilar contours are otherwise unremarkable. There is no effusion pneumothorax.", "output": "Mild vascular congestion without frank interstitial edema. No pneumonia." }, { "input": "The lungs are well inflated. There are increased interstitial markings with a mild prominence of the vasculature in the upper lung fields concerning for mild pulmonary congestion. Otherwise, no focal opacities are observed. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. Sternotomy wires are intact. Of note, there is a rectangular shape foreign object projecting over the thoracic inlet, which is likely external to the body.", "output": "1. Mild pulmonary vascular congestion. 2. Radiopaque foreign object projecting over the left thoracic inlet, likely external to the patient." }, { "input": "A central venous catheter terminates in the right atrium. The patient is status post coronary artery bypass graft surgery. The heart is normal in size. The mediastinal and hilar contours appear unchanged. Hazy predominantly central opacification suggests mild fluid overload, and streaky new right basilar opacities can probably be attributed atelectasis. There is no definite pleural effusion or pneumothorax. There is no free air.", "output": "No free air identified. Findings suggest mild fluid overload and minor right basilar atelectasis." }, { "input": "Patient is status post median sternotomy and CABG. Moderate enlargement of the cardiac silhouette appears increased compared to the previous radiograph. There is increased perihilar haziness and vascular indistinctness compatible with mild pulmonary edema, new in the interval. More focal opacity in the left lung base could reflect atelectasis. No large pleural effusion or pneumothorax is present. No acute osseous abnormality is detected.", "output": "Mild congestive heart failure. More focal patchy left basilar opacity may reflect atelectasis, but infection cannot be excluded completely." }, { "input": "A portable frontal chest radiograph again demonstrates sternal wires and clips overlying the left mediastinum. The right central line has been removed. There are low lung volumes, with increased prominence of the cardiac silhouette and bronchovascular crowding. No pleural effusion or pneumothorax is identified. The visualized upper abdomen is unremarkable.", "output": "Mild prominence of the pulmonary interstitial markings without focal consolidation." }, { "input": "The patient is status post median sternotomy with intact wires. Clips are seen within the mediastinum. The lungs do not demonstrate focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is stable. The bony structures are grossly intact.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral chest radiographs are provided. A right PICC terminates in the mid SVC. Median sternotomy wires are intact. There is no focal consolidation, pleural effusion or pneumothorax. The lungs are well expanded. The cardiomediastinal silhouette is normal. The bones are intact.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is status post coronary artery bypass graft surgery. A dialysis catheter terminates in the upper right atrium. The cardiac, mediastinal and hilar contours appear unchanged. There is very mild pulmonary congestion with interstitial changes at the lung bases and mild perihilar congestion but not highly striking and not nearly as severe as on prior presentation. On the prior chest CT discrete nodules were identified. These are not well assessed with this technique. Accordingly, if no other intervention is planned short-term follow-up CT should be considered.", "output": "Findings suggesting mild vascular congestion. Nodules seen on prior CT not well assessed; persistent nodules cannot be excluded." }, { "input": "The lungs are well expanded. Compared with ___, there is increased conspicuity of interstitial markings, more pronounced in the left lung. There is also mild vascular congestion with upper redistribution. A small right-sided pleural effusion is present. Cardiomediastinal and hilar contours are otherwise unremarkable. Sternotomy wires are intact and mediastinal surgical clips are unchanged in position. There is no pneumothorax.", "output": "Findings compatible with mild pulmonary interstitial edema and vascular congestion with associated small right-sided pleural effusion." }, { "input": "Median sternotomy wires are unchanged. Lung volumes remain slightly low. Mild left greater than right edema. Heart size is probably still enlarged despite lower lung volumes and AP projection. No large pleural effusion. No pneumothorax or focal consolidation. Aortic knob calcifications are mild.", "output": "Findings suggestive of mild volume overload with likely asymmetrical edema pattern. Superimposed infection in the left lung cannot be excluded, and short-term followup radiographs may be helpful in this regard." }, { "input": "The cardiomediastinal and hilar silhouettes are stable since the prior exam. No focal consolidation, pleural effusion, or pneumothorax. Intact median sternotomy wires and unchanged positioning of the mediastinum surgical clips. No evidence of free subdiaphragmatic air.", "output": "No evidence of free subdiaphragmatic air. No focal consolidation concerning for pneumonia." }, { "input": "The cardiomediastinal and hilar contours are stable. There is no pneumothorax or large pleural effusion. Lungs are adequately expanded without focal consolidation concerning for pneumonia. Mild vascular congestion is again noted. Post CABG changes are noted, including median sternotomy wires.", "output": "Mild pulmonary vascular congestion, similar to prior." }, { "input": "Patient is status post median sternotomy and CABG. No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "There has been interval removal of a right-sided PICC. No focal consolidation, pleural effusion, pneumothorax or pulmonary edema is seen. Heart and mediastinal contours are stable. Sternal wires appear intact. Mediastinal clips are again seen.", "output": "No acute findings." }, { "input": "Stable slight bilateral lower lung volumes. Mild pulmonary vascular congestion that appears slightly increased from the prior exam. Stable appearance of the cardiomediastinal silhouette with mild cardiomegaly. Stable appearance of the hila. No pleural effusion, focal consolidation, overt pulmonary edema, or pneumothorax. Post-median sternotomy changes are stable. No evidence of pneumoperitoneum.", "output": "1. Mild pulmonary vascular congestion compatible with congestive heart failure. 2. No evidence of free air." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well expanded and clear. There is no focal consolidation, pleural effusion, or pneumothorax. Cardiac and mediastinal contours are normal. Median sternotomy wires are intact and mediastinal clips are in the expected positions.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiograph demonstrate clear lungs bilaterally. Lung volumes are slightly low exaggerating size of the heart which is otherwise normal in size. Hilar contours are within normal limits. There is no pleural effusion, pneumothorax, or pulmonary edema. There is no air under the right hemidiaphragm. Air-filled loop of bowel is noted in the left upper quadrant.", "output": "No acute intrathoracic abnormality. Although no acute fracture or other chest wall lesion is seen, conventional chest radiographs are not sufficient for detection or characterization of most such abnormalities. If the demonstration of trauma to the chest wall is clinically warranted, the location of any referrable focal findings should be clearly marked and imaged with either bone detail radiographs or Chest CT scanning." }, { "input": "PA and lateral views of the chest. The lungs are clear. Cardiac silhouette is normal in size. Hilar and mediastinal contours are normal. No pleural effusion. No evidence of pneumothorax. No displaced rib fractures are noted.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Both lungs are well expanded and clear. There is no evidence of pneumonia. Heart size, mediastinal and hilar contours are normal. No pleural effusion,", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. The osseous structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear of airspace or interstitial opacity. The cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax. No acute or aggressive osseus changes.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal, and hilar contours are normal. Scarring within the lung apices is present. There is no pulmonary edema. Focal patchy opacity is noted within the right upper lung field spanning a diameter of approximately 2.4 cm. No focal consolidation, pleural effusion or pneumothorax is identified. There are no acute osseous abnormalities.", "output": "Focal patchy opacity within the right upper lung field. Findings could reflect an infectious, inflammatory, or neoplastic process. Further assessment with chest CT is suggested." }, { "input": "A left ventriculoperitoneal shunt catheter is seen coursing along the lower left neck across the left hemithorax towards the abdomen. A slightly rounded nodular airspace opacity projects over the lower lobe on the lateral view and may represent an infectious process. Rounded atelectasis is not excluded. The right lung is relatively clear. Trace pleural fluid layers posteriorly on the lateral view. No pneumothorax is detected. The pulmonary vasculature is not engorged. The cardiac silhouette is enlarged but stable. There is prominence of the mediastinum due to unfolding of the thoracic aorta, which is unchanged. The trachea is midline.", "output": "1. Rounded nodular airspace opacity in the lower lobe concerning for infectious process. Followup PA and lateral radiographs are recommended in six to eight weeks following appropriate therapy to confirm resolution. 2. Stable cardiomegaly." }, { "input": "Linear left lower lung atelectasis/scarring is re- demonstrated. No new focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process. No significant interval change. No focal consolidation to suggest pneumonia." }, { "input": "Elevation the right hemidiaphragm is chronic. The lung volumes are low which causes crowding of bronchovascular structures. There is no focal opacity concerning for pneumonia. No pulmonary vascular congestion, pleural effusion or pneumothorax. The cardiac and mediastinal contours are unchanged.", "output": "No pneumonia." }, { "input": "Single semi-upright AP view of the chest was obtained. Minimal vascular congestion. Slight prominence of the right pulmonary hilum is relatively unchanged since ___ and is likley due to vascular engorgement. The right costophrenic angle is clear; however, obscuration of the left costophrenic angle is likely due to overlying soft tissue. Underlying trace effusion is difficult to exclude. Cardiomediastinal silhouette is enlarged. No pneumothorax. No free air below the diaphragm.", "output": "Minimal vascular congestion. Slight prominence of the right hilum is similar to the prior study and may be due to vascular engorgement. Evaluation of the left costophrenic angle is limited due to overlying soft tissue. Underlying trace pleural effusion is difficult to exclude. Cardiomegaly." }, { "input": "PA and lateral views of the chest provided. Lung volumes are somewhat low though allowing for this, no definite signs of pneumonia or overt CHF. No large effusion or pneumothorax is seen. The cardiomediastinal silhouette appears stable. Degenerative changes are again noted in the thoracic spine with anterior spur formation. No free air below the right hemidiaphragm is seen.", "output": "No acute findings." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. Mildly coarsened interstitial lung markings may reflect underlying emphysema. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Prominent costochondral calcification noted. Old left rib deformities are present. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process" }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. There is no pulmonary edema. The heart is normal in size, and the mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. The lungs are clear of consolidation, effusion or pulmonary vascular congestion. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process. No evidence of pneumonia." }, { "input": "The lungs are well expanded and clear. Hila and cardiomediastinal contours and pleural surfaces are normal. Azygos lobe noted incidentally, a normal variant. No osseous abnormality within the limits of plain radiography.", "output": "No abnormality explain the patient's left arm and chest pain." }, { "input": "The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "No acute cardiopulmonary process." }, { "input": "There has been interval placement of an orogastric tube with tip in the stomach. The endotracheal tube remains in standard position. Remainder of the examination is unchanged with continued mild pulmonary edema, small left pleural effusion, and bibasilar airspace opacities. No pneumothorax. Cardiac and mediastinal contours are unchanged.", "output": "Orogastric tube tip within the stomach." }, { "input": "Patient is status post median sternotomy and aortic valve replacement. Moderate cardiomegaly remains unchanged. Mediastinal contours are similar. There is mild pulmonary edema, with patchy atelectasis noted in the lung bases. A small left pleural effusion appears not substantially changed in the interval. Patchy opacities are noted in the lung bases. No pneumothorax is detected. No acute osseous abnormality is visualized.", "output": "Continued moderate cardiomegaly and mild pulmonary edema. Small left pleural effusion, not substantially changed in the interval. Patchy bibasilar airspace opacities likely reflect atelectasis however infection cannot be excluded." }, { "input": "Compared to ___, there is some improvement of the nodular opacities in bilateral lung. Lung volumes are grossly similar compared to prior. More focal opacity at the right hilum may be due to rotation of the patient. Bilateral atelectasis and some pleural effusion is likely, though unchanged from prior. Moderate to severe cardiomegaly is again seen, unchanged from prior. ETT is unchanged in position. The proximal port of the nasogastric tube may be at the GE junction. Sternotomy wires, aortic valve replacement are intact and unchanged from prior.", "output": "1. Mildly improved pulmonary edema. 2. Proximal port of the nasogastric tube at the GE junction." }, { "input": "Lung volumes are low. There is diffuse interstitial opacity with engorgement of the central vasculature, consistent with moderate pulmonary edema. Heart is moderately enlarged but unchanged. There is a small right pleural effusion. A retrocardiac opacity presumably reflects a component of pleural effusion and overlying atelectasis and appears similar to ___. A superimposed infection be difficult to exclude. Sternotomy wires and an aortic valve prosthesis are constant.", "output": "1. Moderate pulmonary edema. 2. Retrocardiac opacity is presumably component of pleural effusion and overlying atelectasis. A superimposed infection would be difficult to exclude." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "There are low lung volumes. Left base opacity is again seen which could be due to pleural effusion and overlying atelectasis, consolidation due to pneumonia or/ and aspiration not excluded. Pulmonary vascular congestion persists. The patient is status post median sternotomy and aortic valve replacement. Cardiac and mediastinal silhouettes are stable.", "output": "Aside from subtle decrease in opacity in the left mid lung, there has been no significant interval change. Persistent pulmonary vascular congestion and left basilar opacity. Stable cardiac and mediastinal silhouettes." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Comparison is made with the next preceding chest examination of ___. As before, there is considerable right-sided convex scoliosis in the lower thoracic spine, with corresponding mild shift of the mediastinal structures towards the left. All these findings are unchanged. No cardiac enlargement is present now, thoracic aorta remains unremarkable. The pulmonary vasculature is not congested and there is no evidence of acute or chronic parenchymal infiltrates. Lateral and posterior pleural sinuses remain normal. A most recent chest CT of ___ is reviewed and showed multiple bilateral basal peripheral pulmonary emboli.", "output": "Unchanged chest findings in comparison with previous study of ___. Thus, no cardiac enlargement or acute pulmonary infiltrates. Thus, it can be concluded that the episode of pulmonary emboli did not result in major infarctions or pleural effusions." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is stable and within normal limits. Imaged osseous structures are intact. Dextroscoliosis of the T-spine again noted. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process" }, { "input": "Frontal and lateral views of the chest. The lungs are clear of focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications noted at the aortic arch. Left chest wall single lead pacing device is identified. Degenerative changes in the spine without acute osseous abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "Portable supine chest radiograph was obtained. Endotracheal tube terminates at the level of thoracic inlet, 5.4 cm above the carina. Nasogastric tube courses into the stomach. The lungs are low in volume, giving the appearance of bronchovascular crowding. Bibasilar streaky opacities likely reflect atelectasis. There is no pleural effusion or pneumothorax identified on this supine film. The heart and mediastinum appear unremarkable. Non-displaced right second rib fracture is seen. Possible right clavicular fracture with periosteal reaction is noted distally.", "output": "1. Satisfactory position of ET tube, which should not be withdrawn any further as it is at thoracic inlet. 2. Non-displaced right second rib fracture. Possible right distal clavicular fracture." }, { "input": "There is no consolidation, pleural effusion, or pneumothorax. Cardiomediastinal and hilar silhouettes are normal size.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs demonstrate bibasilar atelectasis and mild cardiomegaly, unchanged from ___. There is no focal consolidation, pleural effusion, or pneumothorax. Leftward deviation of the trachea is likely due to known right thyroid nodule. The heart size is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable upright chest radiograph. Relative lucency of the bilateral upper lungs suggests background emphysematous changes. Bibasilar opacifications identified, left greater than right. Right-sided opacification may merely represent crowding and atelectasis; however, more dense opacification on the left may reflect atelectasis, combined with small effusion versus developing pneumonia. Please note, the lung apices are excluded from view by the patient's overlying chin.", "output": "Bibasilar opacification, left greater than right. On the left, the opacifications may represent atelectasis with small effusion or developing pneumonia. Background emphysematous changes." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. Lung volumes are low. Opacities in the lingula suggest pneumonia in the appropriate setting. Elsewhere, the lungs are probably clear although it is difficult to exclude vague additional area of possible infection in the left lower lobe. Elsewhere the lungs appear clear. There is no pleural effusions or pneumothorax. Bones appear demineralized.", "output": "Vague opacity in the left lower lung, probably for the most part in the lingula, concerning for possible pneumonia in the appropriate setting." }, { "input": "There is rotated positioning. Probable background COPD. Mild cardiomegaly, with calcified slightly unfolded aorta. There is slight upper zone redistribution, but I doubt overt CHF. There is atelectasis the left lung base, without definite consolidation. No gross left effusion. There is hazy obscuration of the right lung base raising the question of a small effusion and/or atelectasis. No definite consolidation. Due to patient rotation, the previously seen large right-sided thyroid mass, possibly a goiter, which compresses and displaces the trachea, is less well delineated, but probably similar to the prior study. Known recent fracture of the left anterior second rib is not well depicted radiographically.", "output": "Hazy opacity at the right lung base may represent a combination of a small amount of pleural fluid and/or atelectasis. Some patchy retrocardiac opacity is also present. No definite consolidation is identified at either lung base, though an early infiltrate would be difficult to completely exclude in either location. Doubt focal consolidation in the mid or upper zones. Hazy opacity in the right paratracheal . Region is from double with the previously demonstrated large right thyroid mass, question goiter. Mild cardiomegaly and and COPD. Mild vascular plethora, but doubt overt CHF. Known left anterior second rib fracture not well visualized." }, { "input": "AP, upright and lateral views of the chest provided demonstrate vague opacity at the left lung base concerning for an early pneumonia. The lung appears clear. No large effusion is seen. There is no pneumothorax. Cardiomediastinal silhouette is stable. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Vague opacity at the left lung base concerning for an early pneumonia." }, { "input": "Mild cardiomegaly is persistent. There is calcification of the aortic knob. Otherwise, the hilar and mediastinal contours are unremarkable. Opacities in the mid to lower lungs have continued to improve and appear interstitial in character, suspected to represent persistent or resolving airway inflammation. Degenerative changes are seen throughout the spine. There is no large pleural effusion or pneumothorax.", "output": "Continued improvement in areas of airway inflammation and possibly pneumonia." }, { "input": "Frontal and lateral views of the chest. Mild cardiomegaly is unchanged. Tortuous aorta with calcification of the aortic knob is similar to prior. Interstitial fluid has increased with indistinct appearance of the pulmonary vasculature. Small right base and retrocardiac opacities are new since the prior exam. Bilateral lower lobe predominant increased interstitial markings are similar to prior and may represent a chronic interstitial disease. No pneumothorax or substantial pleural effusion.", "output": "Pulmonary edema with bibasilar air space opacities that could represent superimposed pneumonia." }, { "input": "When compared to prior, the left lung base opacity is more conspicuous, particularly on the frontal exam, and it was new from ___. Elsewhere, the lungs are clear. There is a small right effusion with possible trace left effusion as well. Cardiac silhouette is enlarged but stable. Atherosclerotic calcification is again seen at the aortic arch.", "output": "More conspicuous left mid lung to basilar opacity when compared to most recent exam, compatible with pneumonia in the proper clinical setting. Recommend repeat after treatment to document resolution." }, { "input": "The heart size remains mildly enlarged. The aorta is tortuous and demonstrates calcifications particularly at the aortic knob. There is minimal bibasilar atelectasis, but no focal consolidation, pleural effusion or pneumothorax is present. No overt pulmonary edema is seen, though there is mild crowding of the bronchovascular structures. Mild degenerative changes are noted within the thoracic spine. Degenerative changes are also seen within both acromioclavicular and right glenohumeral joints.", "output": "Mild bibasilar atelectasis. Cardiomegaly without evidence for congestive heart failure." }, { "input": "Mild cardiomegaly is unchanged, and there is calcification of the aortic knob. Previous bibasilar opacities have cleared. Interstitial edema has also resolved. No pleural effusion.", "output": "Resolution of previous bibasilar opacities." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "AP portable upright view of the chest. Lung volumes are low. Overlying EKG leads are present. Allowing for limitations, the lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process" }, { "input": "Endotracheal tube tip is 4.2 cm from the carina. Moderate hiatal hernia is again noted. Enteric tube tip projects in the region of the hiatal hernia in the retrocardiac region. Left basilar opacities are identified potentially atelectasis given the low lung volumes and adjacent hernia. Lungs are otherwise clear of confluent consolidation. Surgical clips project over left upper quadrant. The cardiomediastinal silhouette is unchanged.", "output": "ET tube 4.2 cm from the current. Enteric tube tip projects over the retrocardiac region in the region of the hiatal hernia." }, { "input": "Assessment is somewhat limited due to patient positioning and exclusion of the left costophrenic angle. Endotracheal tube tip terminates approximately 3 cm from the carina. An enteric tube courses below the left hemidiaphragm, with tip off the inferior borders of the film. Cardiac silhouette size appears mildly enlarged. Multiple clips are noted projecting over the left lower hemi thorax. Mediastinal contour is otherwise unremarkable. Mild pulmonary vascular congestion is likely present. Patchy opacities in lung bases may reflect areas of atelectasis. Infection or aspiration is not excluded. There may be small bilateral pleural effusions. No large pneumothorax is identified, though assessment is limited on this single supine view. No acutely displaced fractures are visualized.", "output": "Limited exam. Standard position of the endotracheal and enteric tubes. Bibasilar opacities, likely atelectasis though aspiration or infection is not excluded. Possible small bilateral pleural effusions and pulmonary vascular congestion." }, { "input": "PA and lateral views of the chest were reviewed. Normal lungs, heart, pleural and mediastinal surfaces. A large hiatal hernia and intra-abdominal clips from prior fundoplication are noted.", "output": "Large hiatal hernia. No radiographic findings suggestive of lung cancer." }, { "input": "The heart size is normal. Hilar and mediastinal contours are normal. Subtle retrocardiac opacity is likely secondary to atelectasis. No other consolidations concerning for infection are identified. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "Subtle retrocardiac opacity is likely secondary to atelectasis. No other consolidations concerning for infection is identified." }, { "input": "AP portable upright view of the chest. D dense airspace consolidation with air bronchograms noted in the right lower lung likely residing within the right middle lobe concerning for pneumonia. Left lung is clear. No large effusion or pneumothorax is seen. The cardiomediastinal silhouette appears normal. Bony structures are intact.", "output": "Right middle lobe pneumonia, possibly also involving the right lower lobe." }, { "input": "New large right pleural effusion. Multiple spiculated nodules are again appreciated in the right upper, left upper and left mid lungs. The heart is at the upper limit of normal in terms of size.", "output": "New large right pleural effusion is seen. Multiple spiculated nodules in the right upper, left upper and left mid lung appear stable. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 3:56 PM, a few minutes after discovery of the findings." }, { "input": "Right basilar chest tube remains in unchanged position. Small right hydropneumothorax is unchanged. There is increased patchy opacification within the right lung base. This could reflect asymmetric pulmonary edema given its rapid development over the course of a few hours. Multiple scattered ill-defined nodular opacities are compatible with known metastatic disease. The cardiac and mediastinal contours are unchanged. Streaky left basilar atelectasis is re- demonstrated.", "output": "Unchanged appearance of small right hydropneumothorax. Interval development of patchy opacification in the right lung base which given its rapid development may reflect asymmetric pulmonary edema, but is nonspecific, and hemorrhage or infection can have a similar appearance. Continued followup is recommended." }, { "input": "There has been interval placement of a right chest tube with dramatic improvement in the right pleural effusion. A small apical hydropneumothorax remains. Patchy peripheral opacities throughout both lungs are consistent with known metastatic disease. There is no new definite focal consolidation concerning for pneumonia. Known mediastinal lymphadenopathy is reflected in an abnormal right upper mediastinal contour. The heart is normal in size.", "output": "Interval placement of a right chest tube with decreased size of the right pleural effusion. Now with a small apical hydropneumothorax." }, { "input": "The right basilar chest tube remains in place, though the side ports no longer lie in the posterior costophrenic angle. The small right pleural effusion has decreased in size. There is no left-sided pleural effusion. The previously seen right lung base patchy opacification has resolved. Multiple scattered ill-defined nodular opacities are compatible with known metastatic disease, which has progressed compared with ___. There is no focal consolidation, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "1. Interval resolution of right lung base patchy opacification, likely asymmetric edema. 2. Decreased size of small right pleural effusion. 3. Right basilar chest tube side ports no longer lie in the posterior costophrenic angle." }, { "input": "There has been interval decrease in size of the right pleural effusion. There is atelectasis at the bilateral bases. There are multiple scattered nodular opacities bilaterally, relatively unchanged from multiple recent prior studies, and are consistent with metastatic foci. Known osseous metastatic lesions are better assessed on recent CT of the chest. The cardiomediastinal and hilar contours are unchanged. There is no pneumothorax.", "output": "1. Interval decrease in size of the right pleural effusion. 2. Atelectasis at the bilateral bases. 3. No pneumothorax." }, { "input": "Multiple nodules are again seen in the bilateral lungs, consistent with known metastatic disease. There has been interval recurrence of the large right pleural effusion. There is no left pleural effusion. There is no pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "Interval recurrence of a large right pleural effusion." }, { "input": "Frontal and lateral chest radiographs were obtained. A right chest Port-A-Cath has its tip terminating in the right atrium. There is no evidence of catheter fractures or complications. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The heart is mildly enlarged. Mediastinal and hilar contours are within normal limits.", "output": "Right chest Port-A-Cath terminates in the right atrium, without evidence of complication." }, { "input": "Left-sided ICD with the tip in the right ventricle. No pneumothorax. The lungs are clear. Mild cardiomegaly with LAD stent. No significant pleural effusions.", "output": "Left-sided ICD with the tip in the right ventricle." }, { "input": "There is mild left basal atelectasis. Otherwise, the lungs are clear with no evidence of consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette appears normal. The aorta appears tortuous but stable. Mild atherosclerotic calcifications are noted at the aortic arch. Kyphoscoliosis of the thoracic spine is again noted.", "output": "No acute cardiopulmonary process." }, { "input": "Low lung volumes are again noted. There is left basilar opacity silhouetting the hemidiaphragm, similar to prior. There is likely component of effusion although underlying consolidation is also possible. New right basilar opacity is also noted, some of which may be due to atelectasis. Blunting of the posterior costophrenic angle suggests bilateral effusions. Pulmonary vascular congestion appears to have progressed. Cardiomediastinal silhouette is stable.", "output": "Bibasilar opacities left worse than right have progressed since prior likely in part due to underlying effusions with superimposed atelectasis noting that infection would also be possible. Interval worsening of the pulmonary vascular congestion." }, { "input": "Single lead left-sided pacer device extends to the expected location of the right ventricle.The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. The aorta is calcified.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes lung. Small left pleural effusion is new. There is a new mild pulmonary vascular congestion. Borderline enlarged cardiac silhouette is exaggerated by low lung volumes. Bibasilar opacity is likely secondary to atelectasis.", "output": "New small left pleural effusion and mild pulmonary vascular congestion." }, { "input": "Low lung volumes cause mild bronchopulmonary crowding. Mild atelectasis is noted at the left lung base. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "In comparison with the study of ___, there is no interval change. Again there is some blunting of the right costophrenic angle on the frontal view but not posteriorly on the lateral, consistent with pleural scarring. No acute pneumonia, vascular congestion, or pleural effusion.", "output": "No significant interval change, acute cardiopulmonary process." }, { "input": "There is a stable 4 mm right upper lobe granuloma. Otherwise, the lungs are clear with no evidence of a consolidation, effusion, or pneumothorax. Heart appears at the upper limits of normal in size but stable. No acute fractures are identified.", "output": "No acute cardiopulmonary process." }, { "input": "Following placement of a pigtail pleural catheter in the lower right hemithorax, a large right pleural effusion has substantially decreased in size with residual moderate amount of pleural fluid remaining. A moderate-sized right pneumothorax has developed, with a very small apical component but more substantial lateral and basilar component. The underlying lung in the right middle and lower lobes is partially atelectatic, but the right upper lobe is relatively well expanded. Cardiomediastinal contours are stable in appearance. Left lung and pleural surfaces are grossly clear. Lytic skeletal lesions are consistent with known metastatic disease.", "output": "1. Decrease in right pleural effusion following pigtail pleural catheter placement and development of a moderate hydropneumothorax. 2. Lytic rib metastases." }, { "input": "Heart appears normal in size. Cardiomediastinal contours are unremarkable. There is blunting of the right costophrenic angle with moderate pleural effusion reaching the minor fissure. There is no pleural effusion on the left. Lung fields are otherwise clear. Bony structures are intact.", "output": "Moderate right-sided pleural effusion reaching the minor fissure." }, { "input": "A right pigtail pleural catheter is in place. The lateral right hydropneumothorax is now more filled with fluid with small amount of air seen at the apex. There is now a small left pneumothorax. Hazy opacity overlying the right base is likely atelectasis. The left lung is clear. Cardiomediastinal silhouette is unchanged in the setting of lower lung volumes compared to prior radiograph. Multiple loops of distended bowel are incompletely visualized.", "output": "1. New small left pneumothorax. 2. Right hydropneumothorax persists with now more fluid in the lateral basilar portion with air collecting at the apex. These findings were discussed with ___ by Dr. ___ ___ telephone at 10:15 a.m." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. Compared with prior, there has been significant interval enlargement of the right-sided pleural effusion which is now large. There is some aerated right upper lobe however there is essentially complete collapse of the lower lobe with underlying consolidation not completely excluded. Left lung is clear and there is no left pleural effusion. Osseous and soft tissue structures are unremarkable.", "output": "Significant interval enlargement of the right-sided pleural effusion which is now large." }, { "input": "There is opacification of the right mid and lower lung concerning for pneumonia. Probable small right effusion also present. Left lung is not fully inflated though no definite signs of pneumonia. Heart size cannot be assessed. Mediastinal contour is normal. Bony structures are intact.", "output": "Opacification of the right mid and lower lung concerning for pneumonia, likely with subjacent small pleural effusion. Recommend followup to resolution." }, { "input": "As compared to chest radiograph from 1 day prior, insertion of a right-sided pigtail catheter with interval decrease in the moderate right-sided pleural effusion. No pneumothorax. The left lung is clear.", "output": "No pneumothorax. Interval slight decrease in right moderate pleural effusion." }, { "input": "New small right pleural effusion with right basilar opacity, question atelectasis and/or pneumonia. Left lung is clear. No left pleural effusion. The cardiomediastinal silhouette is partially obscured due to parenchymal opacity. No pneumothorax. Hila are unremarkable.", "output": "Right pleural effusion with subjacent consolidation concerning for atelectasis and/or pneumonia." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Moderate size right pleural effusion appears minimally decreased in size compared to the prior study. Small left pleural effusion appears almost completely resolved. Bibasilar airspace opacities likely reflect atelectasis. Pulmonary vasculature is not engorged. No pneumothorax is identified. There are no acute osseous abnormalities.", "output": "Moderate size right and small left pleural effusions, both of which have decreased since the previous study. Bibasilar atelectasis." }, { "input": "When compared to previous exam, the large right pleural effusion has increased in size. There is adjacent atelectasis. The left lung is clear without consolidation or effusion. Cardiac silhouette is unchanged. No acute osseous abnormalities. Calcifications in the right upper quadrant are likely due to known cholelithiasis.", "output": "Large right pleural effusion has increased since ___." }, { "input": "The right-sided pigtail chest tube is again visualized. There is increased volume loss in the right lower lobe with layering effusion. There is also volume loss/effusion in the left lower lung. That similar compared to prior. There is increased pulmonary vascular congestion pulmonary vascular redistribution and a minimal hazy alveolar infiltrate", "output": "Worsened fluid status. An underlying infectious infiltrate in the left lower lobe cannot be totally excluded" }, { "input": "From chest radiograph earlier today further significant interval decrease in the right-sided pleural effusion with essentially complete resolution. Minimal basal atelectasis in the right lung. The left lung is relatively clear. The heart is not enlarged. Tiny right apical pneumothorax.", "output": "Further significant interval decrease in right-sided effusion with essentially complete resolution. Tiny right apical pneumothorax." }, { "input": "Since the chest radiograph obtained approximately 2 weeks prior, there have been no appreciable changes. There has been no reaccumulation of the previous right pleural effusion. Lungs are fully expanded and clear without consolidations. Heart size is normal. Cardiomediastinal and hilar silhouettes are normal. Pleural surfaces are normal.", "output": "No pleural effusion reaccumulation or other significant cardiopulmonary abnormalities." }, { "input": "PA and lateral views of the chest demonstrate the lungs are well expanded and clear. The cardiomediastinal silhouette is unremarkable. There is no evidence of subdiaphragmatic free gas. Gastric bubble is seen in the left upper quadrant and is unremarkable. There is no pleural effusion, pulmonary edema, pneumothorax or focal consolidation concerning for pneumonia.", "output": "No subdiaphragmatic free air. No acute cardiopulmonary process." }, { "input": "The small right pleural effusion is unchanged. Since the prior radiograph performed yesterday, there now appears to be a new small left pleural effusion with adjacent atelectasis. The upper regions of both lungs appear clear. No evidence of pneumonia or pneumothorax. Stable cardiomediastinal silhouette. No acute osseous abnormalities. No free air under the diaphragms.", "output": "Stable small right pleural effusion. New small left pleural effusion with adjacent atelectasis." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Lungs are well expanded with no focal consolidation concerning for pneumonia. Pulmonary vasculature is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable view of the chest is compared to previous exam from ___. Low lung volumes are seen on the current exam. There is retrocardiac opacity which silhouettes the hemidiaphragm. This could be accounted for by atelectasis given lower lung volumes on the current exam noting that effusion or consolidation cannot be excluded. Elsewhere, the lungs are grossly clear. Cardiomediastinal silhouette is stable as are the osseous and soft tissue structures.", "output": "Limited exam due to low inspiratory effort. Retrocardiac opacity may be due to atelectasis; however, effusion or consolidation also possible. Repeat with PA and lateral could offer additional detail if patient is amenable." }, { "input": "The lungs are clear. There are small bilateral pleural effusions which are increased, without pneumothorax. The cardiac silhouette is top normal in size, the mediastinal contours are unchanged, with calcification and tortuosity of the aorta again noted.", "output": "Clear lungs, small increased pleural effusions." }, { "input": "The heart size is top normal. The aorta is mildly tortuous and diffusely calcified. The mediastinal and hilar contours are otherwise within normal limits. The pulmonary vascularity is not engorged. Minimal blunting of the costophrenic angles posteriorly on the lateral view may reflect chronic pleural thickening. There is no large pleural effusion or pneumothorax. Mild atelectatic changes are noted within the left lung base. No acute osseous abnormalities are seen. There are multilevel degenerative changes in the thoracic spine.", "output": "Minimal left basilar atelectasis." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. Mild degenerative changes are noted in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is scarring in the right lower lobe. There is cardiomegaly and evidence of mitral valve replacement. Otherwise, the hilar and cardiomediastinal contours are normal. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "Right lower lobe scarring. No focal airspace consolidation." }, { "input": "AP portable upright view of the chest. Multiple overlying EKG leads are present. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process" }, { "input": "", "output": "Normal heart, lungs, hila, mediastinum, and pleural surfaces. No evidence of intrathoracic malignancy or infection. No evidence of pneumonia. FINDINGS: The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. The lungs are clear." }, { "input": "PA and lateral views of the chest demonstrate the lungs are well expanded and clear. The cardiomediastinal silhouette is unremarkable. There is no pleural effusion, pulmonary edema, pneumothorax, or focal airspace opacity.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unremarkable. The pulmonary vasculature is normal. Minimal atelectasis is noted in the left lung base. The right lung is clear. No pleural effusion or pneumothorax is identified. There are no acute osseous abnormalities.", "output": "Minimal left basilar atelectasis. Otherwise no acute cardiopulmonary abnormality." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is mildly improved aeration within the right lower lobe since prior examination. Persistent bilateral heterogeneous lower lobe opacities are unchanged since prior examination. Small left pleural effusion is stable. No right pleural effusion. No pneumothorax. The heart is top-normal in size and obscured due to overlying parenchymal opacities. Mediastinal contour and hila are unremarkable. Intact median sternotomy wires and mediastinal clips. A right IJ CVL tip is in the mid SVC.", "output": "1. Mildly improved right lower lobe aeration. 2. Persistent bilateral heterogeneous lower lobe opacities are worrisome for aspiration or infectious process 3. Stable small left pleural effusion." }, { "input": "The lungs are moderately well inflated. There is mild worsening of pulmonary edema compared to the prior radiograph. Cardiomegaly, bilateral layering pleural effusions are slightly worsened. Endotracheal tube terminates 3.1 cm above the carina. Enteric tube courses below the diaphragm, distal tip not included on this radiograph. Right-sided central venous catheter terminates in the SVC. Sternotomy sutures and EKG leads noted in place.", "output": "Worsening pulmonary edema. Worsening bilateral layering pleural effusions. Lines and tubes as above." }, { "input": "Interval decrease in pulmonary edema. Interval decrease in bilateral pleural effusions. Stable and normal postoperative widening of the cardiomediastinal silhouette, as expected. Bibasilar atelectasis. Median sternotomy wires are intact. Right PICC line is in the cavoatrial junction. The right IJ venous catheter is in the upper SVC. Endotracheal tube tip is approximately 3 cm proximal to the carina.", "output": "Interval decrease in pulmonary edema and bilateral pleural effusions. Stable bilateral atelectasis, severe on the left, moderate on the right. ." }, { "input": "There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "Normal chest radiographs." }, { "input": "Mediastinal silhouette is normal. There is bilateral pulmonary venous congestion There is bilateral lower lobe opacities more severe than prior consistent with pneumonia. There is bilateral pleural effusion. No pneumothorax. No fractures. The right IJ central venous catheter has been removed.", "output": "Findings consistent with bilateral lower lobe pneumonia" }, { "input": "Compared to the previous film there is increasing bilateral pleural effusions. ___ be atelectasis in the left base. No pulmonary vascular congestion pre heart is normal in size", "output": "Slight increase to the bilateral pleural effusions." }, { "input": "The bilateral lower lobe pneumonia is unchanged. No new consolidation. The bilateral pleural effusion is worse compared to prior. No pneumothorax. The hila and pulmonary vasculatures are normal unchanged. The cardiomediastinal silhouette is unchanged and normal. No fractures.", "output": "1. Unchanged bilateral lower lobe pneumonia. No new pneumonia. 2. Worsened bilateral pleural effusion." }, { "input": "The patient is status post median sternotomy and CABG. The heart size is normal. The mediastinal and hilar contours are unremarkable. Lungs are clear. Mild biapical scarring is unchanged. There is no pulmonary vascular congestion. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are identified.", "output": "No acute cardiopulmonary process." }, { "input": "Patient is status post median sternotomy and CABG. Cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormality is visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The patient is status post coronary artery bypass graft surgery. The cardiac, mediastinal and hilar contours appear stable. The chest is hyperinflated. There is no pleural effusion or pneumothorax. The lungs appear clear. Nipple shadows are again visible bilaterally.", "output": "No evidence of acute disease." }, { "input": "There are relatively low lung volumes. Given this, no focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac silhouette is top normal to mildly enlarged. Mediastinal and hilar contours are unremarkable. There is no overt pulmonary edema.", "output": "Relatively low lung volumes. Otherwise, no acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. Lungs are clear. No focal consolidation, effusion, or pneumothorax is seen. The cardiomediastinal silhouette appears normal. No pleural parenchymal scarring is noted. The heart and mediastinal contour is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Normal study." }, { "input": "AP upright and lateral views of the chest provided. Overlying EKG leads are present. There is mild to moderate pulmonary edema with central hilar engorgement and diffuse mild ground-glass opacity. The heart remains moderately enlarged. The thoracic aorta is unfolded. No large effusion or pneumothorax. No convincing signs of pneumonia. Bony structures appear grossly intact.", "output": "Stable cardiomegaly with mild to moderate pulmonary edema." }, { "input": "Stable cardiomegaly, but decreased pulmonary vascular congestion and resolution of pulmonary edema. No confluent areas of consolidation are evident to suggest the presence of pneumonia. Linear atelectasis is noted in the mid lung region on the left. Small right pleural effusion has improved.", "output": "Resolution of pulmonary edema." }, { "input": "The patient's chin overlies the medial lung apices, partially obscuring the view. There are low lung volumes which accentuate the bronchovascular markings. Patchy right basilar opacity may be due to confluence of structures and is not substantiated on the lateral view although a subtle consolidation is not excluded. No large pleural effusion is seen. There is no pneumothorax. The cardiac and mediastinal silhouettes are grossly stable.", "output": "No acute cardiopulmonary process." }, { "input": "Severe cardiomegaly is re- demonstrated along with marked tortuosity of the thoracic aorta. The mediastinal and hilar contours are unchanged and the pulmonary vasculature is normal. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. There are mild multilevel degenerative changes in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest were obtained. Enlargement of the cardiac and mediastinal silhouettes are stable. There is slight blunting of the costophrenic angles on the lateral view and a trace pleural effusion may be present. No focal consolidation is seen. There is no overt pulmonary edema.", "output": "Persistent enlargement of the cardiomediastinal silhouette. Possible trace pleural effusions without overt pulmonary edema." }, { "input": "AP and lateral views of the chest. The lungs are clear of confluent consolidation or pulmonary vascular congestion. There are trace bilateral pleural effusions. Cardiac silhouette is within normal limits for technique and low inspiratory volumes. Thoracic aorta is tortuous with some scattered atherosclerotic calcifications of the arch. No acute osseous abnormalities detected.", "output": "Trace bilateral effusions. Otherwise no acute cardiopulmonary process." }, { "input": "Moderate to severe cardiomegaly appears slightly increased compared to the previous exam. The aorta remains tortuous and diffusely calcified. Moderate pulmonary edema is new in the interval, with small bilateral pleural effusions, right greater than left. No pneumothorax is identified. There are no acute osseous abnormalities.", "output": "Moderate pulmonary edema with small bilateral pleural effusions." }, { "input": "PA lateral and AP chest radiographs demonstrate an enlarged heart, seen previously on prior examination, unchanged. There is no pleural effusion. When compared to prior radiograph, there has been interval improvement in pulmonary edema. Cardiomediastinal contours are stable when compared to prior radiograph. No opacity is seen in concerning for pneumonia.", "output": "No opacity convincing for pneumonia." }, { "input": "The heart is normal in size. The mediastinal and hilar contours are unremarkable. This is aside from mild unfolding of the descending thoracic aorta. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute disease." }, { "input": "A single upright portable radiograph of the chest was acquired. An NG tube courses below the level of the diaphragm, with its tip positioned in the mid stomach. Lung volumes are low. There is minimal bilateral lower lobe atelectasis. There is no focal consolidation. The heart size is normal. The mediastinal contours are normal. There is no definite pleural effusion. No pneumothorax is seen. Subtle lucency under the right hemidiaphragm is concerning for pneumoperitoneum. Air is seen within non-dilated loops of colon. Previously seen air-filled dilated loops of small bowel on the prior radiograph from earlier today are not identified on the present study.", "output": "1. Lucency under the right hemidiaphragm is concerning for pneumoperitoneum. Recommend further evaluation with a left lateral decubitus radiograph. 2. Interval resolution of air-filled dilated loops of small bowel seen on radiographs from earlier today. 3. Minimal bilateral lower lobe atelectasis." }, { "input": "An upper enteric tube is looping in the gastric body, terminating at the fundus. Heart size is top normal with tortuosity of the thoracic aorta. Hilar contours are unremarkable. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality. Upper enteric tube in place with the tip terminating at the gastric fundus." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax identified. The size the cardiomediastinal silhouette is within normal limits.", "output": "No radiographic evidence of acute cardiopulmonary disease." }, { "input": "Inspiratory volumes are low. The heart is not enlarged. No CHF, focal infiltrate, effusion, or pneumothorax is detected. No radiopaque tracheal stent is identified. The tracheal air column is grossly unchanged. Surrounding mediastinal soft tissues are within normal limits. No pneumothorax detected. No obvious pneumomediastinum identified", "output": "No acute pulmonary process identified. Please note that no radiopaque structure is identified over the tracheal air column." }, { "input": "There is interval placement of an NG tube, which on the final image terminates in the stomach. An ET tube is in standard position. Cardiomediastinal and hilar contours are stable. There is no pleural effusion or pneumothorax. The lungs are well-expanded and clear without focal consolidation concerning for pneumonia. Previously noted haziness over the left lung field is resolved. The upper abdomen is unremarkable in appearance.", "output": "1. Interval placement of an NG tube, whose tip terminates in the stomach. 2. Interval resolution of diffuse left lung opacity. Otherwise unremarkable chest radiograph." }, { "input": "An ET tube is present, terminating 2.5 cm above the carinal, in appropriate position. The enteric tube has been removed. The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. The lungs are well expanded. Diffuse haziness projecting over the entire left lung is noted, which may be due in part to overlying support devices. Gaseous distension of the stomach is noted. The visualized osseous structures are within normal limits.", "output": "1. Endotracheal tube in standard position. 2. Diffuse haziness projecting over the left lung, which may be due to overlying support devices. Repeat chest radiograph with removal of overlying devices is reocmmended." }, { "input": "Endotracheal tube is low lying with tip approximately 1 cm from the carina. Orogastric tube tip is within the distal stomach. Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax demonstrated. There are no acute osseous abnormalities.", "output": "1. Low lying endotracheal tube with tip just proximal to the carina. 2. Standard positioning of the orogastric tube. 3. No acute cardiopulmonary abnormality." }, { "input": "Lungs are clear. There is no effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear of consolidation, effusion, or edema. Nodular density projecting over the right lung base is most suggestive of a nipple shadow. The lungs are otherwise clear where not obscured by overlying cardiac leads. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. Heart size is top-normal. The mediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process. Please note that chest radiographs are not ideal for detection of subtle chest trauma." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. A calcified granuloma projects over the right mid lung. Otherwise lungs are clear. No large effusion or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. Patient is status post aortic valve replacement. Right PIC line ends close to the cavoatrial junction. There is no focal consolidation, effusion, or pneumothorax. Sternotomy wires are present without migration of wires or retrosternal soft tissue abnormality. Prosthetic aortic valve in adequate position. Heart is decreased in size compared to ___. Tortuous thoracic aorta. Dilated azygos vein it is a congenital anatomic variant. No free air below the right hemidiaphragm is seen.", "output": "Heart decreased in size compared to ___. Right PIC line ends close to the cavoatrial junction. Dilated azygos vein common anatomic variant, not clinically significant." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "There is relative lucency at the right upper lung, corresponding to a large bulla seen on prior chest CT. Lower lung reticular opacities are consistent with clinical history/chest CT of pulmonary fibrosis. A more confluent region of opacity in the right lower lung is new, raising the possibility of superimposed infection. The heart and mediastinum are stable.", "output": "Known pulmonary fibrosis, however a more focal region of airspace opacity in the right lower lung could represent infection." }, { "input": "Increased rounded opacity in the right mid lung is concerning for infection in the appropriate clinical situation. Background fibrosis is again demonstrated. No pneumothorax, pleural effusion, or frank pulmonary edema. Cardiomediastinal silhouette is unchanged.", "output": "Right mid lung opacity concerning for focal pneumonia. Recommend repeat radiograph in ___ weeks after treatment to ensure resolution. RECOMMENDATION(S): AP chest radiograph in ___ weeks after treatment to ensure resolution of right mid lung opacity." }, { "input": "The heart is mildly enlarged. Mild unfolding is noted along the thoracic aorta. The right upper lung is relatively lucent with a paucity of bronchovascular markings, which is also true to a lesser degree of the left upper lobe, suggesting emphysema. A nipple shadow projects over the right lower lung. There is a striking moderate interstitial abnormality predominantly involving the the mid-to-lower lungs with peribronchial cuffing. Slight subpleural scarring is present at each lung apex. There is no pleural effusion or pneumothorax. Mild degenerative changes are present along the lower lumbar spine.", "output": "Findings suggestive of emphysema including a widespread moderate interstitial abnormality. The appearance is concerning for pulmonary edema in the appropriate clinical setting superimposed on background abnormal lung architecture, although a more chronic interstitial abnormality could also be considered; correlation with prior films, if available, would be helpful." }, { "input": "Persistent diffuse right lung opacities again seen and left lower lobe opacities. The heart remains enlarged. The aorta is tortuous. Central line in SVC. .", "output": "Stable appearance of the chest with multifocal opacities. More severe on the right." }, { "input": "Again seen are cavitary changes in the right upper lung. Mildly improved surrounding consolidation. Changes of pulmonary fibrosis bilateral lungs, similar. Shallow inspiration accentuates heart size.", "output": "Mild interval improvement." }, { "input": "Increased confluence in density of the right upper lobe consolidation consistent with progression of recurrent pneumonia. No new consolidations. Relative lucency over the right apex reflects underlying bullous disease. No pleural effusion or discrete pneumothorax identified. There is persisting interstitial prominence. The appearance of the cardiomediastinal silhouette is unchanged.", "output": "Increasing opacification/ consolidation in the right upper lung. No new consolidation identified." }, { "input": "The right IJ central venous catheter is in satisfactory and unchanged position. Diffuse interstitial opacities are unchanged. No new consolidation is appreciated but impossible to exclude due to the diffuse interstitial opacities. There is chronic unchanged cardiomegaly. The mediastinum is unchanged. No pleural effusion. No pneumothorax. No fractures.", "output": "1. Diffuse interstitial opacities with no significant change from prior. 2. No new consolidation is appreciated but impossible to exclude due to the diffuse interstitial opacities." }, { "input": "Procedure bilateral opacities seen with a partial clearing. Especially in the left lung. Right IJ line in cavoatrial juncture no pleural effusion or pneumothorax.", "output": "Slight clearance of bilateral opacities particularly in the left" }, { "input": "Chronic changes noted in the lungs compatible with honeycombing and bullous changes, particularly at the right lung apex. On the current exam, there is more dense opacity at the right upper lung raising the possibility of a superimposed infection. Component of edema would be difficult to exclude. Moderate cardiac enlargement and tortuosity of the descending thoracic aorta is again noted. Prior right-sided central venous catheter is no longer visualized.", "output": "Chronic changes noted in the lungs with more dense opacity in the right upper lung raising the possibility of a superimposed infection versus edema." }, { "input": "The right IJ line terminates in the right atrium. The heart is moderately enlarged. The mediastinal silhouette is unchanged. The diffuse bilateral parenchymal reticular opacities are consistent with patient's background fibrosis and severe emphysema. Rounded lucencies in the right upper lung consistent with chronic bullous emphysematous changes better evaluated on chest CT from ___. Lobe opacity in the right middle lung as seen on the prior study from ___ is consistent with 80 pneumonia. There is no pulmonary edema, pleural effusion, or pneumothorax.", "output": "Right mid lung opacity consistent with a pneumonia in the setting of underlying pulmonary fibrosis and severe emphysema. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 12:19 PM, 10 minutes after discovery of the findings." }, { "input": "Right upper consolidation with lucencies towards the apex consistent with known pneumonia in setting of bullous emphysema and are unchanged. No new consolidations. Bilateral, predominantly basilar, interstitial markings is unchanged and better seen on recent CT consistent with interstitial lung disease in setting of emphysema. Cardiac size is enlarged but unchanged. There is no pneumothorax or pleural effusion.", "output": "No significant interval change since ___ with no evidence of pulmonary edema. Stable right upper lobe consolidation" }, { "input": "The tip of a left PICC line projects over the distal SVC. There is a new opacity in the right upper lung zone in the area of the previously described cavitary lesion. Otherwise the diffuse and prominent reticular markings are unchanged. No pleural effusion or pneumothorax identified. The size the cardiac silhouette is enlarged.", "output": "New opacity in the right upper lung zone in the area of a previously described cavitary lesion likely reflects superimposed infection. Unchanged interstitial markings suggestive of pulmonary fibrosis." }, { "input": "There is diffuse lower lobe predominant opacities bilaterally, concerning for multi focal pneumonia. Superimposed pulmonary edema is mild. Background increased interstitial markings are suggestive of underlying emphysema. No pneumothorax or large pleural effusions. Cardiac silhouette is top normal size.", "output": "Diffuse lower lobe predominant opacities in bilateral lungs are concerning for multifocal pneumonia. Mild pulmonary edema." }, { "input": "Left PICC line tip in the upper SVC. Increased heart size, pulmonary vascularity, stable. Stable right upper lung opacity. Minimal improvement of interstitial markings. No pneumothorax.", "output": "Minimal interval improvement." }, { "input": "The lungs are essentially clear. Blunting of the right posterior costophrenic angle could represent a small effusion. The cardiac silhouette is top-normal in size. Atherosclerotic calcifications noted at the aortic arch as well as a slightly tortuous descending thoracic aorta. There is no acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unremarkable. The lungs are hyperinflated with lucency of the lung apices and attenuation of the pulmonary vascular markings compatible with severe bullous emphysema. No focal consolidation, pleural effusion or pneumothorax is identified. There are degenerative changes in the thoracic spine with anterior bridging osteophytes.", "output": "Severe bullous emphysema but no acute cardiopulmonary abnormality." }, { "input": "Left pectoral pacemaker has a single lead terminating in the right ventricle. There is no consolidation, pleural effusion, or pneumothorax. Stable mild cardiomegaly.", "output": "Left pectoral pacemaker has a single lead terminating in the right ventricle." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Lateral left base linear atelectasis/scarring is noted and is mild. No focal consolidation is seen No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. Heart size and mediastinal contours are normal. There is no pleural effusion or pneumothorax.", "output": "Normal chest radiographs" }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures are unremarkable.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Cardiac silhouette is upper limits of normal in size, similar to recent chest radiograph of ___, but slightly increased from the earlier radiograph of ___. On the lateral chest radiograph, there are apparent small bilateral pleural effusions, new since ___. Minimal adjacent basilar lung opacities are present. The remainder of the lungs are clear except for unchanged relatively symmetrical bi-apical scarring.", "output": "Small bilateral pleural effusions with minimal adjacent basilar lung opacities, which likely reflect atelectasis. No definite pneumonia, but followup radiographs may be helpful if symptoms persist in order to exclude a subtle basilar pneumonia." }, { "input": "AP and lateral views of the chest. The lungs are clear of consolidation, effusion or pulmonary vascular congestion. Cardiomediastinal silhouette is stable in configuration. Vascular coronary stent is also noted.Nodular opacity projecting over the right mid lung laterally is compatible with callous from prior rib fracture. Chronic changes noted at the proximal left humerus suggestive of prior trauma. No acute osseous abnormality detected.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac silhouette is normal in size. The mediastinal and hilar contours are within normal limits. The pulmonary vasculature is not engorged. The lungs are well expanded and well aerated without focal consolidation concerning for pneumonia. No pleural effusion or pneumothorax is detected. Mild biapical pleural thickening is symmetrical.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest demonstrate hyperexpansion of the lungs and relative flattening of the bilateral hemidiaphragms, consistent with emphysema. The cardiomediastinal silhouette is stable. There is no evidence of pulmonary edema, pleural effusion or focal consolidation concerning for pneumonia. Multilevel degenerative changes are present in the thoracic spine. Bilateral nipple shadows should not be confused for pulmonary nodules.", "output": "1. No acute cardiopulmonary process. 2. Emphysema." }, { "input": "Single portable view of the chest. Enteric tube is seen coiled within the stomach, tip off the inferior field of view. The lungs are clear of focal consolidation. The cardiac silhouette is slightly enlarged, unchanged. No acute osseous abnormality detected noting degenerative changes at the right glenohumeral joint and possible post traumatic changes in the proximal left humerus, incompletely visualized.", "output": "Cardiomegaly without acute cardiopulmonary process. Incompletely visualized changes of the proximal left humerus. Please correlate clinically." }, { "input": "Since the prior exam, new pulmonary vascular prominence is noted. There is no overt edema. There is no consolidation, pleural effusion, or pneumothorax. The cardiac size is mildly enlarged, which is new from ___. The mediastinal contours are normal. A right internal jugular hemodialysis catheter ends in the low SVC.", "output": "1. Pulmonary congestion without overt pulmonary edema. 2. Mild cardiomegaly, new from ___." }, { "input": "There is no focal consolidation, pleural effusion or pulmonary edema. The heart is top-normal in size. The mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "An orogastric tube courses below the diaphragm, the tip projects over the gastric body. Lung volumes are decreased, accentuating the cardiac silhouette. The left costophrenic angle is not clearly visualized, could be secondary to a pleural effusion, atelectasis or could be due to patient's positioning and overlying soft tissues. The right costophrenic angle is not included in this examination. The upper lung fields are clear. No definite focal consolidation identified on this single portable radiograph.", "output": "1. Orogastric tube terminates in the stomach. 2. Low lung volumes. Left costophrenic angle is not clearly visualized, could be secondary to atelectasis, pleural effusion or also secondary to patient's positioning and overlying soft tissues." }, { "input": "Enteric tube tip is within the stomach. Lung volumes are lower compared to the prior study. Heart size is accentuated as result of low lung volumes, appearing mildly enlarged. The mediastinal and hilar contours are unremarkable. Crowding of bronchovascular structures is likely due to low lung volumes without overt pulmonary edema. Patchy opacities in lung bases most likely reflect atelectasis. No pleural effusion, focal consolidation or pneumothorax is present.", "output": "Enteric tube tip within the stomach. Low lung volumes with patchy bibasilar atelectasis." }, { "input": "Frontal and lateral views of chest demonstrate interval placement of a left pectoral single lead cardiac pacer/AICD, with the lead terminating in the right ventricle. Median sternotomy wires are intact. There is no evidence of pneumothorax, vascular congestion, or pleural effusion. There is linear atelectasis in the right base. Cardiomediastinal silhouette is within normal limits.", "output": "Single cardiac pacer lead terminating in the right ventricle. No pneumothorax." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unremarkable. The pulmonary vascularity is not engorged. The lungs are hyperinflated. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormalities are seen. Minimal deformity of the ___ posterior rib on the left may reflect prior fracture.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Left basal platelike atelectasis. Otherwise lungs are clear. No signs of pneumonia or edema. No effusion or pneumothorax. Cardiomediastinal silhouette is stable. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. The lungs are clear. Cardiomediastinal silhouette is within normal limits. Mild mid thoracic dextroscoliosis is noted.", "output": "No acute cardiopulmonary process." }, { "input": "There are right pleural catheter is present unchanged. There is a persisting trace right pneumothorax. A small right pleural effusion with adjacent atelectasis is present. Unchanged right hilar prominence. The left lung is clear. The size the cardiac silhouette is unchanged.", "output": "Persisting trace right pneumothorax with a right pleural pigtail catheter present." }, { "input": "Compared with the prior study, the previously seen right lung base pigtail catheter is no longer visualized. A moderate to moderately large right pneumothorax is newly visible. Possible small amount of fluid in the right costophrenic sulcus, unchanged. Prominence of the right hilum is again noted. The cardiomediastinal silhouette remains grossly midline. Prominence of the superior mediastinum is also again noted. On the left, there is minimal upper zone redistribution, without overt CHF. No focal infiltrate or effusion is identified in the left chest.", "output": "Previously seen right pigtail catheter no longer visualized. New moderately large right pneumothorax identified. Probable small right effusion. Prominence of superior mediastinum and right hilum is similar to prior. (Note is made that the patient underwent a chest CT on ___). Aside from minimal upper zone redistribution, left lung and pleural sulcus are grossly clear. No overt CHF. NOTIFICATION: Findings discussed by phone with covering intern Dr. ___ ___ by Dr ___, 5 minutes after discovery on ___ . By report, the right pigtail catheter has been removed." }, { "input": "2 right pleural catheters in place. Stable right pleural effusion. Mildly worsened right lung opacity. Left lung is clear.", "output": "Mildly worsened opacities right lung. Stable right pleural fluid." }, { "input": "A large right pleural effusion is present with compressive atelectasis of the right lung accounting for near complete opacification of the right hemithorax. Mediastinal and left hilar contours appear unremarkable. Heart size cannot be assessed given the presence of the large right pleural effusion. Left lung is clear. No pulmonary vascular congestion is present. There are no acute osseous abnormalities. Clips are seen in the right upper quadrant of the abdomen likely reflective of prior cholecystectomy.", "output": "Large right pleural effusion with associated compressive atelectasis. Clear left lung." }, { "input": "A right pigtail pleural catheter is present. No significant interval change in the loculated appearing fluid at the right lateral lung base. Unchanged right hilar and perihilar mass. The left lung is clear. The size the cardiac silhouette is within normal limits.", "output": "No significant interval change since the prior exam." }, { "input": "right-sided chest drain in situ. Interval decrease in size of the right-sided pleural effusion. No right-sided pneumothorax. The cardiomediastinal shadow is unchanged.Low lung volumes most likely a contribute to the increased bronchovascular markings seen in the lung bases. Spondylotic changes of the thoracic spine.", "output": "Chest drain in the appropriate position. Interval decrease in size of the right-sided pleural effusion. No pneumothorax." }, { "input": "The right pleural pigtail catheter is present. No discrete pneumothorax identified. There is a small right pleural effusion tracking along the lateral chest wall. Right basilar atelectasis. There is a persistent prominence of the right hilum. The left lung is clear. The size of the cardiac silhouette is within normal limits.", "output": "No discrete pneumothorax identified. Unchanged appearance of the right pleural pigtail catheter. Small right pleural effusion. Persisting right hilar prominence." }, { "input": "There is been interval placement of a pleural drainage catheter projecting over the right mid lung. There may be kinking of the mid catheter, difficult to assess on this single view. There is a large right pleural effusion with associated compressive atelectasis, not significantly changed compared to the prior study from ___. The left lung is clear. The cardiomediastinal silhouette is difficult to assess secondary to obscuration of the right heart border by the pleural effusion. There is no pneumothorax.", "output": "Interval placement of a pleural drainage catheter projecting over the right mid lung. Questionable kinking of the mid catheter, difficult to assess on a single view, and correlation with output is recommended. Large right pleural effusion with associated compressive atelectasis, not significantly changed compared to the prior study from ___. This preliminary report was reviewed with Dr. ___, ___ radiologist." }, { "input": "Interval placement of a right pleural pigtail catheter with no significant interval change in the moderate to large right pneumothorax. Unchanged small right pleural effusion, right hilar prominence and increased opacities at the right lung base. The left lung remains clear. No mediastinal shift. The appearance of the cardiac silhouette is unchanged.", "output": "Interval placement of a right pigtail catheter without significant change in the appearance of the moderate to large right pneumothorax." }, { "input": "2 right pleural catheters, 1 new since prior exam. Decreased right pleural effusion. Improved right mid, lower lung opacity. Left lung is clear.", "output": "Improvement since prior exam." }, { "input": "There has been no significant interval change in the moderate to large right pneumothorax. There is persistent right hilar prominence in addition to increasing opacities in the right lower and mid lung zone. The trachea remains midline. A small right pleural effusion is noted. The left lung is clear. The appearance of the cardiac silhouette is unchanged.", "output": "No significant interval change in the moderate to large right pneumothorax." }, { "input": "A right pleural pigtail catheter remains in place with interval re-expansion of the right lung. A trace right pneumothorax likely persists. Unchanged right hilar prominence as well as a small right pleural effusion. The left lung is clear. No significant interval change in appearance of the cardiomediastinal silhouette.", "output": "Interval re-expansion of the right lung with a suspected persisting trace pneumothorax. Small right pleural effusion." }, { "input": "Right-sided chest tube has been repositioned with tip in the lower hemithorax. Small right apical pneumothorax without tension. Right-sided pleural effusion has nearly completely resolved with small residual pleural fluid. No pulmonary edema. No left-sided pleural effusions or pneumothorax. Cardiomediastinal silhouette is normal and unchanged.", "output": "1. Interval near complete resolution of right-sided pleural effusion. 2. Small apical pneumothorax without tension." }, { "input": "Compared with the most recent prior film, the overall appearance is probably similar. The right-sided pigtail is again seen. There is prominence the right hilum, which is likely related to the patient's known hilar mass. Question minimal increased patchy opacity in the right mid zone laterally, immediately above the slightly thickened minor fissure. Minimal atelectasis at the right base and slight prominence of the right paratracheal soft tissues. No definite pneumothorax is identified The left lung is grossly clear, without pneumothorax without obvious pneumothorax. Minimal atelectasis left lung base is noted, but improved.", "output": "No gross change compared 1 day earlier. Question minimal increased hazy opacity in the right mid zone laterally --___ this area on followup films is requested. No obvious pneumothorax detected in the right lung. Possibility of a tiny occult pneumothorax cannot be entirely excluded. No right pleural effusion identified." }, { "input": "Again demonstrated is a right hilar mass with worsening volume loss in the right lung and unchanged nodular pleural thickening. Increased interstitial opacities throughout the right lung may reflect worsening lymphatic engorgement superimposed on tumor and infiltration. Small to moderate size right pleural effusion is without substantial interval change. Left lung is hyperinflated without new focal consolidation. No left-sided pleural effusion or pneumothorax is present. Cardiac and mediastinal contours are similar.", "output": "Increased volume loss in the right lung and increased interstitial opacities in the right lung suggestive of worsening lymphatic engorgement, superimposed upon tumor infiltration. Unchanged small to moderate right pleural effusion." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear and the pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is present. There is no subdiaphragmatic free air. Dilated air-filled loops of small bowel are seen within the left upper quadrant.", "output": "No acute cardiopulmonary abnormality. No subdiaphragmatic free air. Mildly dilated gas-filled loops of small bowel in the left upper quadrant, concerning for obstruction. Recommend dedicated abdominal radiographs for further assessment." }, { "input": "Single supine AP portable view of the chest was obtained. Endotracheal tube is seen terminating approximately 5 cm above the level of the carina. Enteric tube is seen coursing below the level of the diaphragm, inferior aspect not included on the image. The lungs are grossly clear. No definite focal consolidation is seen. Subtle streaky left base retrocardiac opacity may be due to atelectasis, although an early aspiration is not excluded. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. There is no overt pulmonary edema.", "output": "1. Endotracheal tube terminates approximately 5 cm above the level of the carina. 2. Enteric tube courses below the level of the diaphragm, inferior aspect not included on the image." }, { "input": "Portable upright chest radiograph shows the endotracheal tube tip 4 cm above the carina but with the edge abutting the left lateral wall of the mid trachea. Nasogastric tube tip and side hole both below the left hemidiaphragm off the view of the film. The studies taken in relative degree of expiration but no focal lung consolidation is seen and no pneumothorax or pleural fluid hemothorax is evident.", "output": "No acute intrathoracic process. Note distal left edge of the endotracheal tube abutting left tracheal wall" }, { "input": "The heart size is normal. Calcification of the aortic knob is present. Lungs are well-expanded. There is mild pulmonary edema. Opacification of the right hemidiaphragm with hazy opacity likely reflects a layering pleural effusion with underlying atelectasis. Developing consolidation is not excluded. There is no large left pleural effusion. There is no pneumothorax. ET tube is present in standard position. An enteric tube is present with distal tip not captured but sideholes just distal to the GE junction. A right axillary dual lead pacemaker is present with tips expected positions.", "output": "Support devices in standard positions. Increased opacity at the right base likely reflects layering pleural effusion and atelectasis. Mild pulmonary edema." }, { "input": "The right-sided chest tube has been removed. No pneumothoraces are seen. Subsegmental atelectasis at the lung bases is seen and there is persistent prominence of the interstitial markings. Heart size is within normal limits.", "output": "Removal of the right-sided chest tube without pneumothoraces." }, { "input": "There is subsegmental linear atelectasis at the lung bases. There is mild elevation of the right hemidiaphragm. Small bilateral effusions are seen. There are low lung volumes. Heart size is within normal limits. There is minimal prominence of the pulmonary interstitial markings without overt pulmonary edema. There are no pneumothoraces. There is mild wedging of a lower thoracic vertebral body, age indeterminate.", "output": "As above." }, { "input": "PA and lateral chest radiographs were obtained. The patient is status post median sternotomy and CABG. There are prominent interstitial markings as well as bronchovascular crowding accentuated by low lung volumes. No focal opacity is seen. The cardiac silhouette is mildly enlarged. There is no pleural effusion or pneumothorax.", "output": "No focal opacity. Prominent interstitial markings, mild pulmonary edema cannot be excluded." }, { "input": "Cardiomediastinal contours are stable. There are bibasilar atelectasis larger on the left side. There is a new subcutaneous ICD in appropriate position. . There is no pneumothorax or pleural effusion. Sternal wires are aligned. There are mild degenerative changes in the thoracic spine", "output": "No acute cardiopulmonary abnormalities. New subcutaneous ICD in standard position" }, { "input": "The lungs are fully expanded and clear. The cardiomediastinal and hilar contours are normal. There are small bilateral pleural effusions. There is no pneumothorax. Visualized osseous structures are unremarkable.", "output": "Small bilateral pleural effusions. No radiographic evidence of pneumonia." }, { "input": "In comparison to prior study there is little overall change. Redemonstrated is heterogeneous with right basilar airspace opacities likely related to a combination of consolidation, atelectasis, and effusion. Left lung is clear. Cardiomediastinal silhouette is stable. Dual chamber pacemaker leads are unchanged in position.", "output": "No substantial change from prior" }, { "input": "A portable frontal chest radiograph demonstrates a dual lead pacemaker with the leads overlying the right atrium and ventricle. Prominence of the cardiomediastinal silhouette may be due to magnification related to the patient's body habitus. Surgical material along the mediastinum is unchanged. Opacity along the right hemidiaphragm may be a combination of atelectasis and post-biopsy bleeding. There is no pneumothorax or large pleural effusion.", "output": "No pneumothorax." }, { "input": "Portable semi-upright radiograph of the chest demonstrates extensive opacification involving much of the right hemithorax, which likely represents a combination of asymmetric pulmonary edema and pneumonia. The cardiomediastinal and hilar contours are unchanged. There is no pneumothorax.", "output": "Extensive opacification involving much of the right hemithorax is grossly unchanged, and likely represents a combination of asymmetric pulmonary edema and pneumonia." }, { "input": "Compared to the most recent prior chest radiograph, the moderate right pleural effusion and right middle lobe mass appear stable. The left lung is clear. The aortic knob is calcified. The heart size is normal. A left pectoral pacer, mediastinal clips and right rib deformities are stable. A sclerotic met in the T9 vertebral body is again noted.", "output": "Stable appearance of right middle lobe mass and pleural effusion and since ___." }, { "input": "The endotracheal tube has been removed. 2 right-sided chest tubes are unchanged in position. The pneumothorax on the right is slightly increased in size. Volume loss at the bases is slightly increased. No change in the 2 lead pacemaker", "output": "Slight increase in size in right pneumothorax" }, { "input": "Asymmetric hazy air space consolidation, right greater than left appears slightly increased from yesterday morning study and this could represent pneumonia, pulmonary hemorrhage, or, less likely, asymmetric edema. Right-sided pleural of pleural fluid appears stable as does a small amount of residual subcutaneous emphysema on the right status post removal of the right-sided thoracic catheter. No pneumothorax is seen. Calcified plaque is seen in the thoracic aorta. Resection of the right fifth and and sixth ribs is seen and proliferative osteophytes are seen at the inferior humeral heads bilaterally.", "output": "Increasing airspace consolidation right lung. No pneumothorax" }, { "input": "Moderate cardiomegaly, mediastinal silhouette and hilar contours are unchanged from prior exam. There is persistent mild pulmonary edema and in this setting is difficult to discretely identify pneumonia. Bibasilar patchy opacities are relatively unchanged compared to prior exam. There is no pleural effusion or pneumothorax.", "output": "Unchanged pulmonary edema with no change in appearance of bibasilar patchy opacities. Infection is not excluded given the correct clinical circumstance." }, { "input": "Frontal and lateral views of the chest were obtained. Cardiomediastinal silhouette is stable. Slight prominence of the right hilum is also stable. There are relatively low lung volumes. Given this, patchy bibasilar opacities are seen, which while could relate to underlying edema, raises a concern for multifocal infection. There is also mid lung atelectasis. There is prominence of interstitial markings bilaterally. This may be due to underlying edema. No large pleural effusion or pneumothorax is seen.", "output": "Low lung volumes accentuate the bronchovascular markings. Stable prominence of the right hilum. Bibasilar opacities may be due to multifocal infection superimposed on mild interstitial edema depending on the clinical scenario." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. Anterior cervical fixation hardware it is partially visualized.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are clear of consolidation. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "No focal opacity to suggest pneumonia is seen. No pleural effusion, pulmonary edema, or pneumothorax is present. The heart, mediastinal and pleural surface contours are normal. Incidental note is made of an azygos lobe. There is likely a calcified granuloma in the right upper lobe. No displaced fracture is identified.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are well inflated and clear. A calcified granuloma is again seen in the right upper lobe, unchanged, as well as calcified granulomas at the left hilus. An azygos fissure is noted. The cardiomediastinal silhouette and hilar contours are normal. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Lungs are grossly clear. Cardiomediastinal silhouette is within normal limits. Hiatal hernia is noted. Mid thorax the dextroscoliosis is noted. Bilateral breast tissue expanders are noted.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs were obtained. A right chest tube remains in place over the right apex without apical pneumothorax. There is now a moderate hydropneumothorax adjacent to right lung base anteriorly with atelectasis of the medial base of right upper lobe. No pulmonary edema is seen. The left lung is fully expanded and clear. The cardiomediastinal silhouette and hilar contours are stable.", "output": "Moderate hydropneumothorax adjacent to anterior right lung base with atelectasis of the medial base of the right upper lobe. Findings were discussed with Dr.___ by Dr.___ ___ telephone at 11:19am on ___." }, { "input": "Frontal and lateral chest radiographs were obtained. The rigth chest tube has been removed. There is now a small right apical pneumothorax. There is no evidence of tension. There is a persistent moderate hydropneumothorax adjacent to anterior right lung base. The left lung is fully expanded and clear. Cardiomediastinal silhouette and hilar contours are stable. There is also increased subcutaneous gas at right lateral chest wall.", "output": "Interval removal of right chest tube with small right apical pneumothorax as well as persistent moderate hydropneumothorax at the anterior right lung base. There is also increased right lateral subcutaneous gas. Findings were communicated with Dr.___ by Dr.___ ___ telephone at 6:30pm ___ ___." }, { "input": "Compared with the prior radiograph, no significant changes. The left subclavian line has been removed. Endotracheal tube is unchanged in position. No evidence of pneumothorax. Bilateral perihilar and bibasilar opacifications may be due to worsening pulmonary vascular congestion and edema, but superimposed bilateral aspiration must also be considered.", "output": "Bilateral perihilar and basilar opacifications may be due to worsening pulmonary edema, but superimposed aspiration must also be considered." }, { "input": "The tip of the endotracheal tube is situated just at the thoracic inlet terminating 6.6 cm above the carina. An enteric tube is also present with its tip within the gastric body but the side port is at the GE junction. The lungs are clear. The cardiomediastinal silhouette and hilar contours are normal. There is no pleural effusion or pneumothorax. Osseous structures are grossly intact.", "output": "1. ETT terminates at the thoracic inlet 6.6 cm above the carina. 2. Enteric tube with side port at the GE junction. Consider advancing if the tube is used for feeding. 3. Clear lungs." }, { "input": "The lungs hyperinflated but clear without focal opacity, pulmonary edema or pneumothorax. Minimal left pleural thickening is unchanged since ___. The cardiac and mediastinal contours are normal. There is no free air beneath the right hemidiaphragm.", "output": "No acute cardiopulmonary process." }, { "input": "Endotracheal tube is noted in the region of right mainstem bronchus and retraction by 3.5 cm would be recommended for optimal positioning. The ET tube appears properly positioned on the followup radiograph at 9:31 am however and no adjustment is needed at this time. The heart appears moderately enlarged but stable. Mild bibasilar atelectasis is noted along with mild vascular congestion. Otherwise, the lungs are clear. Postsurgical changes are noted in the lower cervical spine. Known T8 vertebral body fracture is not well evaluated on this study.", "output": "Endotracheal tube was in the region of the right mainstem bronchus retraction by 3.5 cm was recommended for optimal positioning. However, the followup radiograph at 9:31 am demonstrates proper positioning of the Endotracheal tube and thus no adjustment is needed at this time. These findings were discussed by Dr. ___ with Dr. ___ at the time of discovery at 10:15 am on ___." }, { "input": "Endotracheal tube is appropriately positioned in the mid trachea. Enteric tube traverses to the stomach. The heart appears stably enlarged. Mild bibasilar atelectasis is noted and mild vascular congestion has increased. Postsurgical changes are noted in the lower cervical spine. Known T8 vertebral body fracture is not well evaluated on this study.", "output": "Enteric tube traverses to the stomach. Endotracheal tube appears properly positioned. Vascular congestion appears slightly worse. These findings were discussed by Dr. ___ with Dr. ___ at the time of discovery at 10:15 am on ___ ___." }, { "input": "Enteric tube traverses the stomach. Post-surgical changes are noted in the lower cervical spine. Known T8 vertebral body fracture is not well evaluated on this study. Lung aeration appears improved. Heart appears stably enlarged. Bilateral small pleural effusions appear stable with adjacent atelectasis. Previously noted left basilar atelectasis is again noted in the retrocardiac region.", "output": "Improved aeration with bilateral small pleural effusions and adjacent atelectasis persisting in the lower lungs." }, { "input": "The heart is mildly enlarged. There is mild pulmonary vascular redistribution. There is no focal infiltrate. There is a probable small left effusion. Compared to the prior exam aeration in the lower lungs is improved", "output": "Slight improvement in lung aeration in the lower lobes" }, { "input": "The heart is top normal in size, but may be accentuated by AP technique. The hilar contours are within normal limits. Lung volumes are low but no focal consolidation is seen. There is no evidence of pleural effusion or pneumothorax.", "output": "Low lung volumes, but not definite focal consolidation." }, { "input": "PA and lateral views of the chest provided. They vagal nerve stimulator is seen projecting over the left chest wall with catheter extending to the left neck. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral radiographs of the chest demonstrate low lung volumes. There is new elevation of the right hemidiaphragm. New plate-like atelectasis at the right lung base is likely secondary to the newly elevated right hemidiaphragm. An old right-sided ninth rib fracture is seen. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion, pneumothorax or consolidation concerning for pneumonia. Contrast is seen in the transverse and proximal descending colon with multiple diverticula present.", "output": "Plate-like atelectasis at the right lung base likely secondary to newly elevated right hemidiaphragm." }, { "input": "In comparison with chest radiographs from ___, there has been interval removal of a right pigtail catheter. Small bilateral pleural effusions are mildly improved, with a possible loculated appearance of the right effusion. Bilateral lower lobe opacities are unchanged and likely reflect associated atelectasis, less likely pneumonia. Persistent small right apical pneumothorax. There is no new focal consolidation. Mild central vascular congestion with increased interstitial markings could reflect mild interstitial pulmonary edema. Mediastinal and hilar contours are stable. Mild tortuosity and unfolding of the thoracic aorta, as before. Heart size is normal.", "output": "1. Status post removal of right pigtail catheter improved small bilateral pleural effusions, with possible loculation on the right. Persistent small right apical pneumothorax. 2. Persistent bilateral lower lobe opacities suggest atelectasis, less likely pneumonia. 3. Mild central vascular congestion with increased interstitial markings could reflect mild interstitial pulmonary edema." }, { "input": "Right pigtail chest tube clamped showing no the appearance of a pneumothorax. No other interval change. .", "output": "No reappearance of pneumothorax after clamping of right chest tube." }, { "input": "Chest tube in the right the costophrenic angle again seen. The previously seen pneumothorax has resolved. Bilateral pleural effusion may have increased slightly. Bilateral lower lobe opacities unchanged. The heart is normal in size. The aorta is tortuous as previously.", "output": "Resolution small right basal pneumothorax. Probable slight increase to the bilateral pleural effusions." }, { "input": "AP portable upright view of the chest. Since the prior PET-CT exam, the right pleural effusion has increased in size, with known right lower lobe mass obscured. The there is a small left pleural effusion seen. The mild ground-glass opacity in the left lower lung is potentially concerning for pneumonia versus atelectasis. No pneumothorax. Heart size difficult to assess. Bony structures appear grossly intact.", "output": "Interval development of a right pleural effusion, moderate in size. Small left pleural effusion with left basal ground-glass opacity concerning for atelectasis versus pneumonia." }, { "input": "Compared to chest radiographs from ___, small right pleural effusion has increased and appears loculated with increased fissural fluid, now moderate. Right chest tube is in unchanged position. At the right lateral lung base. R persistent opacity in the right lower lobe without significant re-expansion. Small to moderate right apical pneumothorax persists. Small left pleural effusion is stable. Mediastinal and hilar contours are stable. Heart size, though partially obscured by effusion and atelectasis, is likely normal.", "output": "1. Increased right pleural fluid loculated at the right lateral lung base. Opacity in the right lower lobe without significant re-expansion. 2. Right apical right pneumothorax, small to moderate. 3. Stable small left pleural effusion." }, { "input": "Interval placement of a right pleural pigtail catheter with decrease in size of the right pleural effusion. Opacities in the right lower lung zone are noted, likely reflect development of pulmonary edema and the patient's underlying lung cancer. Patchy airspace opacities in the left mid to lower lung zone have increased and may reflect a combination of atelectasis and superimposed infection. A small left pleural effusion persists. No pneumothorax identified. The size of the cardiac silhouette is within normal limits.", "output": "Interval decrease in size of the right pleural effusion status post placement of a right pleural pigtail catheter. No pneumothorax identified. Persisting and slightly increased mid to lower lung zone airspace opacities likely reflect atelectasis and/or pneumonia." }, { "input": "A right pleural pigtail catheter is again present. There are persisting small bilateral pleural effusions with subjacent atelectasis/ consolidation. The appearance of both mid to lower lung zones are unchanged. There is a small right basilar pneumothorax. The appearance of the cardiomediastinal silhouette is unchanged.", "output": "Small bilateral pleural effusions with subjacent atelectasis/consolidation. Unchanged mid to lower lung zone opacities. Small right basilar pneumothorax." }, { "input": "There is a moderate left pleural effusion with overlying atelectasis, underlying consolidation is not excluded. The right lung is clear. No right pleural effusion is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Moderate left pleural effusion, with overlying atelectasis, underlying consolidation not excluded. No prior for comparison to assess for interval progression." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is visualized. There are mild degenerative changes in the thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is at the upper limits of normal size. The mediastinal and hilar contours appear unchanged. A prominent pericardial fat pad again is noted about the right costophrenic sulcus as well as the apex of the heart. The minor fissure is again slightly thickened. The lungs appear clear. Hyperinflation is noted. There is no pleural effusion or pneumothorax. Mild degenerative changes are similar along the thoracic spine.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The cardiac silhouette size is top normal, unchanged. Prominent epicardial fat pad is again noted. Mediastinal and hilar contours are stable, with minimal tortuosity of the thoracic aorta again noted. Pulmonary vascularity is normal. Lungs remain hyperinflated, with unchanged mild thickening of the minor fissure. No focal consolidation, pleural effusion or pneumothorax is detected. There are mild degenerative changes in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is no focal consolidation, pleural effusion, or pneumothorax. There is mild pulmonary vascular congestion without frank pulmonary edema. Subsegmental atelectasis noted are right greater the left bases. The cardiomediastinal silhouette is enlarged with prominence of the right hilum, consistent with the known right hilar lymphadenopathy.", "output": "Mild pulmonary vascular congestion without frank edema. Basilar atelectasis. No consolidation detected. Unchanged cardiomegaly and prominence of the right hilum." }, { "input": "AP upright frontal and lateral views of the chest are provided. Underpenetration limits evaluation through the lung bases. A prominent epicardial fat pad accounts for the subtle effacement of the heart borders. There is no lobar consolidation, effusion, or pneumothorax. There is mild coarsening of the perihilar bronchovascular markings, which could represent mild airways inflammation. The cardiomediastinal silhouette is stable. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No lobar consolidation. Possible airways inflammation with perihilar reticular opacities noted." }, { "input": "Chest, portable AP upright. The lungs are hyperinflated. However, there is no airspace consolidation. There is no pneumothorax or pleural effusion. Several eventrations of the diaphragm are unchanged. The hilar and mediastinal contours are normal. The pulmonary vascularity is normal.", "output": "No acute cardiopulmonary process. Hyperinflation of the lungs suggestive of COPD." }, { "input": "PA and lateral chest radiograph is compared to prior radiograph dated ___. The chest overall is unchanged in appearance. No focal opacity convincing for pneumonia is present. Obscuration of the right heart border is unchanged relative to prior examination and when correlated with CTA performed ___ appears to be correlate with mediastinal fat. Lungs are slightly hyperinflated with emphysematous changes. There is no large pleural effusion. There is no pneumothorax or evidence of pulmonary edema. Heart size is top normal. Vasculature is slightly engorged relative to prior examination.", "output": "Emphysematous changes without evidence of pneumonia." }, { "input": "Frontal and lateral views of the chest. The lungs remain hyperinflated but clear without consolidation or pulmonary vascular congestion. There is no effusion. Cardiomediastinal silhouette is stable. No acute osseous abnormality is identified.", "output": "Hyperinflation without acute cardiopulmonary process." }, { "input": "AP and lateral views of the chest provided. Hyperinflated lungs and flattened diaphragms are grossly unchanged from comparison study and likely sequelae of COPD. Heart size is mildly enlarged, unchanged. Mediastinal contour similar. Prominence of the right hilar contour is compatible with underlying lymphadenopathy as seen on the previous CT. Pulmonary vasculature is not engorged. Minimal patchy opacities are seen in the lung bases without focal consolidation. No pleural effusion or pneumothorax is present. There are mild degenerative changes seen in the thoracic spine.", "output": "1. Patchy bibasilar opacities likely reflect atelectasis. . 2. Hyperinflated lungs compatible with COPD with unchanged right hilar lymphadenopathy." }, { "input": "The lungs are relatively hyperexpanded and clear without focal consolidation, pleural effusion, or pneumothorax. The pulmonary vasculature is not engorged and there is no overt pulmonary edema. The cardiac silhouette is mildly enlarged. The mediastinal and hilar contours are within normal limits. There is mild tortuosity of the thoracic aorta. There is kyphotic curvature of the thoracic spine with hypertrophic changes and mild generalized loss of vertebral body height.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is mildly enlarged. The mediastinal and hilar contours appear unchanged. A prominent pericardial fat pad is present, but otherwise aside from patchy bibasilar atelectasis, the lungs appear clear. There is no pleural effusion or pneumothorax. Hyperinflation is present.", "output": "No evidence of pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. There is again seen flattening of the diaphragms and mild basilar atelectasis. No definite focal consolidation is seen. There is no large pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are stable.", "output": "No significant interval change. Again seen hyperinflated lungs without significant interval change." }, { "input": "AP upright and lateral chest radiographs were obtained. The lungs are hyperinflated and the diaphragms are flattened. A vague opacity in the mid left lung without definite correlate on the lateral projection and is likely due to soft tissue summation of shadows. There may be mild right basilar atelectasis. There is no effusion or pneumothorax. The top normal heart is unchanged. The central pulmonary vasculature is indistinct.", "output": "No acute cardiopulmonary process." }, { "input": "Compared to ___ chest x-ray, there is new patchy opacity at the right lung base, slight blunting of the right costophrenic angle, AND minimal, if any, atelectasis at the left lung base. No gross left effusion. No CHF. Cardiomediastinal silhouette unchanged. Biventricular pacemaker again noted. No pneumothorax detected.", "output": "New or worsened right base patchy opacity. Differential diagnosis includes aspiration or an early pneumonic infiltrate. Atelectasis is in the differential, but considered less likely, as there also appears to be a small right effusion." }, { "input": "Cardiac size is top normal. Transvenous pacemaker leads are in standard position. The lungs are clear. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary abnormality. There is no pneumothorax" }, { "input": "Single portable view of the chest. No prior. Linear opacities at the left lung base laterally in the retrocardiac region are identified, potentially due to atelectasis. Lungs are otherwise clear. Cardiomediastinal silhouette is within normal limits. Mid thoracic dextroscoliosis is noted. Osseous and soft tissue structures are otherwise unremarkable.", "output": "Linear opacities at the left lung base suggestive of atelectasis; however, if high clinical suspicion for infection, two-view chest may offer additional detail." }, { "input": "PA and lateral views of the chest. The lungs are clear given slightly low lung volumes. The aorta is unfolded. Cardiac silhouette is normal in size. Hilar and mediastinal contours are normal. No pleural effusion. No evidence of pneumothorax. Degenerative changes are noted along the thoracic spine.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Again, slightly low lung volumes are seen. Given this, there is no focal consolidation, pleural effusion, or evidence of pneumothorax. The cardiac and mediastinal silhouettes are stable with the aorta being tortuous. There is no overt pulmonary edema. Some degenerative changes are seen along the spine. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. The heart and mediastinal contours are stable. No bony abnormalities.", "output": "No signs of pneumonia." }, { "input": "The cardiomediastinal and hilar contours are stable. The lung fields are clear. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable. There is mild dextroscoliosis of the thoracic spine.", "output": "No acute cardiopulmonary abnormalities." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. Heart and mediastinal contours are stable with aortic tortuosity. Sternal wires appear intact on these views. Coronary artery stent is imaged.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "There are calcified pleural plaques at the lung bases. Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is no focal lung consolidation. The lungs are hyperinflated with changes of emphysema.", "output": "1. Hyperinflated lungs, but no focal consolidation seen. 2. Calcified pleural plaque at the lung bases." }, { "input": "Cardiac silhouette size is mildly enlarged. The mediastinal and hilar contours are similar. There is mild pulmonary vascular congestion, improved compared to the previous study. No focal consolidation, pleural effusion or pneumothorax is present. Linear opacities within the right mid lung field may reflect areas of atelectasis or scarring. Clips are demonstrated in the left aspect of the neck. There are moderate degenerative changes seen in the thoracic spine.", "output": "Mild pulmonary vascular engorgement." }, { "input": "There is moderate interstitial edema. Streaky atelectasis is noted at the lung bases bilaterally. No focal consolidation is identified. The cardiac silhouette is mildly enlarged. There are small bilateral, right greater than left pleural effusions. No pneumothorax is seen.", "output": "Moderate interstitial edema. 2. Mild cardiomegaly with small bilateral, right greater than left pleural effusions" }, { "input": "Hyperinflated lungs noted with flattening of the diaphragms, suggesting COPD. There is no focal consolidation, effusion or pneumothorax. Mediastinal and hilar contours are normal. Heart size is normal.", "output": "1. No evidence of pneumonia. 2. Hyperinflated lungs and diaphragmatic flattening, suggestive of COPD." }, { "input": "The lungs are hyperinflated. No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process. No focal consolidation to suggest pneumonia." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. The lungs are hypoinflated but clear without focal consolidation. Known left humerus fracture is redemonstrated. The upper abdomen is unremarkable. No nondisplaced rib fracture is seen.", "output": "No acute cardiopulmonary process. Left humerus fracture, better assessed on dedicated radiographs." }, { "input": "AP upright portable chest radiograph obtained. No free air below the right hemidiaphragm is seen. Lungs are clear. Cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "No free air below the right hemidiaphragm. No acute intrathoracic process." }, { "input": "The heart is of normal size with normal cardiomediastinal contours. Small bilateral pleural effusions are new. Nodular opacity in the right upper lobe is likely a vessel on end. No focal consolidation or pneumothorax. No radiopaque foreign body.", "output": "New small bilateral pleural effusions." }, { "input": "Lung volumes are normal. There is an opacity in the right middle lung slightly obscuring the right heart border neck corresponds to a opacity projecting over the heart on lateral views. A small round well demarcated opacity is seen in left upper lung projecting over the inferior border of the sixth posterior rib. The cardiomediastinal hilar contours are normal. Possible small right pleural effusion. Otherwise remaining pleural surfaces are normal.", "output": "1. Right middle lobe pneumonia. 2. A possible new left upper lung nodule. Repeat chest radiographs with oblique views is recommended for further evaluation. RECOMMENDATION(S): Repeat chest radiographs with oblique views is recommended for further evaluation of possible left upper lung nodule. Please request that the technologist reviews the imaging with the radiologist prior to patient dismissal. If equivocal at that time, same day CT imaging is recommended. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 2:30 PM, 5 minutes after discovery of the findings." }, { "input": "The lungs are well-expanded and clear. No focal consolidation, effusion, edema, or pneumothorax. The heart is moderately enlarged. No acute osseous abnormality.", "output": "1. Moderate cardiomegaly. 2. No focal pneumonia." }, { "input": "The patient is status post median sternotomy and CABG. There appears to be stenting of a bypass graft. Lung volumes are reduced. The heart size is mildly enlarged. The aorta demonstrates atherosclerotic calcifications of the knob. Widening of the right paratracheal stripe is likely due to vascular structures and/or mediastinal fat. There is no pulmonary vascular congestion, focal consolidation or pleural effusion. No pneumothorax is identified, and there are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal silhouette and hilar contours are normal. Patient is status post CABG and atherosclerotic calcifications of the bypass graft vessels are present. Median sternotomy wires are well aligned and intact. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No evidence of sarcoid or infection. Atherosclerotic disease within the coronary artery bypass graft vessels." }, { "input": "Portable AP semi-erect chest radiograph ___ at 21:25", "output": "Tracheostomy tube is in satisfactory position with the tip 4.5 cm above the carina. The right internal jugular central line and nasogastric tube are unchanged in position. The heart remains stably enlarged. Lung volumes are markedly reduced and there is a small layering left effusion with persistent retrocardiac consolidation likely reflecting partial lower lobe atelectasis. No pulmonary edema. No obvious pneumothorax." }, { "input": "Portable semi-erect chest radiograph ___ 11:53 is submitted.", "output": "Tracheostomy tube and right internal jugular central line are unchanged in position. There is persistent collapse of the left lower lobe with an associated layering effusion. Pneumonia in this area cannot be excluded. A patchy opacity at the right medial lung base has developed and more likely reflects atelectasis in the setting of low volumes, although again pneumonia cannot be excluded. No pneumothorax. No pulmonary edema. The heart remains stably enlarged." }, { "input": "The patient is status post tracheostomy with the tube projecting over the trachea. An enteric tube courses below the level of the diaphragm and coils in the stomach. The cardiomediastinal and hilar contours are within normal limits. Atelectasis is noted at the left lung base, otherwise the lung fields are clear. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable.", "output": "No pneumothorax. Significant volume loss, left lower lobe, could be due to retained secretions. RECOMMENDATION(S): Consider chest CT for evaluation of the airway if left lower lobe does not re-expand." }, { "input": "The heart remains moderately enlarged. Lung volumes are decreased. Retrocardiac opacity could be secondary to atelectasis, however an underlying focal consolidation cannot be entirely excluded in this single-view. Blunting of the left costophrenic angle could be secondary to a small amount of pleural fluid. The right hemithorax remains clear with no new focal consolidation identified.", "output": "1. Persistent retrocardiac opacity which could be secondary to atelectasis, however an underlying focal consolidation cannot be entirely excluded in this portable examination. 2. Blunting of the left costophrenic angle reflect moderate amount of pleural fluid. Small right pleural effusion 3. Low lung volumes and cardiomegaly." }, { "input": "The left apical pulmonary contusion is better demonstrated the subsequent chest CT. No other areas of parenchymal consolidation. No evidence of pneumothorax or pleural effusions. Heart size is within normal limits. Known left first through third rib fractures are better assessed on the subsequent chest CT. Pneumomediastinum and extensive subcutaneous emphysema is seen bilaterally.", "output": "1. Left apical contusion is better demonstrated on the subsequent CT. No evidence of pneumothorax. 2. Known rib fractures involving the left ___ - 3rd ribs. 3. Pneumomediastinum and subcutaneous emphysema. RECOMMENDATION(S): Close interval follow-up with a chest radiograph." }, { "input": "Compared to the prior chest x-ray there is no significant change. There is persistent subcutaneous emphysema most prominent on the left. The pneumomediastinum does not appear to have significantly worsened. Stable left basilar atelectasis. Cardiac size is normal. There is no pneumothorax or pleural effusion.", "output": "No appreciable change in the pneumomediastinum and subcutaneous emphysema. No pneumothorax or pleural effusion. Stable left basilar atelectasis." }, { "input": "Single upright portable view of the chest is provided. Lung volumes are low bilaterally. Mild residual subcutaneous emphysema is seen on the left. There is no pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process, though low lung volumes limits detection of focal consolidation." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. Mild degenerative changes are noted in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Mild left basilar atelectasis is noted. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "There is a subtle left retrocardiac opacity which is concerning for infectious process. The right lung is clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "Subtle opacity in the left retrocardiac region possibly reflecting acute pneumonia. Repeat radiograph following treatment is advised. NOTIFICATION: Change to wet read conveyed to ___, RN for Dr.___, by Dr.___ ___ phone at 1:45pm on ___, 5 minutes following attending review." }, { "input": "Frontal and lateral chest radiographs were obtained. The lungs are fully expanded and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "The heart size, mediastinal, and hilar contours are normal.The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.", "output": "No evidence of pneumonia." }, { "input": "PA and lateral views of the chest provided. Previously noted PICC line has been removed. Mild right middle lobe atelectasis is noted. No focal consolidation concerning for pneumonia. No effusion or pneumothorax. No signs of congestion or edema. Cardiomediastinal silhouette is normal. Imaged bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or edema. Cardiac silhouette is within normal limits. Atherosclerotic calcifications seen at the aortic arch. No acute osseous abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "Linear opacities at the lung bases are most suggestive atelectasis. The lungs are otherwise clear without consolidation or effusion. There is pulmonary vascular congestion without edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "Bibasilar atelectasis and pulmonary vascular congestion without consolidation worrisome for pneumonia or edema." }, { "input": "Unchanged bilateral lower lobe atelectasis. No pleural effusion or pneumothorax identified. No focal consolidation. The size of the cardiomediastinal silhouette is within normal limits.", "output": "No significant interval change since the prior exam." }, { "input": "One portable upright view of the chest. The right internal jugular central venous catheter is stable. An ET tube ends 4.4 cm from the carina. NG tube traverses the esophagus and tip is below the level of this film. Compared to most recent study, there are new, mostly central and bibasilar opacities. A new right lower lobe heterogeneous opacity likely represents pulmonary edema; however, pneumonia cannot be ruled out. No pneumothorax. New small left pleural effusion.", "output": "New pulmonary edema with a more discrete opacity in the right lower lobe that likely also represents pulmonary edema however pneumonia cannot be ruled out. New small left pleural effusion." }, { "input": "Endotracheal tube ends approximately 4.4 cm above the carina and is adequately positioned. Orogastric tube is seen coursing into the stomach; however, the distal end is off radiographic view. Since ___, right lower lung opacities have increased and is concerning for aspiration/pneumonia. Increased retrocardiac density suggestive of lower lung atelectasis and presumed small bilateral pleural effusions is similar. Left-sided internal jugular line ends at upper SVC.", "output": "1. Increased right lower lung opacities since ___ is concerning for aspiration/pneumonia. Clinical correlation is required 2. Left lower lung atelectasis and presumed small bilateral pleural effusions are unchanged since ___." }, { "input": "A right internal jugular approach central venous catheter tip projects within the mid SVC. An endotracheal tube is in standard position with tip 4.4 cm above the carina. An enteric feeding tube courses below the diaphragm out of field of view. Since the prior examination, there has been improvement in parenchymal opacification, likely related to edema/atelectasis. There are no new focal occurring parenchymal opacities concerning for pneumonia. Pulmonary vascularity is not increased. Since the prior examination, there are areas of hyperlucency demonstrated along the left lateral aspect of the mediastinum projecting over the mid aspect of the mediastinum and adjacent to the left main stem bronchus, for which the possibility of pneumomediastinum cannot be excluded. Cardiomediastinal and hilar contours are otherwise stable. There is mild tortuosity of thoracic aorta. There are no pleural effusions or pneumothorax.", "output": "Multiple areas of hyperlucency as detailed above projecting in the region of the mediastinum which raises the possibility of pneumomediastinum, for which patient must undergo chest CT for further evaluation. Findings were discussed with Dr. ___ ___ telephone by Dr. ___ at 10:45 a.m. on ___." }, { "input": "There is interval removal of left PICC line. The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. The lungs are well expanded and clear of focal consolidation concerning for pneumonia.", "output": "No acute cardiopulmonary process." }, { "input": "A right chest port is present with distal tip in the proximal right atrium. Cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Atelectatic changes are present in the right lung base. The lungs are well expanded without focal consolidation. The upper abdomen is unremarkable.", "output": "Atelectatic changes at the right lung base." }, { "input": "A right subclavian central venous catheter terminates at the mid SVC. The heart size is normal. The hilar and mediastinal contours are within normal limits. There is no pneumothorax, focal consolidation, or pleural effusion.", "output": "No consolidation." }, { "input": "Frontal lateral radiographs of the chest demonstrate well expanded lungs. Mild bibasalar atelectasis is present. The cardiomediastinal and hilar contours are unchanged. A right-sided PICC line ends in the distal SVC. There is no consolidation, pneumothorax, or pleural effusion.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is mildly enlarged. There is new moderate pulmonary edema. There is no appreciable large pleural effusion. There is no focal consolidation or pneumothorax. Patient is status post mitral valve repair. Sternal wires are intact.", "output": "Mild cardiomegaly and moderate pulmonary edema." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. On the lateral view, a mild compression deformity involving a lower thoracic vertebral body (likely T10) is new from the prior radiograph. Deformity of the sternum likely reflect an old injury as is unchanged from prior. No free air below the right hemidiaphragm is seen.", "output": "T10 compression deformity, better assessed on same-day CT exam." }, { "input": "PA and lateral views of the chest were obtained. Cardiomediastinal silhouette is within normal limits. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "Heart size is top normal. The aorta is unfolded. Mediastinal and hilar contours are unchanged. Pulmonary vasculature is not engorged. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. Compression deformity of a low thoracic vertebral body, likely T10, is worse in the interval with at least ___% loss of vertebral body height anteriorly. Remote sternal fracture is again noted.", "output": "No acute cardiopulmonary abnormality. Interval worsening of a compression fracture within the low thoracic spine, likely the T10 vertebral body." }, { "input": "Lungs are clear and well inflated bilaterally with no focal consolidation, lesions, masses, pleural effusion, or evidence of pneumothorax. The cardiomediastinal silhouette is within normal limits. The pleural surfaces are unremarkable. Minimal degenerative changes of the thoracic spine is seen. There is no evidence of vascular congestion, pulmonary edema. Nipple markers were placed in order to disambiguate round opacities overlying lateral lung fields which were seen in the first image.", "output": "No evidence of CHF." }, { "input": "The lungs are clear of consolidation, effusion, or vascular congestion. The heart is mildly enlarged. No acute osseous abnormalities.", "output": "Mild cardiomegaly without acute cardiopulmonary process." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are unremarkable. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "A pacemaker is seen projected over the left chest wall with dual leads overlying the right atrium and ventricle. The lungs are clear. The cardiomediastinal silhouette and hilar contours are normal. The pleural surfaces are normal without effusion or pneumothorax.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Chronic left ribcage deformity noted. A sclerotic focus within a lower thoracic vertebral body is likely a bone island. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process. Please refer to subsequent CTA chest for further details." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "Endotracheal tube tip is 5.8 cm from the carina. Enteric tube passes below the field of view. Catheter projects over the right chest wall and abdomen, potentially a ventricular shunt. Diffuse bilateral parenchymal opacities seen in the lungs, right greater than left. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "Diffuse bilateral parenchymal opacities in the lungs. This could be due to multi focal pneumonia, edema, or ARDS." }, { "input": "The lungs are well-expanded and clear. The cardiomediastinal silhouette is unremarkable. The hilar pleural surfaces are normal. There is no subdiaphragmatic free air.", "output": "No acute cardiopulmonary pathology. No subdiaphragmatic free air." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unremarkable. Lungs are clear and the pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Patient is status post median sternotomy and CABG. There is cardiomegaly. Prominence of the main pulmonary artery raises concern for pulmonary arterial hypertension. Fluid is seen along the right major fissure, likely loculated. There are small bilateral pleural effusions. Right perihilar opacity may be due to vascular congestion and/or atelectasis, although focal consolidation is difficult to exclude. No evidence of pneumothorax is seen.", "output": "Bilateral pleural effusions with likely loculated component along the right major fissure. Pulmonary vascular congestion. Cardiomegaly." }, { "input": "PA and lateral views of the chest provided. Clips in the right upper quadrant again noted. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "No acute findings in the chest." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Vague sclerosis along the anterior lateral course of the left second rib may indicate a prior non-displaced fracture. Bony structures are otherwise unremarkable.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "PA and lateral views of the chest demonstrate the lungs are well expanded. Subtle increased opacity projects over the periphery of the right midlung. Elsewhere the lungs are clear. The cardiomediastinal silhouette is unremarkable. There is no pneumothorax, pleural effusion, pulmonary edema. Surgical clips are noted in the thyroid bed.", "output": "Subtle increased opacity projects over the periphery of the right midlung. This is nonspecific, could be infectious in the proper clinical setting. Recommend repeat after treatment to document resolution." }, { "input": "There has been interval removal of the endotracheal tube. The heart and mediastinal contours are at the upper limits of normal but unchanged from prior study. Bilateral hilar calcifications reflect calcified lymph nodes as demonstrated on prior torso.", "output": "Status post extubation without evidence of pulmonary consolidation or pneumothorax." }, { "input": "Portable AP supine chest radiograph obtained. The endotracheal tube is seen with its tip located about 2.9 cm above the carina. The NG tube courses into the left upper quadrant. Scattered pulmonary opacities could represent atelectasis, though a component of aspiration not excluded. Cardiomediastinal silhouette appears normal. Bony structures appear intact.", "output": "ET and NG tubes positioned appropriately. Scattered pulmonary opacities could represent aspiration or atelectasis. Please refer to subsequent CT torso for further details." }, { "input": "The lungs are grossly clear. Calcific densities project over lateral soft tissues and over the lower lobes but are seen within the breasts on prior CT. The lungs are clear of new consolidation or large effusion. The cardiomediastinal silhouette is unchanged. No acute osseous abnormalities identified.", "output": "No definite acute cardiopulmonary process." }, { "input": "The cardiac silhouette size remains mildly enlarged. The mediastinal and hilar contours are unchanged with calcified mediastinal and hilar lymph nodes again demonstrated compatible the patient's history of sarcoidosis. There is no pulmonary vascular congestion. Streaky and linear opacities within the lingula and left lower lobe appear similar compared to the previous exam, and may reflect areas of scarring and/or atelectasis. Minimal patchy opacity within the right lung base could reflect infection or atelectasis. No pleural effusion or pneumothorax is identified.", "output": "Patchy opacity within the right lung base could reflect atelectasis but infection is not excluded. Probable scarring or linear atelectasis within the left lung base." }, { "input": "Single frontal AP upright view the chest provided. Lung volumes are low limiting assessment. The heart appears moderately enlarged though this may be partially exaggerated by technique. In the setting of low lung volumes, the lungs appear relatively clear though the retrocardiac space is poorly assessed. No large pneumothorax or effusion is seen. The mediastinal contour cannot be assessed. No definite fracture is seen.", "output": "As above." }, { "input": "Linear retrocardiac opacity is seen and could potentially represent atelectasis however infection is not entirely excluded. Multiple previously seen calcified conglomerate lymph nodes in the mediastinum and left hilum as seen on prior studies. There is no effusion, or pneumothorax. No evidence of cardiomegaly. Imaged osseous structures are intact. No evidence of free air below the diaphragm.", "output": "1. Linear retrocardiac opacity is seen and could potentially represent atelectasis however infection is not entirely excluded. 2. Multiple stable calcified conglomerate lymph nodes in the mediastinum and left hilum." }, { "input": "Portable semi-upright radiograph of the chest demonstrates low lung volumes with resulting bronchovascular crowding. Again seen is extensive retrocardiac atelectasis and extensive bilateral parenchymal opacities with air bronchograms. Overall the appearance is not significantly changed from the prior study dated the same day. An endotracheal tube ends 4.3 cm from the carina. An enteric feeding tube courses into the stomach with the last side port below the GE junction. There is no pneumothorax. Calcified hilar lymph nodes are suggestive of prior granulomatous infection.", "output": "Enteric feeding tube courses into the stomach with the last side port below the GE junction." }, { "input": "Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is no focal lung consolidation. Calcified left hilar and adjacent mediastinal and cervicothoracic lymph nodes, demonstrated on prior abdominal CT from ___, indicate prior granulomatous infection, including tuberculosis or histoplasmosis.", "output": "No evidence of pneumonia." }, { "input": "Subtle right base opacity is more likely due to atelectasis or overlap of vascular structures rather than pneumonia. . The left lung is clear. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Subtle right base opacity is more likely due to atelectasis or overlap of vascular structures rather than pneumonia" }, { "input": "The examination is markedly limited by a severe chest deformity including dextroscoliosis and extensive ___ rod stabilization. Left hemithorax remains markedly opacified, unchanged from ___. The visualized left upper lobe and right lower lobes are grossly clear. The cardiac silhouette is not well evaluated but appears moderate to severely enlarged. The mediastinum cannot be assessed that also appears prominent. It is unclear how much of this is due to increased vascularity. . The patient's tracheostomy tube terminates 4.5 cm above the carina.", "output": "Markedly limited examination which appears grossly unchanged from ___." }, { "input": "There is no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal contour is normal. The previously seen aortic pseudoaneurysm is not radiographically appreciable.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. Coronary artery stent is noted. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "AP portable upright view of the chest. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process" }, { "input": "The lungs are hyperinflated but remain clear without consolidation, effusion, or edema. Mild cardiac enlargement is noted as well as coronary artery stent. Median sternotomy wires and mediastinal clips are seen. The thoracic aorta is heavily calcified. Bones are diffusely demineralized.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or edema. Cardiomediastinal silhouette is stable. Median sternotomy wires, mediastinal clips, and coronary artery stents are again noted. Dense atherosclerotic calcifications noted in the aorta. No acute osseous abnormalities, mild height loss of lower thoracic/ upper lumbar vertebral body is unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "No change since ___, with a moderately calcified aortic arch, mild cardiomegaly, and a tortuous descending thoracic aorta. No pleural effusion or pneumothorax. No pneumonia. Mild scoliosis of the thoracic spine. Osseous structures are diffusely demineralized.", "output": "No pneumonia. No change since ___." }, { "input": "As before, the patient is status post median sternotomy, coronary artery stenting and CABG. Mild unchanged cardiomegaly. The aorta is tortuous and diffusely calcified. The mediastinal and hilar contours are unchanged. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. As before, degenerative changes are noted in the imaged thoracolumbar spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear without consolidation, effusion, or pulmonary vascular congestion. Cardiomediastinal silhouette is stable. Atherosclerotic calcifications noted at the aortic arch. Median sternotomy wires and mediastinal clips are again noted.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well inflated and clear. The cardiac silhouette is mildly enlarged, as before. The thoracic aorta is tortuous and calcified. There is no pleural effusion or pneumothorax. Median sternotomy wires and surgical clips are again noted. There is scoliosis of the thoracolumbar spine.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is minimally enlarged, but stable in size from the prior examination. Sternotomy wires and surgical clips are stable. The aorta is tortuous and calcified, but unchanged. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. No edema.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear. No evidence of pneumonia. There is no pleural effusion. No pneumothorax. Cardiac, mediastinal, and hilar contours are normal and stable. Post-surgical changes of median sternotomy with CABG are again seen. Calcifications in the aortic arch are stable. Stable appearance of wedge deformity of T12.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. There is no effusion or pneumothorax. The heart size is normal. There are post-surgical changes and median sternotomy with CABG. Note is made of calcification of the aortic arch. The pulmonary vasculature is normal appearing. There is stable appearance of wedge deformity of T12. No displaced rib fracture is appreciated.", "output": "No acute chest pathology. If there is further concern for rib fracture, recommend repeat dedicated views with a BB marker to mark the site of pain." }, { "input": "Frontal and lateral views of the chest. The lungs are clear of consolidation, effusion, or pulmonary vascular congestion. The cardiomediastinal silhouette is stable when compared to prior. Hypertrophic changes are seen in the spine without acute osseous abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. There is a large amount of free air beneath the hemidiaphragms.", "output": "Clear lungs. Large amount of pneumoperitoneum. The patient is reportedly status post recent cholecystectomy ; amount of air appears larger than would be expected for cholecystectomy 5 days prior, unclear whether findings may relate to post surgical change, bowel perforation not excluded. NOTIFICATION: Emergency medicine team is aware." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiograph demonstrate clear lungs bilaterally. No focal opacity convincing for pneumonia are identified. Cardiomediastinal and hilar contours are within normal limits. There is no pleural effusion or pneumothorax. Visualized osseous structures demonstrates no acute abnormality. No air under the right hemidiaphragm is noted.", "output": "No acute intrathoracic abnormality." }, { "input": "Study is essentially unchanged from prior. Lungs are well expanded and clear bilaterally with no masses, lesions or pleural effusion. There is no pneumothorax. Again visualized is a large hiatal hernia, essentially unchanged from before. Cardiomediastinal silhouette is stable demonstrating normal-sized heart with a tortuous aorta. Pleural surfaces are unremarkable. There is stable moderate multilevel degenerative change seen along the thoracic spine.", "output": "1. No evidence of pneumonia or congestive heart failure. 2. Large hiatal hernia, unchanged." }, { "input": "The ET tube is not visualized on the current study and is apparently been removed. Clinical correlation is requested. An NG type tube extends to a site overlying the left lung base, presumably ___ within the stomach at the site of a large left hiatal hernia. Again seen is extensive opacification of the left mid and lower zones. On today's study, there is additional hazy opacity extending into the lower portion of the left upper zone. The right lung is similar in appearance, with hazy opacity at right lung base which could reflect pleural fluid and underlying collapse and/or consolidation. Background interstitial opacities in the right upper and mid could represent either interstitial edema or other interstitial infiltrates.", "output": "Apparent interval removal of the ET tube --___ correlation is requested. Overall similar to the prior study, but with new hazy opacity in the left upper zone." }, { "input": "Rotated positioning. This limits assessment of the cardiomediastinal silhouette. An ET tube is present, tip in satisfactory position approximately 2.5 cm above the carina. An NG tube is present. This overlies a rounded focus of air which is thought to represent gas within a large hiatal hernia. There is associated elevation of left hemidiaphragm and overlying left base atelectasis. The left lung apex appears grossly clear. Left mid zone is considerably obscured due to rotation, but the possibility of pleural fluid at the left base cannot be excluded. On the right, there is new opacity, particularly in the right mid and lower zones. This in part represents vascular plethora, but the right hemidiaphragm is now obscured suggesting a pleural effusion, with underlying collapse and/or consolidation. No pneumothorax is identified.", "output": "1. New opacity at the right lung base, likely a pleural effusion, with underlying collapse and/or consolidation. 2. Suspect new vascular plethora/early CHF, based on the appearance of the right upper and mid zones. 3. Large left hiatal hernia, with left lung base atelectasis and pleural effusion. 4. Limited assessment of the cardiomediastinal silhouette. Allowing for significant rotation, no definite change. 5. No pneumothorax identified." }, { "input": "Again seen is a large left upper lobe mass abutting the mediastinal border measuring approximately 7.5 cm in the CC direction, perhaps slightly increased since the prior studies. There are no pleural effusions or pneumothorax. The right lung is predominantly clear. The cardiomediastinal silhouette is unchanged. Imaged upper abdomen is unremarkable. There is stable elevation of the left hemidiaphragm. Multiple old healed rib fractures are again noted.", "output": "Large left upper lobe mass may be slightly increased since the prior studies." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable otherwise. There is no pleural effusion or pneumothorax. Deformities of multiple posterior ribs bilaterally are unchanged from prior exam and suggest healed old fractures. There is also a stable wedging deformity of a mid thoracic vertebrae which is also unchanged compared with ___.", "output": "No evidence of acute cardiopulmonary process. Old healed fractures of the posterior rib as well as the compression fracture of the mid thoracic vertebrae are unchanged since ___. Left upper lobe mass adjacent to aortic knob is better seen in subsequent CT." }, { "input": "A large left upper lobe mass containing fiducial markers is re- demonstrated, as seen on the prior PET-CT, and increased when compared to the prior chest radiograph exam. Heart size is normal. Right mediastinal and hilar contours are unchanged. Elevation of the left hemidiaphragm is noted. The lungs otherwise are otherwise clear with no new areas of consolidation identified. No pulmonary vascular congestion is seen. No pleural effusion or pneumothorax is noted. Remote bilateral rib fractures are noted.", "output": "Re- demonstration of left upper lobe mass compatible with known non-small cell lung cancer. No acute cardiopulmonary abnormality otherwise noted." }, { "input": "The cardiac and mediastinal silhouettes are unremarkable. No pleural effusion or pneumothorax is seen. On the lateral view, there is equivocal opacity projecting over the posterior lung base, not well substantiated on the frontal view. Findings could be due to atelectasis although an underlying consolidation is not entirely excluded.", "output": "On the lateral view, there is equivocal opacity projecting over the posterior lung base, not well substantiated on the frontal view. Findings could be due to atelectasis although an underlying consolidation is not entirely excluded." }, { "input": "AP and lateral views of the chest. The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are normal. Atherosclerotic calcifications at the aortic knob. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "Normal chest radiograph." }, { "input": "PA and lateral chest views were obtained with patient upright position. The heart size is normal. No configurational abnormality is present. Thoracic aorta and mediastinal structures are unremarkable. The pulmonary vasculature is not congested. No signs of acute or chronic parenchymal infiltrates are present and the lateral and posterior pleural sinuses are free. No pneumothorax in apical area. Skeletal structures of the thorax are grossly unremarkable. When comparison is made with the next preceding chest examination of ___, chest findings as seen on the frontal view are stable. The previous examination was obtained to identify a dislocated right-sided PICC line.", "output": "No evidence of acute pneumonic infiltrate in a ___-year-old male patient with cough." }, { "input": "AP portable chest x-ray shows moderate lung volume without consolidation, suspicious for pneumonia. Minimal linear opacity at the left lung base is due to atelectasis. Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax.", "output": "There is no sign of pneumonia." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and hyperinflated lung volumes. There is no focal opacity, pneumothorax, or pleural effusion. Pes excavatum is noted.", "output": "No acute cardiopulmonary process." }, { "input": "AP portable upright view of the chest. Overlying EKG leads are present. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process" }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well expanded. Bibasilar linear opacities are attributable to vascular markings. There is no definite consolidation, effusion, or pneumothorax. Cardiac and mediastinal contours are normal. On the lateral view, a relatively dense well circumscribed 1 cm nodule is again seen, unchanged from ___.", "output": "1. No acute cardiopulmonary process. 2. Well-circumscribed nodule either within the anterior left lung or anterior mediastinum. The nodule is stable since ___ but should be assessed with CT, if this exam has not been performed elsewhere." }, { "input": "Dobbhoff tube terminates in the stomach on the second in a series of two images. The lungs are well expanded. Right base opacity is unchanged from prior exam, likely a moderate right pleural effusion. The lungs are clear. There is no pneumothorax. There is no left pleural effusion. The cardiomediastinal silhouette is unremarkable.", "output": "Dobbhoff tube terminates in the stomach. Otherwise unchanged exam from prior, with probable moderate right pleural effusion unchanged." }, { "input": "ET tube and right IJ central line are in adequate position. The NG tube terminates with the side port at the level of the GE junction. The tube could be advanced 5-10 cm for more optimal positioning. The lungs are well expanded. Peribronchial opacification is seen in the right lower lung extending to the chest wall, concerning for aspiration. There is left lower lobe collapse, which could also possibly be due to aspiration. Diffuse hazy opacity at the left lung base suggests a left pleural effusion. There is no effusion. The cardiomediastinal silhouette is unremarkable.", "output": "1. Peribronchial opacification in the right lower lung extending to the chest wall, concerning for aspiration. 2. Left lower lobe collapse, which could also be possibly due to aspiration. 3. Left pleural effusion. 4. ET tube and right IJ central line are in adequate position. 5. NG tube terminates with the side port at the level of the GE junction. The tube could be advanced 5-10 cm for more optimal positioning. NOTIFICATION: Updated findings from original wet read communicated to Dr. ___ at 7:51 a.m. ___ by phone." }, { "input": "PA and lateral views of the chest. No prior. Lungs are essentially clear, noting mild bibasilar left greater than right subsegmental atelectasis. The cardiomediastinal silhouette is within normal limits. Hypertrophic changes are seen in the spine.", "output": "Bibasilar atelectasis. Otherwise, no acute cardiopulmonary process." }, { "input": "Lungs are hyperinflated, suggesting background COPD. Right size is at the upper limits of normal. No CHF, focal infiltrate or effusion is detected. Probable mild eventration of the right hemidiaphragm. Scattered bilateral carotid artery calcification noted.", "output": "Suspected background COPD. No focal infiltrate to suggest pneumonia or aspiration. No free air seen beneath the diaphragm." }, { "input": "Bilateral diffuse pulmonary opacities consistent with moderate pulmonary edema in a patient with cardiogenic shock. Moderate cardiomegaly is noted. The intra-aortic balloon pump tip terminates at the aortic arch.", "output": "Moderate pulmonary edema and cardiomegaly consistent with cardiogenic shock. The intra-aortic balloon pump tip terminates at the border of the aortic arch. Recommend retraction by 2 cm. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 2:08 PM, 20 minutes after discovery of the findings." }, { "input": "The Swan-Ganz catheter is been removed. Sternal wires are again visualized. There is mild cardiomegaly. There bilateral pleural effusions right greater than left with volume loss in both lower lobes, right more so than left. There is mild pulmonary vascular redistribution. Compared to the prior exam the amount of volume loss in the lower lobes has increased but the vascular plethora has decreased", "output": "Persistent bilateral effusions and lower lobe volume loss" }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs. There is no focal consolidation, pleural effusion, or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Supine portable AP view of the chest provided. The endotracheal tube is seen with its tip located approximately 4.2 cm above the carina. The NG tube courses inferiorly, though the tip is not clearly visualized. The lung volumes are low, though aside from scattered mild atelectasis the lungs appear clear. Cardiomediastinal silhouette appears grossly unremarkable. No bony abnormalities.", "output": "Appropriately positioned endotracheal tube. A nasogastric tube tip not visualized." }, { "input": "AP upright view of the chest demonstrates normal lung volumes without pleural effusion, focal consolidation, or pneumothorax. The hilar and mediastinal silhouettes are unremarkable. Heart is normal in size. There is no pulmonary edema. Right hilar fullness is noted. Old bilateral rib fractures are seen. Partially imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "One portable AP upright view of the chest. There are low lung volumes. The lungs are grossly clear. There is no evidence of pneumothorax or pleural effusion. Cardiac, mediastinal, and hilar contours are normal. There are apparently old rib fractures at T7 and T8 on the right and T7 on the left.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Left-sided Port-A-Cath tip terminates in the mid SVC. Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is identified. Pulmonary vasculature is normal. There are no acute osseous abnormalities. Previously demonstrated sclerotic foci in the vertebral bodies are not well assessed on the current exam.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Left-sided Port-A-Cath tip terminates in the mid SVC. The cardiac, mediastinal and hilar contours are normal. Lungs are clear and the pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary abnormality." }, { "input": "A left Port-A-Cath terminates in the mid SVC. The lungs are well expanded. There is a retrocardiac opacity that is not well localized on the frontal view, but which could be an area of developing pneumonia in the right clinical setting. There is a small right pleural effusion. There is no left pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "1. Retrocardiac opacity, not well localized on the frontal view, which could be an area of developing pneumonia in the right clinical setting. 2. Small right pleural effusion." }, { "input": "PA and lateral views of the chest. The lungs are clear. There is no effusion or pneumothorax. The cardiomediastinal silhouette is normal. Osseous structures are unremarkable.", "output": "Normal chest x-ray." }, { "input": "PA and lateral views of the chest. The lungs are clear. The cardiomediastinal silhouette is normal. Surgical clips project over the left lateral chest wall, and patient is status post left mastectomy. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. There is no pneumomediastinum. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. Low lung volumes somewhat limit the assessment. There is no focal consolidation, large effusion or pneumothorax. Cardiomediastinal silhouette appears grossly unremarkable. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Heart size is normal. Atherosclerotic calcifications are seen at the aortic knob. Mediastinal and hilar contours are normal. Pulmonary vasculature appears normal. Lungs are clear. No pleural effusion or pneumothorax is present. Moderate degenerative spurring is seen the imaged thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. No evidence of free air is seen beneath the diaphragms. Degenerative changes are seen along the spine.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs are clear without any consolidation, pleural effusion or thickening, pulmonary edema or masses. The cardiac, mediastinal and hilar contours are normal without any lymphadenopathy.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen on this single view. The aorta is tortuous. There is no mediastinal widening. Heart size is normal.", "output": "No radiographic evidence for acute cardiopulmonary process. This study was discussed with Dr. ___ by Dr. ___ by telephone at 6:40 a.m. on ___ at the time of initial review of the study and wet read request." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. There is no pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Minimal right basilar atelectasis/scarring is seen. There is no focal consolidation. No pleural effusion or pneumothorax is seen. The hilar contours are stable. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Hilar contours are stable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The endotracheal tube is low, with the tip terminating just above the carina. Recommended retracting at least 3cm for optimum positioning. Nasogastric tube ends in the proximal portion of the body of the stomach with sidehole at the level of the gastroesophageal junction, and recommended further advancement. A right IJ approach venous pacer lead ends at the level of the right ventricle. The lung volumes are extremely low. Mild pulmonary congestion is seen. Small left pleural effusion with likely compressive atelectasis of the left lung base is noted. The cardiomediastinal and hilar contours are stable, with mild cardiomegaly. No pneumothorax is seen. Old healing left rib fracture is again seen.", "output": "1. ET tip terminating at the carina, recommended retraction. 2. NG tube sideholes are at the level of the gastroesophageal junction, recommended further advancement. 3. Right IJ approach venous pacer lead ends at the level of the right ventricle. 4. Small left pleural effusion and left basal atelectasis. The above findings were discussed with Dr.___ at 10:00 p.m on ___ via telephone." }, { "input": "The heart is mildly enlarged. A left sided pacemaker is seen in adequate position with its leads terminating in the right atrium and right ventricle, expected locations. There is calcification of the aortic knob. There are increased interstitial pulmonary markings which may relate to chronic lung findings or mild pulmonary edema. There is no definite focal consolidation, pleural effusion or pneumothorax.", "output": "Increased interstitial pulmonary markings may relate to chronic lung findings or mild pulmonary edema." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion pneumothorax. The lungs are expanded clear without focal consolidation concerning for pneumonia. Known right rib fractures are better assessed on recent chest CT. The upper abdomen is unremarkable.", "output": "No pneumothorax or other acute cardiopulmonary process." }, { "input": "The lungs are well inflated and free of consolidation. The heart is not enlarged. The osseous structures are normal for age.", "output": "Lungs clear." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. A moderate interstitial abnormality is a finding that could be seen with severe airway inflammation, atypical pneumonia or possibly pulmonary edema, although without specific signs of the latter.", "output": "Moderate interstitial abnormality which is not specific but could be seen with reactive airway disease as clinically suspected." }, { "input": "PA and lateral radiographs of the chest were acquired. The lungs are clear. Previously seen mild interstitial pulmonary edema on radiographs from ___, has resolved. There are no pleural effusions. No pneumothorax is seen. The cardiac and mediastinal contours are normal. There is unchanged resorption of the distal right clavicle.", "output": "No acute cardiac or pulmonary process." }, { "input": "Lung volumes are low. No focal consolidation, pleural effusion, or pneumothorax is seen. Heart size is top normal. Linear opacity projecting over the right middle lobe likely represents atelectasis.", "output": "Low lung volumes without radiographic evidence for acute cardiopulmonary process." }, { "input": "The lungs are slightly hyperexpanded, with relative flattening of the bilateral hemidiaphragms. There is enlargement of the ascending thoracic aorta, seen best on the lateral view, compatible with known history of aortic aneurysm. The lungs are clear, with no pneumothorax, pulmonary edema, pleural effusion, or focal consolidation.", "output": "Enlargement of the ascending thoracic aorta, compatible with known history of aneurysm. No pneumonia or effusion." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs are fully expanded and clear. Cardiomediastinal and hilar silhouettes and pleural surfaces are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable view of the chest. Endotracheal tube is approximately 3.2 cm from the carina. Enteric tube passes below the inferior field of view, tip not clearly identified. Relatively low lung volumes are noted with crowding of the bronchovascular markings. Lungs are grossly clear. The cardiac silhouette appears enlarged but this is likely accentuated due to technique and low inspiratory effort.", "output": "ET and enteric tubes in appropriate position." }, { "input": "There are bilateral pulmonary nodules and potentially masses, most numerous at the lung bases. The largest conglomerate abnormality projects over the superior segment of the right lower lobe. Blunting the left costophrenic angle could be due to atelectasis or small effusion. The cardiomediastinal silhouette is within normal limits. No definite focal osseous abnormality identified. Deformity of the mid left clavicle suggests prior healed fracture.", "output": "Diffuse bilateral nodules/masses in the lungs, most numerous at the lung bases worrisome for metastatic disease. Please note that superimposed infection, particularly in the right lower lobe would be difficult to exclude given disease burden and lack of priors." }, { "input": "Opacity in the right lower lobe is concerning for pneumonia. . No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Right lower lobe pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. Dr. ___ on the ___ ___ at 4:00 PM, 5 minutes after discovery of the findings." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest demonstrate well-expanded clear lungs. The heart is normal in size and cardiomediastinal contour is unremarkable. There is no pleural effusion and no pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is no focal lung consolidation. Calcification projecting over the left heart border, likely corresponding to LAD coronary artery stent.", "output": "No evidence of pneumonia." }, { "input": "Frontal and lateral views of the chest. There is new patchy consolidation identified in the right lower and middle lobes. Elsewhere, the lungs are clear. The cardiomediastinal silhouette is unchanged. Atherosclerotic calcification seen at the aortic arch. No acute osseous abnormalities detected.", "output": "Right lower lobe consolidation compatible with pneumonia. Recommend repeat after treatment to document resolution." }, { "input": "There is a persistent multi cavitary consolidation in the right upper lobe with associated mild volume loss. There has been interval development of bilateral heterogeneous consolidations concerning for multi focal pneumonia. Moderate bilateral pleural effusions are better seen on concurrent CT. The cardiac silhouette is normal. There is no pneumothorax. A right chest Port-A-Cath terminates at the distal SVC.", "output": "1. Persistent right upper lobe cavitary consolidation remains concerning for post-primary TB. 2. Bilateral heterogeneous consolidations are concerning for multi focal pneumonia, massive aspiration, or hemorrhage. 3. Moderate bilateral pleural effusions are seen to better detail on concurrent chest CTA dictated separately." }, { "input": "2 views were obtained of the chest. The lungs are low in volume but clear with minimal basilar atelectasis. There is no pleural effusion or pneumothorax. The heart is mildly enlarged. Hilar and mediastinal contours are unremarkable.", "output": "No acute intrathoracic process." }, { "input": "A Port-A-Cath terminates at the cavoatrial junction. The heart is normal in size. The mediastinal and hilar contours appear stable. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "AP and lateral views of the chest are compared to previous exam from ___ and CT from ___. Nodular mass projecting over the left mid lung is again seen, compatible with patient's known lung cancer. As on prior, there is elevation of the left hemidiaphragm. Left basilar linear atelectasis is also seen. There is no effusion or large consolidation. Cardiac silhouette is stable. Catheter projects over the anterior right chest wall. Osseous and soft tissue structures are otherwise unremarkable.", "output": "No significant interval change since prior." }, { "input": "Left lung nodule is present and better evaluated on prior CT. Adjacent linear scarring is present Ventriculoperitoneal shunt is seen to course through the right hemithorax and into the abdomen. Atelectasis and scarring is seen at the bilateral bases as well as persistent elevation of the left hemidiaphragm. There is no pleural effusion or pneumothorax.", "output": "Left lung nodule. No acute process." }, { "input": "A right-sided ventriculoperitoneal shunt is noted. Known left upper lobe mass is not clearly delineated on this study. There is however a new small to moderate left pleural effusion with adjacent opacity suggesting atelectasis. An overlying infectious process cannot be excluded. A small opacity is noted overlying the right middle lobe. Cardiac and mediastinal contours appear stable. No acute fractures are identified.", "output": "In this patient with a known left upper lobe mass, there is a new small left pleural effusion with adjacent atelectasis. Overlying infection in this region cannot be excluded. Additionally, a faint opacity is noted over the right middle lobe. Further characterization may be obtained with a dedicated Chest CT." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is enlarged but likely exaggerated related to lower lung volumes. Pulmonary vascular congestion is unchanged. The left hemidiaphragm is obscured secondary to a small left pleural effusion and increasing adjacent atelectasis though given patient's current symptoms a superimposed pneumonia cannot be excluded. No pulmonary edema or pneumothorax are seen.", "output": "Small left pleural effusion and adjacent atelectasis though superimposed left lower lobe pneumonia cannot be excluded." }, { "input": "PA and lateral views of the chest. Low lung volumes limits assessment. Within that limitation no definite focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "Low lung volumes limits assessment. Recommend repeat films with better inspiration." }, { "input": "PA and lateral views of the chest. No focal consolidation, pleural effusion, or pneumothorax. Cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Single frontal view of the chest demonstrates an ET tube extending approximately 5 mm into the proximal right main bronchus. The enteric tube extends into the region of the stomach with side port below the GE junction. An IVC filter is in expected location. Mildly prominent cardiac silhouette is accentuated by low lung volumes and AP technique. Mild mediastinal prominence is likely due to supine technique, although in the setting of trauma, vascular injury should be correlated with cross-sectional imaging. Mild atherosclerotic calcifications are seen in the aortic arch. Interstitial markings are prominent, likely due to crowding related to low lung volumes. Trace effusions cannot be excluded. There is mild irregularity along the anterolateral aspect of the left eighth and ninth ribs, to be correlated with focal tenderness.", "output": "1. ET tube 5 mm distal to the right main bronchus. Recommend retraction by approximately 4-5 cm to achieve appropriate positioning. 2. Enteric tube in appropriate position. 3. Subtle irregularity along anterolateral left eighth and ninth ribs, to be correlated with focal tenderness for possible fracture. 4. Low lung volumes, accentuating bronchovascular markings. Finding of right mainstem bronchus intubation phoned to the SICU at 6:30 pm by Dr. ___." }, { "input": "An endotracheal tube is in place with the tip approximately 2.9 cm from the carina. A left subclavian central line is seen with the tip terminating in the mid SVC, approximately 6 cm from the atriocaval junction. A small bore feeding tube is seen passing below the diaphragm with the tip and side port seen within the stomach. There is a partially visualized IVC filter. There are atelectatic changes at the left base. The lungs are otherwise clear without consolidations or pleural effusions. There is mild prominence of the mediastinum, which is unchanged from prior radiographs. The heart is normal in size.", "output": "1. Small bore feeding tube is seen within the stomach in proper position. 2. Endotracheal tube approximately 2.9 cm from the carina. 3. Left subclavian central line with tip terminating in the mid SVC." }, { "input": "Large amount of free intraperitoneal air is present below the right hemidiaphragm. Within the chest, small calcified granulomas are present in the right apex, seen to better detail on recent CT. New patchy left basilar opacity likely reflects atelectasis, although aspiration is an additional consideration given patient's risk for this entity. Several sclerotic left rib lesions are noted and may be related to metastatic prostate cancer as reported on recent CT torso.", "output": "1. Large amount of free intraperitoneal air, as discussed by telephone with Dr. ___ at 9:41 a.m. on ___. 2. Patchy left basilar atelectasis versus aspiration." }, { "input": "The NG tube is seen within the stomach. A left subclavian central venous catheter ends in the upper SVC. There has been removal of the endotracheal tube. In comparison to the prior radiograph, there are lower lung volumes with new mild hazy bibasilar opacities consistent with atelectasis. The cardiomediastinal silhouette appears slightly larger, likely due to the lower lung volumes. There is no pleural effusion or pneumothorax. An IVC filter is seen within the abdomen.", "output": "1. NG tube ends in the stomach. 2. Mild bibasilar hazy opacities consistent with atelectasis." }, { "input": "The cardiomediastinal and hilar contours are stable since the prior examination with bilateral hilar and and subcarinal lymphadenopathy. There is no pleural effusion or pneumothorax. No focal consolidation concerning for pneumonia is seen.", "output": "Stable lymphadenopathy without other acute intrathoracic abnormality. No evidence of disease progression." }, { "input": "PA and lateral views of the chest were provided. There is slight prominence of the right pulmonary hilum. No definite signs of pneumonia or CHF. No large effusion or pneumothorax. Heart size is normal. Mediastinal contour is unremarkable. Bony structures appear intact.", "output": "Right hilar prominence, consider non-emergent CT to further assess." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Streaky opacity in the left lower lobe is concerning for pneumonia. Right lung is clear. No pleural effusion or pneumothorax is present. No acute osseous abnormality is identified.", "output": "Left lower lobe pneumonia. Followup radiographs after treatment are recommended to ensure resolution of this finding." }, { "input": "Lower lung volumes seen on the current exam however the lungs remain clear. There is no focal consolidation, effusion, pneumothorax, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax identified. The size the cardiac silhouette is within normal limits.", "output": "No radiographic evidence of acute cardiopulmonary disease." }, { "input": "A right Port-A-Cath is unchanged with the tip terminating in the proximal right atrium. The inspiratory lung volumes are appropriate. Bibasilar opacities are improved from the prior study of ___. A trace right pleural effusion is likely present. The lungs are clear without focal consolidation concerning for pneumonia. No pneumothorax or left pleural effusion is seen. The pulmonary vasculature is not engorged. The cardiomediastinal and hilar contours are within normal limits. No acute osseous abnormality is detected.", "output": "No focal consolidation concerning for pneumonia." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. The pulmonary vasculature is normal. No pleural effusion or pneumothorax is visualized. No acute osseous abnormalities seen. There is mild dextroscoliosis.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The endotracheal tube terminates 3.3 cm above the carina. A right internal jugular central venous line terminates at the level of the brachiocephalic vein, but is now apparently curved back on itself and the tip has moved away from the heart over time. An orogastric tube courses into the stomach and inferiorly out of the field of view. There is persistent bilateral lower lobe atelectasis, right greater than left. The hilar and cardiomediastinal contours are normal. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal.", "output": "1. The right internal jugular central line is now curved back on itself and has been retracting superiorly over time. Correlate with examination. If the catheter is not visibly further out of the skin accesss ite, the catheter could be curved back into the Right IJ. 2. Bibasilar subsegmental atelectasis. NOTIFICATION: Findings regarding the central venous line were communicated to Dr. ___ by Dr. ___ ___ phone on ___ at 11:22 am, 5 minutes after discovery." }, { "input": "Single portable view of the chest. Endotracheal tube is seen with tip approximately 4 cm from the carina. Enteric tube is seen passing below the inferior field of view, tip not visualized. The lungs are grossly clear. The cardiomediastinal silhouette is within normal limits. Contour irregularity of the medial aspect of the proximal left humerus is incompletely evaluated.", "output": "Endotracheal and enteric tubes in appropriate position. Contour irregularity of the medial aspect of the proximal left humerus could be further assesses by nonurgent dedicated exam when feasible." }, { "input": "The heart size is at the upper limits of normal. The mediastinal contours are unchanged. An AA central venous line is seen with its tip at the cavoatrial junction. The lungs are clear. There are no pleural effusions. The initial film obtained at 16 hr and ___ min demonstrates an NG tube in the midesophagus with its tip curving cranially. The second film obtained obtained at 16 hr and ___ min demonstrates the tip of the to straightened out and positioned in the lower esophagus close to the GE junction. A third film obtained at 16:00 and ___ min demonstrates the tube in the stomach with the last side hole in the stomach.", "output": "NG tube in adequate position in the stomach." }, { "input": "Portable semi-upright radiograph of the chest demonstrates low lung volumes which results in bronchovascular crowding. There is mild bibasalar atelectasis. Cardiomediastinal and hilar contours are unchanged. No pneumothorax. Right-sided internal jugular central venous line is at the thoracic inlet. Right-sided PICC line ends in the right atrium. Endotracheal tube ends 3.2 cm from carina. The Dobbhoff tube is seen ultimately with the tip in the stomach and last side port below the GE junction. The second enteric feeding tube is seen coursing into a post pyloric position.", "output": "1. Dobbhoff tube ultimately ends in the stomach with the last side port below the GE junction. The second enteric feeding tube courses into a post pyloric position. 2. Right-sided PICC line ends in the right atrium and should be pulled back 3 cm for positioning at the cavoatrial junction. NOTIFICATION: These findings were discussed with Dr. ___ By Dr. ___ ___ telephone at 14:48 on ___, 5 minutes after discovery." }, { "input": "Endotracheal tube is again seen with tip approximately 4 cm from the carina. Enteric tube passes below the inferior field of view. Interval placement of right IJ central venous catheter is seen with tip in the mid SVC. There is no visualized pneumothorax based on this portable film. There is, however, new right basilar opacity, which silhouettes the hemidiaphragm. Cardiomediastinal silhouette is within normal limits. No displaced fracture is identified. Contour abnormality of the proximal left humerus is again noted and not fully assessed.", "output": "New right IJ line without visualized pneumothorax. Right basilar opacity may represent a combination of a layering effusion and/or atelectasis." }, { "input": "There is interval placement of a Dobbhoff tube with its tip in the stomach. A right PICC is in the mid SVC. Skin ___ along the left shoulder and two screws in the left humeral head are new. The cardiomediastinal silhouette is stable. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "Interval placement of a Dobbhoff tube with tip in the stomach." }, { "input": "The endotracheal and enteric tubes are unchanged.Heart size is normal and lungs are clear. No pleural effusion or pneumothorax.", "output": "Clear lungs, with unchanged support devices." }, { "input": "Mild to moderate cardiomegaly is present. Diffuse atherosclerotic calcifications are seen within the thoracic aorta. The mediastinal and hilar contours are unremarkable. Mild upper zone vascular redistribution is present along with mild pulmonary vascular engorgement. No focal consolidation, pleural effusion, or pneumothorax is present. No acute osseous abnormality is clearly identified.", "output": "Mild pulmonary vascular congestion." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Severe rotary dextroscoliosis of the thoracolumbar spine limits assessment of the chest. Cardiac, mediastinal and hilar contours are unremarkable. Pulmonary vasculature is not engorged. Linear opacities are demonstrated in both lower lobes, likely reflective of atelectasis. No focal consolidation, pleural effusion or pneumothorax is clearly visualized. Pulmonary vasculature is not engorged. Cervical spinal fusion hardware is incompletely imaged.", "output": "Severe rotary dextroscoliosis of the thoracolumbar spine. Bibasilar atelectasis." }, { "input": "Frontal and lateral views of the chest are obtained. Left ___- and infra-hilar opacity is worrisome for infection. No pleural effusion or pneumothorax is seen. The lungs are relatively hyperinflated, suggesting chronic obstructive pulmonary disease. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Left ___- and infra-hilar consolidation worrisome for infection. Recommend followup to resolution to exclude underlying lesion." }, { "input": "No prior studies for comparison. The lungs are clear, the paranasal sinuses and hila are normal. There is no pleural effusion and no pneumothorax.", "output": "No acute cardiothoracic process." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are unremarkable. No definite consolidation is identified. No pleural effusion or pneumothorax is identified.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral chest radiographs demonstrate clear lungs. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "There is no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal contour is normal. There is no subdiaphragmatic free air.", "output": "No evidence of acute cardiopulmonary process. No evidence of pneumoperitoneum." }, { "input": "Subtle retrocardiac opacity projecting over the lower thoracic spine on the lateral view may relate to vascular structures however, underlying consolidation cannot be excluded in the appropriate clinical setting. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "Slight increase in retrocardiac opacity on the lateral view most likely relates to vascular structures, but underlying consolidation is difficult to exclude in the appropriate clinical setting. No diffuse opacity is seen to suggest PCP, ___, chest CT is more sensitive in evaluating for PCP." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The heart is normal in size with normal cardiomediastinal contours.", "output": "No acute intrathoracic process." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are unremarkable. Lungs are clear. There is no pleural effusion or pneumothorax. The osseous structures are grossly unremarkable.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. Clips are noted in the left axilla. There is subtle consolidation in the left lower lung which is concerning for an early pneumonia. Subtle opacity at the right lung base may also represent a focus of pneumonia versus atelectasis. The lungs appear otherwise clear. Cardiomediastinal silhouette is normal. No large effusion or pneumothorax. Bony structures appear intact.", "output": "Subtle opacity in the left lower lung and right lung base concerning for early pneumonia, less likely atelectasis." }, { "input": "PA and lateral views of the chest. The lungs are clear without consolidation, effusion, or pneumothorax. Note is made of eventration of the right hemidiaphragm. Cardiomediastinal silhouette is within normal limits. Hypertrophic changes seen in the spine without acute osseous abnormality.", "output": "No acute cardiopulmonary process, no findings to explain patient's symptoms." }, { "input": "The heart is markedly but stably enlarged. Pulmonary vasculature is normal. There is no focal consolidation, pneumothorax, or pleural effusion.", "output": "Stable marked cardiomegaly." }, { "input": "Severe cardiomegaly is present. Mediastinal and hilar contours are unremarkable. There is no pulmonary edema. Patchy opacities in lung bases may reflect atelectasis. No pleural effusion or pneumothorax is demonstrated. There are no acute osseous abnormalities.", "output": "Severe cardiomegaly with mild bibasilar atelectasis." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Consolidative opacity within the left lung base is compatible with pneumonia. Right lung is clear. No pleural effusion or pneumothorax is identified. There are no acute osseous abnormalities.", "output": "Left basilar consolidative opacity concerning for pneumonia. Follow up radiographs after treatment are recommended to ensure resolution of this finding." }, { "input": "Left pectoral AICD with intact leads seen projecting over the right atrium and right ventricle. Minimal left basilar atelectasis. A linear, ___-___ opacity is seen in the retrocardiac region, corresponding to an area of pneumonia in ___, and likely representing a residual scar. No pleural effusion, pneumothorax, or pulmonary edema is identified. Stable, mild cardiomegaly. Mediastinal hilar contours are normal.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs were obtained. Multiple median sternotomy wires fractures are present. The lungs are fully expanded and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "1. No pneumonia or pulmonary edema. 2. Multiple fractured sternotomy wires. CT scan can be performed to assess migration of fragments into the retrosternal space." }, { "input": "PA and lateral views of the chest were provided. Fragmented midline sternotomy wires are again noted. The lungs are clear. Cardiomediastinal silhouette is stable. No effusion or pneumothorax is seen. The imaged bony structures appear intact with degenerative spurring noted anteriorly in the lower thoracic spine.", "output": "No acute findings in the chest." }, { "input": "PA and lateral chest views have been obtained with patient in upright position. Analysis is performed in direct comparison with the next preceding similar study of ___. Heart size is at the upper limit of normal variation but unchanged when comparison is made with previous studies. No typical configurational abnormalities identified. The aorta is of ordinary ___ and does not show any local contour abnormalities or walled calcifications. The pulmonary vasculature is not congested. There are no signs of acute or chronic pulmonary parenchymal densities. The pleural spaces are free. There is no fluid in lateral or posterior pleural sinuses. No pneumothorax is present in the apical area seen on the frontal view. Skeletal structures of the thorax grossly unremarkable.", "output": "No evidence of acute pulmonary infiltrates or pleural effusions which could explain patient's cough. Heart size at upper limit of normal variation existed already on three previous chest examinations obtained in ___, ___ and ___. There is no evidence of any abnormal pulmonary vascular changes so cardiac chronic failure is unlikely to be the cause of the patient's cough. IMPRESSION: No acute infiltrates or pulmonary congestion in this patient with history of chronic cough." }, { "input": "The lungs are clear. There are unchanged chronic pleural parenchymal scarring. Blunting of the right costophrenic sulcus is likely secondary to scarring. Mild cardiomegaly is chronic and unchanged. There is no pneumothorax. There are stable calcifications of the aortic arch. There are a number of old healed rib fractures on the right.", "output": "Stable chronic findings as described. No evidence of the cardiogenic pulmonary edema." }, { "input": "Seen are pleural and parenchymal scars, notably at the right lung base and right lateral aspect of the lungs, overall unchanged compared to the prior exam. There is a small right pleural effusion, also overall unchanged compared to the prior exam. There is stable mild cardiomegaly compared to the prior exam. There is no pneumothorax. Note is made of discontinuity of the left hemidiaphragm, with herniation of fat, better characterized on the prior CT. Note is made of extensive aortic calcification on this study, however extensive coronary and aortic calcifications were also better characterized on the prior CT. Deformities of the right ___th ribs are likely due to old, healed rib fractures, as seen on the prior CT.", "output": "1. No acute abnormalities identified within the lungs. 2. Stable right lung base pleural and parenchymal scars." }, { "input": "Frontal and lateral views of the chest. The lungs are clear without focal opacity, pleural effusion or pneumothorax. The heart size is normal. There is calcification of the left aortic knob. Old left posterior rib fracture.", "output": "No acute intrathoracic process. Conventional chest radiographs are not sensitive for detecting subtle chest wall trauma. If there are focal findings, dedidcated views of those areas are recommended." }, { "input": "The lungs are clear with no evidence of consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. No acute fractures are identified.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. The lung volumes are low with resultant bronchovascular crowding noted. There is no clear evidence of pneumonia or CHF. No pleural effusion or pneumothorax is seen either. Cardiomediastinal silhouette is normal. Anterior spurring is noted throughout the thoracic spine. No free air below the right hemidiaphragm.", "output": "Limited, negative." }, { "input": "Right PICC tip has been withdrawn narrow terminating within the mid subclavian vein. Patient is status post median sternotomy and CABG. Left-sided pacer device is again noted with leads terminating in the right atrium and right ventricle. Mild enlargement of the cardiac silhouette is unchanged. Diffuse atherosclerotic calcifications are noted within the aorta. Mediastinal and hilar contours are similar. Minimal pulmonary vascular engorgement is seen without overt pulmonary edema. Small bilateral pleural effusions are demonstrated with mild atelectasis in the lung bases. No pneumothorax.", "output": "1. Right PICC has been withdrawn with tip now projecting over the right mid subclavian vein. 2. Mild pulmonary vascular engorgement and small bilateral pleural effusions." }, { "input": "A dual-lead pacemaker/ICD device appears unchanged with leads again terminating in the right atrium and ventricle, respectively. The patient is status post coronary artery bypass graft surgery. The lungs appear clear. There is no pleural effusion or pneumothorax. Mild thoracic degenerative changes are unchanged.", "output": "No evidence of acute disease." }, { "input": "In comparison with chest radiographs from ___, there has been interval development of central vascular congestion with moderate interstitial pulmonary edema. Mild bibasilar opacities likely reflect atelectasis. Left-sided cardiac pacing device with dual leads following their expected courses to the right atrium and right ventricle. No pleural effusion. No pneumothorax. Mild-to-moderate cardiomegaly is stable. Median sternotomy wires are intact.", "output": "1. No evidence of pneumonia. 2. Interval development of increased central vascular congestion with moderate pulmonary edema. Stable mild to moderate cardiomegaly. 3. Mild bibasilar opacities, most consistent with atelectasis." }, { "input": "There is no evidence of PICC line fragment. Small bilateral pleural effusions are similar to the recent prior study and are accompanied by mild basilar atelectasis. A left pectoral dual-chamber pacemaker and its leads project in unchanged location. There is no focal consolidation, pulmonary edema, or pneumothorax.", "output": "1. No evidence of PICC fragment. 2. No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. Midline sternotomy wires, mediastinal clips, and dual-lead pacer are unchanged with lead tips extending to the region of the right atrium and right ventricle. The heart is normal in size and shape. No effusion or pneumothorax. No focal consolidation or signs of pulmonary edema. The heart and mediastinal contours are stable. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "The cardiomediastinal and hilar contours are normal. Subtle increase in opacities in the right lung base, overlying the right lower lobe in the lateral view, are worrisome for pneumonia. No edema, pleural effusion or pneumothorax is seen.", "output": "Right lower lobe pneumonia. Recommend followup chest radiographs in six to eight weeks after treatment to document resolution. Findings discussed with Dr.___ on ___." }, { "input": "Cardiomediastinal silhouette and hilar contours are normal. Previously noted right lower lobe consolidation completely resolved. However, there is a new vague opacity in the left lower lung at the left heart border. There is no pleural effusion or pneumothorax.", "output": "Complete resolution of prior right lower lobe pneumonia, however, with a new vague opacity at the left heart border in the left lower lung. Correlation to any remaining symptomatology is recommended as this appearance may be suggestive of chronic aspiration. Results were entered into the online critical results database as Dr. ___ ___ was not available for contact at the time of dictation." }, { "input": "The cardiac, hilar, and mediastinal contours are normal. The lungs are clear. Pulmonary vascularity is normal. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Two views were obtained of the chest. The lungs are low in volume but clear. There is no pleural effusion or pneumothorax. The heart is top normal in size with tortuous aortic contour.", "output": "No acute intrathoracic process." }, { "input": "Minimal patchy opacity at both lung bases could represent atelectasis. However, on the lateral view, there is patchy opacity projecting over the posterior segment of 1 of the lower lobes , which could represent a focal infiltrate. The upper and mid zones of both lungs are clear, without focal infiltrate. No CHF or effusion identified. The cardiomediastinal silhouette is stable, with mild unfolding of the aorta, but no frank cardiomegaly. Subtle, small concavity along the right border of the trachea at the level of the clavicular head is probably unchanged compared with ___ and ___. The patient has a known multi nodular goiter and this may be related to that. On today's exam, there is suggestion of some increased soft tissue density in this area.", "output": "1. Possible infiltrate in the posterior segment of one of the lower lobes. This is new compared with ___ and probably also ___. 2. Mild concavity of the right border of the trachea, not significantly changed compared with ___, may reflect mass effect from a known multinodular goiter. However, on today's exam, there is also suggestion of some soft tissue density in this area. Correlation with physical exam and, if indicated, repeat thyroid ultrasound is recommended. Alternatively, this area could be assessed by chest CT. RECOMMENDATION(S): Mild concavity of the right border of the trachea, not significantly changed compared with ___, may reflect mass effect from a known multinodular goiter. However, on today's exam, there is also suggestion of some soft tissue density in this area. Correlation with physical exam and, if indicated, repeat thyroid ultrasound is recommended. Alternatively, this area could be assessed by chest CT (which would also allow for assessment of parenchymal infiltrates)." }, { "input": "Interval increase in cardiac size with cephalization of pulmonary blood vessels and mild vascular indistinctness suggesting early interstitial edema. No alveolar edema. No pleural effusions. No focal airspace consolidation to suggest pneumonia. Spondylotic changes of the thoracic spine.", "output": "Findings in keeping with cardiac decompensation and early interstitial edema." }, { "input": "There is mild linear mid lung atelectasis/scarring. No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Mild linear mid lung atelectasis/ scarring. Otherwise, no acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs were provided. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal. The osseous structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest demonstrate no areas of focal consolidation. No pneumothorax or pleural effusion. Cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. The lungs are noted to be mildly hyperexpanded, compatible with mild chronic obstructive pulmonary disease. The cardiomediastinal silhouette is stable. No acute bony abnormality is detected.", "output": "1. No radiographic evidence for acute cardiopulmonary process. 2. Mild COPD." }, { "input": "There is airspace opacity in the right upper lobe, and there is linear opacity seen in the bilateral lower lungs, likely reflecting a combination of atelectasis and airspace consolidation. Right upper lobe nodularity raises the possibility of mycetoma. The heart size is normal, the mediastinal contours are normal. The pulmonary vasculature is normal. There is no pneumothorax or pleural effusion.", "output": "Right upper lobe airspace opacity, with bilatearl atelectasis. Findings are concerning for multifocal pneumonia in this immunosuppressed patient. Alternatively, aspiration could have this appearance. Follow up is recommended to exclude developing mycetoma. Findings of pneumonia versus aspiration were discussed with Dr. ___ at 11:30 a.m." }, { "input": "The examination is somewhat limited by low lung volumes and the patient's body habitus. As compared to the prior examination, there has been no significant interval change. There is no focal consolidation, pleural effusion, pneumothorax, or overt pulmonary edema identified. There is stable, moderate cardiomegaly. The mediastinal is somewhat widened, but stable in appearance from the prior examination.", "output": "Somewhat limited examination demonstrating no radiographic evidence for acute cardiopulmonary process. Findings were conveyed by Dr. ___ to the offices of Dr. ___ ___ telephone at 16:35 on ___, at the time of discovery." }, { "input": "AP upright and lateral views of the chest provided. Lung volumes are low. There is mild elevation the right hemidiaphragm. Lungs appear clear. Cardiomediastinal silhouette is stable. No large effusion or pneumothorax. No edema or definite signs of pneumonia. High-riding humeral head suggests chronic rotator cuff disease. There is a chronic deformity of the left distal clavicle with chronic widening of the left AC joint.", "output": "No pneumonia." }, { "input": "AP upright and lateral views of the chest provided. Cardiomegaly is again noted with a unfolded thoracic aorta. Airspace consolidation within the right mid to lower lung is concerning for pneumonia likely residing in the right lower lobe. There may be a small right pleural effusion. The left lung is clear. No pneumothorax is seen. Degenerative changes of the shoulders is again noted.", "output": "Right lower lobe pneumonia. Stable cardiomegaly." }, { "input": "Lung volumes are low. Cardiomediastinal silhouette is stable and prominent. No definite signs of pneumonia or edema. No large effusion or pneumothorax. Bony structures appear unchanged with chronic degenerative disease at both shoulders.", "output": "As above." }, { "input": "In comparison to ___ study there is diffuse pulmonary opacities seen, with progression in the right upper and right middle lobes as well as new opacities in upper lung. Again given the setting setting of hemoptysis pulmonary hemorrhage cannot be excluded as well as pulmonary edema and aspiration. Given the rapidity of the progression pneumonia is less likely. Again seen is a right jugular central venous catheter which terminates in the right atrium. The cardiomediastinal silhouette appears stable when compared to previous studies.", "output": "Progression of diffuse pulmonary opacities in the right upper, right middle, and left upper lobes that may represent pulmonary hemorrhage in the setting of hemoptysis versus pulmonary edema versus aspiration, with pneumonia being less likely given rapid time course." }, { "input": "ET tube, enteric tube, and left PICC are stable. Bilateral lower lung opacities are unchanged or slightly increased. No pneumothorax. Trace left pleural effusion. Cardiomediastinal and hilar contours are stable.", "output": "Bibasilar opacities are unchanged or slightly increased and may represent developing pneumonia. Trace left pleural effusion." }, { "input": "An endotracheal tube tip terminates 2 cm above the carina. A nasogastric tube courses below the diaphragm and out of view on this image. A left PICC line ends in the low SVC. The lung volumes remain low. Bilateral parenchymal opacities seen previously are not substantially changed. The symmetry and distribution favors atelectasis over pneumonia. A small left pleural effusion is increased from ___. The cardiomediastinal silhouette is prominent but unchanged.", "output": "1. Low lung volumes and bilateral atelectasis. 2. Small left pleural effusion, increased from ___." }, { "input": "An endotracheal tube is in satisfactory position 3.1 cm from the carina. An enteric tube courses below the diaphragm with the tip out of the field of view. Since the prior exam, the lung volumes are lower. There is increased bibasilar atelectasis. No definite pneumonia is identified. There is no pulmonary edema, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Lower lung volumes with increased atelectasis. No definite pneumonia, though if there is high clinical concern, continued radiographic follow-up is recommended." }, { "input": "The lungs remain hyperinflated. There is mild right base atelectasis. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. No pulmonary edema is seen.", "output": "No focal consolidation to suggest pneumonia. Mild right base atelectasis." }, { "input": "Endotracheal tube tip terminates approximately 6.4 cm from the carina. Orogastric tube tip courses below the left hemidiaphragm, into the stomach, with tip projecting off the inferior borders of the film. The heart size is normal. The mediastinal and hilar contours are unremarkable. A deep left sulcus is noted concerning for a pneumothorax. No mediastinal shift is evident. The pulmonary vascularity is not engorged. Streaky bibasilar airspace opacities likely reflect atelectasis. No large pleural effusion is identified. There are no acute osseous abnormalities.", "output": "1. Standard positioning of the endotracheal tube and orogastric tube. 2. Deep left sulcus highly concerning for a pneumothorax. Findings discussed with Dr. ___ by Dr. ___ at 19:40, ___ by telephone." }, { "input": "An endotracheal tube is present in standard position approximately 6 cm above the carina. An enteric tube is present with the distal tip overlying the stomach. Cardiomediastinal and hilar contours are stable. There is no pleural effusion or pneumothorax. There is a new small patchy opacity at the right lung base, which may represent atelectasis or aspiration.", "output": "1. Endotracheal tube in standard position. 2. New pathcy opacity at the right lung base, which may represent atelectasis or aspiration." }, { "input": "Endotracheal tube is seen, terminating approximately 5.8 cm below the level of the diaphragm. Nasogastric tube is seen coursing below the level of the diaphragm, inferior aspect not seen. No focal consolidation, large pleural effusion, or evidence of pneumothorax is seen. There may be minimal pulmonary vascular congestion without overt pulmonary edema. The cardiac and mediastinal silhouettes are stable.", "output": "Possible minimal pulmonary vascular congestion without overt pulmonary edema. Otherwise, no significant interval change." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are clear without focal consolidation, pleural effusion or pneumothorax.", "output": "No acute intrathoracic process." }, { "input": "There is minimal streaky density at the left base most consistent with subsegmental atelectasis. The left hemidiaphragm is now mildly elevated. The lungs are otherwise clear. The heart is normal in size. Mediastinal structures are otherwise unremarkable and stable in appearance. The bony thorax is grossly intact.", "output": "Left basilar subsegmental atelectasis. Mild elevation of the left hemidiaphragm." }, { "input": "AP upright portable chest radiograph was provided. Midline sternotomy wires are noted as well as mediastinal clips. A rounded density projects over the left mediastinal border which is of unclear etiology. Enlargement of the main pulmonary arterial silhouette suggests pulmonary arterial hypertension. The heart is mildly enlarged. The lungs appear grossly clear, though perihilar opacities could reflect bronchovascular crowding. No pneumothorax or effusion. Clips in the left upper quadrant noted. EKG leads and a catheter overlie the field of view somewhat limiting evaluation.", "output": "Mild cardiomegaly with abnormal mediastinal contour. A chest CT is recommended with contrast to further evaluate." }, { "input": "Patient is status post median sternotomy and CABG. Heart size remains severely enlarged. Pulmonary arteries also are massively enlarged compatible with pulmonary arterial hypertension, unchanged. There is mild pulmonary edema, with small right pleural effusion, as seen on the previous exam. Bibasilar atelectasis is re- demonstrated. There is no pneumothorax. Clips in the right upper quadrant the abdomen indicate prior cholecystectomy.", "output": "Severe cardiomegaly with mild pulmonary edema and small right pleural effusion. Bibasilar atelectasis. Massive pulmonary arteries compatible with pulmonary arterial hypertension." }, { "input": "Portable single frontal chest radiograph was obtained. Diffuse prominent interstitial markings and pulmonary vascular congestion are present with a new small right pleural effusion. Severe bilateral hila enlargement, left greater than right, likely secondary to dilated pulmonary arteries. Moderate cardiomegaly with right atrial configuration.", "output": "1. Moderate cardiomegaly with pulmonary edema and small right pleural effusion. 2. Severely dilated pulmonary arteries, left greater than right, consistent with underlying pulmonary hyertension." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lung fields are clear. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable.The patient is status post posterior spinal fusion.", "output": "No evidence of trauma." }, { "input": "PA and lateral chest radiograph demonstrates clear lungs bilaterally. Cardiomediastinal and hilar contours are within normal limits. There is no pleural effusion or pneumothorax. Visualized osseous structures demonstrates no acute abnormality.", "output": "No acute intrathoracic abnormality." }, { "input": "The lungs are clear. The heart size is top normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen.", "output": "No acute cardiac or pulmonary findings." }, { "input": "Cardiac, mediastinal and hilar contours are normal. The pulmonary vascularity is normal. Lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are present.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Portable AP upright chest film ___ at 10:30 is submitted.", "output": "There are layering bilateral effusions with increasing consolidation at the bases suggestive of partial lower lobe atelectasis. The more wedge-shaped opacity in the right upper lung on the previous study has resolved. Findings suggest fluctuating but slightly worse pulmonary edema. Overall cardiac and mediastinal contours are stable. Interval removal of right internal jugular central line. No pneumothorax." }, { "input": "An endotracheal tube terminates 3.9 cm above the carina. A nasogastric tube extends to at least the level of the stomach. The cardiac and mediastinal contours are within normal limits. There is no pneumothorax or focal consolidation. A trace left pleural effusion is present.", "output": "Trace left pleural effusion." }, { "input": "Frontal and lateral views of the chest show different lung volumes, but lungs are probably clear. There is no pleural abnormality. Hilar and mediastinal silhouettes are unremarkable aside from heavily calcified aorta and top normal heart. There is no pulmonary edema. Partially imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided.Low lung volumes limit eval. There is no focal consolidation, effusion, or pneumothorax. No evidence of pulmonary edema. The heart size is top normal. The mediastinal contour is unchanged. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "PA and lateral views of the chest were provided. The lungs are clear and well expanded. No signs of pneumonia or CHF. The cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "PA and lateral views of the chest. Lungs are hyperinflated. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process. Lungs are hyperinflated." }, { "input": "Redemonstrated is a large right lower lobe pulmonary metastases. The cardiomediastinal silhouette and hila are normal. There is no pleural effusion or pneumothorax. There is no new lung consolidation to suggest pneumonia.", "output": "Known metastatic disease with no evidence of superimposed pneumonia." }, { "input": "Redemonstrated is the known large right lower lobe pulmonary metastasis. Additional known smaller right pulmonary nodules as seen on the previous CT of the torso are not visualized on this radiograph. There is no evidence of pneumonia, pleural effusion or pneumothorax. Cardiac, mediastinal, and hilar contours are unchanged.", "output": "No evidence of pneumonia." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were performed. The lungs are hyperinflated. There is no pleural effusion, pneumothorax or focal airspace consolidation. The cardiac silhouette is top-normal in size but unchanged from prior. The mediastinal contours are unremarkable. There is a moderate kyphosis of the thoracic spine without a discrete compression fracture.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. The lungs are hyperinflated. There is biapical scarring noted. No signs of pneumonia or CHF. No pleural effusion or pneumothorax. Tiny clips are noted in the right axilla. The cardiomediastinal silhouette is normal. No acute bony abnormalities are detected. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "PA and lateral views of the chest demonstrate the bilateral lungs are well-expanded and clear. The cardiomediastinal silhouette is unremarkable. The hilar and pleural surfaces are normal in appearance. There is no pleural effusion or pneumothorax. No focal opacity is identified within the lungs.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. The pulmonary vascularity is normal. Linear opacity in the right lung base likely reflects subsegmental atelectasis and/or scarring. No focal consolidation, pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "The lungs are normally expanded. There are opacities in the right mid lung and left retrocardiac region, new since CT of ___. There is no large pleural effusion or pneumothorax. The heart is mildly enlarged.", "output": "Right middle lobe and left lower lobe opacities concerning for multifocal pneumonia versus aspiration pneumonitis." }, { "input": "Portable upright AP view of the chest is obtained. Patient rotated to the right, which significantly limits evaluation. The endotracheal tube is seen with its tip located just above the carina. Recommend slight retraction for more optimal position. Lung volumes are low. An NG tube courses into the left upper abdomen, tip excluded from view. Bibasilar atelectasis present. No large effusion.", "output": "Low position of ET tube, retraction by at least 2 cm is advised. NG tube positioned appropriately." }, { "input": "Since prior examination there is no significant interval change. The patient is status post endotracheal tube placement which is in an unchanged low position with the tip 7 mm above the carina. There is relatively increased distention of the endotracheal retention balloon. An enteric feeding tube courses below the diaphragm coiled within the stomach. There are low lung volumes with bibasilar atelectasis. Tortuosity of the thoracic aorta and mild cardiomegaly is accentuated by severe thoracic kyphosis. There is increased pulmonary vascular engorgement without frank interstitial pulmonary edema. Partially imaged are severe degenerative changes involving the left glenohumeral joint.", "output": "No significant change since ___." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are slightly low. Heart size is mildly enlarged, unchanged. The aorta remains tortuous. The mediastinal and hilar contours are similar. Pulmonary vasculature is not engorged. Minimal patchy opacities are noted in the lung bases. No pleural effusion, focal consolidation or pneumothorax is present. Mild degenerative spurring is visualized in the thoracic spine.", "output": "Minimal patchy bibasilar airspace opacities may reflect atelectasis in the setting of low lung volumes. Infection is not excluded in the correct clinical setting." }, { "input": "Frontal and lateral views of the chest were performed. There is no pleural effusion, pneumothorax or focal airspace consolidation. The cardiac and mediastinal contours are normal. The hilar structures and pleural surfaces are unremarkable. The imaged upper abdomen is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were performed. The lungs are clear. There is no pleural effusion, pneumothorax or focal airspace consolidation. The cardiac and mediastinal contours are normal. The hilar structures and pleural surfaces are normal. The imaged upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "___ CT torso", "output": "Lungs are fully expanded and clear. No pleural abnormalities. Mild cardiomegaly. Cardiomediastinal and hilar silhouettes are normal. A left pectoral pacemaker with right atrial and right ventricular leads is unchanged. RECOMMENDATION(S): No evidence of intrathoracic metastasis." }, { "input": "A left chest wall pacemaker generator and leads are unchanged. The lungs are clear.The cardiac, hilar and mediastinal contours are stable, and the heart size is top normal.No pleural abnormality is seen.", "output": "Mild cardiomegaly with no evidence of pulmonary edema, or metastatic disease." }, { "input": "PA and lateral views of the chest provided. The lungs appear clear bilaterally without focal consolidation, effusion, or pneumothorax. There is biapical pleural parenchymal scarring noted. The heart and mediastinal contours appear normal. Bony structures are intact.", "output": "No acute findings in the chest." }, { "input": "Heart size is normal with mild tortuosity of the thoracic aorta. Hilar contours are unremarkable. The lungs are mildly hyperinflated but otherwise clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality. Mild hyperinflation." }, { "input": "Moderate cardiomegaly is re- demonstrated, unchanged. The aorta remains tortuous. Mediastinal and hilar contours are similar. Pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is seen. Lungs are hyperinflated. Mild degenerative changes are noted in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. There is mild tortuosity of the thoracic aorta. Lung volumes are slightly decreased when compared to prior examination. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The aorta is mildly tortuous. There are mild atherosclerotic calcifications along the aorta. The hilar contours are normal. Pulmonary vascularity is normal. Minimal blunting of the left costophrenic angle suggests a trace pleural effusion. Lungs are otherwise clear. No focal consolidation or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Tiny left pleural effusion. Otherwise no acute cardiopulmonary abnormality." }, { "input": "No focal opacities concerning for infection although enlargement of the cardiac silhouette as well as the azygos vein is noted. No large effusions. Stable tortuous aorta. No pneumothorax.", "output": "Mild cardiomegaly, new since the prior study, and enlargement of the azygos compatible with volume overload without frank pulmonary edema." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No large pleural effusion or evidence of pneumothorax is seen. The aorta is calcified and tortuous. The cardiac silhouette is top normal. No overt pulmonary edema is seen. Some degenerative changes are seen along the spine.", "output": "No acute cardiopulmonary process." }, { "input": "AP portable upright view of the chest. Midline sternotomy wires and mediastinal clips are noted as well as surgical clips projecting over the upper abdomen. Evaluation is somewhat limited due to subtle motion artifact on the single view provided. Allowing for this, volumes are low though the imaged portions of the lungs appear clear. Cardiomediastinal silhouette appears grossly unchanged. Bony structures are intact.", "output": "Limited exam without signs of overt abnormality. Motion artifact limits evaluation." }, { "input": "Portable upright chest film ___ at 21:39 is submitted.", "output": "The patient is status post median sternotomy with stable postoperative cardiac and mediastinal contours. There has been interval appearance of a layering right effusion and increasing consolidation at the right base which may reflect atelectasis, although pneumonia or aspiration should also be considered. Lung volumes remain low with crowding of the vasculature. However, there now is mild perihilar edema. No large pneumothorax." }, { "input": "Frontal and lateral views of the chest. The lungs are clear without focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is no pneumothorax. There is no pleural effusion or focal airspace consolidation. The cardiac and mediastinal contours are normal. The hilar structures are unremarkable.", "output": "No pneumothorax." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable", "output": "No acute cardiopulmonary abnormalities" }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear of consolidation effusion, or pulmonary vascular congestion. Moderate hiatal hernia is again noted. The cardiomediastinal silhouette is otherwise unremarkable. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process. Moderate hiatal hernia again noted." }, { "input": "The heart size is within normal limits. The mediastinal contours are largely unchanged demonstrating a moderately sized but stable hiatal hernia. The lungs demonstrate mild bibasilar atelectasis, more pronounced on the left. There is no pleural effusion or pneumothorax.", "output": "Hiatal hernia, but no acute cardiopulmonary process." }, { "input": "Cardiac, mediastinal and hilar contours are normal. The lungs are clear and the pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Normal chest radiograph." }, { "input": "The lungs appear well expanded and are clear. No focal consolidation is identified. There is no pneumothorax, pulmonary edema, or pleural effusion. The cardiomediastinal silhouette and hilar contours are normal.", "output": "No acute cardiopulmonary process" }, { "input": "Frontal and lateral views of the chest were obtained. The cardiac silhouette is top normal to mildly enlarged. There may be minimal central pulmonary vascular engorgement without overt pulmonary edema. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen.", "output": "Top normal to mildly enlarged cardiac silhouette with minimal central pulmonary vascular engorgement. No focal consolidation." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "There is mild unfolding of the thoracic aorta. The heart is normal in size. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "There is faint lingular and right lower lobe opacities concerning for pneumonia. There is no pleural effusion pneumothorax. There is no overt pulmonary edema. The heart is normal in size. The lungs are hyperinflated reflecting COPD, and apical pleural thickening is noted.", "output": "Pneumonia. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 7:30 AM, 5 minutes after updated findings." }, { "input": "Right PICC tip terminates in the upper SVC. Cardiac, mediastinal and hilar contours are unremarkable with the heart size within normal limits. Lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are visualized.", "output": "Right PICC tip in the upper SVC." }, { "input": "PA and lateral views of the chest provided. No PICC line is visualized in the imaged field. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No PICC line seen. No acute intrathoracic process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. The aortic knob appears mildly dilated ; this could be further assessed on nonurgent chest CT for assess for underlying aortic dilatation. .", "output": "No acute cardiopulmonary process. The aortic knob appears mildly dilated which could be further assessed for on non emergent chest CT." }, { "input": "2 views were obtained of the chest. The heart is moderately enlarged with tortuous aortic contour. Tracheal deviation is consistent with known multinodular goiter. The lungs are clear without pleural effusion or pneumothorax.", "output": "Moderate cardiomegaly without acute intrathoracic process." }, { "input": "The lungs are clear. No pleural effusion, pneumothorax or focal airspace consolidation. Heart is normal size. Mediastinal and hilar structures are unremarkable. There is no free air under the diaphragm.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. The lungs are clear. Slight loss of the right heart border on the frontal view may be due to subtle pectus deformity. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality detected.", "output": "No acute cardiopulmonary process." }, { "input": "Two views of the chest demonstrate clear lungs without effusion or pneumothorax. Cardiac silhouette is normal in size, the mediastinal contours are normal.", "output": "Normal chest." }, { "input": "Compared to the prior film, the cardiomediastinal silhouette is unchanged. Sternotomy wires and 2 prosthetic valves again noted. The degree of retrocardiac density is not significantly changed and, as before, is consistent with left lower lobe collapse and/or consolidation. The possibility of a small left pleural effusion cannot be excluded. Elsewhere, the lungs are clear, without CHF or right-sided infiltrate. Equivocal trace right pleural effusion.", "output": "As above" }, { "input": "There has been interval removal of multiple support devices, including a mediastinal drain, a right-sided thoracostomy tube, orogastric tube, endotracheal tube, and Swan-Ganz catheter. There is no pneumothorax. Multiple intact sternal wires and prosthetic aortic and mitral valves are present. The heart is moderately enlarged.", "output": "No pneumothorax." }, { "input": "PA and lateral views of the chest provided. The heart is markedly enlarged. There is a tiny left pleural effusion. Mild central congestion noted. No pneumothorax. Mediastinal contour is normal. Bony structures are intact.", "output": "Marked cardiomegaly, tiny left effusion with central congestion." }, { "input": "The patient is status post recent aortic and mitral valve replacements with intact sternotomy wires. Massive cardiomegaly is unchanged. A small left pleural effusion is unchanged. There is no pneumothorax.", "output": "Stable massive cardiomegaly. Stable small left pleural effusion." }, { "input": "The lungs are clear. The heart size is top normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen. Degenerative changes of the right humeral head are noted. Mild wedging of mid thoracic vertebral bodies is unchanged.", "output": "No acute cardiac or pulmonary process." }, { "input": "Lungs are well inflated. Heart size is normal. Rounded density in the central mediastinum may represent a hiatal hernia. No pleural effusion or pneumothorax. No pneumonia.", "output": "1. No evidence of pneumonia. 2. Rounded density in the central mediastinum could represent a hiatal hernia, however this can be further proven with a lateral view." }, { "input": "Heart size is normal. Moderate sized hiatal hernia is present with otherwise normal appearance of the mediastinal and hilar contours. Lungs and pleural surfaces are clear.", "output": "Moderate hiatal hernia. No evidence of aspiration or pneumonia." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The patient has had. Left upper lobe wedge resection. The tiny left apical pneumothorax has resolved. Aside from left midlung linear atelectasis, the lungs are clear. Mild cardiomegaly is stable. Multilevel spinal degenerative changes are again noted.", "output": "Resolved tiny left apical pneumothorax. Left midlung linear atelectasis with otherwise clear lungs." }, { "input": "A right lower lobe opacity is concerning for pneumonia. A rounded density projecting over the anterior right second rib was not seen on ___. Osseous structures are unremarkable. The cardiomediastinal silhouette is unremarkable. There is no pneumothorax.", "output": "1. Right lower lobe pneumonia. 2. A rounded density projecting over the anterior right second rib was not seen on ___. Attention on follow-up and correlation with clinical examination is recommended as this may lie outside the patient." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No evidence of pneumomediastinum is seen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiograph demonstrate stable cardiomegaly. Mild central vascular engorgement is not significantly changed relative to prior study. There is interval resolution of previously present right lower lobe opacity as seen on chest radiograph dated ___. There is no pneumothorax or pleural effusion.", "output": "Central vascular engorgement without overt pulmonary edema. Stable cardiomegaly. Interval resolution of right lower lobe pneumonia as described on radiograph dated ___." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes, which accentuate bronchovascular markings. There is no focal consolidation, pleural effusion or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is top normal. No pulmonary edema. Partially imaged upper abdomen is unremarkable.", "output": "No focal consolidation." }, { "input": "Patient is markedly kyphotic. Cardiac silhouette size remains mild to moderately enlarged. Mediastinal contour is similar with tortuosity of the thoracic aorta again noted. Lungs are hyperinflated without focal consolidation. Interstitial opacities are seen within the lung bases as well as the right upper lobe, potentially atelectasis or chronic interstitial change. Pulmonary vasculature is not engorged. No pleural effusion or pneumothorax is present. Renal osteodystrophy is again noted with loss of height of several thoracic vertebral bodies. Multiple clips are noted in in the region of the gastroesophageal junction.", "output": "No radiographic evidence for pneumonia." }, { "input": "Interval placement of a right PICC line, projecting over the superior cavoatrial junction. Interval increase in the pulmonary vascular congestion and bilateral diffuse patchy airspace opacities consistent with pulmonary edema. A retrocardiac opacity is again present and likely reflective of atelectasis. Small bilateral pleural effusions are suspected. No pneumothorax identified. The size the cardiomediastinal silhouette is enlarged.", "output": "Increased pulmonary edema. The tip of the right PICC line projects over the cavoatrial junction." }, { "input": "There is an accentuated thoracic kyphosis. The lungs remain clear without focal consolidation. There is no overt pulmonary edema or effusion. Mild cardiomegaly is unchanged as well as tortuosity of the descending thoracic aorta. No acute osseous abnormalities. There surgical clips in the upper abdomen.", "output": "No acute cardiopulmonary process." }, { "input": "AP portable upright view of the chest. Cardiomegaly is mild. Hila appear congested and there is mild pulmonary edema noted. No large effusion is seen. No pneumothorax. No convincing signs of pneumonia. Overall mediastinal contour is stable. Bony structures are intact.", "output": "Mild pulmonary edema, mild cardiomegaly." }, { "input": "The carina is not well visualized. However, the ET tube tip probably lies approximately 4.0 cm above the carina. NG tube tip is present, tip extending beneath diaphragm, off film. Right IJ central line tip overlies the upper right atrium. Cardiomediastinal silhouette is probably unchanged, allowing for considerable technical difference. Again seen is upper zone redistribution mild vascular plethora, overall similar to the prior study. There is increased retrocardiac density with obscuration left hemidiaphragm, which may be slightly worse. Clips again noted in the region of the GE junction.", "output": "Possible slight worsening of retrocardiac opacity. CHF findings are similar to the prior study. Right subclavian central line tip overlies right atrium." }, { "input": "AP and lateral views of the chest demonstrate low lung volumes with mild bibasilar atelectasis. There is no focal consolidation concerning for pneumonia, pleural effusion. There may be mild pulmonary vascular congestion. No pneumothorax is present. The heart is top normal in size and the intrathoracic aorta is tortuous, which is stable since the prior study. Upper mid abdominal surgical clips are again noted.", "output": "Possible mild pulmonary vascular congestion." }, { "input": "Compared with the prior study and allowing for significant differences in positioning, degree of vascular plethora may be slightly increased. There is also slight blurring due to respiratory motion. Left lower lobe collapse and/or consolidation is again seen. The right hemidiaphragm is much less well delineated --___ could be an artifact of positioning, but suggests the presence of collapse and/or consolidation at the right lung base. No gross pleural effusion, though small effusions would be difficult to exclude. The cardiomediastinal silhouette is probably unchanged. Clips again noted in the the region of the GE junction. ET tube tip lies 3.8 cm above the carina. Right IJ central line lies near the cavoatrial junction, unchanged. NG type tube extends beneath the diaphragm to overlie the proximal stomach. No pneumothorax is detected.", "output": "Probable slight interval increase in degree of CHF findings. Persistent left lower lobe collapse and/or consolidation. New poor visualization of the right hemidiaphragm raises the possibility of right base collapse and/or consolidation, this appearance could be accentuated by differences in The patient position. ." }, { "input": "The heart size remains mild to moderately enlarged. Mediastinal and hilar contours are unchanged, with tortuosity of the thoracic aorta again demonstrated. Mild atherosclerotic calcifications are seen within the aortic arch. The pulmonary vasculature is not engorged. Minimal atelectasis is noted within the left lung base. No focal consolidation, pleural effusion, or pneumothorax is seen. Loss of height of several mid and lower thoracic vertebral bodies appear unchanged. Multiple clips are demonstrated at the GE junction.", "output": "No acute cardiopulmonary process." }, { "input": "The tip of the endotracheal tube projects over the mid thoracic trachea. A feeding tube extends to the gastric body. A right PICC line extends into the right atrium. Interval decrease in size of the bilateral pleural effusions and pulmonary edema, now mild in extent. No pneumothorax identified. Patchy opacities in the left lower lung zone may reflect atelectasis. The size and appearance of the cardiomediastinal silhouette is unchanged.", "output": "Interval decrease in extent of the pulmonary edema and bilateral pleural effusions, now mild in extent." }, { "input": "There is mild pulmonary edema. Left retrocardiac opacity likely represents atelectasis. No other focal consolidation. No pleural effusion or pneumothorax. Moderate cardiomegaly and torturous aorta are stable.", "output": "Mild pulmonary edema." }, { "input": "Lower lung volumes seen on the current exam. There is crowding of the bronchovascular markings however superimposed pulmonary vascular congestion is probable. There is no effusion or confluent consolidation. Moderate cardiac enlargement is unchanged. Tortuosity of descending thoracic aorta is again noted. Accentuated thoracic kyphosis is seen although osseous structures are not particularly well assessed due to technique. There is suspected thoracic compression deformity which appears new since ___.", "output": "Limited exam due to lung volumes and technique with suspected pulmonary vascular congestion. No confluent consolidation or effusion. Probable lower thoracic compression deformity new since ___, not well assessed." }, { "input": "Heart size is normal. Mediastinal and hilar contours are within normal limits. Pulmonary vasculature is normal. Eventration of the hemidiaphragms bilaterally is re- demonstrated. Linear opacity in the left mid lung field is compatible with scarring or subsegmental atelectasis. No focal consolidation, pleural effusion or pneumothorax is present. There are moderate multilevel degenerative changes demonstrated in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Bilateral diaphragmatic eventration is similar to prior.", "output": "No acute intrathoracic process." }, { "input": "The lungs are moderately well inflated and clear. No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable.", "output": "No acute cardiopulmonary process. Specifically, no pulmonary edema, effusion or pneumonia." }, { "input": "Frontal and lateral chest radiographs demonstrate clear lungs without focal consolidation. There is no pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are stable with enlargement of the pulmonary arteries seen since ___.", "output": "Clear lungs with stable cardiomediastinal contour." }, { "input": "Frontal and lateral chest radiographs demonstrate linear opacities at the bilateral bases, likely reflecting scar. Lung volumes are slightly decreased compared with ___ years prior. There is no significant effusion, or pneumothorax. The cardiac silhouette remains normal in size, the mediastinal contours are notable only for tortuosity of the aorta. Pulmonary vasculature is normal.", "output": "No acute chest abnormality." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. The lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "AP upright portable view of the chest provided. The lungs appear largely clear bilaterally aside from mild dependent basilar atelectasis. Slightly underpenetrated technique limits the evaluation for subtle mild congestion, though there is no overt evidence for pulmonary edema. The heart size appears normal. The mediastinal contour is stable and within normal limits. The bony structures appear intact. There is no free air below the right hemidiaphragm.", "output": "Bibasilar atelectasis. No overt evidence for pneumonia or edema." }, { "input": "Single frontal view of the chest demonstrates stable cardiomegaly. New consolidation in the upper lobes and right lower lobe is most likely pneumonia. There is also retrocardiac opacity which could represent dependent atelectasis versus additional site of consolidation. Trace effusions cannot be excluded. There is no pneumothorax or vascular congestion.", "output": "Multifocal pneumonia. Under appropriate clinical circumstances peripheral consolidation can be seen with chronic eosinophilic pneumonia." }, { "input": "Single AP upright portable view of the chest was obtained. There has been interval removal of a right-sided PICC. Moderate to marked cardiomegaly persists. There is blunting of the left costophrenic angle suggesting a combination of pleural effusion and atelectasis. There may also be a trace right pleural effusion. No overt pulmonary edema is seen. There is no pneumothorax. Mediastinal contours are stable.", "output": "Persistent, stable moderate to marked cardiomegaly with small left and possibly trace right bilateral pleural effusions with overlying atelectasis." }, { "input": "Heart size is normal. Minimal bibasilar atelectasis. No pneumonia. Streaky opacity in the left mid lung base is stable. Calcific density projecting over left upper lung apex is also stable. Aortic knob calcifications.", "output": "Stable exam without acute cardiopulmonary process." }, { "input": "MODERATE RIGHT PLEURAL EFFUSION IS COLLECTED POSTERIORLY. WORSENED RIGHT LOWER LOBE ATELECTASIS RAISES CONCERN ABOUT CHRONIC BRONCHIAL OBSTRUCTION. RIGHT HILUS DISPLACED INFERIORLY AND MEDIALLY COULD CONTAIN ADENOPATHY. CT SCANNING IS RECOMMENDED FOR EVALUATION OF THE AIRWAY AND RIGHT LOWER LOBE. HEART SIZE TOP-NORMAL. LEFT LUNG CLEAR. BORDERLINE CARDIOMEGALY, WITH NO PULMONARY VASCULAR CONGESTION, EDEMA, OR LEFT PLEURAL EFFUSION.", "output": "1. PROGRESSIVE RIGHT LOWER LOBE ATELECTASIS RAISES CONCERN ABOUT BRONCHIAL PATENCY AND POSSIBILITY OF RIGHT HILAR MASS. . RECOMMENDATION(S): CHEST CT WITH INTRAVENOUS CONTRAST. NOTIFICATION: Dr. ___ reported the findings to ___ QA nurses by email on ___ at 8:05 AM, 1 minutes after discovery of the findings." }, { "input": "A small right layering pleural effusion is unchanged. Bibasilar subsegmental atelectasis is present. Airspace opacification at the right lung base has slightly increased. There is no pneumothorax. The heart and mediastinum are within normal limits despite the projection.", "output": "Stable small layering right pleural effusion with bibasilar subsegmental atelectasis. Infection at the right base cannot be excluded in the appropriate clinical setting." }, { "input": "Compared with prior radiographs on ___, there has been interval placement of the left chest pacemaker, with leads terminating in the right atrium and right ventricle. Overall lung volumes are low. A moderate right-sided pleural effusion is stable from prior There is no new focal consolidation. No pneumothorax is seen. There is borderline cardiomegaly, unchanged from prior..", "output": "Interval placement of a pacemaker, with leads terminating in the low right atrium and right ventricle." }, { "input": "Heart size is normal with mild unfolding of the thoracic aortic arch. Lung volumes are low accentuating pulmonary vasculature. Hilar contours are normal. Trace right greater than left pleural effusion. Lungs are otherwise clear. No pneumothorax.", "output": "Trace right greater than left pleural effusions. Otherwise unremarkable study." }, { "input": "PA and lateral views of the chest. No prior. Extremely low lung volumes are seen particularly on the lateral. Linear bibasilar opacities therefore are suggestive of atelectasis. There is no large confluent consolidation. Costophrenic angles are sharp. Cardiomediastinal silhouette is within normal limits. Lucency under the right hemidiaphragm is confirmed as interposition of colonic loops above the liver on the lateral. Soft tissues and osseous structures are unremarkable.", "output": "Low lung volumes. No confluent consolidation." }, { "input": "There is pulmonary vasculature indistinctness compatible mild pulmonary edema. Cardiomediastinal silhouette is at the upper limits of normal. There is no evidence of pneumothorax or pleural effusions. Endotracheal tube tip is 4.5 cm from the carina, in standard position, and an enteric tube tip is in the stomach.", "output": "Mild pulmonary edema. Standard positioning of the endotracheal and NG tubes." }, { "input": "Mild cardiomegaly with enlargement of the pulmonary vasculature and diffuse airspace opacities, suggestive of mild pulmonary edema. A more confluent opacity at the right lung base could reflect asymmetrical edema or secondary process such as pneumonia. No evidence pneumothorax. No significant pleural effusions.", "output": "Moderate pulmonary edema. Underlying pneumonia in right lung base is difficult to exclude and follow-up radiograph after diuresis is recommended. RECOMMENDATION(S): Follow up radiograph after diuresis is recommended." }, { "input": "PA and lateral views of the chest show a right PICC terminating in the upper SVC. In comparison to the prior exam on ___, it may be slightly pulled back, although exact amount of change is difficult to tell based on differences in angulation and patient positioning. Basilar atelectasis is unchanged from the prior exam. Small focal opacity at the right lung base was not present on prior or on CT torso from ___ and most likely represents overlapping structures; developing consolidation not excluded in the appropriate setting. No pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "1. PICC in the upper SVC, possibly pulled back slightly from the prior exam, although evaluating for change is difficult giving different angulation of radiograph in patient positioning. 2. Stable bibasilar atelectasis. Small focal opacity at the right lung base most likely represents overlapping structures; developing consolidation not excluded in the appropriate clinical setting." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures appear within normal limits.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Frontal and lateral views of the chest were obtained. Mild bibasilar atelectasis is seen. No definite focal consolidation. No pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable. Hilar contours are also stable.", "output": "No significant interval change. Bibasilar atelectasis." }, { "input": "Frontal and lateral views of the chest were obtained. Mild bibasilar atelectasis is noted. No pleural effusion or pneumothorax noted. The cardiomediastinal and hilar contours are unchanged from the prior examination. Mild low lung volumes are noted with crowding of bronchovascular markings. No rib fractures are visualized.", "output": "1. Low lung volumes with crowding of bronchovascular markings and bibasilar opacification increased on the right, most likely representing atelectasis; however, infectious process such as pneumonia cannot be completely excluded in the correct clinical setting. 2. No rib fractures. If rib fractures are clinically suspected then a dedicated rib series can be obtained." }, { "input": "Heart size is normal. The aorta is tortuous, as seen previously. Mediastinal and hilar contours are otherwise unchanged. Pulmonary vasculature is normal. Patchy opacities are seen in the right lung base, possibly atelectasis. Subsegmental atelectasis is also noted in the left lung base. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities seen. Mild degenerative changes are noted in the thoracic spine.", "output": "No evidence for pulmonary edema. Minimal patchy opacity in the right lung base, likely atelectasis." }, { "input": "PA and lateral chest radiograph demonstrates clear lungs bilaterally. Heart size is within normal limits. The aorta is tortuous but stable in appearance when compared to radiograph dated ___. There is no pleural effusion or evidence of pneumothorax. No acute osseous abnormality is identified.", "output": "No acute intrathoracic abnormality." }, { "input": "Lung volumes have improved. No focal consolidation, effusion, edema, or pneumothorax. The heart is normal in size. The mediastinum is not widened. Hilar and pleural contours are normal. A 3-mm opacity projecting over the lateral aspect of the right eighth posterior rib is unchanged since at least ___, favoring benign etiology, likely calcified granuloma. A hiatal hernia small.", "output": "1. No pneumonia. 2. 3-mm probable right calcified granuloma, unchanged since ___. 3. Small hiatal hernia." }, { "input": "Minimal elevation of the right hemidiaphragm is seen. Slight opacity projecting over the inferolateral right lower lung on the frontal view may relate to scarring or atelectasis, not substantiated on the lateral view. Small rounded opacities projecting over the bilateral lower thorax at the same level bilaterally are most consistent with nipple shadows. The left lung is clear. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable and unremarkable.", "output": "Minimal elevation of the right hemidiaphragm with slight inferolateral opacity seen on the frontal view, not well substantiated on the lateral view, may be due to underlying scarring/atelectasis. Otherwise, no focal consolidation seen." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are well expanded and clear without focal consolidation, pleural effusion or pneumothorax. Scarring in the right upper lung is similar to CT ___. Linear medial right upper lobe opacity is likely sequelae of prior radiation. Heart size is normal. Mediastinal silhouette and hilar contours are stable. Haziness at the right heart border is mediastinal fat, seen on CT. Surgical clips are seen in the left upper quadrant. No displaced rib fracture is seen. Thoracic vertebral body heights are maintained.", "output": "No evidence of acute intrathoracic injury." }, { "input": "Frontal and lateral views of the chest are obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Post-surgical changes are again seen in the right mid lung. The lungs remain relatively hyperinflated. The aorta remains calcified and tortuous. The cardiac silhouette is not enlarged. There is no evidence of free air beneath the diaphragms.", "output": "No acute cardiopulmonary process. No evidence of free air beneath the diaphragms." }, { "input": "The right lung is clear. There is blunting of the left costophrenic recess in the lateral view without clear fluid meniscus suggesting pleural effusion. Otherwise, the rest of the lung fields are clear. Cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax or rib fractures.", "output": "Blunting of the left costophrenic recess in the lateral view without a clear fluid meniscus is concerning for parenchymal opacity of the left lower lobe. This may represent inflammation/infection versus lung contusion. Clinical correlation is advised." }, { "input": "The lungs are clear of focal consolidation, pleural effusion or pneumothorax. The heart size is normal. The mediastinal contours are normal. A left Port-A-Cath terminates in the mid SVC. There is retrosternal calcification near the sternomanubrial junction best seen on the lateral radiograph, and a calcified right hilar lymph node is noted.", "output": "No acute cardiopulmonary process. Retrosternal calcification near the sternomanubrial junction and calcified right hilar lymph node. Recommend correlation with prior imaging." }, { "input": "The lungs are clear. No pleural effusion or pneumothorax. Heart size and mediastinal contours are normal. Osseous structures are intact.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs were obtained. The lungs are fully expanded and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "No radiographic evidence of acute cardiopulmonary process. Findings were communicated with Dr. ___ by Dr.___, at time of observation at 2:40 p.m. on ___." }, { "input": "The lungs are well-expanded and clear. No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable.", "output": "No evidence of pneumonia." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Mild relative elevation of the right hemidiaphragm is noted. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "Cardiomediastinal contours are normal. Patchy and linear left lower lobe opacity with associated volume loss is present, as well as a focal linear opacity in the right lower lobe. Remainder of lungs are clear. No definite pleural effusion.", "output": "1. Patchy and linear left lower lobe opacity favors atelectasis over infectious pneumonia. 2. No acute fracture within the visualized portion of the thoracic spine, but dedicated radiographs or cross-sectional imaging of the spine may be considered if clinical suspicion for a thoracic spine abnormality is high." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volume is low. Mild bibasilar opacities are likely secondary to atelectasis and/ or small pleural effusions. Cardiac silhouette is mildly enlarged. The radiograph is labeled as upright, however patient position appears supine or semi upright. Suboptimal patient position limits the evaluation for pneumoperitoneum. Given the limitation, no evidence of large pneumoperitoneum is identified.", "output": "Bibasilar atelectasis and/ or small pleural effusions. No evidence of large pneumoperitoneum is identified. If there is clinical concern for pneumoperitoneum, consider repeat radiograph with upright patient position or CT." }, { "input": "PA and lateral views of the chest are provided. The heart is mildly enlarged. There is no focal consolidation, effusion, or pneumothorax. There is no sign of pulmonary edema or CHF. Bony structures are intact. No free air below the diaphragms.", "output": "No acute findings in the chest." }, { "input": "Lung bases are partially obscured by overlying pulse generator devices bilaterally. There is no pneumothorax. Opacity at the left lung base most likely represents atelectasis, but infection cannot be excluded in the appropriate clinical setting. There is also subtle opacification of the left apex, which may represent pleural scarring. No large pleural effusions are seen. Cardiomediastinal silhouette is within normal limits. Median sternotomy wires are intact. Patient is kyphotic. No acute osseous abnormalities are identified. Surgical clips are seen in the epigastric region.", "output": "Left lung base opacity most likely represents atelectasis, but infection or aspiration should be considered in the appropriate clinical setting. No large pleural effusions." }, { "input": "A single portable AP upright view of the chest was obtained. Lung volumes are low. There is dense retrocardiac opacification with obscuration of the medial margin of the left hemidiaphragm, consistent with left lower lobe consolidation. Streaky opacities at the right base probably reflect atelectasis. Cardiomediastinal silhouette is otherwise stable. Prominence of the right paratracheal soft tissues is unchanged. There is no large effusion or pneumothorax.", "output": "Dense retrocardiac opacification, consistent with left lower lobe pneumonia in the appropriate clinical setting." }, { "input": "The lungs are hypoinflated. Right mid lung linear atelectasis or scarring is noted. Left lung base subsegmental atelectasis is also present. There is no pneumothorax. The heart size is suboptimally assessed due to low lung volumes. The mediastinum is not widened. Multilevel spinal degenerative changes are present.", "output": "Left lung base subsegmental atelectasis. Right mid lung linear atelectasis or scarring. No radiographic evidence of pneumonia." }, { "input": "AP single view of the chest has been obtained and is analyzed in direct comparison with the next preceding similar study of ___. The previously described two right-sided chest tubes placed following decortication procedure remain in unchanged position and the findings are unchanged. No pneumothorax has developed. The local small amount of chest wall emphysema remains. No new abnormalities are seen. The on previous examination identified plate atelectasis in the mid left lung field has disappeared and only a peripheral small plate atelectasis remains. No new abnormalities are seen.", "output": "Disappearance of left-sided plate atelectasis, otherwise no significant interval change observed during the latest 20 hours examination interval." }, { "input": "A tiny right apical pneumothorax in the position of the recently removed chest tube is seen. There is a small left pleural effusion seen. Right lower lobe atelectasis is stable. There is stable subcutaneous emphysema seen in the soft tissues of the right hemithorax.", "output": "Interval removal of right-sided tube with tiny apical pneumothorax seen. Remainder of study is unchanged." }, { "input": "There is a persistent small right apical pneumothorax which is unchanged from prior study. There is stable right lower lobe atelectasis and a small effusion may be present if any. Left pleural effusion is unchanged. The cardiomediastinal silhouette is stable and within normal limits. The left lung is unremarkable. Right chest wall subcutaneous emphysema is reduced.", "output": "Small right apical pneumothorax is unchanged. Stable right lower lobe atelectasis." }, { "input": "No focal consolidation is seen. There is blunting of the costophrenic angles may be due to trace pleural effusions and/or mild atelectasis. No pneumothorax is seen. The cardiac silhouette is top-normal to mildly enlarged. There is prominence of the hila without vascular congestion and underlying lymphadenopathy could be present.", "output": "Blunting of the costophrenic angles may be due to trace pleural effusions and/or mild atelectasis. Prominence of the hila without vascular congestion could be due to prominent pulmonary vessels however underlying lymphadenopathy is not excluded. This could be further evaluated for on nonurgent chest CT." }, { "input": "There is consolidation within the left upper lung, localized to the upper lobe on the lateral, concerning for pneumonia. However, the consolidation has convex outward borders, and this should be followed up with a repeat chest radiograph to ensure resolution. The lungs are otherwise clear. No pulmonary edema. Cardiomediastinal silhouette is within normal limits. No pleural effusion. No pneumothorax.", "output": "Consolidation within the left upper lobe, which likely represents pneumonia, however due to the convex outward borders, this should be followed to resolution to ensure there is no underlying malignancy. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 1:12 PM, 2 minutes after discovery of the findings. RECOMMENDATIONS: Follow-up chest radiograph is recommended in ___ months." }, { "input": "Unchanged masslike opacity in the left upper lobe. No discrete pneumothorax identified. No new consolidation or pleural effusion. The size of the cardiac silhouette is mildly enlarged but unchanged. Degenerative changes of the both glenohumeral joints.", "output": "No pneumothorax identified. Unchanged left upper lobe masslike opacity." }, { "input": "Heart size remains normal. Mild atherosclerotic calcification is noted within a mildly tortuous aorta. The mediastinal and hilar contours remain unchanged. Pulmonary vasculature is not engorged. Left upper lobe consolidative opacity with convex outward borders remains unchanged from prior. No new focal consolidation, pleural effusion or pneumothorax is identified. Moderate degenerative changes of both glenohumeral joints are again noted as well as within the thoracic spine.", "output": "No substantial interval change in left upper lobe consolidative opacity which may reflect pneumonia but malignancy is not excluded. Follow up radiographs in 2 months is recommended after treatment to ensure resolution of this finding, as was previously recommended." }, { "input": "Moderate enlargement of the cardiac silhouette is present. The aorta is tortuous with atherosclerotic calcifications noted at the knob. There is likely a moderate-sized hiatal hernia. Hilar contours are normal. No pulmonary edema seen. Linear and streaky opacities in the lung bases likely reflect areas of atelectasis. Lungs are hyperinflated with relative attenuation of pulmonary vascular markings towards the apices suggestive of emphysema. No focal consolidation or pneumothorax is duct identified. Moderate degenerative changes are noted in the thoracic spine.", "output": "Streaky bibasilar atelectasis without focal consolidation. Emphysema and probable moderate size hiatal hernia." }, { "input": "An external pacer wire is present. The endotracheal tube and orogastric tube are unchanged in position. A right-sided IJ catheter terminates at the cavoatrial junction. Again seen is central pulmonary vascular congestion with new increased right pulmonary opacities reflecting mild edema. There is no large effusion or pneumothorax.", "output": "New mild edema within the right lung." }, { "input": "Central pulmonary vascular engorgement has increased since the ___ examination. There is no pulmonary edema. There is no pneumothorax, focal consolidation, or pleural effusion. The heart is mildly enlarged.", "output": "No focal consolidation." }, { "input": "An endotracheal tube terminates 6.2 cm above the carina. Orogastric tube extends to at least the level of the stomach, with the tip excluded by this study. A right IJ catheter terminates at the lower SVC. The heart size is top normal, appearing slightly improved since ___. Central pulmonary vascular congestion has improved, and pulmonary edema is nearly resolved. A left pleural effusion has resolved. No pneumothorax is detected. There is no new focal consolidation.", "output": "Decreased central pulmonary vascular congestion with nearly-resolved pulmonary edema. Resolved left pleural effusion." }, { "input": "AP portable view of the chest demonstrates left PIC catheter tip projecting over cavoatrial junction. No pneumothorax. Lung volumes are low. Left lung base consolidations likely represents atelectasis. There is no pleural effusion or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema.", "output": "Low lung volumes with left lung base consolidation, most likely atelectasis or infection in the appropirate clinical setting." }, { "input": "A right-sided PICC terminates at the caval atrial junction. The heart size is normal. The hilar and mediastinal contours are within normal limits. There is no pneumothorax, focal consolidation, or pleural effusion.", "output": "No acute intrathoracic process. Right PICC terminates at the cavoatrial junction." }, { "input": "Single portable view of the chest. Right PICC is seen with tip in the lower SVC. Relatively low lung volumes are noted. The lungs are clear of consolidation or large effusion. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "Portable upright chest radiograph ___ at 13:34 is submitted.", "output": "The lung volumes remain low with streaky opacity at the left base 's favoring atelectasis. Overall, there is increasing hazy opacity within the right lung which may reflect a combination of increasing airspace disease as well as layering pleural fluid. These findings, given the asymmetry, would be concerning for evolving pneumonia or aspiration. Clinical correlation is recommended. No pneumothorax. Interposition of the colon beneath the right hemidiaphragm and liver consistent with Chiladiti's." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. There is prominent eventration of the left hemidiaphragm with overlying left basilar atelectasis and with stomach/ bowel beneath. The cardiac silhouette is top-normal to mildly enlarged. Mediastinal contours are unremarkable. Partially imaged degenerative change at the right shoulder joint.", "output": "Eventration of the left hemidiaphragm with overlying left basilar atelectasis. No focal consolidation to suggest pneumonia." }, { "input": "The heart size is normal. The aorta is tortuous. The lungs are clear without evidence of focal consolidations concerning for pneumonia. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Heart size is borderline enlarged. Mediastinal and hilar contours are unchanged. Pulmonary vasculature is normal. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is detected. No acute osseous abnormality is visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Single AP portable chest radiograph demonstrates clear lungs bilaterally. Cardiomediastinal and hilar contours are within normal limits. There is no pleural effusion or pneumothorax. Visualized osseous structures demonstrates no acute abnormality. No air under the right hemidiaphragm is identified.", "output": "Unremarkable radiograph." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest demonstrate well-expanded and clear lungs. The heart is normal in size and cardiomediastinal contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic process." }, { "input": "AP view of the chest. There is no free air. The lateral part of the right hemithorax and right upper abdomen is not imaged. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal. The esophagus is dilated consistent with known achalasia.", "output": "No acute cardiopulmonary process. No free air is identified." }, { "input": "Lung volumes are low, which leads to bronchovascular crowding. No focal consolidation is identified. There is chronic scarring at the left lung base. The cardiomediastinal silhouette and hilar contours are stable. There is no pleural effusion or pneumothorax. A right chest dual lead pacemaker is in unchanged position.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Dual lead pacemaker/ICD device appears unchanged. Lung volumes are low. The heart is mild to moderately enlarged. There is mild to moderate perihilar congestion which is new since the prior radiographs but with no focal opacification. There is no definite pleural effusion or pneumothorax.", "output": "Cardiomegaly. Findings suggesting mild vascular congestion." }, { "input": "Low lung volumes are present. This accentuates the size of the cardiac silhouette which is likely top-normal. The mediastinal and hilar contours are unremarkable. There is crowding of the bronchovascular structures. Patchy opacities in the lung bases likely reflect atelectasis. No pleural effusion is present. No pneumothorax or overt pulmonary vascular congestion is present. An inferior vena cava filter is detected. There are no acute osseous abnormalities.", "output": "Low lung volumes with bibasilar atelectasis." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. The imaged upper abdomen is unremarkable. The bones are intact.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest demonstrate clear lungs. Cardiac size is normal. No pleural effusion or pneumothorax.", "output": "Unremarkable chest x-ray" }, { "input": "The patient is status post median sternotomy and CABG. Fracture of the ___ sternotomy wire from the top is unchanged. The heart size appears normal. Aorta remains mildly tortuous and diffusely calcified. Mediastinal contours are unchanged. Mild interstitial pulmonary edema, which is similar compared to the prior exam, with unchanged trace bilateral pleural effusions is re- demonstrated in. No pneumothorax is identified. Calcified granuloma within the left upper lobe is unchanged. There is continued kyphosis of the thoracolumbar spine with multilevel degenerative changes again noted.", "output": "Chronic mild congestive heart failure with small bilateral pleural effusions and mild interstitial pulmonary edema." }, { "input": "Frontal and lateral radiographs of the chest show persistent low inspiratory lung volumes with increased size of small bilateral pleural effusions from ___. Mild pulmonary edema bilaterally is improved from the preceding radiograph. The pulmonary vasculature is not engorged. No focal consolidation or pneumothorax is present. A tiny calcified nodule in the periphery of the left upper lobe is stable from ___. The patient is status post median sternotomy and CABG with preserved alignment. The cardiac silhouette is unchanged. The mediastinal and hilar contours are stable. No prominence of the azygos vein is seen.", "output": "Findings consistent with chronic heart failure. No evidence of acute exacerbation. Findings were communicated by Dr. ___ to Dr. ___ by phone at 13:50 p.m. on ___." }, { "input": "Vascular congestion and interstitial pulmonary edema has increased since yesterday. In the right medial lung base, there is increased opacity since yesterday which is not clearly seen on the lateral view. Oblique views may be helpful to further characterize, but it is concerning for pneumonia. No pleural effusion or pneumothorax is present.", "output": "1. Increasing pulmonary edema and vascular congestion consistent with volume overload. 2. New right medial lung base opacity not clearly seen on the lateral, could consider oblique views to further evaluate, but it is concerning for a developing pneumonia. NOTIFICATION: Telephone notification to Dr. ___ by Dr. ___ at 12:37 p.m. on ___, 5 minutes after discovery of findings." }, { "input": "The patient is status post sternotomy and probably coronary artery bypass graft surgery. The heart appears mildly enlarged. Pulmonary vascularity is mildly prominent, suggesting mild vascular congestion. There is a small-to-moderate pleural effusion on the right, but decreased. Subpulmonic opacification of the left lung base is not well delineated but may indicate a small effusion and atelectasis. The bones appear demineralized. The right acromiohumeral interval is effaced.", "output": "Right pleural effusion, somewhat decreased, and findings consistent with pulmonary vascular congestion. Although pneumonia at the one or both lung bases is difficult to exclude, findings are more suggestive of mild congestive heart failure than infection." }, { "input": "Frontal and lateral views of the chest are compared with previous exam from ___. Compared to prior, there has been no significant interval change. There is no large confluent consolidation or pulmonary edema. Small bilateral pleural effusions persist, not significantly changed. The cardiac silhouette is enlarged but stable. Median sternotomy wires are again seen noting a fracture of the second one from the top. Lower thoracic kyphosis with associated degenerative changes is again seen as well as partially visualized lumbar spine fixation hardware.", "output": "No acute cardiopulmonary process. Persistent small bilateral pleural effusions." }, { "input": "AP view of the chest. Right-sided pleural effusion has significantly resolved. No pleural effusion identified. No left pleural effusion. The sternotomy wires are intact. Mild cardiomegaly is stable. Mediastinal and hilar contours are normal. There is some mild pulmonary vascular congestion. No pneumothorax.", "output": "Interval resolution of right-sided pleural effusion. Mild pulmonary vascular congestion." }, { "input": "AP and lateral views of the chest. When compared to prior, there has been no significant interval change. There are bilateral right greater than left effusions with pulmonary vascular congestion. Given lordotic positioning, the lungs are clear and the cardiomediastinal silhouette has not definitely changed. Median sternotomy wires are again seen with fracture of the second wire from the top as on prior. No acute osseous abnormality is identified.", "output": "Persistent right greater than left effusions and pulmonary vascular congestion without definite superimposed acute process." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs without focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is a three-lead pacemaker/ICD device with leads again terminating in the right atrium, right ventricle, and coronary sinus, respectively. The patient is status post coronary artery bypass graft surgery. The heart is moderately enlarged. The mediastinal and hilar contours appear unchanged. There is mild upper zone redistribution of the pulmonary vascularity without frank pulmonary edema. There is no pleural effusion or pneumothorax. Thin anterior flowing osteophyte formation is noted along the mid-to-lower thoracic spine.", "output": "Mild vascular prominence suggesting pulmonary venous hypertension without frank edema. Cardiomegaly. Unchanged configuration of AICD device." }, { "input": "PA and lateral views of the chest. Moderate-to-severe cardiomegaly is seen. A left-sided pacemaker is in place. Mediastinal wires and mediastinal clips are seen. There is mild pulmonary vascular congestion, but no focal consolidation and no evidence of pulmonary edema. There may be small bilateral pleural effusions.", "output": "Moderate to severe cardiomegaly. Mild pulmonary vascular congestion and small bilateral pleural effusions." }, { "input": "PA and lateral views of the chest. The left-sided pacemaker/AICD with 3 leads is unchanged in position. Sternotomy wires are intact. Mediastinal clips are unchanged. There is severe cardiomegaly. Again seen is mild pulmonary vascular congestion, similar to prior study. Trace bilateral pleural effusions are unchanged.", "output": "Severe cardiomegaly and mild pulmonary vascular congestion and trace bilateral pleural effusions are unchanged from prior study on ___." }, { "input": "The patient is status post median sternotomy and CABG. Left-sided AICD device is noted with leads terminating in the right atrium, right ventricle, and region of the coronary sinus, unchanged. Moderate to severe cardiomegaly persists. There is continued mild pulmonary vascular congestion. Right PICC tip terminates in the SVC. No pleural effusion or pneumothorax is seen. No focal consolidation is present. Inferior subluxation of the left humeral head relative to the glenoid fossa persists.", "output": "Mild pulmonary vascular congestion and moderate to severe cardiomegaly, unchanged." }, { "input": "The new RV lead terminates in the right ventricle. The remaining leads are unchanged in position. Median sternotomy wires are noted. There is some opacification of the right lower lobe, likely reflecting atelectasis. Marked cardiomegaly is unchanged. There is a small right pleural effusion. There is no pulmonary vascular congestion or pneumothorax.", "output": "Standard positioning of new RV lead." }, { "input": "When compared to the study from the prior day the severely enlarged heart is similar. The vascular engorgement on the right is more pronounced. There are small right and small left effusions, both of which are slightly larger compared to prior. The pacing device is unchanged.", "output": "Impression worsened fluid status" }, { "input": "Left-sided AICD/pacemaker device is noted with the leads terminating in the right atrium, right ventricle and coronary sinus. Moderate-to-severe cardiomegaly is unchanged. The patient is status post median sternotomy and CABG. There is mild pulmonary vascular congestion, similar compared to the prior study, with probable trace bilateral pleural effusions. No pneumothorax is present. There are no acute osseous abnormalities.", "output": "No significant interval change in mild congestive heart failure with probable small bilateral pleural effusions and mild pulmonary edema." }, { "input": "The lungs are well expanded. Assessment of the left lower lung field is limited due to stable severe cardiomegaly. No focal opacities are noted in the remaining lung fields. A small right-sided pleural effusion is present. There is mild interstitial thickening bilaterally with vascular cephalization. An enlarged right hilum is unchanged, left is obscured by pacing device. There is a tiple lead pacemaker, with leads in stable positions. Sternotomy wires are intact.", "output": "Mild interstitial edema and new right-sided pleural effusion in the setting of chronic congestive heart failure." }, { "input": "Single AP upright portable view of the chest was obtained. Per the radiology technologist, these are the best radiographs obtainable. Patient stated he would pass out if standing and has a sling. Left side of the AICD is again seen with leads in stable position. The cardiac silhouette remains markedly enlarged. There is prominence of the central pulmonary vessels. There is likely a trace left pleural effusion. No definite focal consolidation is seen. Mediastinal and hilar contours are stable.", "output": "Severe enlargement of the cardiac silhouette again seen. Prominence of the central pulmonary vasculature without overt pulmonary edema. Likely trace left pleural effusion." }, { "input": "Frontal and lateral views of the chest. Heart size and cardiomediastinal contours are normal. Lungs are clear without focal consolidation, pleural effusion, or pneumothorax.", "output": "Normal chest radiographs." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well-expanded clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, consolidation, or pleural effusion. Incidental note is made of mild cervical scoliosis.", "output": "No pneumonia." }, { "input": "Frontal and lateral radiographs of chest demonstrate well expanded clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion, pneumothorax or consolidation.", "output": "No pneumonia. COMMENTS: These findings were discussed with Dr. ___ by Dr. ___ ___ telephone at 4pm on ___, 5 minutes after their discovery." }, { "input": "Interval removal mechanical support devices including left chest tube, ET tube, and NG tube. More distal projection of right IJ catheter terminating in right atrium likely due to interval decrease lung volumes. There is expected postoperative leak, the cardiomediastinal silhouette is enlarged but stable with mild increase of right and left lower lung atelectasis. No pneumonia, pleural effusions or pneumothorax.", "output": "No pneumothorax. Stable cardiomegaly with mild worsening of right and left lower lung atelectasis." }, { "input": "Right IJ central line tip overlies the right atrium common similar prior. Status post sternotomy. Mild prominence of cardiomediastinal silhouette overall similar to the prior study. As before, the right hilum is somewhat prominent. There is platelike atelectasis in both lower zones similar to prior, slightly more pronounced on the left. There is upper zone redistribution and mild diffuse vascular blurring, consistent with mild CHF. There is a new small to moderate left pleural effusion with increased retrocardiac density consistent with left lower lobe collapse and/or consolidation. Minimal blunting the right costophrenic angle and minimal atelectasis at the right lung base, without gross effusion. Advanced osteoarthritis of both glenohumeral joints again noted.", "output": "Suspect slight interval increase in CHF. Increased opacity left base, consisting of increased left pleural effusion and increased retrocardiac density, compatible with left lower lobe collapse and/or consolidation. Minimal blunting of the right costophrenic angle, without gross right effusion. Minimal patchy atelectasis at the right lung base is similar to prior" }, { "input": "Cardiomediastinal contours are unchanged. The left hemidiaphragm continues to be elevated with volume loss/ infiltrate in the left lower lobe. The remainder of the lungs are clear", "output": "No significant change. There continues to be volume loss/ infiltrate in the left lower lobe." }, { "input": "Patient is status post coronary artery bypass graft surgery. There is patchy opacity at the left lung base with new elevation of the left hemidiaphragm, moderate in degree, suggesting coinciding volume loss. Otherwise, the lungs appear clear. There is no definite pleural effusion although it would be difficult to detect a subpulmonic pleural effusion on the left.", "output": "New opacity with volume loss at the left lung base which can probably be attributed to atelectasis although pneumonia is not excluded. Short-term follow-up radiographs with PA and lateral technique may be helpful to reassess." }, { "input": "The heart is not enlarged. Mild prominence the main pulmonary artery is within normal limits. There is slight upper zone redistribution, but no overt CHF. No focal infiltrate, effusion, or gross pneumothorax is detected. Lateral view suggest possible minimal blunting of both costophrenic angles. No free air seen beneath the diaphragm.", "output": "No focal infiltrate to suggest pneumonia. No overt CHF. Possible minimal blunting of the costophrenic angles posteriorly." }, { "input": "Increased heterogeneous opacities predominantly in the right mid and lower lung and left lower lung in conjunction with vascular engorgement likely represents asymmetric pulmonary edema; however, a diffuse viral bronchopneumonia could have a similar appearance. No change in numerous pleural plaques and scarring of the right middle lobe. Normal heart size with stable aortic tortuosity. No pleural effusion or pneumothorax.", "output": "Heterogeneous opacities in right mid and lower lung and left lower lung likely represent asymmetric pulmonary edema; however, diffuse viral bronchopneumonia could have a similar appearance." }, { "input": "Heart size remains mildly enlarged. The mediastinal and hilar contours are within normal limits. There is no pulmonary vascular congestion. Right lower lobe patchy opacity could reflect atelectasis. No focal consolidation, pleural effusion or pneumothorax is visualized.", "output": "Patchy right basilar opacity could reflect atelectasis. No evidence for congestive heart failure." }, { "input": "Airspace opacities within the left lower lobe and lingula obscuring the left hemidiaphragm and left heart border, respectively. There is a probable superimposed small-moderate left pleural effusion. Streaky right basilar opacities likely reflect atelectasis. The cardiomediastinal silhouette is within normal limits. Possible calcified left hilar node is noted. No acute osseous abnormalities are detected.", "output": "1. Left base opacity silhouetting the hemidiaphragm likely due to a combination of consolidation in the setting of infection with superimposed effusion. 2. Streaky right basilar opacities, may reflect pneumonia or atelectasis." }, { "input": "Increased interstitial markings are seen throughout the lungs which are chronic likely due to underlying interstitial process. Lower lung volumes seen on the current exam and subsequent retrocardiac opacity is likely due to atelectasis. There is no effusion or overt edema. Right apical scarring is again noted. This may also cause increased opacity at the right paratracheal stripe region however underlying lesions such as adenopathy is difficult to exclude.", "output": "Chronic changes in the lungs without definite focal consolidation. Increased soft tissue in the region of the right paratracheal stripe, potentially related to adjacent right apical scarring and AP technique, however underlying adenopathy is possible. Suggest repeat exam with PA technique if patient is amenable or alternatively CT scan for re-evaluation." }, { "input": "In comparison to the most recent prior study of ___, there is increased opacity at the left lung base, which in the setting of a productive cough and fever raises concern for pneumonia. However, a remote prior chest CT from ___ demonstrates bibasilar fibrotic changes and the increased markings in the left lung base may also represent progression of the patient's chronic lung disease/emphysema. Right apical pleural thickening is also seen, which is similar to the prior chest radiograph and chest CT. The lung volumes remain decreased. Irregularity of the peripheral pulmonary vasculature is compatible with emphysema. The cardiomediastinal silhouette is mildly enlarged but stable. The mediastinal and hilar contours are within normal limits. The pulmonary vasculature is not engorged, and there is no evidence of overt pulmonary edema.", "output": "Progression of chronic lung disease/emphysema with increased opacity at the left lung base which given symptoms of fever and cough raises concern for a superimposed pneumonia. Findings were discussed by Dr. ___ with Dr. ___ ___ telephone at 5 p.m. on ___." }, { "input": "AP upright and lateral views of the chest provided. Pulmonary interstitial opacity is new from prior exam and may represent pulmonary edema. Pleural based opacity is noted at the right apex. The lower lungs are poorly assessed given low lung volumes. Small pleural effusions likely present. Heart size is poorly assessed. No large pneumothorax. Bony structures appear intact.", "output": "Limited exam with interstitial pulmonary edema, small pleural effusions and pleural based opacity at the right apex. Lower lung atelectasis." }, { "input": "Since the prior examination, there is interval development of opacification along the medial right base that in setting of productive cough is concerning for infection. This is in the setting of bibasilar fibrotic change, and right apical thickening as better appreciated on prior CT examinations, most recent from ___. There are reduced lung volumes. Irregularity of the peripheral vasculature is in keeping with emphysema. The cardiomediastinal and hilar contours are normal. Pulmonary vascularity is normal.", "output": "Increased confluent opacity involving the medial aspect of the right base since prior examination from ___ raises concern for acute infection superimposed upon chronic basilar predominant fibrotic change. Recommend followup to resolution. Findings were logged into the critical results dashboard at 5:30 p.m. on ___." }, { "input": "The heart size is normal. The hilar and mediastinal contours are within normal limits. There is no pneumothorax, focal consolidation, or pleural effusion.", "output": "No acute intrathoracic process." }, { "input": "Lung volumes are slightly low. Streaky bibasilar opacities are most likely atelectasis. The lungs are otherwise clear without consolidation, effusion, or edema. Cardiac silhouette is top-normal. There is slight tortuosity of the descending thoracic aorta. No acute osseous abnormalities, hypertrophic changes are noted in the spine.", "output": "No acute cardiopulmonary process." }, { "input": "Exam is limited by significant rotation. Heart size is enlarged. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Cardiomegaly, but no evidence of pulmonary edema or pneumonia." }, { "input": "There is a small amount of pneumoperitoneum below the left hemidiaphragm, which may be expected considering the recent percutaneous G-tube placement. There is persistent mild pulmonary edema. The small bilateral pleural effusions are unchanged in size. There are no new focal consolidations. The cardiomediastinal silhouette is stable. There is no pneumothorax.", "output": "1. Small amount of pneumoperitoneum, which may be expected with the recent percutaneous G-tube placement. 2. Persistent mild pulmonary edema. 3. Small bilateral pleural effusions. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 9:50 AM, 5 minutes after discovery of the findings." }, { "input": "Compared with the prior radiograph, moderate cardiomegaly is unchanged, without pleural effusions or pneumothorax. Edema has improved. Course of the feeding tube is unchanged. A faint right lower lobe opacity is new.", "output": "A very faint right lower lobe opacity is new, and PA and lateral radiographs may be helpful to evaluate, when the patient is able to tolerate. Edema has improved." }, { "input": "Re- demonstration of a small amount of presumed free subdiaphragmatic air below left hemidiaphragm, described previously as the likely a consequence of recent percutaneous G-tube placement. On this semi-erect view, it is difficult to evaluate for interval change. Persistent mild pulmonary edema, without new focal consolidation or pneumothorax. Small bilateral effusions are unchanged. The cardiomediastinal silhouette is also unchanged.", "output": "1. Persistent presumed free left subdiaphragmatic air due to recent G-tube placement, as discussed with the clinician yesterday. On this semi-erect view, it is difficult to evaluate for interval change. 2. Persistent mild pulmonary edema." }, { "input": "There is a dobhoff coursing below the diaphragm, however the tip is not visualized. There is increasing interstitial pulmonary edema. There are small bilateral pleural effusions and bibasilar atelectasis, however an underlying pneumonia cannot be excluded. The cardiomediastinal silhouette is stable. There is no pneumothorax.", "output": "1. Appropriately positioned Dobhoff. 2. Increasing interstitial pulmonary edema with small bilateral pleural effusions, however an underlying pneumonia cannot be excluded." }, { "input": "The heart is mildly enlarged. The aorta is mildly tortuous. Hilar contours are unremarkable. The lungs are slightly hyperinflated. There is no evidence for pulmonary edema or pulmonary consolidation. The right costophrenic angle is sharp. The left costophrenic angle is relatively sharp posteriorly the less than the right, and appears blunted laterally. The ___ abdominal CT demonstrates prominent epicardial fat as well as linear atelectasis or scarring at the base of the lingula, which may account for blunting of the lateral left costophrenic angle, as well as slight eventration of the left posterior hemidiaphragm which accounts for slightly decreased sharpness of the left posterior costophrenic angle. Dextroconvex curvature of the thoracic spine is noted.", "output": "No evidence for acute cardiopulmonary abnormalities." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "AP upright and lateral chest radiograph demonstrates a moderate right pleural effusion and smaller left pleural effusion. Relative to CT dated ___, allowing for differences in modality, this appears increased. Known left upper lung spiculated nodule suspicious for malignancy is not significantly changed. No opacity is identified convincing for pneumonia. Bibasilar atelectasis is moderate. Heart is enlarged. Hiatal hernia seen in the retrocardiac region on the frontal view. No evidence of pulmonary edema. There is no pneumothorax.", "output": "Bilateral pleural effusions, right greater than left, appear increased relative to CT dated ___, allowing for differences in modality. Known left upper lung spiculated nodule suspicious for malignancy is again seen." }, { "input": "Frontal and lateral views of the chest. Heart size and cardiomediastinal contours are normal. Lungs are clear without focal consolidation, pleural effusion, or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is top normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cardiomediastinal contours are unchanged with tortuous aorta. The lungs are clear. There is no pneumothorax or pleural effusion. There are mild degenerative changes in the thoracic spine", "output": "No acute cardiopulmonary abnormalities" }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "There are low lung volumes. The heart size is moderately enlarged but stable. The aorta is calcified and tortuous, unchanged. The pulmonary vascularity is accentuated, but no frank pulmonary edema is identified. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Low lung volumes but no acute cardiopulmonary abnormality." }, { "input": "Single portable view of the chest is compared to previous exam from ___. The lungs are grossly clear. Cardiac silhouette is enlarged, potentially accentuated by portable technique and low inspiratory effort. There is no large effusion. Degenerative changes noted at the right shoulder. Osseous and soft tissue structures are otherwise grossly unremarkable.", "output": "No definite acute cardiopulmonary process." }, { "input": "Heart size, mediastinal and hilar contours are normal. Lungs and pleural surfaces are clear. Exam was not specifically tailored to evaluate for rib abnormalities, but no acute, displaced rib fractures evident within this limitation.", "output": "1. No acute cardiopulmonary radiographic abnormality. 2. No acute, displaced rib fracture. If there remains strong clinical suspicion for acute rib abnormality, coned-down dedicated rib views at the site of pain may be helpful if warranted clinically." }, { "input": "PA and lateral views of the chest provided. The heart is mildly enlarged. The lungs are clear without focal consolidation, large effusion or pneumothorax. No signs of edema or congestion. Mediastinal contour is normal. Bony structures are intact.", "output": "Mild cardiomegaly. No signs of pneumonia or edema." }, { "input": "AP upright portable chest radiograph obtained. Lungs are clear. Heart size is within normal limits. Mediastinal contour is unremarkable. No large pneumothorax or pleural effusion seen. Bony structures appear intact with mild arthropathy at the AC joints bilaterally.", "output": "No acute intrathoracic process." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is identified. Chain sutures are seen within the left lung apex. Mild degenerative changes are noted in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Stable cardiomegaly without evidence of congestive heart failure. Multifocal linear opacities in the mid and lower lungs likely represent a combination of linear scar and focal atelectasis. No evidence of pleural effusion or pneumothorax.", "output": "Cardiomegaly without evidence of congestive heart failure." }, { "input": "Low lung volumes with increasing bibasilar opacities. Linear opacity radiating from the hilum appears to be atelectatic lung. Probable small left effusion. Mild cardiomegaly. No pulmonary edema.", "output": "Slight increase in bibasilar opacities with lower lung volumes are favored to be atelectasis." }, { "input": "Lung volumes are extremely low. Oval opacity at the right lung base is slightly more prominent than on ___. Borderline cardiomegaly is stable from ___. A left internal jugular central venous catheter terminates in the mid SVC, unchanged. No pneumothorax. Small if any bilateral pleural effusions.", "output": "Right basilar opacity likely represents atelectasis or fluid in the fissure. No pneumonia. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 5:09 PM, at the time of discovery of the findings." }, { "input": "The cardiac silhouette is enlarged. Lung volumes are decreased with associated crowding of the bronchovascular structures. There is also bibasilar atelectasis. No focal consolidation is identified. There is no pneumothorax in this portable chest radiograph.", "output": "1. Low lung volumes with bibasilar atelectasis. No focal consolidation. 2. Stable cardiomegaly." }, { "input": "The left PICC terminates in the upper SVC. Lung volumes are low. The heart is mildly enlarged. Prominent lobulated hilar contours bilaterally secondary to dilated pulmonary arteries and a large right pulmonary vein better evaluated on chest CT from ___. Linear opacity at the right mid lung likely represents platelike atelectasis, unchanged from prior study. Left basilar atelectasis is noted. Small bilateral pleural effusions may be present. There is no focal consolidation or pulmonary edema.", "output": "1. Bilateral pleural effusions in the setting of very low lung volumes. 2. Prominent hilar contours attributable to enlarged right and left pulmonary arteries and large right pulmonary vein better evaluated on chest CT from ___." }, { "input": "Low lung volumes with vascular crowding. The linear opacities within the mid lung fields bilaterally likely represent subsegmental atelectasis. No new focal consolidations. Persistent eventration of the right hemidiaphragm. The cardiomediastinal silhouette is stable. The pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen.", "output": "Low lung volumes with bibasilar atelectasis. No evidence of pneumonia." }, { "input": "A right internal jugular catheter likely terminates in the upper SVC. Lung volumes are low which accentuates bronchovascular markings. There is mild pulmonary vascular congestion without frank pulmonary edema. There is mild right basal atelectasis. No large effusion or pneumothorax is identified.", "output": "Right IJ likely terminates in the upper SVC. No pneumothorax. Mild vascular congestion." }, { "input": "Since the prior radiograph, there has been improvement in pulmonary edema. Lung volumes are low and there is mild bilateral atelectasis. Heart size is top-normal. There is no evidence of pneumonia or pleural effusion.", "output": "Low lung volumes with mild bilateral atelectasis. No evidence of pneumonia." }, { "input": "Compared to chest radiograph from ___, lung volumes have decreased and remain low. Linear opacity at the right lung base likely represents chronic atelectasis or fissural thickening. Possible effusion on the right, likely moderate. There are no new focal consolidations. There is no pneumothorax. Moderately cardiomegaly with pulmonary vascular congestion suggests mild heart failure. Mediastinal and hilar contours are stable.", "output": "1. No evidence of pneumonia. 2. Low lung volumes. Probable moderate right effusion. Moderate cardiomegaly with pulmonary vascular congestion suggests mild heart failure. 3. Right basilar linear opacity likely represents chronic atelectasis or fissural thickening." }, { "input": "In comparison to the most recent prior, a left internal jugular central venous catheter has been placed. The catheter terminates in the mid SVC. Again noted are low lung volumes. No new focal consolidation is identified. There is no pneumothorax. Again seen is a possible diffusion on the right, unchanged since the prior examination. The cardiac silhouette is borderline enlarged and the pulmonary vascularity is indistinct, which may be suggestive of mild edema.", "output": "Left internal jugular venous catheter terminates at the mid SVC. Otherwise no significant interval change." }, { "input": "Comparison to ___. Moderate cardiomegaly. The pre-existing signs of mild pulmonary edema are mildly improved. Mild bilateral subsegmental atelectasis. No pleural effusions. Free intraperitoneal air under the right hemidiaphragm and possibly the left hemidiaphragm are new.", "output": "Slight improvement mild pulmonary edema. New free air under the right hemidiaphragm related to recent PEG insertion. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the ___ ___ at 3:43 PM, 20 minutes after discovery of the findings." }, { "input": "Since the previous film there is a increased an pulmonary vascular congestion. Inspiratory effort remains limited increased opacity in the left lower lobe may suggest early edema. PICC line in SVC with no interval change. .", "output": "Decreased inspiratory effort and increased congestion compared to previous film" }, { "input": "Examination limited due to patient body habitus and portable technique. No significant interval change. Hazy bibasilar opacities most likely represent atelectasis in the setting of low lung volumes. Left PICC line. Elevated right diaphragm, stable. Prominent pulmonary arteries again noted. No acute osseous abnormality.", "output": "No significant interval change. Hazy bibasilar opacities most likely represent atelectasis in the setting of low lung volumes. Small effusion is not excluded. Examination and study reviewed with Dr. ___." }, { "input": "No significant interval change compared to the prior radiograph performed 1 hr earlier. Lung volumes remain low. Bibasilar opacities are again noted. No pleural effusion or pneumothorax. No evidence of pulmonary edema. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities are identified.", "output": "No significant interval change in left greater than right bibasilar opacities that may represent atelectasis or infection." }, { "input": "PA and lateral views of the chest provided. Overlying EKG leads are noted. Bibasilar atelectasis is noted. No convincing evidence for pneumonia or edema. No large effusion or pneumothorax. The cardiomediastinal silhouette appears grossly unremarkable. Bony structures are intact.", "output": "Mild bibasal atelectasis. Otherwise unremarkable." }, { "input": "Portable AP upright chest radiograph was provided. Linear left mid lung opacity is unchanged and may represent scarring or platelike atelectasis. There is no pulmonary edema. No evidence of pneumonia. The heart is top normal in size though stable. Mediastinal contour is unremarkable. No large effusion or pneumothorax. Bony structures are intact. Mild AC joint arthropathy is noted bilaterally.", "output": "Mild cardiomegaly without signs of pulmonary edema." }, { "input": "Increased bilateral symmetric central pulmonary opacities seen. Name compatible with increased pulmonary edema.", "output": "Increased pulmonary edema" }, { "input": "The left internal jugular venous catheter line has been removed in the interim. A left subclavian approach PICC tip has been retracted in the interim and now projects over expected region of the cavoatrial junction. Lung volumes are low with bronchovascular crowding. Linear bandlike opacity projecting over the left mid lung is probably platelike atelectasis and/or scarring, seen on the prior exam and unchanged. No pleural effusion, pneumothorax, or frank pulmonary edema. No definite focal consolidation.", "output": "1. Left PICC tip now projects over the expected region of the distal cavoatrial junction. 2. Lung volumes are low with atelectasis but no frank pulmonary edema or focal pneumonia. If concern for pneumonia persists recommend returning for conventional PA and lateral radiograph views with better inspiration." }, { "input": "Portable upright chest radiograph ___ at 12:00 is submitted.", "output": "The feeding tube courses below the diaphragm with the tip not identified. Right internal jugular central line has its tip proximal to mid in the SVC. Prominent hilar contours may represent engorged vessels, although lymphadenopathy cannot be excluded. There has been interval worsening of mild pulmonary edema. Linear opacity in the left mid lung likely reflects scarring or subsegmental atelectasis. Probable small layering left effusion. No pneumothorax." }, { "input": "The cardiomediastinal contours are within normal limits. The bilateral hila are unremarkable. The lungs are clear without focal consolidation. There is no evidence of pulmonary vascular congestion. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest demonstrate stable mildly prominent cardiac silhouette, accentuated by low lung volumes. The mediastinal and hilar contours are otherwise unremarkable. The lungs are clear with the exception of trace if any bibasilar atelectasis. Mild blunting of the left costophrenic angle may be related to presence of a pericardial fat pad. There is no pneumothorax or vascular congestion. Minimal multilevel lower thoracic spondylosis is present.", "output": "No definite evidence of acute cardiopulmonary process such as pneumonia. Mild left costophrenic blunting likely due to pericardial fat pad. No pneumothorax." }, { "input": "The lung volumes are low. There is mild enlargment of the cardiac silhouette. Mild widening of the mediastinal contour is likely due to low lung volumes. Mild patchy opacities likely represent atelectasis. There is no evidence of pneumothorax, large pleural effusions or pulmonary edema.", "output": "Mild bibasilar atelectasis. No pneumonia or pneumothorax seen." }, { "input": "Cardiomediastinal contours are normal. Lungs are clear. No definite pleural effusion. Bones are diffusely demineralized.", "output": "No acute cardiopulmonary radiographic abnormality." }, { "input": "The lungs are clear without a consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal, and unchanged from the prior exam. The bones are diffusely demineralized. No acute fracture is identified.", "output": "No acute cardiopulmonary process; specifically, no evidence of pneumonia." }, { "input": "Heart size remains mildly enlarged. The mediastinal and hilar contours are unchanged with dense atherosclerotic calcification again seen in the thoracic aorta. The aorta remains tortuous. Pulmonary vasculature is not engorged. Streaky linear opacities in the lung bases likely reflect areas of atelectasis. No focal consolidation, pleural effusion or pneumothorax is present. Old bilateral rib fractures are noted.", "output": "Mild bibasilar atelectasis." }, { "input": "The cardiomediastinal silhouette is stable. The hilar contours are within normal limits and stable. There is moderate bilateral pleural effusions and moderate bibasilar atelectasis, left worse than right, which are unchanged when compared to ___ study. There is no evidence of pulmonary edema or atelectasis.", "output": "Moderate bilateral pleural effusions and moderate bibasilar atelectasis unchanged from ___ study. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 10:04 AM, 5 minutes after discovery of the findings." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is stable with calcification along the arch and ascending segments. Imaged osseous structures are intact. Chronic left and right rib deformities are again noted. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The heart is at the upper limits of normal size. The aorta shows mild unfolding and calcification along the arch. The lung volumes are low. Streaky left basilar opacity suggests minor atelectasis. There is no pleural effusion or pneumothorax. Mild degenerative changes are similar along the thoracic spine.", "output": "Streaky left basilar opacity, unchanged, probably atelectasis, without clear evidence for pneumonia." }, { "input": "Supine portable view of the chest demonstrates low lung volumes. Bibasilar opacities likely represent atelectasis. Perihilar vascular congestion is noted. Tortuosity of the descending aorta is noted. Heart size is normal. No pleural effusion or pneumothorax.", "output": "Low lung volumes. Bibasilar opacities, likely atelectasis and perihilar vascular congestion." }, { "input": "Lordotic positioning. Again seen is mild cardiomegaly, with a calcified ascending aorta There is patchy relatively confluent opacity at the right lung base extending to the costophrenic sulcus. , new compared with ___. No associated air bronchograms are identified, however. Elsewhere, no focal infiltrate or effusion. No CHF. Thin vertical linear lucency along the mid left chest wall is noted, new compared with the prior study. This may represent artifact due to out overlying soft tissues. An atypical pneumothorax along the left mid chest wall is considered less likely. No other evidence of pneumothorax. Probable old healed left sided rib fractures noted, unchanged.", "output": "New confluent opacity at the right lung base, suspicious for a focal pneumonic infiltrate. A small associated effusion would be difficult to exclude. If clinically indicated, a lateral view could help for further characterization. Minimal, if any, left base atelectasis. No left base consolidation or effusion. Thin linear lucency abutting the inner surface of the left mid chest wall. Is there clinical concern for a pneumothorax in this location? . This appearance is more suggestive of artifact due to overlying soft tissue planes. No other evidence of pneumothorax." }, { "input": "The inspiratory lung volumes are slightly decreased. Mild opacification at the left costophrenic angle may represent atelectasis or underpenetration. No definite consolidation concerning for pneumonia is seen. No significant pleural effusion or pneumothorax is present. The cardiac silhouette is top normal in size. The cardiomediastinal and hilar contours are within normal limits and unchanged from the prior study. Calcification at the aortic knob is noted. No displaced rib fractures are detected.", "output": "Limited examination with no acute cardiopulmonary process." }, { "input": "AP upright and lateral chest radiograph demonstrate a retrocardiac opacity, best seen on the lateral image, for which an infectious process cannot be excluded. Heart is borderline enlarged. No overt pulmonary edema is visualized. There is no pleural effusion or pneumothorax. Aortic arch calcifications are noted, similar in appearance to prior study dated ___.", "output": "Retrocardiac opacity best seen on the lateral view, for which an acute infectious process cannot be excluded." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes without focal consolidation, pleural effusion or pneumothorax. Left lung base atelectasis is noted. Hilar and mediastinal silhouettes are unchanged. Aortic arch calcifications are again noted. The descending aorta appears tortuous. The heart size is top normal.", "output": "No acute cardiopulmonary process." }, { "input": "Compared to prior study the lung volumes are lower. There is a right pleural effusion with adjacent compressive atelectasis. A consolidation in this region cannot be excluded. The cardiomediastinal contours are stable. Stable calcification of the ascending aorta and aortic arch. There is calcification noted in the left carotid artery and right rotator cuff.", "output": "Increased opacity in the right lower lung may represent worsening pleural effusion and compression atelectasis. However in the appropriate clinical setting, superimposed pneumonia cannot be excluded." }, { "input": "The heart is mildly enlarged. There is no focal consolidation, pleural effusion or pneumothorax. There is no overt pulmonary edema. Atherosclerotic calcifications are noted along the ascending aorta and aortic knob.", "output": "Mild cardiomegaly." }, { "input": "The cardiac silhouette is top-normal in size. There is calcification of the aortic knob. Lung volumes are decreased. However, there is no focal consolidation, pleural effusion or pneumothorax. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low. There is superimposed mild pulmonary edema. There bibasilar opacities which are most likely atelectasis, left greater than right. Infection cannot be entirely excluded. Cardiomediastinal silhouette is grossly unchanged.", "output": "Mild pulmonary edema. Left basilar opacity. This could be due to a combination of atelectasis and/or infection." }, { "input": "AP and lateral views of the chest. On the current exam, the lungs are clear. Cardiomediastinal silhouette is mildly enlarged, similar to prior. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low. The heart is mildly enlarged. There is pulmonary vascular redistribution. There is volume loss in both lower lungs. An early infiltrate/aspiration cannot be excluded.", "output": "Low lung volumes with worsened appearance to the lungs." }, { "input": "PA and lateral views of the chest provided. Lungs are hyperinflated and clear aside from a linear density in the left mid lung which could represent a focus of scarring or atelectasis. No focal consolidation, large effusion or pneumothorax. The heart size is top-normal. No signs of congestion or edema. Imaged bony structures are intact. Mediastinal contour is normal.", "output": "Top normal heart size, hyperinflated lungs likely reflect COPD, left mid lung linear density likely scarring or atelectasis. If symptoms persist, a nonemergent chest CT may be performed to further assess." }, { "input": "Hyperinflated lungs. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Hyperinflation, but no evidence of pneumonia." }, { "input": "The ETT terminates approximately 4.5 cm above the carina. An NG tube is seen coursing below the diaphragm. Hyperinflated lungs. No focal consolidations. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen.", "output": "Appropriately positioned ET and NG tubes." }, { "input": "There is diffuse airspace opacification seen involving the majority of the left lower lobe, most notable at the left base. There is also small focal region of consolidation in the mid right lung. The left lung apex and remaining right lung are clear. There is no pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "Left lower lobar pneumonia. Additional smaller focus in the right midlung as well." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "No significant change since ___ when accounting for differences in imaging technique. Persistent bilateral effusions, moderate on the right and small on the left, with adjacent stable compressive atelectasis bilaterally. Stable elevation of left hemidiaphragm. The left upper lung peripheral opacity, better characterized on recent CT as a fluid and air collection, is unchanged. The lungs are otherwise clear, without focal consolidation to suggest pneumonia or pulmonary edema. No pneumothorax. Stable cardiomediastinal silhouette and hila appear Sternotomy wires, prosthetic cardiac valve, left PICC line, and enteric feeding tube read, appear intact and unchanged in position. Expected post-lymphangiogram appearance of the nodes.", "output": "Persistent moderate right and small left pleural effusions." }, { "input": "Right-sided pleural effusion appears unchanged. Cardiomegaly is stable. Platelike atelectasis in the mid left hemi thorax and left base, are improving. Median sternotomy wires are unchanged in position, however the inferior most wire has been broken since the first postop radiograph. Left-sided chest tube remains within the basal left lung. Midline drains remain in place. Right IJ sheath appears unchanged.", "output": "Right-sided pleural effusion appears unchanged." }, { "input": "As compared to the prior examination dated ___, there has been no relevant interval change. Redemonstrated are bilateral, moderate size pleural effusions. The upper lung zones remain clear bilaterally. The patient is status post CABG and median sternotomy, and the upper mediastinal silhouette is stable in appearance.", "output": "Stable, moderate, bilateral pleural effusions. No relevant interval change." }, { "input": "Compared with the immediate prior study of earlier the same day, the right base is slightly more aerated. The pericardial drain projects in unchanged position. Tiny biapical pneumothoraces are unchanged. There is no pneumomediastinum. A moderate left pleural effusion is unchanged. The pneumatocele that projects over the left hemithorax is unchanged. There may be a small to moderate right pleural effusion.", "output": "Slightly improved aeration of the right base, otherwise no change." }, { "input": "The patient is status post recent median sternotomy and coronary bypass surgery and mitral valve replacement. Cardiomediastinal contours are within normal limits for postoperative status of the patient. Interval improvement in extent of bibasilar atelectasis. Bilateral small to moderate pleural effusions also appears slightly improved. No visible pneumothorax.", "output": "Improving bibasilar atelectasis and bilateral pleural effusions." }, { "input": "There is a new moderate right pleural fluid collection. There has been interval removal of left chest tube, ET tube, NG tube and Swan-Ganz catheter. A the midline drain is still present. Median sternotomy wires are unchanged in position. Left middle and right middle lung atelectasis is seen. Cardiomediastinal silhouette is largely unchanged.", "output": "There is a new right pleural fluid collection, which could represent a hemothorax. NOTIFICATION: The findings were relayed to the NP ___." }, { "input": "Portable frontal AP chest film of ___ at 10:42 is submitted.", "output": "Right subclavian line is unchanged in position. Right basilar chest tube remains in place. A basilar left chest tube remains in place with the second tube having been removed. There is marked interval improvement in aeration within the left lung with residual patchy opacity in the mid lung. This may reflect residual atelectasis, although contusion should also be considered as this opacity is in the same vicinity as the previous chest tube. No large effusion is seen. The patient is status post median sternotomy with CABG and valve replacement and stable postoperative mediastinal and cardiac contours. There is a stable small right apicolateral pneumothorax. No definite pneumothorax is seen on the left. No pulmonary edema." }, { "input": "Sternotomy wires and valve repair are intact and unchanged in position. The Dobbhoff tube is demonstrated coursing past the diaphragm with its tip in the left upper quadrant in the expected area of the stomach. The left PICC line is intact and unchanged in position at the level of the lower SVC. Stable appearance of the left lower lobe atelectasis and moderate left pleural effusion. Slight interval increase in the left lateral lung focal opacity. Stable right small pleural effusion. The heart is top-normal in size. The overall cardiomediastinal silhouette is unchanged. There is no pneumothorax or pulmonary edema. The remnants of a recent lymphogram are again demonstrated.", "output": "1. Slight interval increase in the left lateral focal opacity. 2. Stable left lower lobe atelectasis and moderate left pleural effusion. 3. Stable small right pleural effusion. NOTIFICATION: The impression above was entered by Dr. ___ on ___ at 20:17 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "Portable AP chest film ___ 07:55 is submitted.", "output": "Interval placement of a second left sided pleural catheter with introduction of some air within the pleural space consistent with a hydropneumothorax but no substantial change in opacification of the left hemithorax. Given the lack of improvement and when correlated with the CT dated ___, this likely reflects left lung collapse given the presence of debris filling the left mainstem bronchus on the recent CT study. Superimposed infection cannot be excluded. Bronchoscopy may be helpful. Patchy opacity at the right base is stable and could reflect an area of aspiration, pneumonia or atelectasis. No pulmonary edema. Right chest tube in place with stable small right apical pneumothorax. Status post median sternotomy with valve replacement. Assessment of the cardiac and mediastinal contours, however, is difficult given the opacification of the left hemithorax. NOTIFICATION: Results were communicated to the patient's nurse, ___, by phone on ___ at 10:40am. She informed us that the second chest tube has subsequently been removed and the patient has already undergone bronchoscopy." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "There has been interval placement of bilateral pigtail catheters and interval decrease in size of the bilateral pleural effusions. There is a small left apical pneumothorax, and no pneumothorax is seen on the right. The patient is status post median sternotomy, mitral valve replacement and CABG. There is no focal consolidation..", "output": "Small left apical pneumothorax. Interval decrease in bilateral pleural effusions following pigtail catheter placement. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 4:20 PM, 5 minutes after discovery of the findings." }, { "input": "Chest tube tips are at the bases bilaterally. NG tube passes into the stomach and out of view. Sternotomy wires are intact. Heart size is top normal. Left hemidiaphragm is elevated. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Bilateral effusions are improved and are minimal on the right and moderate on the left. No focal consolidation or pneumothorax.", "output": "1. Bilateral effusions are improved and are minimal on the right and moderate on the left. 2. Chest tube tips are at the bases bilaterally." }, { "input": "Cardiac size cannot be evaluated. Upper mediastinum is normal. There is no pneumothorax. Moderate to large bilateral effusions with adjacent atelectasis are grossly unchanged allowing the difference in positioning of the patient. Left pigtail catheter has been removed. The upper lungs are clear", "output": "Stable pleural effusions with adjacent atelectasis." }, { "input": "Portable AP upright chest film ___ at 13 47 is submitted.", "output": "There has been interval placement of a Dobbhoff feeding tube which courses below the diaphragm and is coiled within the stomach. Bibasilar chest tubes remain in place with no pneumothorax appreciated. The patient is status post median sternotomy for CABG and valve replacement with stable cardiac and mediastinal contours. Lungs are relatively well inflated with small residual pleural effusions and suggestion of possible underlying emphysema. Patchy opacities at the bases likely reflect scarring or atelectasis. No pulmonary edema." }, { "input": "Bilateral moderate pleural effusions with superimposed atelectasis are unchanged from the prior study of ___. The right apical pneumothorax is stable. A right pleural drain and left chest pigtail catheter are in unchanged position. The right-sided PICC line ends at the low SVC. Note is made of median sternotomy wires, left mediastinal clips, and a prosthetic mitral valve. Overall, there is little change from the prior study of ___.", "output": "1. Stable bilateral pleural effusions with superimposed atelectasis. 2. All lines and tubes in satisfactory position." }, { "input": "Portable AP upright chest film ___ 04:57 is submitted.", "output": "Interval near-complete opacification of the left hemithorax likely reflecting increasing pleural effusion or possibly hemorrhage into the pleural space. Clinical correlation is advised. A left basilar chest tube remains in place with the small pneumothorax seen on recent CT dated ___ not appreciated. A right basilar chest tube is again seen and there is a small but stable right apical pneumothorax. Stable small right effusion. Rounded lucency adjacent to the right hemidiaphragm on the previous study does not persist. Right subclavian PICC line is unchanged in position. Cardiac and mediastinal contours cannot be assessed due to the opacity of the left hemithorax. The patient is status post median sternotomy with valve replacement. Patchy opacity at the right lung base persists and may represent an area of atelectasis or pneumonia, less likely hemorrhage. Clinical correlation is advised. No evidence of pulmonary edema." }, { "input": "Cardiac size cannot be evaluated. It appears to be smaller than in prior study. Small bilateral effusions have decreased. There is no evident pneumothorax. The left hemidiaphragm is elevated as before. NG tube is coiled in the stomach. The tip could be also in the stomach but is not totally included in the film. Residual contrast is visualized in the right paraspinal region. Sternal wires are aligned.", "output": "Decrease in size in pleural effusions which are likely loculated on the left." }, { "input": "Frontal and lateral chest radiographs demonstrate hypoinflated lungs. Persistent small bilateral pleural effusions are noted. Bilateral lower lobe atelectasis again noted. Retrocardiac opacity is most consistent with combination of atelectasis and pleural fluid given elevated left hemidiaphragm however cannot exclude overlying infection in the appropriate clinical setting. No focal opacity. No pneumothorax. Heart size mediastinal contour are unremarkable. Multiple clips noted within mediastinum in a patient who is status post coronary artery bypass graft. Diffuse hyperdensity of bilateral lungs is likely artifactual due to over penetration given hypodensities over bilateral subcutaneous tissue. Sternotomy wires are intact and mitral valve replacement is again noted. Limited assessment of upper abdomen is unremarkable and osseous structures are within normal limits.", "output": "Persistent retrocardiac opacity is most consistent with combination of atelectasis and pleural fluid however cannot exclude overlying infection in the appropriate clinical setting. No evidence of pulmonary edema." }, { "input": "Cardiac size is top normal. There is mild vascular congestion and atelectasis in the right base. There is no pneumothorax or pleural effusion.", "output": "Mild vascular congestion." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. An opacity in the left lower lobe is consistent with pneumonia. Elsewhere, the lungs appear clear. There is no pleural effusion or pneumothorax.", "output": "Findings consistent with left lower lobe pneumonia." }, { "input": "2 views of the chest demonstrate clear lungs. The cardiac, hilar, and mediastinal contours are normal. No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest provided. VP shunt tubing traverses the left hemi thorax. Lung volumes are low though allowing for this, there is no definite evidence for pneumonia, edema, effusion or pneumothorax. Crowding of bronchovascular markings in the lower lungs and perihilar region does limit the evaluation. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process. VP shunt tubing crosses the left hemi thorax." }, { "input": "The cardiac, mediastinal and hilar contours are normal. The pulmonary vascularity is normal. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is identified. There are mild degenerative changes in the thoracic spine. Appropriate positioning of the gastric band is identified in the left upper quadrant of the abdomen.", "output": "Appropriate positioning of the gastric band in the left upper quadrant. No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest are compared to previous exam from ___. New when compared to prior is increased opacity at the right upper lung medially. Lungs are otherwise clear and the cardiomediastinal silhouette is within normal limits. Hypertrophic changes are seen in the spine.", "output": "New parenchymal opacity in the right upper lung medially compatible with pneumonia in the proper clinical setting. Recommend repeat after treatment to document resolution." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Previously reported small nodular opacity adjacent to the right second anterior rib is no longer visualized. Lungs remain markedly hyperexpanded, in keeping with emphysema, but there are no focal areas of consolidation or substantial atelectasis present. Heart size, mediastinal and hilar contours are within normal limits and without change.", "output": "1. Resolution of small right upper lobe nodular opacity, which was likely infectious or inflammatory in etiology. 2. Hyperinflated lungs, likely due to severe emphysema." }, { "input": "There is streaky retrocardiac opacity. The lungs are otherwise clear. Cardiac silhouette is top-normal in size. No acute osseous abnormalities.", "output": "Streaky retrocardiac opacity which is likely atelectasis. No definite acute cardiopulmonary process." }, { "input": "PA and lateral chest radiograph demonstrates clear lungs bilaterally. No focal consolidation concerning for pneumonia is identified. Linear opacity within the right mid lung zone most compatible with linear atelectasis. Cardiomediastinal and hilar contours are within normal limits. No evidence of pulmonary edema. No large pleural effusion is identified. Osseous structures are unremarkable.", "output": "No acute intrathoracic abnormality identified. No focal consolidation concerning for pneumonia is identified" }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of normal size with normal cardiomediastinal contours. The pulmonary vasculature is unremarkable. The lungs are clear without focal or diffuse abnormality. No radiopaque foreign body. Osseous structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Single frontal view of the chest. Heart size and cardiomediastinal contours are normal. Lungs are clear without focal consolidation, pleural effusion, or pneumothorax. No displaced rib fracture is identified. Mild dextroscoliosis of the thoracic spine is noted.", "output": "Normal chest radiograph." }, { "input": "Left-sided pacer device is stable in position. The patient is status post median sternotomy and CABG. The cardiac and mediastinal silhouettes are stable. No focal consolidation is seen. There is no pleural effusion or pneumothorax.There is pulmonary vascular congestion.", "output": "Pulmonary vascular congestion." }, { "input": "Supine portable AP view of the chest provided demonstrates endotracheal tube residing within the trachea with its tip approximately 4.8 cm above the carina. The nasogastric tube descends into the left upper quadrant with the distal side port at the level of the gastroesophageal junction. Linear density in the left mid to upper lung is stable and compatible with scarring. No large consolidation, effusion or pneumothorax is seen. There is an expansile and sclerotic appearance of the left second rib, better assessed on prior CT, which is compatible with metastatic disease. Cardiomediastinal silhouette appears normal. In the imaged portion of the upper abdomen, excreted contrast is noted within the bilateral renal collecting system.", "output": "1. Endotracheal tube appropriately positioned. Orogastric tube may be advanced for more optimal positioning. 2. Stable findings in the chest as compared with recent CT." }, { "input": "Scarring/consolidation in the left upper lobe is unchanged. There is no new focal airspace opacity. The heart is not enlarged. The mediastinal and hilar contours are stable. There is no large pleural effusion or pneumothorax. Enteric tube courses below the left hemidiaphragm and across midline to likely in the distal stomach. A round, rim calcified focus in the left upper quadrant is likely a splenic aneurysm.", "output": "Enteric tube is in the distal stomach." }, { "input": "Portable AP semi-erect view of the chest was reviewed. Compared to the most recent study the left lung has totally collapsed and the small right basilar atelectasis has increased. The amount of pleural effusion is difficult to evaluate given the lung abnormalities. The cardiomediastinal contour is partially obscured by the pleuroparenchymal abnormality. There is no evidence of pneumothorax. A transverse non-displaced linear fracture in the right median scapula has been present since ___. The known left scapular fracture is again noted.", "output": "1. Total left lung collapse and increased small right basilar atelectasis. 2. Non-displaced fracture of the right median scapula has been present since ___" }, { "input": "No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. No evidence of free air is seen beneath the diaphragms.", "output": "No acute cardiopulmonary process. No evidence of free air beneath the diaphragms." }, { "input": "Right pleural effusions is slightly smaller than on the prior exam. Lungs are clear. There is no focal consolidation or pneumothorax. Cardiomediastinal silhouette is unremarkable. Median sternotomy wires are intact. Osseous structures are unremarkable.", "output": "Right pleural effusion smaller than on the prior study." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are clear without focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs which are clear. There is no pleural effusion or pneumothorax.", "output": "Normal chest radiograph." }, { "input": "Inspiratory volumes are slightly low. The heart is not enlarged. The cardiomediastinal silhouette is unchanged compared with ___. Mild upper zone redistribution, without overt CHF. No focal infiltrate or effusion is detected. The left anterior seventh rib has an unusual configuration, in that the superior border/ cortex is indistinct, new compared with ___. Other visualized ribs are within normal limits. Mild degenerative changes of the thoracic spine are noted.", "output": "1. No acute pulmonary process. In particular, no pneumonic infiltrate identified. 2. Unusual appearance to the anterior left seventh rib, with indistinctness of the superior border of the rib. While this may represent an unusual artifact, it raises the possibility of a lytic area in the rib. Correlation with physical exam to assess for any focal tenderness or mass in this location is requested. RECOMMENDATION(S): Unusual appearance to the anterior left seventh rib, with indistinctness of the superior border of the rib. While this may represent an unusual artifact, it raises the possibility of the lytic area in the rib. Correlation with physical exam to assess for any focal tenderness or mass in this location is requested." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. Given slightly low lung volumes, there has been no change. The lungs are clear of confluent consolidation or effusion. Cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs are clear without consolidation or effusion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "A dialysis catheter terminates in the upper right atrium. The cardiac, mediastinal and hilar contours appear unchanged. There is a small to moderate effusion on the left with volume loss including elevation of the left hemidiaphragm and opacity probably due to atelectasis. A diffuse mild interstitial abnormality suggests mild congestion that is new since the prior examination. There is no evidence for free air or pneumomediastinum. Mild degenerative changes are similar along the mid thoracic spine. The lateral view depicts a TIPS shunt.", "output": "Findings suggesting mild vascular congestion with a left-sided pleural effusion and probable associated atelectasis." }, { "input": "Portable AP upright chest radiograph obtained. A left IJ tunneled dialysis catheter is again noted with its tip residing in the expected location of the right atrium. Lung volumes are low. Previously noted right PICC line has been removed. Given the low lung volumes, evaluation of the lung bases is limited. There is linear opacity in the left retrocardiac space, likely representing atelectasis. No definite signs of pneumonia or CHF. No pleural effusion or pneumothorax. The heart size cannot be readily assessed. Mediastinal contour appears stable with atherosclerotic calcifications along the aortic knob. Bony structures are intact.", "output": "Basilar atelectasis without definite signs of pneumonia." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities are identified.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac silhouette is mildly . There is tortuosity of the descending aorta. There is redemonstration of calcified granulomas. There is no focal consolidation, pleural effusion or pneumothorax. Moderate hiatus hernia is larger today than in ___.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest demonstrate normal cardiac and mediastinal silhouette. The lungs are well expanded and clear. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary process such as pneumonia." }, { "input": "A right pectoral pacemaker with leads terminating in the right atrium and right ventricle is unchanged in position. Sternotomy wires, epicardial pacer wires and mediastinal clips are constant. The heart is mildly enlarged, which accounting for technique, is unchanged. There is central vascular congestion without overt pulmonary edema. No pleural effusion or pneumothorax. An opacity in the right low lung, only appreciated on the frontal view, could reflect atelectasis or infection. There is no rib fracture.", "output": "Subtle opacity of the right lower lung could reflect atelectasis or infection, less likely contusion after trauma." }, { "input": "Patient is status post median sternotomy and CABG. A left-sided AICD/pacemaker device is re- demonstrated with leads in unchanged positions. Mild enlargement of the cardiac silhouette is re- demonstrated. The mediastinal and hilar contours are unchanged. Patchy opacities in the lung bases are again noted, most likely reflective of atelectasis. No pleural effusion, pulmonary edema, or pneumothorax is identified. Minimally displaced fracture of the right eleventh rib laterally is better assessed on the previous. Coarse calcification within the right breast is unchanged.", "output": "Bibasilar atelectasis. No pleural effusion or pneumothorax." }, { "input": "There is mild central peribronchial cuffing. No focal consolidation or pleural effusion. The heart size is top normal and mediastinal contours are normal.", "output": "Mild central peribronchial cuffing likely representing bronchitis in the setting of infectious symptoms." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unchanged. Pulmonary vasculature is not engorged. Minimal patchy opacities are noted in the lung bases, findings which could reflect atelectasis but infection is not excluded. No focal consolidation, pleural effusion or pneumothorax is present. There are mild to moderate multilevel degenerative changes seen in the thoracic spine.", "output": "Mild patchy bibasilar opacities, potentially atelectasis, but infection is not excluded." }, { "input": "Frontal and lateral views of the chest are obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Lungs are hyperinflated and appear clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Partially visualized are degenerative changes at the right glenohumeral joint. Thoracic spine aligns normally with mild degenerative spurring. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are normal. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. The lungs are well expanded and clear without focal consolidation. The upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal silhouette is normal. There is no pneumothorax or pleural effusion. There is no focal consolidation. There is no acute osseous abnormality.", "output": "No radiographic evidence of pneumonia." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "PA and lateral views of the chest were obtained demonstrating clear well expanded lungs without focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Comparison is made to prior study from ___. The heart size is within normal limits. Lungs are clear. There is no focal consolidation, pleural effusions or signs for overt pulmonary edema. Bony structures are intact.", "output": "No signs for acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. Streaky lingular opacity suggests minor atelectasis. Otherwise, the lungs remain clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The right PICC line terminates approximately 3 cm below the carina, ending in the lower SVC. The cardiomediastinal silhouette is unremarkable. No pleural effusion or pneumothorax is seen. The lungs are of normal lung volumes without definite consolidation.", "output": "Right PICC line terminates 3 cm below the carina, in the lower SVC. NOTIFICATION: Findings were discussed with the IV nurse at 11:36am, ___" }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax. Mild bibasilar atelectasis is similar to prior studies.", "output": "No acute cardiopulmonary process, specifically without focal consolidation concerning for pneumonia." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Right chest wall Port-A-Cath is noted. Catheter tip is not clearly delineated. The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process, no focal consolidation." }, { "input": "The lungs are clear. There is no pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is mildly enlarged with a left ventricular predominance. The aorta is mildly tortuous. The cardiac, mediastinal and hilar contours are probably unchanged, allowing for differences in technique. There is no pleural effusion or pneumothorax. The left hemidiaphragm is mildly elevated. The lungs appear clear.", "output": "Cardiomegaly. No evidence of acute cardiopulmonary disease." }, { "input": "Portable upright chest radiograph demonstrates interval removal of the endotracheal tube and enteric tube. The right internal jugular central venous catheter is unchanged. The heart size appears unchanged and the pleural effusions are redistributed due to patient positioning. The lung parenchyma is clear and there is no pneumothorax.", "output": "Interval extubation and layering of pleural effusion but no interval change in pericardial size." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures appear within normal limits.", "output": "No evidence of acute disease." }, { "input": "A single portable AP semi-upright view of the chest was obtained. Right internal jugular central venous catheter is in the upper SVC, unchanged. Heart size and mediastinal contours are stable. Lungs are clear. Large bilateral pleural effusions and mild pulmonary edema persist. No pneumothorax.", "output": "Persistent large bilateral effusions and mild pulmonary edema." }, { "input": "Current study is somewhat lordotic in projection. Until does not fit changed positioning of pericardial drain. Better, but incomplete aeration at the left lung base.", "output": "Improved aeration/ re-expansion of left lung base." }, { "input": "Portable semi-upright radiograph of the chest demonstrates low lung volumes with resultant bronchovascular crowding. A pericardial drain projects over the cardiac silhouette. There is a small amount of new pneumopericardium. Increased opacification of the retrocardiac space likely represents atelectasis. There is no pneumothorax.", "output": "New small pneumopericardium. NOTIFICATION: These findings were discussed with Dr. ___ by Dr. ___ ___ telephone at 14:10 on ___, 2 minutes after discovery." }, { "input": "Left chest tube has been removed. A pigtail pericardial drain is noted. Right PICC ends at the cavoatrial junction. Cardiomediastinal silhouette is stable. Lung volumes have increased. Right lung is clear. There is persistent atelectasis and effusion at the left base. No pneumothorax.", "output": "Increased lung volumes with persistent left lower lung atelectasis and effusion." }, { "input": "There is again seen a left chest tube in stable position. There is stable position of left-sided PICC line with distal tip projecting over the lower SVC. The cardiomediastinal silhouette is unchanged in appearance. The bilateral hila are unchanged and normal in appearance. The bilateral lung parenchyma are unchanged in appearance. There is seen in the right lower lung a circumscribed calcified nodule which corresponds to a calcified granuloma seen on prior CT scan from ___. The known 4 mm right middle lobe nodule seen on prior CT is not well visualized on this radiograph. There are no other focal lung consolidations. There is no evidence of pulmonary vascular congestion, pulmonary edema, pneumothorax or effusion.", "output": "No evidence of pleural effusion or pneumothorax. Stable chest x-ray." }, { "input": "Opacity in the right hemithorax has improved due to decrease in size and redistribution of the right effusion. Bibasilar atelectasis have improved. Cardiomediastinal contours are unchanged. Left subcutaneous emphysema has improved. There is no pneumothorax. Lines and tubes are in unchanged position", "output": "Improved left subcutaneous emphysema and right effusion." }, { "input": "There is again seen left-sided PICC line whose distal tip projects over the cavoatrial junction. The cardiomediastinal silhouette is unchanged. The bilateral hila are normal. There is a stable right lower lung calcified granuloma. There may be minimal left basilar atelectasis obscuring the left hemidiaphragm. There are no new focal lung consolidations. There is a stable minimal left apical pneumothorax, with a small medial component seen along the superior border of the cardiac silhouette. There are no pleural effusions.", "output": "Stable minimal/small left apical pneumothorax with minimal medial component seen along superior cardiac silhouette. Otherwise stable chest x-ray." }, { "input": "Heart size is normal. Mediastinal and hilar contours are normal. Pulmonary vasculature is not engorged. Clips are noted within the left chest wall anterolaterally. Calcified granuloma in the right lung base is unchanged. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Right-sided PICC line tubing is in unchanged position. A new pigtail drain is projected over the lower border of the heart at the midline of the body. No pneumothorax is seen, however the left hemidiaphragm is now completely obscured and there is haziness in the costophrenic angle. The findings suggest some combination of lung collapse and fluid at the left base.", "output": "Pigtail pericardial drain position as described. New consolidation left base." }, { "input": "Portable semi-upright radiograph of the chest demonstrates slight increase in retrocardiac opacity, consistent with atelectasis or consolidation. The cardiomediastinal and hilar contours are unchanged. There is no pneumothorax or pleural effusion. Tiny clacified granuloma in the right base.", "output": "Slight increase in retrocardiac opacity, consistent with atelectasis or consolidation. Stable cardiomediastinal contours." }, { "input": "Cardiac, mediastinal and hilar contours are normal. There are low lung volumes which causes crowding of the bronchovascular structures. No pulmonary edema is seen. There are minimal patchy opacities in the lung bases. This likely reflects atelectasis. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Low lung volumes with probable bibasilar atelectasis. No pulmonary edema or pleural effusion." }, { "input": "That pigtail catheter is again seen from projecting over the expected midline region for pericardial catheter. The right-sided PICC line tip is in the SVC. The upper lungs are clear without infiltrate. There is volume loss in the left lower lobe with retrocardiac opacity. There is a moderate left pleural effusion. .", "output": "Increased size of left pleural effusion." }, { "input": "PA and lateral views of the chest provided. Right upper extremity PICC line is seen with its tip extending into the upper SVC. The heart is mildly enlarged. The lungs are clear. Mediastinal contour is normal. Tiny clips project over the left clavicle.", "output": "1. PICC line positioned appropriately. 2. Mild cardiomegaly. 3. No signs of pneumonia." }, { "input": "The heart is moderately enlarged and is larger than on the prior film. The right-sided PICC line is unchanged. There is a new small left pleural effusion. There is mild pulmonary vascular redistribution. There is no infiltrate.", "output": "Fluid overload" }, { "input": "ET tube terminates approximately 3.4 cm above the carina. Right-sided central line terminates in the mid SVC. A right-sided PIC line terminates in the mid SVC. There is an enteric tube which extends below the diaphragm with the tip in the body of stomach. Overall, there has been slight interval increase in small-to-moderate bilateral pleural effusions with adjacent compressive atelectasis compared to the prior exam. There has been an interval decrease in the heart size, with interval placement of a pericardial drain. There is no evidence of a pneumothorax. The visualized osseous structures are unremarkable.", "output": "1. Slight interval increase in small-to-moderate bilateral pleural effusions with adjacent bibasilar atelectasis. 2. Interval improvement in the size of the heart, with the presence of a pericardial drain." }, { "input": "Right internal jugular and right PICC are stable. Heart size and mediastinal contours are unchanged. Layering bilateral pleural effusions are stable. No pneumothorax.", "output": "No interval change." }, { "input": "The pericardial drain is again visualized, right-sided PICC line with tip in the distal SVC is unchanged. Volume loss is again seen in the retrocardiac region. A small left pleural effusion is again visualized. Compared to the study from earlier the same day there is no significant interval change", "output": "No change" }, { "input": "No evidence of free air. Cardiomediastinal silhouette is normal. There is no focal lung consolidation. There is no pleural effusion or pneumothorax. Midline surgical ___ are noted within the abdomen. Right basilar calcified granuloma again noted.", "output": "No evidence of free air." }, { "input": "Right IJ central line and right IJ PICC present, both with tips overlying the distal SVC. ET tube tip approximately 3.9 cm above the C sign rib arina. NG tube extending beneath the diaphragm, off the film. Mild prominence of the cardiomediastinal silhouette is similar to the prior film, with an apparent pericardial drain in place. No pneumomediastinum detected. Again seen are bilateral layering effusions, slightly larger on the left on the left side, with underlying collapse and or consolidation. These are similar, possibly slightly larger than on the prior film. Slight vascular plethora is suspected.", "output": "As above." }, { "input": "Large right pleural effusion is new. Cardiac size is top-normal. Extensive left subcutaneous emphysema is new. Pneumopericardium is mild. Left basal and mediastinal tubes are in place. Right PICC tip is in the mid SVC There is no pneumothorax. Pigtail catheter projecting mid line appears lower than in prior study", "output": "New large right pleural effusion. NOTIFICATION: The findings were discussed by Dr. ___ with house staff in charge of the patient on the telephone on ___ at 10:04 AM, 2 minutes after discovery of the findings." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "A left PICC has been replaced with a right PICC, which terminates in the mid SVC. The inspiratory lung volumes are appropriate. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. Right basilar calcified granuloma is noted. The pulmonary vasculature is not engorged. The cardiomediastinal and hilar contours are within normal limits. No acute osseous abnormality is detected. Surgical clips overlying the left chest wall.", "output": "Right PICC terminating at the level of the mid SVC without evidence of complications." }, { "input": "Frontal and lateral views of the chest are obtained. Right suprahilar opacity is seen which may represent consolidation from infection, not clearly present on the recent prior CT. Left lung is clear. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "Mild right suprahilar opacity may represent consolidation due to infection; not clearly seen on recent prior chest CT. Recommend followup to resolution." }, { "input": "PA and lateral views of the chest compared to previous exam from ___. There is subtle increased opacity projecting in the right mid lung, not significantly changed from prior. Somewhat linear opacity seen in the right lung base medially, likely within the lower lobe could be due to atelectasis. The lungs are otherwise clear. Biapical scarring again noted. Cardiomediastinal silhouette is stable as are the osseous and soft tissue structures.", "output": "Subtle increased opacity in the right lower lobe, potentially due to atelectasis; however, developing infiltrate cannot be excluded." }, { "input": "The lungs are clear without consolidation, effusion, or edema. There is no pneumothorax. Cardiac silhouette is top-normal. Atherosclerotic calcifications are seen at the aortic arch. There are hypertrophic changes in the spine.", "output": "No acute cardiopulmonary process." }, { "input": "There are mildly low lung volumes. Allowing for changes due to this, the cardiomediastinal silhouettes are within normal limits. The bilateral hila are unremarkable. An azygos fissure is noted. The lungs are clear without focal consolidation. There is no evidence of pulmonary vascular congestion. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary process. No evidence of pneumonia or sequelae of aspiration." }, { "input": "The endotracheal tube terminates 5 cm above the carina. The NG tube terminating in the stomach and the right PICC line terminating at the cavoatrial junction are unchanged. No change in the bilateral pleural effusions or known bilateral rib fractures.", "output": "1. Endotracheal tube terminates 5 cm above the carina. 2. No change in the bilateral pleural effusions." }, { "input": "The endotracheal tube terminates at the level of the clavicles. A nasogastric tube coils in the stomach, tip not visualized. Minimal retrocardiac atelectasis is unchanged. Small bilateral layering pleural effusions are unchanged, right greater than left. There is no pneumothorax. The heart and mediastinum are within normal limits despite the projection.", "output": "No significant interval change from the study of 1 day prior." }, { "input": "Portable erect chest film ___ at 428 is submitted.", "output": "Endotracheal tube, nasogastric tube, and left subclavian central line are unchanged in position. Incidental note is made of an azygos lobe. There are small layering effusions with patchy opacity at the right base suggestive of atelectasis. There is improved aeration at the left base. A minimally displaced fracture of the right posterior third rib is again seen. Overall cardiac and mediastinal contours are unchanged. No pneumothorax." }, { "input": "The ET tube still terminates at the level of the upper clavicles. The nasogastric tube is coiled in the stomach. There are unchanged small bilateral pleural effusions with basilar atelectasis. No pneumothorax. An accessory azygos fissure is incidentally noted.", "output": "No significant interval change." }, { "input": "Tracheostomy tube, enteric catheter, and left PICC are unchanged in position. Bilateral airspace opacities, greater on the right, are similar in appearance, with mild improvement in right pleural effusion. The cardiomediastinal silhouette is unchanged. No pneumothorax is present.", "output": "Mild interval improvement in right pleural effusion. Otherwise, no significant change in appearance of the chest since the prior study." }, { "input": "The ET tube has been removed. A left-sided PICC line terminates in the mid SVC. Moderate layering pleural effusions with associated atelectasis are unchanged, right greater than left. There is no pneumothorax. The heart and mediastinum are magnified by the projection. New airspace opacification in the left lung may be due to edema or infection.", "output": "New left lung edema or infection. Stable layering bilateral pleural effusions with associated atelectasis, right greater than left." }, { "input": "Enteric feeding tube is seen coursing mid line with tip out of field of view. Portion of enteric feeding tube is coiled within the stomach. An endotracheal tube is seen above the level of the mid clavicles, 5.5 cm above the level of the carina in appropriate position. Interval placement of a left subclavian central venous catheter with tip at the left brachiocephalic/ SVC junction. The lungs are hypoinflated with bibasilar atelectasis. Small right pleural effusion is again noted. Heterogeneous opacity is again seen within the right lower lobe. No left pleural effusion. No pneumothorax. Heart size, mediastinal contour, and hila are otherwise unremarkable. Limited assessment of the upper abdomen is unremarkable. A minimally displaced rib fracture is seen along the posterior aspect of the right third rib.", "output": "1. Left subclavian CVL tip at left brachiocephalic/SVC junction. Additional support lines and tubes as described above. 2. Heterogeneous opacity in right lower lobe is worrisome for pneumonia with small pleural effusion. 3. Hypoinflated lungs with bibasilar atelectasis. 4. Minimally displaced rib fracture of posterior aspect of right third rib. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 4:40 PM." }, { "input": "Single portable frontal chest radiograph demonstrates enteric feeding tube coursing midline with tip out of field of view. Portion of enteric feeding tube is coiled within the stomach. An endotracheal tube is seen at the level of the mid clavicles, 5 cm above the level of the carina in appropriate position. The lungs are hypoinflated with bibasilar atelectasis. Small right pleural effusion is noted. Heterogeneous opacity is seen within the right lower lobe. No left pleural effusion. No pneumothorax. Heart size, mediastinal contour, and hila are otherwise unremarkable. Limited assessment of the upper abdomen is within normal limits. Minimally displaced fracture of the right posterior third rib is noted.", "output": "1. Endotracheal tube in appropriate position. Additional support tube as described above. 2. Heterogeneous opacity in right lower lobe is worrisome for pneumonia with small pleural effusion. 3. Hypoinflated lungs with bibasilar atelectasis. 4. Minimally displaced right posterior third rib fracture." }, { "input": "Portable supine chest film ___ at 15:59 is submitted.", "output": "Stable cardiac and mediastinal contours. There continues to be a layering right effusion and a smaller left effusion with associated bibasilar airspace opacities likely reflecting partial lower lobe atelectasis, although pneumonia cannot be excluded. Incidental note is made of an azygos lobe. Endotracheal tube has its tip at the thoracic inlet approximately 6.5 cm above the carina. A nasogastric tube is seen coursing below the diaphragm with the tip not identified. No pneumothorax." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. The hilar and mediastinal contours are within normal limits. There is no pneumothorax, focal consolidation, or pleural effusion.", "output": "No acute intrathoracic process." }, { "input": "There is opacification of approximately ___ of the left hemithorax with aeration at the left lung apex and a meniscus, suggesting that this is due to a large pleural effusion with underlying atelectasis. Underlying consolidation cannot be excluded. There is rightward shift of mediastinal structures. There is a small right pleural effusion and vague opacification of the right lung base, which is improved but not entirely resolved compared to prior. No pneumothorax is detected. Heart size cannot be well evaluated in the setting of overlying left pleural effusion. Aortic knob calcification is seen. The stomach bubble appears to be inferiorly displaced relative to the right hemidiaphragm, suggesting downward mass effect on the left hemidiaphragm by the left pleural process. Pigtail projecting over the right upper quadrant is incompletely imaged.", "output": "1. Large left pleural effusion with rightward shift of mediastinal structures. Findings were reported to ___ by ___ by telephone at 4:05 p.m. on ___ at the time of discovery of these findings. 2. Improved but persistent opacity at the right lung base." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes. Small right pleural effusion persists and cardiac silhouette is larger. There is no left pleural effusion. Right infrahilar peribronchial opacification is either early edema or mild pneumonia. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. Imaged upper abdomen is unremarkable.", "output": "1. Small right pleural effusion is unchanged since ___ exam. 2. New mild cardiomegaly and/or pericardial effusion. 3. Right basal edema, or early pneumonia. Distinguishing between the two, and evaluating possible pericardial effusion could be achieved by Chest CT performed with the patient prone. I discussed these findings by telephone with housestaff [details addended]." }, { "input": "There has been interval placement of a left pleural pigtail catheter with interval decrease in size of the left pleural effusion which now occupies approximately half of the area of the left hemithorax. There is interval resolution of rightward mediastinal shift. Small right pleural effusion persists. Subtle opacity of the right lower lung field persists. Aortic knob calcification is again noted. Evaluation of heart size is limited in the setting of overlying pleural effusion. There is decreased downward displacement of the gastric bubble.", "output": "Interval placement of a left pleural catheter with decreased size of left pleural effusion, which is now moderate to large, with resolved rightward mediastinal shift and decreased downward displacement of the gastric bubble." }, { "input": "Right lower lobe consolidation has progressed compared to the prior study and is concerning for an evolving pneumonia in the setting of febrile neutropenia. It is associated with mild volume loss. Additional nonspecific opacity has developed in the left retrocardiac region and could be due to either atelectasis or an additional site of infection. Several linear areas of atelectasis are also present in the left lower lobe and lingular regions. Small right pleural effusion appears slightly decreased compared to the prior study. No definite left pleural effusion. Cardiomediastinal and hilar contours appear unchanged. Fullness of right hilar region is concerning for lymph node enlargement, and note is made of both mediastinal and hilar nodal abnormalities reported on prior PET-CT of ___.", "output": "1. Evolving right lower lobe pneumonia with a component of mild volume loss. Followup radiograph is suggested to document resolution following appropriate therapy. 2. Persistent small right pleural effusion." }, { "input": "There has been interval placement of a right internal jugular central venous line which terminates at the cavoatrial junction. An endotracheal tube is in stable position, and an enteric tube terminates in the distal stomach. There has been interval decrease in the low lung volumes causing crowding of the central bronchovascular structures. There is a left retrocardiac opacity which may reflect atelectasis. The cardiac silhouette is stable in size.", "output": "1. Appropriate positioning of support lines devices as described above. 2. Worsening low lung volumes with a left retrocardiac opacity which may reflect atelectasis." }, { "input": "The endotracheal tube terminates in position 3.5 cm above the level of the carina. An enteric tube courses below the level of the diaphragm. Lung volumes are low causing crowding of the central bronchovascular structures, and elevation of the right hemidiaphragm is noted. The cardiac silhouette is top-normal in size, and no definite pleural effusion, focal consolidation or overt pulmonary edema is seen.", "output": "Appropriate positioning of endotracheal tube. Low lung volumes." }, { "input": "PA and lateral views of the chest were provided. The lungs are clear bilaterally without focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures are intact. No free air is seen below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "On this study, the lungs are better expanded and the lungs appear clear. A right upper lobe granuloma is unchanged. No pneumothorax or pleural effusion is present. The cardiac silhouette, hilar and mediastinal contours appear normal.", "output": "No acute cardiopulmonary findings." }, { "input": "Left AC separation is again seen. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits.", "output": "1. No acute cardiopulmonary process. 2. Left AC separation." }, { "input": "The lungs are hyperinflated with distinct attenuated vessels compatible with emphysema. There is no focal opacity suggestive of pneumonia. Atherosclerotic calcification of the aorta is prominent. There is no pleural effusion or pneumothorax. Cardiomediastinal and hilar contours are unremarkable.", "output": "No evidence of acute cardiopulmonary process or atelectasis in this patient with underlying emphysema." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cardiomediastinal contours are normal. Lungs are well-expanded and clear. Mild scoliosis is noted.", "output": "No radiographic evidence of active pulmonary infection or interstitial lung disease. If warranted clinically, high-resolution CT could be performed that to exclude radiographically occult airway or interstitial lung abnormality." }, { "input": "PA and lateral views of the chest are provided. There are low lung volumes, which limit the evaluation. Mild pulmonary interstitial edema is evidenced by mild increase in reticular interstitial markings. No large effusion or pneumothorax is seen. The cardiomediastinal silhouette is stable with atherosclerotic calcifications again noted along the thoracic aorta. The bony structures are intact.", "output": "Findings concerning for mild interstitial edema." }, { "input": "Low lung volumes cause bronchovascular crowding. Mildly increased interstitial markings at bilateral lung bases are unchanged from multiple prior studies and likely represent chronic interstitial lung disease. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is stable. The descending aorta is partially calcified and tortuous.", "output": "Unchanged chronic interstitial lung disease. No focal consolidation." }, { "input": "There are low lung volumes. Mild interstitial markings are suggestive of mild pulmonary edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "Mild pulmonary edema." }, { "input": "Frontal and lateral radiographs of the chest were obtained. Heart size and mediastinal contours are unchanged with tortuosity of the thoracic aorta. Atherosclerotic calcification of the ascening aorta and aortic arch are noted. No focal consolidation, pleural effusion or pneumothorax is present.", "output": "Stable appearance of the chest with no evidence of pneumonia." }, { "input": "Mild enlargement of the cardiac silhouette is stable. The mediastinal and hilar contours are unchanged. The pulmonary vascularity is normal. The lungs are clear. No pleural effusion or pneumothorax is demonstrated. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes, which accentuate bronchovascular markings. Retrocardiac opacity is noted. Left hemidiaphragm is obscured on the frontal view. No large pleural effusion. No pneumothorax. Hilar and mediastinal silhouettes are unremarkable. The heart size is top normal.", "output": "Low lung volumes. Retrocardiac opacity, likely atelectasis. However, superimposed infection cannot be excluded." }, { "input": "The lung volumes are low. There is a linear opacity in the right base, which is new from the prior exam. There is an ill-defined opacity at the left base, which appears mostly stable, and may represent prominent osteophytes. The apices of the lungs are clear. There is no pulmonary edema, pleural effusion, or pneumothorax. The mediastinal contours are normal. The heart size is at the upper limits of normal.", "output": "Bibasilar opacities, which are likely due to atelectasis, although a developing infiltrate cannot be completely excluded. Further evaluation with oblique views is recommended to better characterize the opacities. Recommendations were discussed with Dr. ___ ___ resident) at 10 AM on ___ via telephone by Dr. ___." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Subtle, streaky opacities in the right and left lower lobes are most consistent with atelectasis. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs demonstrate very low lung volumes with bibasilar atelectasis. However, there is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Very low lung volumes with bibasilar atelectasis. No pneumothorax." }, { "input": "AP upright and lateral views of the chest were obtained. The heart is normal in size and cardiomediastinal contours are unremarkable. Lung volumes are low and atelectasis is noted at the left base and to a lesser extent right base. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "Mild cardiomegaly is unchanged. Consolidations of the lung bases, right greater than left. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "Although consolidation at the right lung base could be secondary to atelectasis, the findings are concerning for right lower lobe pneumonia." }, { "input": "Since the prior radiograph, there has been no significant change. Lung volumes are again low, probably due to poor inspiration. Retrocardiac opacity is similar in appearance to prior on the frontal but improved onthe lateral likely from better inspiratory effort. There is no pneumothorax or pleural effusion. The cardiomediastinal silhouette is unchanged and mildly enlarged. The osseous structures are unremarkable.", "output": "No significant change since the prior radiograph. Retrocardiac opacity likely due to atelectasis; however, infectious process cannot be completely excluded." }, { "input": "AP and lateral images were obtained with patient in semi-upright position. There are low lung volumes likely due to poor inspiration. The patient is also in a slightly lordotic position. There is a retrocardiac opacity that may be related to poor inspiration or overlying soft tissues, but in the appropriate clinical setting this opacity would be concerning for possible pneumonia. There is no pneumothorax or pleural effusion. Heart size is normal. Visualized osseous structures are unremarkable.", "output": "Retrocardiac opacity, possibly consistent with low lung volumes or overlying soft tissue, but could also represent pneumonia in the appropriate clinical setting." }, { "input": "Chest, PA and lateral. The appearance of the heart and lungs is essentially unchanged from the prior study. Lung volumes are again low, and there is atelectasis at the right base. A prominent epicardial fat pad causes a hazy opacity at the left lower lung. There is no focal consolidation. Heart size normal.", "output": "1. No definitive evidence of infection. 2. Low lung volumes with bibasilar atelectasis." }, { "input": "PA and lateral chest radiograph demonstrate streaky opacities in the bases bilaterally, possibly reflective of aspiration. Bronchial wall thickening at the lower lobes is also noted. There is no pleural effusion. Mediastinal and hilar contours are stable relative to prior examinations. The left heart border is partially obscured but the heart is probably mildly enlarged. There is no evidence of pulmonary edema. There is no pneumothorax.", "output": "Lower lobe bronchial inflammation could be due to aspiration. Overall stable appearance of the chest, similar to examination performed ___." }, { "input": "PA and lateral views of the chest provided. The upper mediastinum is widened. There is pulmonary interstital edema. There are bibasilar opacities which may represent edema versus less likely infection. There is no pneumothorax The upper mediastinum is widened. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "1. Widened mediastinum likely represents mediastinal lymphadenopathy. Chest CT is recommended for further characterization. 2. Pulmonary interstitial edema. 3. Bibasilar opacities which may represent edema versus infectious etiology. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 9:36 AM, 4 minutes after discovery of the findings." }, { "input": "The size of the cardiomediastinal silhouette is unchanged including widening of the upper mediastinum. There are increasing predominantly perihilar and right lower lobe opacities, possibly reflective of pulmonary edema. Underlying infection cannot be excluded in the proper clinical context. Airspace opacity in the left mid lung zone may correlate to the nodule described on the recent CT scan of the chest. Small bilateral pleural effusions are present. No pneumothorax identified.", "output": "Increasing perihilar and right lower lobe opacities which can be seen in the context of worsening pulmonary edema however superimposed infection cannot be excluded in the proper clinical context." }, { "input": "PA and lateral views of the chest were provided demonstrating no focal consolidation, effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. Mild subsegmental left basal atelectasis noted. Otherwise lungs appear clear. There is no convincing sign of pneumonia or edema. No large effusion or pneumothorax is seen. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest. There are increased interstitial markings in the lungs, particularly superiorly, which could be due to chronic underlying parenchymal disease. There is no confluent consolidation nor effusion or pneumothorax. The cardiac silhouette is at upper limits of normal. Descending thoracic aorta is tortuous. No acute osseous abnormality is identified.", "output": "No definite acute cardiopulmonary process." }, { "input": "There is prominence of the aortic knob with mild calcification. The cardiomediastinal and hilar contours are otherwise within normal limits. Lungs are well expanded. Note is made of increased retrocardiac opacity and atelectasis at the right lung base. There is no significant pneumothorax or large pleural effusion in this single frontal chest radiograph.", "output": "1. No evidence of pneumothorax in this single frontal chest radiograph. 2. Patchy left Retrocardiac opacity could reflect atelectasis versus aspiration. If clinical concern, dedicated chest radiograph with a lateral view can be considered for more complete evaluation and to help exclude the possibility of a developing infectious pneumonia at this site. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 12:28 PM." }, { "input": "Heart size is normal. The aorta is mildly unfolded. Mediastinal and hilar contours are otherwise within normal limits. Pulmonary vasculature is normal. Subsegmental atelectasis is noted in the left lower lobe. The lungs are otherwise clear without focal consolidation. No pleural effusion or pneumothorax is present. No acute osseous abnormalities seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The aorta is mildly tortuous and demonstrates mild atherosclerotic calcifications. Pulmonary vasculature is normal. Patchy opacity within the left lung base with blunting of the left costophrenic angle appears chronic, and may reflect scarring with small left pleural effusion or pleural thickening. There is streaky atelectasis in the right lung base. No focal consolidation, right pleural effusion or pneumothorax is demonstrated. Clips from prior cholecystectomy are seen in the right upper quadrant of the abdomen. There are no acute osseous abnormalities. Mild degenerative changes are noted in the thoracic spine.", "output": "No substantial interval change from the previous radiograph. Chronic left basilar scarring and blunting of the left costophrenic sulcus, possibly suggestive of a small left pleural effusion or pleural thickening. No focal consolidation." }, { "input": "2 views were obtained of the chest. The lungs are well expanded. A small left pleural effusion has increased over 5 hours. Associated peripheral opacities seen better on outside hospital CT are probably pulmonary infarctions. Heart and mediastinal contours are unremarkable. There is no pneumothorax.", "output": "Increasing small left pleural effusion with accompanying peripheral opacities which may reflect infarction in the setting of known pulmonary emboli." }, { "input": "Frontal radiographs of the chest demonstrate normal heart size. The ET tube terminates 6 cm above the carina. The cardiomediastinal silhouette and hilar contours are normal. The lungs are clear. No pleural effusion or pneumothorax. No displaced rib fracture identified.", "output": "ET tube in appropriate position." }, { "input": "PA and lateral views of the chest provided. Left chest wall AICD again noted with tripolar leads extending to the region the right atrium, right ventricle and coronary sinus as on prior. 2 prosthetic cardiac valves are in place. Midline sternotomy wires and mediastinal clips are noted. Mild interstitial edema and hilar engorgement is increased from prior. Cardiomegaly is mild. Tiny pleural effusions are present. No pneumothorax. Mediastinal contour is unchanged. Bony structures are intact.", "output": "Mild interstitial pulmonary edema, mild cardiomegaly, tiny pleural effusions." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. Hilar contours are stable, including prominence of the left pulmonary artery. Patient is status post median sternotomy. Left-sided pacer device is stable in appearance. There is no pulmonary edema.", "output": "No acute cardiopulmonary process. No significant interval change." }, { "input": "Left pectoral pacemaker has 3 leads terminating in the right atrium, right ventricle, and coronary sinus. Prosthetic mitral and aortic valves are noted. There is no consolidation, pleural effusion, or pneumothorax. Mildly enlarged cardiac silhouette is similar as before. Left pulmonary artery is prominent as seen on prior CT.", "output": "No radiographic evidence of pneumonia." }, { "input": "AP and lateral chest radiographs. Right PICC tip is in the lower SVC. The lungs are clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "1. No acute cardiopulmonary process. 2. Right PICC tip is in the lower SVC." }, { "input": "PA and lateral views of the chest provided. The lungs appear clear without focal consolidation, large effusion or pneumothorax. The cardiomediastinal silhouette appears stable. No convincing signs of congestion or edema. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear without focal consolidation or effusion. The cardiomediastinal silhouette is within normal limits. Slightly tortuous descending thoracic aorta is again noted. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "A previously seen right basilar opacity on the ___ examination has decreased in density, reflecting interval improvement. No new consolidation, effusion, or pneumothorax is detected. The heart size is normal. The hilar and mediastinal contours remain within normal limits.", "output": "Interval improvement of a previously-seen right basilar opacity. No new consolidation." }, { "input": "Mildly hypoinflated lungs with crowding of vasculature. Heterogeneous right lower lobe opacity is noted. No pleural effusion or pneumothorax. Mild accentuation of the heart size is likely due to patient positioning and low lung volumes. Mediastinal contour and hila are unremarkable.", "output": "Heterogeneous right lower lobe opacity may represent superimposed vessels however differential includes early pneumonia. Clinical correlation is recommended. If concern consider repeat radiograph with better positioning for further evaluation." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "There is no focal consolidation, pleural effusion, or pneumothorax. Lung volumes are low. Heart size is mildly enlarged. There are no acute skeletal abnormalities.", "output": "Low lung volumes, mild cardiomegaly." }, { "input": "The cardiac silhouette size is top normal. The aorta is mildly tortuous. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is not engorged. Minimal patchy opacities are demonstrated in the right lower lobe which may be infectious in etiology. Left lung is clear. No pneumothorax or pleural effusion is identified. No acute osseous abnormalities seen.", "output": "Minimal patchy right lower lobe opacity which is concerning for infection in the correct clinical setting. NOTIFICATION: The findings were discussed by Dr. ___ with ___, the receptionist at ___ to relay to Dr. ___ on the telephone on ___ at 8:46 PM." }, { "input": "PA and lateral views of the chest. The lungs are clear, there is no region of focal consolidation or effusion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality detected.", "output": "No acute cardiopulmonary process." }, { "input": "The patient has had recent esophagectomy with gastric pull-through. An endotracheal tube terminates at the level of the clavicles. A right chest tube and mediastinal drain are in place. There is no pneumothorax. Small bilateral pleural effusions with bibasilar subsegmental atelectasis are unchanged. Previous mild pulmonary vascular congestion has improved.", "output": "Small bilateral pleural effusions, bibasilar subsegmental atelectasis. Improved mild pulmonary edema." }, { "input": "Compared with ___ at ___:47, there is opacity along the right chest wall, slightly increased. On today's exam, there is equivocal irregularity involving at least 1 rib along the lower right chest, as well as a defect in the posterior sixth rib that likely relates to the recent surgery. Otherwise, I doubt significant interval change. Again seen is the NG type tube extending along the right mediastinum. Additional linear density likely reflects an epidural catheter. A right-sided chest tube is also present, unchanged. There is mild vascular plethora without frank CHF. Patchy opacity at the left base medially is again noted, possibly slightly increased. Patchy opacity at the right base is similar to the prior film. No gross effusion. No pneumothorax detected.", "output": "1. NG tube extending along right mediastinum in this the patient with a history of esophageal surgery . Tip poorly visualized, but probably lies at the level of the right cardiophrenic angle. 2. Mild vascular plethora, without frank CHF. 3. Patchy bibasilar opacities, possibly slightly increased on the left side, but without significant change on the right. 4. Opacity along the right chest wall slightly increased, question pleural fluid and/or thickening. Possible irregularity of a lower right chest wall rib raising the question of a nondisplaced rib fracture. Does the the patient have focal tenderness in this location? This is in addition to the postsurgical defect of the right sixth rib posteriorly. NOTIFICATION: Page placed to covering physician ___. ___ ___ ___:38 am on ___" }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unchanged. Mild aortic tortuosity is unchanged since prior. There is no pulmonary edema. Heart size is normal. Multiple surgical clips project over right upper abdomen. Partially imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Single AP upright portable view of the chest was obtained. The cardiac silhouette is mildly enlarged. The mediastinal contours are not widened and are without significant interval change. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. No pulmonary edema is seen. Right upper quadrant surgical clips are again seen.", "output": "Mildly enlarged cardiac silhouette. The mediastinum is not widened and is similar in appearance compared to the prior study." }, { "input": "PA and lateral views of the chest. The lungs are clear of consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "There is a new opacity obscuring the right heart border suggestive of a new right middle lobe pneumonia. Otherwise, the remainder of the lungs are clear. Cardiomediastinal silhouette is normal. Osseous structures are normal.", "output": "Right middle lobe pneumonia. These findings were discussed by Dr. ___ with Dr. ___ at 1:15 p.m. on ___." }, { "input": "PA and lateral views of the chest provided. The right loculated pleural effusion is mildly improved since ___. Right subcutaneous emphysema has improved. The left lung is clear. Stable mild cardiomegaly. No pneumothorax or pulmonary edema. The cardiomediastinal silhouette is normal.", "output": "Mild improvement in right loculated effusion. Right subcutaneous emphysema has improved." }, { "input": "A right chest tube appears to be moved in positioning. A probable loculated pleural effusion in the right lower lung is increased since ___. Moderate bibasilar atelectasis is again seen with elevation of the left hemidiaphragm. The heart size is unchanged. The known multiple pulmonary nodules are not well seen on this exam, and are better assessed on recent CT Chest from ___. Substantial subcutaneous emphysema persists. No pneumothorax.", "output": "1. Interval increase in right lower lung loculated pleural fluid. Right chest tube persists. No pneumothorax. Less likely this opacity represents hematoma. 2. Multiple known pulmonary nodules are better assessed on recent CT Chest from ___" }, { "input": "Interval removal of right chest tube. The right loculated pleural effusion appears more prominent. The left lung is clear. The heart size is unchanged. No pneumothorax or pulmonary edema. Otherwise, little interval change since earlier same day portable radiograph.", "output": "1. Interval removal right chest tube. Right loculated pleural effusion is slightly more prominent. No pneumothorax" }, { "input": "A battery overlies the medial mid left hemithorax. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. There is persistent elevation of the left hemidiaphragm.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac, mediastinal and hilar contours are unremarkable. Lung volumes are low, but the lungs are clear. There is no pulmonary vascular engorgement. No pleural effusion or pneumothorax is present. Bilateral ___ rods with fixation wires spanning the thoracolumbar spine are incompletely imaged.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Compared to the prior study there is no significant interval change. The NG tube is in the stomach. Spinal fixation device and scoliosis are again seen. The heart is normal in size. The lungs are clear without infiltrate or effusion", "output": "No change." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Lungs are clear and the pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral views were obtained. Cardiomediastinal and hilar contours are stable. There is no pleural effusion or pneumothorax. Bibasilar consolidations are nonspecific.", "output": "Bibasilar atelectasis or pneumonia. Aspiration is also possible in the correct clinical setting." }, { "input": "PA and lateral views of the chest. There is no focal consolidation. There is no pleural effusion or pneumothorax. The heart size is normal. There are normal cardiomediastinal contours.", "output": "No evidence of pneumonia or other acute intrathoracic process." }, { "input": "The heart is mildly enlarged. The cardiomediastinal and hilar contours are unremarkable. Mild atherosclerotic calcifications are noted at the aortic knob. The pulmonary vasculature is normal. Lung volumes are low and there is minimal bibasilar atelectasis. No focal consolidation is identified. No large pleural effusion or pneumothorax is seen. Widened right acromioclavicular joint may be posttraumatic or postsurgical.", "output": "Low lung volumes with bibasilar atelectasis. No focal consolidation is identified." }, { "input": "PA and lateral views of the chest were provided demonstrate no focal consolidation, effusion, or pneumothorax. Heart and mediastinal contours appear normal. Bony structures are intact.", "output": "No acute intrathoracic process." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. Heart and mediastinal contours are unremarkable.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. Biapical scarring is noted. The cardiomediastinal silhouette is within normal limits. Calcifications are noted at the aortic arch. Diffuse idiopathic skeletal hyperostosis is seen within the imaged thoracic spine.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "PA and lateral images of the chest demonstrate well-expanded lungs which are clear. There is no pneumothorax or pleural effusion. Cardiomediastinal silhouette is unremarkable. Visualized osseous structures are unremarkable.", "output": "Normal chest x-ray." }, { "input": "Heart size is mildly enlarged. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lung volumes are low. Left lower lung opacity overlies the spine on lateral view. Mediastinal contour, hila, cardiac silhouette are normal. There is no pneumothorax or pleural effusion.", "output": "Left lower lung opacity may represent pneumonia or atelectasis." }, { "input": "Lungs appear hyperinflated. Cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs demonstrate retrocardiac opacity which corresponds to opacities projecting over the lower lumbar spine on the lateral view worrisome for airspace disease and infectious process. Cardiomediastinal and hilar contours are within normal limits. There is no evidence of pulmonary edema, pleural effusion, or pneumothorax. Eventration of the right hemidiaphragm is noted.", "output": "Retrocardiac opacity worrisome for a left lower lobe infectious process." }, { "input": "PA and lateral views of the chest are provided. The lungs are clear without focal consolidation, effusion or pneumothorax. No displaced rib fractures are seen. Cardiomediastinal silhouette appears normal. No free air below the right hemidiaphragm.", "output": "No acute findings. If there is strong clinical concern for rib fracture, dedicated rib series may be obtained to further assess." }, { "input": "There has been little interval change in comparison to the prior study. The lungs are clear with no evidence of a consolidation, effusion or pneumothorax. Cardiac and mediastinal silhouettes are normal. Atherosclerotic calcifications are again noted at the aortic arch. Diffuse idiopathic skeletal hyperostosis is noted throughout the thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "Small-to-moderate right pleural effusion is stable. Mild-to-moderate pulmonary edema with basal component is overall stable since the prior study, with possible very minimal improvement at the left lung base. Cardiomediastinal silhouette and hilar contours are stable. Small left pleural effusion persists. Right PICC is stable, only being able to be traced to the junction of the brachiocephalic veins.", "output": "Overall stable with possible minimal improvement at the left lung base." }, { "input": "The large right loculated pleural effusion is unchanged from yesterday. Blunting of the left costophrenic angle likely reflects a small left pleural effusion. The cardiac silhouette remains moderately enlarged. There is worsening of moderate pulmonary edema. Evidence of prior sternotomy and coronary pericardial stripping is unchanged.", "output": "1. Unchanged, large right loculated pleural effusion. 2. Worsened moderate pulmonary edema. 3. Focal opacity of the right upper lung may reflect asymmetric pulmonary edema or a secondary process such as infection. Evaluation after diuresis is recommended." }, { "input": "Persistent cardiomegaly and upper zone vascular redistribution, but decreased in extent of bilateral perihilar haziness and bilateral septal thickening, suggesting improved pulmonary edema in the setting of interval diuresis. Geographically marginated opacities in left juxtahilar region correspond to apparent post-radiation fibrosis on prior CT chest of ___, and correlation with previous treatment history would be helpful in this regard. Small-to-moderate right pleural effusion has decreased in size and a small left pleural effusion is similar to the prior study. Pericardial calcifications are noted, best visualized on the lateral view, and correlate to findings concerning for constrictive pericarditis on prior CTA of the chest.", "output": "1. Improving pulmonary edema. An underlying chronic interstitial process cannot be excluded, and continued radiographic followup may be helpful in this regard. 2. Improving right pleural effusion and persistent left pleural effusion. 3. Post-treatment changes in left juxtahilar region. 4. Pericardial calcifications as described above." }, { "input": "A new right-sided pleural drain has been placed in the pleural effusion has significantly decreased in size. Cardiomegaly as well as pulmonary edema remaining. The small left pleural effusion is still present. The patient status post median sternotomy. There is no evidence of pneumonia. Increased vascular markings in the right upper lobe is likely asymetric edema, however pneumonia can be considered in the correct clinical setting.", "output": "Significantly reduced right pleural effusion status post drain placement. No pneumothorax." }, { "input": "AP single view of the chest has been obtained with patient in sitting semi-upright position. Analysis is performed in direct comparison with the next preceding similar study of ___. Unchanged evidence of cardiac enlargement, pulmonary congestion and bilateral pleural effusions. No evidence of new discrete local parenchymal infiltrates and no evidence of pneumothorax.", "output": "Similar as on next preceding examination of ___, the portable examination shows unchanged findings. Consider detailed chest examinations in this patient who allegedly has history of lung cancer." }, { "input": "Endotracheal tube tip terminates approximately 7 cm from the carina. The heart size is mild to moderately enlarged. Perihilar haziness with vascular indistinctness is compatible with moderate-to-severe pulmonary edema. Small bilateral pleural effusions are noted. No pneumothorax is identified. Right PICC tip terminates in the junction of the SVC and right atrium. No acute osseous abnormality is detected.", "output": "Moderate-to-severe pulmonary edema with small bilateral pleural effusions." }, { "input": "The patient is status post median sternotomy and pericardial stripping. There is persistent right pleural effusion which may be partially loculated and may have increased in size, is concerned that is increased in size given the patient is upright in both images. Opacity is again seen in the mid-to-lower lung which may be mildly increased. Left perihilar and left basilar opacity is again seen. There is blunting of the left costophrenic angle, raising concern for a small left pleural effusion. The cardiac and mediastinal silhouettes are stable.", "output": "Likely interval increase in right pleural effusion which may be partially loculated. Small left pleural effusion. Increased perihilar and right mid-to-lower lung opacities may relate in part to pulmonary edema; however, superimposed infectious process may also be present." }, { "input": "The cardiomediastinal silhouette and hilar contours are unchanged with re demonstration of paramediastinal fibrosis from prior radiation therapy. Small bilateral pleural effusions are similar in volume compared to ___. Again appreciated is mild central vascular fullness compatible with volume overload. There is no pneumothorax. Median sternotomy wires in are in place. The osseous structures are grossly unremarkable.", "output": "Similar appearance to ___ with redemonstration of small bilateral pleural effusions, mild volume overload and paramediastinal fibrosis." }, { "input": "Portable upright view of the chest demonstrates low lung volumes. Small-to-moderate pleural effusions, right greater than left have decreaed in size since prior exam. There is persistent mild pulmonary edema, which has improved since ___ exam. Mediastinal wound VAC is in place. The superior mediastinal sutures appear fractured, unchanged. Heart size is moderately enlarged, stable. No pneumothorax.", "output": "1. In comparison to ___ exam, there is interval improvement in pulmonary edema, which is now mild. 2. Small-to-moderate bilateral pleural effusions, right greater than left, slightly decreased in size since prior." }, { "input": "There are moderate bilateral pleural effusions, slightly larger than on the study of 2 days prior. There continues to be moderate cardiomegaly with pulmonary vascular redistribution and alveolar infiltrates most marked in the lower lobes, right greater than left.", "output": "Continued CHF with moderate bilateral pleural effusions and underlying infectious infiltrate can't be excluded, particularly on the right." }, { "input": "There is a right-sided PIC line which terminates in the mid SVC. There has been interval extubation of the patient. There is moderate cardiomegaly, stable compared to studies dating back to ___. Again seen is mild-to-moderate bilateral perihilar haziness with vascular indistinctness compatible with moderate-to-severe pulmonary edema, overall unchanged compared to the prior exam. There appears to be slight interval worsening of a focal consolidation overlying the left lower lung concerning for aspiration pneumonia. There is increased consolidation at the right lung base, which could be secondary to atelectasis or pneumonia. There is no pneumothorax. There are small bilateral pleural effusions.", "output": "1. Interval worsening of mid left lung focal opacity concerning for aspiration pneumonia. 2. Stable bilateral mild-to-moderate pulmonary edema." }, { "input": "There has been interval removal of right pigtail catheter. There are bilateral pleural effusions right greater than left. There is bilateral lower lobe volume loss with iincreased nfiltrate in the right lower lobe. vascular redistribution and perihilar haze have worsened compared to the prior study. There is moderate cardiomegaly.", "output": "1. Increased fluid overload. 2. Right lower lobe infiltrate/volume loss increased in the interval." }, { "input": "Again appreciated are small-to-moderate bilateral pleural effusions; the amount on the left unchanged and decreased on the right, expected after thoracentesis. There is no pneumothorax. Again appreciated are perihilar and bibasilar opacities and vascular congestion compatible with edema. Longstanding appearance of paramediastinal fibrosis is compatible with history of radiation therapy.", "output": "Interval decrease in size of right pleural effusion without evidence of pneumothorax. Persistent edema." }, { "input": "Small bilateral pleural effusions persist. Bilateral interstitial abnormality appears unchanged compared to most recent prior exam. Heart and mediastinal contours are stable. There has been interval removal of sternal wires and hardware; 2 paramedian drains are now seen. There is no mediastinal widening or radiographically apparent mediastinal air.", "output": "Chronic-appearing interstitial abnormality without radiographic evidence for acute change." }, { "input": "PA and lateral views of the chest. Left PICC is seen with tip in the mid SVC. Asymmetric right apical scarring is again seen, unchanged. The lungs are clear of consolidation or effusion. Cardiomediastinal silhouette is stable. Descending thoracic aorta is tortuous. No acute osseous abnormality detected.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours are unremarkable. The lung volumes are low, and in that context, streaky basilar opacities, left greater than right, suggest minor atelectasis. There is no pleural effusion or pneumothorax. No fracture is identified.", "output": "No evidence of injury." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Surgical clips are seen within the right upper quadrant abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size and cardiomediastinal contours are normal. Lungs are clear without focal consolidation, pleural effusion, or pneumothorax.", "output": "Normal chest radiographs." }, { "input": "Portable supine frontal chest radiographs demonstrate no acute consolidation, effusion, or pneumothorax. The heart size is moderately enlarged. The mediastinal contours are slightly hazy, with note of calcification of the aortic arch. The pulmonary vasculature is normal.", "output": "Moderate cardiomegaly, though normal pulmonary vasculature. No consolidation." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. Mild calcification at the aortic knob is noted. The pulmonary vascularity is normal. Subsegmental atelectasis in the lingula is present. Lungs are otherwise clear. No focal consolidation is visualized. Blunting of the right costophrenic angle posteriorly likely reflects a small pleural effusion. No pneumothorax is present.", "output": "Small right pleural effusion." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process. No focal consolidation to suggest pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. No overt pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "ET tube tip is 6 cm above the carina. NG tube and up of tube passes below the diaphragm most likely terminating in the stomach or more distally. Right PICC line tip is at the level of cavoatrial junction. Minimal bibasal atelectasis has improved. No evidence of pulmonary edema is seen. No pneumothorax is present.", "output": "No evidence of pulmonary edema is seen. No pneumothorax is present." }, { "input": "Lung volumes are unchanged compared to the prior study. The trachea is central. The cardiomediastinal contour is unchanged. The patient is intubated, an endotracheal tube terminates 5 cm above the level of the carina. There appear to be 2 nasoenteric tubes in-situ, the tips not visualized but lie below the left hemidiaphragm. A side port is in the stomach. A right-sided PICC terminates in the mid SVC. No consolidation or pneumothorax seen.", "output": "No significant interval change when compared to the prior study." }, { "input": "The ET tube extends 1.3 cm below the carina into the right mainstem bronchus. The NG tube extends below the diaphragm with a side hole at the level of the GE junction. Retrocardiac opacity likely reflects atelectasis in the setting of right mainstem intubation. There are small bilateral pleural effusions with mild interstitial edema.", "output": "1. Right mainstem intubation. 2. NG tube with side hole at GE junction. RECOMMENDATION(S): Recommend repositioning of ET tube. NOTIFICATION: Posted to the ED dashboard flagged with urgent attention at 05:19 on ___, 1 minutes after discovery of finding and confirmed with Dr. ___ ___ telephone that the tube had been repositioned." }, { "input": "The lungs are normally expanded and clear. The heart is larger since the study of ___, now top normal. The mediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Left brachiocephalic vascular stent is re-demonstrated. Loss of height of two vertebral bodies at the thoracolumbar junction is unchanged.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiac, mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. Left brachiocephalic vascular stent is re- demonstrated. Previously seen right sided dual lumen central venous catheter has been removed. Partially imaged is cervical fusion hardware. Mild loss of height of 2 vertebral bodies at the thoracolumbar junction is unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. A vascular stent is again noted projecting over the mediastinum. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Cardiomediastinal contours are stable. Lungs and pleural surfaces are clear, with no new areas of consolidation.", "output": "No evidence of pneumonia." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Bony hypertrophy the right AC joint noted. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral radiographs of the chest demonstrates clear lungs. The cardiac, hilar, and mediastinal contours are normal. No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is unchanged with mild cardiomegaly. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Mild cardiomegaly without signs of pneumonia or edema." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded, clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No pneumonia." }, { "input": "PA and lateral views of the chest are provided. Lungs are clear without focal consolidation, effusion, or pneumothorax. The heart and mediastinal contour is stable and normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. The pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are present. There are clips noted in the upper abdomen.", "output": "No acute cardiopulmonary process." }, { "input": "There is bibasilar opacities, likely representing atelectasis on the right, however the opacities in the left lower lung are slightly more confluent and may represent atelectasis or pneumonia. No large pleural effusion or pneumothorax. Mild to moderate cardiomegaly. The cardiomediastinal and hilar contours are stable.", "output": "Bibasilar opacities, likely representing atelectasis on the right, however the opacities in the left lower lung are slightly more confluent and may represent atelectasis or pneumonia. Mild to moderate cardiomegaly." }, { "input": "Normal heart, lungs, pleural and mediastinal surfaces.", "output": "Clear lungs." }, { "input": "Assessment is limited by low lung volumes as well as patient rotation. Heart size is accentuated due to low lung volumes appearing borderline enlarged. The mediastinal and hilar contours are grossly unremarkable. Crowding of bronchovascular structures is seen without overt pulmonary edema. Patchy opacities within the lung bases presumably reflect atelectasis. No focal consolidation, pleural effusion or pneumothorax is detected. Previously noted focal opacity overlying the left lateral mid lung field is not clearly visualized on the current examination. Multiple clips are again seen within the right axilla. Compression deformity of a mid thoracic vertebral body is new from ___, but appears to reflect a chronic abnormality. There are mild to moderate multilevel degenerative changes.", "output": "Low lung volumes with probable bibasilar atelectasis." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process. Specifically, no pneumothorax." }, { "input": "The cardiomediastinal contours are within normal limits. The bilateral hila are unremarkable. The lungs are clear without focal consolidation. There is no evidence of pulmonary vascular congestion. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. There are no pleural, mediastinal or hilar abnormalities. The cardiac silhouette is normal in size. There is a tortuous aorta. There are no cavitary lesions within the lungs.", "output": "No evidence of prior or current granulomatous disease." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is mildly enlarged, exaggerated by slightly diminished lung volumes. As before, there is tortuosity of the aortic contour with prominence of the aortic knob. Minimal bilateral atelectasis is seen. The lungs are otherwise clear without focal consolidation or diffuse abnormality. There is no pleural effusion or pneumothorax. There is compression deformity of a lower thoracic vertebrae, similar to ___. No radiopaque foreign bodies are seen.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are unremarkable. Patchy bibasilar opacities greater on the left appear slightly progressed compared to prior study. No pleural effusion or pneumothorax.", "output": "Increasing patchy bilateral opacities suggestive of atelectasis; however, pneumonia is not excluded given the appropriate clinical setting." }, { "input": "Lung volumes are low. Bibasilar opacities, left more than right are present, new, and might represent a combination of infectious process and atelectasis. Mild vascular engorgement is noted but no overt pulmonary edema is seen. Small bilateral pleural effusion is better appreciated on the lateral view. There is no pneumothorax. There is no other focal consolidation. Cardiomediastinal silhouette is within normal limits.", "output": "1. Bibasilar opacities most likely representing a combination of atelectasis and infectious process. Small bilateral pleural effusion. 2. Mild vascular congestion. NOTIFICATION: The addition of mild vascular congestion was discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 9:16 AM, 15 minutes after discovery of the findings." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. The imaged upper abdomen is unremarkable. The bones are intact.", "output": "No acute cardiopulmonary process." }, { "input": "Patchy left base opacity is seen, in a relative linear configuration on the frontal view, may be due to platelike atelectasis, but underlying infection is not excluded in the appropriate clinical setting. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Patchy left base opacity, in a relative linear configuration on the frontal view, may be due to platelike atelectasis, but underlying infection is not excluded in the appropriate clinical setting." }, { "input": "The lungs are well expanded and clear. Lung volumes are mildly diminished with no evidence of overt airtrapping. The mediastinum is unremarkable. The cardiac silhouette is within normal limits for size. No effusion or pneumothorax is noted. No radiopaque foreign body is identified.", "output": "No acute pulmonary process." }, { "input": "No definite focal consolidation is seen. Possible mild left base atelectasis. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture seen.", "output": "Possible mild left base atelectasis. No definite focal consolidation. No evidence of pneumothorax." }, { "input": "Compared with ___, there is mild increase in blunting of the left hemidiaphragm, with a most conspicuous meniscus seen in the left posterior costophrenic sulcus in the lateral view compatible with increasing pleural effusion. Biapical scarring is present but there is no focal opacity to suggest pneumonia. Cardiac size is mildly enlarged, but otherwise the cardiomediastinal and hilar contours are unremarkable. There is no right-sided pleural effusion. No pneumothorax is identified.", "output": "Slightly worsening left-sided pleural effusion. No evidence of pneumonia." }, { "input": "Frontal and lateral radiographs of the chest demonstrate an unchanged left chest wall pacemaker with right atrial and ventricular leads. There is a small left pleural effusion, unchanged. Additionally, mild bibasilar atelectasis is present, although there is some increase in focal consolidation at the left base which may be attributable to an infectious process. The opacification in the retrocardiac region may also be a function of atelectasis and developing pneumonia. No pneumothorax is appreciated. The cardiac and mediastinal contours are otherwise within normal limits.", "output": "Bibasilar atelectasis with increased retrocardiac opacity which may represent left lower lobe pneumonia." }, { "input": "Single frontal view of the chest was obtained. Leads of a left chest wall pacer terminate in the right atrium and ventricle. Lung volumes are decreased, exaggerating heart size, which appears mildly enlarged. Mediastinal contours are otherwise stable. Pulmonary edema has increased since the prior exam with small bilateral pleural effusions. Increased retrocardiac opacity may represent atelectasis or aspiration. No pneumothorax.", "output": "Pulmonary edema with small bilateral pleural effusions and bibasilar lung opacities that may represent atelectasis or aspiration in the appropriate clinical setting." }, { "input": "Frontal and lateral radiographs of the chest demonstrate a newly placed left chest wall pacemaker generator with a right atrial and ventricular leads appropriately positioned. No pneumothorax is seen. Compared to the prior radiograph, there is unchanged left pleural effusion and right basilar atelectasis. The cardiac and mediastinal contours are normal. No acute pneumonia is appreciated.", "output": "Satisfactory position of left chest wall pacemaker with appropriately positioned right atrial and ventricular leads. No pneumothorax." }, { "input": "The study is somewhat limited due to low lung volumes and lordotic positioning. Heart size appears mildly enlarged but this is likely accentuated due to low lung volumes. Mediastinal and hilar contours are unremarkable. There is crowding of the bronchovascular structures but no pulmonary edema is demonstrated. No focal consolidation, pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Limited exam with low lung volumes. No acute cardiopulmonary process otherwise identified." }, { "input": "Lung volumes are low. Heart size is accentuated as a result and appears mildly enlarged. Mediastinal and hilar contours are normal. Minimal atelectasis is seen in the lung bases without focal consolidation. No pleural effusion or pneumothorax is identified. Pulmonary vasculature is normal. No acute osseous abnormality is demonstrated. Remote left-sided rib fractures are again noted.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lung volumes are low and there is crowding at both bases. On the lateral view, there is increased opacity projecting over the lower lobes posteriorly. It is unclear if this is all due to volume loss or if an infectious infiltrate is present. The heart size continues to be mildly enlarged. the mediastinal silhouette is unchanged compared to prior.", "output": "Compared to prior study of ___, the appearance of the lower lobes is worse and it is unclear if this is due to volume loss or new infiltrate." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The cardiac, mediastinal and hilar contours are unremarkable. Heart size is normal. Diffuse atherosclerotic calcifications are noted throughout the aorta. Lungs are hyperinflated with bullous changes again noted most pronounced in the upper lobes. Patchy opacities are re- demonstrated most pronounced in the right lower lobe, but also involving the right upper and left upper lobes. Chain sutures are noted in the right apex. No new focal consolidation, pleural effusion or pneumothorax is present. Mild degenerative changes are seen in the thoracic spine.", "output": "Patchy opacities in the right lower lobe as well as in both upper lobes concerning for areas of infection. Previous CT also demonstrated airway wall thickening and small areas of mucous plugging in these areas of infection." }, { "input": "PA and lateral views of the chest. Normal heart size, mediastinal and hilar contours no pleural effusion or pneumothorax. Clear lungs.", "output": "Normal chest radiograph." }, { "input": "Portable AP supine chest radiograph obtained. The tip of the endotracheal tube resides approximately 2 cm above the carina. The NG tube courses inferiorly below the diaphragm, though the tip is not imaged. Low lung volumes. No definite consolidation, large effusion or pneumothorax. Bony structures appear grossly intact.", "output": "ET and NG tubes appear to be positioned appropriately though the tip of the NG tube is not included in the field of view. No gross consolidation, effusion, pneumothorax." }, { "input": "The cardiac silhouette is top-normal to mildly enlarged. The aorta is calcified and tortuous. There is slight prominence of the interstitial markings diffusely bilaterally which is most likely due to chronic lung disease, although minimal interstitial edema is not excluded. Areas of bilateral costochondral calcifications are seen. No evidence of pneumothorax or focal consolidation is seen. There is no large pleural effusion.", "output": "Slight diffuse prominence of the bilateral interstitial markings most likely relates to chronic lung disease however, mild interstitial edema is not excluded. No large pleural effusion. No focal consolidation." }, { "input": "PA and lateral views of the chest were obtained. Cardiomediastinal silhouette is stable. Lungs are symmetrically expanded. There is no focal consolidation. Linear bibasilar opacities likely represent atelectasis. There is no pleural effusion. No pneumothorax. Pulmonary vasculature is within normal limits.", "output": "A subtle increased opacity in the right lower lobe, likely represents subsegmental atelectasis, very early pneumonia not excluded." }, { "input": "Study is technically limited by the patient's hair overlying both lungs. However, diffuse parenchymal opacities noted on ___ have resolved. There is no new focal consolidation, pleural effusion, vascular congestion, or pneumothorax. The heart size is normal. The cardiac, hilar and mediastinal contours are within normal limits.", "output": "Resolved multifocal pneumonia." }, { "input": "Cardiomediastinal contours are unchanged with mild cardiomegaly and tortuous aorta. The lungs are clear. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable", "output": "No acute cardiopulmonary abnormalities" }, { "input": "No significant interval change. No edema, effusion, focal consolidation, or pneumothorax. Mild cardiomegaly is unchanged. The ascending and descending thoracic aorta is ectatic, unchanged since at least ___.", "output": "1. No pneumonia. 2. Tortuous thoracic aorta, similar to ___." }, { "input": "Frontal and lateral views of the chest were obtained. There is diffuse bilateral alveolar opacities involving all lobes. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable.", "output": "Diffuse bilateral alveolar opacities. Differential diagnosis includes diffuse pneumonia, which may be atypical, pulmonary hemorrhage, even pulmonary edema. Recommend clinical correlation and followup to resolution." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear. There is no evidence of pneumonia, pneumothorax, or pleural effusion. Cardiac silhouette is normal in size.", "output": "Normal chest x-ray." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. The lungs are well expanded and clear without focal consolidation concerning for pneumonia. Pulmonary vascularity is within normal limits. A right chest port is present with tip terminating in the low SVC.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Clips in the right upper quadrant of the abdomen suggest prior cholecystectomy.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There are low lung volumes, which results in bronchovascular crowding. Right perihilar opacity may represent atelectasis or aspiration. Cardiomediastinal and hilar contours are unchanged. Endotracheal tube ends 4.3 cm from the carina. A nasogastric tube courses into the stomach, with the last side port at the GE junction. No pneumothorax.", "output": "1. Right perihilar opacity may represent atelectasis or aspiration. 2. Unremarkable position of the endotracheal tube. 3. Nasogastric tube ends in the stomach, with the last side port at the GE junction. This should be advanced prior to use. NOTIFICATION: Updated impression was discussed with Dr. ___ by Dr. ___ ___ telephone at approximately 09:40 on ___, approximately 1.5 hrs after discovery." }, { "input": "Left pectoral pacemaker leads terminate in right atrium and right ventricle. No consolidation, pneumothorax, or pleural effusion is identified. Cardiomediastinal silhouette is normal size. Severe dextroscoliosis of the thoracic spine is noted.", "output": "No acute cardiopulmonary process." }, { "input": "Normal heart, lungs, pleura and mediastinal surfaces.", "output": "No acute intrathoracic process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Single AP upright portable view of the chest was obtained. Evaluate for right-sided dialysis catheter seen extending deeper into the right atrium. No focal consolidation, large pleural effusion, or evidence of pneumothorax is seen. No overt pulmonary edema is seen. The cardiac silhouette is mildly enlarged.", "output": "Mildly enlarged cardiac silhouette without overt pulmonary edema. No definite focal consolidation." }, { "input": "Frontal and lateral views of the chest were obtained. Low lung volumes result in bronchovascular crowding. There is no focal consolidation, pleural effusion or pneumothorax. Minimal bibasilar atelectasis is seen. Heart size is normal. Mediastinal silhouette and hilar contours are normal. The patient is status post CABG with intact median sternotomy wires.", "output": "No pneumonia, edema, or effusion." }, { "input": "Heart size is normal. The aorta demonstrates diffuse atherosclerotic calcifications and unchanged mild tortuosity. Mediastinal and hilar contours are otherwise within normal limits. Lungs remain hyperinflated with mild emphysematous changes again demonstrated. Small left pleural effusion appears not substantially changed in the interval with left basilar opacity likely reflective of compressive atelectasis. No large right pleural effusion is demonstrated, and no pneumothorax is detected. Dextroscoliosis of the thoracolumbar spine is again noted. Marked degenerative changes of both glenohumeral joints as well as a narrowed right acromiohumeral interval is suggestive of rotator cuff disease. Remote right-sided tenth rib fracture is again noted.", "output": "Unchanged small left pleural effusion with left basilar opacity, likely compressive atelectasis. Infection cannot be completely excluded in the correct clinical setting." }, { "input": "Compared with the study of ___, small to moderate left pleural effusion with adjacent atelectasis is grossly unchanged. Left basilar opacity likely represents a combination of pleural fluid and atelectasis, but superimposed infection/consolidation is not excluded. No focal consolidation in the right lung. No change in the cardiomediastinal silhouettes. Calcification of the trachea is again noted.", "output": "Persistent small to moderate left pleural effusion and atelectasis. Underlying consolidation/infection is not excluded in the correct clinical setting. Findings are similar to that of ___." }, { "input": "The lungs are well expanded. Blunting of the posterior costophrenic angles suggests small bilateral pleural effusions are identified. On the frontal view there is more dense opacity at the left lung base without correlative finding on the lateral view suggesting at least some component of atelectasis. Superiorly, the lungs are clear. The cardiac silhouette there is mildly enlarged. Atherosclerotic calcifications noted within the aorta. Degenerative changes seen at the shoulders bilaterally. No displaced fractures there noted. Compression deformities in the mid thoracic spine are unchanged.", "output": "Small bilateral effusions. More dense retrocardiac opacity on the frontal view suggests component of atelectasis as it is not clearly delineated on the lateral view although component of infection is possible." }, { "input": "Heart is normal in size and demonstrates left ventricular configuration. Tortuosity of thoracic aorta is unchanged. Focal linear areas of scarring at the lung bases appear unchanged. No new areas of lung opacity are identified. Bones are diffusely demineralized, and compression deformities are again demonstrated in the thoracic spine.", "output": "No evidence of pneumonia." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Analysis is performed in direct comparison with two previous chest examinations dated ___ and ___. The heart size remains within normal limits. No typical configurational abnormality is identified. Mild degree of general widening of the thoracic aorta is again noted as well as mild elongation of the descending aorta following the left-sided convex scoliotic curvature of the thoracic spine. The pulmonary vasculature is not congested. No evidence of new acute parenchymal infiltrates are present. As before, the generally, irregular pulmonary vascular peripheral distribution in this elderly woman appears to represent some form of emphysema/COPD, but no new acute parenchymal infiltrates can be identified. No pleural effusions are seen. As before, diffuse demineralization of the vertebral bodies of the thoracic spine is noted with some mild compression deformities in the mid and lower portion, but no significant interval changes since the previous studies can be identified.", "output": "Stable chest findings, no evidence of cardiac enlargement, CHF or acute infiltrates in this elderly female patient." }, { "input": "Similar small to moderate left pleural effusion with overlying atelectasis is seen. Left base opacity likely represents combination of pleural effusion and atelectasis, but underlying consolidation is not excluded in the appropriate clinical setting. No focal consolidation is seen on the right. Cardiac and mediastinal silhouettes are stable.", "output": "Grossly stable small to moderate left pleural effusion with overlying atelectasis, underlying consolidation is not excluded in the appropriate clinical setting." }, { "input": "The right lung is clear. The left lung demonstrates basilar atelectasis versus scarring. No pleural effusion or pneumothorax is present. No evidence of pneumonia. The aorta is unfolded. Hilar contours and mediastinal silhouette is unremarkable. There is no cardiomegaly. There is loss of several vertebral bodies in the thoracic spine, particularly in the upper-to-mid thoracic spine. The patient has already been ordered for a CT of the T-spine and better evaluation will be provided on this exam. Right shoulder", "output": "1. No evidence of acute cardiopulmonary process. 2. Thoracic vertebral bodies demonstrate height loss, which will be better evaluated on the CT of the T-spine, which is already ordered at the time of this dictation." }, { "input": "The lungs are hyperexpanded. There is a background of emphysema. There is a questionable opacity in the right lower lung, which would be better evaluated with chest CT. Calcifications along the left chest laterally suggest calcified pleural plaques. Scarring may account for obscuration of the left costophrenic angle. There may also be calcified pleural plaques projecting over the right lung laterally as well. No pneumothorax is seen. Heart size is normal. The aorta is calcified, indicating atherosclerosis. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. There are no acute osseous abnormalities.", "output": "Questionable opacity in the right lower lung, which would be better evaluated with chest CT. Calcifications along the left chest suggesting calcified pleural plaques. Left basilar opacity may be due to scarring." }, { "input": "The lungs are again noted to be hyperinflated with flattening of the diaphragms. Persistent left lower lobe opacity with interval progression of right lower lobe opacity. Again seen are calcifications along the left chest wall which are unchanged prior examination can consistent with calcified plaques. Scarring within the left costophrenic angle is again noted. Possible calcified plaques along the right lateral lung are similar to prior examination. No pneumothorax. Heart size, mediastinal contour, and hila are unremarkable. The aorta is calcified consistent with atherosclerosis.", "output": "1. Unchanged left lower lobe opacity with progression of right lower lobe opacity consistent with evolving multifocal pneumonia. 2. Findings suggestive of emphysema or COPD. 3. Calcified pleural plaques. 4. No pulmonary edema." }, { "input": "Prominence of the right hilum corresponds to the known right lower lobe lesion, as seen on prior chest CT. The cardiomediastinal and left hilar contours are unremarkable. There is no pleural effusion or pneumothorax. The lungs are well-expanded with hazy opacity at the right lung base, likely post procedural. Gaseous distension of the stomach is noted. The visualized portion of the upper abdomen is otherwise unremarkable.", "output": "1. No pneumothorax. 2. Fullness of the right hilum corresponds to the known right lower lobe lesion." }, { "input": "Single AP view of the chest demonstrates an unchanged position of tracheal stent. The heart and mediastinal contours are stable. There is no pleural effusion or pneumothorax. There is no focal consolidation concerning for pneumonia seen on the radiograph. Again seen is a left Port-A-Cath with tip terminating in the proximal left brachiocephalic vein. Postoperative changes after upper lobectomy are again seen.", "output": "No pneumonia on chest x-ray. Tree-in-___ opacities and mucous plugging seen in the right lower lobe on the recent CT are not clearly observed on these radiographs and are probably too subtle to visualize radiographically." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The mediastinal contours are normal. Atherosclerotic calcifications are noted along the aortic arch. The cardiac silhouette is normal. There is no free air below the hemidiaphragms.", "output": "1. No acute cardiopulmonary process. 2. No free air below the hemidiaphragms." }, { "input": "The cardiomediastinal and hilar contours are normal, with calcification of the aortic arch. There is no pleural effusion or pneumothorax. The lungs are well expanded. A vague retrocardiac density, better seen on the lateral view, with hazy left retrocardiac density on the frontal view, may represent an infectious process. The upper abdomen is unremarkable.", "output": "Vague left retrocardiac density may represent an infectious process. This result was emailed to the ED QA nurses by Dr. ___ on ___ at 8:31 PM." }, { "input": "Lung volumes are lower than on prior exam and there are uniformly distributed bilateral reticular opacities, suggestive of possible pulmonary fibrotic changes although cannot exclude a superimposed interstitial pulmonary edema. Bibasilar opacities are seen, which may represent atelectasis but cannot exclude pneumonia or aspiration in the right clinical setting. There is a new left retrocardiac opacity. Small bilateral pleural effusions are noted. There is no pneumothorax. The cardiomediastinal silhouette is mildly enlarged.", "output": "1. Lower lung volumes and uniformly distributed bilateral reticular opacities, suggestive of possible pulmonary fibrotic changes although cannot exclude a superimposed interstitial edema. 2. Bibasilar opacities, which may represent atelectasis but cannot exclude pneumonia or aspiration in the clinical setting." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are unremarkable. No focal consolidation is identified. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "The lung volumes are somewhat low, accentuating lung markings.Otherwise, the lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Osseous structures are unremarkable.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral chest radiograph demonstrate streaky opacity in the left lung base thought likely sequela of atelectasis. No opacity convincing for pneumonia is seen. Cardiomediastinal and hilar contours are stable. There is mild cardiomegaly. No evidence of pulmonary edema. There is no pneumothorax or pleural effusion. There is no air under the right hemidiaphragm.", "output": "Left lung base atelectasis. No evidence of pneumonia. Mild cardiomegaly." }, { "input": "Frontal and lateral views of the chest are compared to previous exam from ___. The lungs are clear. There is no effusion or pneumothorax. The cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable noting no displaced rib fracture.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is mildly enlarged. The aorta is unfolded. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Except for minimal subsegmental atelectasis in the lower lobes, the lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. No acute osseous abnormalities seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart size is top-normal. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lung volumes are low. There is no consolidation, pulmonary edema, pleural effusion, or pneumothorax. The heart size is at the upper limits of normal, and unchanged from the prior exam. The mediastinal contours are stable. There is no evidence of free air below the hemidiaphragms.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. Mediastinal and hilar contours are normal. Lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities are visualized.", "output": "Normal chest radiograph." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are normal. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. There is vague opacity in the lingula but probably due to minor atelectasis, airway inflammation or both. Suspicion for a significant aspiration event is low, although some degree of aspiration is difficult to exclude as an explanation for this appearance.", "output": "Vague streaky opacity at the left lung base." }, { "input": "The heart is top-normal in size. There is no pleural effusion or pneumothorax. There is little if any vascular congestion without pulmonary edema. There is no focal consolidation. Surgical clips along the right neck are demonstrated.", "output": "Little if any vascular congestion. No pulmonary edema or focal consolidation identified." }, { "input": "Portable semi-upright radiograph of the chest demonstrates low lung volumes with resulting bronchovascular crowding. There are patchy opacifications in the right lung field, which may represent asymmetrical pulmonary edema, but superimposed infection cannot be excluded. There is cephalization of vessels, suggestive of pulmonary edema. Small bilateral pleural effusions. The heart is top normal in size. There is no pneumothorax.", "output": "Patchy opacifications within the right lung field may represent asymmetrical pulmonary edema, but superimposed infection is not excluded. There is cephalization of vessels and small bilateral pleural effusions, suggestive of pulmonary edema." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouettes is normal.", "output": "No acute cardiopulmonary process; specifically, no evidence pneumonia." }, { "input": "AP and lateral views of the chest. The lungs are clear. There is no consolidation, pleural effusion or pneumothorax. The cardiac, mediastinal and hilar contours are normal.", "output": "Normal radiographic examination of the chest. These findings were reported to the Pastor Medical Group at 3:15 p.m. on ___ by telephone." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are well expanded and clear without focal consolidation, pleural effusion, or pneumothorax. Heart size is normal. Mediastinal silhouette and hilar contours are normal. No osseous abnormality is identified. There is no free air under the diaphragm.", "output": "Normal chest radiographs." }, { "input": "The lungs are well-expanded. Right lung is clear. A heterogeneous retrocardiac opacity is noted. A well demarcated lentiform opacity within the left lower lobe is best seen on frontal view. No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable.", "output": "1. Lentiform opacity projecting over the left lung base is nonspecific and may represent loculated pleural fluid. 2. Retrocardiac opacity is worrisome for pneumonia." }, { "input": "The patient has been intubated. The endotracheal tube terminates shortly below the thoracic inlet, approximately 5 cm above the carina. An orogastric tube has been placed, but it terminates only slightly below the left hemidiaphragm, and its sidehole projects along the distal esophagus. The cardiac, mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax.", "output": "1. Status post endotracheal intubation and placement of orogastric tube. The endotracheal tube could be advanced slightly for more optimal positioning if clinically indicated. Advancing the orogastric tube by approximately 12 cm is suggested if placement of the sidehole below the hemidiaphragm is desired and to gain better purchase. 2. No evidence of acute disease." }, { "input": "Right pectoral infusion port terminates in low SVC. There is no consolidation, pleural effusion, or pneumothorax. Cardiomediastinal and hilar silhouettes are normal size. Old fractures are noted at multiple right upper posterior ribs. A 0.5 cm opacity seen on frontal view overlying the right lower lung is unchanged since ___.", "output": "No radiographic evidence pneumonia." }, { "input": "Right chest wall port terminates at the lower SVC/cavoatrial junction. There are no pleural effusions. There are no pneumothoraces. The lungs without consolidation. The cardiomediastinal silhouettes are unremarkable. The posterior aspects of the right third and fourth ribs have been broken in the past correlated with CT chest done ___.", "output": "Right chest wall port terminating at the lower SVC/cavoatrial junction." }, { "input": "Heart size is within normal limits.Mediastinal and hilar contours are unremarkable. There is no evidence for pulmonary edema, pulmonary consolidation, pleural effusion, or pneumothorax. Again seen is a right-sided Port-A-Cath terminating in the mid to low SVC. Old right rib fractures.", "output": "No evidence for active cardiopulmonary disease." }, { "input": "PA and lateral views of the chest. The lungs are clear. The cardiomediastinal silhouette is normal. Osseous structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. A nipple shadow projects over the left mid lung field. Otherwise, the lung fields appear clear. There is no pleural effusion or pneumothorax. The bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "There has been improved aeration of the lung bases with slight residual remaining in the retrocardiac left lower lobe. Mild prominence of the pulmonary vasculature is evident and which may be in part indicative of underlying interstitial edema. There has been prior median sternotomy. The cardiac silhouette remains borderline enlarged but stable. No definite effusion or pneumothorax is seen. The osseous structures are unremarkable.", "output": "Mild interstitial edema, likely cardiogenic in etiology. Recommend repeat radiography after appropriate diuresis to assess for underlying infection." }, { "input": "Comparisons were made to prior study from ___. There has been improved aeration of the airspace opacities within the right lung. Persistent opacities at the lung bases are seen. Cardiac size remains enlarged but unchanged. There is calcification in thoracic aorta. The endotracheal tube, nasogastric tube and PICC line are stable in position.", "output": "Improved aeration of the airspace opacities at the lung bases." }, { "input": "AP single view of the chest has been obtained with patient in sitting semi-upright position. Comparison is made with the next preceding similar study obtained five hours earlier during the same day. Status post sternotomy, previous bypass surgery and moderate cardiac enlargement, appear unchanged. Comparison of the pulmonary vasculature clearly identifies a more marked vascular plethora that has developed during the latest examination interval of less than five hours. There is a degree of perivascular haze suggestive of some beginning interstitial edema. The lateral pleural sinuses remain grossly free. No evidence of pneumothorax in the apical area. Review of previous chest examinations including a chest CT dated ___ indicates that the patient had multiple parenchymal densities on the lung bases, as shown on previous CT. There was no evidence of new masses or discrete pneumonic processes.", "output": "Increased pulmonary vascular pattern clearly developing during the latest four and a half hours examination interval. Increased circulating blood volume can explain the increased pulmonary vascular pattern. The suggested finding of perivascular haze on the lung bases indicates some element of left-sided failure in this patient with history of previous bypass surgery and chronic moderate cardiac enlargement. Clinical measures to accomplish dehydration appear indicated and followup chest examination can be used to monitor the success." }, { "input": "AP single view of the chest was obtained with patient in sitting semi-upright position. Comparison is made with the next preceding similar study of ___. There is status post sternotomy, apparently related to previous bypass surgery. Moderate cardiac enlargement is noted. The pulmonary vasculature demonstrates an upper zone redistribution pattern and diffuse haze over the bases is consistent with interstitial edema. The previously described superimposed patchy and partially confluenting parenchymal infiltrates have regressed slightly, but persist to some degree bilaterally. The right-sided diaphragm can now be identified again, so that major pleural effusion is unlikely. If evaluation of pleural effusion is essential, one should consider the performance of a lateral view as well.", "output": "Mild improvement of previously identified scattered parenchymal infiltrates superimposed on chronic CHF." }, { "input": "The cardiac silhouette has increased in size now moderately enlarged with a globular configuration raising the possibility of pericardial effusion. There is minimal blunting of the left costophrenic angle consistent with a small pleural effusion. No focal consolidation or pneumothorax. Pulmonary vascularity is in normal limits.", "output": "Increase in size in the cardiac silhouette now moderately enlarged with a globular configuration concerning for a pericardial effusion. Recommend correlation with echocardiogram. No pulmonary edema NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 2:39 PM, 2 minutes after discovery of the findings." }, { "input": "Heart size is upper limits of normal. The mediastinal and hilar contours are remarkable for a mildly tortuous thoracic aorta. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. There is a background of chronically increased interstitial markings without overt pulmonary edema.", "output": "No acute cardiopulmonary process." }, { "input": "Study is slightly limited due to motion within the right lung base. Mild enlargement of the cardiac silhouette is unchanged. The mediastinal and hilar contours are similar. Mild pulmonary vascular congestion is present. Patchy opacities in the lung bases may reflect areas of atelectasis, but infection or aspiration cannot be excluded. No large pleural effusion or pneumothorax is present however the left costophrenic angle is not included in the field of view. Prominent air-filled loops of bowel are seen within the upper abdomen.", "output": "Mild pulmonary vascular congestion. Patchy opacities within the lung bases may reflect atelectasis, but infection or aspiration cannot be excluded." }, { "input": "The patient is rotated somewhat to the left. Bilateral perihilar opacities are most likely due to mild to moderate pulmonary edema, underlying infectious process is not excluded in the appropriate clinical setting. There are trace bilateral pleural effusions. No pneumothorax is seen. Cardiac silhouette is mildly enlarged. Mediastinal contours are similar to the prior study.", "output": "Bilateral perihilar opacities most likely due to mild to moderate pulmonary edema, underlying infectious process not excluded in the appropriate clinical setting. Trace bilateral pleural effusions." }, { "input": "The lateral view is limited by motion artifact. Left basilar opacity is unchanged since at least ___ suggesting atelectasis/scarring. Otherwise the lungs are clear. No pneumothorax or pleural effusion is present. Cardiac silhouette, hilar and mediastinal contours appear stable. The aorta remains markedly tortuous. Scoliosis is present.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low. This accentuates the size of the cardiac silhouette which is mildly enlarged. Mediastinal and hilar contours are unchanged. There is crowding of bronchovascular structures without overt pulmonary edema. Increased opacity within the retrocardiac region likely reflects atelectasis. No pleural effusion or pneumothorax is present. There are moderate multilevel degenerative changes in the thoracic spine.", "output": "Low lung volumes with retrocardiac opacity, likely reflective of atelectasis. Infection or aspiration cannot be excluded in the correct clinical setting." }, { "input": "AP upright and lateral views of the chest were provided. Lung volumes are low. Bronchovascular crowding and atelectasis noted in the lower lungs. No large consolidation, effusion or pneumothorax is seen. The heart and mediastinal contour appear grossly stable. No definite fracture is identified.", "output": "Limited exam, basilar atelectasis, no definite acute traumatic findings. If strong clinical concern, PA and lateral views or chest CT would be recommended." }, { "input": "The patient is slightly rotated, which alters the appearance of the cardiomediastinal silhouette. There is no definite evidence of pneumonia or heart failure. No pleural effusion or pneumothorax. Osseous structures are demineralized.", "output": "Rotated radiograph with no definite acute finding." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Lungs are clear and the pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities demonstrated.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs remain clear. The cardiomediastinal silhouette is normal. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Subtle linear density in the left mid to lower lung is most compatible with platelike atelectasis. No convincing evidence for pneumonia or edema. No large effusion or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No displaced fractures are identified.", "output": "No acute cardiopulmonary process." }, { "input": "The Dobbhoff tube has been advanced distally from its position on prior abdominal radiograph. The tip of the Dobhoff tube terminates in the region of the second portion of the duodenum. The heart remains mildly enlarged with bilateral hilar opacification. A right supraclavicular central venous catheter is noted terminating in the SVC. There is no pneumothorax. There is no abdominal free air.", "output": "Post-pyloric positioning of the Dobbhoff tube in the region of the second portion of the duodenum." }, { "input": "Minimal biapical scarring is unchanged. The lungs are otherwise clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "A right internal jugular venous catheter tip projects within the mid SVC. An enteric feeding tube tip is demonstrated in the region of the pylorus. Since the prior examination there has been interval worsening of now moderate interstitial pulmonary edema. There are small bilateral pleural effusions. There is left retrocardiac atelectasis. There is no evidence of pneumothorax. The cardiomediastinal and hilar contours are stable, demonstrating moderate cardiomegaly.", "output": "1. Interval worsening of now moderate interstitial pulmonary edema. 2. Dobbhoff tube tip is demonstrated in the region of the pylorus and a post-pyloric position cannot be confirmed." }, { "input": "The right internal jugular approach venous catheter remains in the mid SVC. An enteric feeding cord tube courses through the stomach out of field of view. There are scattered areas of linear atelectasis. There is persistent moderate interstitial pulmonary edema. There are no new focal opacities concerning for pneumonia. There are no pleural effusions or pneumothorax. The cardiomediastinal and hilar contours are stable demonstrating moderate cardiomegaly.", "output": "No significant interval change. Moderate interstitial pulmonary edema." }, { "input": "PA and lateral views of the chest provided. Lung volumes are somewhat low. Allowing for this, there is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "A single portable chest radiograph was obtained. A Dobbhoff tube projects over the stomach. The tip is folded back on itself and points towards the body of the stomach. Lung volumes are low. Retrocardiac atelectasis has increased slightly. No effusion, consolidation, or pneumothorax is present.", "output": "Dobbhoff tube in the stomach. The tip is folded back on itself and points towards the stomach body." }, { "input": "The inspiratory lung volumes are appropriate. There is improved pulmonary vascular engorgement since the prior study of ___ and no pulmonary edema. The lungs are clear without pleural effusion, focal consolidation or pneumothorax. The cardiac silhouette is normal in size. The mediastinal and hilar contours are unchanged with persistent prominence of the azygos vein.", "output": "No acute cardiopulmonary process. Improved pulmonary vascular engorgement since ___." }, { "input": "PA and lateral views of the chest were obtained demonstrating clear well expanded lungs without focal consolidation, effusion, pneumothorax. There is no free air below the right hemidiaphragm. Cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "No signs of pneumonia or other acute process." }, { "input": "A right internal jugular approach central venous catheter tip projects within the mid SVC. A left internal jugular approach Swan-Ganz catheter tip is within the main pulmonary artery. An endotracheal tube is 4.8 cm above the carina. Enteric feeding tube courses below the diaphragm. A right basilar chest tube is in stable position. Interstitial pulmonary edema is improved, with remaining mild pulmonary vascular congestion. There is bibasilar opacification, likely atelectasis with low lung volumes. There are no new focal opacities concerning for pneumonia. There are no pleural effusions or pneumothorax. The cardiomediastinal and hilar contours are stable. There is moderate cardiomegaly.", "output": "Improvement in interstitial edema with otherwise no significant change." }, { "input": "The inspiratory lung volumes are slightly decreased from the most recent prior study. The lungs are otherwise symmetrically expanded and clear without focal consolidation concerning for pneumonia. No pleural effusion or pneumothorax is detected. Mild biapical pleural thickening is noted. The pulmonary vasculature is not engorged and there is no overt pulmonary edema. The cardiac silhouette is normal in size allowing for slightly decreased lung volumes. The mediastinal and hilar contours are stable. The trachea is midline. There is no evidence of free air beneath the right hemidiaphragm.", "output": "1. No acute cardiopulmonary process. 2. No free air beneath the right hemidiaphragm." }, { "input": "Mild linear atelectasis in the right lung is unchanged. There is no new consolidation, pleural effusion, or pneumothorax. The cardiomediastinal and hilar silhouettes are normal.", "output": "No focal consolidation concerning for pneumonia." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. The heart appears mildly enlarged. There is slight unfolding of the thoracic aorta. The lungs appear clear. There are no pleural effusions or pneumothorax. Mild relative elevation of the right hemidiaphragm is similar. Although this study does not include a dedicated rib series, no fracture is identified.", "output": "No definite evidence of injury." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. Heart size is normal. There is persistent aortic tortuosity. No rib fracture is detected, although sensitivity is low on routine chest radiography.", "output": "No acute findings." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Evaluation is somewhat limited by underlying trauma board. A right IJ central venous catheter terminates in the upper to mid SVC. Markedly enlarged mediastinum is due to calcified lymph nodes as seen on outside chest CT. The cardiac silhouette is within normal limits. Lung volumes are decreased and there is atelectasis at the left lung base. There is no large pleural effusion or pneumothorax. No acute osseous injury identified.", "output": "Limited evaluation due to underlying trauma board, however no definite acute cardiopulmonary process. No acute osseous injury identified." }, { "input": "Linear opacities at the left lung base likely reflect atelectasis. No focal consolidations to suggest pneumonia. Stable appearance of the cardiomediastinal silhouette. No pneumothorax. No pleural effusion. Cervical fixation hardware is partially visualized.", "output": "No evidence of acute traumatic injury." }, { "input": "Cardiac silhouette is normal. Widened mediastinum with loss of the right paratracheal stripe and enlarged hilum represent enlarged lymph nodes, similar in appearance to ___. The lungs are clear. There is no pleural effusion or pneumothorax. Visualized osseous structures are unremarkable.", "output": "No evidence of pneumonia. Hilar and mediastinal lymphadenopathy represents known history of sarcoidosis." }, { "input": "Lung volumes are somewhat low.No focal consolidation is seen. There may be a very trace right pleural effusion, as there is blunting of the right costophrenic angle on the frontal view. No pneumothorax is seen. The cardiac silhouette is top-normal in size. Cervical surgical hardware is incidentally noted. No overt pulmonary edema.", "output": "Possible very trace right pleural effusion. No overt pulmonary edema." }, { "input": "Compared with ___, there are new bibasilar opacities raising the possibility of infectious infiltrates. There is upper zone redistribution and mild vascular blurring,, slightly more than on ___. Probable small right effusion and minimal blunting of left costophrenic angle are new compared with ___. Cervical spine fusion hardware is again incidentally noted. Calcification tubular calcification adjacent to the right neck at the upper edge of this film could represent carotid artery calcification.", "output": "Probable mild CHF. New small right greater left effusions. New patchy bibasilar opacities. While this could represent atelectasis in the setting of CHF, it raises concern for pneumonic infiltrates." }, { "input": "Mild pulmonary edema. Small bilateral pleural effusions. Moderate cardiomegaly. Minimal subsegmental atelectasis in the at the left lung base. Interval anterior cervical spine fusion C5-C7.", "output": "Mild pulmonary edema and small bilateral pleural effusions." }, { "input": "The cardiac, mediastinal and hilar contours appear stable including a stable bulging contour to the right lateral mid peritracheal stripe suggesting lymphadenopathy, probably unchanged. There is no pleural effusion or pneumothorax, but there is new very mild right lateral pleural thickening. The lungs appear clear. The right lateral seventh rib shows a new contour irregularity with a sclerotic line suggesting interval fracture, otherwise age-indeterminant.", "output": "Slight right lateral pleural thickening which may be seen after trauma inflammation or infection; new but not very striking. Contour irregularity to the right lateral seventh rib, new since prior studies and consistent with a non-displaced fracture although otherwise of uncertain acuity." }, { "input": "Heart size is normal. The mediastinal and hilar contours are within normal limits. The pulmonary vasculature is normal. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities demonstrated.", "output": "Normal chest radiograph." }, { "input": "ET tube is in standard position, the tip is 5.3 cm above the carina. Cardiac size is normal. The lungs are clear. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary abnormality ET tube in appropriate position ." }, { "input": "Moderate enlargement of cardiac silhouette is unchanged. Mediastinal and hilar contours are grossly stable with diffuse calcification of the thoracic aorta noted. The pulmonary vasculature is normal. Apart from minimal linear atelectasis in the lung bases, the lungs are clear with no focal consolidation, pleural effusion or pneumothorax identified. There are no acute osseous abnormalities. Mild loss of height of a mid thoracic vertebral body appears unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. There is no overt pulmonary edema though mild hilar congestion may be present given the slightly engorged appearance of the pulmonary hilum. Heart size is mildly enlarged. The mediastinal contour is normal. A chronic compression deformity of L1 is re- demonstrated. Clips in the upper abdomen noted. A focal calcification adjacent to the right humeral head is stable from prior exams, likely indicating rotator cuff tendinopathy. No acute fracture seen.", "output": "Mild pulmonary vascular congestion, mild cardiomegaly." }, { "input": "Moderate to severe enlargement of the cardiac silhouette is re- demonstrated. Mediastinal and hilar contours are unchanged. Mild pulmonary vascular congestion is noted. No focal consolidation, pleural effusion or pneumothorax is noted. Streaky opacities in the lung bases likely reflect areas of atelectasis. Multiple compression deformities are again demonstrated in the thoracic spine, unchanged, and most severe at T12.", "output": "Mild pulmonary vascular congestion and mild bibasilar atelectasis." }, { "input": "Stable cardiomegaly without evidence of congestive heart failure. Focal linear scar in the periphery of the left mid lung with otherwise clear lungs. No definite pleural effusion. Scoliosis is noted as well as wedge compression deformity at L1, similar to prior abdominal CT of ___. Additional compression deformities in the thoracic spine are grossly similar to previous chest radiograph of ___. .", "output": "No radiographic evidence of pneumonia or congestive heart failure." }, { "input": "PA and lateral views of the chest provided. An ET tube terminates 4.0 cm above the carina. Diffuse, alveolar and interstitial opacities in the right lung are worsened. Prominence of pulmonary vasculature is unchanged. No pleural effusion or pneumothorax. Moderate cardiomegaly is unchanged. Multiple compression deformities are unchanged in the thoracic spine.", "output": "1. Diffuse, alveolar and interstitial opacities in the right lung are worsened from ___ and likely represent pneumonia or asymmetric pulmonary edema. 2. Moderate cardiomegaly and prominence of pulmonary vasculature is unchanged. 3. Multiple compression deformities are unchanged in the thoracic spine." }, { "input": "Compared with ___, the ET and NG tube is been removed.Tracheostomy tube is in place. A G-tube appears to be present. Again seen is moderate to moderately severe cardiomegaly. There has been partial clearing of the retrocardiac opacity. There does appear to be some leftward shift of the mediastinum, which is unchanged. There is upper zone redistribution and diffuse vascular blurring, consistent with CHF, very slightly improved. At the right lung base, there are some hazy, more nodular densities which were not visible on the prior film. Question residua from resolving pulmonary edema. The differential diagnosis could include callus about anterior rib fractures.", "output": "1. Moderate to moderately severe cardiomegaly, unchanged. 2. CHF, with interstitial and question alveolar edema, slightly improved compared with ___. 3. Left lower lobe collapse and/or consolidation, also slightly improved. This could include an area of pneumonic infiltrate. 4. Hazy nodular densities right lung base, newly visible. Question artifact due to resolving pulmonary edema versus callus about anterior rib fractures. Attention to these areas on followup films are requested." }, { "input": "Frontal and lateral chest radiographs demonstrate severe cardiomegaly, increased compared to ___. Increased vascular markings and haziness of the vascular structures reflects vascular congestion. There is no appreciable focal consolidation, pleural effusion, or pneumothorax. Atelectasis or scarring is noted in the left mid lung. The visualized upper abdomen is unremarkable. There are multiple wedge shaped compression fractures in the thoracic and lumbar spine unchanged from prior study", "output": "Increased cardiomegaly compared to ___ with mild vascular congestion. No appreciable focal consolidation, pleural effusion, or pneumothorax." }, { "input": "Single AP view of the chest provided. Right PICC ends at the upper right atrium. An endotracheal tube is in standard position. An orogastric tube courses below the level of the diaphragm and out of view. Prominence and haziness of the pulmonary vasculature is consistent mild pulmonary edema, unchanged from ___. Severe atelectasis and mild to moderate pleural effusion at the left lung base is unchanged. Obliteration of the lower lobe bronchial air column suggests retained secretions No pneumothorax. Mild cardiomegaly is unchanged. Mild dextroscoliosis is unchanged.", "output": "1. Mild pulmonary edema is unchanged from ___. 2. Persistent collapse of the left lower lobe probably due to retained secretions is unchanged from ___." }, { "input": "PA and lateral views of the chest demonstrate the lungs are well expanded and clear. The cardiomediastinal silhouette is unremarkable. There is no pleural effusion, pulmonary edema, pneumothorax, or focal airspace opacity. Intravenous catheter tubing is noted along the left lateral neck soft tissues. Mild degenerative changes are again noted in the thoracic spine, with multilevel disc space narrowing and anterior osteophytosis, similar compared to the prior study.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is again mild to moderately enlarged. The mediastinal and hilar contours appear unchanged. There is no pleural effusion or pneumothorax. The lungs appear clear. Mild degenerative changes throughout the thoracic spine appear very similar.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "There is no focal consolidation, pleural effusion, pulmonary edema or pneumothorax. A left central venous line continues to terminate within the right atrium. The heart and mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well expanded. There is blunting of the right costophrenic angle which is unchanged compared with multiple prior exams. Retrocardiac consolidations are noted in the left lung base with an associated pleural effusion which is new compared with prior exam. Otherwise, the mediastinal and hilar contours appear stable. Mild vascular congestion again seen. Sternotomy wires are intact.", "output": "Left lower lobe consolidation with associated pleural effusion may represent atelectasis versus inflammatory consolidation." }, { "input": "Status post median sternotomy with unchanged appearance of sternotomy wires and aortic valve replacement. In comparison most recent prior radiograph there is increased opacity at the left base, likely representing atelectasis and effusion. Mild cardiomegaly is unchanged. Subtle interstitial opacities are consistent with mild pulmonary edema. No focal consolidation or pneumothorax is present.", "output": "1. No pneumonia. 2. Small left pleural effusion with associated atelectasis and mild pulmonary edema are new from ___." }, { "input": "The lungs are well expanded. A right pleural effusion and overlying atelectasis have increased since ___. A left pleural effusion remains small. Interstitial edema has improved. There is no focal consolidation or pneumothorax. Median sternotomy wires are intact. Mild cardiomegaly is stable.", "output": "Slight interval increase in small right pleural effusion and adjacent atelectasis. Stable small left pleural effusion" }, { "input": "Frontal and lateral chest radiographs demonstrate clear, well-expanded lungs. There is mild pulmonary vascular engorgement and chronic interstitial abnormality. The cardiac silhouette is moderately enlarged. The mediastinal contours are notable for changes of median sternotomy and AVR. There is no pleural effusion.", "output": "Mild pulmonary vascular engorgement and moderate cardiomegaly." }, { "input": "Frontal and lateral views of the chest were obtained. The patient is status post median sternotomy and cardiac valve replacement. In the interval since the prior study, there has been development of a right mid-to-lower lung lateral opacity likely involving the lateral segment of the right middle lobe, worrisome for consolidation/infection. There is also mild blunting of the bilateral costophrenic angles, right greater than left, concerning for small pleural effusions. Minimal pulmonary vascular congestion is also noted. The cardiac silhouette remains enlarged. The aorta is calcified and tortuous. Thoracic scoliosis is incidentally noted but not well evaluated.", "output": "1. Interval development of lateral right middle lobe opacity worrisome for consolidation and pneumonia. 2. Small bilateral pleural effusions." }, { "input": "The patient is status post CABG and aortic valve replacement. Median sternotomy wires are well aligned and intact. The previous left basilar opacity is significantly improved or resolved. The right mid lung opacity is resolved. Mild cardiomegaly is unchanged. The mediastinal and hilar contours are normal. There is no pulmonary vascular congestion. Mild volume overload on comparison exam is resolved. Apical pleural thickening, right greater than left, is re- demonstrated. There are no focal opacities concerning for pneumonia. Tiny bilateral pleural effusions are not appreciably changed. Tortuosity and calcification of the thoracic aorta is again noted.", "output": "1. Resolution or near resolution of left basilar and right mid lung opacities. Resolution of mild volume overload. 2. Mild cardiomegaly is unchanged." }, { "input": "AP portable upright view of the chest. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is stable with mild unfolding of the thoracic aorta. Imaged osseous structures are intact.", "output": "No acute intrathoracic process" }, { "input": "Right IJ catheter terminates in the lower SVC. Median sternotomy wires intact and aligned. Interval removal of ET tube, NG tube, and chest tube. No appreciable pneumothorax. Decreased, mild pulmonary vascular congestion. Improvement in perihilar and basilar opacities suggests resolving atelectasis. Cardiomediastinal contours are within normal postoperative limits.", "output": "No appreciable pneumothorax. Improving pulmonary vascular congestion and perihilar and basilar atelectasis." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "There is persisting consolidation at the right lung base. Left basilar opacity is more conspicuous on today's exam. Superiorly, the lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "Essentially unchanged right basilar pneumonia. Opacity at the left lung base could represent atelectasis although developing pneumonia is also possible." }, { "input": "Heart size and cardiomediastinal contours are normal. Lungs are clear without focal consolidation, pleural effusion, or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process. NOTIFICATION: The findings were paged to Dr. ___ on ___ at 3:06 PM, 15 minutes after discovery of the findings." }, { "input": "Cardiomediastinal silhouette is within normal limits. Lungs are clear. There is no pleural effusion or pneumothorax. Bones are grossly unremarkable.", "output": "No evidence of pneumonia." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Single AP upright portable view of the chest was obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Hilar contours are also unremarkable. No overt pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Right lower lobe consolidation is seen, consistent with pneumonia. The left lung is clear. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Right lower lobe pneumonia." }, { "input": "The lungs are clear.The cardiac, hilar and mediastinal contours are normal.No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal opacity, pulmonary edema, pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal. No acute osseous abnormality identified.", "output": "Normal chest radiograph." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities demonstrated.", "output": "No acute cardiopulmonary process." }, { "input": "Compared to the prior exam, there are lower lung volumes which exaggerate the bronchovascular structures and crowd the mediastinum; however, given this, there is no evidence of pneumonia. There is no pleural effusion. The aorta is tortuous. Cardiac size is normal. There are new clips in the right thyroid bed.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Low lung volumes. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is stable with mildly enlarged heart and unfolded thoracic aorta. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Both humeral heads appear high riding at the shoulders, suggesting chronic rotator cuff disease. Clips in the right upper quadrant noted. Tiny clips in the right neck likely reflect prior thyroid surgery.", "output": "Stable mild cardiomegaly. No acute findings." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable and unremarkable. Old posterior right ninth rib fracture is re- demonstrated.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well expanded. A band-like opacity in the left base likely represents segmental atelectasis. No other focal opacities are identified. There is no pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are unremarkable.", "output": "Band-like opacity in the left lower lobe may represent atelectasis although infection cannot be excluded in the right clinical setting." }, { "input": "There are relatively low lung volumes. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac, mediastinal, and hilar contours are stable. There is mild anterior wedging of a mid thoracic vertebral body, stable since the prior study.", "output": "Low lung volumes, otherwise, no acute cardiopulmonary process." }, { "input": "AP and lateral views of the chest are compared to previous exam from ___. There are linear bibasilar opacities. Superiorly, the lungs are clear. There is no effusion. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "Linear bibasilar opacities suggestive of atelectasis, noting that infection cannot be excluded." }, { "input": "PA and lateral chest radiographs demonstrate no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lungs appear clear. Cardiac silhouette is normal in size. No pleural effusion, pneumothorax, or pulmonary edema is present.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. The heart size and cardiomediastinal contours are normal. The lungs are clear. No focal consolidation, pleural effusion, or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were obtained. Lung volumes are low, though no focal consolidation is seen. No effusion or pneumothorax. Cardiomediastinal silhouette appears grossly stable, though lung volumes are low, limiting evaluation of the heart size. Bony structures are intact.", "output": "Limited, negative." }, { "input": "Frontal and lateral views of the chest were obtained. There are slightly low lung volumes and mild right base atelectasis. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable. Mild anterior wedging of a mid thoracic vertebral body is stable since the prior study.", "output": "Slightly low lung volumes without other evidence of acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were obtained. Lung volumes are low with bibasilar plate-like atelectasis, left greater than right. No definite signs of pneumonia or CHF. No large pleural effusion or pneumothorax is seen. Heart size is difficult to assess though appears grossly stable. Mediastinal contour is normal. Bony structures appear intact.", "output": "Bibasilar plate-like atelectasis, left greater than right. Please refer to subsequent CTA chest for further details." }, { "input": "The lungs are clear. No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette, hila, and pleura are unremarkable. No acute osseous abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. Cardiac silhouette is normal in size. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The heart is stable in size. The aorta is tortuous and calcified at its knob. Bilateral airspace opacities are seen and are increased from the prior examination consistent suggestive of pulmonary edema and more confluent areas suggest possible underlying infection. No pneumothorax or large pleural effusion is seen.", "output": "Bilateral airspace opacities are increased from the prior exam suggestive of pulmonary edema and possible underlying infection." }, { "input": "Endotracheal tube is noted with the tip terminating approximately 3.4 cm above the level of the carina. A nasogastric tube courses into the diaphragm with the tip projecting over the left upper quadrant. Streaky bibasilar airspace opacities are noted prominent within left, and may represent atelectasis versus aspiration. The upper lobes are clear bilaterally. There is no pneumothorax identified. The cardiomediastinal silhouette is grossly within normal limits.", "output": "Bibasilar airspace opacities, left greater than right, which may represent atelectasis versus aspiration." }, { "input": "The lungs are clear, the cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax.", "output": "No acute cardiothoracic process." }, { "input": "PA and lateral views of the chest. The lungs are clear without focal consolidation, effusion or pulmonary vascular congestion. The cardiomediastinal silhouette is within normal limits. The thoracic aorta is tortuous. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. The lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. The imaged bony structures are intact. No free air is seen below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "The cardiomediastinal and hilar contours are normal. There is a left subclavian port with tip terminating in the mid SVC. Low lung volumes may be accounted for by ascites. There is new plate-like atelectasis at the right mid-to-lower lung zone. There is a new moderately-sized left pleural effusion with atelectasis.", "output": "1. Left subclavian port with tip terminating in the mid SVC. 2. New left pleural effusion with associated atelectasis. New plate-like atelectasis in the right mid-to-lower lung." }, { "input": "Heart size and mediastinal contours are normal. No focal consolidation, pleural effusion or pneumothorax.", "output": "Normal chest radiograph" }, { "input": "A vagal nerve stimulator is present. There is no evidence of pneumothorax or pleural effusions. No focal consolidations are seen within the lungs. The overlying chin does however obscure the left apex. The heart is normal in size. No acute fractures are seen within the osseous structures.", "output": "No acute intrathoracic process." }, { "input": "There are low lung volumes and mild to moderate pulmonary vascular congestion. Linear left mid to lower lung atelectasis/scarring is again seen. No large pleural effusion is seen. There is no evidence of pneumothorax. The cardiac and mediastinal silhouettes are stable.", "output": "Low lung volumes with likely pulmonary vascular congestion." }, { "input": "Aside from bibasilar atelectasis, the lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Compared to most recent prior exam, there has been interval development of a retrocardiac opacity and small left pleural effusion. No pneumothorax is detected. There is no evidence for pulmonary edema. Heart and mediastinal contours are within normal limits.", "output": "New retrocardiac opacity, which could represent atelectasis, pneumonia or aspiration. New small left pleural effusion. Findings reported to Dr. ___ by Dr. ___ by telephone at 9:49 a.m. on ___ at the time of discovery of these findings." }, { "input": "The lungs are well inflated and clear. Blunting of the bilateral costophrenic angles is likely secondary to basilar atelectasis. The heart and mediastinal contours are normal. No focal consolidation, nodule, fusion, or pneumothorax is present. There is no pneumoperitoneum.", "output": "Bibasilar atelectasis. No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were obtained. Lung volumes are low which limits evaluation. Jewelry in the left nipple projects over the left lung base. There is subtle increased opacity in the lower lungs which could represent crowding of bronchovasculature, though the possibility of an early pneumonia is impossible to exclude. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is stable. Bony structures are intact.", "output": "Subtle opacities in the lower lungs bilaterally could represent early pneumonia in the correct clinical context. Low lung volumes limit the evaluation." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There are no pleural effusions or pneumothorax. Aside from patchy basilar opacities most suggestive of minor atelectasis in association with low lung volumes, the lungs appear clear. The bony structures are unremarkable.", "output": "Slight basilar opacities suggestive of mild volume loss with no definite evidence for acute disease." }, { "input": "Pulmonary edema since ___ radiograph has improved. The mediastinum has an expected postop appearance. No pneumothorax is seen. Mild bibasilar atelectasis is seen. Mild cardiomegaly which is largely unchanged.", "output": "Improved pulmonary edema as compared to radiograph dated ___" }, { "input": ".", "output": "Worsening subcutaneous emphysema in the right lateral chest wall and supraclavicular regions. No visible pneumothorax. Cardiomediastinal contours are stable with persistent mild pulmonary vascular congestion. Small to moderate right pleural effusion is again demonstrated as well as bibasilar atelectasis, right greater than left." }, { "input": "A right upper extremity PICC courses into the low SVC. Mild pulmonary edema is slightly worse from yesterday morning. A moderate right pleural effusion persists. No parenchymal opacity worrisome for pneumonia. Heart remains mildly enlarged. Postoperative mediastinal and hilar contours are unchanged. No pneumothorax.", "output": "1. Right upper extremity PICC in the low SVC. 2. Slight worsening of mild pulmonary edema from yesterday morning." }, { "input": "There appears to be increased subcutaneous air overlying the right infrascapular region. There has been interval removal of right-sided chest tube. A right PICC is seen terminating in the mid SVC. Cardiomediastinal silhouette appears unchanged. Bibasilar atelectasis largely unchanged.", "output": "After right chest tube removal, there is increased subcutaneous air overlying the right infrascapular region which could represent an air leak. NOTIFICATION: The PA, ___ assured me (Dr. ___) That there is no clinical signs of an air leak at this time." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is stable. Heart size is top-normal. Eventration of the right hemidiaphragm again noted. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "An endotracheal tube is present with tip 4.9 cm above the carina. An enteric tube is also present with tip in the proximal stomach but sideholes likely above the gastroesophageal junction. Cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Bilateral increased interstitial markings are concerning for moderate pulmonary edema. Additional hazy opacity in the right apex may be due to aspiration or infection.", "output": "1. Pulmonary edema with right upper lung opacity concerning for aspiration. 2. Enteric tube should be advanced by at least several centimeters to guarantee positioning of sideholes in the stomach. 3. Endotracheal tube in standard position." }, { "input": "Right subclavian central venous catheter, Swan-Ganz catheter, endotracheal tube, nasogastric tube and left chest tube are unchanged in position. There is persistent retrocardiac and left basilar opacification with deep sulcus sign on the left suggesting a combination of atelectasis and pneumothorax, although superimposed infection is not excluded. A small left apical pneumothorax is also present. Multiple rib fractures are re-demonstrated. The cardiomediastinal and hilar contours are within normal limits.", "output": "Left apical and basilar pneumothoraces with probable left basilar atelectasis." }, { "input": "There is a small persistent right-sided pleural effusion. Calcified granuloma projects over the right midlung laterally. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits.", "output": "Persistent small right pleural effusion." }, { "input": "Lung volumes are low. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. The previous right pleural effusion is substantially improved.", "output": "No acute intrathoracic process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Apart from subsegmental atelectasis in the lung bases, the lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Subsegmental atelectasis in the lung bases. Otherwise no acute cardiopulmonary abnormality." }, { "input": "Heart size, mediastinal and hilar contours are normal and without change. Lungs and pleural surfaces are clear.", "output": "No evidence of intrathoracic lymphadenopathy." }, { "input": "Portable semi-upright radiograph of the chest demonstrate well expanded clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion, pneumothorax or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well inflated and clear. No nodule, consolidation, effusion, or pneumothorax is present. The cardiac and mediastinal contours are normal. Trachea is now midline status post hemithyroidectomy.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest demonstrates the lungs are well expanded and clear. The cardiomediastinal silhouette is unremarkable. There is no evidence of pulmonary edema, pneumothorax or pleural effusion. No focal opacity is present within the lungs.", "output": "No acute cardiopulmonary process." }, { "input": "Endotracheal tube, right internal jugular central venous line, and enteric tube are unchanged in position. Heart size is mildly enlarged, as before. Pulmonary edema is moderate, slightly worse from the prior study. Lung volumes are similarly low. No large pleural effusion or pneumothorax.", "output": "Mild-to-moderate interstitial edema and cardiomegaly, with similar low lung volumes." }, { "input": "Frontal and lateral radiographs of the chest were acquired. There is minimal atelectasis or scarring in the lingula as well as evidence of emphysema. A large rounded left infrahilar opacity corresponds to a left lower lobe mass, better assessed on recent CT from ___. The lungs are otherwise clear. There are no pleural effusions. No pneumothorax is seen. The heart size is normal. The mediastinal contours are normal.", "output": "1. No acute cardiac or pulmonary process. 2. Left lower lobe lung mass, better evaluated on recent CT from ___." }, { "input": "ET tube and transesophageal tube have been removed. 2 right internal jugular introducer is terminate in right brachiocephalic vein. 2 left chest tubes are in unchanged position. Prosthetic heart valve valve is noted. There is increased elevation of right hemidiaphragm. Previous Left lower lobe collapse is resolved in the left lower lobe is better aerated. Platelike atelectasis is noted at right lung base. Mildly enlarged cardiac silhouette is unchanged. There is no pneumothorax. Dextroscoliosis of lower thoracic spine is noted.", "output": "No pneumothorax. Increased elevation of right hemidiaphragm may be related to local pain at the site of right chest tube entrance." }, { "input": "Tiny right apical pneumothorax, similar. Probable tiny left apical pneumothorax, decreased. Sternotomy. Right IJ central line tip in the low SVC. Heart is enlarged, improved. Borderline pulmonary vascularity, improved. There are tiny pleural effusions, improved on the left, more apparent on the right. Minimal basilar atelectasis, improved. Chronic left clavicle fracture. Minimal retrosternal pneumomediastinum, in keeping with recent surgery.", "output": "Tiny right apical pneumothorax, similar. Tiny pleural effusions" }, { "input": "IABP in place, 4.7 cm below upper margin of aortic arch. It has been pulled back since prior exam. There is chronic left clavicle fracture. Lungs are clear. Normal heart size, pulmonary vascularity. Interstitial prominence has resolved since prior exam.", "output": "IABP 4.7 cm below upper margin of aortic arch." }, { "input": "Compared with ___, an intra-aortic balloon pump has been removed. Heart size is normal. Cardiomediastinal silhouette is stable. There is no focal consolidation. No pneumothorax or pleural effusion.", "output": "Interval removal of an intra-aortic balloon pump." }, { "input": "There is intra-aortic balloon pump, appropriately positioned 3 cm below superior aspect of the aortic arch. Bilateral lung bases are not fully included on the radiograph. Minimal new right basilar atelectasis. Mild interstitial prominence in the lower lungs, may represent developing edema, clinically correlate. Otherwise no change.", "output": "Intra-aortic balloon pump has been repositioned. Mild interstitial prominence in the lower lungs, may represent developing edema." }, { "input": "IABP is located 6 cm below the apex of the aortic knob and may be advanced about 3 cm for standard positioning. Cardiac size appears enlarged but this may be exaggerated by technique and positioning. The lungs are clear. There is no pneumothorax or pleural effusion.", "output": "IABP is located 6 cm below the apex of the aortic knob and may be advanced about 3 cm for standard positioning. NOTIFICATION: The findings were discussed with ___, N.P. by ___ ___, M.D. on the telephone on ___ at 2:24 PM, 5 minutes after discovery of the findings." }, { "input": "Lungs are hyperinflated.The lungs are clear without focal consolidation. Small bilateral pleural effusions. No pneumothorax. Mild cardiomegaly stable. Mediastinal hilar contours are normal.", "output": "No acute cardiopulmonary process or pneumonia. Lungs hyperinflated. Small bilateral pleural effusions, likely new." }, { "input": "Mild advancement of the intra-aortic balloon pump to now 4.8 cm below the apex of the aortic knob. Otherwise no significant interval change since chest radiograph performed earlier on the same day.", "output": "IABP 4.8 cm below apex of aortic knob, consider advancing 2 cm for standard positioning. NOTIFICATION: The findings were discussed with ___ , M.D. by ___ ___, M.D. on the telephone on ___ at 4:29 PM, 10 minutes after discovery of the findings." }, { "input": "Mild left pleural effusion has decreased since prior exam. Decreased left basilar opacity. Small right pleural effusion is similar. Decreased right basilar opacity. Increased heart size. Normal pulmonary vascularity. Sternotomy. Chronic fracture left clavicle.", "output": "Interval mild improvement" }, { "input": "Patient is status post median sternotomy and CABG. The heart size is top-normal. The mediastinal and hilar contours are within normal limits. The pulmonary vasculature is not engorged. Previously noted bilateral pleural effusions have essentially resolved. Aeration within the lung bases is improved with only minimal atelectasis seen in the left lung base. Hyperinflation of the lungs is again noted. No pneumothorax is identified. No acute osseous abnormality is visualized. Chronic deformity of the left midclavicle is re- demonstrated.", "output": "Resolution of previously noted bilateral pleural effusions. Minimal left basilar atelectasis." }, { "input": "The lungs are moderately well inflated. No pulmonary edema. Left basilar opacity is new. Stable trace right pleural effusion with interval increase in small left pleural effusion. Stable mild cardiomegaly. Mediastinal contour and hila are unremarkable. Intact median sternotomy wires are noted.", "output": "1. Increase in small left pleural effusion with left basilar opacity likely representing combination of compressive atelectasis and pleural fluid. Superimposed infection cannot be excluded. 2. Stable trace right pleural effusion. 3. Stable mild cardiomegaly. 4. No pulmonary edema." }, { "input": "PA and lateral views of the chest provided. Moderate left pleural effusion and small right pleural effusion are increased in size from chest radiograph ___. Bibasilar atelectasis is noted. There is no pneumothorax or evidence of pulmonary edema. Evaluation of the cardiomediastinal silhouette is limited by left-sided pleural effusion. Sternotomy wires and surgical clips overlying the upper mediastinum are again noted.", "output": "1. Moderate left pleural effusion and small right pleural effusion are increased in size and chest radiograph ___. 2. No evidence of pulmonary edema." }, { "input": "Lungs are fully expanded and clear. No pleural abnormalities. Severe cardiomegaly is unchanged. No pulmonary vascular congestion or edema. Cardiomediastinal and hilar silhouettes are normal.", "output": "No evidence of acute cardiopulmonary abnormality." }, { "input": "Nasogastric tube terminates in the left upper quadrant, beyond the diaphragm. Endotracheal tube and left internal jugular central venous line are in satisfactory position. Heart size is enlarged and the partially imaged lungs demonstrate a right pleural effusion and heterogeneous bilateral opacities.", "output": "Satisfactory position of nasogastric tube." }, { "input": "The patient is rotated. The endotracheal tube terminates 3 cm above the carina. The enteric tube extends beyond the GE junction with tip out of view. The lung volumes are low resulting in bronchovascular crowding. The heart is moderately enlarged. Thickening along the minor fissure is noted.", "output": "The endotracheal tube terminates 3 cm above the carina. The enteric tube extends into the stomach with tip out of view." }, { "input": "The endotracheal tube and enteric tube are in standard position. Left internal jugular central line projects over the upper right atrium, and appears to have been advanced, however the apparent position could be secondary to lower inspiratory level. Lung volumes are low and there is persistent left lower lobe collapse. Mild pulmonary edema is unchanged. Upper lung parenchymal opacities are more readily recognized than in the lower lobes. Moderate cardiomegaly is stable.", "output": "1. Lower lung volumes with stable mild pulmonary edema and left lower lobe collapse. 2. Stable support lines and tubes." }, { "input": "New moderate right pleural effusion with fluid in the minor fissure. There is worsening retrocardiac. New opacities in the right mid lung and left mid lung as well are all concerning for multifocal infection. Upper redistribution of pulmonary vessels suggest element of volume overload as well. No pneumothorax. Moderate cardiomegaly stable.", "output": "New multifocal pneumonia superimposed on bilateral vascular congestion and new moderate right pleural effusion." }, { "input": "AP and lateral chest radiograph demonstrate no focal consolidation convincing for pneumonia. Lung volumes are low resulting in bronchovascular crowding. An elevated left hemidiaphragm is noted with a large air-fluid level noted within the stomach on lateral images. There is no pleural effusion or pneumothorax. Visualized osseous structures are unremarkable.", "output": "No focal consolidation convincing for pneumonia is identified. Gastric distension." }, { "input": "The patient is status post median sternotomy with aortic corevalve device again noted in unchanged position. Cardiac silhouette remains unchanged, mildly enlarged. The aorta is tortuous and diffusely calcified. Mild to moderate pulmonary edema is somewhat worse compared to the previous exam. Small right pleural effusion is noted. Bibasilar atelectasis is demonstrated. No pneumothorax is identified. Multilevel degenerative changes are seen in the thoracic spine.", "output": "Mild to moderate pulmonary edema, worse compared to the previous study, with small right pleural effusion." }, { "input": "Frontal and lateral views of the chest demonstrate no significant interval change since prior. Small right pleural effusion persists. There is no left-sided effusion. Minimal bibasilar atelectasis is unchanged. Cardiomediastinal silhouette, including a bulging contour of the right upper mediastinum is stable. There is no pneumothorax. Aortic core valve has normal postoperative appearance.", "output": "No significant interval change. Stable small right pleural effusion." }, { "input": "The cardiomediastinal and hilar contours are normal. There is mild blunting of the left costophrenic angle, which may represent scarring or small pleural effusion. There is rightward shift of the anterior junction line suggestive of bullae in the left upper lobe. Otherwise, lungs are clear.", "output": "1. No focal consolidation to suggest pneumonia. 2. Probable left upper lobe bullae. 3. Left costophrenic angle blunting which may represent scarring or small pleural effusion. If symptoms persist, repeat conventional chest radiography supplemented by oblique views may be obtained in several weeks." }, { "input": "Frontal and lateral radiographs of the chest with bilateral nipple markers show clear lungs with no evidence of nodules. There is mild hyperinflation with flattening of the diaphragms, consistent with chronic lung disease. Cardiac and mediastinal contours are normal. Mild bilateral apical thickening is seen. No pneumothorax or pleural effusion is seen.", "output": "No evidence of lung nodules. No acute infection." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded, clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is status post median sternotomy and mitral valve prosthesis. Left-sided dual-chamber pacemaker device is noted with leads terminating in the right atrium and likely within the outflow tract of the right ventricle, unchanged. The heart remains moderately enlarged with right ventricular and left atrial enlargement. The mediastinal and hilar contours are stable. Mild pulmonary vascular congestion is noted, slightly worse when compared to the prior study. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Cardiomegaly with mild pulmonary vascular congestion." }, { "input": "There is a left chest wall pacemaker with the leads terminating in the right atrium and likely in the coronary sinus. Patient is status post MVR with valvular placement in the appropriate positioning. Opacity at the right base has improved. There is slight blunting of the left costophrenic angle. There is no pneumothorax. The cardiomediastinal silhouette is enlarged but unchanged in appearance. There are median sternotomy wires that are intact. Osseous structures are unremarkable.", "output": "New dual-chamber dual-lead pacemaker with leads in the right atrium and coronary sinus. Improved opacity at the right base." }, { "input": "There are bilateral small pleural effusions, and the patient is status post CABG and median sternotomy. The heart is mildly enlarged. Lungs are clear of focal consolidations, pneumothorax or overt pulmonary edema.", "output": "Bilateral small pleural effusions." }, { "input": "PA and lateral views of the chest provided. Midline sternotomy wires and overlying EKG leads are present. There is mild bibasilar atelectasis without convincing signs of pneumonia, edema, effusion or pneumothorax. The cardiomediastinal silhouette is unchanged. Bony structures are intact. No free air seen below the right hemidiaphragm.", "output": "As above." }, { "input": "Compared to ___, lung volumes remain low. Lungs are clear. No pleural effusion or pneumothorax. Heart size is normal and unchanged. As before, the patient is status post midline sternotomy and CABG.", "output": "No acute intrathoracic abnormality." }, { "input": "Left chest wall dual lead pacing device is seen with leads in the right atrium and right ventricular apex. Cardiac silhouette is within normal limits. The lungs are clear without consolidation, effusion, or edema. Hypertrophic changes noted in the spine. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal and hilar contours are within normal limits. There is increased opacity in the right mid to lower lung, best appreciated on the frontal view concerning for pneumonia. No pleural effusion or pneumothorax.", "output": "Findings worrisome for pneumonia in the right mid to lower lung." }, { "input": "The heart is normal in size. The aorta is mildly tortuous. The aortic arch is calcified. The pulmonary interstitium appears irregular and there is a patchy peripheral opacification suggesting a substantial interstitial abnormality. Although lung volumes are low, there may be an emphysematous component noting relative lucency and attenuation of bronchovascular structures in the upper lung. Associated with slight elevation of the left hemidiaphragm is predominantly streaky focal opacification in the left lower lobe, which may be due to chronic scarring or atelectasis, although an infectious cause is hard to completely exclude. There is no pneumothorax or pleural effusion. The bones appear demineralized. There are mild degenerative changes along the thoracic spine.", "output": "1. Findings suggesting interstitial lung disease and perhaps coinciding emphysema. 2. Focal opacity in the left lower lung, not specific although compatible with atelectasis. Particularly if pulmonary symptoms are chronic and of uncertain etiology, a chest CT may be considered depending on clinical evaluation, particularly if the cause of lung disease depicted on the radiographs is unknown and prior imaging is not available." }, { "input": "The cardiac silhouette is mildly enlarged. Cardiomediastinal contours are unchanged. Reticular opacities seen at the periphery of both lungs likely represent chronic interstitial lung disease and are unchanged. Lung fields are otherwise clear with no evidence of focal consolidation to suggest acute pneumonia. No pleural effusions. No pneumothorax.", "output": "No significant changes compared to the prior study. No radiographic evidence of acute pneumonia." }, { "input": "Compared to prior exam, there has been significant resolution of the pulmonary edema. Increased reticular markings at the lung peripheries again consistent with intersitial disease. No focal consolidations concerning for pneumonia are present. No pleural effusion is noted. Bones appear intact.", "output": "1) No acute findings 2) Stable interstitial lung disease." }, { "input": "Portable AP upright chest film ___ 05:43 is submitted.", "output": "There has been interval appearance of opacity in the right upper and mid lung as well as increase in soft tissue in the right paratracheal and hilar region. When correlated with selected cross-sectional images as well as the scout image from the chest CT dated ___, some of these findings may reflect post radiation pneumonitis and lymphadenopathy, although it does appear that there is possibly increasing confluent opacity in the right upper lobe which would be concerning for superimposed infection. Clinical correlation is advised. The left lung is grossly clear. The right hemidiaphragm is elevated consistent with volume loss. There is likely a small right effusion. No pulmonary edema. No pneumothorax." }, { "input": "As before, there is complete whiteout of the right lung field with shift to the hilar and mediastinal structures put the right. The left lung is clear, the visualized heart border is unremarkable, and there is no left-sided pleural effusion pneumothorax.", "output": "Minimal interval change in the right lung opacification. Clear left lung." }, { "input": "Right upper lobe opacity is improved since most recent radiograph and stable since CT chest from ___. There is residual volume loss and streaky opacities likely due to post radiation changes. A persistent loculated right pleural effusion is likely also stable. No new consolidation is identified. Known mediastinal and right hilar lymphadenopathy are better evaluated on prior chest CT. The cardiac silhouette is stable. There is no pneumothorax. A right mainstem endobronchial stent is again noted. Visualized upper abdomen is unremarkable.", "output": "Unchanged volume loss and post radiation changes in the right upper lobe. No new consolidation identified." }, { "input": "PA and lateral views of the chest. The heart size is normal. The lungs are clear. No evidence of pulmonary edema. No pleural effusion or pneumothorax. The cardiac, mediastinal, and hilar contours are normal. No pulmonary vascular congestion.", "output": "1. No evidence of cardiomegaly. 2. Normal radiographic examination of the chest." }, { "input": "Heterogeneous opacity at the right lung base corresponds to an early pneumonia. The cardiac, hilar and mediastinal contours are normal.No pleural abnormality is seen.", "output": "Heterogeneous right lower lobe opacity could represent an early pneumonia. Correlate with auscultatory findings." }, { "input": "Heart size, mediastinal and hilar contours are normal. Lungs and pleural surfaces are clear. No acute skeletal findings.", "output": "No findings to account for left chest pain." }, { "input": "PA and lateral chest radiographs demonstrate right lower lobe opacification, consistent with pneumonia. There is also hyperexpansion and flattening of the diaphragms consistent with known COPD. There are two contiguous compression fractures in the mid thoracic spine, markedly worsened from ___. There AP diameter of the chest has increased since this prior. There is no pleural effusion or pneumothorax. Mild cardiomegaly is unchanged.", "output": "1. Right lower lobe pneumonia. 2. Multiple compression fractures of the mid thoracic spine, worsened since ___. Results were relayed by Dr. ___ to Dr. ___ by phone at approximately 11:10 a.m. on ___." }, { "input": "The lungs are well expanded. Increased bilateral interstitial opacities are present, with more consolidative processes in the right lung base partially obscuring the right hemidiaphragm margin and the left upper lung. The right basilar opacities appear worsened than in the previous studies. Blunting of the right posterior costophrenic sulcus in the lateral view suggests a small right sided pleural effusion. There is no left-sided pleural effusion. Mild cardiomegaly is stable. Otherwise, cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax.", "output": "Consolidative opacities in the right lung base and the upper left lung may represent infectious processes. If the clinical presentation is compatible with pneumonia, follow up is recommended ___ weeks after treatment to assess for resolution. However, if the presentation is not compatible with penumonia, further assessment with chest CT is recommended given progressive worsening of the right basilar and new left upper lung opacities." }, { "input": "The cardiac silhouette size is normal with a left ventricular predominance. The aorta remains unfolded. The mediastinal contours are unchanged. There is no pulmonary edema. Patchy opacity is noted within the right lower lobe and to a lesser extent within the left lower lobe with bronchial wall thickening, findings compatible with known bronchiectasis and probable small airways infection or inflammation. There is no pleural effusion or pneumothorax. No acute osseous abnormalities detected.", "output": "Patchy bilateral lower lobe airspace opacities with bronchial wall thickening, more pronounced in the right lower lobe, compatible with bronchiectasis and small airways infectious or inflammatory process, including ___." }, { "input": "Lung volumes are normal. There is no focal consolidation, pleural effusion or pneumothorax. No pulmonary edema. Cardiomediastinal contours are normal. No acute osseous abnormalities. No subdiaphragmatic free air.", "output": "No acute cardiopulmonary process." }, { "input": "The right lung is hyperexpanded with mild leftward shift of the mediastinum. There is consolidation of the peripheral left upper lung zone seen only on the PA view. There is no pleural effusion or pneumothorax. The heart size is normal. There is irregularity of the left hilar contour. These findings would be compatible with a prior history of empyema.", "output": "Mediastinal shift and parenchymal irregularities are compatible with a prior history of empyema. However, in the abscence of such a history, further evaluation with CT-Chest is recommended. These results were entered into the critical results dashboard by ___ ___ at 9:54 a.m. on ___." }, { "input": "Compared to the recent scout view, there is fairly little, if any, change. Multiple circumscribed cavities and ill-defined opacities with thickening of the left lung apex appear very similar. Discussed in the prior CT report the appearance is worrisome for a superimposed infectious process involving cavity formation, including a prominent cavity in the right upper lobe measuring approximately 5 cm in diameter with a small fluid level. The right lung remains clear. There is no pleural effusion or pneumothorax. Opacification of the left aortopulmonary window is similar. The heart is normal in size. Bony structures are unremarkable.", "output": "Findings compatible with the recent prior CT including multiple cavities in the left upper lobe worrisome for an infectious process including abscess formation." }, { "input": "Frontal views of the chest were obtained. Leads of a left chest wall generator pack terminate in the right atrium and right ventricle. Heart size and cardiomediastinal contours are normal. The lungs are clear except for very minimal bibasilar linear atelectasis. No edema, pleural effusion, or pneumothorax.", "output": "No evidence of pulmonary edema." }, { "input": "Heart size remains mild to moderately enlarged. Mediastinal and hilar contours are normal. Subsegmental atelectasis is seen within the left lung base. No focal consolidation, pleural effusion or pneumothorax is identified. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Interval increase in left pleural effusion is seen. No focal consolidation or pulmonary edema is seen. The cardiac silhouette has not changed from the most recent chest radiograph. The left central line tip is unchanged in position and appropriately ends within the lower SVC.", "output": "Mild interval increase in left pleural effusion. No change in cardiac silhouette size." }, { "input": "There has been interval improvement of the left pleural effusion. The cardiac silhouette is unchanged, and no signs of pulmonary congestion are noted. Left-sided central line is unchanged in position.", "output": "Interval improvement of left pleural effusion, and no change in cardiac silhouette. No signs of pulmonary congestion are noted." }, { "input": "A left PICC has been removed. The heart size is normal. The mediastinal and hilar contours are unremarkable. The pulmonary vasculature is normal. A new patchy opacity is demonstrated within the left lower lobe, with a small left pleural effusion. Right lung is clear. No pneumothorax is identified. There are no acute osseous abnormalities.", "output": "New left lower lobe patchy opacity is concerning for pneumonia in the correct clniical setting with adjacent small left pleural effusion." }, { "input": "The lungs are well expanded. There is a vague opacity abutting the left cardiac margin, with obscuration of the left cardiac margin. There might be a small associated pleural effusion in the left. No other focal opacities are identified. Scarring in the right lung apex is redemonstrated. There is no right-sided pleural effusion. No pneumothorax is identified. Cardiac size is top normal. A left-sided PICC line ends at the cavoatrial junction.", "output": "Findings compatible with lingular pneumonia." }, { "input": "Radiograph of the chest shows a left PICC with the tip of the catheter in the low portion of the SVC. No pneumothorax. Otherwise, lungs are clear and the cardiac and mediastinal contours are normal.", "output": "Satisfactory positioning of left PICC line in the low SVC." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are normal. Lungs are clear. Lungs appear hyperexpanded with apical lucency gradient. Pleural surfaces are clear without effusion or pneumothorax.", "output": "Emphysema. No pneumonia or pulmonary edema." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded and clear lungs. Incidental note is made of a pneumatocele at the left lung base. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation. There is pes excavatum.", "output": "1. No pneumonia. 2. Pneumatocele present at the left lung base. Recommend shallow oblique radiographs for additional evaluation. 3. This radiograph does not confirm nor exclude the presence of a pulmonary embolism, and CT of the chest would be appropriate if suspicion for pulmonary embolism is high. COMMENTS: These findings were discussed with ___ (NP) by Dr. ___ ___ telephone at 2:15pm on ___, 10 minutes after discovery." }, { "input": "PA and lateral views of the chest provided. Lungs are hyperinflated likely due to COPD. There is no focal consolidation, effusion, or pneumothorax. The heart is moderately enlarged. Mediastinal contours unremarkable. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Moderate cardiomegaly. COPD." }, { "input": "Frontal and lateral views of the chest were obtained. There are relatively low lung volumes. There is mild elevation of the right hemidiaphragm. Evidence of the central vasculature may relate to low lung volumes although there may be a component of central vascular engorgement. No focal consolidation or pleural effusion is seen. There is no evidence of pneumothorax. The cardiac silhouette is top normal to mildly enlarged. Mediastinum is unremarkable.", "output": "Low lung volumes. Eventration of the right hemidiaphragm. Mild prominence of the central vasculature may relate to low lung volumes although pulmonary engorgement may be present." }, { "input": "Bilateral multifocal pneumonias are in a similar distribution and extent as compared to prior radiograph from ___. However, some of these cavitations are showing central lucencies which is concerning for cavitation. Bilateral small pleural effusions are present, which are unchanged. Top normal heart size, mediastinal and hilar contours are stable.", "output": "1. Bilateral multifocal pneumonia persist, some of them demonstrating focal lucencies which is concerning for a cavitation. 2. Small bilateral pleural effusions, stable." }, { "input": "There has been dramatic improvement in the lungs bilaterally with some residual abnormalities seen in the right mid lung zone. Lungs are well expanded bilaterally with no pleural effusions or pneumothorax. The cardiomediastinal silhouette is stable and within normal limits. There are several areas of focal pleural thickening on the right. Otherwise, pleural surfaces are unremarkable. Minimal stable degenerative changes of the thoracic spine are again noted. There has been interval removal of a left-sided PICC catheter.", "output": "Substantial but incomplete resolution of COP." }, { "input": "In comparison with study of ___, there is little interval change. Residual areas of focal pleural thickening on the right are again seen, though there is no evidence of acute focal pneumonia. Mild elevation of the right hemidiaphragm persists.", "output": "Little change." }, { "input": "The lungs are hyperinflated but clear without consolidation, effusion, or pneumothorax. Cardiomediastinum silhouette is stable. No displaced fractures identified. Hypertrophic changes are noted in the spine.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. Cardiomediastinal silhouette is top-normal in size. There is no pneumothorax or pleural effusion. Visualized osseous structures are unremarkable. No free air is identified diaphragm.", "output": "No acute cardiopulmonary process. No free air under the diaphragm." }, { "input": "The lungs are clear of focal consolidation, pleural effusion or pneumothorax. Flattening of the diaphragms likely reflects chronic pulmonary disease. The heart size is normal. The mediastinal contours are normal. There are no signs of latent or active tuberculosis.", "output": "No signs of latent or active tuberculosis." }, { "input": "PA and lateral views of the chest were obtained demonstrating clear, well-expanded lungs without focal consolidation, effusion, pneumothorax. The previously noted opacity in the right upper lobe has completely resolved. The heart size is normal. Mediastinal contour is unremarkable. The imaged osseous structures are intact. There is no free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Heart size is upper limits of normal.Mediastinal and hilar contours are unremarkable. There is no evidence for pulmonary edema, pulmonary consolidation, pleural effusion, or pneumothorax.Osteophytes in the low thoracic spines and rightward scoliosis appear unchanged. Prior thyroidectomy clips are noted.", "output": "No evidence for active cardiopulmonary disease." }, { "input": "PA and lateral views of the chest provided. There is increased opacity overlying the spine on lateral projection, which is most likely due to positioning. Pulmonary vasculature is normal. Cardiomediastinal and hilar contours are normal. There are no pleural effusions. Prior thyroidectomy clips are noted. S-shaped scoliosis again seen.", "output": "No evidence of pneumonia. NOTIFICATION: Final results were emailed to ED QA nurses at 23:00 on ___, 2 minutes after the images were reviewed." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The patient remains intubated, the endotracheal tube is unchanged in position compared to the prior study. A nasogastric tube and left-sided subclavian catheter are also unchanged. There is persistent left lower lobe atelectasis. Mild cardiomegaly. Small left pleural effusion. No pneumothorax seen.", "output": "No significant interval change when compared to the prior study." }, { "input": "The ETT terminates 1.5 cm above the carina. There is a left subclavian, which terminates in the mid SVC. There is an NG tube seen coursing below the diaphragm, however the tip is not visualized on this image. There is left basilar atelectasis. The lungs are otherwise clear. Heart size is stable. The mediastinal and hilar contours are stable. The pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "1. ETT tube too low and should be pulled back 2 cm. 2. Subclavian and NG tube in appropriate positioning. 3. Left basilar atelectasis. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 5:02 PM, 5 minutes after discovery of the findings." }, { "input": "The patient remains intubated, the position of the monitoring and support devices is unchanged. The lung volumes remain low. Mild interval improvement of the retrocardiac opacity, likely reflecting the clinically suspected pneumonia/atelectasis. No pleural effusions. No pneumothorax.", "output": "Mild interval improvement of the left retrocardiac opacity." }, { "input": "Portable chest film ___ at 456 is submitted.", "output": "Endotracheal tube has its tip approximately 5.5 cm from the carina. Left subclavian central venous line unchanged in position. Nasogastric tube seen coursing below the diaphragm with the tip not identified. Overall cardiac and mediastinal contours are likely unchanged. Low lung volumes with crowding of the vasculature and no overt pulmonary edema. Streaky opacities at the left base likely reflect atelectasis. No large effusions. No obvious pneumothorax." }, { "input": "Endotracheal tube has been retracted now terminating in standard position, with tip approximately 5.6 cm from the carina. An enteric tube has been advanced, coursing below the left hemidiaphragm, with tip off the inferior borders of the film. Heart size is normal. Mediastinal and hilar contours are unremarkable. There has been interval re-expansion of the left lung with residual hazy opacity in the left mid and upper lung fields, perhaps residual atelectasis or re-expansion pulmonary edema. Right lung is grossly clear without focal consolidation. No large pleural effusion or pneumothorax is present.", "output": "1. Interval withdrawal of the endotracheal tube with tip now in standard position. Re-expansion of the left lung and resolution of previously noted leftward shift of mediastinal structures. 2. Enteric tube in standard position. 3. Residual hazy opacity in the left upper and midlung fields may reflect atelectasis and/or mild re-expansion pulmonary edema." }, { "input": "The patient remains intubated, an endotracheal tube terminates 5.5 cm above the level of the carina. A left-sided subclavian catheter terminates in the mid SVC. There is persistent left lower lobe atelectasis. Mild cardiomegaly may be exaggerated due to the projection. Probable small left pleural effusion although the left costophrenic angle is not fully visualized. A nasogastric tube terminates in the stomach. No pneumothorax seen.", "output": "No significant interval change when compared to the prior study." }, { "input": "Lung volumes are again low with right basal atelectasis, which potentially might represent pneumonia. The right heart border is obscured, new since prior. There is no effusion or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. VP shunt is partially imaged.", "output": "Right middle lobe pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 10:56 AM." }, { "input": "PA and lateral chest radiograph demonstrate clear lungs bilaterally. No focal consolidation convincing for pneumonia is present. There is no effusion or pneumothorax. Cardiomediastinal and hilar contours are within normal limits. Visualized osseous structures demonstrates no acute abnormality.", "output": "No focal opacity convincing for pneumonia." }, { "input": "The lungs are well expanded and clear. There is no pneumothorax. The heart size is normal. The mediastinal contours are normal. There are no pleural effusions.", "output": "No acute cardiac or pulmonary process." }, { "input": "Lines and Tubes: ET tube, enteric tube are unchanged in position. Lungs: No interval change in right upper lobe opacities. Asymmetric density with the right hemi thorax appearing more lucent compared to the left side remains unchanged. Pleura: There is no pleural effusion or pneumothorax Mediastinum: There is no cardiomegaly. Mediastinal silhouette is within normal limits. Bony thorax: No interval change.", "output": "No significant interval change." }, { "input": "The ETT and enteric tube are unchanged in position. Cardiac silhouette is within normal limits. Right upper lobe opacity is again identified, unchanged. There is prominence of both hilar regions and new patchy opacity in the left upper lung which may represent developing infiltrate. There is no pleural effusion.", "output": "New patchy opacity in the left upper lung may represent developing infection." }, { "input": "The endotracheal tube terminates at the level of the clavicles. An enteric tube enters the stomach, tip not visualized. A rounded opacity at the right lung apex corresponds to extensive scarring and bronchiectasis, which was partially imaged on the recent C-spine CT. Left apical scarring with retraction of the hilum and of volume loss is unchanged. The heart and mediastinum are within normal limits. Overlying tubing contributes to increased opacification at the left base.", "output": "Right apical mass-like opacity may be due to scarring from prior infection (e.g. TB) or radiation fibrosis, but a dedicated chest CT is recommended to exclude malignancy. No other significant interval change. Correlation with clinical history for possible previous radiation is suggested. NOTIFICATION: The impression and recommendation above was entered by Dr. ___ on ___ at 10:44 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "Frontal and lateral views of the chest. There are bilateral calcified pleural plaques. These are identified along the diaphragmatic pleural surfaces, as well as anteriorly, posteriorly and along the mediastinum. Please note that these plaques and lack of prior to evaluate for change limits sensitivity for detection of subtle underlying parenchymal opacity although no clear consolidation is identified. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality.", "output": "Bilateral calcified pleural plaques which limits detection for subtle parenchymal opacity, especially given lack of priors to evaluate for interval change. No definite acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. Lung volumes are low. In addition to widespread calcified pleural plaques, there are bilateral perihilar opacities as well as a diffuse moderate interstitial abnormality including ___ B-lines. Findings are most 6 the consistent with congestive heart failure.", "output": "Findings consistent with congestive heart failure. Calcified pleural plaques which are most often seen with prior asbestos exposure. Interstitial process is likely for the most part due to pulmonary edema although coinciding development of interstitial disease is not excluded." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs without focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well inflated. Minimal left lower lobe atelectasis is noted. No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable.", "output": "1. Minimal left lower lobe atelectasis. 2. No pneumonia." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. When compared to prior, there has been no change. Again noted are nodular opacities in the lungs bilaterally, stable in configuration. There is no evidence of new consolidation or effusion. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Again seen is a diffuse nodular pattern, worse on the right with peribronchial thickening , patient has known bronchiectasis. Compared to the most recent prior radiograph there has been no signficant change. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal", "output": "No acute pulmonary process. Stable diffuse nodular pattern, unchanged from recent prior radiographs." }, { "input": "Diffuse reticular and nodular opacities bilaterally are unchanged from the prior study. More focal opacity in the lingula has slightly increased from ___, but is similar to ___ and may represent a waxing and waning abnormality. There is no new consolidation, and no pleural effusion or pneumothorax. Biapical pleural thickening is unchanged. The cardiac and mediastinal silhouettes and hilar contours are stable.", "output": "Waxing and waning focal opacity in the lingula. Recommend treating for infection and repeating chest radiograph to ensure this area improves." }, { "input": "One AP view of the chest. There is no focal consolidation, pleural effusion, or pneumothorax. The heart size is top normal. Otherwise, the mediastinal and hilar contours are unremarkable. The aorta is tortuous.", "output": "Heart size is top normal. No acute cardiopulmonary process." }, { "input": "Cardiac and mediastinal contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest demonstrate diffuse granular/reticular opacities in the bilateral lungs, with relative sparing of the right lower lobe, likely due to underlying chronic fibrotic disease. There is no evidence of pneumothorax, pleural effusion, or focal consolidation. The cardiomediastinal silhouette is unremarkable.", "output": "Diffuse granular/reticular opacities, likely due to underlying chronic fibrotic disease. Superinfection cannot be excluded, and correlation with prior imaging is recommended. If none is available, dedicated CT with contrast could be performed if clinically indicated." }, { "input": "The patient is status post median sternotomy. Multiple mediastinal surgical clips are compatible with CABG surgery. The cardiac silhouette is moderately to severely enlarged, as before. The thoracic aorta is tortuous, result in prominence of the mediastinum and rightward deviation of the trachea. Mild pulmonary vascular congestion is unchanged with slightly improved pulmonary edema from ___. No large pleural effusion or pneumothorax is seen. The lung volumes are decreased.", "output": "1. Low lung volumes. 2. Mildly improved pulmonary edema and unchanged vascular congestion from ___." }, { "input": "Heart size is normal. The aorta is tortuous. Mediastinal and hilar contours are otherwise unremarkable. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Mild degenerative changes are noted in the mid thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is normal. The mediastinal and hilar contours are ___ allowing for slight tortuosity and unfolding of the no CHF, focal infiltrate or effusion is detected. No pneumothorax identified. There are no acute osseous abnormalities.", "output": "No evidence of pneumonia." }, { "input": "AP upright and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process. ___, MD" }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or pneumothorax is seen. Cardiac and mediastinal silhouettes are stable and unremarkable. There is no evidence of pneumomediastinum.", "output": "No acute cardiopulmonary process. No significant interval change." }, { "input": "In the interval, the endotracheal tube, left-sided chest tube, mediastinal tube, enteric tube, and right central line have been removed. No pneumothorax. Lung volumes are lower and there is increased bibasilar atelectasis and stable bilateral upper lobe atelectasis. Small left pleural effusion.", "output": "No pneumothorax. Low lung volumes, increased bibasilar atelectatic change compared ___." }, { "input": "The heart is mildly enlarged. There is mild unfolding and calcification along the aorta. The right upper mediastinal contour demonstrates a converse contour, which is most frequently seen with tortuosity of the great vessels, but not specific. The lungs appear clear. There are no pleural effusions or pneumothorax. Mild-to-moderate degenerative changes are incompletely characterized along the mid thoracic spine.", "output": "No evidence of acute disease. Convex contour to the right upper mediastinum, probably due to tortuosity of great vessels; other etiologies such as lymphadenopathy are hard to excluded, however. If prior films are not available to show long-term stability of this appearance, then chest CT is suggested in follow-up to assess further." }, { "input": "There is no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal contour is normal. Heterotopic ossification of the right shoulder suggests remote prior injury.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest are provided. Port-A-Cath resides over the left chest wall with catheter tip extending to the level of the low SVC. Tiny clips project over the superior mediastinum. The lungs are clear without signs of pneumonia or CHF. The cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No signs of pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. There is mild elevation of the left hemidiaphragm. The patient is rotated slightly to the left. Given this, no focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Degenerative changes are seen along the spine, though not optimally evaluated.", "output": "No acute cardiopulmonary process." }, { "input": "Mild cardiomegaly is chronic. The lung fields are clear. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral chest radiographs demonstrate clear lungs, without focal consolidation, pleural effusion, or pneumothorax. The cardiac silhouette and mediastinal contours are normal. The pulmonary vasculature is normal. There is mild wedge deformity of a lower thoracic vertebral body, unchanged from prior.", "output": "No evidence of acute chest abnormality." }, { "input": "The lung volumes are normal. Normal size of the cardiac silhouette. Normal hilar and mediastinal structures. No pneumonia, no pulmonary edema. No pleural effusions.", "output": "Normal chest radiograph without evidence of pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with ___, medical assistant of Dr. ___ On the telephone on ___ at 4:48 PM, 10 minutes after discovery of the findings." }, { "input": "There is elevation of the right hemidiaphragm. The cardiomediastinal silhouettes are within normal limits. The bilateral hila are normal. There is a sub-optimal inspiratory effort, however, within this limitation the lungs are clear without focal consolidation. There is no pulmonary vascular congestion. There is no pneumothorax or effusion.", "output": "1. No focal consolidation. Low lung volumes. 2. Elevated right hemidiaphragm." }, { "input": "The heart is at the upper limits of normal size. The mediastinal and hilar contours appear unchanged, including calcification and unfolding along the aorta. There is similar moderate relative elevation of the right hemidiaphragm compared to the left. The mediastinal and hilar contours appear unchanged. There is again a coarse reticular abnormality favoring the bases and peripheral aspects of the lung, most consistent with pulmonary fibrosis. Parenchymal findings appear stable allowing for small differences in technique. There is no pleural effusion or pneumothorax. The lateral view depicts air-fluid level in the mediastinum suggesting esophageal fluid which could be seen with esophageal dysmotility that may accompany CREST syndrome. In addition, there is a cluster of small densities, possibly pill fragments, three altogether projecting near the expected site of the gastroesophageal junction. The bones appear demineralized.", "output": "1. Stable findings of chronic interstitial lung disease without definite evidence for superimposed process. 2. Air-fluid level in the esophagus which could be seen with known CREST syndrome. In addition, there is a cluster of small densities, possibly pill fragments, three altogether, projecting near the expected site of the gastroesophageal junction. Clinical correlation regarding any potential aspiration risk is recommended." }, { "input": "AP upright portable views of the chest were obtained. Per the radiology technologist, x-ray was repeated due to patient kyphosis. The patient's chin overlies the lung apices. Again seen are increased interstitial markings, worse at the lung bases in this patient with history of known chronic interstitial pulmonary disease. Opacity at the right lung base appears increased compared to the prior study and superimposed infectious process is not excluded. No large pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "Known chronic interstitial disease with increased interstitial markings seen at the lung bases. Interval increase in right base opacity raises concern for a superimposed infectious process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No evidence of free air is seen beneath the diaphragms.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. The heart size and cardiomediastinal contours are normal. The lungs are clear. No focal consolidation, substantial pleural effusion, or pneumothorax. No radiopaque foreign body.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear aside from linear bibasilar atelectasis. There is no pleural effusion or pneumothorax. The heart is normal in size with tortuous thoracic aorta.", "output": "No acute intrathoracic process." }, { "input": "Persistent mild to moderate cardiomegaly and pulmonary vascular congestion persists, with an interval increase in the severity of pulmonary edema. There is also moderate interstitial edema. Again noted, at the periphery of the right upper lobe, at the level of the ___ posterior rib, there is a 8 mm nodular opacity, overall unchanged compared to the prior exam. Small bilateral pleural effusions are persistent. There is a right-sided central line which terminates in the right atrium.", "output": "1. Overall, interval increase in the moderate to severe diffuse pulmonary edema compared to the prior exam. 2. 8-mm lung nodule in the right upper lobe is unchanged compared to the prior exam, however a chest CT is recommended to differentiate a benign nodule from a slowly growing lung adenocarcinoma." }, { "input": "A left hemodialysis catheter tip projects over the cavoatrial junction. There bilateral lower lobe opacities, greater on the left likely reflective of atelectasis and/or consolidation. No pleural effusion or pneumothorax identified. The size and appearance of the cardiac silhouette is unchanged. A transcutaneous AICD lead is present.", "output": "Bibasilar opacities likely reflective of atelectasis and/or pneumonia in the proper clinical context." }, { "input": "Persistent cardiomegaly and pulmonary vascular congestion with interval decrease in severity of pulmonary edema with residual mild interstitial edema remaining. Within the periphery of the right upper lobe, at the level of the sixth posterior rib level is a poorly-defined 7-mm diameter nodular opacity which in retrospect is present on older study of ___. Note is also made of small bilateral pleural effusions.", "output": "1. Improving pulmonary edema. 2. 7 mm peripheral right upper lobe nodular opacity, for which chest CT is recommended in order to differentiate a benign nodule from a slowly growing lung adenocarcinoma. Dr. ___ was telephoned with this recommendation on ___ at 10:45 a.m. at time of discovery." }, { "input": "Again noted is a right PICC line with tip terminating in the mid-to-low SVC. The heart size is slightly enlarged compared to the prior studies. Hilar vessels are newly enlarged, and vascular caliber in the lung apices is also noted. There are small bilateral pleural effusions. There is no pneumothorax. Increased interstitial markings is indicative of chronic lung disease.", "output": "Acute cardiac decompensation with mild edema, small bilateral pleural effusions, and increased heart size." }, { "input": "Frontal and lateral chest radiographs demonstrate a dialysis catheter with the tip terminating in the mid SVC. The cardiomediastinal silhouette is unchanged. Pulmonary edema is similar to ___, but improved from ___. Left base atelectasis is also improved. There is no pleural effusion or pneumothorax. No clear sternal fracture is identified.", "output": "1. No clear sternal fracture, but if clinical suspicion is high, dedicated sternal views are recommended for better evaluation. 2. Left basal atelectasis imporved since ___; no indication of pneumonia. These findings were communicated via telephone by Dr. ___ to Dr. ___ at ___ on ___." }, { "input": "The cardiomediastinal silhouettes are stable, reflective of a mildly tortuous thoracic aorta. An left chest cardiac device is unchanged in orientation. The left chest Port-A-Cath has been removed since prior radiograph. Diffuse prominence of the pulmonary interstitium is most conspicuous in the lower lobes, similar appearance to prior exams, and may relate to volume overload. Bibasilar atelectasis is stable from multiple prior exams. The bilateral hila are unremarkable. There is no focal consolidation. There is no pleural effusion or pneumothorax.", "output": "Stable prominence of the pulmonary interstitium likely relates to volume overload, similar appearance to prior exams. No definite focal consolidation." }, { "input": "AP upright and lateral views of the chest provided. Dialysis catheter is in unchanged position with catheter tip in the region of the lower SVC. A subcutaneous ICD is again seen projecting over the left lower chest wall with lead extending into the anterior subcutaneous tissues of the mid chest. There is mild hilar congestion and interstitial edema without significant change. No focal opacity concerning for pneumonia. No large effusion or pneumothorax. Overall cardiomediastinal silhouette is unchanged. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Congestion with mild interstitial edema unchanged. No convincing signs of pneumonia." }, { "input": "PA and lateral radiographs of the chest. Normal heart size and mediastinal contours. There is a 6 mm nodular opacity in the peripheral right midlung which was present on the prior radiograph; however, no prior CT is available to evaluate. On the lateral view there an interphase corresponding to overlying arm. No focal consolidation or pleural effusion. No pneumothorax.", "output": "6 mm nodule in the peripheral right midlung for which further evaluation with nonemergent CT is recommended. No focal consolidation." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. Right PICC is no longer seen. Increased interstitial markings are seen throughout the lungs. There is blunting of the posterior costophrenic angles, which may represent small effusions, although smaller when compared to prior. Streaky right basilar opacity may be due to atelectasis. No acute osseous abnormality detected.", "output": "Mild pulmonary edema and trace effusions, smaller when compared to ___." }, { "input": "A subcutaneous ICD and a left hemodialysis catheter are unchanged in position. There is again seen, are are primarily lower lobe predominant dominance of the interstitial markings, similar to prior, but likely reflects chronic vascular congestion. No focal consolidation is seen. There is no pleural effusion or pneumothorax.", "output": "Stable mild pulmonary vascular congestion. No focal consolidation." }, { "input": "The heart size remains mildly enlarged. Mediastinal contours stable. There is persistent mild perihilar haziness with vascular indistinctness compatible with mild interstitial pulmonary edema. Small bilateral pleural effusions are milldy increased in size compared to the previous exam. Streaky bibasilar opacities most likely reflect atelectasis, but infection is not excluded. No pneumothorax is demonstrated. There are no acute osseous abnormalities.", "output": "Mild interstitial pulmonary edema with small bilateral pleural effusions, slightly increased in size compared to the previous exam. Bibasilar streaky opacities likely reflect atelectasis but infection cannot be completely excluded." }, { "input": "The radiograph is underpenetrated secondary to the patient's body habitus. Allowing for this limitation, the lungs are well expanded. There are slightly increased interstitial opacities compared with prior chest radiographs, but no focal parenchymal opacity. Moderate cardiomegaly is unchanged. Costophrenic angles are partially obscured potentially from overlying soft tissue/technique versus small effusions. There is no pneumothorax. A left-sided PICC line ends in the lower SVC.", "output": "Mild interstitial edema in the setting of moderate cardiomegaly. No evidence of pneumonia. PA and lateral views may offer additional detail if desired." }, { "input": "Bibasilar opacities, left greater than right, likely represent a combination of pleural effusion and atelectasis, however pneumonia could be considered in the appropriate clinical setting. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax. Free air beneath the right hemidiaphragm is consistent with recent postoperative status.", "output": "Bibasilar opacities, left greater than right, likely represent a combination of pleural effusion and atelectasis, however pneumonia could be considered in the appropriate clinical setting." }, { "input": "There is persistent left basilar opacity. , unchanged compared to the prior study. Again this may reflect a combination of pleural effusion and atelectasis versus pneumonia. The right basilar opacities are unchanged. No additional areas of concern are identified in the bilateral lungs. The cardiomediastinal contour is within normal limits. No pneumothorax seen. The free air seen under the right hemidiaphragm, consistent with the patient's recent surgery.", "output": "No significant interval change when compared to the prior study. Persistent airspace opacity in the left lower lobe may reflect a combination of pleural effusion and atelectasis however pneumonia cannot be excluded." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. No visualized free intraperitoneal air.", "output": "No acute cardiopulmonary process." }, { "input": "AP portable semi upright view of the chest. Tip of the endotracheal tube resides 2.2 cm above the Carina. An NG tube courses into the left upper quadrant. The lungs are clear. Curvilinear coarse calcification projecting over the left heart may reside within the mitral annulus. The heart is within normal limits of size allowing for technique. The lungs appear grossly clear. Mediastinal contour is unremarkable. No acute bony abnormalities are seen. Partially imaged levoscoliosis of the lumbar spine noted.", "output": "Appropriately positioned endotracheal and nasogastric tube appearing" }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Mild scoliosis. Unchanged appearance of healed right rib fractures.", "output": "No acute cardiopulmonary process or evidence pneumonia." }, { "input": "The lungs are clear with no evidence of a consolidation, effusion, or pneumothorax. Cardiac and mediastinal silhouettes are normal. No acute fractures are identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lung volumes are low. There is an area of patchy opacity in the region of the right hila, more prominent than on prior exam, which may represent atelectasis, but aspiration or infection in the right lower lobe cannot be excluded. There is an area of loculated pleural effusion vs. pleural thickening along the lateral left lung. Cardiomediastinal silhouette is unremarkable. A pacer is seen in the left anterior chest with intact leads in appropriate position. There is no pneumothorax or pleural effusion. Right ___ and ___ lateral rib fractures, age indeterminate.", "output": "1. Area of patchy opacity in the region of the right hila, more prominent than on prior exam, which may represent atelectasis, but aspiration or infection in the right lower lobe cannot be excluded. 2. Area of loculated pleural effusion vs. pleural thickening along the lateral left lung. 3. Right ___ and ___ lateral rib fractures, age indeterminate." }, { "input": "Lung volumes are low. This accentuates the size of the cardiac silhouette which appears mildly enlarged. Mediastinal and hilar contours are unremarkable. Crowding of the bronchovascular structures is demonstrated without pulmonary edema. Calcified granuloma within the right lung base is unchanged. Patchy opacities are noted in the lung bases, more so on the left. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Low lung volumes with patchy opacities at the lung bases, likely atelectasis. Infection or aspiration cannot be completely excluded." }, { "input": "Lingular pulmonary nodule is again seen, previously characterized as a hamartoma, may be slightly increased in size as compared to the prior study. The aorta is calcified and tortuous. The cardiac silhouette is top-normal. No pleural effusion or pneumothorax is seen.", "output": "Again seen lingular nodule previously characterized as a hamartoma, may be slightly increased in size. No focal consolidation to suggest pneumonia." }, { "input": "Left chest wall transvenous pacer with leads ending in the right atrium and right ventricle, as expected. Left lingular pulmonary nodule measuring approximately 2.1 cm is stable. Lungs are otherwise clear. Heart size is normal. There is no pneumothorax. Pleural surfaces are unremarkable.", "output": "No significant interval change. Left chest wall dual lead pacer appropriately positioned." }, { "input": "Known 2.1 cm pulmonary nodule in the left lower lung, unchanged compared to prior studies.Otherwise, lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac, hilar and mediastinal silhouettes are unremarkable. A dual lead transvenous pacemaker with leads terminating in the right atrium and right ventricle noted.", "output": "Dual lead transvenous pacemaker with leads appropriately positioned. Stable left lower lung pulmonary nodule previously characterized as a hamartoma." }, { "input": "As seen on recent CT, there is a 2 cm lingular nodule. Blunting of the right costophrenic angle suggests small effusion. The lungs are hyperinflated but otherwise clear. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "Left pulmonary nodule as on prior. Small right pleural effusion. Hyperinflation." }, { "input": "Portable upright chest radiograph demonstrates a tracheostomy tube in unchanged position. There has been interval removal of a right upper extremity PICC. Median sternotomy wires are in place, the uppermost of which is broken, though this finding is chronic. There are post-surgical changes of CABG. The lungs are clear. There is no pleural effusion or pneumothorax. The cardiac silhouette remains mildly enlarged, the mediastinal contours are normal. The pulmonary vasculature is normal.", "output": "No acute chest abnormality." }, { "input": "The patient is status post previous median sternotomy and coronary artery bypass surgery. Heart size is normal, and mediastinal contours are stable in appearance. Previously present linear focus of atelectasis in the left lower lobe has resolved and the left pleural effusion is no longer apparent. On the lateral radiograph, subtle peribronchial opacities are present in the retrocardiac region and likely correspond to the left lower lobe on the frontal view. Lungs and pleural surfaces are otherwise clear. Tracheostomy tube remains in place within the trachea.", "output": "Subtle retrocardiac opacity, which could reflect either atelectasis or developing pneumonia. Followup radiographs may be helpful in this regard." }, { "input": "Supine portable AP view of the chest provided. The lungs appear clear, though lung volumes are low. Midline sternotomy wires and mediastinal clips again noted with fragment at uppermost sternotomy wire. No pneumothorax or pleural effusion, though study provided is a supine image. Bony structures are intact.", "output": "No acute findings in the chest." }, { "input": "Single frontal view of the chest was obtained. Interval placement of tracheostomy tube. Uppermost sternotomy wire is fractured, similar to ___. Other sternotomy wires and mediastinal clips are intact. Lung volumes are low, exaggerating heart size. Mediastinal contours are stable. Retrocardiac opacity is compatible with left base atelectasis. No pneumothorax.", "output": "Status post tracheostomy tube placement. Low lung volumes with left base atelectasis." }, { "input": "Compared with ___:50, I doubt significant interval change. Again seen are sternotomy wires, including a fractured uppermost sternotomy wire, and mediastinal clips. The cardiomediastinal silhouette is unchanged. There is upper zone redistribution, but no other evidence for CHF. There is minimal linear atelectasis and/or scarring at the left lung base, unchanged. No focal opacity to suggest pneumonia. No frank consolidation or effusion. No pneumothorax detected. Right-sided central line tip overlies the distal SVC, similar to the prior film.", "output": "1. No significant change compared with ___. 2. No focal opacity to suggest pneumonia. 3. Fractured upper most sternotomy wire noted." }, { "input": "There has been placement of a tracheal tube just above the level of the clavicles. The tip is not well seen. There is no pneumothorax or pneumomediastinum. There is linear atelectasis at the left lung base with a small left-sided pleural effusion. The cardiomediastinal and hilar silhouettes are unremarkable.", "output": "1. Tracheostomy tube placed in proximal trachea just above the level of the clavicles. PA and lateral chest radiographs can be obtained for better visualization of the tube tip. 2. No pneumothorax or pneumomediastinum." }, { "input": "AP upright and lateral views of the chest were provided. Midline sternotomy wires and mediastinal clips are again noted. There is a new right arm PICC line with tip located in the mid SVC. There is no pneumothorax. No focal consolidation, effusion, or signs of CHF. The heart and mediastinal contour is stable. Bony structures appear intact.", "output": "Right arm PICC line with tip positioned appropriately." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are normal. Lungs are hyperinflated with apical lucency gradient. Lungs are otherwise clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "1. No acute cardiopulmonary abnormality. 2. Severe emphysema." }, { "input": "Frontal and lateral views of the chest were obtained. The small right apical pneumothorax is slightly improved. Small right pleural effusion and right basilar and right upper lung atelectasis are similar. Linear opacity at the left base is likely atelectasis. Cardiac and mediastinal silhouettes are stable. An right clavicular fracture is again noted. The right rib fractures are not well seen.", "output": "Right apical pneumothorax is slightly improved from ___." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.", "output": "No acute intrathoracic process." }, { "input": "The cardiac silhouette is enlarged. A left-sided dual lead pacemaker is again seen with its leads terminating in the right atrium and right ventricle, expected locations. Lung volumes are decreased. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. Dual-lead left-sided pacemaker is seen. There is minimal blunting of the left costophrenic angle which may be due to pleural thickening. No focal consolidation or pneumothorax is seen. The cardiac silhouette is mildly enlarged. The aorta is calcified and tortuous. Evidence of DISH is seen along the thoracic spine as well as some additional degenerative changes.", "output": "Enlarged cardiac silhouette without overt pulmonary edema." }, { "input": "There is minor basilar atelectasis without definite focal consolidation. No pleural effusion or evidence of pneumothorax is seen. Cardiac and mediastinal silhouettes are stable. Evidence of DISH is seen along the spine.", "output": "No acute cardiopulmonary process. No significant interval change." }, { "input": "The cardiac, mediastinal and hilar contours appear stable, including borderline cardiomegaly and a substantial epicardial fat pad on each side of the mediastinum. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "A right internal jugular central venous catheter is unchanged with the tip in the mid SVC. An endotracheal tube is borderline high at the level of the clavicles, approximately 6.5 cm from the carina, similar to the prior exam. An enteric tube courses below the diaphragm with the tip out of field of view. Since the prior exam, the lung volumes have improved. There is persistent bibasilar atelectasis. No new opacities identified. There is no pleural effusion or pneumothorax. The aorta is tortuous and calcified, similar to prior exams. The cardiomediastinal silhouette is otherwise normal.", "output": "Improved lung volumes; otherwise, no significant change from the prior exam." }, { "input": "Right IJ central venous catheter with the catheter tip at the superior cavoatrial junction. Again noted are relatively stable bilateral opacities in the mid-to-lower lung fields which are suggestive of mild to moderate pulmonary edema. There are bilateral small pleural effusions with adjacent atelectasis. Heart size remains normal and mediastinal veins continue to be dilated. There is no pneumothorax.", "output": "Bilateral opacities in the mid-to-lower lung fields are more suggestive of mild to moderate pulmonary edema and bilateral small pleural effusions." }, { "input": "A portable view of the chest demonstrates worsening bibasilar opacities with less distended pulmonary vasculature. The cardiomediastinal silhouette is unchanged. There is no pneumothorax. A right internal jugular line ends in the low SVC.", "output": "Worsening bibasilar opacities which may be due to aspiration pneumonia in the appropriate clinical setting. Dependent edema is considered less likely." }, { "input": "The heart size is top normal, unchanged over multiple prior studies. The aorta is slightly unfolded. The lungs are clear without focal opacity, pleural effusion or pneumothorax.", "output": "No pneumonia." }, { "input": "The lungs are well inflated. Flattening of the diaphragms is consistent with COPD. There is bibasilar atelectasis. The cardiac silhouette is not enlarged. No consolidation or pneumothorax is present. Left-sided pleural plaque is stable. An abdominal drain is partially visible.", "output": "COPD. No acute cardiopulmonary process." }, { "input": "The lungs are clear. Tortuosity and dilation of the aorta is again seen, grossly stable since ___. The heart size is normal. No pneumothorax, pleural effusion, or pulmonary edema. No focal consolidations are noted.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low, causing bronchovascular crowding. A new opacity has developed in the posterior segment of the left lower lobe, partially obscuring the descending thoracic aortic interface in resulting in increased opacity overlying the thoracic spine on the lateral view. . There is no effusion or pneumothorax. The aorta is tortuous, unchanged from prior. The cardiomediastinal silhouette is otherwise normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Focal left lower lobe pneumonia. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 3:29 PM, 12 minutes after discovery of the findings." }, { "input": "The lungs are well inflated and clear. No pleural effusion. Mild cardiomegaly as before. Linear metallic densities project over the lower neck as before. Surgical clips project over bilateral axillae as before. Left PICC terminates at the cavoatrial junction. Enteric tube tip terminates in the proximal stomach. EKG leads overlie the chest wall.", "output": "1. No acute cardiopulmonary process. 2. Enteric tube tip terminates in the proximal stomach. Left PICC terminates at the cavoatrial junction." }, { "input": "PA and lateral views of the chest provided. Overlying EKG leads are present. Clips in the left and right axilla noted. Linear densities are again seen projecting over the neck soft tissues. Lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Median sternotomy wires are present. Heart is mildly enlarged. Lung volumes are low, but there is no focal consolidation. No overt pulmonary edema is present. Views of the upper abdomen are normal.", "output": "Low lung exaggerate borderline cardiomegaly." }, { "input": "Frontal and lateral chest radiographs demonstrate a left chest port with the tip terminating at the cavoatrial junction. Lung volumes are low, with increased prominence of the cardiac silhouette and bronchovascular crowding, including bibasilar atelectasis. No definite focal consolidation is identified. There is no pleural effusion or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No definite focal consolidation." }, { "input": "Chronic appearing right rib deformity or pleural thickening is unchanged from prior studies. A left pectoral port catheter tip terminates in the mid SVC. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "The left pectoral port catheter tip terminates in the mid SVC, unchanged. Cardiomediastinal borders are stable. Lung volumes are low. Mild left basilar atelectasis is present. No focal consolidation, pleural effusion, or pneumothorax. Chronic right-sided and left-sided pleural thickening with bilateral rib deformities is unchanged from prior studies. Surgical clips are seen in the left upper quadrant.", "output": "1. Low lung volumes with left basilar atelectasis. 2. Port catheter tip terminates in the mid SVC." }, { "input": "PA and lateral views of the chest provided. Port-A-Cath resides over the left chest wall with catheter tip extending to the mid SVC region. The lungs appear clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Old bilateral rib deformities noted. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Left-sided Port-A-Cath terminates in the mid SVC without evidence of pneumothorax. Lung volumes are low. Destructive lytic lesion at the posterior left seventh rib was better seen on CT as were numerous small pulmonary nodules. No definite new focal consolidation is seen. No large pleural effusion or pneumothorax. Stable cardiac and mediastinal silhouettes.", "output": "Left-sided Port-A-Cath terminates in the mid SVC without evidence of pneumothorax. Lung volumes are low. Destructive lytic lesion at the posterior left seventh rib was better seen on CT as were numerous small pulmonary nodules. No definite new focal consolidation is seen. No large pleural effusion or pneumothorax. Stable cardiac and mediastinal silhouettes." }, { "input": "Well inflated clear lungs. No pleural effusion or pneumothorax. Stable appearance of cardiomediastinal silhouette. Mild crowding of right-sided ribs is unchanged. A left-sided Port-A-Cath terminates at the cavoatrial junction.", "output": "No significant interval change compared to ___." }, { "input": "In comparison to the chest radiographs obtained ___, no significant changes are appreciated. A left-sided Port-A-Cath tip terminates in the upper SVC and runs through his expected course without any kinks or abnormalities. Lungs are fully expanded and clear without consolidations or effusions. Heart size is normal. Cardiomediastinal and hilar silhouettes are normal. Pleural surfaces are normal. Old rib fractures unchanged.", "output": "A left-sided IJ Port-A-Cath tip terminates in the upper SVC. No significant acute cardiopulmonary abnormalities." }, { "input": "Left dual lumen chest wall Port-A-Cath is seen with catheter tip in the mid SVC. Opacity at the left lung base is compatible with prominent fat pad. The lungs are otherwise clear without consolidation, effusion, or edema. Known pulmonary nodules are better seen on prior dedicated chest CT. The cardiomediastinal silhouette is within normal limits. Multiple healed right lateral rib fractures are noted as well as hypertrophic changes in the spine.", "output": "No acute cardiopulmonary process." }, { "input": "A left-sided Port-A-Cath is in stable position. Low lung volumes are demonstrated, which may accentuate bronchovascular markings. A diffuse interstitial abnormality is present and is increased from the prior examination, consistent with mild pulmonary edema. No pneumothorax or pleural effusion.", "output": "Diffuse interstitial abnormality is increased from the prior examination and likely reflects mild pulmonary edema." }, { "input": "A left Port-A-Cath is stable in position, terminating in the SVC. The cardiac silhouette is stable in size. There are coarse bronchovascular markings without focal consolidation, pleural effusion or pneumothorax. No overt pulmonary edema is seen. Chronic bilateral rib deformities are noted, and degenerative changes of the thoracic spine are seen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Port-A-Cath resides over the left chest wall with catheter tip in the region of the mid SVC unchanged. The lungs appear clear. No large effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures appear intact. DISH related changes of the T-spine noted. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Portable AP upright chest film ___ at 09:47 is submitted.", "output": "A left-sided Port-A-Cath remains in place with the tip terminating in the mid to distal SVC. Overall cardiac and mediastinal contours are stable. Lung volumes remain low with crowding of the pulmonary vasculature and no overt pulmonary edema. No focal airspace consolidation to suggest pneumonia. No pneumothorax." }, { "input": "No change in the overall position of the left chest a port with its tip terminating in the region of the cavoatrial junction. Lower lung volumes are again demonstrated and overall unchanged. Slight increased opacification in the lower lung bases appear overall similar to the prior exam and suggest chronic atelectasis associated with prominent epicardial fat pad, better seen on CT. No definite focal consolidation to suggest pneumonia. No pneumothorax, pleural effusion, or pulmonary edema. The cardiomediastinal silhouette is within normal limits. Multiple known bilateral pulmonary nodules are better seen on prior CT. Stable bilateral rib deformities and associated pleural thickening.", "output": "No acute intrathoracic process." }, { "input": "A left Port-A-Cath catheter is stable in position, terminating in the mid SVC. The cardiomediastinal and hilar contours are within normal limits. There is redemonstration of prominent bronchovascular markings. No focal consolidation is identified. There is scarring at the lingula. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The left atrial appendage is perhaps somewhat prominent, noting a mildly convex contour to the left mid mediastinum. There is no pleural effusion or pneumothorax. Best seen on the lateral view is a patchy opacity projecting over the lower spine. Although it overlaps with the course of the left hemidiaphragm, it does not silhouette the the hemodiaphragm, so it seems perhaps more likely to reside in the right than left lower lobe. Bony structures are unremarkable.", "output": "1. Patchy posterior basilar opacity, most likely in the right lower lobe, suggesting pneumonia, although the side is not entirely certain. 2. Mildly bulging left mid mediastinal contour, suggesting enlargement of the left atrial appendage. Other etiologies could yield this contour too, such as a thymic cyst. Correlation with prior films may be helpful if available clinically." }, { "input": "Lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. There is a slight irregularity to the right hemidiaphragm, likely from a small diaphragmatic eventration. The size of the cardiac silhouette is at the upper limits of normal. The mediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "AP and lateral views of the chest. The lungs are essentially clear noting some streaky left basilar opacity not significantly changed, potentially due to atelectasis. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality detected.", "output": "No definite acute cardiopulmonary process." }, { "input": "AP and lateral views of the chest are compared to previous exam from ___. Right PICC is no longer seen. Lower lung volumes seen on the current exam suggesting bibasilar opacities are atelectasis. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are grossly unremarkable.", "output": "Lower lung volumes without definite acute cardiopulmonary process." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are unremarkable. There are small, bilateral pleural effusions. In the retrocardiac region, there is a streaky opacity. While this may represent atelectasis, aspiration or pneumonia is not entirely excluded.", "output": "Left lower lobe retrocardiac opacity may represent atelectasis, aspiration, or developing infectious pneumonia in the appropriate clinical context. Follow-up chest x-ray ___ weeks after treatment is recommended to document resolution. RECOMMENDATION(S): Retrocardiac opacity may represent aspiration/pneumonia in the appropriate clinical context. Follow-up evaluation ___ weeks after treatment is recommended to document resolution." }, { "input": "The cardiac silhouette is moderately enlarged with tortuosity of the thoracic aorta with dense aortic calcifications. The hilar contours are unremarkable. There is a right lung base atelectasis with more dense consolidation in the right mid lung field with layering posterior pleural effusion. There is no pneumothorax. Calcified pleural plaques are noted in the lung apices.", "output": "Consolidation of the right mid lung field with associated right-sided pleural effusion as well as biapical calcified pleural plaques which are better described on same-day CT examination. This could represent infection or mass." }, { "input": "The lungs are hyperinflated but remain clear. Posterior eventration of the left hemidiaphragm versus Bochdalek's hernia is again noted. Calcification projecting over the anterior right fifth rib is likely costochondral cartilage, present on prior but currently more conspicuous. Cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications are noted at the aortic arch. Right breast surgical clips are noted. Surgical clips also seen in the upper abdomen. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "Tip of endotracheal tube is in unchanged position and heart and mediastinal contours are also stable. A small right pleural effusion is present. Right-sided PICC line has been pulled back to the level of the central subclavian vein on the right. New, mild right basilar subsegmental atelectasis.", "output": "Small right pleural effusion and slight interval increase in subsegmental atelectasis right lung base. Note right-sided PICC line tip now pulled back to level of central subclavian vein on that side" }, { "input": "The right PICC line a has pulled back a little bit with is still in adequate position in the mid SVC. The NG tube has been removed. The heart is normal in size. There is a tortuous aorta. The pulmonary vasculature is normal. Is small right pleural effusion is noted.", "output": "A PICC line is pulled back somewhat but still adequate position in the mid SVC." }, { "input": "There has been interval removal of a right chest tube. Again seen is decreased volume of the right lung. Also seen is a small right apical pneumothorax, which is unchanged in size. There is significant atelectasis of the base of the right lung and gas in the soft tissues of the right chest. The left lung is normal appearing the heart is mildly enlarged.", "output": "Small right apical pneumothorax, unchanged in size from the prior study. No evidence of tension." }, { "input": "AP single view of the chest has been obtained with patient in sitting semi-upright position. The heart size remains normal and no configurational abnormality is noted. The entire thoracic aorta is generally widened and elongated, and this includes also the ascending portion to the right of the midline. The pulmonary vasculature is not congested and there are no signs of acute pulmonary parenchymal infiltrates. Also, the lateral pleural sinuses remain free from fluid accumulation and there is no pneumothorax in the apical area. Our records do not include a previous chest examination available for comparison.", "output": "General widening and elongation of thoracic aorta compatible with the diagnosis of aortic dissection. Prominence of ascending aorta is also noted. There is no cardiac enlargement, no evidence of pulmonary congestion or pleural effusion on this preoperative single view chest examination." }, { "input": "Frontal and lateral chest radiographs demonstrate volume loss within the right hemithorax consistent with patient's history of prior right lower lobe lobectomy. No residual subcutaneous emphysema. When compared to prior radiograph dated ___, there is decreased but persistent moderate right pleural effusion with adjacent atelectasis. There is resolution of right upper lobe consolidation. The left lung is clear. Stable cardiomediastinal and hilar contours with stable appearing prominent and tortuous aorta. No pneumothorax.", "output": "Stable postoperative changes within the right hemithorax. Improved right pleural effusion, though moderate, and resolved right upper lobe consolidation seen on prior radiograph." }, { "input": "Portable semi upright radiograph of the chest demonstrates stable right lower lobe collapse and small right pleural effusion. The cardiomediastinal and hilar contours are unchanged. The endotracheal tube ends 5 cm from the carina. A nasogastric tube courses into the stomach and out of the field of view. There is no pneumothorax. The right-sided PICC line ends in the region of the axilla.", "output": "The right-sided PICC line ends in the region of the right axilla." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion or evidence or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Hilar contours are stable. There has been no significant interval change since the prior study.", "output": "No acute cardiopulmonary process. No significant change since the prior study." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are unremarkable. The lungs are clear and hyperinflated, consistent with emphysema. A large left perihilar bleb is noted, better assessed on prior CT scan of the chest. There is no pneumothorax or pleural effusion.", "output": "No acute intrathoracic findings." }, { "input": "AP upright and lateral views of the chest were provided. Lungs are clear though hyperinflated. No focal consolidation, effusion or pneumothorax is seen. The heart and mediastinal contours appear normal. Bony structures appear intact.", "output": "Emphysema without superimposed pneumonia or CHF." }, { "input": "Portable AP upright chest radiograph obtained. The lungs appear clear without focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours appear grossly unremarkable. No bony abnormalities are seen.", "output": "No acute findings in the chest. Please refer to subsequent chest CTA for further details." }, { "input": "Heart size is normal. Aorta is mildly tortuous. Patchy and linear opacities are present in the mid and lower lungs bilaterally. Paucity of vasculature in the upper lobes, right greater than left, appears to correspond emphysema on prior chest CTA of ___. No pleural effusion or pneumothorax. On the lateral view, focal lucency and discontinuity of the right eleventh posterior rib is present, difficult to assess on the frontal radiograph due to superimposition of structures. This region was not included on the prior chest CTA.", "output": "1. Focal discontinuity and lucency of right limit posterior rib, seen only on lateral view and incompletely evaluated radiographically. Although potentially due to a fracture, in the absence of traumatic history, a destructive bone lesion from myeloma or metastatic disease should be considered. 2. Multifocal atelectasis in the mid and lower lungs. RECOMMENDATION: DEDICATED CHEST CT TO FURTHER EVALUATE THE RIGHT ELEVENTH RIB. IT WITH WITH NOTIFICATION: THE ITS THE IS PRESENT ITS AS IS T THE CM CYSTIC was entered by Dr. ___ on ___ at 11:42 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "Minor left basilar atelectasis is seen. There is no focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Lateral view is partially obscured by patient's overlying arm. No focal consolidation, pleural effusion, or pneumothorax is seen. Heart and mediastinal contours are within normal limits. There is possible focal narrowing of the distal trachea vs artifact.", "output": "1. No focal consolidation to suggest pneumonia 2. Possible focal narrowing of the distal trachea vs artifact. Further evaluation is recommended with non-emergent CT. This finding and recommendation were e-mailed to the ED QA nurses at 9 p.m. on ___." }, { "input": "There is increased retrocardiac opacification, concerning for pneumonia. The lungs are hyperinflated. The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax.", "output": "Left lower lobe pneumonia." }, { "input": "Endotracheal tube in appropriate position ending approximately 3.5 cm above the carinal. A left subclavian central venous catheter ends in the low SVC. Nasoenteric tube enters the stomach with the tip not included on this radiograph, the side port is at the GE junction. There is no pneumothorax. Cardiomediastinal silhouette is normal. Lungs are clear. There is no pleural effusion.", "output": "1. Endotracheal tube in appropriate position. 2. Nasoenteric tube side port at the GE junction can be advanced for more optimal positioning." }, { "input": "The patient is status post median sternotomy and CABG. The heart size is mild to moderately enlarged. The aorta is moderately tortuous but unchanged and diffusely calcified. There is mild pulmonary vascular congestion. No pleural effusion or pneumothorax. Minimal atelectasis is also seen within the lung bases. There are multilevel moderate degenerative changes seen in the thoracic spine.", "output": "Mild pulmonary vascular congestion. Mild bibasilar atelectasis." }, { "input": "Midline sternotomy wires and prosthetic cardiac valve again noted. There is interval increase in right pleural effusion, now moderate to large in size. Associated with this is right basal compressive atelectasis, difficult to exclude aspiration or pneumonia. A left mid lung opacity likely represents atelectasis. Heart size cannot be assessed. There is probable mild edema. Mediastinal contour remains prominent. No definite pneumothorax. No large left effusion. Bony structures are intact.", "output": "As above." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Punctate calcified granuloma is seen within the medial aspect of the right lung base. Lungs are otherwise clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities demonstrated. Screw is noted within the right proximal humerus. Degenerative changes are seen involving both AC joints.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Prominent degenerative changes of the first costochondral junction are stable from ___. There is minimal scarring adjacent to the right hemidiaphragm. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is stable and there is no evidence of central adenopathy.", "output": "No acute cardiopulmonary process. No evidence of central adenopathy." }, { "input": "The patient is rotated and kyphotic. Opacities overlying the right lower lobe and spine. Lung markings are coarsened. Nodular opacity overlying right lung apex is unchanged ___. The aorta is tortuous. Cardiac silhouette is normal. There is no pleural effusion or pneumothorax. Multiple mild-to-moderate thoracic spine vertebral body wedge deformities are age indeterminate, new since ___. Bilateral rib deformities are consistent with chronic fractures.", "output": "1. Opacities overlying the right lower lung and spine may represent atelectasis, mild pulmonary edema, or pneumonia in the right clinical setting. 2. Multiple mild to moderate thoracic vertebral body compression deformities are age-indeterminate, new from ___. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 7:22 AM, 5 minutes after discovery of the findings." }, { "input": "The lungs are clear. The heart size is normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen. The imaged osseous structures are grossly unremarkable including both clavicular heads.", "output": "No acute intrathoracic process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax. Imaged osseous structures are grossly intact. Cholecystectomy clips are seen in the right upper quadrant.", "output": "No acute intrathoracic process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest demonstrate an increase in large left-sided pleural effusion with adjacent atelectasis. In addition, there is now obscuration of the right heart border. This could be due to atelectasis versus pneumonia in the correct clinical setting. There may be a small right-sided pleural effusion as well. Right-sided Port-A-Cath terminates in the right atrium, unchanged.", "output": "Enlarging left-sided pleural effusion with compressive atelectasis. In addition, right-sided opacities, atelectasis versus pneumonia in the correct clinical setting." }, { "input": "AP single view of the chest has been obtained with patient in semi-upright position. Comparison is made with the next preceding similar study obtained two hours earlier during the same day. An NG tube has now been placed, seen to reach below the diaphragm with the line tip and the sidehole overlying the body of the stomach. No significant interval changes are present in the lungs and the previously described left-sided pleural effusion. Unchanged position of right internal jugular approach central venous line.", "output": "Appropriate position of NG tube." }, { "input": "There is a right-sided Port-A-Cath which terminates in the low SVC. The lung volumes are low. There has been an interval increase in the moderate right-sided pleural effusion with an increase in mild adjacent atelectasis. There has been a slight decrease in the size of a now small to moderate left pleural effusion with a new small caliber pleural catheter projecting over the left lung base. There has also been interval improvement of the left base compressive atelectasis. There is no pneumothorax.", "output": "1. Interval decrease in the left-sided small to moderate pleural effusion with a new pleural catheter projecting over the lateral left lung base. No pneumothorax. 2. Interval increase in the moderate right-sided pleural effusion and mild adjacent atelectasis." }, { "input": "The left lower lung atelectasis and pleural effusion are stable. There is interval improvement of the right basilar opacity. There is a stable small right-sided pleural effusion. The right-sided Port-A-Cath terminates in the mid SVC. The heart size is stable. The hilar and mediastinal contours are otherwise unremarkable. There is no pneumothorax.", "output": "1. Interval improvement of the right basilar opacity. Stable small right pleural effusion. 2. Stable lower left lung atelectasis and small pleural effusion. 3. No evidence of worsening or new focal consolidations." }, { "input": "PA and lateral chest views have been obtained with patient in upright position. There is a sizeable left-sided pleural effusion that obliterates the diaphragmatic contour and the lateral portion of the heart shadow. Heart size cannot be accurately assessed, but is probably within normal limits as there is no evidence of pulmonary congestion. A right-sided Port-A-Cath system introduced via the right internal jugular vein approach is seen to terminate in the lower third of the SVC close to the expected entrance into the right atrium. No pneumothorax can be identified. There is evidence of bilateral pleural effusion, more so on the left than the right, where the effusion just blunts mildly the right lateral and right posterior pleural sinuses. On the left side, the pleural effusion reaches along the left lateral wall up to the hilar level. There is no pneumothorax on either side. Our records do not include a previous chest examination available for comparison.", "output": "Heart size cannot be assessed because of left-sided pleural densities obliterating the contours. Small amount of pleural effusion also seen on right side. Port-A-Cath system in place. No pneumothorax. Moderate gas distention of stomach. No evidence of acute pulmonary vascular congestion or infiltrates or masses. A page call was rendered on specific request for #___ at 5:20 p.m. Contact with the house officer was established and the findings reported. An estimate is that the left-sided pleural effusion may contain up to 500 mL." }, { "input": "Left-sided AICD/ pacemaker device is noted with leads terminating in the right ventricle and region of the coronary sinus. Lung volumes are low. Heart size is mildly enlarged. Mediastinal contours are unchanged with calcification of the thoracic aorta noted. Increased interstitial markings are seen, most pronounced along the periphery of the lungs and within the upper lobes suggestive of a chronic interstitial lung disease. There may be mild interstitial pulmonary edema superimposed. No focal consolidation, pleural effusion or pneumothorax is identified. No acute osseous abnormality is detected. Degenerative changes are seen within the right glenohumeral joint.", "output": "Possible mild interstitial pulmonary edema superimposed on a background of chronic interstitial lung disease. A high-resolution chest CT could be obtained for further assessment on a non-emergent basis, if not done previously." }, { "input": "The cardiomediastinal and hilar silhouettes and pleural surfaces are normal. A subtle area of peribronchial opacification projecting over the cardiac apex is seen only on the lateral view. No effusion or pneumothorax.", "output": "A subtle area of opacification projects over the cardiac apex only on the lateral view. This radiograph is otherwise normal, as we would hesitate to call this area pneumonia without old films to suggest it is a new finding." }, { "input": "The heart is borderline in size with a left ventricular configuration. The mediastinal and hilar contours appear unchanged. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "PA and lateral views of the chest were obtained. The heart is mild to moderately enlarged. There is no focal consolidation, effusion or signs of CHF. No pneumothorax is seen. Mediastinal contour is unremarkable. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Cardiomegaly without signs of failure or pneumonia." }, { "input": "Right-sided chest tube has been removed. Loculated right-sided hydro pneumothorax has changed slightly in morphology with increasing air-fluid level and convexity of the opacity extending in the right fissure. Although the volume of pleural fluid has marginally increased. The left lung is clear. Multiple fractures, lateral right lower lobe ribs, in various stages of healing, most unfused. Moderate cardiomegaly.", "output": "Mild to moderate multiloculated right sided hydro pneumothorax has more air following removal of the right pleural drain, unchanged in overall size. Multiple incompletely healed, right lower lateral rib fractures." }, { "input": "The cardiomediastinal silhouette is stable from prior exam consistent with a least moderate cardiomegaly. Lower lobe lobe opacity best seen on the lateral radiograph. There is no pulmonary edema. There may be a trace residual right pleural effusion, smaller from prior exam. There is no left pleural effusion. There is no pneumothorax. Right chronic posterior rib deformities representing healed fractures.", "output": "Left lower lobe opacity may represent pneumonia. Stable at least moderate cardiomegaly. Trace recurrent right pleural effusion or right pleural scarring. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 5:26 PM, 5 minutes after discovery of the findings." }, { "input": "As compared to radiographs from 1 day prior, right-sided pigtail catheter in similar position. Right lower lobe opacity has marginally increased and right-sided pleural effusion have not significantly changed. In retrospect, small apical right-sided pneumothorax is stable. Moderate cardiomegaly. The left lung is relatively clear. Mild biapical scarring.", "output": "Marginal increase in right lower lobe opacity and stable right pleural effusion. In retrospect, small apical right-sided pneumothorax is unchanged." }, { "input": "Moderate cardiomegaly is unchanged. There is no pulmonary edema. Lungs are clear. A small right pleural effusion has decreased in size compared the prior examination. Right pleural thickening persists. No pneumothorax.", "output": "1. Small right pleural effusion, decreased, and persist pleural thickening at the right base. 2. Stable moderate cardiomegaly." }, { "input": "PA and lateral views of the chest provided. The cardiomediastinal silhouette remains prominent though unchanged in overall appearance. There is no convincing evidence of pneumonia. No large effusion or pneumothorax. Blunting of the right CP angles unchanged likely reflecting pleural thickening. Chronic right rib deformities are again seen. There is also a chronic right clavicular midshaft deformity. The hila appear slightly congested though there is no frank edema. No free air below the right hemidiaphragm.", "output": "Stable cardiomegaly, probable mild congestion. No signs of pneumonia or edema." }, { "input": "Rounded opacity projecting over the left hemi-diaphragm unchanged from ___, the date of earliest available imaging, potentially eventration of the diaphragm. No pleural effusion, pneumothorax or focal airspace consolidation. Heart is mildly enlarged but unchanged. Mediastinal hilar contours are unremarkable.", "output": "1. No acute cardiopulmonary process. 2. Rounded opacity projecting over left hemidiaphragm is unchanged from ___. Nonemergent chest CT imaging is recommended for further evaluation." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart is moderately enlarged. There is patchy opacification of the left lower hemithorax with a suspected pleural effusion, possibly moderate in size. There is a lesser degree of opacification in the left lower lung, largely streaky and probably due to minor atelectasis or scarring, although there may also be a small pleural effusion potentially on the left side. Mild degenerative changes are noted along the lower thoracic spine. There is also mild rightward convex curvature and a moderate thoracolumbar compression deformity, incompletely characterized.", "output": "1. Moderate cardiomegaly. In addition to true enlargement of the myocardium, the possibility of a pericardial effusion could be considered. 2. Basilar opacification, greater on the right than left with a suspected pleural effusion, at least on the right side. 3. Moderate thoracolumbar compression deformity." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Pulmonary vascularity is normal. The lungs are clear. No pleural effusion or pneumothorax is identified. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Low lung volumes are noted with secondary crowding of the bronchovascular markings. Prominence of the upper mediastinum is likely secondary to low lung volumes and portable supine technique. The cardiac silhouette is within normal limits. No acute osseous abnormalities.", "output": "Low lung volumes no definite superimposed acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are hyperinflated as described on the prior report. There is no focal consolidation or pneumothorax. Tiny pleural effusions are noted. Heart size is normal. Mediastinal silhouette and hilar contours are normal.", "output": "Tiny pleural effusions are new from CT ___. No pneumonia." }, { "input": "The heart size is normal. The aorta remains tortuous. There is mild pulmonary vascular engorgement but no overt pulmonary edema is demonstrated. Streaky opacities in the lung bases likely reflect atelectasis. Minimal blunting of the costophrenic angles posteriorly appears unchanged, compatible with trace bilateral pleural effusions. There is no pneumothorax. Partially imaged is an aortic stent graft within the upper abdomen.", "output": "Mild pulmonary vascular engorgement and trace bilateral pleural effusions." }, { "input": "The heart size is within normal limits. The mediastinal and hilar contours are normal. The lungs are hyperinflated, which is stable compared to prior exam. They are clear of consolidation. There is no pleural effusion or pneumothorax.", "output": "Stable pulmonary hyperinflation." }, { "input": "The right pleural effusion has increased and is now moderate in size with overlying atelectasis, underlying consolidation cannot be excluded. There may be a very trace left pleural effusion, decreased in size since the prior. The cardiac silhouette remains enlarged. The aorta is calcified and tortuous. Evidence of hiatal hernia is again seen. The lateral view is suboptimal due to the patient's overlying arm. A few punctate calcifications in the lung apices may represent calcified granulomas or may be related to scarring.", "output": "Increased right pleural effusion which is now moderate, with overlying atelectasis, underlying consolidation cannot be excluded. Trace left pleural effusion, slightly decreased." }, { "input": "Single portable frontal radiograph through the chest demonstrates low lung volumes. The chin overlies and obscures bilatearl apices. There is opacification of the right lung base which likely reflects a small pleural effusion with underlying atelectasis. Infection cannot be excluded. This has a similar appearance since prior examination dated ___. Incidental note is made of bilateral hilar calcified nodes, which may relate to prior granulomatous disease. The heart is enlarged, unchanged since prior examination. Redemonstration of CoreValve in unchanged position. Aortic arch calcifications again noted. Degenerative changes within osseous structures again identified.", "output": "Right basilar opacity compatible with pleural effusion and likely atelectasis, although infection cannot be excluded. Stable cardiomediastinal silhouette." }, { "input": "In the right lung, small to moderate right pleural effusion is unchanged. Additional opacity of the right lung base is also similar in appearance, and this may be due to infectious consolidation or layering of the pleural effusion. The left lung is essentially clear. No pneumothorax or pulmonary edema. Stable cardiomegaly. The aortic root stent graft is unchanged in position.", "output": "1. Unchanged small-to-moderate right pleural effusion. 2. The right lung base opacity could be explained by a layering pleural effusion or pneumonia. Correlate clinically with signs of infection." }, { "input": "Single portable view of the chest. Lower lung volumes seen on the current exam. There is increase in degree of the opacity at the right lung base likely due to pleural effusion with underlying atelectasis, noting infection is not excluded. There is also a small left pleural effusion, new since prior. Retrocardiac opacity is in part due to known hiatal hernia. The cardiac silhouette is enlarged, similar to prior. Core-valve is also seen, similar to prior. Degenerative changes seen at the shoulders.", "output": "Right basilar opacity compatible with pleural effusion and likely atelectasis, noting infection cannot be excluded. It appears increased in degree when compared to prior. New left-sided effusion." }, { "input": "There is a small to moderate right pleural effusion with overlying atelectasis, which appears smaller in size as compared to the prior study given differences in technique. Retrocardiac air-fluid level is most consistent with a hiatal hernia. There is adjacent bibasilar atelectasis. Small scattered calcified nodular opacities in both lungs are likely due to prior granulomatous disease. Core-valve placement. There is no overt pulmonary edema. The right aspect of the cardiac silhouette is difficult to assess due to the right base opacity. Mediastinal contours are grossly stable.", "output": "Small to moderate right pleural effusion with overlying atelectasis, underlying consolidation is not excluded. No overt pulmonary edema. Hiatal hernia." }, { "input": "AP single view of the chest has been obtained with patient in supine position. Available for comparison is the next preceding PA and lateral chest examination of ___. During the latest examination interval, the patient has undergone an intravascular placement of a CoreValve. The patient is now intubated, the ETT terminating in the trachea 4 cm above the level of the carina. A right internal jugular approach wire has been placed, seen to terminate in the apical portion of the right ventricle, thus representing a temporary pacing wire. The grid structures of a CoreValve device are seen in expected location covering the outflow tract of the left ventricle and the root of the aorta. There is no evidence of pulmonary vascular congestion similar as such finding was absent on the preceding chest examination of ___. A now present diffuse haze over the entire right-sided hemithorax can be explained by patient's previously identified right-sided basal pleural effusion which is now layering in the posterior compartments of the pleural space as the patient is in supine position. No pneumothorax can be identified on either side.", "output": "Satisfactory findings on interventional procedure chest examination with patient in supine position. No pneumothorax." }, { "input": "PA and lateral views of the chest. Lateral view shows greater basal consolidation due to new or increased pneumonia. Small bilateral pleural effusions are slightly bigger. Mild cardiomegaly is new. There is no pneumothorax. Aortic calcifications are unchanged. Hiatal hernia is again seen.", "output": "Probable pneumonia. Hiatus hernia. New mild cardiomegaly and increased small pleural effusions. No pulmonary edema." }, { "input": "The cardiac and mediastinal contours are somewhat difficult to assess owing to persistent opacification of the right lower hemithorax. The patient is status post aortic valve replacement using an endoluminal approach. A moderate hiatal hernia is noted, similar to prior findings. Opacification of the right lower hemithorax which probably relates to elevation of the right hemidiaphragm, atelectasis, and possibly a pleural effusion, appears very similar to both prior studies without clear change. The right acromioclavicular joint is again widened and irregular. Moderate incompletely characterized degenerative changes affect each shoulder. The bones appear demineralized.", "output": "Stable appearance of the chest. No definite acute process. Suspicion for persistent pleural effusion and atelectasis at the right lung base. Hiatal hernia." }, { "input": "Frontal views of the chest were obtained. Right pleural effusion has increased, now moderate to large in volume, with bilateral lower lung opacities presumed to be atelectasis. Small left pleural effusion is unchanged. No pneumothorax. Heart size and cardiomediastinal contours are stable. Right internal jugular transvenous pacer has been removed. The replaced aortic valve is unchanged in position.", "output": "Increased right pleural effusion, now moderate to large, with presumed bibasilar atelectasis. No pneumothorax." }, { "input": "A small right pleural effusion is present. There is otherwise no focal consolidation or pneumothorax. The cardiomediastinal silhouette is unremarkable. A hiatal hernia is present. There are degenerative changes at the left shoulder joint and in the spine.", "output": "1. A small right pleural effusion. 2. Small hiatal hernia. These findings were discussed with Dr. ___ by Dr. ___ at 4pm via telephone" }, { "input": "From ___, there is increase in confluent bilateral airspace consolidation with air bronchograms. This precludes evaluation of the cardiac silhouette and of the mediastinal contours. There is no pneumothorax or pneumomediastinum. A left IJ catheter tip both projects in the mid SVC. An endotracheal tube is unchanged in position. An NG tube passes below the level of the diaphragm, though the tip is not seen.", "output": "1. Increasing confluent bilateral diffuse airspace disease, consistent with given clinical history of ARDS. 2. Stable and appropriate positioning of support lines and tubes." }, { "input": "A bedside AP radiograph of the chest shows a new endotracheal tube terminating no less than 4 cm above the carina. Compared to 4.5 hours earlier, there has been marked worsening of alveolar pulmonary edema, now largely masking the peripheral nodular opacities likely representing disseminated infection. Small bilateral pleural effusions persist. There is no pnuemothorax. Marked widening of the cardiac silhouette is stable since admission and reflects the presence of pericardial effusion and cardiomegaly.", "output": "1. Worsening pulmonary edema superimposed on what is likely a disseminated infectious process. 2. Stable pericardial effusion and cardiomegaly. 3. The endotracheal tube is properly positioned. NOTE: The results, in conjuction with the prior radiograph taken at 4:16 am, were communicated to Dr. ___ by Dr. ___ ___ telephone on ___ at 9:35 am." }, { "input": "The patient remains intubated, with the tip of the endotracheal tube positioned 3.5 cm from the level of the carina. An NG tube is in place, though the tip and side hole are not seen. There is interval improvement from 8AM in severe bilateral alveolar opacity, with small bilateral pleural effusions. The cardiac silhouette remains markedly enlarged reflecting known moderate pericardial effusion. A left internal jugular central venous catheter has been placed in the interim, the tip projects over the mid SVC. There is no pneumothorax on this limited supine film.", "output": "1. Interval left IJ catheter placement; the tip is positioned in the mid SVC. 2. Slight improvement from 8AM of severe alveolar opacities which likely reflect edema superimposed upon disseminated infection." }, { "input": "PA and lateral radiographs of the chest depict bilateral small pleural effusions, left greater than right, which were not present on the most recent available comparison study from ___. There is marked cardiomegaly, which also appears to be new from ___. Multifocal peripheral opacities on both sides may represent a process involving the pleura, parenchyma, or both. There is no pneumothorax or pulmonary edema. Note is made of bilateral widening of the glenohumeral joint spaces, which may be indicative of rotator cuff laxity.", "output": "1. Bilateral pleural effusions, left greater than right. 2. Moderate-to-severe cardiomegaly. 3. Peripheral parenchymal or pleural opacities bilaterally. 4. These findings appear to be new at least since ___ when the lung bases were visualized on the CT. Further evaluation with chest CT is recommended. 5. Bilateral widening of the glenohumeral joint spaces may be indicative of rotator cuff laxity. Correlation with history and physical examination is recommended. NOTE: Findings were communicated to ___ by Dr. ___ ___ telephone on ___ at 11:11 a.m., immediately after discovery." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Clips in the right upper quadrant of the abdomen are noted.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is identified.", "output": "No acute cardiopulmonary process." }, { "input": "The endotracheal tube terminates. 4.1 cm from the carina. An enteric tube courses below the diaphragm and terminates outside of the field of view within the stomach. Dense opacification of the right lung base with associated rightward mediastinal shift disc consistent with right lower lobe collapse. Granular opacification of the left mid lung corresponds to airspace opacity seen chest CT concerning for aspiration pneumonia. There is no left-sided pleural effusion. There is no pneumothorax. Chain sutures project over the right wall of suggesting prior lobe wedge resection. The cardiomediastinal silhouette is partially obscured by the right basilar opacity. The osseous structures are notable for partially evaluated severe degenerative change of the cervical spine. Known osseous metastatic disease is better evaluated on same day CT. The upper abdomen is unremarkable.", "output": "1. Standard positioning of endotracheal tube and enteric tube. 2. Opacification of the right lung base with associated right or mediastinal shift concerning for right lower lobe collapse. 3. Granular opacification of the left lung concerning for aspiration or pneumonia." }, { "input": "Cardiac silhouette size is normal. Mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is identified. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality. Normal mediastinal contour." }, { "input": "The lungs are clear with no evidence of a consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. No acute fractures are identified.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is had median sternotomy with AVR and MVR. The cardiac silhouette is severely enlarged and unchanged from ___ study. A single chamber pacemaker is seen with the lead terminating in the right ventricle. Vascular engorgement is limited to the hila. No focal consolidations, pleural effusions, or pulmonary edema are seen.", "output": "Stable severe cardiomegaly without pulmonary edema and no evidence of pneumonia. NOTIFICATION: The findings were discussed with ___, N.P. by ___ ___, M.D. on the telephone on ___ at 10:35 AM, 15 minutes after discovery of the findings." }, { "input": "The patient is status post median sternotomy and cardiac valve replacements. A single lead left-sided pacemaker is seen with lead extending to the expected position of the right ventricle. The cardiac silhouette is mild to moderately enlarged with concern for left ventricular enlargement. There is slight prominence of the central pulmonary vasculature. No pleural effusion is seen. There is no pneumothorax. No focal consolidation.", "output": "Cardiomegaly and central pulmonary vascular engorgement." }, { "input": "PA and lateral views of the chest provided. Left chest wall pacer is again noted with pacer lead extending to the region the right ventricle. AVR and MVR replacements noted. Cardiomegaly is again noted. Suture is seen in the region of the left hilum. Hila are engorged. No frank edema or pneumonia. No large effusion or pneumothorax. Bony structures are intact. Mediastinal contour is unchanged. No free air below the right hemidiaphragm.", "output": "Stable cardiomegaly with hilar engorgement and no frank edema." }, { "input": "The heart size is top normal. The cardiomediastinal silhouette and hilar contour is stable. The lungs are clear without focal consolidation, effusion or pneumothorax. No acute bony abnormality is identified.", "output": "No acute intrathoracic process." }, { "input": "There is no focal consolidation, pleural effusion, pulmonary edema or pneumothorax seen. The heart and mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "", "output": "Heart size is normal. No mediastinal or pleural abnormality." }, { "input": "ET tube is at 2.7 cm from carina. NG tube ends in distal gastric cavity. Stable appearance of the ventriculoperitoneal shunt. Lung volume is minimally reduced but without consolidation or nodule. Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax.", "output": "No sign of acute cardiopulmonary processes." }, { "input": "The heart is enlarged. Mediastinal widening may be due to low lung volumes. There is mild pulmonary edema. There are probable bilateral small pleural effusions. Focal opacity in the right upper and mid lung fields and in both lung bases are non-specific but could reflect areas of infection.", "output": "1. Cardiomegaly with mild pulmonary edema. Probable small bilateral pleural effusions. 2. Focal opacities in the right upper and mid lung fields and lung bases are non-specifically, possibly reflecting areas of infection. Short interval radiographic follow up is recommended after treatment to document resolution." }, { "input": "Endotracheal tube tip is low lying, terminating approximately 1.8 cm from the carina, and should be withdrawn. Orogastric tube is seen with tip appearing to terminate in the distal esophagus, and should be advanced for optimal positioning. Lung volumes remain low. The heart size remains moderately enlarged. There is unchanged mediastinal widening, likely related to low lung volumes. There is worsening pulmonary edema, now mild to moderate in extent with probable small bilateral pleural effusions. Focal opacity is seen within the periphery of the right mid-to-upper lung field, could reflect an infectious process. No pneumothorax is clearly evident.", "output": "1. Low-lying endotracheal tube, terminating approximately 1.8 cm from the carina, and should be withdrawn slightly. 2. Orogastric tube tip appears to terminate within the distal esophagus and should be advanced. 3. Interval worsening of mild to moderate pulmonary edema with probable small bilateral pleural effusions. Continued opacification within the peripheral right upper-to-mid lung field." }, { "input": "Portable AP chest radiograph. The patient has been extubated and the NGT removed. Right IJ catheter remains in the low SVC. Right upper lobe consolidation is not significantly changed. The vascular pedicle has widened and mild interstitial pulmonary edema is slightly worse. Small bilateral pleural effusions and cardiomegaly are also stable. There is no pneumothorax.", "output": "Slightly worse mild interstitial pulmonary edema. Stable right upper lobe pneumonia." }, { "input": "Lung volumes continue to be low with unchanged mild edema. Previous right peripheral upper lobe consolidation has worsened, and a possible new left peripheral upper lobe consolidation has appeared. External intubation tubing overlies the area causing increased opacity. Mild cardiomegaly and vascular engorgement are unchanged with bilateral subpulmonic effusions.", "output": "Right peripheral upper lobe pneumonia has worsened since ___. New left peripheral upper lobe consolidation may be a developing pneumonia or artifact from overlying intubation tubing. Recommend repeat chest x-ray for follow-up. Cardiomegaly and edema are unchanged since ___." }, { "input": "Patient is status post tracheobronchoplasty. Since ___, the previously noted right upper lung opacities are improved. There is mild pulmonary congestion, left worse than right. A small left pleural effusion is probable. Mild bibasilar atelectasis is increased. A right chest tube is in unchanged positioning. The heart size is stable. Widening of the mediastinum is expected postsurgically. An apical right pneumothorax is tiny, if any.", "output": "1. Improvement in previously noted right upper lung opacities, likely from atelectasis or hematoma. 2. Mild pulmonary congestion, left worse than right, with a small probable left pleural effusion. 3. An apical right pneumothorax is tiny, if any." }, { "input": "Interval removal of right-sided PICC. Stable, mild cardiomegaly. Normal mediastinal and hilar contours. Interval resolution of mild pulmonary vascular congestion. Stable postsurgical defect in the right posterior third rib. Interval decrease in size of right apical radiodensity suggests a decreasing postsurgical fluid collection. No pneumothorax or pleural effusion. No convincing radiographic evidence of pneumonia.", "output": "1. Interval resolution of mild pulmonary vascular congestion. 2. No convincing radiographic evidence of pneumonia." }, { "input": "Compared to ___, the right perihilar heterogeneous opacity has minimally improved and could represent residual edema or pneumonia. There is mild vascular congestion. Mild cardiomegaly is stable. No pleural effusion. No pneumothorax. Right PIC line terminates at the cavoatrial junction.", "output": "Questionable right perihilar residual edema or small pneumonia, minimally improved from ___. Mild vascular congestion. Stable mild cardiomegaly." }, { "input": "Postsurgical changes following right thoracotomy and tracheobronchoplasty are noted. The lungs are otherwise clear. The heart size is unchanged. There is no pulmonary edema, pneumothorax, or pleural effusion.", "output": "Postsurgical changes following right thoracotomy and tracheobronchoplasty without evidence of acute cardiopulmonary process." }, { "input": "Lung volumes are low, with left lower lobe atelectasis. Superimposed infection cannot be excluded however appearances are similar when compared to the prior studies. No other areas concerning for consolidation are identified. No pneumothorax seen. The cardiomediastinal contour is unchanged. No frank pulmonary edema.", "output": "Low lung volumes with left lower lobe atelectasis, superimposed infection cannot be excluded however appearances are unchanged when compared to the prior study." }, { "input": "PA and lateral views of the chest provided. Stable moderate cardiomegaly and widened mediastinum. Opacity adjacent to right thoracotomy site is unchanged and consistent with expected postoperative changes. Stable bibasilar atelectasis. No pneumothorax or pleural effusion.", "output": "Unchanged opacity adjacent to right thoracotomy site, consistent with expected postoperative changes. Stable bibasilar atelectasis." }, { "input": "Cardiomegaly is stable. Widening of the mediastinum has improved. Bilateral multifocal atelectasis have improved. There is no pneumothorax. Right pleural effusion is small. There are low lung volumes. The aorta is tortuous", "output": "Improved multifocal atelectasis. Small right effusion." }, { "input": "Cardiomediastinal contours are stable with moderate cardiomegaly and widening of the mediastinum. Peripheral opacity in the right apex and apical pleural cap are persistent, could be loculated fluid with adjacent atelectasis. Bibasilar atelectasis have improved. There is no evident pneumothorax. .", "output": "Peripheral opacity in the right apex and apical pleural cap are persistent, could be loculated fluid with adjacent atelectasis. Bibasilar atelectasis have improved." }, { "input": "Moderate bibasilar atelectasis is increased and lung volumes remain low. A right chest tube is in unchanged position. Heart size is top normal. No pneumothorax. Part of the right posterior 4th rib is removed. Small amount of bilateral apical fluid is noted. Mild mediastinal widening, predominantly paratracheal, is improved since ___, an expected finding after tracheobronchoplasty.", "output": "Increased moderate bibasilar atelectasis and improvement of mild postoperative mediastinal widening." }, { "input": "There is complete opacification at the left lung base obscuring the left costophrenic angle, which is new from the prior study. A small left pleural effusion is difficult to exclude on this single AP view. The right lung is relatively clear. No pneumothorax is detected. The pulmonary vasculature is not engorged. The cardiac silhouette is incompletely evaluated due to opacification of the left lung base. The mediastinum appears prominent compared to the most recent prior study, which is in part related to technique; however, there is indistinctness at the aortic knob for which further evaluation with chest CTA is warranted.", "output": "1. Prominent mediastinum in part related to technique with indistinct aortic knob. Further evaluation with chest CTA is pending. 2. Left basilar opacification may represent pneumonia or lung collapse." }, { "input": "Frontal and lateral views of the chest were obtained. The heart size and cardiomediastinal contours are normal. The lungs are hyperinflated with flattening of the diaphragms. No focal consolidation, pleural effusion, or pneumothorax. No radiopaque foreign body.", "output": "Lung hyperinflation, suggestive of COPD." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is not engorged. Consolidative opacity is noted within the lingula compatible with pneumonia. Right lung is clear. No pleural effusion or pneumothorax is identified. No acute osseous abnormality is present.", "output": "Lingular pneumonia. Followup radiographs after treatment are recommended to ensure resolution of this finding." }, { "input": "Heart size is top normal. There is mild unfolding of the thoracic aorta. Hilar contours are unremarkable. Lungs are clear except for left base atelectasis. There are trace bilateral pleural effusions. There is no pneumothorax. The osseous structures are grossly unremarkable.", "output": "Trace bilateral pleural effusions. No focal consolidation worrisome for pneumonia." }, { "input": "AP upright and lateral views of the chest provided. Implanted device projecting over the left chest wall noted. The heart is moderately enlarged. There is no convincing evidence for pneumonia. Mild congestion and edema likely present. No large effusion or pneumothorax. Bony structures are grossly intact.", "output": "Moderate cardiomegaly with mild pulmonary vascular congestion and likely mild edema." }, { "input": "Lung volumes are lower on the current exam with secondary crowding of the bronchovascular markings. There is mild superimposed pulmonary edema. More discrete opacities in the right mid to lower lung as well as in the retrocardiac region are now seen. Moderate cardiac enlargement is grossly similar given lower lung volumes. Degenerative changes noted at the shoulders. Old right lateral rib fractures are seen. Surgical clips seen in the right upper quadrant.", "output": "Opacities in the retrocardiac region and right mid to lower lung which could be due to atelectasis given lower lung volumes on the current exam. Superimposed infection would be difficult to exclude. Cardiomegaly and mild pulmonary edema." }, { "input": "In comparison to ___, There is decreased effusion in the right with mild basilar atelectasis. The left lung is clear with no effusion. No focal consolidation. No pneumothorax is seen. The cardiac silhouette is enlarged. Mediastinal contours unchanged. No vascular congestion.", "output": "There remains right pleural effusion with mild right basilar atelectasis. The left lung is clear with no evidence of pleural effusion. No evidence of pneumonia. Enlarged heart with no vascular congestion. NOTIFICATION: The impression and recommendation above was entered by Dr. ___ ___ on ___ at 17:24 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "As compared to chest radiograph from 1 day prior, mild pulmonary vascular congestion has improved. Retrocardiac opacity and small left-sided pleural effusion have marginally improved. Moderate cardiomegaly persists. No pneumothorax.", "output": "Interval improvement in mild pulmonary vascular congestion. Retrocardiac opacity and small left-sided pleural effusion have marginally improved." }, { "input": "PA and lateral views of the chest provided. Clips in the right upper quadrant noted. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Low lung volumes are noted with secondary crowding of the bronchovascular markings. Exam is also limited due to overlying soft tissues and portable technique. There is no confluent consolidation or frank pulmonary edema. The cardiomediastinal silhouette is stable given differences in technique. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process based on this limited exam." }, { "input": "Again seen is mild pulmonary vascular congestion, but no overt pulmonary edema. This is similar in appearance to the radiograph from ___. Heart size is enlarged and unchanged from that time. No pneumothorax, pleural effusion, or focal consolidation.", "output": "Vascular congestion, with similar radiographic appearance to the study from ___. No focal consolidation." }, { "input": "Frontal and lateral radiographs of the chest demonstrate pulmonary vascular congestion, without overt pulmonary edema. The heart size has decreased significantly from the prior study, but remains enlarged. There is no pneumothorax, pleural effusion, or consolidation.", "output": "Vascular congestion without overt pulmonary edema." }, { "input": "The heart is mildly enlarged. The aortic arch is calcified. The lungs are hyperinflated. A rounded contour projecting along the lower central mediastinum suggests a substantial hiatal hernia, although not fully characterized. The lungs appear clear. There are no pleural effusions or pneumothorax. The bones appear demineralized. Moderate-to-severe rightward convex curvature is centered along the upper lumbar spine.", "output": "No evidence of acute cardiopulmonary disease. Rounded contour in the lower mediastinum, probably a substantial hiatal hernia." }, { "input": "The study is somewhat limited due to the apical lordotic view. There is a vague opacity in the right lung base which obscures the right hemidiaphragmatic contour. The lungs are otherwise clear. The hilar and cardiomediastinal contours are normal. There is no pleural effusion or pneumothorax. The pulmonary vascular markings appear normal. Incidental note is made of an old left clavicular fracture.", "output": "Probable mild atelectasis at the right lung base, though pneumonia cannot be excluded in the right clinical setting. A more optimized PA and lateral chest radiograph may be useful to further characterize this finding." }, { "input": "Lungs are clear of focal consolidation, effusion, or pulmonary vascular congestion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Normal chest radiograph without evidence of pneumonia." }, { "input": "Heart size remains moderately enlarged. The mediastinal contour is unchanged. There is persistent moderate interstitial pulmonary edema with perihilar haziness. Small bilateral pleural effusions are present, perhaps new from the prior study. Retrocardiac opacity may reflect atelectasis. No pneumothorax is identified. No acute osseous abnormalities demonstrated.", "output": "Persistent moderate interstitial pulmonary edema. Small bilateral pleural effusions. Retrocardiac opacity may reflect atelectasis though infection cannot be excluded." }, { "input": "Again seen is a pacemaker type device, overlying the left upper chest, with 3 leads noted. It the inferior approach catheter seen on the prior film, presumably a Swan-Ganz catheter, has been removed. If again seen is a left-sided chest tube. No well-defined pneumothorax is identified, though subtle pneumothorax might not be apparent on this exam. On today's exam, a thin linear lucency projects over the cardiac silhouette, of uncertain etiology or significance. There has been some interval clearing of the left lower lobe collapse and/or consolidation, with partial visualization of the left hemidiaphragm on today's exam. Vascular engorgement left upper zone is again noted, similar to the prior study. Possibility of a small left effusion would be difficult to exclude. Subcutaneous emphysema along the lower left chest wall again noted. The right lung is unchanged, with atelectasis in the infrahilar region. No CHF or right pleural effusion identified. Note is made that the right cardiac border is well defined. Small calcified granuloma in the right upper lung is again noted.", "output": "Interval removal of presumed Swan-Ganz catheter. Slight interval improvement in left base opacity. Otherwise, I doubt significant interval change. Please note that although no obvious pneumothorax is detected, a subtle pneumothorax might not be apparent on this examination." }, { "input": "AP view of the chest provided. There is now partial opacification of the left hemithorax, concerning for increased layering pleural effusion. In addition, there is left lower lobe atelectasis. There appears to be new slight mediastinal shift to the left, however this may be due to the slight obliquity of the patient. Right lung is unchanged. New Swan-Ganz catheter is seen terminating in the left pulmonary artery. Impella catheter courses to the region of the left ventricle. Endotracheal tube terminates approximately 3 cm above the carina. Left-sided chest tube and transcutaneous atrial biventricular pacer defibrillator leads are in unchanged positions. There is no pneumothorax.", "output": "1. Other tubes and lines are in appropriate positions. 2. Increased left pleural effusion and left base atelectasis. 3. Possible mild mediastinal shift to the left, but finding likely due to obliquity of the patient. When repeating chest radiograph, nonoblique views is recommended. NOTIFICATION: The findings and recommendations were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 4:59 PM, 2 minutes after the images were reviewed." }, { "input": "Compared with the film from earlier the same day, I doubt significant interval change. The cardiomediastinal silhouette appears stable. Left-sided 3 lead pacemaker type device is present, similar to the prior study. Again seen is left lower lobe collapse and/or consolidation, possibly slightly improved. Also again seen is a left chest tube. No obvious pneumothorax or gross effusion is detected. Subcutaneous emphysema along the lower left chest wall is again noted. There is atelectasis and/or vascular plethora in the left upper lung, similar to the prior study. Right infrahilar atelectasis is unchanged. No gross right effusion.", "output": "Doubt significant interval change compared with earlier the same day." }, { "input": "Patient is status post median sternotomy and CABG. Triple lead left-sided AICD is seen with leads in the expected positions of the right atrium, right ventricle, and coronary sinus. Endotracheal tube is seen terminating approximately 5 cm above level of the carina. Enteric tube courses below the diaphragm however the side port appears in the distal esophagus/ GE junction and should be advanced so that it is well within the stomach. Left base opacity may be due to pleural effusion and atelectasis, underlying consolidation not excluded. No overt pulmonary edema is seen.", "output": "Endotracheal tube in appropriate position. Enteric tube courses below the diaphragm however the side port appears in the distal esophagus/ GE junction and should be advanced so that it is well within the stomach. Left base opacity may be due to pleural effusion and atelectasis, underlying consolidation not excluded." }, { "input": "No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "A right internal jugular approach central venous catheter terminates in the low SVC. Median sternotomy wires are unchanged. Lung volumes are markedly low. The mediastinum shows an expected post operative appearance. There is bibasilar atelectasis as well as mild pulmonary vascular congestion and mild interstitial edema, minimally improved from yesterday. No pneumothorax. No large pleural effusions.", "output": "Mild pulmonary edema, improved from the most recent prior exam." }, { "input": "Lung volumes are low, likely due to elevation of the diaphragm. There are patchy retrocardiac opacities which may reflect atelectasis versus pneumonia. Otherwise, the lungs appear clear. No pneumothorax or pleural effusion seen.", "output": "Patchy retrocardiac opacities localizing to the left lower lobe on the lateral projection may reflect atelectasis or pneumonia." }, { "input": "Chest, PA and lateral, radiographs demonstrate unremarkable mediastinal, hilar, and cardiac contours. The lungs are clear. No pleural effusion or pneumothorax evident. No osseous abnormality present.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal with mild lung old male thoracic aorta. Hilar contours are unremarkable. Lung volumes are low. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Ill-defined opacities at the right lung base are nonspecific and may represent atelectasis. No pleural effusion or pneumothorax. Heart size and cardiomediastinal contours are normal.", "output": "Ill-defined right lung base opacities may represent atelectasis but infection or aspiration cannot be excluded in the appropriate clinical setting." }, { "input": "PA and lateral chest radiographs demonstrate no focal consolidation, pleural effusion or pneumothorax. The heart size is normal. The cardiac, hilar, and mediastinal contours are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable. Intravenous contrast is present within each kidney and collecting system, partly visualized, associated with recent prior CT of the same day.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Port-A-Cath terminates in the lower SVC, unchanged. The lung volumes are lower. Small bilateral pleural effusions, left more than right, are new compared to the prior examination. Bibasilar opacities likely represent atelectasis. No pneumothorax.", "output": "New small bilateral pleural effusions and adjacent atelectasis." }, { "input": "Single portable view of the chest. Increased interstitial markings are seen throughout the lungs. There is also focal increased opacity at the right lung base overlying the hemidiaphragm and region of atelectasis seen on previous exam. No other focal consolidation identified. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "Pulmonary vascular congestion and right basilar opacity, may be atelectasis, although infection is not entirely excluded." }, { "input": "A single portable AP supine view of the chest was obtained. Cardiomediastinal silhouette is unchanged. A right internal jugular venous catheter terminates in the lower SVC. In comparison to the prior study there is increased opacification in the right upper lung zone extending from the right apex to the minor fissure, representing consolidation in the right upper lobe. There is also interval development of moderate bilateral pleural effusions and mild pulmonary interstitial edema. The left lung is clear. Cardiomediastinal silhouette is unchanged. Percutaneous biliary catheters are noted in the upper abdomen.", "output": "1. Interval development of airspace consolidation in the right upper lobe which in the appropriate clinical context is concerning for pneumonia. 2. New moderate bilateral pleural effusions and mild interstitial edema." }, { "input": "The lungs are well-expanded and notable for left lower lobe atelectasis. Lungs are otherwise clear. No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable. Persistent posterior elevation of the left hemidiaphragm is most consistent with diaphragmatic eventration. No displaced rib fractures. Visualized upper abdomen is within normal limits.", "output": "1. Stable chest. 2. No displaced rib fractures. Although no fracture or other bone abnormality is seen, conventional chest radiographs are not appropriate for detection or characterization of chest cage lesions. Any focal findings should be clearly marked and imaged with either bone detail views or CT scanning." }, { "input": "Bibasilar opacities may be due to atelectasis although an infectious process is not excluded, particularly on the right. No large pleural effusion is seen. There is no pneumothorax. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Bibasilar opacities may in part be due to atelectasis however infectious process is not excluded, particularly in the right lower lobe." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax or pleural effusion. There are mild degenerative changes in the thoracic spine. There is mild increase of the thoracic kyphosis", "output": "No acute cardiopulmonary abnormalities" }, { "input": "1 AP view of the chest. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal. No acute fracture is identified. There are old left lateral ___ and 7th rib fractures.", "output": "No acute cardiopulmonary process." }, { "input": "There has been interval removal of the left-sided pleural pigtail catheter. Clips in the left hilum are compatible with prior lobectomy changes. The cardiomediastinal contours are stable. There is expected aeration of the remaining left lung with elevation of the left hemidiaphragm and small amount of pleural fluid occupying the vacant left chest cavity space. No large pneumothorax is appreciated.", "output": "Status post left pleural pigtail catheter removal with post-lobectomy changes noted on the left; no large pneumothorax; expected left pleural fluid." }, { "input": "", "output": "Expected post left lobectomy changes without evidence of complication. ______________________________________________________________________________ FINAL REPORT HISTORY: A ___-year-old male status post left upper lobectomy for stage III non-small cell lung cancer with left apical pigtail catheter placement on ___ for worsening pleural effusion. STUDY: PA and lateral chest radiograph. COMPARISON: ___. FINDINGS: Clips in the left hilus and at the left costophrenic angle are compatible with prior lobectomy changes. The remaining left lung appears well aerated. Small amount of expected pleural fluid is seen occupying the left apical region, although it is stable compared to prior study. The cardiomediastinal contours are within normal limits. The right lung is clear. There is no pneumothorax. Suspected elevation of the left hemidiaphragm persists. IMPRESSION: Expected post left lobectomy changes without evidence of complication." }, { "input": "There is increasing opacification of the right hemithorax, which could represent pneumonia or hemorrhage. There is bilateral low lung volume with persistent elevation of the left hemidiaphragm. Slightly greater rightward deviation of the trachea at the level of left upper lobe is observed. The cardiomediastinal silhouette is difficult to discern secondary to bilateral opacification.", "output": "Worsening opacity of the right hemithorax, which can represent pneumonia or hemorrhage." }, { "input": "Endotracheal tube ends approximately 5.2 cm above the carina and is appropriate. An orogastric tube is seen to course below the diaphragm and ends into the stomach; however, the distal end is beyond the radiograph view. Bilateral lung opacities, right side more than left, which increased between ___ and ___, concerning for an aspiration or pulmonary edema have improved over past five to six hours. Small pleural effusions bilaterally are unchanged. Left upper lung opacities which are due to combination of loculated fluid and collapsed adjacent lung and elevation of the left hemidiaphragm and left hilus are unchanged in appearance. The mediastinal silhouette is stable.", "output": "1. Bilateral lung opacities, right side more than left, which increased between ___ and ___, concerning for an aspiration or pulmonary edema have improved. 2. Left upper lung opacities from loculated pleural fluid and collapse of the adjacent lung as suggested from the chest CT dated ___ is unchanged." }, { "input": "Post-surgical changes are again visualized throughout the left lung with ___ and clips. A left subclavian PICC remains stable with the tip at the superior cavoatrial junction. However, there is improved aeration of the left lung with the previously visualized left upper lobe opacity appearing less confluent. Furthermore, the left pleural effusion has also decreased in size. The right lung appears clear. The visualized portions of the cardiomediastinal silhouette remains stable. There is no pneumothorax. The stomach appears distended with gas.", "output": "1. Improved aeration of the left lung with decreased atelectasis and effusion. 2. The stomach appears distended with gas. Clinical correlation is recommended." }, { "input": "Direct comparison with previous study is limited due to rightward rotation of this study. Small quantity of bilateral pleural effusion is again seen. There is stable elevation of the left hemidiaphragm. Left upper lobe opacity representing atelectasis and loculated fluid has not changed significantly. There is extensive ground-glass opacity of the right hemithorax representing either widespread pneumonia or vascular congestion. Heart is stably enlarged. Endotracheal tube is positioned no less than 5 cm from the carina. IJ catheter is seen in appropriate position terminating within the low SVC. No pneumothorax is seen.", "output": "Essentially no change since prior study. Stable bilateral pleural effusion and atelectasis." }, { "input": "The lungs are well expanded and clear. No pleural abnormality is seen. The heart size is normal. The mediastinal and hilar contours are normal. Mild left convex scoliosis is seen.", "output": "No acute cardiopulmonary abnormality. No evidence of prior TB infection." }, { "input": "In comparison to the prior radiograph pulmonary edema is nearly resolved. There is an unchanged small right and trace left pleural effusion with associated bibasilar atelectasis worse at the right lung base. Focal opacity in the left mid lung and at the left lung base with apparent air bronchograms is essentially unchanged. Moderate cardiomegaly is unchanged. There is no pneumothorax.", "output": "1. Unchanged left midlung opacity with air bronchograms, concerning for pneumonia. 2. Possible mild fluid overload without pulmonary edema, improved from prior. 3. Right-sided pleural effusion with adjacent right basilar opacity potentially atelectasis noting that infection is possible as well." }, { "input": "A right pleural effusion is small to moderate. A left pleural effusion is trace to small. Pulmonary edema is mild. The heart is moderately enlarged. No pneumothorax. Thoracic aortic calcification is mild. Degenerative changes in the shoulders are moderate. Degenerative changes of thoracic spine are also moderate.", "output": "Findings consistent with volume overload/heart failure." }, { "input": "When compared to most recent radiograph dated ___, there is improved aeration of the left lung. However, persistent opacification and leftward mediastinal shift in addition to right lung hyperexpansion is consistent with left lung collapse. There is increased opacity of the right lower lobe with obscuration of the right hemidiaphragm. While this may reflect atelectasis, infection cannot be excluded. There is likely a small left pleural effusion. There is no pneumothorax. Redemonstration of anteriorly dislocated right shoulder as well as third and second right rib fractures, present previously.", "output": "1. Persistent left lung collapse though better aerated. 2. Right lower lung opacification which may reflect atelectasis though infection cannot be excluded. 3. Unchanged right anterior shoulder dislocation and multiple right sided chronic rib fractures." }, { "input": "Mediastinal shift towards the left in a slightly rotated film with a veil-like opacity in the left upper hemithorax, with gradual increase in opacity inferiorly and is obscuring the left hilus and superior aspect of the aortic arch, which is suggestive of left upper lobe collapse. Increased homogeneous opacification of the left lower lobe with silhouting of the left hemidiaphram. Right lung is clear with little if any pleural fluid in the right lower lobe. No pneumothorax or bony abnormality.", "output": "Left upper lobe collapse with large left basal consolidation, and pleural effusion. Results were conveyed via telephone to Dr. ___ by Dr. ___ on ___ at 4:00 p.m. within 20 minutes of the results." }, { "input": "There is continued mediastinal shift to the left due to volume loss in the left lower lobe. The left upper lobe is aerated. There is a stable small right pleural effusion and right basilar atelectasis. Aortic calcifications are noted. The cardiomediastinal silhouette is obscured due to bibasilar opacities.", "output": "1. Marked volume loss in the left lower lobe resulting in mediastinal shift to the left, unchanged since ___ 2. Stable right pleural effusion and atelectasis." }, { "input": "Compared to prior exam there has been improvement in left lower lobe collapse with greater aeration. Additionally, there has been improvement in the left pleural effusion which remains moderate in size. There has also been marked improvement of the right pleural effusion which is now minimal. Fluid is seen tracking along the left major fissure on the lateral view. Bibasilar atelectasis is unchanged. Cardiomediastinal silhouette and hilar contours are stable. There is no pneumothorax. Increased AP chest wall diameter is consistent with given history of COPD.", "output": "Interval improvement in bilateral pleural effusions and left lower lobe collapse." }, { "input": "Portable semi-upright radiograph of the chest demonstrates slight interval improvement in aeration of the right lung. There is continued near complete opacification of the left hemi thorax, secondary to large pleural effusion and compressive atelectasis. There is a small area of persistently aerated lung in the left upper thorax. As before there is a moderate right-sided pleural effusion with some adjacent atelectasis. There is no pneumothorax. Note is made of a chronic right anterior shoulder dislocation, which is unchanged.", "output": "Slight interval improvement in aeration of the right lung. Continued near complete opacification of the left hemi thorax secondary to large pleural effusion and compressive atelectasis." }, { "input": "Since ___, mild cardiomegaly, an otherwise normal mediastinum are stable, and small layering pleural effusions are stable, but mild pulmonary edema is worse. Bilateral lower lung opacification has increased. Whether this is dependent edema and atelectasis alone, or hides pneumonia is radiographically indeterminate. There is no pneumothorax.", "output": "Mild, worsened congestive heart failure. Pneumonia not excluded." }, { "input": "There is near-complete opacification of the left hemithorax, due to atelectasis/collapse of the left lung. There is leftward deviation of the trachea, as before. The right demonstrates slight interval worsening of linear basal atelectasis. Chronic right humeral head dislocation is again noted, unchanged compared to the prior study.", "output": "Atelectasis/collapse of the left lung. Right basilar atelectasis is sligtly worse. Chest phsyiotherapy and bronchoscopy is recommended. Chronic right humeral head dislocation." }, { "input": "Portable semi-upright radiograph of the chest demonstrates near complete opacification of the left hemi thorax consistent with known large left pleural effusion and compressive atelectasis. There is a small aerated portion of the lung in the upper left hemi thorax. There is a new moderate right-sided pleural effusion. Linear annular abnormality over the right central lung field likely represents artifact external to the patient. There is no pneumothorax. Note is made of a chronic right anterior shoulder dislocation, which is stable over multiple recent radiographs.", "output": "Near complete opacification of the left hemi thorax consistent with large left pleural effusion and compressive atelectasis. New moderate right-sided pleural effusion. No pneumothorax." }, { "input": "Frontal and lateral chest radiographs were obtained, but evaluation is somewhat limited by patient rotation. Again seen is moderate cardiomegaly and extensive calcification of the thoracic aorta. Leftward shift of the mediastinum is similar in appearance to ___ and ___, possibly related to left volume loss. There is persistent elevation of the left hemidiaphragm. Right base atelectasis is also persistent. A rounded retrocardiac opacity projecting posteriorly on lateral view is of unclear etiology. No definite focal consolidation is identified. Pleural fluid is seen within the fissure on the left. There is no pneumothorax. Chronic rib deformities are again noted.", "output": "1. Rounded mass- like opacity projecting over the posterior lung is of unclear etiology, and should be further evaluated with CT. NOTIFICATION: Updated recommendations were communicated via telephone by Dr. ___ to Dr. ___ at ___ on ___." }, { "input": "Compared to the prior study, the large left pleural effusion resulting in complete collapse of the left lung is now moderate to large, with residual partial collapse of the left upper and lower lobes, although improved.Small right pleural effusion is unchanged.", "output": "Decrease in size of left pleural effusion, now moderate to large. Continued partial collapse of the left upper and lower lobes." }, { "input": "There are increased bilateral pleural effusions and bibasilar opacities. Although these likely contain a component of compressive atelectasis, infection cannot be excluded. The right lower lung opacity projecting above the effusion demostrates a fluffy appearance more concerning for pneumonia or aspiration. There has been interval near-complete resolution of the left perihilar opacity. No pneumothorax is seen. Heart size is difficult to evaluate in the setting of these overlying opacities.", "output": "Bilateral pleural effusions and bibasilar opacities, which may represent aspiration or pneumonia, likely with a component of ateletasis." }, { "input": "Portable semi-upright chest radiograph demonstrates decreased lung volumes, with interval increase in bibasilar opacities particulary on the right likely reflecting a combination of pleural effusions and adjacent atelectasis. The pulmonary vasculature is normal. The cardiac silhouette is incompletely evaluated, and the mediastinal contours again show calcification of the aortic knob and aortic tortuosity. Healed left rib fractures are unchanged. There is no pneumothorax.", "output": "Increased bilateral, particularly right sided pleural effusions with probable adjacent atelectasis, although in the appropriate clinical setting, pneumonia cannot be excluded in the lower lobes." }, { "input": "There are bibasilar opacities consistent with bilateral pleural effusions and associated atelectasis. There continues to be opacification in the left upper lobe, likely sequela of prior infection. The cardiac silhouette is mildly enlarged. There is no evidence of pulmonary edema or pneumothorax.", "output": "Bibasilar pleural effusions with associated atelectasis. Left upper lobe opacities, likely sequela of prior infection." }, { "input": "Compared with the prior film, I doubt significant interval change. Again seen is cardiomegaly with a calcified, unfolded aorta ; small left effusion with increased retrocardiac density and obscuration of the left hemidiaphragm, consistent with left lower lobe collapse and/or consolidation; patchy opacity at the right base with a small right effusio; and upper zone redistribution, without other evidence of CHF. There is background hyperinflation suggestive of COPD. There is deformity of some of the right upper ribs consistent with old rib fractures. As before, the there is anterior dislocation of the right humeral head with respect to the glenoid .", "output": "1. Doubt significant change compared with ___. No definite acute superimposed process. 2. Upper zone redistribution, without overt CHF, similar to the prior film. 3. Small left-greater-than-right effusions, with left lower lobe collapse and/or consolidations and patchy opacity at the right base, unchanged. 4. COPD and old thoracic deformity again noted. 5. Anterior dislocation of the right shoulder again noted." }, { "input": "Increased opacification of the left lung with leftward mediastinal shift is suggestive of increased left lung collapse from prior exam. Opacity of the right lung base could represent atelectasis, however cannot exclude pneumonia or aspiration in the right clinical setting. Along the lateral border of the right lung, there is again seen a fluid collection adjacent to several rib fractures which are more displaced than on prior exam. This fluid collection is larger than on prior exam and likely reflect ongoing bleeding into the extra-pleural space. There is increased right pleural effusion from prior exam. The cardiomediastinal silhouette cannot be well evaluated due to collapse of left lung. Right anterior shoulder dislocation and multiple right-sided chronic rib fractures are again noted.", "output": "1. Increases fluid collection along the lateral aspect of the right lung adjacent to several rib fractures which are more displaced than on prior exam, likely representing ongoing bleeding into the extrapleural space. 2. Interval increase in collapse of the left lung. 3. Opacity in the right lung base, which could represent atelectasis but cannot exclude pneumonia or aspiration in the right clinical setting. NOTIFICATION: Findings communicated to the___ medical team at 10:50 a.m. on ___ by phone." }, { "input": "The tip of the endotracheal tube is approximately 3 cm from the carina. There is slight interval aeration of the left upper lobe with continued collapse of the left lower lobe. Atelectasis at the right lung base has increased. Evaluation of the heart is obscured.", "output": "Endotracheal tube tip is 3 cm from the carina. Improved ventilation of the left lung apex." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. A diffuse mild interstitial abnormality suggests pulmonary vascular congestion. A more focal left upper lobe opacity has resolved and streaky left basilar opacities have also mostly resolved leaving what probably represents minor residual atelectasis. Fissures are thickened with suspected small pleural effusions and patchy right basilar opacity again likely reflects atelectasis. The left acromiohumeral interval is effaced suggesting rotator cuff pathology.", "output": "Findings suggesting mild pulmonary vascular congestion with patchy atelectasis and suspected small pleural effusions with fissural fluid." }, { "input": "AP upright of the chest provided. Hemidiaphragm is elevated with left basal opacity, likely atelectasis vs. pneumonia. There is normal aeration of the right lung without definite signs of effusion. There is a left apical cap, which could represent fluid along the left lung apex. Heart size cannot be assessed. Mediastinum is difficult to assess due to leftward patient rotation. Bony structures are intact.", "output": "Findings as above with possibility of left lung base pneumonia not excluded. Please correlate clinically." }, { "input": "There has been interval improved aeration of the left mid and upper lung, with persistent left lower lung opacity, likely a combination of pleural effusion and left lower lobe collapse. The appearance of the right hemithorax is unchanged, with multiple right rib fractures, moderate pleural effusion, and basilar atelectasis. No new opacities are identified in the right lung. .", "output": "Improved aeration of the left upper and midlung since the prior study. Right hemi thorax is unchanged." }, { "input": "Patient is rotated to the left. The cardiac and mediastinal silhouettes are grossly stable. There is slight increase in obscuration of the left hemidiaphragm of the consistent with a pleural effusion and overlying atelectasis. Left retrocardiac opacity could be due to combination of pleural effusion and atelectasis although consolidation is not excluded. There is right base atelectasis and possible trace right pleural effusion. Chronic rib deformities on the right are again noted. Again, there appears be dislocation of the right shoulder joint.", "output": "Small pleural effusions and bibasilar atelectasis. Left base retrocardiac opacity could be due to combination of pleural effusion and atelectasis, but consolidation is not excluded. Again seen right shoulder dislocation." }, { "input": "Lung volumes are low, accentuating pulmonary vascular crowding. The lungs are clear. Mediastinal contours, hila, and cardiac silhouette are normal. No pleural effusion or pneumothorax. Residual contrast is seen in the in the colon.", "output": "No evidence of pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. Low lung volumes result in bronchovascular crowding. A dialysis catheter ends in the mid SVC. There is no focal consolidation, pleural effusion, or pneumothorax. Heart size and pulmonary vasculature are normal. Mediastinal silhouette and hilar contours are normal.", "output": "No pneumonia, edema or effusion." }, { "input": "Frontal and lateral radiographs of the chest demonstrate normal heart size. The cardiomediastinal silhouette and hilar contours are normal. The lungs are clear. No pleural effusion or pneumothorax. No displaced rib fracture identified. There is a 16 mm nodular density projecting over the rib shadow on the lateral projection anteriorly without correlate on the frontal. Those of unknown etiology", "output": "1. No evidence of pneumonia 2. Subtle nodular density projecting over a rib shadow on the lateral projection anteriorly of unknown etiology. Consider nonemergent repeat radiograph to clarify or if the patient has risk factors, a nonemergent chest CT could be considered." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well-expanded clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No pneumonia." }, { "input": "Frontal and lateral chest radiographs demonstrate mild increase in heart size, which may be due to image acquisition during different phases of the cardiac cycle. The lungs demonstrate normal volumes and are clear. The pleural surfaces are normal, without pleural effusion or pneumothorax.", "output": "Normal chest radiograph." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear, hyperlucent and hyperexpanded. There is no pneumothorax or pleural effusion. There are mild degenerative changes in the thoracic spine", "output": "No acute cardiopulmonary abnormalities Severe emphysema" }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs which are clear. There is no focal consolidation, pleural effusion, or pneumothorax. No pacer device is identified. The visualized upper abdomen is unremarkable.", "output": "Normal chest radiograph. No pacer device identified." }, { "input": "A retrocardiac opacity with slight leftward shift of the mediastinum is consistent with the patient's known chronic left lower lobe collapse. Relative hyperlucency and mild hyperinflation is new in the right lung which may be secondary to new or worsened asthma and bronchospasm or from decreased perfusion, possibly due to a pulmonary embolism. There is no pleural effusion or pneumothorax. There is no new consolidation. The cardiomediastinal silhouette is stable.", "output": "1. Hyperlucency and mild hyperinflation on the right may represent acute bronchospasm or oligemia from pulmonary embolism. 2. Stable left lower lobe collapse. Results were discussed with Dr. ___ at 12:25 p.m. on ___ via telephone by Dr. ___." }, { "input": "Similar to multiple prior exams, there is relative opacification of the left lower lobe which is partially atelectatic but also in part consolidation without volume loss resulting in the relatively bizarre morphology in the retrocardiac left lung. No further consolidation is noted. There is no superimposed edema. The mediastinum is unremarkable. The cardiac silhouette remains enlarged but stable. There is no effusion or pneumothorax. Degenerative changes are noted throughout the thoracic spine.", "output": "Persistent part atelectatic and part consolidative left lower lobe opacification. Prior CT imaging on successive occasions has demonstrated extensive filling of the corresponding bronchioles with material." }, { "input": "A bedside AP radiograph of the chest demonstrates continued opacification of the lingula, superimposed on chronic left lower lobe collapse. Heterogeneous left perihilar opacities are unchanged from ___, but slightly increased from ___. Right lower lobe atelectasis is unchanged, as is mild pulmonary edema and cardiomegaly. Engorgement of the mediastinal vessels is also unchanged and suggestive of elevated central venous pressure. There is no pneumothorax. A left-sided pleural effusion cannot be excluded. A left PICC has been advanced slightly, and now no longer abuts the lateral wall of the SVC, terminating in the mid portion of the SVC.", "output": "Compared to yesterday's study, there is overall interval stability of mild acute-on-chronic congestive heart failure, right lower lobe atelectasis, and opacification of the lingula. This may represent atelectasis, or given the patient's clinical history, consolidation from pneumonia. This is stable from yesterday's study, but slightly increased since ___." }, { "input": "Bedside AP radiograph of the chest demonstrates that the left PICC has been retracted and now lies in the upper segment of the SVC. The study is otherwise unchanged, including atelectasis of the right lower lobe and left lingula, as well as chronic left lower lobe collapse. There is no pneumothorax or effusion.", "output": "Repositioned left PICC now terminates in the upper SVC. The study is otherwise unchanged." }, { "input": "Bedside AP radiograph of the chest re-demonstrates the patient's longstanding chronic left lower lobe collapse. Between ___ and yesterday, a segment of aerated lung overlying the left heart border has become uniformly opacified. This may be due to atelectasis of the lingula. The lungs are otherwise clear. Heart is top normal in size and chronically leftward shifted. Once again, the left PICC terminates within the right atrium and would need to be withdrawn 5.5 cm to ensure placement in the low SVC.", "output": "1. Left lingular atelectasis superimposed on chronic left lower lobe collapse. No evidence of acute cardiothoracic process. 2. The left PICC needs to be withdrawn 5.5 cm to ensure proper placement in the low SVC. NOTE: Findings were communicated to Dr. ___ by Dr. ___ ___ telephone on ___ at 11:45 a.m." }, { "input": "AP upright and lateral views of the chest are provided. Previously noted PICC line has been removed. The tracheostomy is poorly visualized. The previously noted pleural effusions have resolved. There is no focal consolidation seen. No signs of CHF or pneumothorax. Cardiomediastinal silhouette appears normal. Bony structures appear unchanged.", "output": "Resolved pleural effusions. No acute findings on today's exam." }, { "input": "A left pectoral single lead pacemaker partially obscures the left mid lung. The chin and associated soft tissues partially obscures the lung apices. Suboptimal aeration of the left lower lobe may be due to overlaying soft tissue, but there may be a component of atelectasis or aspiration. The right lung is clear. There is no pneumothorax. The bones are diffusely osteopenic. Dense vascular calcifications are incidentally noted.", "output": "Possible left lower lobe atelectasis or aspiration. A repeat PA and lateral radiograph would be helpful." }, { "input": "The lungs are clear. There is no pleural effusion, pneumothorax or focal airspace consolidation to suggest pneumonia. Atelectasis/scaring is seen at the left lung base. There is no displaced rib fracture appreciated.", "output": "No acute cardiopulmonary process. For full details, please refer to the same day CT torso." }, { "input": "Pulmonary vascular engorgement suggest mild cardiac decompensation. Heart is top normal size. Lungs are clear. No pleural effusion.", "output": "Mild cardiad decompensation." }, { "input": "There is a possible small apical right pneumothorax. There is no left pneumothorax. There is no focal consolidation or pleural effusion. Cardiomediastinal silhouette is unremarkable. This study is not tailored for detection of subtle trauma, but there are no displaced fractures identified.", "output": "Possible small right apical pneumothorax. Suggest followup PA and lateral films in several hours. These findings were discussed with Dr. ___ by Dr. ___ ___ telephone at 11 a.m." }, { "input": "AP portable view of the chest demonstrates low lung volumes. No large pleural effusion, pneumothorax or focal consolidation. The aorta is markedly tortuous without focal aneurysmal changes. Heart is mildly enlarged. Mild perihilar vascular congestion is noted.", "output": "Mild cardiomegaly and perihilar vascular congestion." }, { "input": "Portable AP upright chest radiograph was obtained. The lungs are somewhat low in volume, with resultant mild basilar linear atelectasis. Blunting of the costophrenic angles bilaterally is likely due to overlying soft tissues rather than pleural effusion. Mild cardiomegaly persists without overt edema. The mediastinal and hilar contours are otherwise unremarkable.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear. The heart is stably enlarged with tortuous aortic contour. Hilar and mediastinal contours are stable with stable mild prominence of the pulmonary arteries. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic process. Stable cardiomegaly." }, { "input": "Lung volumes are low. There is no focal consolidation. Moderate cardiomegaly is not significantly changed. The descending thoracic aorta is mildly tortuous, as before. There are no definite pleural effusions. No pneumothorax is seen.", "output": "1. Low lung volumes. No focal consolidation. 2. Unchanged moderate cardiomegaly." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes. No focal consolidation or pneumothorax. Again seen minimal blunting of costophrenic angles, probable pleural thickening. The aorta is generally large, very tortuous, but stable in appearance longterm. Moderate to severe enlargement of the cardiac silhouette is also chronic due to a combination of cardiomegaly and pericardial effusion.", "output": "Stable moderate cardiomegaly, some pericardial effusion, generally large and tortuous aorta." }, { "input": "Lung volumes are low. The lungs are clear without a focal consolidation, effusion, or pneumothorax. Moderate cardiomegaly is stable. Descending thoracic aorta remains mildly tortuous. No acute fractures are identified.", "output": "Low lung volumes with no focal consolidation. Moderate cardiomegaly is again noted." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is mildly enlarged, similar to prior, and exaggerated by technique and low lung volumes. The thoracic aorta is unfolded. Pulmonary vasculature is unremarkable. The lungs are clear without focal or diffuse abnormality. No pleural effusion or pneumothorax is noted. Osseous structures are unremarkable. No radiopaque foreign body.", "output": "Unfolded thoracic aorta. Mild cardiomegaly. No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. Again, relatively low lung volumes are seen. There is no large focal consolidation or effusion. There is no pulmonary vascular congestion. Cardiac silhouette is enlarged but stable in configuration. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is top normal. A moderate-sized hiatal hernia is noted. The mediastinal and hilar contours otherwise are unremarkable. The pulmonary vascularity is normal, and the lungs are clear. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality. Moderate size hiatal hernia." }, { "input": "Frontal and lateral views of the chest. The lungs are clear of consolidation or effusion. Mild biapical scarring is seen. There is no pneumothorax. The cardiomediastinal silhouette is within normal limits. Scattered atherosclerotic calcifications noted at the aortic arch. No displaced rib fracture identified. Degenerative changes seen at the right shoulder and in the thoracic spine. Surgical clips seen in the right upper quadrant.", "output": "No acute cardiopulmonary process. No definite rib fractures identified however if desired, dedicated rib series could be performed." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Again seen are diffuse parenchymal consolidations, unchanged in appearance from the prior study. The heart size is moderately enlarged and there is evidence of some pulmonary vascular congestion and a small loculated pleural effusion on the right. No evidence of pneumothorax.", "output": "Pneumonia and mild pulmonary edema, unchanged in appearance from the prior exam." }, { "input": "The patient is status post median sternotomy and CABG. Heart size remains moderately enlarged. Mediastinal and hilar contours are stable. Diffuse parenchymal opacities, more pronounced in the right lung base, are slightly improved compared to the previous study, suggestive of slight interval improvement in multifocal pneumonia. Mild pulmonary vascular congestion persists. Small right pleural effusion is also unchanged. No pneumothorax is identified.", "output": "Diffuse parenchymal opacities, more pronounced in the right lung base, minimally improved overall compared to the previous exam, but remains compatible with multifocal pneumonia. There is persistent mild pulmonary vascular congestion and a small right pleural effusion." }, { "input": "Frontal and lateral radiographs of the chest demonstrate fractured lower three median sternotomy wires which are unchanged from ___. Compared to the prior radiograph, there is increase in airspace opacity at the right lung base, consistent with pneumonia. The remainder of the lungs is unchanged from the prior radiograph. The cardiac contour is slightly enlarged, unchanged from the prior radiograph. No pleural effusion or pneumothorax is seen.", "output": "Right lower lobe pneumonia." }, { "input": "PA and lateral views of the chest are provided. There are scattered airspace consolidations, worse in the right upper and lower lung concerning for worsening pneumonia. Small right pleural effusion is present. The cardiomediastinal silhouette is stable. Midline sternotomy wires and mediastinal clips are stable. Bony structures are intact.", "output": "Scattered airspace opacities concerning for worsening multifocal pneumonia." }, { "input": "Lower lung volumes seen on the current exam. The lungs however remain clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is detected. Heart and mediastinal contours are stable with top normal heart size. The fourth median sternotomy wire from is fractured, similar compared to ___.", "output": "Stable chest radiographs with top normal heart size and no radiographic evidence for acute cardiopulmonary process." }, { "input": "Low lung volumes with subsegmental atelectasis in the lower lobes. Prominence of the pulmonary vasculature can be related to crowding from low lung volumes or mild elevated pulmonary venous pressure. Mild cardiomegaly. No effusions or pneumothorax. Prior sternotomy, CABG and implanted left chest wall Holter monitor.", "output": "Prominence of the pulmonary vasculature can be related to crowding from low lung volumes or mild elevated pulmonary venous pressure. Mild cardiomegaly." }, { "input": "The lungs are relatively well inflated and clear. The heart is top-normal in size. The cardiomediastinal silhouette is unchanged. Median sternotomy wires and a left chest wall pulse generator device are unchanged in position. Fracture of one of the sternotomy wires is unchanged. There is no pneumothorax, pleural effusion, or overt pulmonary edema.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The left lung is clear. However, there is subtle right infrahilar opacity which may be due to overlap of vascular structures and costochondral calcification, but underlying consolidation is not excluded. It is not well substantiated however, on the lateral view. The cardiac silhouette is top-normal to mildly enlarged. The aorta is calcified and tortuous.", "output": "Subtle right infrahilar opacity may be due to overlap of vascular structures in costochondral calcification, but underlying consolidation is not excluded in the appropriate clinical setting. Finding is not well substantiated on the lateral view, however." }, { "input": "Lung volumes are low. There are bilateral pleural effusions with overlying atelectasis. Prominence of the hila may be due to low volume overload. Bibasilar opacities may relate to combination of pleural effusion and atelectasis although underlying consolidation due to infection cannot be excluded on this study. The cardiac silhouette appears at least mildly enlarged. The aortic knob is calcified. No pneumothorax is seen.", "output": "Bilateral pleural effusions with overlying atelectasis in combination with prominence of the hila and enlarged cardiac silhouette, could be due to CHF/fluid overload in the appropriate clinical setting. Alternatively, infectious process is not excluded, nor is underlying hilar adenopathy. Suggest repeat after diuresis for further evaluation. ." }, { "input": "One AP view of the chest. There is a linear right basilar atelectasis or scarring. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process. Mild linear right basilar atelectasis or scarring." }, { "input": "Lung volumes are low. There is opacity in the bilateral lung bases, likely reflecting atelectasis. Bilateral pleural effusions are seen, right greater than left. Mild hilar prominence is again noted, right greater than left, similar to prior exam. There is no pneumothorax. The cardiomediastinal silhouette is mildly enlarged. No pulmonary edema or pneumothorax.", "output": "Bilateral pleural effusions with associated bibasilar atelectasis, right greater than left, similar to prior exam. Mild prominence of the hila is unchanged." }, { "input": "Minimal left base atelectasis/scarring is seen. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable given differences in inspiration. Aortic knob calcification is again seen.", "output": "No acute cardiopulmonary process. Specifically, no finding to suggest pneumothorax." }, { "input": "The heart is normal in size. The mediastinal and hilar contours are unremarkable. The pulmonary vasculature is normal. The lungs are clear. There are no pleural effusions.", "output": "No acute intrathoracic process." }, { "input": "The patient is rotated towards the left. The lungs appear grossly clear without lobar consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits. There is no evidence of free subdiaphragmatic air.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest were obtained. Lung volumes are low though lungs appear clear. No signs of pneumonia or CHF. No large effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "The cardiomediastinal shadow is normal. Normal hila. No airspace consolidation. No suspicious pulmonary nodules or masses. No pneumothorax. No pleural effusions. Right-sided Port-A-Cath in situ with the tip in the mid to distal SVC. No right-sided pneumothorax.", "output": "No features of pneumonia. This preliminary report was reviewed with Dr. ___, ___ radiologist." }, { "input": "A right chest port terminates in the low SVC. Unremarkable cardiomediastinal silhouette. No pneumothorax. No pleural effusion. Lungs are clear.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest were obtained. The lung volumes are reduced. The cardiomediastinal silhouette is unremarkable. There is no evidence of pneumonia, effusion or pneumothorax. There are degenerative changes of the thoracic spine.", "output": "No evidence of pneumonia or other acute intrathoracic process. Degenerative changes of the thoracic spine." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unchanged, with mild unfolding of the thoracic aorta again demonstrated. Pulmonary vascularity is normal. The lungs are clear. No pleural effusion or pneumothorax is identified. No acute osseous abnormality is seen. There are mild degenerative changes in thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "Right-sided central venous catheter seen with tip at the lower SVC. The lungs are clear. The cardiomediastinal silhouette is stable. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest provided. A Port-A-Cath resides over the right chest wall with catheter tip in the region of the mid SVC. Lung volumes are low though allowing for this the lungs appear clear. No convincing signs of pneumonia, edema, effusion or pneumothorax. The heart and mediastinal contours appear normal and stable. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Portable AP upright chest radiograph was obtained. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The endotracheal tube is satisfactorily positioned, 3.5 cm above the carina. Nasogastric tube courses into the stomach with side hole at the level of the GE junction, can be advanced 5-7 cm for more optimal positioning. Numerous radiodensities project over the upper abdomen but may be external as they were not present on the prior examination.", "output": "No acute intrathoracic process. Nasogastric tube with side hole at the level of the GE junction and can be advanced 5-7 cm for optimal positioning." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. An endotracheal tube ends 4 cm above the carina. Stomach is severely distended with gas.", "output": "No evidence of acute cardiopulmonary process. Endotracheal tube ends 4 cm above the carina. Gastric distension. Of note, outside CT, ___ showed dissection of the lower abdominal aorta and extensive secretions in the major airways. Dr ___ ___ I discussed these findings by telephone at the time of approval." }, { "input": "Heart size is normal with mild tortuosity of the thoracic aorta. Hilar contours are unremarkable. Lungs are clear. There is no pleural effusion or pneumothorax. There is eventration of the left hemidiaphragm. The osseous structures are grossly unremarkable.", "output": "No acute intrathoracic process." }, { "input": "There has been interval removal of a right-sided PICC. Minimal left base atelectasis is seen. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. There has been interval removal of the previously seen left-sided PICC. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac silhouette is top normal to mildly enlarged. The aortic knob is calcified. Some degenerative changes are seen along the spine.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is no evidence of pulmonary vascular congestion.", "output": "No evidence of pneumonia." }, { "input": "The endotracheal tube terminates 5.7 cm above the carina. A right IJ catheter terminates at the mid to lower SVC. There is mild pulmonary edema. The opacity at the right lung base appears to be improving compared to prior studies likely resolving atelectasis. Opacification of the left lung base is likely due to the small pleural effusion with adjacent atelectasis. Since the prior radiograph performed 2 days earlier, there has been interval enlargement in the cardiomediastinal silhouette. No acute osseous abnormalities identified.", "output": "1. Endotracheal tube is appropriately positioned at 5.7cm above the carina. 2. Interval enlargement of cardiomediastinal silhouette over past several days, which may be due to portable technique/change in patient positioning. Alternative diagnostic considerations include worsening heart failure vs. developing pericardial effusion. NOTIFICATION: Findings telephoned to Dr. ___ by Dr. ___ ___ at 10:09am." }, { "input": "Portable semi-erect chest film ___ at 06:05 is submitted.", "output": "Nasogastric tube is seen coursing below the diaphragm with the tip not identified. A right internal jugular central line is unchanged. Overall cardiac and mediastinal contours are stably enlarged. There is interval improvement in the pulmonary edema. Small layering left effusion and possibly a smaller right effusion are again seen. Patchy bibasilar opacities likely reflect patchy atelectasis. No pneumothorax." }, { "input": "There has been interval removal of the nasogastric tube. The right internal jugular central line is unchanged. The degree of vascular congestion is less prominent. However, a right lower lobe opacity appears more coalescent, which could be postsurgical substantial atelectasis. However, in the appropriate clinical setting, superimposed pneumonia could be considered. There is a left-sided pleural effusion. The heart and mediastinal contours are stable and enlarged.", "output": "1. More coalescent right lower lobe opacity could be merely substantial atelectasis after surgery, but in the appropriate clinical setting, superimposed pneumonia is considered." }, { "input": "Portable semi-erect chest film ___ at 05:41 is submitted.", "output": "Right internal jugular central line and endotracheal tube unchanged in position. There are increasing patchy bilateral airspace opacities throughout both lungs and perihilar fullness. These findings most likely reflect worsening pulmonary edema, although superimposed infectious process should also be considered. Clinical correlation is advised. No pneumothorax. Stable cardiac enlargement which may reflect cardiomegaly, although pericardial effusion should also be considered." }, { "input": "Portable AP upright chest ___ at 17:22", "output": "Nasogastric tube seen coursing below the diaphragm with the tip not identified. Right internal jugular central line is unchanged in position. There is interval improvement but residual mild pulmonary edema. Patchy bibasilar opacities more likely reflect atelectasis in the setting of small layering effusions, left greater than right. No pneumothorax. Heart remains stably enlarged. Mediastinal contours are unchanged given differences in patient rotation." }, { "input": "Heart size is top normal. The mediastinal and hilar contours are unremarkable. The pulmonary vascularity is normal. No focal consolidation, pleural effusion or pneumothorax is present. Asymmetric opacity within the medial aspect of the right lung is noted, and it is unclear if this reflects overlapping shadows versus a true pulmonary lesion. No acute osseous abnormalities detected.", "output": "1. Asymmetric opacity within the right lung apex. Apical lordotic views are recommended to assess whether this reflects a true pulmonary lesion. 2. No acute cardiopulmonary abnormality otherwise detected." }, { "input": "Linear branching opacities projecting over the right mid and lower lung may be external to the patient. The lung volumes are persistently low, with bilateral fibrotic changes and parenchymal opacities, similar in appearance since the prior study. A right internal jugular approach Swan Ganz catheter is unchanged in position, with tip terminating in the left pulmonary artery. The heart size is stable. There is no pneumothorax or large pleural effusion. An aortic stent graft projecting over the mid abdomen is again noted.", "output": "Linear branching opacities projecting over the right mid and lower lung are likely external to the patient, but could also represent fissural fluid. In order to resolve this, a repeat radiograph is recommended. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 1:23 PM, 5 minutes after discovery of the findings. After this discussion, Dr. ___ ___ the patient was to have a repeat chest CT this afternoon." }, { "input": "There is again seen evidence of previous endovascular repair of AAA. The cardio mediastinal silhouettes are unchanged. The bilateral hila are not well visualized. There are again seen low lung volumes and widespread increased interstitial opacities consistent with known pulmonary fibrosis. Grossly, there is no interval change in appearance of lungs in comparison to prior radiograph, although evaluation for secondary processes such as superimposed infection is limited given the extent of fibrosis. There is poor visualization of the right lateral CP angle which may signify a small right pleural effusion, although this is difficult to evaluate given extensive fibrosis. There are no pneumothoraces.", "output": "Low lung volumes and interstitial opacities consistent with known pulmonary fibrosis. Possible small right pleural effusion. No other significant interval changes." }, { "input": "PA and lateral views of the chest. There is no focal consolidation. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. No rib fractures identified.", "output": "No acute cardiopulmonary process. No fracture identified. Conventional chest radiographs are not designed for evaluation of rib fractures, detailed views of the ribs in question based on physical exam findings is recommended." }, { "input": "The heart is normal in size. There is a retrocardiac consolidation with air bronchograms in the left lower lobe, consistent with pneumonia. Elsewhere, the lungs appear clear. There is no pleural effusion or pneumothorax. The bony structures are unremarkable.", "output": "Fairly extensive focus of pneumonia with air bronchograms in the left lower lobe." }, { "input": "There has been interval retraction of the nasogastric tube, the tip of which is now seen within the lower esophagus. As compared to the prior examination, there has been no significant interval change. Redemonstrated is right-sided apical scarring. There is no focal consolidation, pleural effusion, pneumothorax, or frank pulmonary edema identified. The heart size is grossly normal. The mediastinal contours are normal", "output": "Interval retraction of the nasogastric tube, the tip of which is now seen in the lower esophagus. No radiographic evidence for acute cardiopulmonary process. Findings were conveyed by Dr. ___ to Dr. ___ ___ telephone at 17:02 on ___, at the time of discovery." }, { "input": "Frontal radiograph of the chest when compared to the prior study demonstrates continued elevation of left hemidiaphragm with left basilar atelectasis. The cardiac and mediastinal contours are unchanged. Scarring in the right apex is of unclear etiology and may be a sign of prior tuberculosis infection or post-radiation fibrosis. No pleural abnormality.", "output": "1. Bibasilar atelectasis with pulmonary vascular congestion and no evidence of developing pneumonia. 2. Right apical scarring which is of unclear etiology. Correlation with prior imaging is recommended and if not available, CT of the chest can be obtained for further evaluation." }, { "input": "Decreased lung volumes are noted. The heart size is normal. The aorta is calcified, and the mediastinal contours are normal. Persistent right upper lobe volume loss, with >2 cm width of right apical pleural thickening and reticulonodular parenchymal opacities. Subtle new right basilar opacity is also demonstrated.", "output": "1. Right apical pleural and parenchymal abnormalities may be the sequelae of prior granulomatous or other infectious process, but it is difficult to exclude an active process (reactivation TB or scar carcinoma) without more remote radiographs for comparison. CT is recommended for further characterization. 2. Subtle right basilar opacity, which could reflect aspiration, atelectasis or early pneumonia. Findings were conveyed by Dr. ___ to Dr. ___ ___ telephone at 11:39am on ___, 5 minutes after discovery." }, { "input": "Patient is status post median sternotomy and CABG. There are low lung volumes and elevation of the right hemidiaphragm. There is patchy right mid lung opacity may represent atelectasis, but pneumonia is not excluded in the appropriate clinical setting. Left base opacity may be due to combination of the large hiatal hernia with adjacent atelectasis. Overall, there appears to be mild pulmonary vascular congestion. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal to mildly enlarged. Mediastinal contours are stable.", "output": "Patchy right mid lung opacity may be due to atelectasis but pneumonia is not excluded in the appropriate clinical setting. Left base opacity most likely due to combination of large hiatal hernia with adjacent atelectasis. Low lung volumes, elevation of the right hemidiaphragm, and possible mild vascular congestion." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. There is no pleural effusion or pneumothorax. The lungs appear otherwise clear.", "output": "No evidence of acute disease." }, { "input": "The heart size is top normal and unchanged. The mediastinal and hilar contours are stable and within normal limits. The pulmonary vascularity is not engorged. A trace left pleural effusion is likely present. There is minimal bibasilar atelectasis. No pneumothorax is present, and no acute osseous abnormalities seen.", "output": "Small left pleural effusion and mild bibasilar atelectasis." }, { "input": "Frontal and lateral views of the chest were obtained. Minimal basilar atelectasis is seen without definite focal consolidation. No pleural effusion or pneumothorax is seen. The patient is status post median sternotomy. The patient is rotated somewhat to the left on the frontal view.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest views were obtained with patient in upright position. There is status post sternotomy. The presence of multiple surgical clips in the anterior left-sided mediastinum are indicative of previous bypass surgery. Heart size is not significantly enlarged. No pulmonary vascular congestive pattern is identified. No evidence of acute or chronic pulmonary infiltrates is present and the lateral and posterior pleural sinuses are free. No pneumothorax in the apical area.", "output": "On previous chest examination suggested basal infiltrates cannot be verified. Pulmonary parenchyma is presently clear and the chest findings are unremarkable in this patient with evidence of previous bypass surgery." }, { "input": "Single frontal view of the chest demonstrates intact median sternotomy wires. New irregular opacification at both lung bases could be pneumonia due to virus or mycoplasma infection or aspiration. Vertically oriented lucency projecting to the left of the lower trachea could be air in a thick walled esophagus; consider esophagitis or other infiltrative abnormality thickening the esophageal wall. The heart is normal size and there is no vascular congestion or appreciable pleural effusion to point to cardiac decompensation. There is no pneumothorax, vascular congestion, or pleural effusion.", "output": "Probably pneumonia, due to aspiration or atypical pathogen. Possible esophageal abnormality should be evaluated at least clinically, if not with a contrast swallow. atyp pna or aspiration" }, { "input": "The lungs are clear. There is no focal consolidation. The cardiomediastinal silhouette is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Clips in the right upper quadrant of the abdomen indicate prior cholecystectomy.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified", "output": "Normal chest x-ray." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Patchy opacities in bilateral lung bases are similar compared to 1 day prior and may represent aspirated blood. Left lung base atelectasis is increased. There is no new consolidation. No pneumothorax or large pleural effusion is identified. Bibasilar bronchiectasis is again noted. Cardiomediastinal silhouette is normal size.", "output": "Persistent bibasilar opacities, which may represent aspirated blood, and right lower lobe pneumonia. Minimally increased left lower lobe atelectasis." }, { "input": "A moderate right pleural effusion is unchanged. A right-sided pigtail catheter is in stable position, now above the meniscus of the effusion. A right-sided PICC line terminates at the cavoatrial junction. Left basal atelectasis is mild. The upper lungs are clear. There is no new consolidation, effusion or pneumothorax. No new abnormal cardiac or mediastinal contour.", "output": "Stable appearance of right pleural effusion." }, { "input": "The patient is rotated to the right. There are persistent opacities in both lung bases, somewhat more conspicuous in the right mid lung on the frontal radiograph although not confirmed on the lateral radiograph. The small anterior loculated collection seen ___ has resolved. The small pleural effusion has resolved. The cardiomediastinal silhouette and hilar contours are normal. There is no pneumothorax.", "output": "1. Persistent bilateral lower lung opacities are somewhat more conspicuous in the right mid lung and may represent atelectasis however, infection is not excluded. 2. The small anterior loculated fluid collection, and small pleural effusion have resolved." }, { "input": "There are extensive bilateral regions of consolidation most notable at the right lung base but also at the left lung base. These are seen on previous exam. There is also new focal opacity in the left mid lung as well. Blunting of the posterior costophrenic angles suggests small effusions. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "Diffuse bilateral parenchymal opacities mostly similar compared to prior with new region in the left mid lung worrisome for active infection superimposed on patient's known bronchiectasis." }, { "input": "Single frontal image of the chest demonstrates well-expanded lungs. The hazy opacity in the right lung base is again seen, unchanged from previous imaging but much improved from earlier images. The left lung is clear. There is no left pleural effusion. There is no pneumothorax. Cardiomediastinal silhouette is unremarkable.A chest tube is again seen in place.", "output": "Right basilar opacity consistent with empyema, unchanged from most recent imaging." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. The chest is hyperinflated. There is no pleural effusion or pneumothorax. Multifocal opacities are bronchovascular and most prominent in the lower lungs, right greater than left, with lesser left upper lobe opacity. Vague opacity is less extensive in the right mid lung.", "output": "Multi focal bronchovascular opacities suggesting an infectious process." }, { "input": "There is widespread opacification of the right lower hemithorax including a suspected large pleural effusion on the right with an expansile appearance. There may be a corresponding consolidation or extensive atelectasis involving the right lower lobe and possibly parts of the right middle and upper lobe. The lenticular shape of right mid lung opacity could potentially be seen with a loculated pleural effusion, but a mass could also be considered. The cardiac, mediastinal and hilar contours appear within normal limits. The left costophrenic sulcus is excluded, but there is no evidence of abnormality in the left hemithorax. Mild mass effect with leftward shift of midline structures is noted. There is no pneumothorax. No bone destruction is appreciated.", "output": "Widespread opacification of the right mid-to-lower hemithorax with mass effect, suspected to represent a pleural effusion at least in part, including a possible large loculated component; a mass could also be considered, in addition to widespread atelectasis or pneumonic consolidation." }, { "input": "An ICD device is noted over the left anterior chest. Lead positions remain unchanged from the prior study. Heart is normal in size and configuration. Cardiomediastinal contours are unremarkable. Lungs are clear with no evidence of focal infiltrates. No pleural effusion and no pneumothorax.", "output": "Biventricular ICD leads remain in the same position as in the previous examination of ___." }, { "input": "PA and lateral views of the chest provided. Mild pulmonary edema is again noted. There is no large pleural effusion seen. The heart and mediastinal contour is stable with atherosclerosis of the unfolded thoracic aorta. Patient's chin obscures the lung apices partially. The bony structures appear intact. Kyphotic angulation of the T-spine again noted.", "output": "Mild interstitial pulmonary edema." }, { "input": "PA and lateral views of the chest were obtained. Lung volumes are low with kyphotic angulation of the T-spine, limiting evaluation through the lower lungs. Allowing for this, there is no focal consolidation, effusion, or pneumothorax. Subtle Kerley B lines likely indicate mild interstitial edema. Cardiomediastinal silhouette is stable. Atherosclerotic calcifications along the aortic knob and descending thoracic aorta noted. Again seen is a mild compression deformity in the upper T-spine seen on the lateral view. Bones are demineralized.", "output": "Mild interstitial edema." }, { "input": "The lungs are grossly clear. There is no consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications are noted at the aortic arch. No acute osseous abnormalities identified, although osteopenia limits evaluation. Known upper thoracic compression deformity is not particularly well assessed.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. Kyphotic deformity of the thoracic spine slightly limits evaluation. There is again noted to be mild reticular opacity within the lungs, which could represent a combination of bronchovascular crowding and overlying chronic disease, i.e., emphysema. No large effusion. No signs of pneumonia. The cardiomediastinal silhouette appears stable. Bony structures are intact.", "output": "Coarsened reticular markings likely represent emphysema." }, { "input": "Compared to recent prior exam, there has been no significant interval change. No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. Heart and mediastinal contours are stable with calcified tortuous aorta and dilated ascending aorta.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "Single upright view of the chest demonstrates low lung volumes without pleural effusion or focal consolidation. No pneumothorax or pneumomediastinum. The ascending aorta is prominent, consistent with patient's known ascending aortic aneurysm, better seen on CT exam of the same date. Aortic arch calcifications are noted. Heart size is top normal. No pulmonary edema. There is no free air under the diaphragms. Partially imaged upper abdomen is unremarkable.", "output": "1. No free air. 2. Prominent ascending aorta corresponds to patient's known ascending aortic aneurysm better demonstrated on the CT exam of the same date." }, { "input": "Frontal and lateral radiographs of the chest were acquired. Lung volumes are low, causing exaggeration of the heart size and accentuation of the pulmonary vasculature. Eventration of the right hemidiaphragm. There is minimal bilateral lower lobe atelectasis. No focal consolidation is seen. The heart size is normal. Tortuosity of the ascending thoracic aorta is redemonstrated, not significantly changed. Aortic calcifications are also noted. There is biapical pleural thickening, without evidence of a pleural effusion. No pneumothorax is seen. Degenerative changes of both humeral heads are noted.", "output": "No acute cardiac or pulmonary process." }, { "input": "PA and lateral views of the chest provided. Lung volumes are low and there is mild elevation of the right hemidiaphragm again noted. The heart remains mildly enlarged. The aorta is unfolded though this is unchanged with aortic atherosclerotic calcifications noted. There is minimal left basal platelike atelectasis. No focal consolidation concerning for pneumonia. No effusion or pneumothorax. No evidence of edema. Bony structures appear intact with bilateral glenohumeral joint degenerative disease again noted.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest were performed. There is no free air beneath the diaphragm. There is no pleural effusion, pneumothorax or focal airspace consolidation. Biapical scarring is evident. The cardiac silhouette is mildly enlarged but is unchanged. A slightly dilated and calcified tortuous aorta is re- demonstrated. The hilar structures are unremarkable.", "output": "No air noted under the diaphragm." }, { "input": "The lungs are clear with no evidence of a consolidation, effusion, or pneumothorax. Again noted is an ascending aortic aneurysm, stable in comparison to prior study. Cardiomediastinal silhouette is otherwise within normal limits. No acute fractures are identified. Extensive degenerative changes are noted at both glenohumeral joints.", "output": "Stable ascending aortic aneurysm with no acute cardiopulmonary process otherwise." }, { "input": "The lungs are hyperinflated. The cardiac, mediastinal and hilar contours are normal. No focal consolidation, left-sided pleural effusion, or pneumothorax is noted. There is mild blunting of the right costophrenic angle which could suggest a trace pleural effusion or chronic pleural thickening. There are no acute osseous abnormalities.", "output": "Blunting of the right costophrenic angle may reflect a trace pleural effusion versus chronic pleural thickening. Hyperinflated lungs, which can be seen with asthma." }, { "input": "PA and lateral views of the chest are provided. A right chest wall Port-A-Cath is again seen with its tip residing in the region of the cavoatrial junction. A rounded density projecting over the right lower lung corresponds to a known breast implant. Bilateral pleural effusions are noted, small, though left greater than right. Basilar atelectasis is again noted. There is no convincing sign of pneumonia. Patient is known to have extensive osseous metastatic disease, which is best evidenced on the lateral view involving the sternum, which is sclerotic with pathological fracture involving the sternomanubrial junction.", "output": "1. Small bilateral effusions with bibasilar atelectasis. No definite signs of pneumonia or overt CHF. 2. Known metastatic osseous disease." }, { "input": "Portable AP chest radiograph. Small right apical pneumothorax is not significantly changed. Small bilateral pleural effusions and atelectasis are stable. Pneumoperitoneum beneath the right hemidiaphram may be related to the pericardial drain, possibly representing an air leak.", "output": "Stable small right apical pneumothorax. Pneumoperitoneum is not appreciated on prior radiographs and could represent an air leak from the pericardial drain. Findings were discussed by Dr. ___ with Dr. ___ by phone at 4:29 p.m. on ___." }, { "input": "A right-sided central venous catheter is seen, Port-A-Cath, terminating at the cavoatrial junction/proximal right atrium. Relative opacity projecting over the right mid-to-lower hemithorax may relate to a breast implant, correlate for history of such. There are small bilateral pleural effusions with mild bibasilar atelectasis. No definite focal consolidation is seen. The cardiac silhouette is top normal. Mediastinal contours are unremarkable. On the lateral view, there is a sclerosis along the inferior aspect of the sternum likely due to metastatic disease.", "output": "Bilateral pleural effusions. Opacity projecting over the right mid-to-lower hemithorax may relate to breast implant. Correlate for history of such. No definite focal consolidation seen. Sclerosis and fragmentation along the sternum likely due to metastasis." }, { "input": "The cardiac silhouette is persistently enlarged. Mediastinum is stable in appearance. Prominence of the hila is stable. Prominence of the vasculature suggests mild to moderate pulmonary edema. More focal right base opacity is again seen, which could relate to fluid overload however, infection is not excluded in the appropriate clinical setting. There are bilateral pleural effusions.", "output": "Bilateral pleural effusions. Mild to moderate pulmonary edema. More focal opacity at the right lung base is again seen, which could relate to fluid overload, but infectious process is not excluded in the appropriate clinical setting." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs without focal consolidation, pleural effusion, or pneumothorax. There is mildly increased vascular congestion and diffuse interstitial abnormality, suggestive of mild cardiac decompensation. A 5 mm nodule in the right lower lobe has been unchanged on CT since ___. The visualized upper abdomen is unremarkable.", "output": "1. No focal consolidation to suggest bacterial pneumonia. 2. Mildly increased vascular congestion and diffuse interstitial abnormality is suggestive of mild cardiac decompensation." }, { "input": "Mild cardiomegaly appears slightly improved compared to the prior study. Dense aortic valvular calcifications are re- demonstrated. The aorta is tortuous. Mild interstitial pulmonary edema is slightly improved compared to the previous chest radiograph. Small bilateral pleural effusions are slightly increased on the right and similar on the left. More focal patchy opacities in the lung bases may reflect areas of atelectasis. No pneumothorax is present. There arm mild to moderate multilevel degenerative changes in the thoracic spine. Embolization coils are noted in the right upper abdomen.", "output": "Mild interstitial pulmonary edema, slightly improved in the interval, with slightly increased small right, and unchanged left, small bilateral pleural effusions. Patchy opacities in lung bases, potentially atelectasis." }, { "input": "There is increased opacity at the bilateral lung bases which could reflect aspiration or infection. Stable heart size and thoracic aortic tortuosity. Right paratracheal soft tissues likely represent vascular structures in someone of this age. No large pleural effusion or pneumothorax. Background hyperinflation is compatible with COPD.", "output": "Increased opacities at the lung bases could reflect aspiration, early infection or atelectasis." }, { "input": "Mild cardiomegaly is re- demonstrated. The patient is status post transcatheter aortic valve replacement. Tortuous aorta is again noted with unremarkable hilar contours. Pulmonary vasculature is not engorged. Lungs are hyperinflated without focal consolidation. No large pleural effusion or pneumothorax is present. Streaky atelectasis is demonstrated in the lung bases. There are moderate degenerative changes seen in the thoracic spine. Embolization coils are again noted in the right mid abdomen.", "output": "Patchy bibasilar atelectasis without focal consolidation. No pulmonary edema." }, { "input": "In comparison to ___ radiograph, heart is increased in size and is accompanied by a new pulmonary vascular congestion, as well as new heterogeneous opacities in the right lung with both alveolar and interstitial features. Small bilateral pleural effusions are also new. Known intrathoracic lymphadenopathy is seen to better detail on prior PET-CT of ___.", "output": "Cardiomegaly and pulmonary vascular congestion are new. Asymmetrically distributed heterogeneous opacities in the right lung could reflect infectious pneumonia or an asymmetrical distribution of pulmonary edema. If the diagnosis is in doubt clinically, short-term followup radiographs after diuresis may be helpful." }, { "input": "The cardiomediastinal silhouettes are stable. The bilateral hila are unremarkable. The lungs are hyperinflated. In comparison to chest x-ray ___, the right upper lobe opacity has resolved. There is persistent hazy airspace opacity at the right lung base. In addition, there is interval worsening of pulmonary vascular congestion and probable early mild pulmonary edema. There is no new focal lung consolidation. There is no pneumothorax. Trace pleural effusions.", "output": "1. Coarsened interstitial markings, likely pulmonary vascular congestion and probable early or mild pulmonary edema. 2. Interval near-resolution of right upper lobe opacity. 3. Trace bilateral pleural effusions." }, { "input": "Left pectoral pacemaker with leads ending in the right atrium and right ventricle. Normal heart size and hilar contours. Normal pleural surfaces. Unchanged dilatation of the thoracic aorta. Fully expanded, clear lungs. No pulmonary nodules.", "output": "No acute cardiopulmonary process." }, { "input": "The aorta remains calcified and unfolded. The cardiac silhouette mildly enlarged. There is mild bibasilar atelectasis without definite focal consolidation. The lungs appear hyperinflated with flattening of the diaphragms. No pleural effusion or pneumothorax is seen.", "output": "Mild basilar atelectasis without definite focal consolidation. No overt pulmonary edema." }, { "input": "Mediastinal contour unchanged from ___. Mild cardiomegaly is unchanged. There is no focal lung consolidation. Transvenous pacing leads and in the right atrium and right ventricle. No acute osseous abnormality.", "output": "No acute cardiopulmonary process. Mediastinal contour unchanged compared to ___" }, { "input": "Mild cardiomegaly and tortuous aorta are unchanged. Pacer leads are in standard position with tips in the right atrium and right ventricle. There is no pneumothorax or pulmonary edema. Bilateral effusions are small. Bibasilar atelectasis are minimal.", "output": "Small bilateral effusions. No pulmonary edema" }, { "input": "The heart is mild-to-moderately enlarged. There is unfolding and calcification of the thoracic aorta. A soft tissue density projecting over the medial right lung apex is uncertain in etiology but may be due to mild vascular congestion or atelectasis, but perhaps less likely pneumonia, in the right upper lobe. To some extent this may be more due to mediastinal widening on the right. Patchy opacity in the left lower lobe is likely compatible with atelectasis. Pulmonary vasculature does not appear particularly prominent. Bones appear demineralized.", "output": "Questionable medial right upper lobe opacity versus mediastinal widening. When clinically feasible, repeat radiographs are suggested with PA and lateral technique to better assess. The main concern is a possible right perihilar consolidation which might indicate pneumonia in the appropriate setting. There is no generalized convincing evidence for fluid overload although the finding may alternatively indicate mild perihilar congestion change." }, { "input": "2 views of the chest demonstrate clear lungs. The cardiac, hilar, and mediastinal contours are normal. No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Permanent pacemaker is present with leads in the right atrium and right ventricle. Heart is upper limits of normal in size. Considering apical lordotic projection. Pulmonary vascularity is normal, and lungs are grossly clear. Thoracic aorta is tortuous and calcified. There are no pleural effusions. Right shoulder prosthesis is incidentally noted and is difficult to assess due to patient positioning.", "output": "No evidence of pneumonia or congestive heart failure." }, { "input": "The lungs are clear without consolidations, nodules, or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. Mild tortuosity of the aorta is unchanged.", "output": "Normal chest radiograph without evidence of intrathoracic malignancy." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. The lungs are slightly hyperinflated. Lungs are clear. No nodules are identified. No pleural effusion or pneumothorax is seen. Chronic fracture of the left 6th rib is unchanged.", "output": "Mildly hyperinflated lungs with no acute cardiopulmonary abnormality." }, { "input": "An opacity seen on the lateral view projecting over the lower lobes in the appropriate clinical setting may represent pneumonia. The cardiomediastinal silhouette is within normal limits. There is no pneumothorax.", "output": "An opacity projecting over the lower lobes on the lateral view in the appropriate clinical setting may represent pneumonia." }, { "input": "Heart size is normal and unchanged. The aorta is calcified, indicating atherosclerosis. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Low lung volumes. Compared to ___, no significant change. Again seen are consolidations overlying the bilateral lower lobes, which may represent atelectasis or scar with pneumonia not excluded. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Compared to ___, no significant change. Unchanged bibasilar consolidations, which may represent atelectasis or scar with pneumonia not excluded." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear aside from minor left basilar atelectasis.", "output": "No evidence of acute disease." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Suboptimal comparison as no lateral view is obtained, however there is a retrocardiac opacity which may correlate with the opacity seen on the prior lateral view. No pleural effusion or pneumothorax identified. In the size the cardiomediastinal silhouette is within normal limits.", "output": "A retrocardiac opacity may correlate with the abnormality seen on the prior radiograph's lateral view, and in the correct clinical context may reflect pneumonia." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. Coronary artery stents are noted. Vague opacity projecting over the mediastinum on the right just below the thoracic inlet is compatible with tortuosity of the great vessels. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. No pulmonary edema. The interstitium is slightly prominent but this likely reflects age related change or small airways disease. On the lateral view, there are several calcified rounded opacity measuring up to 2.2 x 1.6 cm which project over the anterior mediastinum on the lateral projection, and therefore could represent calcified lymph nodes related to prior granulomatous infection. Clinical correlation is recommended. Comparison to prior imaging would also be helpful to better delineate the etiology. Heart is mildly enlarged. Aorta unfolded and tortuous.", "output": "1. No evidence of acute focal pneumonia. 2. Nonspecific rounded calcified opacities on the lateral projection may represent calcified mediastinal nodes suggesting prior granulomatous infection. Clinical correlation is recommended." }, { "input": "Single AP upright portable view of the chest was obtained. Dual-lead right-sided pacemaker is again seen with leads extending to the expected positions of the right atrium and right ventricle, unchanged. Patient is status post median sternotomy. There is mild left base atelectasis. Slight blunting of the left costophrenic angle likely relates to overlying soft tissue, although lateral view would be helpful for confirmation. No focal consolidation or pleural effusion. Cardiac and mediastinal silhouettes are stable.", "output": "Mild left base atelectasis. Relative mild blunting of the left costophrenic angle may be related to overlying soft tissue, though lateral would be helpful to assess for possible small pleural effusion." }, { "input": "Dual lead right-sided pacemaker is seen with lead extending the expected positions of the right atrium and right ventricle. Oblong radiopaque structure projects over the left lower hemi thorax which has the appearance of a pen and is most likely external to the patient. Correlate with direct visualization. No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac silhouette is top-normal to mildly enlarged. Mediastinal contours are stable.", "output": "No acute cardiopulmonary process. Oblong radiopaque structure projects over the left lower hemi thorax which has the appearance of a pen and is most likely external to the patient. Correlate with direct visualization." }, { "input": "No focal consolidation to suggest pneumonia is seen. No pneumothorax is identified. The lungs are hyperinflated. There is likely trace left pleural effusion though improved from the prior exam. Additional opacities at the left base are felt to likely represent residual atelectasis. There is mild cardiomegaly and tortuosity of the aorta. A previously seen left-sided PICC has been removed. A dual-lead pacemaker is unchanged with leads in standard positions. Sternal cerclage wires are intact.", "output": "No evidence of pneumonia." }, { "input": "Single AP upright portable view of the chest demonstrates no acute cardiopulmonary process. Cardiomediastinal, pleural and pulmonary structures are unremarkable. A right-sided pacemaker with leads terminating in the right atrium, right ventricle is again noted. Median sternotomy wires are unchanged. No pleural effusion or pneumothorax. Degenerative changes of the cervical spine, left acromioclavicular and left glenohumeral joint are noted.", "output": "No acute cardiopulmonary process." }, { "input": "Single AP supine portable view of the chest was obtained. Right-sided dual-lead pacemaker is again seen, unchanged in position. The patient is status post median sternotomy. There is minimal pulmonary vascular congestion. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. No displaced fracture is seen.", "output": "Minimal pulmonary vascular congestion." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. There is new mild volume loss at the left lung base, with streaky opacification and a suspected very small pleural effusion. More generally, there is a diffuse mild interstitial abnormality, which is most prominent in the mid and lower lungs and could be seen with pulmonary vascular congestion. In the setting of suspected infection, however, the possibility of atypical pneumonia could be considered and more focal developing pneumonia is also a differential consideration for retrocardiac opacification at the left lung base versus atelectasis.", "output": "1. Mild interstitial abnormality for which fluid overload or atypical pneumonia could be considered. 2. Focal left basilar opacity, possibly developing pneumonia, although atelectasis could explain the findings." }, { "input": "PA AND LATERAL VIEWS OF THE CHEST. The lungs are clear. There is no consolidation, pleural effusion, or pneumothorax. Heart size is normal. The pulmonary vasculature is not congested. Low and flat diaphragms and hyperinflation of the lungs suggests COPD. There is mild dilation and elongation of the aorta with no definite calcifications.", "output": "1. No infiltrate. 2. Lung findings suggesting COPD." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Right diaphragm eventration is noted. Lungs are hyperinflated but without focal consolidation concerning for pneumonia. A calcified granuloma in the right upper the lungs is present. Left base plate like atelectasis is present.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. There is minimal left apical pneumothorax, improved from prior study. The left pleural effusion has resolved. There is minimal left lower base atelectasis. Abnormal contour of the mediastinum on the left likely represents the known mediastinal mass. The right lung is fully expanded and clear. There is no right pleural effusion. The heart size is normal.", "output": "1. Minimal left apical pneumothorax, improved from most recent study. 2. Resolution of left pleural effusion. These findings were discussed with Dr. ___ at 11:00 a.m. on ___ by telephone." }, { "input": "PA and lateral views of the chest. Chest tube is seen in the upper medial left hemithorax. There is a large left pneumothorax and moderate-sized left pleural effusion. No shift in mediastinal structures. The right lung is fully expanded and clear. There is no right pleural effusion. There is no right pneumothorax. The cardiac, mediastinal, and hilar contours are normal.", "output": "New large left pneumothorax and moderate-sized left pleural effusion. There is no shift in the mediastinal structures. Left apical chest tube is in place. These findings were discussed with Dr. ___ at 4:30 p.m. on ___ by telephone." }, { "input": "A left-sided PICC line has been retracted somewhat and terminates in the mid portion of the superior vena cava. The heart is moderately enlarged, as before. There is a suggestion of upper zone re-distribution of pulmonary vascularity, which suggests pulmonary venous hypertension, but congestive heart failure has largely resolved. A developing opacity is suspected in the right lower lung, however, but not optimally evaluated with portable technique. Streaky left basilar opacity probably is probably compatible with minor atelectasis. There is no definite pleural effusion or pneumothorax.", "output": "Near resolution of pulmonary edema. Possible developing opacity at the right lung base. Short-term followup radiographs with standard PA and lateral technique, if possible, may be helpful to assess for whether it may represent a focus of infection rather than atelectasis." }, { "input": "There is moderate cardiomegaly. The aorta is mildly unfolded. Mild perihilar haziness and vascular indistinctness is compatible with mild pulmonary edema. No large pleural effusion or pneumothorax is present. Vascular calcifications are noted overlying both axillary regions and lung apices. Left-sided cervical rib is incidentally detected.", "output": "Mild pulmonary edema." }, { "input": "In comparison with the study of ___, there are lower lung volumes. Continued enlargement of the cardiac silhouette with pulmonary vascular congestion. Opacification at the left base is consistent with atelectasis and effusion, though in the appropriate clinical setting, supervening pneumonia would have to be considered. Continued volume loss in the right middle lobe. Monitoring and support devices remain in place.", "output": "Lower lung volumes but otherwise little change." }, { "input": "The ET tube terminates high, approximately 9 cm above carina. NG tube tip and side hole are in the stomach. New small left pleural effusion is seen. A component of left lower lobe atelectasis is likely present. Patchy right basilar opacity may reflect atelectasis or infection. There is no pneumothorax. The cardiomediastinal silhouette is normal.", "output": "1. ET tube terminating 9 cm above the carina. Recommend advancing this 5-6 cm for optimal positioning. 2. New small left pleural effusion and left lower lobe atelectasis. 3. Patchy right basilar opacity may reflect atelectasis or infection." }, { "input": "Endotracheal tube tip terminates approximately 5.5 cm from the carina. Enteric tube tip is within the stomach. Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is not engorged. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. No acute osseous abnormality is visualized.", "output": "Endotracheal and enteric tubes in standard positions. No acute cardiopulmonary process." }, { "input": "Left subclavian PICC is unchanged, ending in mid SVC. The bilateral parenchymal opacities have reduced also with improvement of the bibasilar pleural effusion, which persists small on the left lung base. Persistent enlargement of the upper mediastinum for for known paraspinal hematoma. Cardiac silhouette is normal. There is no pneumothorax.", "output": "Mild improvement of bibasilar opacities and pleural effusions, which persists small on the left base." }, { "input": "Compared to chest radiographs from ___, right-sided pleural effusion has minimally improved. Left-sided pleural effusion, with fissural fluid, appears loculated and is unchanged. Lungs are hyperinflated with flattening of the bilateral hemidiaphragms, suggestive of emphysema. There is mild central vascular congestion without overt pulmonary edema. No focal consolidation. No pneumothorax. Cardiomediastinal silhouette is stable. Left pectoral cardiac pacing device with dual leads following their expected courses to the right atrium and ventricle, respectively.", "output": "1. Stable left pleural effusion appears loculated with fissural fluid. Minimally improved right pleural effusion. 2. No pulmonary edema. No pneumonia. 3. Hyperinflated lungs with flattening of bilateral hemidiaphragms, suggestive of emphysema. 4. No radiographic findings suggestive of pulmonary embolism, though this exam alone cannot confirm or exclude pulmonary embolism." }, { "input": "The appearance of the chest is without significant interval change from 1 day prior. Re- demonstrated left base opacity likely due to loculated effusion with associated atelectasis, underlying consolidation not excluded. Re- demonstrated loculated appearing left pleural effusion. Re- demonstrated hyperinflated lungs with blunting of the right costophrenic angle. Cardiac and mediastinal silhouettes are stable. The position of the left-sided pacemaker is stable.", "output": "No significant interval change from 1 day prior." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest are obtained. The lungs are well expanded and clear. The cardiomediastinal silhouette is unremarkable. There is mild kyphosis of the thoracic spine and possible fat deposition of the upper back, which may represent exogenous steroid use or ___'s disease.", "output": "No evidence of cardiopulmonary disease. Mild kyphosis and upper back fat deposition may represent steroid use or ___'s disease in the correct clinical setting." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are normal. The lungs are clear. There is no pleural effusion or pneumothorax. No definite clavicular or rib fracture is identified, though this examination is not tailored for evaluation osseous injuries. If there is significant concern for fracture, dedicated views of the ribs and clavicles can be obtained.", "output": "No acute intrathoracic abnormality. No definite fracture identified." }, { "input": "PA and lateral views of the chest provided. On the frontal projection, triangular opacity obscures the left CP angle, possibly representing pleural thickening, pneumonia, vs small effusion. Right lung is clear. Cardiomediastinal silhouette is normal. No large effusion or pneumothorax is seen. No free air below the right hemidiaphragm.", "output": "Small triangular opacity in the left CP angle could represent pleural thickening, pneumonia less likely effusion. Followup to resolution." }, { "input": "No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process. No significant change from earlier today." }, { "input": "Mild to moderate enlargement of the cardiac silhouette is unchanged. The mediastinal and hilar contours are similar. There is mild pulmonary edema, new in the interval, with perihilar haziness and vascular indistinctness. Small amount of fluid is also noted within the fissures, without a large pleural effusion. No pneumothorax is present. No acute osseous abnormality is demonstrated.", "output": "Mild pulmonary edema." }, { "input": "Mild cardiomegaly is grossly unchanged, allowing for differences in technique. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is stable.", "output": "No acute cardiopulmonary process. Grossly unchanged mild cardiomegaly." }, { "input": "The cardiomediastinal and hilar contours are stable with mild tortuosity descending aorta. There is no pleural effusion or pneumothorax. Lungs are well-expanded and clear without focal consolidation concerning for pneumonia. Surgical clips project over the left axilla, new since the prior radiograph. The upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are clear without focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. Lateral view is somewhat limited exam due to patient's arms being down by his side. The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "A portable upright AP radiograph of the chest demonstrates bilateral lower lobe heterogeneous opacities. The lungs are otherwise clear. There is moderate cardiomegaly. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal. No subdiaphragmatic free air is seen.", "output": "1. Bilateral lower lobe heterogeneous opacities may represent atelectasis. Correlate with clinical picture to exclude pneumonia. 2. No free air under the diaphragm 3. Moderate cardiomegaly." }, { "input": "Single portable chest radiograph is limited by obliqued patient position. Within this limitation, the cardiomediastinal contours are unremarkable. Increased density projecting over the right hilus likely reflects a pulmonary vessel, though this could be further evaluated with properly positioned frontal and lateral chest radiographs. Save minimal atelectatic changes in the lung bases, lungs are clear. No pleural effusion or pneumothorax identified.", "output": "No finding concerning for pneumonia. Increased density projecting over right hilum likely reflects pulmonary vessel exaggerated by oblique patient position. Could be further evaluated with conventional frontal and lateral chest radiographs when clinically stable." }, { "input": "Frontal and lateral chest radiographdemonstrates well expanded and clear lungs.No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable. Limited assessment of the upper abdomen is within normal limits.", "output": "Normal chest radiograph." }, { "input": "No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. Mediastinal and hilar contours are within normal limits. Pulmonary vasculature is normal. Lungs are clear. No focal consolidation, pleural effusion or pneumothorax is present. Multiple clips are noted in the right upper quadrant of the abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Single frontal view of the chest. Lung volumes are low, exaggerating heart size. Left lung base ill-defined opacities are consistent with atelectasis or infection. No focal consolidation, pleural effusion, pneumothorax. Two metallic ___ overlie the right supraclavicular region and left upper chest.", "output": "Left lung base opacities could represent atelectasis or infection." }, { "input": "Subtle right basilar opacity may be due to atelectasis and overlap of vascular structures. No definite focal consolidation is seen. Left basilar atelectasis is also noted. There is no pleural effusion or pneumothorax. No pulmonary edema is seen. The cardiac silhouette is top-normal contours are stable. There is marked compression of a lower thoracic vertebral body, also present on the prior studies.", "output": "Subtle right basilar opacity may be due to atelectasis and overlap of vascular structures. No definite focal consolidation is seen" }, { "input": "A portable frontal chest radiograph demonstrates a normal cardiomediastinal silhouette and well-aerated lungs which are clear. There is no focal consolidation, pleural effusion, or pneumothorax. No intra-abdominal free air is appreciated.", "output": "No intra-abdominal free air identified. Normal chest radiograph." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Two views of the chest were obtained. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The heart is normal in size with normal cardiomediastinal contours.", "output": "No acute intrathoracic process." }, { "input": "The heart size is mildly enlarged. There is slight mediastinal widening, however, this is overall stable compared to the prior exam. There is a small linear density at the left lung base which is likely secondary to atelectasis. There are no pleural effusions. No pneumothoraces are seen. The visualized osseous structures are unremarkable. Incidental note is made of a hiatal hernia.", "output": "No focal consolidation concerning for infection. No pulmonary edema. Atelectasis at the left lung base." }, { "input": "Semi-upright portable view of the chest demonstrates low lung volumes. The costophrenic angles are obscured, suggestive of trace pleural effusions. There is perihilar vascular congestion. Mediastinal silhouette is prominent. A large lucency projecting over cardiac silhouette, likely reflects patient's known hiatal hernia. Heart size is difficult to assess. There is no pneumothorax. Coronary artery stents are in place. Sternotomy wires appear intact. Splenic artery calcifications are noted. Otherwise, partially imaged upper abdomen is unremarkable.", "output": "Low lung volumes. Trace bilateral pleural effusions, perihilar vascular congestion. Large hiatal hernia." }, { "input": "Again demonstrated is a very large hiatal hernia. Allowing for relatively low lung volumes, heart is upper limits of normal in size. Aorta is tortuous and diffusely calcified. Pulmonary vascularity is normal. Increased opacity is seen overlying the lower thoracic spine on the lateral radiograph, and likely corresponds to bilateral small pleural effusions and adjacent atelectasis. Compression deformity at thoracolumbar junction appears similar to recent thoracic spine radiograph of ___, and was more fully evaluated at that time.", "output": "Very large hiatal hernia. Adjacent bibasilar opacities favor atelectasis, but aspiration pneumonia is not excluded in the appropriate setting." }, { "input": "Lung volumes are low. A large hiatal hernia causes apparent widening of the mediastinum. In addition, there appears to be a new retrocardiac opacity. There is no definite consolidation, effusion, or pneumothorax. New right-sided internal jugular line tip terminates at the mid SVC. Sternotomy wires and retained internal pacing leads are in stable positions. Aortic arch atherosclerosis and tortuosity are unchanged.", "output": "Low lung volumes and large hiatal hernia. New retrocardiac opacity, potentially atelectasis, infection is also possible. Repeat with PA and lateral views may help further characterize if patient is amenable." }, { "input": "Portable semi erect frontal image of the chest. A right-sided PICC terminates in the mid SVC. A tracheostomy tube is seen in place. Median sternotomy wires and mediastinal clips are noted. An additional catheter is seen overlying the abdomen. An opacity is seen in the left lung base, concerning for pneumonia. Increased mild opacity in the right mid lung may represent developing pulmonary edema. There is a moderate to large left pleural effusion and a moderate right pleural effusion. No pneumothorax is seen. The cardiomediastinal silhouette is obscured by adjacent opacities. Lucency is seen projecting over the mediastinum, which may represent air in the esophagus which would be concerning for a possible tracheoesophageal fistula.", "output": "1. Opacity in the left lung base, concerning for pneumonia. 2. Increased mild opacity in the right mid lung may represent developing pulmonary edema. 3. Bilateral pleural effusions, moderate to large on the left and moderate on the right. 4. Suspected abnormality of the esophagus, possibly a tracheoesophageal fistula. Recommend comparison with old studies from outside hospitals. If no prior imaging is available and if further characterization is desired, Chest CT should be obtained for further assessment. Findings were communicated to Dr. ___ at 8:18 a.m. ___ by phone." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. Bilateral glenohumeral prosthesis are redemonstrated and unchanged in appearance in these limited views.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The cardiomediastinal silhouette is normal and normal. The lungs are fully expanded and clear. There is no pleural effusion or pneumothorax. No large intraperitoneal free air is seen. Partially imaged bilateral shoulder prostheses are noted.", "output": "No evidence of pneumonia." }, { "input": "The heart is top-normal in size. There is no focal consolidation. There is no pneumothorax or pleural effusion. Bilateral shoulder prostheses are present.", "output": "No evidence of pneumonia." }, { "input": "The lungs are well-expanded and clear. No focal consolidation, effusion, edema, or pneumothorax. The heart is normal in size. The mediastinum is not widened. The pleura and hila are grossly unremarkable. No acute osseous abnormality. Bilateral shoulder prostheses.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Bilateral shoulder arthroplasty is again noted. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest are provided. The lungs are clear without focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette appears normal. Bilateral shoulder replacement hardware is noted. No free air below the right hemidiaphragm. No acute bony abnormality.", "output": "No signs of pneumonia or other acute intrathoracic process." }, { "input": "No focal opacity to suggest pneumonia is seen. No pleural effusion, pulmonary edema or pneumothorax is present. The heart size is normal. Bilateral shoulder prostheses appear unchanged.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. The pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Bilateral total shoulder arthroplasties are incompletely imaged.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were obtained. Lungs are clear without focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. Bilateral shoulder replacements noted. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax or pleural effusion. Bilateral shoulder arthroplasty is partially evaluated.", "output": "No acute cardiopulmonary abnormalities" }, { "input": "Single portable view of the chest was compared to previous exam from ___. The lungs remain clear of focal opacity or effusion. The cardiomediastinal silhouette is normal. Bilateral shoulder arthroplasties are stable in configuration.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable. Partially imaged bilateral shoulder arthroplasties. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is top-normal in size. There is no pleural effusion or pneumothorax. There is no focal lung consolidation. Bilateral shoulder prostheses are present. There is no acute osseous abnormality.", "output": "No radiographic evidence of pneumonia." }, { "input": "PA and lateral chest radiograph demonstrates clear lungs bilaterally. There is no pleural effusion. Cardiomediastinal and hilar contours are within normal limits. There is no pneumothorax. Patient is status post bilateral shoulder arthroplasties.", "output": "Clear lungs without acute intrathoracic abnormality." }, { "input": "There has been worsening of the bibasilar opacities. This may represent pneumonia or aspiration. There is likely overlying subsegmental atelectasis at the bases. Heart size is within normal limits. There is no overt pulmonary edema or pneumothoraces. Bilateral shoulder arthroplasties are present.", "output": "As above." }, { "input": "New heterogeneous opacities have developed in the right upper lobe, some of which have a slightly nodular configuration. Lungs are otherwise remarkable for linear atelectasis at the left lung base. Cardiomediastinal contours are within normal limits. Small pleural effusions are new, left greater than right. Bilateral shoulder prostheses are noted.", "output": "1. New heterogeneous right upper lobe opacities consistent with an evolving pneumonia. Poorly defined nodular opacities in this region may reflect coalescing acinar nodules from coalescing airspace disease, but atypical infection should also be considered given the history of immune suppression. Dr. ___ has been telephoned with this result at 4:15 p.m. on ___ at the time of discovery. 2. Small bilateral pleural effusions." }, { "input": "Cardiac, mediastinal, and hilar contours are unremarkable. No evidence for pulmonary consolidation, pulmonary edema, pleural effusion, or pneumothorax. dextroconvex curvature of the thoracic spine is again seen. Bilateral glenohumeral arthroplasties are again partially visualized.", "output": "No radiographic evidence for pneumonia." }, { "input": "The heart is normal in size. The hilar and mediastinal contours are normal. Previously described heterogeneous opacities in the right upper lung have resolved. The lungs are well expanded and clear. No new focal consolidations are identified. There are no pleural effusions or pneumothorax. Bilateral shoulder prostheses are incompletely imaged.", "output": "Resolution of right upper lobe opacities with no new focal consolidations." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Bilateral shoulder arthroplasty noted. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Improving bibasilar atelectasis and decreasing bilateral effusions." }, { "input": "PA and lateral views of the chest demonstrate symmetrically expanded clear lungs. The heart is normal in size and cardiomediastinal contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "PA and lateral views of the chest provided. Left chest tube is been removed. There is subcutaneous emphysema the left chest wall. There is a tiny left apical pneumothorax. Mild left basal atelectasis. Otherwise no change.", "output": "Tiny left apical pneumothorax status post left chest tube removal." }, { "input": "A left chest tube is in unchanged position. There is no pneumothorax. Subcutaneous emphysema is noted. There is new left lower lobe atelectasis as well as a small left pleural effusion. The right lung is clear. The cardiomediastinal silhouette is within normal limits.", "output": "Left lower lobe atelectasis and small left pleural effusion. No pneumothorax." }, { "input": "AP upright and lateral views of the chest provided. Hyperinflated lungs with flattened diaphragms suggests underlying COPD. No focal consolidation, large effusion or pneumothorax is seen. The heart and mediastinal contours appear normal. Bony structures are intact.", "output": "No acute intrathoracic process. Please refer to subsequent CTA chest for further details." }, { "input": "The lungs are well-expanded and clear. No focal consolidation, edema, effusion, pneumothorax. The heart is normal in size. The mediastinum is not widened. The hila is unremarkable. No acute osseous abnormality.", "output": "Normal chest radiograph." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is detected. Heart and mediastinal contours are within normal limits.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "mild interstitial pulmonary edema is improved compared with ___, but likely worsened compared with the chest CT of ___. Ill-defined airspace opacity best appreciated on the lateral view and likely corresponding to the left lower lobe may represent atelectasis or early consolidation. There is no pleural effusion. There is no pneumothorax. The cardiomediastinal silhouette, including mild cardiomegaly, is unchanged.", "output": "1. Improved interstitial edema. 2. Atelectasis or early consolidation of the left lower lobe, best appreciated on the lateral view." }, { "input": "Low lung volumes. There are bilateral pleural effusion with overlying atelectasis. Prominence of the pulmonary vasculature is consistent with pulmonary edema. Bibasilar opacities may be due to combination of pleural effusion and atelectasis but underlying consolidation is not excluded. The cardiac silhouette is enlarged. No pneumothorax is seen.", "output": "Bilateral pleural effusions with overlying atelectasis, pulmonary edema and enlarged cardiac silhouette." }, { "input": "Dual lumen right central venous catheter terminates at the cavoatrial junction and proximal right atrium. Mild to moderate pulmonary vascular congestion is seen with prominence of the central pulmonary vasculature. No discrete focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are grossly stable.", "output": "Mild to moderate pulmonary vascular congestion. No discrete focal consolidation seen." }, { "input": "The lungs are hyperinflated with underlying emphysematous changes. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is notable for prominent main pulmonary artery and right pulmonary artery, likey due to pulmonary hypertension. Again seen is compression fractures of T4 and L1, unchanged. No new fractures are identified.", "output": "1. No acute cardiopulmonary process. 2. Enlarged pulmonary artery silhouettes suggestive of pulmonary hypertension." }, { "input": "PA and lateral chest radiographs are provided. There is a patchy opacity in the left lower lobe on both the frontal and lateral views, new since the prior radiograph and consistent with pneumonia. The right lung is predominantly clear. There is no pneumothorax or pleural effusion. The cardiomediastinal silhouette is unchanged. Again seen are compression fractures of T4 and L1, unchanged.", "output": "New left lower lobe pneumonia." }, { "input": "The lungs are hyperinflated with underlying emphysematous changes. No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is detected. Heart and mediastinal contours are stable. Surgical suture material along the right medial upper lung is seen. This study is not optimized for evaluation of the scapula; no acute bony findings are seen. Old L1 compression fracture is noted. There has been interval compression of T4, age indeterminate but new since prior.", "output": "1. Emphysema without radiographic evidence for acute cardiopulmonary process. 2. Although no acute bony findings are detected on these views, if there is high clinical suspicion for scapular or rib pathology, CT is more sensitive. 3. Age indeterminate compresion fracture of T4, new since ___. This updated finding was e-mailed to the ___ QA nurses on ___ after attending radiologist review. This finding was also reported to Dr. ___, ___ ___ attending, by Dr. ___ by phone at 6:58 p.m. on ___ after attending radiologist review." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. An old right mid shaft clavicle deformity is noted. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is a calcified nodule projecting over the superior segment of the right upper lobe suggesting a granuloma. There may be a small calcified lymph node on the right. Streaky opacities at the left lung base are unchanged and suggest very minor scarring. Otherwise the lungs remain clear. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "PA and lateral views of the chest provided. There is mild basilar atelectasis, otherwise the lungs are grossly clear. No pleural effusion or pneumothorax. Hilar and cardiomediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "There is moderate enlargement of the cardiac silhouette. Retrocardiac opacification likely represents a combination of a left pleural effusion and atelectasis. However, there is a more masslike opacity anterior to the spine on the lateral view. There is moderate pulmonary edema. No pneumothorax.", "output": "1. Cardiomegaly, left pleural effusion and pulmonary edema 2. Opacity anterior to the spine on the lateral view could represent a hiatal hernia; however, a mass is also possible. This could be further evaluated with chest CT NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 8:05 AM" }, { "input": "The enteric tube projects over the stomach, tip not imaged. Diffuse bilateral hazy opacities with perihilar predominance are relatively unchanged and consistent with mild pulmonary edema. Dense retrocardiac opacification with air-bronchograms is also unchanged. A moderate left pleural effusion is present. There is no pneumothorax. Cardiomediastinal silhouette is unchanged and bulging mediastinal contours likely relate to lymphadenopathy see on the recent CT of ___.", "output": "1. Stable mild pulmonary edema and moderate left effusion. 2. Possible left lower lobe pneumonia, unchanged." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No evidence of free air is seen beneath the diaphragms.", "output": "No acute cardiopulmonary process. No evidence of free air beneath the diaphragms." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are essentially clear without focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The heart size is normal. Mediastinal and hilar contours are normal.", "output": "No radiographic evidence for acute cardiopulmonary process. Findings were conveyed by Dr. ___ ___ Dr. ___ ___ telephone at 3:07pm on ___, ___ min after discovery." }, { "input": "The pulmonary vascular congestion is minimally worse since ___. No discrete lung opacities concerning for pneumonia. Moderately enlarged heart size is bigger than it was on ___. Mediastinal and hilar contours are normal. There is no pleural effusion.", "output": "Mild pulmonary vascular congestion and moderate cardiomegaly have minimally worsened since ___; however, there is no pulmonary edema." }, { "input": "Frontal and lateral chest radiographs were obtained. The lungs are fully expanded and clear. The heart is moderately enlarged but stable. Mediastinal and hilar contours are unchanged. There is no pleural effusion or pneumothorax.", "output": "No focal consolidation to suggest pneumonia." }, { "input": "There is minor mid lung atelectasis. No focal consolidation is seen. There is no pleural effusion or pneumothorax. The aorta is tortuous. The cardiac silhouette is mildly enlarged. No overt pulmonary edema is seen.", "output": "No significant interval change." }, { "input": "The lungs are clear with no evidence of consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. No acute fracture is identified.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. The patient is slightly rotated. Slightly increased left lower lobe opacity since ___ in the setting of unchanged left pleural effusion may represent an early or developing pneumonia rather than atelectasis. There is no pneumothorax. Heart size is normal. Increased density adjacent to the right paratracheal stripe is likely due to lymphadenopathy seen on chest CT ___. The aorta is mildly tortuous with aortic knob calcifications, unchanged.", "output": "Slightly increased left lower lobe opacity since ___ in the setting of unchanged left pleural effusion may represent an early or developing pneumonia, less likely atelectasis." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well expanded and clear. There is no focal consolidation, effusion, pneumothorax. Cardiac and mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Compared to the prior radiograph, no significant change is noted. Bilateral pleural effusions with adjacent atelectasis are unchanged. There is minimal fluid overload without overt pulmonary edema. No new focal consolidation concerning for pneumonia. The support and monitor devices are constant in position. Intact median sternotomy wires are unchanged.", "output": "Unchanged bilateral pleural effusions with adjacent atelectasis." }, { "input": "Portable supine chest radiograph ___ at 07:26 is submitted", "output": "Endotracheal tube has its tip 4 cm above the carina. A feeding tube is seen coursing below the diaphragm with the tip projecting over the stomach. A left internal jugular central line is unchanged. There has been interval appearance of a diffuse airspace process in the left lung which in the setting of a recent code could reflect pulmonary hemorrhage or markedly asymmetric edema. Infection would be much less likely. Clinical correlation is recommended. There are likely small layering effusions, left greater than right. The right lung has improved aeration. Given the diffuse abnormality in the left lung, assessment of the cardiac and mediastinal contours is difficult in this patient status post median sternotomy. Clips in the right upper quadrant are consistent with prior cholecystectomy. No large pneumothorax is appreciated." }, { "input": "A left-sided tunnel catheter terminates at the lower SVC, unchanged in position. The patient is post CABG. The heart size and hilar mediastinal contours remain unchanged since ___. Again seen is some central pulmonary vascular congestion with mild edema, overall stable. Small bilateral pleural effusions appear improved. There is no pneumothorax.", "output": "Central pulmonary vascular congestion with mild edema. Improved small bilateral pleural effusions." }, { "input": "AP portable upright view of the chest. Dialysis catheter again seen terminating in the region of the right atrium. Midline sternotomy wires and mediastinal clips are again noted. A PEG tube projects over the left upper quadrant. Clips are noted in the right upper quadrant. Bilateral pigtail chest tubes are in place as on prior. Tracheostomy tube projects over the superior mediastinum. Cardiomegaly is unchanged. There is mild retrocardiac opacity which appear similar to prior and may represent left lower lobe consolidation with possible small effusion. Right lung is grossly clear without significant pleural effusion. Hila appear somewhat congested. No frank pulmonary edema. No pneumothorax. Bony structures are intact.", "output": "Lines and tubes in place. Retrocardiac opacity may represent persistent pneumonia and small pleural effusion." }, { "input": "Since 2 days prior, bilateral parenchymal opacities have minimally improved. Appearance on today's radiograph appears more consistent with moderate pulmonary edema rather than multifocal pneumonia. Silhouetting of the right hemidiaphragm may be due to a combination of pleural fluid, atelectasis, or consolidation. Crease lucency at the lateral left lung base is consistent with a persistent left basilar pneumothorax, best appreciated on CT chest dated ___. Retrocardiac atelectasis is unchanged. Severe cardiomegaly is unchanged.", "output": "Minimal improvement in diffuse parenchymal opacities, which now appear more consistent with moderate pulmonary edema rather than multifocal pneumonia. Persistent left basilar pneumothorax." }, { "input": "AP portable upright as well as a lateral view of the chest was provided. Midline sternotomy wires are again seen. The previously noted left IJ central venous catheter has been removed. Clips are noted in the right upper quadrant. The kyphotic angulation of the T-spine causes distortion of the chest on the frontal projection. However, allowing for this, there is no definite consolidation or pneumothorax. Blunting of the left CP angle is stable and could represent a small effusion. There is likely bibasilar atelectasis. No signs of pulmonary edema. Heart size is difficult to assess. Mediastinal contour is stable. Bony structures appear intact. No free air below the right hemidiaphragm.", "output": "Stable, limited exam with small left effusion and probable bibasilar atelectasis." }, { "input": "There is slight blunting the posterior costophrenic angles which may be due to trace pleural effusions. No new focal consolidation is seen. There is no evidence of pneumothorax. The cardiac and mediastinal silhouettes are stable. The patient is status post median sternotomy.", "output": "Slight blunting of the posterior costophrenic angles may be due to trace pleural effusions though consolidation." }, { "input": "The lungs are well expanded. There are bilateral pleural effusions, which are not significantly changed compared with prior exam. Bibasilar opacities likely reflect atelectasis. No other focal opacities are identified. Mild cardiomegaly is unchanged. Mild vascular engorgement is also stable. There is no pneumothorax. Sternotomy wires are intact. Right upper quadrant clips are present.", "output": "1. Bibasilar opacities, likely atelectasis but pneumonia is not excluded. 2. Small bilateral pleural effusions, mild vascular engorgement, and mild cardiomegaly are unchanged from prior." }, { "input": "The endotracheal tube terminates 2.7 cm above the carina. The OG tube passes just below the diaphragms and should be advanced 5 cm to position the side-hole into the stomach. Left IJ line terminates at the left brachiocephalic vein, with a left HD line terminating in the lower SVC. No change in the right lower lobe atelectasis and pleural effusion. Heterogeneous opacity of the right middle lobe is changed and concerning for pneumonia. The heart size is slightly smaller. Small left pleural effusion is unchanged. No pneumothorax. Surgical clips in the right upper quadrant of the abdomen are unchanged.", "output": "1. OG tube passes just below the diaphragm and should be advanced 5 cm to position the sideholes in the stomach. 2. Persistent right lower lobe atelectasis, bilateral pleural effusions, and right middle lobe opacity concerning for pneumonia. NOTIFICATION: The above findings and recommendation were communicated via telephone by Dr. ___ to Dr. ___ at 12:08 on ___, 5 min after discovery." }, { "input": "As compared to chest radiograph from 1 day earlier, slight interval improvement of widespread multifocal airspace opacities, more pronounced in the right lung. Central pulmonary vascular congestion persists. Bilateral moderate pleural effusions are stable. Moderate to severe cardiomegaly persists.", "output": "Slight interval improvement of widespread multifocal airspace opacities, likely improving pulmonary edema." }, { "input": "The lungs are clear, the cardiomediastinal shilhouette and hila are normal. There is no pneumothorax and no large pleural effusion.", "output": "No acute process." }, { "input": "Bibasilar opacities likely reflect bilateral well pleural effusions, but cannot exclude a component of atelectasis or a superimposed focus of infection or mass. There is pulmonary vascular congestion, reticular opacities, and cardiomegaly, consistent with mild pulmonary edema. There is no pneumothorax. Sternotomy wires are noted. Clips are seen in the right upper quadrant.", "output": "1. Mild pulmonary edema. 2. Bibasilar opacities likely reflecting bilateral moderate pleural effusions, but cannot exclude a component of atelectasis or superimposed focus of infection or mass." }, { "input": "Portable AP upright chest film ___ at 03:51 is submitted.", "output": "Status post median sternotomy with stable cardiac and mediastinal contours. Lungs appear slightly hyperinflated. No pleural effusions pneumothorax or pulmonary edema. Subtle streaky opacity at the left base does not appear to be appreciably changed since the earlier exam but could reflect an area of atelectasis, although early pneumonia cannot be entirely excluded. Clinical correlation is advised and followup imaging may be helpful." }, { "input": "As compared to radiograph from earlier the same day, new right-sided pigtail catheter with interval decrease in the right-sided pleural effusion which is now small. A very small right apical pneumothorax is suspected. Moderate cardiomegaly with left basal opacity. No interstitial edema.", "output": "Status post right pigtail placement with significant interval decrease in right-sided effusion. A very small right apical pneumothorax is suspected." }, { "input": "Tracheostomy tube is in unchanged position. Sternotomy wires are intact. Left internal jugular catheter has been removed. Mild pulmonary edema is similar compared to ___. Right lung base opacity is slightly increased. Moderate cardiomegaly is stable. Small bilateral pleural effusions are unchanged.", "output": "Right lung base opacity is slightly increased compared to ___, which most likely represents pleural effusion and atelectasis, better seen on subsequent CT abdomen and pelvis. Stable mild pulmonary edema and persistent bilateral pleural effusions, right breater than left." }, { "input": "The patient is somewhat rotated on today's study which limits assessment. The endotracheal tube and nasogastric tube are grossly unchanged in position. The left-sided internal jugular catheter appears to terminate in the left brachiocephalic vein. Previous median sternotomy noted with unchanged appearances of the sutures. There is a hazy opacity at the right lung base consistent with a layering effusion. Small left pleural effusion also seen. Bilateral lower lobe atelectasis, unchanged compared to the prior study. Superimposed infection cannot be excluded. An apparent superior mediastinal mass is likely an artifact as this is related to tubing overlying the patient attention on followup recommended.", "output": "No significant interval change when compared to the prior study." }, { "input": "Single AP view of the chest provided. Patient is status post median sternotomy with wires intact and properly aligned. Tracheostomy tube is in standard position. No pneumothorax. A moderate, right pleural effusion is mildly improved. A small, left pleural effusion was not imaged on the prior examination. Collapse of the right lower lobe is worsened. Hilar are normal. Mild atelectasis, moderate consolidation and a small left pleural effusion are unchanged from ___.", "output": "1. A moderate right pleural effusion and a small left pleural effusion are mildly improved from ___. Minimal vascular congestion is resolved from the prior examination. 2. Collapse of the right lower lobe is worsened from ___. 3. Mild atelectasis, moderate consolidation and a small left pleural effusion are unchanged from ___." }, { "input": "Portable AP upright chest film ___ at 04:54 is submitted.", "output": "Endotracheal tube has its tip at the thoracic inlet. Feeding tube is seen coursing below the diaphragm with the tip not identified. There are layering pleural effusions with bibasilar opacities likely reflecting lobar atelectasis. The upper lungs are grossly clear. No pulmonary edema. Overall cardiac and mediastinal contours are stably enlarged status post median sternotomy for CABG and given lordotic technique. No pneumothorax." }, { "input": "Portable upright chest radiograph ___ at 06:10 is submitted.", "output": "Endotracheal tube, feeding tube and left internal jugular central line unchanged in position. The heart remains stably enlarged status post median sternotomy for CABG. There are bilateral layering effusions with bibasilar airspace opacities likely reflecting compressive atelectasis, although pneumonia cannot be excluded. There has been interval appearance of mild perihilar edema. No pneumothorax." }, { "input": "Since ___, moderate pulmonary edema is improved today, especially in the right lung fields. Unchanged moderate cardiomegaly. Right moderate pleural effusion is unchanged in size. Left tunneled dialysis catheter ends in the right atrium. Tracheostomy tube ends approximately 4 cm from the carina. Left sided pigtail chest tube is in place.", "output": "Since ___, moderate pulmonary edema is improved. Unchanged moderate cardiomegaly and unchanged right moderate pleural effusion. Support devices in appropriate locations." }, { "input": "A portable upright frontal chest radiograph demonstrates intact sternal wires, unchanged. The cardiac silhouette is again mildly enlarged. Bilateral diffuse opacity are improved compared to ___, consistent with improved mild pulmonary edema. Bilateral pleural effusions are mildly improved. There is no pneumothorax. The visualized upper abdomen is unremarkable, except for right upper quadrant clips suggestive of prior cholecystectomy.", "output": "Improvement of mild pulmonary edema and bilateral pleural effusions." }, { "input": "The patient is intubated, the tip of the endotracheal tube is difficult to visualize but is grossly unchanged compared to the prior study approximately 4 cm above the carina. A left-sided internal jugular catheter is in-situ, the tip is at the confluence of the left and right brachiocephalic veins. A nasogastric tube is in-situ, the side port is below the left hemidiaphragm. The patient is status post median sternotomy, sternotomy wires are intact. Bilateral pleural effusions are again seen, unchanged compared to the prior study. Bilateral lower lobe atelectasis also noted. There is prominence of the pulmonary vasculature, unchanged compared to the prior study. Assessment of the heart size is limited by the projection.", "output": "No significant interval change compared to the prior study." }, { "input": "The patient is rotated. ET tube ends at the level of the clavicles. Sternotomy wires are intact and aligned. A left IJ central venous catheter likely terminates in the left subclavian vein. Layering bilateral pleural effusions are unchanged. There is no pneumothorax. Bilateral airspace opacities are unchanged. Moderate cardiomegaly despite the projection is stable. A nasogastric tube terminates in the mid esophagus.", "output": "No appreciable change in bilateral airspace opacities which may either be due to pulmonary edema or infection. Stable moderate bilateral pleural effusions. Nasogastric tube terminates in the mid esophagus. Repositioning advised. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 8:38 AM, 5 minutes after discovery of the findings." }, { "input": "The heart size is normal. The NG tube courses below the diaphragm with the tip likely in the antrum of the stomach however appears to be coiled with a kink in the pylorus. A prominent fat pad is again noted on the left. The aorta appears mildly tortuous. The right hemidiaphragm is elevated, overall stable compared to the prior exam. There appears to be increased atelectasis at the right lung base. The lungs are otherwise clear without evidence of focal consolidations concerning for pneumonia. There are no large pleural effusions. No pneumothorax is identified. Subdiaphragmatically note is made of distended small bowel up to 4-cm loops consistent with patient's known small bowel obstruction.", "output": "NG tube terminates below the stomach however appears to be coiled with a kink within the pylorus, with the tip in the antrum. Recommend clinical correlation or repositioning to ensure appropriate function of the tube. ___ were d/w Dr. ___ by Dr. ___ by telephone at ___:___p on the day of the exam." }, { "input": "As compared to ___, the support devices including bilateral pigtail catheters are in similar position. Right basal opacity and moderate effusion have slightly increased. Left hydropneumothorax has not significantly changed. Mild pulmonary vascular congestion with moderate cardiomegaly.", "output": "Slight interval increase in moderate right sided effusion and adjacent basal opacity. Left hydropneumothorax has not significantly changed." }, { "input": "Lung volumes are low which limits assessment. A left-sided tunneled dialysis catheter is in-situ, unchanged in appearance when compared to the prior study. A tracheostomy in-situ. A right-sided PICC terminates in the LS. Pain in cell drain is in-situ small is unchanged in appearance when compared to the prior study there may be a small adjacent pneumothorax. This area is difficult to evaluate. There is persistent prominence of the pulmonary vasculature consistent with pulmonary vascular congestion. Increased opacity is right noted in the right lower lung likely reflect a combination of both pleural effusion and atelectasis.", "output": "Possible loculated pneumothorax at this site of the pigtail catheter. This area is very difficult to evaluate." }, { "input": "The dobhoff tube is seen passing below the GE junction, however it should be advanced 4-5 cm. There is a left IJ, which terminates in the mid SVC. There is a left basilar chest tube, which appears unchanged in comparison to the prior chest radiograph. The sternotomy wires appear intact and in appropriate alignment. The bilateral pleural effusions and moderate vascular congestion is unchanged. Heart size is stable. The mediastinal and hilar contours are stable. No pneumothorax is seen. There are no acute osseous abnormalities.", "output": "1. Dobhoff tube below GE junction, however it should be advanced 4-5 cm. 2. Appropriate positioning of left IJ and left chest tube. 3. Unchanged bilateral pleural effusions and moderate vascular congestion. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 3:06 PM, 5 minutes after discovery of the findings." }, { "input": "Lung volumes are low, but there are no focal consolidations concerning for pneumonia. Cardiac size remains stable; a prominent fat pad is noted on the left. The right hemidiaphragm is elevated. There is no pleural effusion or pneumothorax. Aorta is again tortuous. There is no evidence of free air. Assessment for volvulus will be performed on the subsequent CT of the abdomen and pelvis.", "output": "No evidence of free air or acute cardiopulmonary process." }, { "input": "The previously described right apical pneumothorax is not seen on today's exam. Compared to ___, the right pleural effusion and right basilar atelectasis is worse. Left basilar opacity is more pronounced. Unchanged moderate cardiomegaly. Support devices are unchanged in position. Mediastinal borders and hilar structures are normal.", "output": "No apical pneumothorax is seen on today's exam. Worsening right pleural effusion and right basilar atelectasis. Worsening left retrocardiac basilar opacity." }, { "input": "Frontal and lateral chest radiographs. Left-sided IJ catheter tip remains in the right atrium. Lung volumes are low with moderate bilateral pleural effusions and adjacent atelectasis. However, pulmonary vascular congestion present on ___ has improved considerably and there is no pulmonary edema. There is no pneumothorax. The cardiomediastinal silhouette is stable.", "output": "Resolving pulmonary edema with small bilateral pleural effusions." }, { "input": "The cardiomediastinal and hilar contours are stable. Moderate bilateral pleural effusions are increased from the prior examination. There is pulmonary vascular congestion and mild edema, also increased from the prior examination. No pneumothorax.", "output": "Moderate pulmonary edema and increased bilateral pleural effusions from ___. Difficult to exclude underlying pneumonia in the absence of a lateral view." }, { "input": "A right-sided PICC terminates in the right axillary vein. A tunnel dialysis catheter is seen. In the left internal jugular, terminating in the right atrium. Lung volumes remain low. There is persistent airspace opacity in the right lower lung, likely related to atelectasis as there is a moderate right-sided pleural effusion. Prominence of the pulmonary vascular is consistent with congestive heart failure. There is moderate cardiomegaly. A pigtail drain is seen in the left upper quadrant. No pneumothorax seen. A tracheostomy is unchanged in appearance compared to the prior study.", "output": "A left-sided pigtail drain is seen. A right-sided PICC terminates in the axillary vein." }, { "input": "The endotracheal tube terminates 5.3 cm above the carina. The NG tube extends to the region of the pylorus or beyond. The left lower lobe is less well aerated. Bibasilar atelectasis has worsened, with possible right lower lobe collapse. Moderate cardiomegaly and pulmonary vascular engorgement is unchanged. No edema or new focal consolidation. Unchanged right upper abdominal quadrant surgical clips.", "output": "1. Atelectasis/right lower lobe collapse has worsened. 2. Worsened aeration of the left lower lobe, with increased left basilar atelectasis." }, { "input": "The patient is status post median sternotomy and CABG, with sternotomy wires that appear intact and appropriately aligned. There is an NG tube that is malpositioned with the tip in the midesophagus. The lungs appear hyperinflated. There is mild vascular congestion bilaterally. Moderate enlargement of the cardiac silhouette. The mediastinal and hilar contours are normal. Bilateral pleural effusions, right worse than left. No pneumothorax is seen. There are no acute osseous abnormalities.", "output": "1. NG tube malpositioned with tip in the mid esophagus. 2. Mild vascular congestion and bilateral pleural effusions consistent with CHF. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 11:26 AM, 15 minutes after discovery of the findings." }, { "input": "Increased opacity at the right lung base on the frontal is likely due to configuration of the diaphragm confirmed on the lateral. There is however blunting of the posterior costophrenic angles and silhouetting of the left hemidiaphragm suggesting effusions with adjacent opacity likely component of associated atelectasis. Cardiomediastinal silhouette is stable. Median sternotomy wires and mediastinal clips are again noted. No acute osseous abnormalities.", "output": "Probable bilateral pleural effusions with adjacent opacity potentially atelectasis noting that infection is not excluded." }, { "input": "Sternotomy wires are intact and aligned. Lung volumes are low, but right mid to lower lung airspace opacities may be due to infection or atelectasis. A left basilar retrocardiac airspace opacity may also be due to atelectasis or infection. The patient's chin and overlying soft tissues partially obscure the lung apices. But there is no obvious pneumothorax. Cardiomegaly despite the projection is unchanged.", "output": "New right mid to lower lung airspace opacities may be due to infection or atelectasis. Stable left basilar infection or atelectasis. No pneumothorax. Stable cardiomegaly." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is not engorged. Lungs are clear. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormalities are visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is a small to moderate left-sided pleural effusion. Cardiac size remains stable. NG tube courses into the stomach and off the film. Right-sided PICC line terminates in the high SVC. There is no evidence of infection. Bibasal atelectasis is present.", "output": "Small to moderate left-sided pleural effusion." }, { "input": "ET tube is 6 cm above the carina but remains below the thoracic inlet. An enteric tube terminates within the stomach. A right PICC line is seen terminating in the mid superior vena cava. The lungs are hyperexpanded. Improved haziness at the lung bases compatible with resolving pleural effusions. Small bilateral pleural effusions persist. Pleural calcifications are again noted. There is no pneumothorax or focal airspace consolidation. The cardiac and mediastinal contours are unchanged.", "output": "ET tube 6 cm above the carina but below the thoracic inlet." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are normal. The lungs are clear. There is no pleural effusion or pneumothorax", "output": "No acute intrathoracic abnormality." }, { "input": "Mediastinal air tracks along the descending aorta. There is no evidence of pneumothorax. There is no focal lung consolidation. There is no pleural effusion. Median sternotomy wires are present.", "output": "Mediastinal air tracking along the descending thoracic aorta. NOTIFICATION: Findings of mediastinal air discussed with thoracic surgery resident Dr. ___ by Dr. ___ on ___ at 02:30, at the time of discovery." }, { "input": "Cardiomediastinal contours are normal. Bibasilar atelectasis have improved still larger on the left. Small bilateral effusions are grossly unchanged larger on the left. There is no pneumothorax. Sternal wires are aligned. Patient is status post CABG.", "output": "Small bilateral pleural effusions with adjacent atelectasis larger on the left." }, { "input": "The lungs are well expanded and clear. Hila and cardiomediastinal contours and pleural surfaces are normal.", "output": "Normal. No evidence of pneumonia. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 1:59 PM, 10 minutes after discovery of the findings." }, { "input": "Bibasilar atelectasis and lung volume loss is seen both on the PA and lateral radiographs. Right lung basilar atelectasis is seen with right pleural effusion. Left lower lung volume loss is seen with triangular opacity overlying the posterior left lung base. This opacity may represent pneumonia versus chronic infectious change. No pulmonary edema is noted, and the cardiac silhouette and mediastinal contours are within normal limits.", "output": "There is bibasalir lung volume loss. The right-side has an associated pleural effusion. The left lung base has a posterior triangular opacity which may represent a pneumonia versus chronic infectious change." }, { "input": "The inspiratory lung volumes are appropriate. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The pulmonary vasculature is not engorged. The cardiomediastinal and hilar contours are within normal limits with mild unfolding of the thoracic aorta. Again noted is a moderate hiatal hernia. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process. Unchanged moderate hiatal hernia." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest were obtained. Patchy right basal opacity is seen, which could be due to aspiration or infection. The left lung is clear. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "Subtle patchy right base opacity could be due to aspiration, infection or atelectasis." }, { "input": "Left-sided Port-A-Cath tip terminates in the lower SVC. Heart size is normal. Aorta is tortuous. Mild atherosclerotic calcifications are seen diffusely throughout the aorta. The pulmonary vasculature is normal and the hilar contours are unremarkable. No focal consolidation or pneumothorax is seen. Blunting of the costophrenic angles bilaterally suggests trace bilateral pleural effusions. No acute osseous abnormality is identified.", "output": "Port-A-Cath in the lower SVC. Trace bilateral pleural effusions." }, { "input": "PA and lateral views of the chest demonstrate normal lung volumes. There is no pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Low lung volumes are noted with secondary crowding of the bronchovascular markings. There is no consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. There is deviation of the trachea at the left at the thoracic inlet. Degenerative changes are noted at the shoulders.", "output": "No acute cardiopulmonary process. Deviation of the trachea to the left at the thoracic inlet raising the possibility of underlying right-sided thyroid enlargement. RECOMMENDATIONS: Nonurgent thyroid ultrasound for evaluation for underlying thyroid lesion." }, { "input": "There is a 9 mm rounded opacity projecting over the right anterior 6th rib, which may represent a nipple shadow. 4 mm granuloma is noted in the right upper lung. Otherwise no consolidation, effusion or pneumothorax. Cardiomediastinal contours are normal. No subdiaphragmatic free air.", "output": "9 mm rounded opacity projecting over the right lung base, which may represent a nipple shadow. Recommend repeating a frontal chest radiograph with nipple markers. If this persists, a chest CT is recommended to evaluate for lung nodule. RECOMMENDATION(S): Repeat frontal chest radiograph with nipple markers. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 11:04 AM, 2 minutes after discovery of the findings." }, { "input": "There is a large hiatal hernia. Its size is even increased somewhat, although this may be due to waxing and waning degree of aeration. The pulmonary vasculature appears indistinct, suggesting mild fluid overload. Streaky opacities at the medial lung bases are typical for atelectasis associated with a large hiatal hernia. It is difficult to exclude small pleural effusions, although none are explicitly demonstrated. Spinal curvature and moderate degenerative changes along the lower thoracic spine appears similar, but not completely characterized.", "output": "1. Large hiatal hernia, somewhat increased air bubble associated with it. 2. Findings suggesting mild vascular congestion." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Lung volumes are low with increased bibasilar atelectasis. Moderate to severe cardiomegaly and at least moderate pulmonary edema are unchanged. Pleural effusions are small, if any. Interval removal of a left subclavian central venous catheter introducer.", "output": "Moderate pulmonary edema is unchanged. Increased bibasilar atelectasis and probable small bilateral pleural effusions." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Normal heart size, mediastinal and hilar contours. Faint opacity in the right middle lobe concerning for developing pneumonia. No pleural effusion or pneumothorax.", "output": "Faint right middle lobe opacity concerning for developing pneumonia." }, { "input": "The heart size may be slightly decreased compared to the prior exam but is still mildly enlarged. Bilateral small pleural effusions are overall unchanged. The lungs are clear. No focal consolidation, pulmonary edema, or pneumothorax. The thoracic aorta is calcified and ectatic. Mild dextroconvex scoliosis of the thoracic spine is unchanged.", "output": "No interval change in bilateral small pleural effusions." }, { "input": "Lung volumes are low. Moderate cardiomegaly persists. Mediastinal contour is unchanged. Blunting of the bilateral costophrenic angles likely secondary to small effusions. There is no pneumothorax. No definite focal consolidation is seen.", "output": "1. Moderate cardiomegaly, not significantly changed. 2. Small bilateral pleural effusions. 3. No definite evidence of pneumonia. No pneumothorax." }, { "input": "Frontal and lateral chest radiographs demonstrate an enlarged cardiac silhouette, which may in part be due to low lung volumes. There is no focal consolidation or pneumothorax. There are bilateral small pleural effusions. The visualized upper abdomen is unremarkable.", "output": "1. The cardiac silhouette is enlarged, increased in size compared to ___. Although this could represent recurrent pericardial effusion, it may be related to lower lung volumes. Echocardiography may be more helpful in the detection of pericardial effusion. 2. Bilateral small pleural effusions." }, { "input": "There are small bilateral pleural effusions, with blunting of the posterior costophrenic angles. No focal consolidation is seen. There is no pneumothorax. The cardiac silhouette is moderately enlarged. Mediastinal contours are unremarkable. No overt pulmonary edema is seen.", "output": "Moderate cardiomegaly and small bilateral pleural effusions." }, { "input": "There is a hazy opacity in the right mid to lower lung ___ which is not definitely seen on the lateral radiograph. This is concerning for a possible pneumonia or aspiration. There is no evidence of pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is normal.", "output": "Hazy opacification in the right mid to lower lung ___, ___ be due to infection or aspiration." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The cardiomediastinal silhouettes are stable and within normal limits. The bilateral hila are normal. There is no pulmonary vascular congestion. The lungs are clear. There is no pneumothorax or pleural effusion.", "output": "Unremarkable chest radiograph. No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There is no pleural effusions or pneumothorax.", "output": "No evidence of acute disease." }, { "input": "The lungs are clear. There is no evidence of pneumonia, pneumothorax, or pleural effusion. Cardiac silhouette is normal in size.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart size is top normal. Note is again made of a right paratracheal mediastinal bulge secondary to the previously seen mediastinal cyst. No pleural effusions, pneumothoraces or focal consolidations are identified. Again seen on the lateral radiograph is fracture of the mid shaft of the left humerus, overall stable compared to the prior exam. The lateral radiograph is limited due to the patient being unable to raise his arm.", "output": "1. No evidence of focal consolidation. Stable right paratracheal mediastinal bulge, due to known mediastinal cyst. 2. Stable fracture of the mid shaft of the left humerus." }, { "input": "The right upper mediastinal contour is bulging (part of this area is imaged on a CT of the cervical spine performed on the same day, suggesting a cystic lesion in the area), not significantly changed although long-term follow-up is not available. The heart is normal in size. The mediastinal and hilar contours are otherwise unremarkable. The lung fields appear clear. There is no pleural effusion or pneumothorax.", "output": "1. No evidence of injury. 2. Widening of the right mediastinum, probably reflecting a cystic lesion. Investigation with chest CT, preferably with intravenous contrast, if possible, is suggested when clinically appropriate." }, { "input": "The cardiac and hilar contours are normal. Right paratracheal mediastinal bulge compatible with known mediastinal cyst is unchanged. The pulmonary vasculature is normal and the lungs are clear. There is no pleural effusion or pneumothorax. No acute osseous abnormalities are detected. Mild degenerative changes are noted within the thoracic spine. Partially imaged is hardware within the left humerus.", "output": "No acute cardiopulmonary abnormality. Unchanged right paratracheal mediastinal bulge compatible with known mediastinal cyst." }, { "input": "Heart size is normal. Mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities seen.", "output": "Normal chest radiograph." }, { "input": "Lung volumes continue to be low. There is increased vascular plethora and ill-defined vascularity. Although lung volumes are low on the has a similar volume previously when the vasculature did not appear so engorged. Therefore there is likely an element of fluid overload. It is difficult to assess for focal infiltrate given the low lung volumes", "output": "Vascular plethora likely due to fluid overload" }, { "input": "Low lung volumes cause bronchovascular crowding. Elevation the left hemidiaphragm is stable from multiple prior studies. Enlarged cardiac silhouette is unchanged from multiple prior studies, likely related to tortuous aorta and mediastinal fat. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear aside from minimal dependent atelectasis. There are no pleural effusions. No pneumothorax is seen. The heart size is within normal limits. The mediastinal contours are normal. Note is made of a large hiatal hernia, as before. There is air under both hemidiaphragms, consistent with pneumoperitoneum, not unexpected in a post-operative patient. Additionally, a small quantity of air seen within the mediastinum, also not unexpected post-operatively.", "output": "1. No acute cardiac or pulmonary process. 2. Pneumomediastinum and pneumoperitoneum are not necessarily unexpected findings in a patient status post recent hiatal hernia repair." }, { "input": "No focal consolidation, pleural effusion, or pneumothorax is detected. Heart and mediastinal contours are within normal limits. Left Port-A-Cath terminates in the region of the cavoatrial junction.", "output": "No radiographic evidence for acute cardiopulmonary process. After attending radiologist review, results were discussed with ___ by ___ by telephone at 3:50 p.m. on ___." }, { "input": "Frontal and lateral views of the chest were obtained. There is blunting of the left costophrenic angle which may be due to pleural thickening/scarring versus a trace pleural effusion. Otherwise, no definite effusion is seen on the lateral view. There is no focal consolidation. No overt pulmonary edema is seen. No evidence of pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. Bilateral nipple shadows are incidentally noted.", "output": "Blunting of the left costophrenic angle, of uncertain acuity, could be due to pleural thickening/scarring versus a trace pleural effusion." }, { "input": "Since the chest radiograph obtained 1 day prior, there are new hazy opacities in the mid and lower right lung. Extensive parenchymal and pleural changes in the left hemithorax are grossly unchanged with at least a moderate, loculated, left apical pleural effusion and a moderate, dependent, left pleural effusion. The visualized cardiomediastinal and hilar silhouettes are unchanged. No pneumothorax.", "output": "New hazy opacities in the lateral mid and lower right lung likely reflect an underlying infectious process." }, { "input": "Near complete opacification of the left lung has progressed with increasing left-sided pleural effusion and further collapse of the left lung. The left lower lobe masslike opacity is unchanged an can be round atelectasis. There is crowding of the bronchovascular markings and mild pulmonary vascular congestion in the right lung. Endotracheal tube is 3 cm from the carina. The first side port of the nasogastric tube is at the gastroesophageal junction. In the right upper quadrant a TIPS catheter is noted.", "output": "1. Near-complete opacification of the left lung with worsening pleural effusion and further collapse. 2. Mild pulmonary vascular congestion in the right lung. 3. The first side port of the nasogastric tube is at the gastroesophageal junction." }, { "input": "The lungs are hyperinflated but clear without focal consolidation or edema. Cardiomediastinal silhouette is stable. No acute osseous abnormalities. Hypertrophic changes noted in the spine.", "output": "Hyperinflation without acute cardiopulmonary process." }, { "input": "The lungs are again noted to be mildly hyperexpanded with flattening of the bilateral hemidiaphragms, compatible with mild COPD. No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. The heart size is normal. Mediastinal contours are normal. No acute bony abnormality is detected.", "output": "1. No radiographic evidence for acute cardiopulmonary process. 2. Mild COPD." }, { "input": "The patient is status post VATS within the right lung. There is a moderate in size right pleural effusion which appears loculared and with associated compressive atelectasis. There is trace pleural fluid within the left lung with slight hazy opacity that likely reflects atelectasis. The heart is within upper limits of normal in size. No focal consolidations are seen within the lungs. Trace pleural thickening is noted. There is no evidence of pneumothorax. Mild degenerative change is seen within the thoracic spine.", "output": "Moderate-sized loculated right pleural effusion. Please refer to the most recent CT for further findings in the chest." }, { "input": "The patient is status post right upper lobe wedge resection with a chest tube in place. No large pneumothorax is identified. Mild bibasilar atelectatic changes are again noted. The heart appears moderately enlarged, stable. There is prominence of central pulmonary vasculature suggestive of mild pulmonary venous congestion.", "output": "Status post right upper lobe wedge resection with chest tube in place. No evidence of pneumothorax. There is mild bibasilar atelectasis and mild pulmonary venous congestion postsurgery." }, { "input": "PA and lateral views of the chest were provided. The lungs are hyperinflated. There is no overt edema or signs of pneumonia. There is minimal diffuse ground-glass opacity which could represent a very mild pulmonary edema. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm. The heart is top normal in size.", "output": "COPD, possible mild pulmonary edema." }, { "input": "PA and lateral views of the chest. The lungs are clear of focal consolidation or effusion. Cardiac silhouette is mildly enlarged. The thoracic aorta is tortuous. There is increased density adjacent to the superior portion of the mediastinum on the right. This has the appearance of tortuosity of the vessels, especially given that the density is not seen above the clavicle. No acute osseous abnormality identified.", "output": "No definite acute cardiopulmonary process. Rounded density in the right paramediastinal region, potentially tortuosity of the great vessels, however given lack of prior or other exam to confirm, nonurgent chest CT is suggested." }, { "input": "The heart is moderately enlarged, but unchanged in appearance. The aorta is tortuous. A right basal opacity is minimally increased from the prior study done in ___ and may be due to an area of atelectasis, mild pleural thickening or mild asymmetric edema in that area. There is no large pleural effusion or pneumothorax.", "output": "Right basal opacity appears increased from ___ and may be related to atelectasis, pleural thickening or mild asymmetric edema in that area." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. The lungs are hyperinflated. There is flattening of the right hemidiaphragm with elevation suggestive of a subpulmonic effusion on the right although not substantial on the lateral view. There is patchy peribronchial opacity projecting over the left mid lung, apparently within the lingula which could be seen in the setting of bronchial inflammation. An oval opacity in the right upper lung, probably in the right upper lobe, appears somewhat more dense than before and may be associated with mucous plugging. Degenerative changes appear similar along the thoracic spine.", "output": "Suspected right-sided pleural effusion, which may be have increased. Patchy areas of bronchovascular opacities suggesting airway inflammation and possibly mucous plugging." }, { "input": "PA and lateral views of the chest. The lungs are clear. There is no pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "There are relatively low lung volumes. Mild pulmonary vascular congestion is seen. There is no focal consolidation. No large pleural effusion or pneumothorax is seen. The cardiac silhouette is mildly enlarged. The aorta is calcified and tortuous.", "output": "Mild pulmonary vascular congestion." }, { "input": "Cardiomediastinal contours are within normal limits. Pacer leads are in standard position with tips in the right atrium and right ventricle. There appears to be a coronary stent. . The lungs are hyperinflated and grossly clear. There is biapical pleural - parenchyma scarring There is no pneumothorax or pleural effusion. The osseous structures are unremarkable", "output": "No acute cardiopulmonary abnormalities" }, { "input": "Single semierect frontal view of the chest demonstrates top normal heart size, likely accentuated by AP technique. Apparent mild widening of the mediastinum may be related to semi-supine positioning. Minimal vascular congestion is present. The lungs are relatively well aerated allowing for underpenetration. No pneumothorax or large effusion.", "output": "Limited exam. Mild pulmonary vascular congestion." }, { "input": "PA and lateal views of the chest. The lungs are clear. The cardiac, mediastinal, and hilar contours are normal. There is no pleural effusion or pneumothorax. No evidence of free air.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear without focal airspace consolidation or pulmonary edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. There is no evidence of free intraperitoneal air below the hemidiaphragms. Bridging anterior osteophytes are noted along the low thoracic vertebral bodies.", "output": "1. No evidence of free intraperitoneal air. 2. No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Vascular catheter is unchanged in position.", "output": "No radiographic evidence of pneumonia." }, { "input": "The lungs are clear. There is no effusion, consolidation, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation, pleural effusion or pneumothorax identified. The size of the cardiomediastinal silhouette is within normal limits.", "output": "No pneumonia." }, { "input": "PA and lateral views of the chest. There is no focal consolidation, pleural effusion or pneumothorax. The heart size is mildly enlarged. The mediastinal contours are unremarkable. There is no evidence of widened mediastinum. No free air.", "output": "Mild cardiomegaly. No evidence of widened mediastinum. The lungs appear clear." }, { "input": "Postoperative changes of right upper lobectomy are again seen. Right chest wall port catheter tip at the RA SVC junction. There is more conspicuous opacity at the lateral aspect of the left lung overlying the posterior left eighth rib which corresponds to the nodular opacity on prior chest CT. Known other bilateral pulmonary nodules are not clearly depicted on this chest x-ray. There is no consolidation, effusion, or vascular congestion. The cardiomediastinal silhouette is stable. No acute osseous abnormalities identified.", "output": "No definite acute cardiopulmonary process PA. Opacity in left lung laterally corresponds to region of known pulmonary nodule on prior chest CT. Other known bilateral pulmonary nodules are not as clearly seen on this chest x-ray although CT would offer additional details desired." }, { "input": "PA and lateral views of the chest provided. Right IJ access Port-A-Cath is seen with its tip in the low SVC. There is right apical cap with scarring as on recent CT chest. Scattered known pulmonary nodules are poorly visualized. No convincing evidence for pneumonia, edema, large effusion or pneumothorax. Cardiomediastinal silhouette appears stable. Bony structures are intact.", "output": "As above." }, { "input": "A right IJ line ends in the region of the right atrium. Lung volumes are low and there is moderate atelectasis at the lung bases. The cardiomediastinal silhouette is unchanged. . The lung fields otherwise clear. Elevation of left hemidiaphragm is unchanged.", "output": "A right IJ line ends in the region of the right atrium." }, { "input": "An endotracheal tube ends in the right mainstem bronchus. An enteric tube courses below the level of the diaphragm. Lung volumes are low with mild bibasilar atelectasis. A right IJ line ends in the right atrium.", "output": "An endotracheal tube ends in the right mainstem bronchus and should be pulled back. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the ___ ___ at 1:11 PM, 5 minutes after discovery of the findings." }, { "input": "AP upright and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. Cardiomegaly is similar to prior. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Postoperative changes are similar to prior.", "output": "No acute intrathoracic process." }, { "input": "Compared with prior radiographs on ___, there has been interval placement of a left-sided chest tube, ETT and nasogastric tube, as well as removal of a right IJ catheter. The nasogastric tube terminates above the left hemidiaphragm, possibly in a previously seen hiatal hernia. The ET tube is appropriately positioned. There is no pneumothorax. A right layering pleural effusion and atelectasis are similar to prior.", "output": "A nasogastric tube terminates above the left hemidiaphragm, possibly in a previously seen hiatal hernia. A lateral view could be obtained for further evaluation." }, { "input": "An endotracheal tube terminates 3.7 cm above the carina. An enteric tube terminates within a large hiatal hernia, above the level of the diaphragm. Numerous surgical clips project over the mediastinum. The heart may be minimally enlarged. There is mild pulmonary vascular congestion as well as subtle opacity at the base of the right lung which may represent atelectasis or possibly aspiration in the appropriate clinical setting. There is a large left pneumothorax causing rightward mediastinal shift.", "output": "1. Large left pneumothorax causing rightward mediastinal shift. 2. Enteric tube terminates within a large hiatal hernia above the diaphragm. 3. Opacity at the base of the right lung may represent atelectasis or aspiration in the appropriate clinical setting. 4. Mild pulmonary vascular congestion. NOTIFICATION: Findings communicated with ___ via telephone at 7:42 AM by Dr. ___ 5 minutes after the finding was made." }, { "input": "Again noted is stable appearance of multiple clips overlying the mediastinum. Right sided tubular structure is likely overlying the patient. Lung volumes are slightly smaller than on prior examination. The cardiomediastinal silhouette is stable since the prior examination. There is slight increase in interstitial opacity and pulmonary vascular congestion.Again noted is a large hiatal hernia. Right basilar opacity is again demonstrated, involving portions of the right middle and right lower lobe, slightly improved in the right lower and slightly worse in the right middle lung with increasing obscuration of the right heart border. No definite pleural effusion or pneumothorax is identified.", "output": "1. Persistent right basilar consolidation, concerning for pneumonia in the appropriate clinical setting. 2. Mild pulmonary edema." }, { "input": "Portable upright chest film ___ at 09:08 is submitted.", "output": "Interval removal of the left pigtail chest tube and endotracheal tube. Chain sutures and multiple surgical clips overlying stable postop mediastinal and cardiac contours. Intra thoracic stomach. Increasing right basilar opacity concerning for aspiration or pneumonia rather than atelectasis. Clinical correlation is advised. No evidence of pulmonary edema. No pneumothorax, although the mandible obscures the most medial aspect of the right apex. No large pleural effusions." }, { "input": "Patient is status post esophagectomy with multiple clips noted in the mediastinum and unchanged appearance of the mediastinal contour. Heart size is normal. Mild pulmonary vascular congestion is present. Right basilar patchy opacity has improved in the interval, likely reflective of improving pneumonia. Minimal atelectasis is seen in the left lung base. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "1. Improving right basilar patchy opacity likely reflective of improving pneumonia. 2. Mild pulmonary vascular congestion." }, { "input": "Enteric tube ends in the stomach. Left PICC ends at the origin of the SVC. There is stable elevation of the right hemidiaphragm with adjacent atelectasis. Left lower lobe atelectasis is unchanged. There is possibly a small left pleural effusion. No pneumothorax. No focal consolidation.", "output": "Stable elevation of right hemidiaphragm and bibasilar atelectasis. Mare lateral apex to the right hemidiaphragm suggests subpulmonic pleural effusion. Increase in pulmonary vascular congestion." }, { "input": "Single portable chest radiograph demonstrates interval placement of an enteric catheter, which courses below the left hemidiaphragm and out of view. With consideration to lower lung volumes, there is slightly increased fluid overload. Bibasilar atelectasis identified without focal opacification concerning for pneumonia. No definite pleural effusions identified. No pneumothorax.", "output": "Slightly increased fluid overload. Enteric catheter courses below the left hemidiaphragm and out of view." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged including bilateral hilar prominence, particularly on the right, where it may partly reflect atelectasis associatd with marked relative elevation of the right hemidiaphragm. Opacification of the left costophrenic sulcus suggests minor atelectasis, although small coinciding pleural effusions are difficult to exclude. There is no pneumothorax.", "output": "No definite evidence of acute cardiopulmonary disease." }, { "input": "Single semi-upright portable chest radiograph demonstrates stable elevation of the right hemidiaphragm with adjacent atelectasis. Minimal opacification in the left lung base likely reflects atelectasis. No overt pulmonary edema identified. Cardiomediastinal and hilar contours are unremarkable. No pleural effusion is present.", "output": "Stable right hemidiaphragm elevation. No pneumonia identified." }, { "input": "Single frontal view of the chest demonstrates multiple external EKG leads projecting over the thorax. There is slight patient rotation to the left. There is persistent elevation of the right hemidiaphragm and decreased lung volume on the right. Compared to a week ago, there is mild improvement of pulmonary edema on the right, which remains persistent on the left. The cardiomediastinal silhouette appears prominent but likely accentuated by low lung volume and AP technique. There is no large pleural effusion. Plate-like atelectasis is present at the right lung base.", "output": "Mild improvement of pulmonary edema in the right lung, without significant change on the left." }, { "input": "Left-sided pacemaker device is noted with leads terminating in the right atrium and right ventricle, unchanged. The heart size remains mildly enlarged but unchanged. The mediastinal and hilar contours are stable with mild calcification of the aortic knob. There is no pulmonary vascular congestion. Streaky linear opacities are seen within both lung bases, likely reflective of atelectasis. No focal consolidation, pleural effusion or pneumothorax is visualized. No acute osseous abnormalities are detected.", "output": "Streaky and linear bibasilar airspace opacities most likely reflective of atelectasis." }, { "input": "No pneumothorax is seen bilaterally with both pigtails in stable position. There is moderate left pleural effusion seen with adjacent left lower lobe atelectasis and elevation of the left hemidiaphragm. The cardiac silhouette remains enlarged. No focal consolidation is seen, and surgical changes including median sternotomy wires and aortic valve replacement are unchanged.", "output": "No pneumothorax is visualized on either side. Continued left pleural effusion and associated lower lobe atelectasis." }, { "input": "Right PICC line ends in the mid to lower SVC. The cardiac silhouette continues to be mildly enlarged postoperatively, and no vascular congestion or pulmonary edema is seen. Median sternotomy wires are intact. Continued left lower lobe atelectasis and associated elevation of the left hemidiaphragm is seen. Mild left pleural effusion continues to be seen. No focal consolidation is seen.", "output": "Left lower lobe atelectasis and pleural effusion." }, { "input": "Since the prior radiograph, there has been resolution of the left pleural effusion. The heart is normal in size and mediastinal contours are normal. Aortic valve replacement and sternal wires are noted. No evidence of pneumonia, pleural effusion, or pneumothorax", "output": "No acute cardiopulmonary process." }, { "input": "There are small bilateral pleural effusions, larger on the right than on the left, as seen on previous exam. Associated right basilar atelectasis is noted. Superiorly, the lungs are clear. Cardiac silhouette is enlarged similar to prior. Linear calcific density at the left ventricular apex is compatible with prior infarct. Cystic prevascular mediastinal lesion and bilateral pulmonary nodules are better seen on prior CT scan.", "output": "Bilateral pleural effusions, right greater than left, similar to recent CT scan. Known and pulmonary nodules better seen on CT scan." }, { "input": "There is moderate pulmonary edema. Bilateral pleural effusions are also noted, right greater than left. The cardiac silhouette is mildly enlarged. There is no pneumothorax. A left chest AICD and leads are in unchanged positions.", "output": "Moderate pulmonary edema. Bilateral pleural effusions, right greater than left." }, { "input": "Interstitial markings are increased. There is additional streaky density bilaterally consistent with subsegmental atelectasis or scarring. There are small pleural effusions as well. The heart and mediastinal structures are stable. An ICD remains in place. The bony thorax is grossly intact.", "output": "Increased interstitial markings consistent with edema. Small pleural effusions." }, { "input": "An ICD is seen with leads extending into the right atrium and right ventricle. An aortic abdominal aorta stent is incidentally noted, unchanged and appearance from the prior examination. The lungs appear hyperinflated with flattening of the bilateral diaphragms. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema identified. The heart size is normal. A focal convexity at the left cardiomediastinal contour is see just below the left hilum, likely due to rotation. Incidentally noted are several healed right rib fractures.", "output": "1. Hyperexpanded lungs suggestive of COPD. 2. New focal convexity of the left cardiomediastinal contour just below the left hilum, possibly due to slight patient rotation. Recommend repeating the radiograph with proper patient positioning to exclude a mediastinal mass. Findings were conveyed by Dr. ___ to the office of Dr. ___ on ___ at 11:30 am." }, { "input": "There is a new moderate loculated right-sided pleural effusion with associated compressive atelectasis. An opacification projecting over the heart on the lateral view was not seen on the prior study of ___ and in the proper clinical setting could represent right middle lobe pneumonia. The lungs are stably hyperexpanded, suggesting air trapping. There is no pulmonary vascular congestion or pulmonary edema. The rounded contour seen at the left hilum is more prominent on the current study compared with ___, in spite of improved positioning and a dedicated chest CT is recommended for further evaluation. The heart size is top-normal. Left chest wall dual chamber pacemaker leads in standard position.", "output": "1. New moderate loculated right-sided pleural effusion. 2. New opacity in the right middle lobe, which in the proper clinical setting could represent right middle lobe pneumonia. 3. Prominent left hilar contour for which dedicated chest CT is recommended. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 2:55 PM, 30 minutes after the discovery of the findings." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. There are mild degenerative changes within the thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "A left-sided PICC line has been removed. The heart is mildly enlarged. The mediastinal and hilar contours appear unchanged. There is persistent patchy opacity at the left lung base, suggesting a combination of atelectasis or consolidation and most likely with a small pleural effusion, but not well delineated. The pulmonary vasculature is indistinct and prominent suggesting mild vascular congestion. There is no pneumothorax.", "output": "Findings suggesting mild vascular congestion. Persistent patchy left basilar opacity, probably parenchymal opacity with small pleural effusion, although not well delineated." }, { "input": "Mild pulmonary edema is unchanged since ___. Heart size is mild to moderately enlarged and similar since at least ___. Bilateral lower lung opacities and increased retrocardiac density, likely represent atelectasis and/or consolidation in combination with bilateral pleural effusions, mild-to-moderate left and minimal right, and has not really changed much since last 24 hours. Concurrently associated bilateral lower lung infection cannot be ruled out, and needs clinical correlation.", "output": "Mild-to-moderate pulmonary edema, bilateral lower lung opacities due to combination of atelectasis and/or consolidation, mild-to-moderate left and minimal right pleural effusions and mild to moderately enlarged heart size have not changed over last 24 hours. Concurrently associated infection in lower lungs cannot be ruled out, clinical correlation is required." }, { "input": "AP portable upright view of the chest. There is no free air below the right hemidiaphragm. Small left effusion with left basal atelectasis is again noted. There is mild pulmonary edema which is not significantly changed from prior exam. Heart size remains mildly enlarged.", "output": "No significant change from prior with mild pulmonary edema, small left pleural effusion and left basal atelectasis." }, { "input": "The cardiomediastinal silhouette, aorta, and pulmonary vasculature are within normal limits. There is no consolidation or pleural effusion. Degenerative changes of the mid to lower thoracic spine are moderate.", "output": "No acute process. No pneumonia." }, { "input": "Moderate enlargement of the cardiac silhouette persists. The aorta remains tortuous and diffusely calcified. A moderate to large layering right pleural effusion and small left pleural effusion are present, with the right pleural effusion likely larger in size in the interval. Lung volumes are low with patchy opacities the lung bases likely reflective of compressive atelectasis. Crowding of the bronchovascular structures is noted with probable mild pulmonary vascular congestion. No large pneumothorax is demonstrated. Right PICC has been removed.", "output": "Probable interval increase in size of moderate to large layering right pleural effusion, unchanged small left pleural effusion. Bibasilar atelectasis. Mild pulmonary vascular congestion." }, { "input": "An endotracheal tube terminates approximately 4.3 cm above the carina. Diffuse hazy opacity over the right hemithorax with associated blunting of the right costophrenic angle is likely secondary to a small to moderate-sized pleural effusion. Retrocardiac and left lung base opacity persists, likely secondary to atelectasis and pleural fluid. There is no pneumothorax.", "output": "Small to moderate right pleural effusion. Persistent retrocardiac and left lower lobe opacity likely reflects a combination of atelectasis and pleural fluid." }, { "input": "Since prior chest radiograph, there has been interval placement of an endotracheal tube, which terminates proximal to the carina. An orogastric tube courses below the diaphragm, the tip terminates within the stomach. The cardiac silhouette is difficult to assess. Interval decreased opacity at the right lung base could be secondary to interval decrease in right pleural effusion versus positional changes. There is increased opacity at the left lung base, which could be secondary to fluid and atelectasis. A stent projects over the mid upper abdomen.", "output": "Interval placement of an endotracheal tube which appears to terminate just proximal to the carina. Orogastric tube is in adequate position." }, { "input": "PA and lateral views of the chest are provided. The heart remains markedly enlarged. There is a small left pleural effusion which appears slightly increased from the prior exam. There is no pulmonary edema, focal consolidation or pneumothorax. Bony structures are intact. Mediastinal contour is normal. No free air below the right hemidiaphragm.", "output": "Stable marked cardiomegaly with small left pleural effusion." }, { "input": "The lungs are well expanded. Cephalization of the pulmonary vasculature is seen without overt pulmonary edema. There is also an enlarged cardiac silhouette. Slight blunting of the posterior costophrenic angles is seen on the lateral view which may be due to trace pleural effusions.", "output": "Cephalization of the pulmonary vasculature with enlarged cardiac silhouette. No overt pulmonary edema. Slight blunting of the posterior costophrenic angles seen on the lateral view may be due to trace pleural effusions." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. A left PICC terminates in the mid SVC, unchanged in position from the prior exam. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process. Specifically, no evidence of pneumonia." }, { "input": "The heart size is normal. The hilar and mediastinal contours are unremarkable. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable. Of note, there is an impression in the right superior portion of the trachea which may be secondary to a thyroid abnormality.", "output": "1. No acute abnormalities identified. 2. Impression on the right side of the trachea, likely secondary to a thyroid abnormality." }, { "input": "There has been interval removal of a left subclavian catheter. No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. Heart and mediastinal contours are within normal limits.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "The cardiac silhouette is within normal limits. The mediastinum is not widened and unremarkable in this frontal view. Opacity at the left lung base could reflect overlying costochondral calcifications. There is no large pleural effusion or pneumothorax. No focal consolidations concerning for pneumonia are identified. No definite fractures identified. External leads are seen overlying the chest.", "output": "Mediastinum is not widened and appears unremarkable in this frontal view." }, { "input": "Low lung volumes are seen with secondary crowding of the bronchovascular markings. There is no confluent consolidation or large effusion. There may be mild pulmonary vascular congestion. Cardiac silhouette is difficult to assess given technique and lung volumes although it is unchanged from prior. Atherosclerotic calcifications are noted at the aortic arch. No acute osseous abnormality identified.", "output": "Low lung volumes without focal consolidation. Possible component of vascular congestion." }, { "input": "Moderate cardiomegaly appeasr stable. The thoracic aorta is tortuous with a calcified aortic knob. Mild bibasilar atelectasis without substantial pleural effusion. No overt CHF. No lobar consolidation or pneumothorax.", "output": "Moderate cardiomegaly and mild bibasilar atelectasis. No overt CHF or focal consolidation." }, { "input": "There is moderate cardiomegaly overall unchanged compared to the prior exam. Calcifications are seen within the aortic arch. Prominence of the hilar and mediastinal contours are stable. There is no definite lobar consolidation, or pneumothorax. Low lung volumes result in mild bibasilar atelectasis. There is no large pleural effusion. No evidence of CHF.", "output": "Mild bibasilar atelectasis. A superimposed infectious process can't be excluded in the appropriate clinical setting." }, { "input": "AP and lateral views of the chest. Low lung volumes are seen with secondary crowding of the bronchovascular markings. Streaky bibasilar opacities are most likely due to atelectasis. Lateral view is limited secondary to motion but there is no evidence of effusion. Cardiac silhouette is enlarged and is accentuated by low lung volumes. Atherosclerotic calcifications seen at the aortic arch.", "output": "Low lung volumes without definite acute cardiopulmonary process." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "There is mild effacement of the right cardiac border and faint opacification within the right lower lobe, which could relate to resolving/known pneumonia, however recent radiographs are unavailable for comparison. The cardiomediastinal and hilar contours are within normal limits. There is no pleural effusion or pneumothorax.", "output": "Mild right lower lobe opacity reflecting either resolving or evolving pneumonia. No effusions." }, { "input": "PA and lateral views of the chest provided. Mild cardiomegaly is again seen. Calcified mediastinal and hilar lymph nodes again noted. The lungs are clear without focal consolidation, effusion or pneumothorax. Asymmetric breast tissue again noted with outline of a right breast implant noted. Mediastinal contour stable. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Stable cardiomegaly. No pneumonia or CHF." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. Calcified mediastinal lymph nodes are again noted. No acute osseous abnormalities. Right-sided breast implant is noted.", "output": "No acute cardiopulmonary process." }, { "input": "As compared to the prior chest radiograph dated ___, there has been no relevant interval change. The lungs are grossly clear without lobar consolidation, pleural effusion, pneumothorax, or pulmonary edema. Calcified mediastinal lymph nodes are again seen. The cardiomediastinal silhouette is unchanged. The patient is status post right mastectomy.", "output": "Mild, stable cardiomegaly without acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs are clear. There is no consolidation, pneumothorax, or pleural effusion. The cardiac, mediastinal, and hilar contours are normal. The aortic arch calcifications are stable. No pulmonary vascular congestion.", "output": "Essential normal radiographic examination of the chest. No hemothorax." }, { "input": "Frontal and lateral radiographs of the chest were acquired. A radiopaque skin marker is noted along the anterior aspect of the left sixth rib. The lungs are clear. The heart size is normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen. Anterior wedging of a lower thoracic vertebral body is not significantly changed. There are no displaced rib fractures identified.", "output": "1. No displaced rib fractures identified. If there is persistent concern for rib fracture, further evaluation with a dedicated rib series would be recommended. 2. No acute cardiac or pulmonary process." }, { "input": "There is mild left base atelectasis. No definite focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable and unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Heart is mildly enlarged. No pleural effusions or pneumothorax. No focal consolidations. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. The heart is mildly enlarged, increased since prior. There is pulmonary vascular congestion.", "output": "Mild cardiomegaly, increased since prior exam with pulmonary vascular congestion." }, { "input": "Frontal portable chest radiograph demonstrates low lung volumes and interval placement of right PICC this terminates in the right atrium. Mild bibasilar atelectasis persists as does mild vascular congestion although mildly improved. The heart size is mildly enlarged. There are no new focal consolidations. No pneumothorax.", "output": "No findings to suggest pneumonia." }, { "input": "PA and lateral views of the chest were obtained. There is no focal consolidation, effusion, or pneumothorax. A stable linear density projecting posteriorly on the lateral view is unchanged from multiple prior exams and likely represents a focus of scarring. Cardiomediastinal silhouette appears normal. No pneumothorax or pleural effusion. Bony structures are intact.", "output": "No acute intrathoracic process." }, { "input": "The heart is top normal in size. Mediastinal contours are unchanged. Prominence of the hila bilaterally is unchanged. Low lung volumes are present which result in crowding of the bronchovascular vascular structures. Mild pulmonary vascular congestion may be present. Streaky bibasilar opacities are nonspecific and could reflect atelectasis though infection is not excluded. No pleural effusion or pneumothorax is identified. Ossific density within the right acromiohumeral interval may reflect a loose body.", "output": "Low lung volumes with streaky bibasilar opacities possibly reflective of atelectasis. Clinical correlation is recommended to exclude infection." }, { "input": "Chest, PA and lateral. The lungs are hyperinflated but clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal.", "output": "Hyperinflated lungs suggestive of COPD. Otherwise, no acute cardiopulmonary process." }, { "input": "The heart size remains mildly enlarged. Mediastinal contour is unchanged. Perihilar haziness with vascular indistinctness is compatible with mild pulmonary edema, similar compared to the prior study. Small bilateral pleural effusions have increased in size compared to the prior exam. No pneumothorax is identified. There are no acute osseous abnormalities.", "output": "Mild congestive heart failure with slight interval increase in size of small bilateral pleural effusions." }, { "input": "There is prominence of the hila, particularly on the right which may be due to prominent pulmonary vessels although underlying lymphadenopathy is not excluded. No priors available for comparison. No focal consolidation seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. There may be mild vascular congestion without overt pulmonary edema.", "output": "Prominence of the hila may relate to prominent pulmonary vasculature, however, cannot exclude lymphadenopathy on the right. Correlate with any prior chest radiographs if available, otherwise, suggest nonurgent chest CT for further evaluation. Mild pulmonary vascular congestion." }, { "input": "The lungs are clear. Heart size is normal. There is stable enlargement of the bilateral pulmonary arteries, which is most likely due to chronic pulmonary hypertension. There is no pneumothorax. Bones and soft tissues are unremarkable.", "output": "Clear lungs. Chronic pulmonary hypertension." }, { "input": "Multifocal opacities, primarily affecting the left lung are concerning for pneumonia. There is no pleural effusion. The heart is normal in size. The aorta is tortuous. Of note, the left main pulmonary artery is prominent, similar in appearance to ___.", "output": "Multifocal opacities, primarily affecting the left lower and perihilar lung concerning for pneumonia. Prominent left pulmonary artery, as before." }, { "input": "Compared to chest radiograph from 3 days prior, there are new consolidative opacities in the bilateral upper lobes. Alveolar filling pattern is not typical of pulmonary edema. There is no associated volume loss. No pleural effusion the heart is enlarged. They and mediastinum and hila are difficult to evaluate due to overlying opacities.", "output": "New consolidative appearance of bilateral upper lobes, concerning for bilateral pneumonia. However, pulmonary hemorrhage should also be considered in patient with bleeding diathesis. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the ___ ___ at 10:32 AM, 10 minutes after discovery of the findings." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. The lungs are clear. There is no pneumothorax or effusion. Cardiomediastinal silhouette is normal. Osseous structures are unremarkable without visualized fracture.", "output": "Unremarkable chest x-ray." }, { "input": "2 views were obtained of the chest. A BB marker indicates the site of pain in the left upper quadrant. No focal consolidation, pleural effusion or pneumothorax is seen. The heart and mediastinal contours are unremarkable. No displaced rib fractures are identified. If there is a clinical basis to suspect chest cage trauma and the need to document that radiographically, detail views of marked regions of clinical findings should be requested.", "output": "No acute intrathoracic process." }, { "input": "AP upright and lateral views of the chest provided. Lung volumes are low. Bronchovascular crowding likely accounts for subtle opacity in the lower lungs. There is no large effusion or pneumothorax. No convincing signs of pneumonia or CHF. The heart size appears within normal limits. The aorta is slightly unfolded. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Somewhat limited exam without overt signs of pneumonia or edema." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Cholecystectomy clips are demonstrated in the right upper quadrant of the abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest were reviewed. The heart size is normal. There may be left hilar lymphadenopathy. Obscuration of the left heart border with a focal, almost mass-like opacity in the lingula has the suggestion of an air fluid level, concerning for cavitation. More diffuse increased interstitial markings in the left upper lobe are also present. The right lung is clear. There is no pleural effusion or pneumothorax.", "output": "Lingula and left upper lobe opacities concerning for pneumonia. Close imaging follow up after treatment, within no more than 1 month, is recommended to document resolution." }, { "input": "Lung volumes are decreased, with resultant crowding of bronchovascular structures at the lung bases. Bibasilar patchy opacities are present in appears somewhat more confluent in the right lower lobe on the lateral view. The cardiomediastinal and hilar contours are within normal limits. There is no pneumothorax.", "output": "Bibasilar opacities, which may reflect atelectasis, aspiration, or infectious pneumonia. Short-term followup radiographs may be helpful in this regard. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 3:23 PM." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No fracture.", "output": "No acute cardiopulmonary process." }, { "input": "ET tube is 5 cm above the level of the carina, and is in appropriate position. NG tube with tip in the proximal stomach and is shifted leftwards from a large central paraseptal bullae as is seen on CT chest. Vascular clips are noted, and the sternotomy wires are intact. Stable bibasilar atelectasis, left greater than right. No additional focal opacity or pleural effusions. Lung apices are not imaged on this film, however no large pneumothorax. The aorta is tortuous and dilated, and is unchanged. Heart size is top normal and right hilus is normal.", "output": "1. NG tube enters into the esophagus with tip in the proximal stomach. Consider advancing 3-5 cm to prevent risk of aspiration. 2. Stable bibasilar atelectasis, left greater than right." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There is no pneumomediastinum. No acute osseous abnormalities are detected.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. The cardiac silhouette is mildly enlarged. The aorta is calcified. There is eventration of the anterior right hemidiaphragm. Otherwise, there is flattening of the diaphragms, which may be due to chronic obstructive pulmonary disease. No definite focal consolidation is seen. There is right basilar atelectasis. Minimal pulmonary vascular congestion is noted.", "output": "Enlarged cardiac silhouette with minimal pulmonary vascular congestion. Eventration of the anterior right hemidiaphragm with overlying atelectasis, no definite focal consolidation." }, { "input": "Minimal basilar atelectasis is seen without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. The aorta is calcified.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac silhouette remains enlarged, likely reflecting a pericardial effusion as demonstrated on CT of ___. Marked volume loss in the right hemithorax is again demonstrated with inferior displacement of the right hilum and relatively geographically marginated opacities in the right mid and lower lung corresponding to known areas of post-radiation fibrosis and an accompanying pleural effusion, all essentially unchanged since the recent radiograph. Interval improvement in degree of pulmonary vascular congestion. No new or worsening opacities identified to suggest an acute pneumonia.", "output": "1. Improved pulmonary vascular congestion. 2. Stable post-treatment changes in right hemithorax. Note that an underlying infectious pneumonia would be difficult to detect in this post-treatment region, particularly on a portable chest radiograph. If symptoms of infection persist, PA and lateral chest radiographs may be helpful to more fully evaluate the lung bases." }, { "input": "Two frontal images of the chest demonstrated Dobbhoff tube with the tip in the stomach. The tube is not post-pyloric. There is no pneumothorax or other complications visualized. There is moderate pleural effusion on the right, unchanged since previous imaging. There is a small left pleural effusion also unchanged since previous imaging. A consolidation is again seen in the right lower lobe medially which is due to radiation changes. There is an enlarged cardiac silhouette secondary to a known pericardial effusion.", "output": "Dobbhoff tube with tip in the stomach, otherwise chest radiograph essentially unchanged from previous imaging." }, { "input": "A new area of consolidation has rapidly developed within the left lower lobe, predominantly in the retrocardiac region. Considering clinical history of cough, leukocytosis and fever, this is concerning for an evolving pneumonia in this region. Post-treatment changes in the right hemithorax appear similar to the prior study, and cardiac silhouette enlargement appears unchanged, corresponding to pericardial effusion on prior CT.", "output": "1. New left lower lobe airspace consolidation concerning for developing pneumonia or acute aspiration event. 2. Stable post-treatment changes in right hemithorax." }, { "input": "Again seen is a severely enlarged heart. There are bilateral pleural effusions, which are moderate in size and on the left is larger than on the study from the prior day, on the right is of similar size. There is volume loss in both lower lungs. There is pulmonary vascular redistribution. The feeding tube tip is off the film, at least in the stomach. Worsened fluid status. Vascular redistribution and some patchy areas of alveolar infiltrate.", "output": "CHF." }, { "input": "Two upright images of the chest show moderate chronic cardiomegaly, unchanged acutely. A Dobbhoff tube passes into the stomach, and ends out of view. Mild-to-moderate right pleural effusion is unchanged since late ___. Dependent edema in the right lower lobe has worsened. The consolidation in the right lower lobe appears more typical of atelectasis than pneumonia. A new small left pleural effusion is seen. Interstitial edema in the left lung base has worsened since previous imaging.", "output": "Worsening heart failure in the context of chronic atelectasis. Chronic right lower lobe atelectasis more likely than peristent pneumonia. Dobbhoff tube passes into the stomach and ends out of view." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "A right-sided Port-A-Cath is seen with its tip terminating in the mid SVC. The heart is normal in size and the cardiomediastinal and hilar contours are within normal limits. The lungs are clear. There is no pleural effusion or pneumothorax identified.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. Lung volumes are low, linear retrocardiac opacity seen only on the frontal, most likely due to atelectasis. Lungs are otherwise clear. Costophrenic angles are sharp. Cardiomediastinal silhouette is within normal limits as are osseous and soft tissue structures.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well inflated with stable left lower lobe atelectasis. Right lung is clear. Small left pleural effusion is stable. No right pleural effusion. No pneumothorax. Small amount of subcutaneous emphysema within the left lateral chest wall and left greater than right lateral neck is unchanged. Cervical fusion device is partially visualized and unchanged since prior. Intact median sternotomy wires and mediastinal clips are noted. A right PICC tip is in the low SVC. A left chest tube is in appropriate position, unchanged since prior examination.", "output": "1. No interval change. 2. Stable subcutaneous emphysema along left lateral chest wall and neck without pneumothorax. 3. Stable small left pleural effusion with left lower lobe atelectasis." }, { "input": "There is near complete opacification of the left hemi thorax, compatible with large pleural effusion and collapse. The right lung is clear. Patient is status post median sternotomy and CABG, with intact median sternotomy wires. No pneumothorax.", "output": "1. New complete opacification of the left hemithorax is compatible with large pleural effusion and collapse. 2. The right lung is clear." }, { "input": "The lungs are clear. There has been removal of the left chest tube.The left apical pneumothorax is mildly improved. The left pleural effusion is mildly improved. There has been interval improvement of the left chest wall subcutaneous emphysema. The cardiomediastinal and hilar contours are normal. Median sternotomy wires are intact.", "output": "Slight improvement of left apical pneumothorax and left pleural effusion." }, { "input": "The lungs are clear. The cardiomediastinal and hilar contours are within normal limits. There is no pleural effusion or pneumothorax. There is fusion hardware in the lower cervical spine.", "output": "No evidence of acute cardiopulmonary process. This preliminary report was reviewed with Dr. ___, ___ radiologist." }, { "input": "The lungs are moderately well inflated with no lobar consolidation and bilateral lower lobe vascular prominence. Small left pleural effusion persists. There is a tiny left apical pneumothorax. Cardiomediastinal silhouette is normal. Left-sided chest tube is in unchanged position. Right PICC terminates at the cavoatrial junction. The left lateral chest wall subcutaneous emphysema extending into the left lower neck is slightly improved compared to the prior radiograph.", "output": "1. Small left apical pneumothorax, residual small left pleural effusion, unchanged position of left sided chest tube. 2. Interval decrease in size of subcutaneous emphysema along the left lateral chest wall extending to the left neck." }, { "input": "Cardiac size is top-normal. Widening of the mediastinum has improved. Right IJ catheter tip is in the right atrium. There is no evident pneumothorax. Small right and moderate left pleural effusion associated with adjacent atelectasis. Sternal wires are intact. Patient is status post CABG", "output": "Small right and moderate left pleural effusions. . No pneumothorax." }, { "input": "Left chest tube is in place. Right arterial line is in place. Improving small left pleural effusion with overlying atelectasis. Stable small left apical pneumothorax. Unchanged left chest wall and bilateral neck subcutaneous emphysema. Persistent pneumomediastinum. Normal size of cardiac silhouette. No focal parenchymal opacity suggesting pneumonia. No pulmonary edema. Right lung is clear. Sternotomy clips are intact. Stable ACDF hardware.", "output": "Unchanged small left apical pneumothorax and subcutaneous emphysema. Interval improvement in a small left pleural effusion with left chest tube in place." }, { "input": "Cardio mediastinal contours are normal and unchanged. Left chest tube is in place. Mild increase in subcutaneous air extending to the contralateral side in the neck as well as pneumomediastinum. Difficult to assess for presence of pneumothorax given superimposed subcutaneous air. Right lung is clear. Small left pleural effusion unchanged compared to chest radiograph performed earlier on the same day.", "output": "Mild increase in subcutaneous emphysema to the contralateral side in the neck as well as pneumomediastinum. Left chest tube is in place. Difficult to assess presence of a pneumothorax, chest CT would be the best next imaging modality for further evaluation. NOTIFICATION: The findings were discussed with ___ ___, M.D. by ___ ___, M.D. on the telephone on ___ at 2:51PM, 10 minutes after discovery of the findings." }, { "input": "Interval placement of a right PICC line, the tip extending to the superior cavoatrial junction. A left apically directed chest tube is present. Persisting pneumomediastinum and subcutaneous emphysema over the left chest and over both sides of the neck. A small left pneumothorax is newly noted. Unchanged small left pleural effusion and overlying atelectasis.", "output": "Small left pneumothorax as well as pneumomediastinum and subcutaneous emphysema. A left chest tube is in place. Interval placement of a right PICC line extending to the superior cavoatrial junction. NOTIFICATION: Findings were communicated to and acknowledged by ___ ___ at ___h___ by ___, MD by telephone 5 minutes after discovery." }, { "input": "New extensive subcutaneous emphysema across the left chest wall extent superiorly into the neck and into the face. Improved left pleural effusion. Small left apical pneumothorax difficult to differentiate from overlying emphysema. Right lung is clear. Cardiac size is normal. Left chest tube in place.", "output": "New extensive subcutaneous emphysema across the left chest wall and extending into the left neck and face and small left apical pneumothorax with left chest tube in place. NOTIFICATION: The findings were discussed with ___, ___ ___, M.D. on the telephone on ___ at 11:45 AM, 10 minutes after discovery of the findings." }, { "input": "Lungs appear well inflated and clear. The cardiomediastinal and hilar contours are unchanged. The patient is status post CABG, with intact median sternotomy wires. No pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "Patient is status post median sternotomy and CABG. Cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is not engorged. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Patient is status post CABG, with intact mediastinal wires and mediastinal clips. A cardiac stent is visualized. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is borderline in size. The aorta is mildly tortuous. There is a patchy retrocardiac opacity obscuring the left hemidiaphragm, visible posteriorly on the lateral view. Aside from vague asymmetric hazy opacity that may refer to the lingula, otherwise, the lungs appear clear. There is no definite pleural effusion or pneumothorax. Bony structures are unremarkable.", "output": "Patchy opacities in the left lung, within the left lower lobe and possibly lingula. This appearance is fairly typical for atelectasis but if there is clinical concern regarding possible development of pneumonia, short-term followup radiographs may be helpful to re-assess." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. Correlation is made to CT torso from ___. When correlated to CT scan, there has been no significant interval change. There are bilateral somewhat nodular regions of consolidation in the lungs bilaterally. There is no effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. The osseous and soft tissue structures are unremarkable.", "output": "Bilateral somewhat nodular parenchymal opacities throughout the lungs compatible with multifocal pneumonia given clinical history. Recommend repeat after treatment to document resolution." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. The heart and mediastinal contours appear normal. Bony structures are intact. There is no free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are normal. There is no pleural effusion or pneumothorax. The linear opacities seen in the right base likely represent atelectasis. No definite consolidation is identified. Given density of breasts, however, evaluation of lung bases is limited.", "output": "No acute intrathoracic abnormality. If there is persistent concern for pneumonia, conventional PA and lateral radiographs can be obtained for better evaluation of the lung bases, suboptimally assessed on this single portable projection in the setting of dense overlying breast tissue." }, { "input": "AP and lateral images of the chest. A right-sided central line terminates in the low SVC. The lungs are well expanded. There is mild pulmonary vascular prominence, which has progressed over the last several exams. The lungs are otherwise clear. There is no pleural effusion or pneumothorax. Moderate to severe cardiomegaly is again noted.", "output": "1. No acute cardiopulmonary process. 2. Mild pulmonary vascular prominence, which has progressed over the last several exams, raising the possibility of slowly progressive heart failure." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Comparison is made with the next preceding PA and lateral chest examination of ___. The heart size has moderately increased. No typical configurational abnormality is identified; however, a beginning double contour within the heart shadow on the frontal view and prominence of the left atrial contour posteriorly is suggestive of some increased left atrial enlargement. Appearance of thoracic aorta is unchanged. The pulmonary vasculature demonstrates a known upper zone redistribution pattern. Although there is no evidence of pleural effusion in the lateral and posterior pleural sinuses, one can identify mild thickening of the interlobar fissures, all consistent with some mild degree of chronic CHF. Local discrete acute parenchymal infiltrates cannot be identified and there is no pneumothorax in the apical area.", "output": "Moderately increased heart size, developing since next preceding chest examination eight month ago. Mild degree of chronic pulmonary congestive pattern, but no evidence of pneumonia." }, { "input": "Moderate to severe enlargement of the heart is present. The aorta is unfolded and demonstrates mild diffuse calcifications. The hilar contours are unremarkable. There is mild upper zone vascular redistribution without overt pulmonary edema. No focal consolidation, pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Mild chronic pulmonary vascular congestion. No pneumonia." }, { "input": "Heart size is normal. The aorta is tortuous. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality. No evidence of chronic or active granulomatous disease." }, { "input": "Frontal upright and lateral chest radiographs demonstrate symmetric well-expanded lungs. The appearance of the cardiomediastinal silhouette is unchanged compared to the prior examination. Lungs are clear without focal areas of consolidation. There is no pleural effusion and no pneumothorax. Degenerative changes are again noted in the spine.", "output": "No acute intrathoracic pathology." }, { "input": "The lungs are moderately well inflated. Retrocardiac opacity likely represents atelectasis. Mild vascular congestion is unchanged. Interval increase in small right pleural effusion. No pneumothorax. There is persistent severe cardiomegaly. Mediastinal contour and hila are unchanged. .", "output": "1. There is mild vascular congestion. . 2. Interval increase in small right pleural effusion. RECOMMENDATION(S): Clinical correlation recommended for superimposed infection. NOTIFICATION: The findings were emailed to the ED QA nurse by ___, M.D. on ___ at 7:54 AM, 5 minutes after discovery of the findings." }, { "input": "Lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified. Tubular lucencies in the right upper quadrant are compatible with pneumobilia within enlarged biliary radicles. Two biliary stents are identified in the right upper quadrant. There is no free intraperitoneal air", "output": "No acute cardiopulmonary process. Pneumobilia, as seen on same day ultrasound." }, { "input": "There are low lung volumes. This accentuates the cardiac silhouette size which is likely within normal limits. There is crowding of the bronchovascular structures with mild pulmonary vascular congestion noted. The mediastinal contours are within normal limits. Streaky opacities within the lung bases bilaterally likely reflect atelectasis. No pleural effusion or pneumothorax is identified. No acute osseous abnormalities seen.", "output": "Mild pulmonary vascular congestion. Low lung volumes with bibasilar atelectasis." }, { "input": "Single frontal view of the chest demonstrates interval retraction of a right internal jugular approach central venous catheter, now with tip at the cavoatrial junction. The cardiomediastinal silhouette is within normal limits allowing for low lung volumes. There is no pneumothorax or pleural effusion. Previously seen perihilar vascular congestion has improved in the interim. There may be trace retrocardiac subsegmental atelectasis.", "output": "1. Central line in appropriate location, without pneumothorax. 2. Interval improvement of perihilar vascular congestion." }, { "input": "Lung volumes are lower. Mild elevation of the right hemidiaphragm persists. Atelectasis explains greater opacification lower lungs. The heart is top-normal in size and there is greater distention of pulmonary and mediastinal vasculature, but no pulmonary edema. . There is no pneumothorax or appreciable pleural effusion.", "output": "1. Left lower lung atelectasis, less likely. 2. Increased intravascular volume, no pulmonary edema." }, { "input": "Single frontal view of the chest demonstrates interval placement of a right internal jugular approach central venous catheter with tip in the right atrium. The heart is normal in size. The mediastinal and hilar contours are within normal limits. The lung volumes are low, accentuating bronchovascular crowding. There is mild perihilar vascular congestion without frank edema. There is no large effusion. Mild retrocardiac atelectasis may be present.", "output": "1. Interval placement of a right internal jugular central venous catheter with tip in the right atrium. Recommend retraction. 2. Perihilar vascular congestion." }, { "input": "PA and lateral views of the chest provided. Slight increased opacity in the right mid lung with air bronchogram is most likely due to atelectasis and/or overlap of vascular structures, but in appropriate clinical setting early pneumonia cannot be excluded. Left lung is clear. Cardiomediastinal and hilar contours are normal. There are no pleural effusions.", "output": "Right mid lung opacity is likely atelectasis, however early pneumonia cannot be excluded in appropriate clinical setting." }, { "input": "No definite focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "The endotracheal tube has been pulled back and terminates approximately 5 cm from the carina. The other support lines and tubes are in unchanged position. There continues to be progression of the bibasilar lung opacities. A left rib metastatic lesion is again seen, and lumbar spinal hardware is again noted.", "output": "Interval repositioning of the endotracheal tube tip which terminates 5 cm from the carina. Progression of the bibasilar opacities." }, { "input": "Portable AP upright chest film ___ at 18:20 is submitted.", "output": "The left PICC line has its tip in the proximal SVC. There continues to be bilateral interstitial prominence and patchy opacity at the left base. When compared to prior studies dating back to ___, the interstitial abnormality appears somewhat more prominent which likely reflects a component of superimposed interstitial edema. The expansile lytic lesion of the left lateral fourth anterior rib is again seen. Overall cardiac and mediastinal contours remain stable with the heart being enlarged. No pneumothorax is appreciated. Spinal hardware is incompletely visualized overlying the lower thoracic spine." }, { "input": "Cardiac, mediastinal and hilar contours are unchanged with the heart size within normal limits. Prominence of the hila bilaterally reflects borderline enlarged pulmonary arteries. Lungs are hyperinflated with severe emphysematous changes again noted. Scarring within the lung apices is more pronounced on the right. No pulmonary edema is demonstrated. No focal consolidation, pleural effusion or pneumothorax is noted. Previously seen pulmonary nodules on CT are not as well visualized on the current exam. 5 cm rounded opacity projecting over the left mid lung field is compatible with known osseous metastasis of the left fourth rib.", "output": "Known pulmonary and osseous metastases are better assessed on the prior CT. No focal consolidation to suggest pneumonia. Severe emphysema." }, { "input": "The patient has been extubated. There is central pulmonary vascular congestion with mild edema, minimally changed since ___. Left lower lobe atelectasis has markedly improved. A small left pleural effusion is unchanged. Mild cardiomegaly appears stable. There is no pneumothorax.", "output": "Markedly improved left lower lobe atelectasis. Mild pulmonary edema. Unchanged mild cardiomegaly." }, { "input": "There has been interval improvement of the mild pulmonary edema. A left pleural based opacity is stable, better seen on prior CT, and there no focal consolidations or pleural effusion. Lumbar spinal hardware is partially visualized.", "output": "Interval improvement of mild pulmonary edema." }, { "input": "Portable supine chest film ___ at ___ is submitted.", "output": "The heart remains enlarged. Mediastinal contours are difficult to assess due to marked patient rotation on the current study, although the patient reportedly has mediastinal lymphadenopathy on a recent chest CT. Overall, the appearance of the lungs does not appear changed with parenchymal distortion and scattered opacities suggestive of underlying emphysema and known metastatic disease as demonstrated on chest CT dated ___. A superimposed infectious process cannot be excluded. A soft tissue mass associated with a lytic left fourth anterior rib lesion is again seen consistent with known metastatic renal cell carcinoma. No pneumothorax. No evidence of pulmonary edema. Left costophrenic angle is not entirely included on the study. ." }, { "input": "The cardiac silhouette is enlarged. The right hila is also prominent the likely secondary to known right hilar lymphadenopathy. As compared to prior examination from exam of ___, the degree of congestion has improved. However, known lung nodules are better assessed on prior chest CT. There is extensive background of COPD. There is no focal consolidation concerning for pneumonia. The rounded density in the left chest wall is again seen, compatible with known left fourth rib osseous metastasis.", "output": "1. No focal consolidation concerning for pneumonia. 2. Cardiomegaly in the background of COPD. 3. Lung nodules are better assessed on prior chest CT. 4. Redemonstration of known left fourth rib osseous metastasis." }, { "input": "PA and lateral views of the chest are submitted dated ___ at 11:16", "output": "The left PICC line is unchanged in position. The lytic left fourth rib lesion is stable and the lytic lesions in the left humeral head are not well visualized on the current study. The interstitial edema has improved. However, more focal patchy opacities are now overall cardiac and mediastinal contours are unchanged. Seen in the left lower lung, right lower lung and in the right upper lobe abutting the minor fissure. Although these findings could represent residual edema, multifocal pneumonia should also be considered. Clinical correlation is advised. No pneumothorax." }, { "input": "The endotracheal tube is unchanged in position, 8.6 cm above the carinal. Overlying skin ___ and posterior lumbar fusion hardware are partially visualized. Again seen is a dense left retrocardiac opacity, stable since the prior examination, reflecting left lower lobe collapse. A soft tissue mass overlying the left hemi thorax and involving the left fourth rib is again seen, better visualized on the dedicated CT performed on the same day. There is no pneumothorax.", "output": "1. Unchanged left lower lobe collapse. 2. Large soft tissue mass overlying the left hemi thorax, with involvement of the left fourth rib, better seen on the dedicated chest CT." }, { "input": "Lines and tubes: There is no imaged endotracheal tube. Left subclavian line tip is in the mid SVC. Cardiomegaly is unchanged. The hilar contours are normal. Mediastinal lymphadenopathy is better seen on chest CTA from ___. Bibasilar consolidations are not significantly changed from yesterday. Soft tissue mass associated with the left anterior fourth rib appears similar to prior. The pulmonary vasculature is normal. No pleural effusion or pneumothorax.", "output": "1. There is no imaged endotracheal tube. 2. Bibasilar pneumonia appears similar to ___." }, { "input": "Left PICC is identified elbow tip is not clearly delineated. Persistent retrocardiac opacity is again seen as well as increased interstitial markings throughout the lungs. The cardiomediastinal silhouette is unchanged. Pulmonary nodules are better seen on prior CT scan. Expansile lytic lesion of the left lateral fourth rib there is again noted. Posterior fixation hardware seen in the visualized lumbar spine.", "output": "Retrocardiac opacity potentially atelectasis although infection is also possible. Increased interstitial markings throughout the lungs could be from chronic interstitial process potentially with superimposed interstitial edema. Lytic expansile lesion of the left fourth again seen. Pulmonary nodules are better identified on prior CT scan." }, { "input": "There has been no interval change since the most recent chest radiograph from ___. The endotracheal tube is unchanged in position. Posterior spinal hardware is partially visualized. There is persistent left lower lobe collapse. The soft tissue mass overlying the left hemithorax is again visualized. There is no pneumothorax. A left the most previous ultrasound at.", "output": "Persistent left lower lobe collapse. Findings are unchanged since ___." }, { "input": "As compared to ___, pulmonary interstitial edema has improved. Bibasal opacities have also improved. Slight increase in moderate left pleural effusion. Moderate cardiomegaly persists.", "output": "Improved mild interstitial edema with moderate slightly increased pleural effusion." }, { "input": "Slightly lordotic positioning. The cardiomediastinal silhouette is within normal limits. No CHF, focal infiltrate or effusion is identified. No pneumothorax is detected. A subtle 7 mm rounded density projects over the posterior left seventh rib, in the left mid zone laterally. This is not definitively identified on lateral view, but could correspond to a focal density projecting over the cardiac silhouette anterior to the hila. No other focal nodular densities are identified. No rib fracture is detected on these lung technique films.", "output": "No acute pulmonary process is identified. In particular, no pneumothorax or pneumonic infiltrate is identified. Note is made of a 7 mm nodular density in the left mid zone laterally, equivocally visualized on the lateral view. Further assessment with chest CT is recommended. RECOMMENDATION(S): Chest CT for further evaluation of a 7 mm nodular density in the left mid zone laterally. NOTIFICATION: The impression and recommendation above was entered by Dr. ___ on ___ at 22:47 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "There is mild prominence to the interstitium, which would most commonly be due to mild fluid overload. Otherwise the lungs appear clear. There is no pleural effusion or pneumothorax. The cardiac, mediastinal and hilar contours appear stable. Surgical clips again project over the right axilla.", "output": "Intact appearance of port tubing without discontinuity. Mild nonspecific interstitial abnormality but suggestive of vascular congestion." }, { "input": "Frontal and lateral views of the chest. The lungs are clear without focal consolidation or effusion. There is a nodular opacity projecting over the left lung base, potentially a nipple shadow. No other focal nodular opacity identified. The cardiomediastinal silhouette is within normal limits. Surgical clips project over the chest wall and right axilla. No acute osseous abnormalities.", "output": "Nodular opacity projecting over the left lung base, potentially nipple shadow, but confirmation with nipple markers is suggested. No acute cardiopulmonary process." }, { "input": "Tracheostomy tube is again seen. Left-sided subclavian central venous catheter is present, with the tip in the junction of the brachiocephalic veins. The cardiac and mediastinal silhouettes remain unchanged, allowing for the technique. A balloon is seen projecting over the stomach, probably representing a gastrostomy tube. There is increased opacification of the right hemithorax compared to the prior examination, with an appearance suggesting a small- to moderate-sized layering pleural effusion. The left hemithorax remains clear. No evidence of pneumothorax, although it is noted at the left lung apex is excluded from the imaging.", "output": "Right-sided pleural effusion, small to moderate in size. Otherwise, unchanged examination of the chest." }, { "input": "The ET tube is high, measuring approximately 8 cm above the carina. The OG is in good placement. The cardiomediastinal and hilar silhouettes are stable. There is new left base atelectasis and a small left-sided pleural effusion; however, the left retrocardiac atelectasis is improved. There is no focal consolidation. There is no pneumothorax.", "output": "1. Proximal position of ET tube. 2. Improved left retrocardiac atelectasis. 3. New peripheral left basilar atelectasis with adjacent small pleural effusion. Findings were discussed with Dr. ___ at 15:06 PM, 5 minutes after the time of discovery, by Dr. ___ ___ telephone." }, { "input": "There is interval increase in right lower lobe airspace opacity and small right pleural effusion. There is no pneumothorax. The cardiac silhouette remains moderately enlarged, the mediastinal contours are normal. The pulmonary vasculature is mildly engorged with mild edema.", "output": "Worsening right lower lobe pneumonia and pleural effusion and mild pulmonary edema." }, { "input": "Single semi-erect view of the chest was obtained. Apparent increase in right pleural effusion is likely due to patient rotation with respect to the film. The top normal cardiomediastinal silhouette is similar to prior. No focal consolidation or pneumothorax. A left approach central catheter terminates in the upper SVC. A new tracheostomy terminates in proper position. A new PEG overlies the left upper quadrant.", "output": "Status post tracheostomy and PEG placement, both of which appear in appropriate position. Apparent increase in right pleural effusion is likely due to patient rotation with respect to the film." }, { "input": "Single portable view of the chest was compared to previous exam from ___. There is new opacity at the right lung base suspicious for pneumonia. Patchy opacity also identified at the left lung base, not significantly changed since ___. Superiorly, the lungs are clear. The cardiac silhouette is enlarged but stable. Tracheostomy tube is again seen. Tubing from patient's known VP shunt is also seen along the right chest wall. Incompletely visualized widening of the right acromioclavicular joint is seen. Osseous and soft tissue structures are otherwise unremarkable.", "output": "Bibasilar opacities, larger on the right than on the left, compatible with pneumonia in the proper clinical setting. Repeat exam with PA and lateral suggested after treatment to document resolution." }, { "input": "Support devices are in stable position. Left base opacification has improved compared to prior study. There is a new right linear opacification which likely represents fluid in the fissure. There is improvement in the left lung vascular congestion.", "output": "1. Left lower lung improved. 2. Mild pulmonary edema which is more evenly distributed on the study, but overall unchanged." }, { "input": "The heart is mildly enlarged. The aorta is again mildly tortuous. There is patchy regional opacification of the right middle and lower lobes suggesting pneumonia with fluid along the major and minor fissures as well as a suspected small pleural effusion. A small pleural effusion is also suspected on the left. Hazy opacification and reticulation involving each mid lung zone may be associated with superimposed mild vascular congestion or fluid overload, but also could be secondary to widespread inflammatory process. There is no pneumothorax. The cardiac, mediastinal and hilar contours appear unchanged. Bony structures are unremarkable.", "output": "Extensive new opacification, particularly in the right middle and lower lobes, most suggestive of pneumonia with pleural effusions, although reticulation in the mid lung zones may be due to coinciding fluid overload or sequelae of the inflammatory process." }, { "input": "The heart is mildly enlarged. The mediastinal and hilar contours are within normal limits. The lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is stable with top-normal heart size. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Top normal heart size. Otherwise normal." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are normal. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Linear left basilar opacities are noted. Persistent blunting of the left posterior costophrenic angle suggests persistent small effusion. Elsewhere, the lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities", "output": "Persistent small left effusion and left basilar atelectasis." }, { "input": "Lung volumes are low. This accentuates the size of the cardiac silhouette which appears moderately enlarged. The mediastinal and hilar contours are unchanged. There is crowding of the bronchovascular structures without overt pulmonary edema. Streaky bibasilar opacities are more pronounced in the left lung base, and likely reflect areas of atelectasis. A small left pleural effusion is likely present. No pneumothorax is detected. No acute osseous abnormalities seen. No subdiaphragmatic free air is present.", "output": "Bibasilar atelectasis, more pronounced on the left, with small left pleural effusion. No subdiaphragmatic free air." }, { "input": "The lungs are normally expanded. There is mild linear atelectasis at the left base. A trace left pleural effusion has slightly enlarged. Heart size is exaggerated by AP technique and likely top normal. There is no pulmonary edema.", "output": "Trace left pleural effusion has enlarged. Mild atelectasis at the left base. No focal consolidation." }, { "input": "There is a small left pleural effusion. There is no focal consolidation, pulmonary edema or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Small left pleural effusion." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is again a very small pleural effusion on the left, none on the right side. The lungs appear clear.", "output": "Similar very small left-sided pleural effusion; otherwise unremarkable." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest were obtained. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomegaly is mild. Lungs are clear. No focal consolidation, pleural effusion, or pneumothorax. Pulmonary vascular markings are normal. No radiopaque foreign body.", "output": "Mild cardiomegaly." }, { "input": "Lung volumes are slightly low resulting in slight bronchovascular crowding. Nonetheless, the lungs are clear. No focal consolidation, effusion, pneumothorax, or edema. The heart is normal in size. The mediastinum is not widened. The hila and pleura are unremarkable. The left hemidiaphragm is slightly elevated, likely secondary to-is but non dilated loops of bowel. No subdiaphragmatic free air. No acute osseous abnormality.", "output": "Slightly low lung volumes but no acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "AP portable upright view of the chest. Lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is stable with aortic calcification again noted. Imaged osseous structures are intact. Dextroscoliosis of the spine, apex at the thoracolumbar junction. Tracheobronchial tree calcifications are noted.", "output": "No acute intrathoracic process" }, { "input": "Endotracheal tube terminates approximately in 5 cm above the level of the carina. Enteric tube terminates in the left upper quadrant in the expected location of the stomach. Bilateral perihilar and bibasilar opacities are worrisome for pulmonary edema ; underlying aspiration or infection may be present. Blunting of the costophrenic angles may be due to small pleural effusions. Left diaphragmatic pleural calcification is seen. There is no pneumothorax. The cardiac silhouette is enlarged. The aorta is calcified and tortuous.", "output": "Endotracheal and enteric tubes in appropriate position. Bilateral perihilar and basilar opacities may be due to pulmonary edema. Underlying aspiration or infection not excluded." }, { "input": "Heart size is top normal with mildly tortuous thoracic aortic arch. Hilar contours are unchanged. Again identified is a widespread ground-glass opacity involving most of the right upper lobe and right middle lobe and left lung base, similar compared to a CT examination from one day prior given difference in technique. Again appreciated is small right-sided pleural effusion. Again identified is a roughly 1.6 cm left upper lobe nodule as seen on recent CT examination. The remainder of the left lung field is otherwise clear. There is no pneumothorax.", "output": "1. Similar appearance of widespread ground-glass opacities involving the right upper and middle lobe and left lung base which may represent infection or hemorrhage. Drug toxicity is possible although unilateral focal involvement makes this unlikely. 2. Roughly 1.6 cm left upper lobe lung nodule as on CT. 3. Small right pleural effusion." }, { "input": "AP semi-upright portable chest radiograph obtained. Right CP angle is excluded. A right chest tube is again noted with its tip extending along the right mediastinal border extending superiorly. There is mild left basilar atelectasis. No pneumothorax is seen. The right paratracheal stripe appears thickened up to 2.5 cm, new from prior exam, of unclear etiology. Subcutaneous gas is noted in the right supraclavicular region, possibly related to the right chest tube.", "output": "Right chest tube in place, positioned as described. Subcutaneous gas in the right supraclavicular region likely related to chest tube. Prominence of the mediastinum can be exaggerated due to portable technique, though right paratracheal thickening is of unclear etiology. Please correlate clinically. Left basilar atelectasis noted." }, { "input": "In comparison to the prior exam, the lung volumes are lower. There are stable post-surgical changes in the right lung with linear scarring. The right pleural effusion appears to have resolved. Linear opacification at the left base is stable, and likely a combination of atelectasis and some pleural calcifications. There is no new opacity. There is no pulmonary edema or pneumothorax. The cardiomediastinal contour is within normal limits, and unchanged.", "output": "Stable right-sided post-surgical changes and bibasilar atelectasis. No evidence of pneumonia." }, { "input": "Single frontal view of the chest demonstrates low lung volumes accentuating mildly prominent cardiac silhouette and bronchovascular markings. The thoracic aorta is mildly tortuous. Despite low lung volumes, there is increased hilar vascular congestion and pulmonary edema. A trace left pleural effusion may be present. A rounded opacity in the right lung base is compatible with known mass in the right lower lobe, better seen on prior CT dated ___.", "output": "1. Low lung volumes and increased pulmonary edema. 2. Right lower lobe pulmonary mass." }, { "input": "Emphysematous changes are re- demonstrated with hyperinflation of the lungs. Heart size remains mildly enlarged. The mediastinal contour is similar with previously demonstrated mediastinal lymphadenopathy better seen on CT. Hilar contours are unchanged, and there is no pulmonary vascular congestion. Small right pleural effusion appears unchanged compared to the most recent chest radiograph, and there is no pneumothorax. Streaky opacities in the right lung base likely reflect areas of atelectasis. Interstitial opacities in the left lung base appear chronic. Spiculated nodular opacity in the periphery of the left upper lobe appears relatively unchanged. There are no acute osseous abnormalities.", "output": "Small right pleural effusion, not substantially changed from the previous chest radiograph. Streaky right basilar opacities likely reflect areas of atelectasis, without focal consolidation. Unchanged spiculated nodular opacity in the periphery of the left upper lobe." }, { "input": "AP upright portable chest radiograph was provided. There is increased nodular opacity in the left lung base concerning for pneumonia. The right lung is clear. Heart size is difficult to assess. Mediastinal contour is stable. No large effusion or pneumothorax is seen. Bony structures appear intact, though degenerative changes at the glenohumeral joint is noted bilaterally.", "output": "Subtle nodular opacity at the left lung base is concerning for pneumonia." }, { "input": "A frontal view of the chest was obtained portably. Lung volumes are slightly low, resulting in bronchovascular crowding. There is no focal consolidation, pleural effusion or pneumothorax. Mild cardiomegaly is unchanged. Mediastinal silhouette and hilar contours are unchanged allowing for differences in lung volumes.", "output": "No pneumonia, edema, or effusion." }, { "input": "PA and lateral views of the chest are compared to multiple previous exam from ___. The lungs are clear of focal consolidation. There is, however, suggestion of a nodular opacity just lateral to the right hilum, not clearly identified on the previous, which could potentially be due to differences in positioning and overlap of the hilar structures versus a new finding. Elsewhere, the lungs are unremarkable. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "1.3-cm nodular opacity in the right perihilar region for which dedicated chest CT is suggested." }, { "input": "Lung volumes are relatively low. There is no focal consolidation, effusion, or edema. Moderate sized hiatal hernia is again noted. The cardiomediastinal silhouette is otherwise unremarkable. Mid thoracic dextroscoliosis is noted. Degenerative changes partially visualized at the shoulders bilaterally. No acute osseous abnormality.", "output": "Moderate hiatal hernia. No acute cardiopulmonary process." }, { "input": "AP upright portable chest radiograph is obtained. The lungs appear clear bilaterally without focal consolidation, effusion, pneumothorax. Cardiomediastinal silhouette appears stable and normal. The imaged osseous structures appear intact.", "output": "No signs of pneumonia." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiac silhouette is mildly enlarged, and unchanged from prior exams. No free air is present under the hemidiaphragms.", "output": "1. No acute cardiopulmonary process. 2. Stable mild cardiomegaly." }, { "input": "Single portable view of the chest. There is new patchy consolidation identified at the right mid-to-lower lung. Elsewhere, the lungs are clear and the cardiomediastinal silhouette is stable. Degenerative changes are seen at the left shoulder.", "output": "New right mid-to-lower lung consolidation compatible with pneumonia in the proper clinical setting." }, { "input": "PA and lateral views of chest. Hazy lingular opacity persists from the prior study. There is no pleural effusion or pneumothorax. The right lung is clear. Cardiac silhouette is top-normal in size. The aorta is tortuous.", "output": "Lingular opacity concerning for pneumonia." }, { "input": "The left lung base is partially obscured by overlying soft tissue on frontal view. Heart size is top normal. There is no pneumothorax. There are tiny pleural effusions, but no pulmonary vascular congestion.", "output": "No evidence of volume overload." }, { "input": "There is a moderate-sized hiatus hernia. The cardiomediastinal silhouettes are stable. The bilateral hila are within normal limits. Lungs are clear without focal consolidation. The opacity projecting over the heart on prior lateral radiograph from ___ is no longer identified. There is no pulmonary vascular congestion. There is no pleural effusion or pneumothorax. Degenerative changes are noted at the shoulder and hypertrophic changes seen in the spine.", "output": "No acute cardiopulmonary process. Moderate-sized hiatus hernia." }, { "input": "There is a moderate size hiatal hernia, and left lung base linear opacities likely reflect atelectasis. No focal consolidation, pleural effusion or pneumothorax is seen. There is no overt pulmonary edema. The heart is normal in size. On the lateral view, there is an opacity projecting over the heart, and no correlate is seen on the frontal radiograph. Recommend follow-up after treatment of pneumonia.", "output": "1. Opacity projecting over the heart on the lateral radiograph with no correlate seen on the frontal radiograph. Recommend follow-up radiographs after treatment for pneumonia. 2. Moderate hiatal hernia." }, { "input": "AP and lateral views of the chest were compared to previous exam from ___. Given differences in positioning and technique, there has been no significant interval change. The lungs are essentially clear without pulmonary vascular congestion or consolidation. The cardiomediastinal silhouette is stable. Extensive degenerative change is again seen at the glenohumeral joint. Osseous and soft tissue structures are otherwise unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "AP and lateral views of the chest. Linear opacity in the right upper lung is again seen, potentially scarring or atelectasis. The lungs are otherwise clear. Cardiomediastinal silhouette is stable. Previously seen left PICC is no longer visualized. Degenerative changes are seen at the shoulders bilaterally.", "output": "No definite acute cardiopulmonary process." }, { "input": "AP view of the chest. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal and hilar contours are normal. No displaced fractures are identified.", "output": "No acute cardiopulmonary process. No dispalced fracture is identified. If there is concern for rib fracture, dedicated rib films can be obtained." }, { "input": "Allowing for decreased lung volumes compared with the immediate prior study, overall appearance is slightly improved. Minimal asymmetric left lung opacification has improved compared with the prior study. There is no focal consolidation, pulmonary edema, or pneumothorax. Small bilateral pleural effusions are present.", "output": "Low lung volumes. No focal consolidation. Persistent mild left lung opacification is overall improved from ___." }, { "input": "The lung volumes are low which causes crowding of the bronchovascular structures and accentuates the cardiac silhouette. The aorta is unfolded. New patchy consolidation is present within the lingula, and within the right mid lung. A compression deformity of an upper to midthoracic vertebral body is unchanged since ___.", "output": "New patchy consolidation in the lingula and right mid lung, concerning for pneumonia." }, { "input": "Single frontal chest radiograph was obtained portably. The lungs are clear. No focal consolidation, effusion, or pneumothorax is seen. Heart and mediastinal contours are normal. No definite sign of free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest were obtained. Heart size and cardiomediastinal contours are normal. The lungs are clear. No focal consolidation, pleural effusion, or pneumothorax. No radiopaque foreign body.", "output": "No evidence for acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest are provided. Lungs are clear. No signs of pneumonia or CHF. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "There is no evidence of pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. Patchy right infrahilar opacity seen on the frontal view is not well seen in the lateral view, but raises concern for medial right lower lobe consolidation. Alternatively, this could be an area of atelectasis. The left lung is clear. There is no pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are unremarkable. There is a likely 4 mm calcified granuloma projecting over the right upper lobe.", "output": "Medial right base/infrahilar opacity seen on the frontal view raising concern for consolidation due to infection." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is a coarse interstitial abnormality involving the mid-to-lower lungs to a greater degree on the left than right. How much of this appearance may be associated with pre-existing subpleural abnormalities that were partly visualized on the prior CT is uncertain since no prior radiographs are available for comparison. Mild-to-moderate relative elevation of the right hemidiaphragm compared to the left is similar to the prior examination. There are multiple air-fluid levels, probably in both small and large bowel seen in the upper abdomen, but no free air. Severe degenerative change involves the right shoulder including apparent effacement of the acromiohumeral interval, spurring along the glenohumeral joint and mild acromioclavicular narrowing.", "output": "1. Asymmetric interstitial abnormality involving the left lung. Correlation with the prior CT of the abdomen suggests that much of this appearance is potentially chronic, but acute on chronic process such as pneumonia cannot be excluded. Correlation with prior radiographs is recommended if available in order to help assess acuity. 2. Air-fluid levels along small and large bowel, non-specific appearance. 3. Severe degenerative changes involving the right shoulder." }, { "input": "The lungs are well inflated and clear. No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. Mediastinal contours are within normal limits. Heart size is top normal.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest demonstrate normal heart size, mediastinal and hilar contours. The lungs are clear. No pleural effusion or pneumothorax.", "output": "Normal chest radiograph." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. Surgical clips in the right upper quadrant suggest prior cholecystectomy.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs demonstrate unremarkable cardiomediastinal and hilar contours. The lungs are clear. No bronchial cuffing identified. No pleural effusion or pneumothorax evident. No displaced rib fractures identified.", "output": "Normal chest radiograph." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs were obtained. There has been interval improvement in bilateral lower lung opacifications. However, a persistent retrocardiac opacity remains in the lower lobes. There is left lower lobe atelectasis and layering pleural effusion. There is also an increase in the size of the right pleural effusion. There is moderate, stable cardiomegaly. The mediastinal contours are widened, likely reflective of central lymphadenopathy. There is no pneumothorax.", "output": "1. Focal opacity in lower lobes could reflect an infectious process in the appropriate clinical setting. 2. Mediastinal widening, likely related to central lymphadenopathy. Recommend followup with CT scan. Findings were communicated with ___ by Dr. ___ ___ telephone at the time of observation at 5:11 p.m. on ___." }, { "input": "Single portable view of the chest is compared to previous exam from ___. As on prior, there is mild pulmonary vascular congestion with indistinct central pulmonary vascular markings. The costophrenic angles are not completely included on the field of view, making evaluation for subtle effusion limited. Cardiac silhouette is enlarged but stable in configuration. Median sternotomy wires and prosthetic mitral valve is identified. Chronic deformity seen of the left humerus. There is no visualized acute osseous abnormality.", "output": "Findings suggestive of mild pulmonary vascular congestion." }, { "input": "Frontal and lateral views of the chest were obtained. The patient is status post median sternotomy and cardiac valve replacement. Again seen is a small left pleural effusion with overlying atelectasis, left base consolidation is difficult to exclude. Again seen is slight prominence of the central pulmonary vasculature. A trace right pleural effusion may also be present. Mild interstitial edema is again seen. The cardiac and mediastinal silhouettes are stable.", "output": "Small left pleural effusion with overlying atelectasis. Possible trace right pleural effusion. Cardiomegaly and minimal interstitial edema. Constellation of findings suggests congestive heart failure." }, { "input": "PA and lateral views of the chest demonstrate a small left pleural effusion, not significantly changed from the prior radiograph performed five days prior. There is also a trace right-sided pleural effusion. There is mild pulmonary edema, new compared to prior. No pneumothorax. The cardiac size is mildly enlarged but unchanged. The mediastinal contours are normal. Atherosclerotic calcifications are noted in the aortic arch. Sternal wires are intact and clips from prior CABG are seen. A prosthetic mitral valve is noted. Marked degenerative changes are noted in the left glenohumeral joint.", "output": "Mild congestive heart failure, new compared to the prior exam with mild pulmonary edema and small bilateral pleural effusions." }, { "input": "There is a right supraclavicular central venous catheter which ends in the mid SVC. There appears to be mild interval improvement of the bilateral pulmonary edema with evidence of continued, yet improved vascular engorgement. There appears to be a worsening in opacity in the left retrocardiac region which could be secondary to atelectasis and or worsening pleural effusion, compared to the previous study. The mediastinal contours are stable. There is moderate cardiomegaly, stable at least since ___.", "output": "1. Worsening of the left retrocardiac opacity likely secondary to increasing atelectasis and/or effusion. 2. Slight improvement of pulmonary edema." }, { "input": "AP chest radiograph. ET tube terminates 2.2 cm above the diaphragm. Median sternotomy wires are intact. Mediastinal clips and mitral valve replacement are again noted. A transvenous pacer lead terminates in the right ventricle. There is probably a small left pleural effusion with retrocardiac atelectasis, though left lower lobe collapse cannot be excluded. Large right hilum is chronic, but there are subtle opacities at the right base not present on ___. Moderate cardiomegaly is unchanged. There is no pneumothorax.", "output": "1. ET tube tip terminates 2.2 cm above the carina. 2. New left lower lung opacification may represent left lower lobe collapse or retrocardiac atelectasis with a component of pleural effusion. If obtainable, PA and lateral views would be helpful." }, { "input": "Heart size is normal. Mild calcification of the aortic knob is present. The pulmonary vascularity is not engorged. Hilar contours are unremarkable. Relative lucency within the right lung base likely reflects bullous emphysematous changes. Linear opacities within the left lung base may reflect scarring or subsegmental atelectasis. The patient's forearm obscures visualization of the left costophrenic angle. No large pleural effusion or pneumothorax is identified. There are no acute osseous abnormalities.", "output": "Somewhat limited exam. Bullous emphysema. No acute cardiopulmonary process." }, { "input": "AP view of the chest. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal. ET tube ends 4.1 cm from the carina. There is significant distention of air in the partially imaged stomach.", "output": "No acute cardiopulmonary process. Endotracheal tube in appropriate position. Significant distention of air in the partially imaged stomach." }, { "input": "AP single-view chest x-ray in upright position shows interval improvement of pulmonary edema, but new right lung base opacity due to atelectasis, probably in the right middle lobe. Left lung base opacity has improved, probably for reduced atelectasis. There is no pleural effusion or pneumothorax. Heart size is top normal. Stable aortosclerosis.", "output": "Interval improvement of pulmonary edema with better ventilation of the left lung base, but new right lung base opacity compatible with right middle lobe atelectasis." }, { "input": "The heart is moderately enlarged the aorta is unfolded. There are atherosclerotic calcifications of the aortic knob. Mild pulmonary edema is demonstrated with vascular indistinctness and perihilar haziness. There is blunting of the left costophrenic angle which could suggest a trace left pleural effusion. Patchy retrocardiac opacity likely reflects atelectasis. No pneumothorax is demonstrated. There are moderate multilevel degenerative changes in the thoracic spine.", "output": "Mild pulmonary edema with possible trace left pleural effusion. Retrocardiac atelectasis." }, { "input": "There is mild pulmonary vascular congestion, not significantly changed from the prior study. Left basilar/retrocardiac opacitites have increased since the prior which could be due to atelctasis or infection. There is blunting of the costophrenic angle on the left, which likely represents a small pleural effusion. The right costophenic angle is excluded, but a small right effusion is suspected. The cardiomediastinal silhouette and hilar contours are unchanged. There is no pneumothorax.", "output": "Mild pulmonary vascular congestion and superimposed left basilar/retrocardiac opacitites have increased since the prior which could be due to atelctasis or infection." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "Mild left base atelectasis without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable and stable. Re- demonstrated rounded calcific density projecting over the heart on the lateral view it is stable, and could represent a coronary stent..", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are slightly low. Heart size is normal. The aorta is mildly tortuous. Mediastinal and hilar contours are otherwise unremarkable. Pulmonary vasculature is normal. Minimal atelectasis is demonstrated in the lung bases without focal consolidation. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are detected.", "output": "Low lung volumes with mild bibasilar atelectasis. No focal consolidation." }, { "input": "Lung volumes are low, however the lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. A rounded calcific density projecting over the heart on the lateral view is unchanged from prior and may represent a coronary stent.", "output": "No acute cardiopulmonary process." }, { "input": "A portable frontal chest radiograph demonstrates a normal cardiomediastinal silhouette and fairly well aerated lungs which are clear. There is no focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Streaky left basilar opacity is likely due to atelectasis versus scarring. The lungs are otherwise clear. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process. No large pleural effusion." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. Streaky left basilar opacities suggest minor atelectasis. Otherwise, the lungs appear clear.", "output": "Minimal left basilar opacification most suggestive of minor atelectasis." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "A portable frontal semi-erect chest radiograph. Demonstrates a normal cardiomediastinal silhouette and fairly well-aerated lungs. There is no focal consolidation. Mild blunting of the left costophrenic angle suggestive of minimal, if any, left pleural fluid. There is no pneumothorax. The visualized upper abdomen is unremarkable.", "output": "Minimal, if any, left pleural fluid." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable. A small indentation is noted along the right side of the trachea, which could reflect a prominent right thyroid lobe.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process" }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable", "output": "No acute cardiopulmonary abnormalities" }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. There is mild rightward convex curvature centered along the mid thoracic spine.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The heart size is within normal limits. No typical configurational abnormality is identified. Unremarkable appearance of thoracic aorta contour. The pulmonary vasculature is not congested. There exists a right-sided paramediastinal density within the concave outer contour most likely representing an atelectasis of the apical portion of the right upper lobe. There is no evidence of pneumothorax. No other acute pulmonary abnormalities are seen on this portable chest examination. As our records do not include a preceding chest examination, the scout film of a PET-CT examination transferred into our records and dated ___ was inspected. The atelectasis resembling right superior density existed already at that time.", "output": "No evidence of pneumothorax." }, { "input": "Endotracheal tube is seen with tip approximately 3 cm from the carina. Enteric tube seen within the gastric body, side-port past the GE junction. Filter projects over the IVC. Bilateral parenchymal opacities are seen as on prior. Cardiac silhouette is enlarged. No acute osseous abnormalities identified.", "output": "No significant interval change besides interval placement of an enteric tube which is in appropriate position. Bilateral parenchymal opacities which may be seen in the setting of bilateral infection, edema or ARDS." }, { "input": "Single portable view of the chest. Endotracheal tube is seen with tip approximately 5.3 cm from the carina. Enteric tube passes with tip into the gastric body with side port past the GE junction. There is increased opacity throughout the right hemithorax compared to the left. Focal region of consolidation also seen in the retrocardiac region. Lucency projects over the right chest laterally is thought to be due to skin folds. Cardiac silhouette is mildly enlarged, given positioning and technique. Atherosclerotic calcifications seen throughout the thoracic aorta.", "output": "Increased hazy opacity in the right lung and retrocardiac focal consolidation. Findings are worrisome for multifocal pneumonia. Support lines and tubes as above." }, { "input": "The lungs are clear. No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette, hila, and pleura are unremarkable. No acute osseous abnormality.", "output": "No acute intrathoracic process." }, { "input": "Patchy airspace opacities within the right middle and lower lobe are essentially unchanged, and may represent an infectious etiology. New, bilateral streaky opacities within the mid lungs likely reflect multifocal atelectasis. There is no evidence of pleural effusion, pneumothorax, or frank pulmonary edema. The heart size is top normal. Mediastinal contours are stable. No acute bony abnormality is detected.", "output": "Persistent right middle and lower lobe patchy airspace consolidations, which may represent pneumonia in the appropriate clinical setting. Findings were entered into the radiology dashboard by Dr. ___ at 4:49 pm on ___, ___ min after interpretation." }, { "input": "Heart size is normal. The mediastinal and hilar contours are unremarkable. There is no pulmonary edema. Patchy bibasilar airspace opacities are more pronounced on the right, and are concerning for areas of infection or aspiration. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Patchy bibasilar airspace opacities concerning for pneumonia or aspiration." }, { "input": "Lung volumes are within normal limits. The trachea is central. The cardiomediastinal contour is normal, slightly prominent epicardial fat pad noted at the left apex. No consolidation, pneumothorax or pleural effusion seen.", "output": "No acute cardiopulmonary process seen" }, { "input": "AP portable upright view of the chest. Lung volumes are low and overlying EKG leads are present. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process" }, { "input": "There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "AP and lateral chest radiographs were provided. Lung volumes are low. There is no focal consolidation, pleural effusion, or pneumothorax. Cardiomediastinal silhouette is normal. The bones are intact.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low. There is no focal consolidation, pleural effusion or pneumothorax. Bibasilar atelectasis. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities are identified.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable view of the chest is compared to previous exam from ___. Compared to prior, there has been interval improvement of the left base opacity which still persists. There has been interval development of right basilar opacity compatible with pneumonia in the proper clinical setting. Superiorly, the lungs are clear and the cardiomediastinal silhouette is stable. Dual-lead pacing device is again noted.", "output": "Interval improvement of left basilar opacity with interval development of right basal opacity concerning for pneumonia in the proper clinical setting." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Cardiac silhouette size is normal. Mediastinal and hilar contours are unremarkable. No pulmonary edema is identified. Streaky opacities in the lung bases likely reflect areas of atelectasis. No pleural effusion or pneumothorax is demonstrated. There are no acute osseous abnormalities.", "output": "Mild bibasilar atelectasis." }, { "input": "There are low lung volumes. There is elevation of the right hemidiaphragm. The cardiac and mediastinal silhouettes are likely accentuated by a low lung volumes. There are perihilar opacities raising concern for mild pulmonary edema. Patchy left basilar opacities most likely relate to edema, however, infectious process not excluded in the appropriate clinical setting. Dedicated PA and lateral views or frontal view within improved inspiration would be helpful for further evaluation. No pleural effusion or pneumothorax is seen.", "output": "Low lung volumes. Elevated right hemidiaphragm. Perihilar opacities raising concern for mild pulmonary edema. Patchy basilar opacities most likely relate to edema, however, infectious process not excluded in the appropriate clinical setting. Dedicated PA and lateral views or frontal view within improved inspiration would be helpful for further evaluation." }, { "input": "Lung volumes are low. No focal consolidation, pleural effusion, or pneumothorax is seen on this single view. Cardiomediastinal silhouette is within normal limits. Chronic appearing deformity of the distal right clavicle is noted.", "output": "No radiographic evidence for pneumonia on this single view." }, { "input": "Given low lung volumes, there is not appear free is substantial change from the prior radiograph. The right hemidiaphragm remains elevated. Bibasilar opacities are likely related to atelectasis. Cardiac size is within normal limits. There is no large pleural effusion or pneumothorax. Chronic likely post traumatic changes seen at the right shoulder.", "output": "Unchanged radiograph. Patchy bibasilar opacities likely related to atelectasis ." }, { "input": "Two views of the chest demonstrate clear lungs without effusion, or pneumothorax. The cardiac silhouette is normal in size, the mediastinal contours are normal. There is no displaced rib fracture. If there is further concern for fracture, recommend repeat dedicated views with BB marker to mark the site of pain.", "output": "No acute chest pathology." }, { "input": "NG tube has been placed with tip ending in proximal gastric cavity. Lung is well inflated and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Correct positioning of NG tube without complication." }, { "input": "There is no radiographic evidence for focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. Minimal bronchial cuffing is seen. Heart and mediastinal contours are within normal limits.", "output": "Bronchial cuffing, suggestive of small airways inflammation." }, { "input": "Heart size is borderline. The aorta is minimally unfolded. No chf, focal infiltrate, effusion or pneumothorax is detected.", "output": "No evidence of acute pulmonary process." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax. Chronic compression deformity of L1 with acute kyphotic angulation at this level is again noted.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. Compression deformity of an upper lumbar vertebral body with an acute kyphosis is similar compared to prior.", "output": "No acute intrathoracic process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs remain hyperinflated, but clear. No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable. Chronic compression deformity at the thoracolumbar junction with acute kyphotic angulation is again noted.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. A focal eventration of the right hemidiaphragm is noted. The lungs appear clear bilaterally. No evidence of pneumonia or pulmonary edema. The heart is within normal limits of size. The mediastinal contour is unremarkable though there is faint atherosclerotic calcifications along the knob of the aorta. Mild degenerative changes are noted in the thoracic spine. No free air is seen below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest were provided. The lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. The imaged bony structures are intact. No free air is seen below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest were obtained. There are low lung volumes. Given this, no focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. Hilar contours are also within normal limits.", "output": "Low lung volumes, but otherwise, no acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. Lungs appear clear bilaterally without focal consolidation, effusion, or pneumothorax. There is upper lobe lucency and suggestion of underlying emphysema which was previously detected on CT chest from ___. Cardiomediastinal silhouette is stable. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Emphysema without superimposed pneumonia or pneumothorax." }, { "input": "A chronic right lateral rib fracture with adjacent atelectasis is again noted. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Left-sided PICC terminates in the mid SVC.", "output": "1. No acute cardiopulmonary process. 2. Chronic right lateral rib fracture with adjacent atelectasis. 3. Left-sided PICC terminates in the mid SVC." }, { "input": "Portable upright chest radiograph ___ at 14:10 is submitted.", "output": "Right Port-A-Cath unchanged in position. Cardiac mediastinal contours are stable. Lungs remain well inflated without evidence of focal airspace consolidation to suggest pneumonia. No pleural effusions, pulmonary edema or pneumothorax. Upper lobe emphysema better appreciated on chest CT dated ___." }, { "input": "Compared with ___ at 12:39 and allowing for technical differences, the overall appearance is relatively similar. The interstitial markings at the left base and in the right cardiophrenic region may be slightly coarser. No frank consolidation, effusion, or pneumothorax is detected. The heart is not enlarged and could be slightly smaller. The enlargement of the main pulmonary artery is again noted, in keeping with findings on recent CT. Again noted is left subclavian PICC line, similar in a position, with tip overlying the mid/distal SVC.", "output": "Overall similar appearance to chest x-ray from 1 day earlier. Interstitial markings in the right cardiophrenic region and left base may be slightly coarser. Given the time course, this could reflect asymmetric distribution of early CHF. An interstitial infiltrate is considered less likely but could also account for this appearance. No frank consolidation or effusion. Minimal left greater right upper zone redistribution is unchanged." }, { "input": "The heart size is normal. Emphysematous changes in the upper lobes bilateral. Peripheral/ subpleural airspace opacification in the inferolateral aspect of the right upper lobe appears unchanged to minimally improved. The peripheral airspace opacification in the inferolateral aspect of the left upper lobe is improved. No new airspace consolidation. There is interval improvement of the interstitial thickening (edema or infection) in the anterior aspects of the upper lobes. No pleural effusions. Left-sided PICC line in situ with the tip in the lower SVC. Spondylotic changes of the thoracic spine. Evidence of previous cholecystectomy.", "output": "Mild interval improvement." }, { "input": "The heart size is normal. Enlargement of the left and main pulmonary arteries is again noted, not significantly changed from the prior studies. The right hilar contour is within normal limits. Emphysema is again seen, most pronounced within the lung apices. Minimal streaky opacity in the left lung base is similar and may reflect minimal atelectasis. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities. Cholecystectomy clips are noted in the right upper quadrant of the abdomen.", "output": "No radiographic evidence for pneumonia. Emphysema. Enlargement of the main and left pulmonary arteries, unchanged, for which correlation with echocardiography, if not previously done, is suggested." }, { "input": "AP upright and lateral views of the chest provided. The lungs appear lucent suggesting emphysema. There is mild elevation of the left hemidiaphragm which is unchanged. No convincing signs of pneumonia, edema. No pleural effusion or pneumothorax. The aorta is unfolded. Heart size appears normal. Bony structures are intact.", "output": "No acute findings." }, { "input": "The lungs are hyperinflated without focal opacities. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "Hyperinflated lungs might represent emphysematous disease. Otherwise normal chest radiographic examination." }, { "input": "The lungs are relatively hyperinflated. No focal consolidation is seen. No large pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs are well inflated and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax. Included upper abdomen is unremarkable. Osseous structures are grossly intact.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The cardiac silhouette is unremarkable. Again noted are diffusely increased interstitial markings and bibasilar reticular opacities, corresponding to patient's known chronic interstitial lung disease and pulmonary fibrosis, seen on prior examinations. There is stable elevation of the right hemidiaphragm. No definite consolidation, pleural effusion, or pneumothorax is identified.", "output": "Findings consistent with patient's known chronic pulmonary fibrosis." }, { "input": "There are relatively low lung volumes and persistent elevation of the right hemidiaphragm. Reticular opacities at the lung bases correspond to chronic interstitial lung disease, pulmonary fibrosis as seen on prior studies including PET-CT from ___ however, relative airspace opacities projecting at the left lower lung in bilateral perihilar regions could be due to infection and/or pulmonary edema. No large pleural effusion is seen. There is no evidence of pneumothorax. The cardiac silhouette is not enlarged. Mediastinal contours are unremarkable.", "output": "Known pulmonary fibrosis particularly at the lung bases, right greater than left. Relative airspace appearing opacities in the bilateral perihilar and left lung base regions are nonspecific, but could be due to infection or pulmonary edema." }, { "input": "A PleurX catheter is in-situ in the right lower chest. There is a residual pleural effusion which has increased slightly when compared to the prior chest radiograph. This is similar in appearance when compared to the prior PET-CT. Previous median sternotomy noted. No focal consolidation seen. No left-sided pleural effusion. A surgical clip or fiducial seen in the right lung apex. Mild degenerative changes are seen throughout the thoracic spine.", "output": "Small right pleural effusion with a PleurX catheter in-situ." }, { "input": "Cardiomediastinal contours are unchanged. Small to moderate right effusion high has decreased. Small left effusion has almost completely resolved. Right apical opacities are better seen in prior CT. There is a small right pneumothorax. PleurX catheter is in-situ in the right lower chest. Sternal wires are aligned. Patient is status post AVR.", "output": "Decrease in bilateral pleural effusions. Small right pneumothorax." }, { "input": "There has been interval decrease in right-sided pleural effusion which is now minimal. No evidence of pneumothorax is seen. The appearance of the right apex is stable, better assessed on recent prior PET-CT. Again, the patient is status post median sternotomy.", "output": "Interval decrease in right-sided pleural effusion which is now minimal. No evidence of pneumothorax. The appearance of the right apex is stable, better assessed on recent prior PET-CT." }, { "input": "There is no substantial pleural effusion remaining following recent thoracentesis although a minimal one may remain (the right costophrenic angles are partially excluded). There is no pneumothorax. The lungs appear clear. The cardiac, mediastinal and hilar contours appear stable. The patient is status post sternotomy.", "output": "Marked decrease in pleural effusion." }, { "input": "Frontal and lateral views of the chest are compared to previous exam from ___ and chest CT from ___. There are basilar pleural effusions which appeared to have slightly grown in size given differences in positioning and technique since most recent exam. There is underlying atelectasis, although a component of infiltrate cannot be excluded. Biapical nodular opacities are seen, right greater than left, similar to prior CT scan, which appear more conspicuous, likely due to technique when compared to most recent chest x-ray. Cardiomediastinal silhouette is stable. Osseous and soft tissue structures are unchanged.", "output": "Interval enlargement of bilateral pleural effusions with underlying atelectasis, noting a component of infection cannot be excluded." }, { "input": "Lungs: The lungs are well inflated. A surgical clip is seen in the right upper lobe. There is soft tissue density in the right apex which probably has not changed significantly. There is an infiltrate in the right upper lobe which is likely infectious. Linear atelectasis is seen in left midlung zone. Pleura: There is right pleural disease not changed. The right pleural catheter has been removed. Heart: The heart is not enlarged. An aortic valve prosthesis is noted. Mediastinum and hila: There is no mediastinal mass. Osseous structures: The patient is status post median sternotomy. Other findings: None", "output": "New right upper lobe infiltrate Stable right pleural disease" }, { "input": "PA and lateral chest views were obtained with patient in upright position. The heart size is normal. No typical configuration abnormalities identified. Thoracic aorta of ordinary ___ and no significant calcium deposits are seen in the wall. The pulmonary vasculature is not congested. No evidence of acute parenchymal infiltrates are present. There is mild blunting of the right lateral pleural sinus, but as the posterior pleural sinuses are free, there is no evidence of free pleural effusion. No acute infiltrates can be identified. Skeletal structures are well preserved, considering the patient's high age causing mild degree of vertebral body demyelinization is seen in the thoracic spine, which demonstrates a mildly accentuated kyphotic curvature. No evidence of vertebral body compression fractures is seen.", "output": "Normal heart size, no conclusive evidence for aortic valve or aortic calcifications on standard views. No significant left ventricular or left atrial enlargement, and no pulmonary congestion." }, { "input": "The lungs are hyperinflated. Compared with the most recent examination there has been interval accumulation of a small to moderate right-sided pleural effusion. Linear markings at the right lung base likely represent atelectasis versus scarring. A right small apical pneumothorax persists, with concurrent pleural thickening and pleural calcification likely sequela of prior insult. Left apical calcification and scarring is also present, stable. The left lung is clear. There is no left-sided effusion. No pneumothorax. Cardiac size is top-normal. The aortic valve is replaced. Sternotomy wires are intact", "output": "Interval accumulation of a small to moderate right-sided pleural effusion with associated right basilar atelectasis/scarring. Otherwise unchanged appearance of the lungs with a small right apical pneumothorax with associated pleural thickening and pleural calcification. Left apical calcified pleural plaque. No opacity suggestive of pneumonia." }, { "input": "Again seen is a moderate right pleural effusion. Right apical spiculated pleural-based lesion was better assessed on preceding PET-CT. Grossly, the right apex is similar in appearance to chest radiograph from ___, with the right pleural effusion increased since that time. There is new/patchy right basilar opacity could be atelectasis but overlying consolidation not excluded. Hilar contours are similar to ___, at 12:35. The left lung is clear. The cardiac and mediastinal silhouettes are stable. Patient is status post median sternotomy.", "output": "Again seen is a moderate right pleural effusion. Right apical spiculated pleural-based lesion was better assessed on preceding PET-CT. Grossly, the right apex is similar in appearance to chest radiograph from ___, with the right pleural effusion increased since that time. There is new/patchy right basilar opacity could be atelectasis but overlying consolidation not excluded. Hilar contours are similar to ___, at 12:35." }, { "input": "Median sternotomy wires and mechanical aortic valve are unchanged in location. The small right-sided pleural effusion is stable compared to ___. Pleural thickening at the right apex. The left lung is clear, without evidence of consolidations, pleural effusion or pneumothorax. The hila, mediastinum and heart are within normal limits. No acute osseous abnormalities.", "output": "Stable small right-sided pleural effusion." }, { "input": "The patient is status post median sternotomy with aortic valve replacement. Sternotomy wires are intact. The lungs are clear. Right apical pleural thickening and calcification is unchanged. A small right pleural effusion has increased since ___. The left lung is clear. There is no pneumothorax. The heart and mediastinum are within normal limits. Generalized osteopenia and flowing ossification of the anterior longitudinal ligament is again noted.", "output": "Small right pleural effusion, increased since ___. Diffuse idiopathic skeletal hyperostosis (DISH)." }, { "input": "Median sternotomy wires are intact. Soft tissue surgical clips project over the mediastinum. Prosthetic aortic valve is noted. Heart size is normal. Mediastinal and hilar contours are normal. There is increased opacity at the right base. There is a stable, small right pleural effusion. There is stable volume loss on the right with a right juxtaphrenic peak. There is stable scarring in the right apex. There is a tiny, residual left pleural effusion. There is no pneumothorax.", "output": "Slight interval increase in right basilar opacity with a stable small right pleural effusion." }, { "input": "There is persistent small right-sided pleural effusion. Asymmetric right apical opacity is again seen. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. Hypertrophic changes are noted in the spine.", "output": "Persistent right-sided pleural effusion without superimposed acute cardiopulmonary process. Right apical opacity better characterized by prior PET-CT" }, { "input": "Following right thoracentesis, a right pleural effusion has nearly resolved. No visible pneumothorax. Moderate left pleural effusion with adjacent atelectasis is unchanged. Cardiomediastinal contours are stable in appearance.", "output": "Near resolution of right pleural effusion following thoracentesis with no visible pneumothorax." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Sternal wires are intact. A right-sided pleural effusion has increased in size, now moderate. The left lung is clear. There is mild atelectasis at the right lung base. Thickening at the right apex corresponds to known right apical pleural-based mass as seen on prior PET-CT and CT examinations. There is no pneumothorax.", "output": "Moderate right-sided pleural effusion, increased in size." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or edema. Mean sternotomy wires and prosthetic aortic valve are noted. Incidentally noted are bilateral cervical ribs.", "output": "No acute cardiopulmonary process." }, { "input": "Patient is status post median sternotomy and aortic valve replacements. Heart size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities. Left first rib is again hypoplastic.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is normal. The thoracic aorta is diffusely calcified. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is normal. Elevation of the right hemidiaphragm is of unknown chronicity. There is adjacent right basilar atelectasis, and minimal subsegmental atelectasis in the left lung base. No focal consolidation, pleural effusion or pneumothorax is present. There is mild loss of height anteriorly of ___ mid thoracic vertebral bodies of indeterminate age.", "output": "Elevation the right hemidiaphragm, of unknown chronicity. Mild bibasilar atelectasis." }, { "input": "PA and lateral chest radiographs. The lungs are clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Normal chest radiographs." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lung volumes are low, however the lung fields are clear. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Chest PA and lateral radiograph demonstrates unremarkable mediastinal, hilar, and cardiac silhouette. The patient is status post CABG with midline sternotomy sutures. The superior two sternal wires are fractured. Dual lead left sided pacemaker. The lungs are clear. No pleural effusion or pneumothorax evident.", "output": "Clear lungs. Superior two sternal wires are fractured." }, { "input": "The lungs are well expanded and clear. The hila and pulmonary vascular are normal. No pleural effusions or pneumothorax. The cardiomediastinal silhouette is normal. No obvious osseous abnormalities.", "output": "Normal chest radiograph." }, { "input": "PA and lateral views of the chest demonstrate well-expanded lungs. A small focus of increased opacification overlying the spine adjacent to the diaphragm, seen best on the lateral view may represent a small focus of airspace consolidation, less likely related to overlapping structure or changes related to the spine. Heart is normal in size and cardiomediastinal contour is unremarkable. There is no pleural effusion or pneumothorax.", "output": "1. A small focus of rounded opacification overlying the lower thoracic spine may represent a small focus of pneumonia. 2. Re-evaluation with PA and lateral chest radiographs is recommended 4 weeks after completion of antibiotic therapy. Comment: Findings and recommendations were emailed to the \"ED QA Nurses\" to be directly communicated with the patient's primary care provider." }, { "input": "There has not been significant interval change from ___. Lung volumes are low. The cardiac silhouette is stable in size. No focal consolidation, pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary process." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. The imaged upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Normal chest radiograph." }, { "input": "Slight interval improvement in the bilateral hilar lymphadenopathy. Stable mediastinal widening compared to ___. The lungs are well expanded and clear, without focal consolidation or pulmonary edema. There is no pneumothorax or pleural effusion. The heart is normal in size. There is no acute osseous abnormality.", "output": "1. Slight interval decrease in bilateral hilar lymphadenopathy and stable mediastinal widening due to lymphadenopathy. 2. No new focal consolidation." }, { "input": "Compared with prior radiographs on ___, the hila are more dense and slightly larger, suggestive of recurrence of lymph node enlargement. There are subtle changes in the density of both lungs seen only on the frontal view, which are difficult to assess on radiograph, but are suggestive of interstitial abnormality. There is no focal consolidation, pleural effusion or pneumothorax. Heart size is normal.", "output": "Interval increase in density and size of both hila is suggestive of recurrence of lymph node enlargement. Subtle changes in density of the lungs is suggestive of interstitial abnormality, which would need to be assessed by CT. RECOMMENDATION(S): Recommend CT for evaluation of possible interstitial abnormality. NOTIFICATION: The impression and recommendation above was entered by Dr. ___ on ___ at 13:24 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "There is a central venous catheter terminating at the cavoatrial junction, inserted via a right subclavian approach. The heart is mild-to-moderately enlarged with a globular configuration. The aortic arch is calcified. The aortopulmonary window is slightly prominent suggesting possible enlargement of the main pulmonary artery. Central pulmonary arteries are also mildly enlarged. There is an asymmetric left paramedian opacity with upward tenting, perhaps a form of scarring. Bilateral perihilar fullness suggests mild superimposed pulmonary congestion, however. A moderate left-sided pleural effusion is also noted. Associated parenchymal opacity is suspected, probably attributable to associated atelectasis, although infectious etiology is not entirely excluded.", "output": "Moderate left-sided pleural effusion. Cardiomegaly and prominent central pulmonary vascularity and suspected congestion. Asymmetric left perihilar opacification with a relatively straight edge, possibly due to scarring and congestion; correlation with prior radiographs is suggested as well as clinical history." }, { "input": "PA and lateral images of the chest. The lungs are well expanded. The trachea appears to be deviated slightly to the left at the level of the thyroid, suggestive of a possible right thyroid mass. A lung nodule is seen projecting adjacent to the right anterior third rib. There is no pneumothorax or pleural effusion. The heart is top normal is size. Visualized osseous structures are unremarkable.", "output": "1. No acute cardiopulmonary process. 2. Lung nodule projecting adjacent to the right anterior third rib. CT is recommended for further characterization. 3. Trachea appears to be deviated slightly to the left at the level of the thyroid, suggestive of a possible right thyroid mass. These findings were communicated to Dr. ___ at 6:46 p.m. on ___ by phone." }, { "input": "There is continued right lung volume loss with right perihilar scarring and distortion, similar to ___ and probably due to prior infection . The cardiac mediastinal silhouette is unchanged, and the lungs are clear of focal consolidation, pleural effusions or pneumothoraces.", "output": "No acute cardiopulmonary process." }, { "input": "Stable chest x-ray examination with extensive scarring in the right suprahilar region. The superimposed consolidation or edema is evident. The mediastinum is otherwise unremarkable. There is a prominent right epicardial fat pad. The cardiac silhouette is within normal limits for size. No effusion or pneumothorax is noted. The osseous structures are unremarkable. A mid diaphyseal left clavicular deformity is again present and also stable.", "output": "No acute pulmonary process. Stable chest x-ray examination." }, { "input": "PA and lateral views of the chest provided. Lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is stable. Unchanged scarring in the right suprahilar region compared with multiple prior imaging studies dating back to ___. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest demonstrates the lungs are well expanded and clear. The cardiomediastinal silhouette is unremarkable. There is no pleural effusion, pulmonary edema or pneumothorax. No focal pneumonia seen.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest provided. Bibasilar linear densities likely represent atelectasis. There is no consolidation concerning for pneumonia. No effusion or pneumothorax. No signs of congestion or edema. Cardiomediastinal silhouette is stable. Multiple chronic left ribcage deformities again noted. No acute bony injury.", "output": "No acute findings." }, { "input": "Bibasilar linear opacities are consistent with platelike atelectasis. Otherwise the lungs are clear. No focal consolidation, effusion, edema, or pneumothorax. The heart size is normal. The thoracic aorta is slightly tortuous. Aortic knob calcifications are mild. Segmental fractures of the left posterior ___th rib fractures appear chronic and healed.", "output": "1. No pneumonia. 2. Platelike atelectasis in the lower lungs. 3. Chronic left segmental rib deformities involving the fifth through eighth ribs." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. Hypertrophic changes are noted in the spine.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs are clear. Cardiomediastinal silhouette is normal. Osseous structures are unremarkable.", "output": "Normal chest x-ray." }, { "input": "A three-lead pacemaker/ICD device appears unchanged. The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear. Suture anchors are present in the right humeral head. Surgical clips project over the right upper quadrant.", "output": "No suspicious radiographic findings or evidence for acute cardiopulmonary disease." }, { "input": "Compared to the study of 1 month prior there is no significant change. The left pectoral pacemaker with leads ending in the right atrium, right ventricle and coronary sinus is in unchanged position. Mild enlargement of the cardiac silhouette is stable. No focal consolidation, pleural effusion or pneumothorax. Surgical anchors in the right humeral head and clips in the right upper quadrant are unchanged.", "output": "Stable appearance of the chest and pacemaker" }, { "input": "There are small persistent bilateral pleural effusions. There is pulmonary vascular congestion without overt edema. The lungs are otherwise clear besides linear opacity in the right midlung which is likely atelectasis. Left chest wall triple lead pacing device is again noted with leads in stable position. Moderate to severe cardiomegaly is noted as well as atherosclerotic calcifications. Orthopedic hardware is again seen in the right humeral head and surgical clips identified in the right upper quadrant.", "output": "Persistent small bilateral pleural effusions with pulmonary vascular congestion. No focal consolidation." }, { "input": "Left-sided pacemaker device is noted with leads terminating in the regions of the right atrium, right ventricle, and coronary sinus. Moderate to severe cardiomegaly is present. The aorta is diffusely calcified. There is mild pulmonary edema with small to moderate size bilateral pleural effusions. Associated bibasilar atelectasis is present. No pneumothorax or focal consolidation is otherwise present. Clips are seen in the upper abdomen as well as surgical anchors within the right humeral head.", "output": "Mild pulmonary edema with small to moderate size bilateral pleural effusions and bibasilar atelectasis." }, { "input": "Exam is limited by underpenetrated technique and low lung volumes. With this limitation in mind, a patchy opacity is present in right infrahilar region, but lungs are otherwise grossly clear. Cardiomediastinal contours are stable allowing for low lung volumes. There are no pleural effusions or acute skeletal findings.", "output": "Patchy right infrahilar opacity, which may represent patchy atelectasis, focal aspiration or early pneumonia. Followup radiographs may be helpful in this regard." }, { "input": "A right PICC catheter is seen with the tip in the RA, better seen on the lateral. Recommend retracting it 3 cm to reposition in the lower SVC. Otherwise no significant change from the prior radiograph. Lungs are clear. There is no focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette is unremarkable.", "output": "Right PICC with a catheter tip in the right atrium. Recommend retracting 3 cm to be in the lower SVC. This was discussed with PICC line nurse by Dr. ___ ___ telephone at 2:45 p.m." }, { "input": "The heart is at the upper limits of normal size, although with a left ventricular configuration. The mediastinal and hilar contours are unremarkable. The lung volumes are low. There is no pleural effusion or pneumothorax. The lungs appear clear. Minimal degenerative changes are noted along the thoracic spine.", "output": "No evidence of acute disease." }, { "input": "Frontal and lateral views of the chest were obtained. Low lung volumes result in bronchovascular crowding. Heterogeneous opacity at the left lower lobe is concerning for pneumonia. The right lung is clear. There is no pleural effusion or pneumothorax. Heart size is upper limits of normal allowing for lung volumes. Mediastinal silhouette and hilar contours are normal. Pulmonary vasculature is normal. Degenerative change is seen at the acromioclavicular joints bilaterally.", "output": "Left lower lobe pneumonia. Follow up radiographs after treatment are recommended to ensure resolution of this finding." }, { "input": "AP portable upright view of the chest. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process" }, { "input": "A single portable chest radiograph was obtained. The lungs are well expanded and clear. There is no focal consolidation, effusion or pneumothorax. Cardiac and mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are hyperinflated suggestive of COPD. Blunting of the right costophrenic angle is unchanged, and could suggest chronic pleural thickening. No large pleural effusion or pneumothorax is seen. There are mild degenerative changes in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are well expanded and clear without focal consolidation, pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes and hilar contours are normal.", "output": "No pneumonia, edema, or effusion. A message was left with Dr. ___ office at 1:30 p.m. on ___ with the requested wet read." }, { "input": "The lungs are clear, the cardiomediastinal silhouette and hila are normal. There is mild vascular congestion. There is no pleural effusion and no pneumothorax.", "output": "No acute cardiothoracic process. Mild vascular congestion." }, { "input": "There are low lung volumes. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Compare to the exam on ___, there is interval increase in right interstitial opacity, likely from progression of atelectasis and possible small pleural effusion or due to lower lung volume and elevation of hemidiaphragm. The left lung is grossly unchanged in appearance. Heart size is mildly enlarged.Mediastinal and hilar contours are unchanged. There is no evidence for pulmonary consolidation or pneumothorax.Left-sided central line with terminates in the proximal SVC, unchanged from prior.", "output": "Right atelectasis and right pleural effusion, likely unchanged." }, { "input": "Portable supine chest radiograph ___ at 09:32 is submitted.", "output": "The right internal jugular Swan-Ganz catheter has been substantially pulled back and now has its tip in the pulmonary outflow tract. The left internal jugular central line is unchanged in position. Nasogastric tube is seen coursing below the diaphragm with the tip not identified. The intra-aortic balloon pump has its tip only 0.8 cm below the top of the aortic knob. Overall, the lungs appear clear with continued resolution of interstitial and pulmonary edema. There are likely very small bilateral pleural effusions. Overall cardiac and mediastinal contours are unchanged." }, { "input": "There has been interval placement of a left internal jugular approach central venous catheter, with tip terminating in the left brachiocephalic vein. There is no pneumothorax. Enteric tube is present with distal tip not captured on the current study. The cardiomediastinal and hilar contours are stable. A small left pleural effusion is likely. Massive bilateral airspace opacities appear slightly worsened. There has been interval development of a new left retrocardiac opacity with obliteration of left hemidiaphragm, consistent with left lower lobe collapse. Healed fractures of right posterior ribs 5 and 6 are noted.", "output": "1. Left internal jugular line with tip in the left brachiocephalic vein. No pneumothorax. 2. Interval worsening of bilateral multifocal airspace opacities. Differential is unchanged and includes severe pulmonary edema, ARDS, and severe multifocal infection. 3. Interval development of left lower lobe collapse with likely small left pleural effusion." }, { "input": "Endotracheal tube terminates approximately 7.6 cm above the level of the carina, slightly high. Enteric tube courses below the diaphragm, out of the field of view. There are extensive bilateral airspace opacities with differential diagnosis including severe pulmonary edema/ARDS, massive aspiration, severe multifocal infection, pulmonary hemorrhage not excluded. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal to mildly enlarged. Mediastinal contours are unremarkable.", "output": "Endotracheal tube terminates 7.6 cm above the level of the carina, slightly high the. Enteric tube courses below the diaphragm, out of the field of view. Extensive bilateral airspace opacities with differential diagnosis including severe pulmonary edema/ARDS, massive aspiration, severe multifocal infection, pulmonary hemorrhage not excluded." }, { "input": "ETT is not seen on this exam. Compared to the immediate prior exam, there has been a shift of bilateral interstitial opacities, most likely moderate pulmonary edema re-distributed, but not worsened. Left internal jugular line terminates in the left brachiocephalic vein, unchanged from prior. Heart size is top normal. Pleural effusion is small, if any. No pneumothorax is seen. Left IJ line terminates in the upper SVC.", "output": "Increased interstitial opacities, likely due to redistribution of pulmonary edema." }, { "input": "Portable supine chest radiograph ___ at 12:41 is submitted.", "output": "Bowel jugular Swan-Ganz catheter continues to have its tip in the right lower lobe pulmonary artery in the mid lung and should be pulled back approximately 5-6 cm as previously recommended. The intra-aortic balloon pump has its tip 1.2 cm below the aortic knob. The endotracheal tube and left internal jugular central line are unchanged in position. The nasogastric tube now courses below the diaphragm with both the tip and side port seen over the proximal stomach. There has been substantial interval improvement in the bilateral airspace opacities consistent with resolving but residual edema. The pleural effusions also seen to have decreased in size. Stable cardiac and mediastinal contours. Old right-sided rib fractures again seen." }, { "input": "Portable AP supine chest radiograph ___ at 08:21 is submitted.", "output": "The right internal jugular Swan-Ganz catheter continues to have its tip in the right lower lobe pulmonary artery. Pull-back of 4-5 cm would be recommended. The nasogastric tube courses below the diaphragm with the tip not identified but the side port at the gastroesophageal junction. Advancement of this tube is also recommended. The endotracheal tube, left internal jugular central line, and intra-aortic balloon pump are unchanged in position. Overall cardiac and mediastinal contours are stable. Diffuse bilateral airspace process is unchanged. There may be layering pleural ffusions. NOTIFICATION: Results were communicated to the patient's nurse, ___, by phone on ___ at 10:37 at the time of discovery." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Cholecystectomy clips are seen within the right upper quadrant of the abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is a 2 lead pacemaker with the leads projecting over the expected locations of the heart. There is volume loss in both lower lungs with some scar is are compressive changes at the bases. There is no focal infiltrate or effusion.", "output": "No change." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Median sternotomy wires and an aortic valve prosthesis are noted.", "output": "No acute intrathoracic process." }, { "input": "Heart is upper limits of normal in size, and is accompanied by mild pulmonary vascular congestion. Bibasilar areas of airspace consolidation are present, predominantly in the retrocardiac regions, and affecting the right lower lobe to a greater degree than the left. Small-to-moderate pleural effusions are also present.", "output": "1. Bibasilar airspace opacities, concerning for aspiration pneumonia in the appropriate clinical setting. 2. Bilateral pleural effusions, right greater than left. 3. Mild pulmonary vascular congestion." }, { "input": "Lung volumes are low, and prominent central pulmonary vessels reflect mild pulmonary vascular congestion and edema. There is no focal consolidation, pleural effusion or pneumothorax. The heart is normal in size. Vertebral body height loss in the mid-thoracic spine is compatible with given history of prior osteomyelitis of the thoracic spine.", "output": "Mild pulmonary vascular congestion and edema." }, { "input": "Very shallow inspiration. Endotracheal tube tip is 1.7 cm above carina. Right IJ central line tip in the upper right atrium. Findings are new since prior exam. There is no pneumothorax. Stable thoracic curve convex to the right. Shallow inspiration accentuates heart size, pulmonary vascularity. Bibasilar opacities have resolved.", "output": "There is no pneumothorax, no pneumomediastinum." }, { "input": "Extensive postoperative changes in the thoracic spine, with hardware in place. Left perihilar, basilar consolidation is more prominent, may represent atelectasis, clinically correlate to exclude pneumonitis. Mild left pleural effusion similar. Right lung is clear. Shallow inspiration accentuates heart size, pulmonary vascularity. Heart size is enlarged. Probably prominent pulmonary vascularity. Bilateral perihilar prominence, edema and/or atelectasis, more prominent bilaterally. No pneumothorax. Right IJ central line in place, tip not seen, obscured by surgical hardware. Left chest tube has been removed.", "output": "Worsened left basilar, perihilar consolidation, may represent atelectasis, clinically correlate to exclude pneumonitis. Increased heart size. Prominent perihilar opacities bilaterally, may represent edema and/ or atelectasis. Mild left pleural effusion." }, { "input": "The cardiomediastinal silhouette appears stable. There is evidence of mild cardiomegaly with evidence of slight interval increase in the bilateral pulmonary vascular congestion. The lung volumes are low, however, there appears to be a slight interval increase in linear bibasilar consolidations. The aorta is tortuous. There is no pneumothorax. There is a small left pleural effusion. Visualized osseous structures are otherwise unremarkable.", "output": "New bibasilar linear opacities likely secondary to atelectasis; however, an acute infectious process cannot be excluded. New small left pleural effusion." }, { "input": "The study is somewhat limited due to low lung volumes and the patient's chin and neck obscuring assessment of the right lung apex. Streaky bibasilar airspace opacities likely reflect atelectasis though aspiration or infection cannot be completely excluded. The cardiac, mediastinal and hilar contours are unchanged with mild enlargement of cardiac silhouette and tortuosity of the thoracic aorta again noted. There is crowding of the bronchovascular structures but no overt pulmonary edema is present. A small left pleural effusion is unchanged. Compression deformity of an upper lumbar vertebral body is unchanged. Marked degenerative changes of the left glenohumeral joint are present.", "output": "Persistent bibasilar airspace opacities may reflect atelectasis but infection or aspiration cannot be excluded. Small left pleural effusion." }, { "input": "Heart size is mildly enlarged. The aorta is tortuous and calcified, similar compared to the previous exam. There is no pulmonary edema, and the hilar contours are within normal limits. Patchy opacities are noted in both lung bases, which could reflect areas of atelectasis, though infection is not completely excluded. Small bilateral pleural effusions may be present. No pneumothorax is seen. Degenerative changes of the left shoulder from noted.", "output": "Bibasilar patchy opacities likely reflect atelectasis though infection cannot be excluded. Probable trace bilateral pleural effusions." }, { "input": "The tip of the intra-aortic balloon pump projects 1.7 cm below the aortic knob apex, unchanged but higher than usual. Heart size is normal and the lungs are clear without pleural effusion, focal consolidation or pneumothorax.", "output": "The tip of the intra-aortic balloon pump is higher than usual, projecting 1.7 cm below the aortic knob apex." }, { "input": "A nodule projecting over the left ninth posterior rib measures 1 cm. There is no focal consolidation, pulmonary edema, pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal.", "output": "1 cm nodule projecting over the left ninth posterior rib may represent a nipple shadow, however, an underlying nodule cannot be excluded. Shallow oblique radiographs with nipple markers are recommended." }, { "input": "There is streaky atelectasis or scarring at the left lower lobe. No focal consolidation is identified. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is persistent mild com asymmetric elevation of the right hemidiaphragm. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lung volumes are low, limiting assessment and accentuating the bronchovascular structures. Within the limitations, there is no evidence of a focal consolidation, pulmonary edema, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal. A VNS device overlies the left mid chest. The VNS device that was overlying the left upper chest has been removed.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes remain extremely low resulting crowding of the bronchovascular structures. This fact, in addition to patient body habitus, severely limit the sensitivity of this examination for the detection of subtle pneumonia. Within this limitation, there is no lobar consolidation, large pleural effusion, or overt pneumothorax. The cardiomediastinal silhouette appears similar to the prior examination. A vagal nerve stimulator overlies the left chest wall.", "output": "Extremely limited examination without evidence for large consolidation." }, { "input": "___ THROUGH ___.", "output": "MILD CARDIOMEGALY IS CHRONIC BUT THERE IS NO PULMONARY EDEMA OR EVEN APPRECIABLE VASCULAR ENGORGEMENT. LUNGS ARE CLEAR. NO PLEURAL EFFUSION. ELECTRODES EXTEND FROM THE LEFT PECTORAL PACEMAKER TO THE NECK." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes, which accentuate bronchovascular markings. There is no focal consolidation, pleural effusion, or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Surgical clips project over right upper abdomen.", "output": "Low lung volumes without focal consolidation." }, { "input": "Single portable view of the chest is compared to previous exam from ___. Exam is limited secondary to patient positioning and poor inspiratory effort. Within this, there is no definite large confluent consolidation. Cardiac silhouette is grossly unchanged. Metallic device projecting over the left upper quadrant, although lead is not clearly delineated. Osseous and soft tissue structures are unremarkable, noting surgical clips in the right upper quadrant.", "output": "Extremely limited exam. No definite large consolidation. Consider repeat if clinically indicated." }, { "input": "Low lung volumes persist without focal consolidation. Retrocardiac region is incompletely assessed due to obscuration by battery pack of neural stimulator. Crowding of the vasculature and increased interstitial markings is seemingly unchanged from multiple previous examinations, likely secondary to crowding due to low lung volumes. Cardiac silhouette remains mildly enlarged.", "output": "No acute intrathoracic process." }, { "input": "The lung volumes are very low. Within that limitation, the cardiac, mediastinal and hilar contours are probably unchanged. There is apparent asymmetric opacification of the right lung, particularly in the right lower lung, but somewhat hazy lung fields bilaterally, with increased density at the right lung base, although the study is very limited. There is no pleural effusion or pneumothorax.", "output": "No convincing evidence for pneumonia or aspiration on very limited study. Hazy opacities and patchy opacities at the lung bases may be due to mild vascular congestion and minor atelectasis. Short-term follow-up radiographs are suggested with better inspiration, if feasible, in the event that respiratory symptoms were to persist." }, { "input": "Single AP portable view of the chest was compared to previous exam from ___. Based on a limited portable exam, the lungs are grossly clear of large confluent consolidation or effusion. Cardiomediastinal silhouette is stable. Radiopaque linear structure seen projecting over the left upper quadrant is compatible with a vagal nerve stimulator. Surgical clips seen in the right upper quadrant.", "output": "Unremarkable limited portable chest x-ray." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. The lungs are well expanded and clear without focal consolidation concerning for pneumonia. The upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process. No findings concerning for tuberculosis." }, { "input": "There is no focal consolidation, pneumothorax or evidence of pulmonary vascular congestion. There is a very small left pleural effusion. There is marked cardiac enlargement with tortuous and calcified aorta. Median sternotomy wires are present and intact.", "output": "1. No pulmonary edema. 2. Tiny left pleural effusion." }, { "input": "Frontal and lateral views of the chest demonstrate moderate cardiomegaly with a tortuous aorta with dense mural calcifications. Patient is status post aortic valve replacement with intact median sternotomy wires. The lungs are clear. There is no pulmonary edema, pleural effusion, or pneumothorax. There is diffuse osteopenia and multilevel compression, age indeterminate. Moderate right acromioclavicular osteoarthritis is present.", "output": "No evidence of pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. There is mild bibasilar atelectasis. No definite focal consolidation. There is no pleural effusion or pneumothorax. The cardiac silhouette is top normal to mildly enlarged. The aorta is calcified and tortuous.", "output": "Top normal to mildly enlarged cardiac silhouette. No focal consolidation worrisome for pneumonia." }, { "input": "Heart size is normal. Atherosclerotic calcifications are seen diffusely within the thoracic aorta. Mild pulmonary edema is new compared to the previous study with small new bilateral pleural effusions demonstrated. Patchy opacities in the lung bases may reflect atelectasis however infection or aspiration is difficult to exclude. More focal ill-defined mass in the left upper lobe was better characterized on the recent chest CT as consistent with lung malignancy. No pneumothorax is present. Moderate multilevel degenerative changes are seen in the thoracic spine.", "output": "Interval development of mild pulmonary edema and small bilateral pleural effusions since the previous chest radiograph. Bibasilar patchy opacities may reflect atelectasis however infection or aspiration cannot be excluded. Re- demonstration of left upper lobe mass concerning for malignancy." }, { "input": "PA and lateral views of the chest provided. No convincing evidence for pneumonia or edema. No large effusion or pneumothorax. There is subtle increase in reticular markings in the left lower lobe which may reflect the sequelae of chronic aspiration in the correct clinical setting. Cardiomediastinal silhouette appears within normal limits. Bony structures are intact. Mild scarring projects over the left upper lung.", "output": "No acute intrathoracic process." }, { "input": "The lungs are well expanded. Bilateral calcified pleural plaques are unchanged. Cardiac and mediastinal contours are normal. No effusion, consolidation or pneumothorax is present.", "output": "Stable bilateral pleural plaques." }, { "input": "The lungs are fully expanded and clear. Cardiomediastinal and hilar silhouettes are normal. Pleural surfaces are normal. Surgical clips projecting over the inferior neck suggestive of interval thyroid surgery.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are grossly clear however, known right basilar calcified pleural based opacity is not clearly delineated on this portable film. The cardiac silhouette is moderately enlarged similar to prior and there is enlargement of the main pulmonary artery.", "output": "Cardiomegaly without definite acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest ___ at 08:50 are submitted. The lateral view is suboptimal due to overlying motion artifact.", "output": "Interval placement of a dual lead left-sided pacing device with the leads terminating over the expected location of the right atrium and right ventricle, respectively. The heart remains stably enlarged. There is stable enlargement of the pulmonary artery suggesting underlying pulmonary arterial hypertension. The interstitium is more prominent as compared to ___ which suggests superimposed mild interstitial edema. Clinical correlation is recommended. Status post median sternotomy. No pneumothorax. Minimal blunting of both costophrenic angles may reflect tiny effusions or pleural thickening." }, { "input": "PA and lateral views of the chest provided. A right arm access PICC line is seen with its tip in the mid SVC. Lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Calcification is seen along the course of the thoracic aorta. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process. PICC line in appropriate position." }, { "input": "Lung volumes are low, with mild bibasilar atelectasis. No focal consolidation is present. The hilar and cardiomediastinal contours are normal. There is no pneumothorax or pleural effusion. The pulmonary vascularity is normal. Patient is status post left mastectomy.", "output": "Mild bibasilar atelectasis in the setting of low lung volumes. No definite evidence for pneumonia." }, { "input": "The patient is status post median sternotomy and CABG. The cardiac silhouette size is normal. The aorta demonstrates diffuse atherosclerotic calcifications. Mild pulmonary vascular congestion is demonstrated, as well as patchy opacities in the lung bases that could reflect atelectasis. Infection however is not excluded. Small bilateral pleural effusions are demonstrated. There is no pneumothorax. Marked degenerative changes of the right glenohumeral joint are noted. Moderate degenerative changes within the thoracic spine are also seen.", "output": "Mild pulmonary vascular congestion and small bilateral pleural effusions. Bibasilar patchy opacities could reflect atelectasis but infection is not excluded." }, { "input": "Patient is status post median sternotomy and CABG. The cardiac silhouette is stable. There is mild pulmonary edema. There is mild bibasilar atelectasis. There is no focal consolidation or pneumothorax.", "output": "Mild pulmonary edema." }, { "input": "There are linear opacities at the lung bases bilaterally most suggestive of atelectasis and/or scarring. There is no consolidation worrisome for pneumonia. Cardiac silhouette is top-normal in size. There is tortuosity of the descending thoracic aorta. Known diffuse lytic lesions throughout all visualized osseous structures are better seen on prior CT. Acute kyphosis at a lower thoracic vertebral body compression deformity is unchanged.", "output": "No acute cardiopulmonary process. Known diffuse osseous lesions better seen on prior exam." }, { "input": "No focal consolidation is identified. There is mild atelectasis at the left lung base. There is mild pulmonary vascular congestion without overt pulmonary edema. The cardiomediastinal silhouette is unchanged. Again seen is tortuosity of the descending thoracic aorta. There is no pleural effusion or pneumothorax. Acute kyphosis with lower thoracic vertebral body compression deformities are again noted. Known diffuse lytic lesions are better assessed on prior CT from ___. Visualized upper abdomen is unremarkable.", "output": "No focal consolidation to suggest pneumonia. Mild pulmonary vascular congestion." }, { "input": "AP upright and lateral views of the chest provided. The lungs appear hyperinflated and clear aside from linear atelectasis of the left lung base. The heart is mildly enlarged. The aorta appears unfolded. Diffuse lucency within the AH osseous structures with an expansile lesion in the left scapula appear unchanged in this patient with known multiple myeloma.", "output": "No acute findings. Diffuse lucent osseous lesions consistent with multiple myeloma." }, { "input": "There is hazy increased opacity projecting over the lung apices, left greater than right. This is not definitely parenchymal in nature and may be technical and due to overlying soft tissues. Elsewhere the lungs are clear, there is no effusion. There is an ill-defined contour of the aortic knob. There are diffuse lucencies throughout the bones particularly notable in the region of the left scapula and right clavicle.", "output": "1. Ill-defined contour of the aortic knob. In setting of chest pain, CT should be considered to further assess. Alternatively if low suspicion for acute aortic syndrome, repeat with PA and lateral views can be performed. 2. Increased opacity projecting over the upper lungs, left greater than right likely technical due to overlying soft tissues but can be further clarified by a PA and lateral. 3. Osseous findings compatible with patient's known multiple myeloma. NOTIFICATION: Findings discussed with Dr. ___ by Dr. ___ ___ the phone ___ min after time of discovery at 16:00 on ___ ." }, { "input": "There is bibasilar atelectasis, and there is no focal consolidation, pleural effusion or pneumothorax. There is no overt pulmonary edema, and the heart is mildly enlarged. Lucencies in the osseous structures are compatible with known history of multiple myeloma.", "output": "No acute cardiopulmonary process. Mild bibasilar atelectasis." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. There is a substantial nodular opacity projecting along the left lower lung which may be associated with a nipple shadow or confluence of soft tissue or even potentially atelectasis but when clinically appropriate evaluation with a chest CT is recommended in order to exclude a true lung nodule. Otherwise the lungs appear clear. The osseous structures are unremarkable.", "output": "1. No evidence of acute disease. 2. Nodular opacity in the left lower lung, possibly an artifact or focus of atelectasis, but when clinically appropriate chest CT follow-up is recommended to evaluate further." }, { "input": "No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac silhouette is mildly enlarged. Mediastinal contours are unremarkable.", "output": "Mild cardiomegaly. No focal consolidation." }, { "input": "PA and lateral views of the chest provided. The left apical granuloma is unchanged from ___. There is no focal consolidation, effusion, or pneumothorax. Mild cardiomegaly, minimally increased from ___. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Mild cardiomegaly. No focal consolidation to suggest pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephoneon ___ at 9:43 AM, 5 minutes after discovery of the findings." }, { "input": "There is mild cardiomegaly. . The mediastinal contour is stable. Lung volumes are low resulting in mild basilar atelectasis. There is no consolidation or pleural effusion. A left upper lobe granuloma is stable over multiple prior studies, dating back to the CT scan of ___.", "output": "No evidence of pneumonia" }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of normal size with normal cardiomediastinal contours. The lungs are clear without focal or diffuse abnormality. No pleural effusion or pneumothorax. Osseous structures are unremarkable without evidence of fracture. No radiopaque foreign body.", "output": "No acute cardiopulmonary process. No clavicle fracture." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The inspiratory lung volumes are appropriate. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The pulmonary vasculature is not engorged. The cardiomediastinal and hilar contours are within normal limits. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "Left port a cath sign rib appears intact Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax or pleural effusion. There is S-shaped scoliosis.", "output": "No acute cardiopulmonary abnormalities" }, { "input": "The patient is rotated to the left. Dual lead left-sided pacemaker is seen with leads extending to the expected positions of the right atrium and right ventricle. There is medial left upper lobe opacity worrisome for consolidation. Bibasilar atelectasis is seen. Possible medial right upper lobe atelectasis/ scarring. There may also be trace bilateral pleural effusions. Chronic underlying interstitial prominence is again seen. The cardiac silhouette is top-normal to mildly enlarged. Mediastinal contours are grossly stable given differences in patient positioning. The diaphragm activity right-sided pacer obscures the right lung base.", "output": "Patient rotated to the left. Additional, battery pack from the right-sided pacer obscures the right lung base. Left upper lobe consolidation worrisome for pneumonia. Recommend follow-up to resolution. Bibasilar atelectasis and possible trace pleural effusions." }, { "input": "AP upright and lateral chest radiographs were obtained. Left upper lung consolidative opacities slightly increased from ___. Subpleural basal predominant interstitial opacities may reflect chronic interstitial changes in the setting of emphysema given the increased AP diameter on the lateral view. The heart and mediastinal structures are unchanged with dual lead pacemaker is noted.", "output": "Left upper lobe consolidative opacities worsened from ___ suggesting recurrent or residual pneumonia; however given recurrence/persistence neoplasm must also be considered. See subsequent CT for further details." }, { "input": "Endotracheal tube tip is 5 cm above the carina, right internal jugular line tip is at mid SVC and orogastric tube ends in the stomach and are all appropriate. Since yesterday, pneumonia involving bilateral upper lobe is unchanged, whereas right lower lobe pneumonia show interval improved. Increased retrocardiac opacity reflecting either consolidation and/or combination of consolidation and atelectasis is significantly better. Heart size is normal. Mediastinal and hilar contours are unchanged.", "output": "1. Over last 24 hours, bilateral upper lobe pneumonia is unchanged, but improved in right lower lobe . 2. Retrocardiac opacity likely consolidation and/or combination of consolidation and atelectasis is significantly better." }, { "input": "The mid to lower lateral left hemithorax is not fully included on the image. Single supine portable view of the chest demonstrates nasogastric tube passing into the stomach and out of view. Endotracheal tube noted at the level of the clavicles, 9.9 cm above the carina. The cardiomediastinal and hilar contours are unremarkable. Depression of the right hilum noted in conjunction with the right lower lung opacification is concerning for right lower lobe collapse. Mild blunting of the right costophrenic angle is likely due to small pleural effusion. Faint asymmetry in opacification at the bilateral lung apices may reflect patient positioning or possibly layering effusion.", "output": "Endotracheal tube at the level of the clavicles, 9.9 cm above the carina, could be advanced ~ 3-5 cm. Well-positioned nasogastric tube. Right lower lung opacification may represent collapse. Small right pleural effusion. Asymmetry in opacification of bilateral upper lobes, right greater than left, may reflect patient positioning or possibly layering effusion. See immediately subsequent CT." }, { "input": "There has been placement of a Dobbhoff tube which is in appropriate position within the stomach. Otherwise, there has been no significant change since the most recent prior radiograph. The visualized portions of the lungs demonstrate no new parenchymal opacities. Cardiomediastinal silhouette is unremarkable.", "output": "Placement of a new Dobbhoff tube in appropriate position." }, { "input": "Compared to most recent prior exam, there has been little interval change. Right lower lung opacity is similar in extent but decreased in density compared to prior. No pneumothorax is seen. Endotracheal tube, right internal jugular catheter, and esophageal catheter are similarly positioned with esophageal catheter tip out of view.", "output": "Persistent slightly improved right lower lung opacity." }, { "input": "The lungs are mildly hyperexpanded but clear. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process. Mildly hyperexpanded lungs." }, { "input": "The ETT is 5.8 cm above the carina. The heart is moderately enlarged. There are small bilateral effusions. There is increased alveolar edema compared to the study from the prior evening. The NG tube tip is in the stomach.", "output": "fluid overload" }, { "input": "There is mild enlargement of the cardiac silhouette. There is new pulmonary vascular congestion with mild interstitial edema. No pleural effusion, focal consolidation or pneumothorax.", "output": "Mild cardiomegaly with mild interstitial edema." }, { "input": "A right MediPort is unchanged in configuration from ___. There is no evidence of catheter fracture, kinking or migration. The tip terminates in the low SVC. The lungs are clear. No pleural effusion, pneumothorax or focal airspace consolidation. Heart is normal size. Mediastinal hilar structures are unremarkable. Clips are again noted in the upper abdomen.", "output": "Unchanged appearance of the right MediPort from ___. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ ___ telephone on ___ at 11:31 AM, 2 minutes after discovery of the findings." }, { "input": "A right side Port-A-Cath is in unchanged position ending in the mid SVC. The lungs are clear without focal consolidation. These there is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. There is no evidence of pulmonary vascular congestion. Surgical clips are seen in the right upper abdomen.", "output": "No evidence of pneumonia." }, { "input": "The patient is rotated to the left. Right-sided Port-A-Cath is seen, terminating in the low SVC. Streaky basilar opacity, best seen on the lateral view, most likely represents atelectasis and vascular structures rather than focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema.", "output": "Streaky basilar opacity, best seen on the lateral view, most likely represents atelectasis and vascular structures rather than focal consolidation." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are unremarkable. There is a right-sided internal jugular access Port-A-Cath in place with the tip terminating at the cavoatrial junction. Again appreciated are heterogeneous opacities through much of the right lung field predominantly in the right middle lobe as well as probable right lower lobe. The left lung is essentially clear. There is no pleural effusion or pneumothorax.", "output": "Heterogeneous opacities through much of the right lung slightly improved from earlier same day examination compatible with aspiration." }, { "input": "Lung volumes are low. Right-sided central venous catheter tip terminates at the junction of the SVC and right atrium. Cardiac, mediastinal and hilar contours are unremarkable. Pulmonary vasculature is not engorged. Elevation of the left hemidiaphragm is re- demonstrated. Left basilar streaky opacity likely reflects atelectasis. The right lung is grossly clear. No pneumothorax is identified. Numerous clips are demonstrated within the right upper quadrant of the abdomen.", "output": "Low lung volumes. No radiographic evidence for pneumonia." }, { "input": "Right-sided Port-A-Cath is stable in position. No pneumothorax is seen. There is no pleural effusion. There is persistent eventration of the left hemidiaphragm with overlying mild atelectasis. No definite focal consolidation is seen. The cardiac and mediastinal silhouettes are stable and unremarkable. Partially imaged are surgical clips in the right upper abdomen.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. An opacity at the right lung base is concerning for pneumonia. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable.", "output": "A right lung base opacity is concerning for pneumonia. NOTIFICATION: An e-mail was sent to ___ nurses with the updated ___ at 09:24 on ___." }, { "input": "PA and lateral views of the chest provided demonstrate no signs of pneumonia or CHF. No free air below the right hemidiaphragm. No large effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "No acute findings including no free air below the right hemidiaphragm." }, { "input": "Mild to moderate enlargement of the cardiac silhouette is unchanged. The mediastinal and hilar contours are similar. There is crowding of bronchovascular structures with probable mild pulmonary vascular congestion, but no overt pulmonary edema. Small left pleural effusion is demonstrated along with patchy opacities in the lung bases, possibly atelectasis. No pneumothorax is present. There are mild degenerative changes noted in the thoracic spine.", "output": "Mild pulmonary vascular congestion and small left pleural effusion. Patchy opacities in lung bases may reflect areas of atelectasis, though infection cannot be completely excluded in the correct clinical setting." }, { "input": "The cardiomediastinal hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size remains moderately enlarged. The aorta is tortuous. Mediastinal and hilar contours are similar. Lung volumes are slightly low which causes mild crowding of bronchovascular structures, but no overt pulmonary edema is present. Linear opacities in the lung bases likely reflect areas of atelectasis. Assessment of the right lung apex is is slightly obscured by the patient's neck and chin projecting over this region, but no pneumothorax is identified. No pleural effusion or focal consolidation is present. There are moderate degenerative changes noted in the thoracic spine.", "output": "Moderate cardiomegaly and bibasilar atelectasis. No pulmonary edema." }, { "input": "AP portable upright view of the chest. No radiopaque foreign body is seen in the chest. Overlying EKG leads are present. Lung volumes are somewhat low. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is stable with borderline cardiomegaly. Imaged osseous structures are intact.", "output": "No acute intrathoracic process. No definite foreign body identified." }, { "input": "Compared with prior exam, there has been interval slight worsening of bilateral interstitial opacities, with associated hilar engorgement and vascular upper redistribution. Bibasilar atelectasis is again seen. Elevation of the left hemidiaphragm is not significantly changed from prior, although there is some obscuration of the lateral left hemidiaphragm which may be due to overlying ateletasis and a small left pleural effusion. Cardiac contour cannot be fully assessed due to partial obscuration of the left heart border, but is grossly stable. Mediastinum is stable in appearance. There is no pneumothorax. Patient is status post median sternotomy and CABG. An ill-defined hyperdensity between the fourth and fifth sternotomy wires is not clearly seen in the lateral view and may be external to the patient.", "output": "1. Findings suggest minimal interstitial edema. 2. Stable elevated hemidiaphragm and bibasilar atelectasis. Possible small/trace left pleural effusion." }, { "input": "The patient is status post median sternotomy and CABG. Lung volumes are low. Heart size is difficult to assess given the low lung volumes, but is at least mildly enlarged. There is mild pulmonary vascular congestion. Elevation of the left hemidiaphragm is again noted, with small bilateral pleural effusions visualized. Patchy opacities in the lung bases likely reflect atelectasis. No pneumothorax is seen although the left apex is obscured due to the patient's chin projecting over this region. Bilateral calcified pleural plaques are again demonstrated, compatible with prior asbestos exposure. Multilevel degenerative changes in the thoracic spine with DISH are again noted.", "output": "Pulmonary vascular congestion and small bilateral pleural effusions. Bibasilar atelectasis. Calcified pleural plaques indicative of prior asbestos exposure." }, { "input": "Again appreciated is right basilar atelectasis. Elevation of the left hemidiaphragm is unchanged. There is otherwise no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is stable. Median sternotomy wires are in place. No acute bony changes. Calcifications projecting over the upper lungs correlate to pleural plaques on prior CT.", "output": "No acute intrathoracic process." }, { "input": "The patient is status post median sternotomy and CABG. The cardiac silhouette size remains at least mildly enlarged. Mediastinal contours are unchanged, with mild calcification of the aortic arch. Mild pulmonary edema appears slightly progressed compared to the previous exam. Small pleural effusion is again demonstrated, with bibasilar airspace opacities most likely reflective of atelectasis. The left hemidiaphragm remains elevated. No pneumothorax is present. Multilevel degenerative changes are noted in the thoracic spine.", "output": "Mild congestive heart failure, slightly progressed compared to the previous exam, with small left pleural effusion. Mild bibasilar atelectasis." }, { "input": "Portable AP chest radiograph. Median sternotomy wires are intact. Mild interstitial edema is unchanged, but there is now a moderate pleural effusion on the right. Moderate left pleural effusion is stable. There is no pneumothorax. The heart remains moderately enlarged.", "output": "Stable mild interstitial edema but new moderate right pleural effusion." }, { "input": "There is persistent elevation of the left hemidiaphragm. The hilar and mediastinal contour is slightly exaggerated due to the AP technique. There are low lung volumes. There is bibasilar atelectasis as well as evidence of pleural plaques. No pleural effusions or pneumothoraces are identified. No new focal consolidations concerning for infection are identified.", "output": "No pneumonia." }, { "input": "There is no focal consolidation or pleural effusion. Elevation of the left hemidiaphragm is stable. Linear opacities at the right base are either atelectasis or scarring. The upper lung zones are clear. There is mild enlargement of the cardiac silhouette. Median sternotomy wires are present and intact. Again seen are calcified pleural plaques in the periphery of the left hemithorax.", "output": "Atelectasis or scarring at the right base. No focal consolidation." }, { "input": "Frontal and lateral views of the chest were obtained. There is no focal consolidation, pleural effusion or pneumothorax. Right basilar atelectasis is seen. Elevation of left hemidiaphragm is unchanged. Cardiac and mediastinal silhouettes are stable. Median sternotomy wires are intact status post CABG.", "output": "No acute intrathoracic process." }, { "input": "Chronic elevation of the left hemidiaphragm has been present since at least ___. Cardiomegaly is again noted. Lung volumes are low. Pleural calcifications suggest prior asbestos exposure. Sternal wires appear intact and aligned. Mediastinal clips and hardware are again noted.", "output": "Stable chest radiographs." }, { "input": "Chest, PA and lateral radiographs demonstrate stable elevation of left hemidiaphragm and adjacent left lower lobe atelectasis obscuring left heart border. Left pleural effusion. Stable right lower lung opacifications, likely representing atelectasis. No overt pulmonary edema evident. Stable small left pleural effusion. No pneumothorax identified. Mediastinal and hilar contours are unchanged.", "output": "1. Stable left lower lung atelectasis and pleural effusion. 2. No overt pulmonary edema." }, { "input": "AP upright and lateral views of the chest were provided. Midline sternotomy wires and mediastinal clips are again noted. There is stable elevation of the left hemidiaphragm. Right basal plate-like atelectasis is noted. There is no definite sign of pneumonia. There are calcified pleural plaques projecting over the mid lungs. Heart size cannot be assessed. Mediastinal contour is stable. Bony structures are intact.", "output": "Bibasilar atelectasis with stable elevation of the left hemidiaphragm." }, { "input": "Marked elevation of the left hemidiaphragm is increased compared to the most recent radiograph from ___, although does not appear significantly changed compared to CT from ___. There is minimal bilateral lower lobe atelectasis. The heart is presumed enlarged, but difficult to accurately assess, not significantly changed. The mediastinal contours are normal. There are no definite pleural effusions. No pneumothorax is seen. Dense opacities projecting over both upper lungs correspond to calcified pleural plaques, as seen on prior CT from ___. Midline sternotomy wires are redemonstrated.", "output": "1. No acute cardiac or pulmonary findings. 2. Marked elevation of the left hemidiaphragm, not significantly changed compared to CT from ___." }, { "input": "Lungs are low in volume with persistent elevation of the left hemidiaphragm again noted. Bibasilar atelectasis is seen with perhaps trace pleural effusions. No definite focal consolidation or pneumothorax is identified. Persistent cardiomegaly is noted with intact sternal wires. Hilar and mediastinal contours are unremarkable. Calcified pleural plaques are re- demonstrated.", "output": "Low lung volumes without acute findings." }, { "input": "There is stable elevation of left hemidiaphragm with a corresponding left lower lobe atelectasis. There is mild right lower lobe atelectasis. There has been interval increase in left pleural effusion. Cardiomediastinal silhouette is obscured by pleural effusion. Moderate multilevel degenerative changes of the thoracic spine are noted. Patient is status post sternotomy with sternotomy wires in unchanged vertical alignment with no obvious hardware complications.", "output": "Worsening left pleural effusion. No clear evidence of infection. Stable right basilar atelectasis and elevation of left hemidiaphragm." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unchanged, with aorta appearing tortuous and diffusely calcified. The hilar contours are normal, and the pulmonary vasculature is not engorged. Blunting of the costophrenic angles posteriorly on the lateral view suggests trace bilateral pleural effusions. Minimal streaky opacities in the lung bases may also reflect atelectasis. There is no pneumothorax. There are mild degenerative changes noted in the thoracic spine.", "output": "Trace bilateral pleural effusions. Mild bibasilar atelectasis." }, { "input": "Portable semi-upright radiograph of the chest demonstrates small to moderate right-sided pleural effusion with adjacent compressive atelectasis, which has increased over the interval. The left lung is essentially clear. There is a probable tiny right apical pneumothorax. The cardiomediastinal and hilar contours are unchanged.", "output": "1. Small to moderate right-sided pleural effusion with adjacent compressive atelectasis, which has increased over the interval. 2. Probable tiny right apical pneumothorax." }, { "input": "Portable semi-upright radiograph of the chest demonstrates initial placement of the endotracheal tube into the right mainstem bronchus. The endotracheal tube was subsequently repositioned such that the tip ends 2.2 cm from the carina. There has been interval clearing of the right base, and new obliteration of the left hemi-diaphragm, consistent with pleural effusion and atelectasis. Probably tiny left apical pneumothorax is stable.", "output": "Endotracheal tube ultimately positioned such that the tip ends 2.2 cm from the carina." }, { "input": "Bilateral lung apices are obscured by patient's head. Right upper lung is obscured by an overlying hand. Allowing for the limitations, there is no consolidation. Blunting of left costophrenic angle may be a small pleural effusion. Cardiomediastinal silhouette is difficult to evaluate due to optimal positioning.", "output": "Exam is limited due to poor patient positioning. Allowing for limitations, there is no radiographic evidence of pneumonia." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal. There is no evidence of lymphadenopathy. Bones are intact. The imaged upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process and no evidence of lymphadenopathy." }, { "input": "There is increased vascular congestion with bilateral small pleural effusions and widened mediastinum in area of the azygos vein suggestive of congestive heart failure. No evidence of pneumonia. No pneumothorax. There is increase in cardiac size compared to ___.", "output": "Vascular congestion and bilateral small pleural effusions consistent with heart failure. Increasing cardiac silhouette may suggest new cardiomegaly or pericardial effusion given patient's history of end-stage renal disease requiring dialysis. No evidence of pneumonia NOTIFICATION: The findings were discussed with Dr. ___, ___D. by ___, ___D. on the telephone on ___ at ___:___ PM, ___ minutes after discovery of the findings." }, { "input": "Single frontal view of the chest demonstrates intact median sternotomy wires. Cardiac silhouette is mildly enlarged. Thoracic aorta is tortuous, containing arch calcifications. Since preceding exam, there is increased vascular engorgement without frank edema. New or worsened left basal consolidation is either progressing pneumonia or atelectasis and there may be a new, small left pleural effusion.", "output": "1. Vascular congestion could be due to volume overload (particularly if the patient is receiving volume support). 2. New left base pneumonia or atelectasis." }, { "input": "The heart size is normal. Hilar and mediastinal contours are normal. No pleural effusion, pneumothorax, or focal consolidation. Degenerative changes of the thoracic spine with anterior osteophytes are unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "Left-sided dual-chamber pacemaker device is noted with leads terminating in the right atrium and right ventricle, unchanged. Lung volumes are low which accentuate the size of the cardiac silhouette which appears moderately enlarged. Aorta remains tortuous and calcified. There is crowding of the bronchovascular structures with probable mild pulmonary vascular congestion. Patchy opacities in the lung bases likely reflect areas of atelectasis. A small left pleural effusion may be present. No pneumothorax is demonstrated. Multilevel degenerative changes are seen in the thoracic spine.", "output": "Low lung volumes with patchy bibasilar airspace opacities, likely atelectasis. Possible mild pulmonary vascular congestion and small left pleural effusion." }, { "input": "In comparison to ___ portable chest graft, the lung volumes are low. Additional, when compared to ___ chest radiograph, the superior portion of the trachea is shifted to the right side. There is is a moderate cardiomegaly without overt pulmonary edema. Atelectatic changes are seen in the bilateral lung bases. No pleural effusion is seen. Pacemaker is visualized on the left chest wall. Pacer wires terminate in the right atrium and right ventricle.", "output": "1. Superior portion of trachea appears shifted to the right side when compared to ___ chest radiograph; this could be secondary to low lung volumes or patient's rotated position when image was taken. However, cannot rule out a comparison mass. Recommend repeat chest x-ray with adequate inspiration for further evaluation. RECOMMENDATION(S): Recommend repeat chest x-ray with adequate inspiration for further evaluation. NOTIFICATION: ___ indicated findings with ___ ___ via telephone conversation at 17:37." }, { "input": "There is mild cardiomegaly and moderate pulmonary edema as well as small (right greater than left) pleural effusions. No pneumothorax. Severe degenerative changes at the right glenohumeral joint.", "output": "Moderate pulmonary edema." }, { "input": "Frontal and lateral views of the chest were obtained. The heart size and cardiomediastinal contours are normal. The lungs are hyperinflated, compatible with emphysematous change. No focal pulmonary consolidation, pleural effusion, or pneumothorax. Right rib deformities appear chronic.", "output": "Hyperinflated lungs compatible with emphysema. No pneumothorax." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "There are relatively low lung volumes. No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal in size. No pulmonary edema is seen.", "output": "Low lung volumes. No focal consolidation to suggest pneumonia." }, { "input": "PA and lateral views of the chest provided. New from prior, is consolidation in the left lower lobe which is concerning for pneumonia. No large effusion or pneumothorax. Right lung is clear. Cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "Left lower lobe pneumonia." }, { "input": "Cardiac silhouette size is top normal. Mediastinal and hilar contours are unremarkable. Lungs are clear. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormality is visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Cardiomediastinal contours are normal. Lungs and pleural surfaces are clear.", "output": "No radiographic evidence of pneumonia." }, { "input": "Lung volumes are relatively lower than the prior study. No definite focal consolidation is seen. There is no pleural effusion. The small right-sided pneumothorax seen on preceding chest CT, earlier today, is not appreciated on this radiograph. The cardiac and mediastinal silhouettes are unremarkable. Multiple right-sided rib fractures were better assessed on preceding CT.", "output": "Pneumothorax seen on preceding CT not well seen on radiograph. Known multiple right rib fractures better assessed on CT." }, { "input": "The lung volumes are low which causes crowding of bronchovascular structures. No focal opacity, pleural effusion or pneumothorax is identified. The heart size is likely normal. The mediastinal contours are normal. No rib fracture is identified.", "output": "No rib fracture is identified. If there are focal areas of pain dedicated views of those areas are recommended." }, { "input": "There are multiple bilateral patchy opacities in the lung, the largest in the lateral left mid lung zone but also seen in the right greater than left bibasilar regions and possibly in the upper lobes as well. Differential diagnosis includes multifocal pneumonia versus neoplastic process, metastatic disease, particularly if patient has a known primary. Given history of trauma, pulmonary contusion cannot be excluded. Small left pleural effusion is seen. Difficult to exclude a trace right pleural effusion. No pneumothorax is seen. The cardiac silhouette is mildly enlarged. The aorta is calcified and tortuous. This is a partially imaged the proximal left humerus fracture.", "output": "Multiple bilateral patchy opacities projecting over the lungs. Differential diagnosis includes multifocal pneumonia however, metastatic disease not excluded particularly if this patient has a known history of malignancy. Given setting of trauma, a pulmonary contusion can not be excluded" }, { "input": "Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac pacemaker. Shallow inspiration accentuates heart size, pulmonary vascularity. Small left pleural effusion or thickening, similar. Previous tiny pleural effusion has resolved. Heart size has decreased. Left basilar opacities have nearly resolved. Small area of new right basilar opacity, likely atelectasis, consider pneumonitis in the appropriate clinical setting.", "output": "Small area of new right basilar opacity, likely atelectasis, consider pneumonitis in the appropriate clinical setting." }, { "input": "Left-sided pacemaker device is noted with leads in unchanged positions in the right atrium and right ventricle. Moderate cardiomegaly is similar compared to the prior radiograph. The mediastinal contour is unchanged. Lungs are hyperinflated compatible with underlying emphysema. Prominence of the hilar contours unchanged with mild pulmonary vascular congestion, as seen previously. Patchy airspace opacities are noted in the left lung base, more pronounced than on the previous study, and may reflect early infection. No large pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Mild degenerative changes are present in the thoracic spine.", "output": "Patchy airspace opacities in the left lung base may reflect atelectasis but infection is not excluded. Mild pulmonary vascular congestion." }, { "input": "Left chest wall dual lead pacemaker is present. No focal consolidation, pleural effusion or pneumothorax identified. The appearance of the cardiomediastinal silhouette is unchanged.", "output": "No significant interval change since the prior exam." }, { "input": "Compared with the prior radiograph, a patchy basilar opacities are new, more pronounced on the right. No change in the positioning of the left-sided pacemaker, with leads terminating in the right atrium and right ventricle. There is mild central pulmonary vascular congestion. The heart is top normal in size. Bilateral pleural effusions are small, if any. No evidence of pneumothorax.", "output": "Bibasilar patchy opacities are new, more pronounced on the right, and concerning for pneumonia or aspiration, given the clinical history. Mild pulmonary vascular congestion." }, { "input": "Moderate cardiomegaly is unchanged. Mild pulmonary vascular congestion has improved since ___ and there is no pulmonary edema. Flattening of the hemidiaphragms, seen on the lateral view is consistent with hyperinflation. Bilateral pleural effusions are small if present. There is mild bibasilar atelectasis. No pneumothorax or consolidation. A pacemaker device is present, with unchanged position of the leads, ending in the region of the right atrium and right ventricle.", "output": "Moderate cardiomegaly. No evidence of acute decompensation. No pneumonia." }, { "input": "Left-sided pacer device is again noted with leads terminating in the right atrium and right ventricle. Moderate enlargement of the cardiac silhouette persists. The mediastinal and hilar contours are similar. Pulmonary vasculature is not engorged. Lungs are hyperinflated with emphysematous changes again noted. Patchy opacities within the lung bases without substantial interval change, likely atelectasis, without focal consolidation. No pleural effusion or pneumothorax is demonstrated. Mild to moderate degenerative changes are seen in the thoracic spine.", "output": "No substantial interval change from the previous radiograph with continued emphysema and patchy bibasilar opacities, likely atelectasis, without focal consolidation." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. There is no pulmonary edema. The cardiac and mediastinal silhouettes are unremarkable. Osteophytes are seen along the spine. Surgical clips are seen in the right upper abdomen.", "output": "No acute cardiopulmonary process." }, { "input": "As with most recent radiograph, the patient is significantly rotated, limiting evaluation. Increase in bibasilar opacities, although probably partially explained by low lung volumes and atelectasis, are suspicious for superimposed infection. As previously noted, the aorta is tortuous and the pulmonary artery is enlarged, suggesting pulmonary arterial hypertension. There is no apical pneumothorax and no pleural effusions are seen on this single frontal radiograph.", "output": "Interval increase in bibasilar opacities, although partly explained by atelectasis, are suspicious for infection. The above results were communicated via telephone by Dr. ___ ___ Dr. ___ to Dr. ___ at 4:30 p.m. on ___ at the time of discovery." }, { "input": "The lungs are hyperinflated with emphysematous changes most pronounced in the lung apices. The cardiac, mediastinal and hilar contours are unchanged, with the heart size appearing mildly enlarged. Enlargement of pulmonary arteries is re- demonstrated, compatible with underlying pulmonary arterial hypertension. No pulmonary edema is demonstrated. Bibasilar airspace opacities have progressed compared to the previous radiograph. No pleural effusion or pneumothorax is identified. Posterior thoracic fusion hardware is re- demonstrated along with multiple surgical ___ along the midline.", "output": "Worsening bibasilar airspace opacities may reflect worsening atelectasis or infection, with aspiration not excluded. Emphysema. Enlargement of pulmonary arteries compatible with pulmonary arterial hypertension." }, { "input": "Compared to chest radiograph approximately 14 hours prior, there are no significant appreciable changes. Severe upper lobe predominant emphysema is redemonstrated. There are no new focal lung consolidations concerning for pneumonia. The cardiopulmonary silhouette and hilar contours are stable. The curvilinear density at the lower heart contour representing pericardial calcification is unchanged. There is no pneumothorax or pleural effusion.", "output": "No findings to suggest pneumonia and no appreciable changes compared to chest radiograph 14 hours prior." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. The heart size is normal. Mediastinal contours are normal. Mild, multilevel degenerative changes are seen throughout the visualized thoracic spine. No acute bony abnormality is detected.", "output": "No radiographic evidence for acute cardiopulmonary process or acute fracture." }, { "input": "Frontal and lateral views of the chest were obtained. The heart size and cardiomediastinal contours are normal. The lungs are clear without focal consolidation, pleural effusion, or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Chest, PA and lateral. The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal. The pulmonary edema as seen on the prior radiograph has resolved.", "output": "No acute cardiopulmonary process. Interval resolution of pulmonary edema since ___." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation or pneumothorax. There is prominence of the interstitial markings, unchanged from prior. Hilar and mediastinal silhouettes are stable. The heart size is normal. Partially imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are well expanded. There are diffuse bilateral interstitial opacities which are significantly improved compared with prior exam. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. Biapical pleural parenchymal scarring is present. A new right-sided IJ line ends in the mid SVC.", "output": "1. Significant interval improvement of interstitial edema. 2. Right-sided IJ line in the mid SVC." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. Heart size is normal. Mediastinal silhouette and hilar contours are normal. No osseous abnormality is identified.", "output": "Normal chest radiographs." }, { "input": "The heart is normal in size. The hilar and mediastinal contours are normal. The lungs are well expanded and clear. There is no evidence of active or latent TB. There are no pleural effusions or pneumothorax. The osseous structures are grossly unremarkable.", "output": "No radiographic evidence of active or latent TB." }, { "input": "Frontal and lateral views of the chest were obtained. FINDINGS: Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The aorta is calcified and tortuous. Of note, on prior CT torso from ___, there is prominence of the ascending aorta. The cardiac silhouette is top normal. Multilevel degenerative changes are seen along the spine. Degenerative change at the right acromioclavicular joint.", "output": "No acute cardiopulmonary process." }, { "input": "Hyperinflated lungs with reduced lung markings at the apices consistent with emphysema. No pleural effusion or pneumothorax is seen. The heart is not enlarged. The ascending aorta is dilated or tortuous, unchanged compared to prior study.", "output": "No evidence of pneumonia. Hyperinflation and reduced apical lung markings consistent with emphysema. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 2:16 PM, 5 minutes after discovery of the findings." }, { "input": "The heart is normal in size. The mediastinal and hilar contours are unremarkable. The pulmonary vasculature is normal. The lungs are clear. There are no pleural effusions.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest demonstrate post-operative changes of right-sided thoracotomy and lobectomy with stable architectural distortion. A focal right hilar density appears more pronounced as compared to ___ but similar as compared to ___, which may be in part related to rightward patient rotation. There is no additional opacity in the lung. There is no pneumothorax, vascular congestion, or large effusion. Cardiomediastinal silhouette is within normal limits and stable.", "output": "1. No definite confluent consolidation to suggest infection. 2. Prominent likely stable right hilar density could be related to prior surgery but subtle supervening early infection cannot be excluded and should be clinically correlated." }, { "input": "Heart size is at the upper limits of normal. The cardiomediastinal silhouette is within normal limits, allowing for mild unfolding of the aorta. There is upper zone redistribution, without overt CHF. The right hemidiaphragm is elevated, with minimal bibasilar atelectasis. No frank consolidation or gross effusion. Possible minimal blunting of the right costophrenic angle. Old healed fractures of the right eighth and ninth ribs noted. At the upper edge of these films, note is made of advanced degenerative change in the cervical spine, not fully evaluated. Scattered right carotid artery calcifications are also likely present. At the inferior edge of these films, therefore rounded densities overlying the left upper quadrant --___ pills.", "output": "1. Upper zone redistribution, without other evidence of CHF 2. Elevated right hemidiaphragm and minimal blunting of the right costophrenic, similar to an outside scanned in radiograph from ___ (from ___), 3. Minimal atelectasis at the right and left bases, but no focal infiltrate identified to suggest pneumonia." }, { "input": "2 views were obtained of the chest. Metallic densities, likely bullet fragments, project over the right hemithorax, likely in the right back and right lung or mediastinum. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. Heart and mediastinal contours are unremarkable.", "output": "No acute intrathoracic process with multiple metallic densities projecting over the right back and chest." }, { "input": "Opacity in the right lower lobe is concerning for pneumonia. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Right lower lobe pneumonia." }, { "input": "There is a right pleural effusion which is unchanged since prior exam. Again seen is a right hilar opacity consistent with fibrosis, better assessed on recent CT. A subtle left lower lobe opacity is seen, which may represent atelectasis, but pneumonia cannot be excluded. The lungs are otherwise clear. The cardiomediastinal silhouette is unchanged from prior exam. Visualized osseus structures are unremarkable.", "output": "1. Subtle left lower lobe opacity, which may represent atelectasis, but pneumonia cannot be excluded. PA and lateral radiographs could allow for better assessment of this opacity. 2. Stable right pulmonary effusion." }, { "input": "Portable AP upright chest radiograph obtained. In this patient with known small cell lung cancer, there is stable soft tissue density/prominence of the right pulmonary hilum which is unchanged from prior exams. There is a small right pleural effusion which appears stable from prior exam and is somewhat loculated, tracking along the right lung apex. There is no overt evidence of pneumonia. There are subtle nodular opacities within the periphery of both lungs which are of unknown etiology or significance. Overall heart size appears stable. Bony structures are intact.", "output": "Stable right hilar prominence and right pleural effusion. Subtle nodular opacities in the periphery of the lungs are indeterminant. Nonemergent CT may be performed to further assess." }, { "input": "Since the prior study the pseudotumor (fluid in the major fissure) on the right has resolved. Post treatment changes including elevation of the right hilus and coarse interstitial changes indicative of radiation fibrosis are again noted, a chronic finding. Obscuration of the right hemidiaphragm is likely a function of atelectasis and a small pleural effusion. The left lung is largely clear. Heart size and mediastinal contours are stable. Heavily calcified aortic arch is again noted.", "output": "1. Resolution of fluid in the right major fissure. 2. Small right pleural effusion and right basilar atelectasis. 3. Chronic treatment-related changes in the right lung." }, { "input": "AP portable upright chest radiograph was provided. Loculated right pleural effusion is again seen, with compressive lower lobe atelectasis unchanged. There is right perihilar opacity which likely reflects known fibrosis as seen on prior CT. New consolidation is seen. No pneumothorax. Overall, cardiomediastinal silhouette is stable. Bony structures are intact.", "output": "Unchanged appearance of the chest with findings of right pleural effusion, loculated and lower lobe atelectasis as well as right perihilar fibrosis is unchanged. Please refer to subsequent CTA chest for further details." }, { "input": "Heart size is normal. Again demonstrated within the right upper lobe and perihilar region is a chronic area of opacification compatible with radiation fibrosis. Streaky right lower lobe consolidative opacity is also chronic. Mediastinal contours are unchanged with atherosclerotic calcifications noted at the aortic arch. Mild pulmonary vascular engorgement is re- demonstrated. Small bilateral pleural effusions, right greater than left, are again noted. Streaky left basilar opacity may reflect atelectasis but infection is not excluded. Known spiculated nodule in the left upper lobe is better assessed on the previous CT. No pneumothorax is present. Multilevel degenerative changes are again seen in the thoracic spine. No radiopaque foreign body identified.", "output": "Mild pulmonary vascular congestion with small bilateral pleural effusions, right greater than left. Radiation fibrosis in the right upper lobe and right perihilar region and chronic consolidative opacity in the right lower lobe. Streaky left basilar opacity may reflect atelectasis though infection cannot be completely excluded. No radiopaque foreign body identified." }, { "input": "Single portable view of the chest. There is persistent elevation of the right hemidiaphragm with a superimposed right basilar opacity suggestive of an effusion, similar in size when compared to prior. There is also pulmonary vascular congestion, increased compared to prior. There is no definite focal consolidation. Cardiomediastinal silhouette is unchanged. Elevation of the right hilum with increased density in the right paratracheal region compatible with prior post-treatment changes, better characterized on prior CT.", "output": "Persistent right-sided effusion and pulmonary vascular congestion." }, { "input": "Heart size remains mildly enlarged. Aortic knob is densely calcified. The mediastinal contour is unchanged. Right hilar opacity is similar to the previous examinations. Rounded opacity projecting over the right mid lung field likely reflects fluid loculated within the major fissure. A moderate right pleural effusion and trace left pleural effusion are noted, and there is mild pulmonary edema. Patchy opacity in the lung bases may reflect atelectasis but infection or aspiration is not excluded. No pneumothorax is present. Emphysematous changes are again seen in the lungs.", "output": "1. Mild pulmonary edema and moderate size right and small left pleural effusions. Small amount of fluid is loculated within the right major fissure. 2. Patchy opacity in the lung bases may reflect atelectasis but infection or aspiration cannot be excluded. 3. Unchanged chronic right hilar opacity." }, { "input": "PA and lateral views of the chest. Again seen is a small-to-moderate right pleural effusion, similar in size compared to ___. Vague retrocardiac opacity, difficult to exclude pneuomonia. Since the prior study, there is significant resolution of pulmonary edema. Lungs are hyperinflated. No left pleural effusion. Radiation changes in the right paramedian lungs are unchanged.", "output": "Small to moderate chronic right pleural effusion. Stable cardiomegaly. Vague retrocardiac opacity, difficult to exclude pneuomonia." }, { "input": "Lung volumes are decreased compared to the prior exam. Heart size remains within normal limits. Mediastinal contour is unchanged. Within the right upper lobe and perihilar region, there is chronic opacification compatible with radiation fibrosis. Mild pulmonary edema is demonstrated with perhaps slight enlargement of a moderate size right pleural effusion which is partially loculated superiorly and medially. Right basilar opacification may reflect atelectasis but infection is not excluded. No pneumothorax is seen.", "output": "Mild pulmonary edema with moderate right pleural effusion, perhaps slightly increased compared to the prior study. Chronic opacity within the right upper lobe and perihilar region is compatible with radiation fibrosis. Right basilar opacity may reflect atelectasis but infection is not completely excluded." }, { "input": "Portable AP upright chest radiograph is obtained. Evaluation is somewhat limited given the underpenetrated technique. There is stable prominence of the right hilar structures with slight upward retraction of the right hila again noted. A small right effusion is again noted. Mild congestion is difficult to exclude. The heart is top normal in size. Bony structures appear intact.", "output": "Stable prominence and upward retraction of the right pulmonary hilum in this patient with known lung cancer. Right pleural effusion and probable mild interstitial edema." }, { "input": "A small to moderate right pleural effusion is not significantly changed compared to the prior radiograph ___. Associated consolidation at the right lung base is likely compressive atelectasis, although infection in this region cannot be excluded. There is a diffuse interstitial abnormality that has increased compared to the prior radiograph, likely mild pulmonary edema. The heart size remains top normal. The mediastinal contours are normal. Prominence of the right hilar region is unchanged, compatible with postradiation fibrosis, better evaluated on the CT from ___. There is no pneumothorax.", "output": "1. Unchanged small to moderate right pleural effusion. 2. Right lower lung consolidative opacification, likely compressive atelectasis, although infection in this region cannot be excluded. 3. Mild pulmonary edema." }, { "input": "Frontal and lateral chest radiographs demonstrate clear lungs. There is mild interstitial abnormality, which is not significantly changed compared with prior. The pulmonary vasculature appears normal. The cardiac silhouette is normal in size, the mediastinal contours are normal. A small calcified probable granuloma is again noted in the left upper lobe. ___% vertebral body height loss of a thoracic vertebral body is again noted, and unchanged. There is prior fracture deformity of posterior left seventh rib, unchanged.", "output": "No acute chest abnormality." }, { "input": "Portable upright view of the chest demonstrates ill-defined opacity in the lateral right lung base, slightly more conspicuous since ___. Similar opacities seen in the left lung base, has progressed since prior. Prominence of interstitial markings persists. Hilar and mediastinal silhouettes are unremarkable. The descending aorta is mildly tortuous. Heart size is normal. There is no pneumothorax. Healing remote left-sided rib fracture is noted.", "output": "Ill-defined opacities in bilateral lung bases, more conspicuous since ___ exam, could be atypical infection." }, { "input": "The cardiac, mediastinal, and hilar contours appear unchanged. Patchy calcification is noted along the aortic arch. The heart is at the upper limits of normal size. There is a slightly heterogeneous but predominantly diffuse bilateral interstitial abnormality which appears new since the prior examination and could be seen with interstitial pulmonary edema, mild to moderate in severity, but atypical infection could also be considered. There is, in particular, peripheral opacity layering immediately above the minor fissure and opacification of the lateral left upper lobe is also more prominent than elsewhere. More confluent infrahilar opacity on the lateral view is difficult to place on the frontal view, although likely within the left lower lobe. Fissures are slightly thickened including both major and minor fissure. However, there is no definite pleural effusion or pneumothorax. Mild rightward convex curvature is noted along the thoracic spine.", "output": "New substantial interstitial abnormality, somewhat heterogeneous. Correlation with clinical presentation is recommended. This could be seen with interstitial pulmonary edema but potentially atypical pneumonia could be considered." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of normal size with normal cardiomediastinal contours. Widespread interstitial lung markings are similar to prior and compatible with a combination of interstitial lung disease and emphysema. Small pleural effusions are present. No focal consolidation or pneumothorax. No radiopaque foreign body.", "output": "Interstitial lung disease, similar to prior, with new small pleural effusions. No focal consolidation." }, { "input": "Portable upright frontal chest radiograph demonstrates interval increase in interstitial pulmonary edema, now moderate. There is no large pleural effusion, or pneumothorax. The cardiac silhouette is unchanged, and normal in size. The mediastinal contours remain normal.", "output": "Increase in now moderate pulmonary edema, though the heart size remains normal. Differential diagnosis includes atypical infection, drug reaction, or cardiogenic pulmonary edema. This might also represent an acute exacerbation of chronic interstitial lung disease as acute interstital pneumonitis." }, { "input": "Lung volumes are slightly decreased, and given this, there is an unchanged appearance to a basilar predominant edema and interstitial opacity superimposed upon emphysema, without significant pleural effusion, or pneumothorax. The cardiac silhouette remains mildly enlarged, mediastinal contours are unchanged without evidence of central venous engorgement.", "output": "Given slight decrease in lung volumes, basilar prominent pulmonary edema and interstitial opacity is unchanged from ___. Differential diagnosis is unchanged including atypical infection, acute interstitial pneumonitis, and is unlikely to be cardiogenic pulmonary edema." }, { "input": "The heart size is normal. Mediastinal and hilar contours are unremarkable. Lungs are clear. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities are present. No displaced rib fractures are seen. Bilateral nipple piercings are present.", "output": "No acute cardiopulmonary abnormality. No displaced rib fractures identified. If there is continued clinical concern for rib fracture, dedicated rib series is recommended." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unremarkable. The pulmonary vascularity is normal. Lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary abnormality. No displaced rib fractures are seen. If there is continued clinical concern for rib fracture, then a dedicated rib series is recommended." }, { "input": "The cardiac, mediastinal and hilar contours are normal. The pulmonary vascularity is normal. No pleural effusion, focal consolidation or pneumothorax is seen. Deformities of the bilateral posterior 9th ribs and right 10th rib appear chronic. No acute displaced fractures are seen.", "output": "No acute cardiopulmonary abnormality. No acute fractures identified. Old bilateral rib fractures. If there is continued concern for a rib fracture, then a dedicated rib series is recommended." }, { "input": "There is prominent convexity of the lower right mediastinal contour which is nonspecific but may represent a tortuous ascending aorta or lymphadenopathy. The heart size is normal. Lungs are clear without focal consolidation, pleural effusion, or pneumothorax.", "output": "1. No evidence of pneumonia. 2. Prominence of the lower right mediastinal contour, for which non-emergent chest CT is recommended to distinguish a tortuous or dilated ascending aorta from a low lying anterior mediastinal mass such as a thymoma. NOTIFICATION: The findings were discussed via telephone by Dr. ___ with Dr. ___ on ___ at 12:38 PM, 5 minutes after discovery of the findings." }, { "input": "The lungs are moderately well inflated with a reticular pattern predominately involving the lower lobes consistent with history of interstitial lung disease. Heterogeneous pleural-based right upper lobe opacity with associated rounded lucency centrally is unchanged from ___ with possible progression of its superior most component since ___. No new opacity.", "output": "1. Persistent pleural-based right upper lobe opacity with central lucency is similar to ___ with possible progression of superior aspect since ___. Findings may represent recurrent pneumonia however given persistence over multiple studies adenocarcinoma is on the differential. 2. Diffuse interstitial lung disease, better assessed on CT chest from ___. RECOMMENDATION(S): Recommend follow-up chest radiograph 6 weeks post resolution of symptoms to assess for interval change." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Portable AP upright view of the chest was reviewed and compared to the prior study. Bowel gas extends from the right abdomen through the mediastinum and into the thoracic inlet and represents a colonic conduit from prior esophagectomy. Extensive bilateral parenchymal opacities located predominantly in the right upper lung and lingula are relatively unchanged. There is no pulmonary edema, abscess, pleural effusion or pneumothorax. Right and left calcified pleural plaques located over the hemidiaphragms are from prior asbestos or talc pleuradesis. A left pectoral bi-electrode pacer's leads end in the right atrium and right ventricular apex respectively.", "output": "1. Relatively unchanged extensive bilateral pneumonia. 2. Colonic conduit from prior esophageal resection. COMMENT: Findings were telephoned to Dr. ___ by Dr. ___ at ___ on ___ at the time of discovery." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are normal. The lungs are clear. There is no pneumothorax or pleural effusion.", "output": "No acute intrathoracic process." }, { "input": "Portable semi-upright frontal view of the chest. The endotracheal tube ends 3 cm above the carina. The nasogastric tube terminates off of the radiograph. A right subclavian central venous line ends at the cavoatrial junction. Diffuse bilateral parenchymal opacities persist and are relatively unchanged since ___ and slightly improved since ___. There is bilateral lower lobe atelectasis and unchanged small-to-moderate bilateral pleural effusions. Stable cardiomegaly and widened mediastinum.", "output": "Relatively unchanged appearance of diffuse bilateral parenchymal opacities which could represent pneumonia, edema, hemorrahge or a combination of the above. Small-to-moderate bilateral pleural effusions. Lines and tubes in appropriate position." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lung volumes are significantly decreased. An opacity in the right lower lung field likely represents crowding and atelectasis. The lungs are otherwise clear. There is no osseous abnormality. Visualized abdomen is unremarkable. The heart size is normal.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There are relatively low lung volumes but no definite focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are unchanged. Moderate pulmonary edema and bibasilar linear opacities are new since ___. Mediastinal contours, hila, and cardiac silhouette are normal. No pleural effusion or pneumothorax. Lateral view is highly limited by motion.", "output": "1. Moderate pulmonary edema new from ___. 2. Bibasilar opacities are likely due to pulmonary edema and atelectasis, given distribution, less likely aspiration." }, { "input": "Compared with prior radiographs on ___, there is no significant change. Again seen are low lung volumes with crowding at the hila. There is no focal consolidation to suggest pneumonia. There is no pleural effusion or pneumothorax. The mediastinal silhouette is unchanged.", "output": "No pneumonia." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. The lungs are hyperinflated but clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The cardiomediastinal silhouette is normal. The lungs are clear without consolidation or pleural effusions. There is stable hyperinflation and subtle lucency of the upper lobes consistent with underlying emphysema. There is a stable benign-appearing osseous lesion within the left humerus, likely an enchondroma.", "output": "Emphysema. No acute pneumonia. Results were communicated with Dr. ___ at 3:20 p.m. on ___ via telephone by Dr. ___." }, { "input": "Frontal and lateral chest radiographs demonstrate significant interval improvement in pulmonary edema, with residual small bilateral pleural effusions, right greater than left. Cardiomegaly is mild, and unchanged. The mediastinal contours remain normal, with note made of calcification of the aortic arch. Median sternotomy wires remain intact. Clips of CABG are present, and there is a stent. There is minimal residual interstitial abnormality.", "output": "Small bilateral pleural effusions, right greater than left, are the residua of improved congestive heart failure which is now minimal. Mild cardiomegaly is unchanged. There is no evidence for pneumonia." }, { "input": "The heart is mildly enlarged. The patient is status post coronary artery bypass graft surgery. There is mild unfolding and calcification along the aorta. Hilar contours are unchanged. Within the background of slightly generalized worsening of lung markings there is a focal interstitial opacification at the right lung base, probably in the right lower lobe. The appearance is highly nonspecific. In the absence of pulmonary symptoms, atelectasis or scarring could be considered. Airway inflammation is a differential consideration and in the appropriate clinical setting, an acute process such as pneumonia would not be excluded. The lungs are hyperinflated. There are no pleural effusions or pneumothorax. Slight degenerative changes are present along the thoracic spine.", "output": "Vague but somewhat focal interstitial opacification at the right lung base, highly nonspecific. Scarring atelectasis or airway inflammation could be considered; in the appropriate clinical setting, if matching pulmonary symptoms are present, however, pneumonia would not be excluded." }, { "input": "The patient is status post coronary artery bypass graft surgery. The cardiac, mediastinal and hilar contours appear stable. The heart is at the upper limits of normal size. The lungs appear clear. There are no pleural effusions or pneumothorax.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Frontal and lateral chest radiographs were obtained. The lungs are fully expanded and clear. There is stable bilateral apical pleural thickening. The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax.", "output": "No focal consolidation to suggest pneumonia. No pneumothorax." }, { "input": "The lungs are well expanded and clear. The cardiomediastinal silhouette and hilar contours are normal. Symmetric biapical pleural scarring is unchanged. There are no focal airspace opacities to suggest pneumonia. There is no pleural effusion or pneumothorax. Mildly distended loops of bowel are noted in the left upper quadrant.", "output": "No evidence of acute cardiopulmonary abnormality including pneumonia. The above results were communicated via telephone by Dr. ___ to Dr. ___ ___ at 15:45 on ___ at the time of discovery." }, { "input": "The lungs are clear. There is no pleural effusion, pneumothorax or focal airspace consolidation. The cardiac and mediastinal contours are normal. The hilar contours are unremarkable. Flattening of the diaphragms likely reflects inspiratory effort.", "output": "No acute cardiopulmonary process. These findings were discussed with Dr. ___ By Dr. ___ at ___:___ on ___ by telephone at the time of interpretation." }, { "input": "Compared to radiograph taken approximately 20 hours prior, there is no significant change. The tip of the central line is in the right atrium. There is persistent bibasilar atelectasis. The left lung volume is low, accentuating interstitial markings. Otherwise, there is no evidence of pulmonary edema. The tracheostomy tube is in place. The cardiopulmonary silhouette is mildly enlarged and grossly unchanged from prior. There is no pleural effusion or pneumothorax.", "output": "Central line terminating in the right atrium. No significant interval change." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. There is an interstitial process seen throughout both lungs as well as a more confluent area of consolidation involving the right lower lobe chest above infection, possibly atypical. No pleural effusion or pneumothorax is seen.", "output": "Diffuse interstitial prominence seen throughout both lungs as well as a area of consolidation involving the right lower lobe concerning for infection, possibly atypical. NOTIFICATION: These findings were entered into the critical results dashboard at 16:40 on ___ by Dr. ___." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and moderately well-aerated lungs. The consolidation seen on prior chest radiograph is now resolved, and there is no focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "Interval resolution of the previously seen right lower lobe consolidation." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for pneumonia. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No acute intrathoracic abnormalities identified." }, { "input": "The lungs are clear without focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications noted at the aortic arch. There is mild height loss and a mid thoracic vertebral body level, age indeterminate. Chronic left lateral rib fractures are noted.", "output": "No acute intracranial process. Minimal height loss of a mid thoracic vertebral body age indeterminate and clinical correlation is suggested." }, { "input": "Exam is limited secondary to patient body habitus, lung bases are excluded from the field of view, and portable technique creating increased opacity in the lungs bilaterally. There is suggestion of vascular engorgement and pulmonary edema. Cardiac silhouette is enlarged but grossly unchanged.", "output": "Limited exam as above with suspected pulmonary edema." }, { "input": "Exam is limited secondary to patient body habitus and portable technique. There has been no significant interval change. There is no confluent consolidation or overt pulmonary edema. Prominence of the hila is again seen as well as right upper lung scarring.", "output": "No definite acute cardiopulmonary process on this limited portable exam." }, { "input": "Examination limited secondary to body habitus. AP upright and lateral chest radiograph demonstrate a linear opacity within the right upper lobe, better characterized on CT chest dated ___. Moderate enlargement of the cardiac silhouette is stable. Mediastinal and hilar contours are similar in appearance to prior examination with enlargement of bilateral hila to suggest pulmonary arterial hypertension. There is no large pleural effusion. There is no pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "Images are under penetrated. Allowing for this, lungs appear clear. Lung volumes are low resulting in bibasilar atelectasis. Cardiomediastinal and hilar contours appear stable, heart which is enlarged. There is persistent prominent central pulmonary arteries consistent with pulmonary arterial hypertension. There is no evidence of pulmonary edema. There is no pneumothorax.", "output": "As above." }, { "input": "Compared to the next most recent radiograph of the chest the lungs are similarly expanded. The bandlike opacity in the right upper lobe is not appreciably changed. The cardiomediastinal silhouette is unremarkable without cardiomegaly. The hila are mildly prominent but stable. There is no pleural effusion or pneumothorax. Flowing ossification along the anterior and lateral vertebral bodies is re- demonstrated.", "output": "1. Non resolving bandlike opacity in the right upper lobe may represent scarring from prior pneumonia but should be evaluated by non-urgent CT as neoplasm cannot be excluded given nonresolution. 2. Mild prominence of the hila is unchanged suggesting benign etiology though this can be assessed also at time of chest CT. 3. No evidence of pneumonia." }, { "input": "Right-sided PICC is identified however the tip is not clearly delineated but is likely in the region of the lower SVC based on the lateral view. Examination is limited secondary to AP technique and body habitus. There is no confluent consolidation or overt pulmonary edema. There is no large pleural effusion. The cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications are noted at the aortic arch. Degenerative changes are noted at the shoulders bilaterally.", "output": "Right upper extremity PICC tip not clearly delineated, potentially in the region of the lower SVC based on the lateral view." }, { "input": "Assessment is slightly limited by body habitus. Moderate enlargement of the cardiac silhouette is re- demonstrated. Mediastinal and hilar contours are similar with enlargement of the hila bilaterally compatible with pulmonary arterial hypertension. There is crowding of the bronchovascular structures due to low lung volumes without pulmonary edema. Scarring within the right apex is unchanged. No focal consolidation, pleural effusion or pneumothorax is identified. There are moderate degenerative changes in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Exam is somewhat limited secondary to patient body habitus. The lungs are grossly clear without confluent consolidation or definite effusion. Right apical scarring is faintly visualized overlying the anterior right first rib. Cardiac silhouette is enlarged, similar compared to prior. No acute osseous abnormalities identified.", "output": "No definite acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is a stable appearance of the right upper lobe band like opacity compatible with scarring. The heart is mildly enlarged. Hilar prominence is stable and likely represents prominent hilar vascular structures as better assessed on prior CT. Retrocardiac streaky opacity is present on the lateral projection which raises potential concern for atelectasis versus pneumonia though no correlate opacity is present on the frontal view. No large effusion or pneumothorax is present. Imaged bony structures appear intact. No free air below the right hemidiaphragm is seen.", "output": "Mild cardiomegaly, stable prominence of the pulmonary hila, stable streaky right upper lobe opacity. Retrocardiac opacity seen on lateral view could represent atelectasis versus pneumonia." }, { "input": "PA and lateral chest radiograph is limited secondary to underpenetration/large body habitus. Allowing for this, heart is moderately enlarged though similar in appearance to prior examination dated ___. Hilar and mediastinal contours are within normal limits. No focal consolidation convincing for pneumonia is identified. No definite large pleural effusion or pneumothorax. Visualized osseous structures demonstrates no acute abnormality.", "output": "No acute intrathoracic abnormality." }, { "input": "Study is slightly limited by underpenetrated technique. Heart size remains mildly to moderately enlarged. The aorta is tortuous with mild atherosclerotic calcifications noted at the aortic arch. Enlargement of the pulmonary arteries bilaterally is similar and suggestive of underlying pulmonary arterial hypertension. Retrocardiac opacity could reflect atelectasis though infection is not completely excluded. Right lung is grossly clear. No pleural effusion or pneumothorax is identified.", "output": "Limited study due to underpenetration. Patchy retrocardiac opacity, possibly atelectasis, but infection cannot be excluded." }, { "input": "AP, upright and lateral views of the chest were obtained. There is slight improvement in lung aeration and technique compared with prior. There is right upper lobe consolidation which could represent a small focus of pneumonia. The heart is mildly enlarged. There is no overt CHF. Aorta appears unfolded. No large pleural effusion. Bony structures are intact.", "output": "Focus of consolidation in the right upper lobe is concerning for pneumonia. Mild cardiomegaly is again noted." }, { "input": "No focal consolidation to suggest pneumonia is noted. Tubular opacity extending superiorly from the chronically large right hilar is appears stable dating back to ___ but present since ___. Moderate cardiomegaly is again noted. There is no pleural effusion or pneumothorax. No acute fractures are identified.", "output": "1. No acute pneumonia. 2. Tubular opacity extending superiorly from the chronically large hilus is again noted and may be atelectasis in a region of chronic mucoid impaction, scarring, or an isolanted bronchial abnormality due to asthma or less likely allegeric bronchopulmonary aspergillosis." }, { "input": "Lung volumes are unchanged compared to the prior study. Even allowing for the projection, the heart appears enlarged. The bilateral hila appear prominent with prominence of the pulmonary vasculature consistent with mild congestive heart failure. No frank pulmonary edema seen. No consolidation or pneumothorax.", "output": "Findings consistent with congestive heart failure without frank pulmonary edema." }, { "input": "The exam is suboptimal due to overlying soft tissue and the chest is relatively underpenetrated. Given this, the cardiac and mediastinal silhouettes are grossly stable. Prominence of the hila is re- demonstrated, with prominence of the pulmonary vasculature. No large pleural effusion is seen. No definite focal consolidation is seen although this would be difficult to exclude particularly at the lung bases and the hilar regions. No evidence of pneumothorax.", "output": "Suboptimal due to overlying soft tissue and underpenetration, however, cardiac and mediastinal silhouettes are stable. Re- demonstrated prominence of the central pulmonary vasculature suggests pulmonary vascular engorgement without overt pulmonary edema." }, { "input": "AP and lateral views of the chest ___ at 20:46 are submitted. Best possible images were obtained in this patient with a large body habitus.", "output": "Persistent prominent central pulmonary arteries consistent with pulmonary arterial hypertension when correlated with selected images from a chest CT dated ___. No evidence of pulmonary edema. Focal airspace consolidation to suggest pneumonia. Heart remains stably enlarged. Mediastinal contours are unchanged. No obvious pneumothorax." }, { "input": "Given limitation of AP projection and overlying soft tissues, the lungs are grossly clear. There is no definite focal consolidation or pulmonary edema. Cardiac silhouette is enlarged but similar compared to prior. Atherosclerotic calcifications are noted at the aortic arch. No acute osseous abnormalities.", "output": "Cardiomegaly without definite acute cardiopulmonary process." }, { "input": "Since prior, there is no relevant interval change. Allowing for image under penetration the lungs appear clear. Lung volumes are low. Cardiomegaly is unchanged. Mediastinal contour is stable. There is no large pleural effusion or pneumothorax.", "output": "No relevant change in the appearance of the chest since ___." }, { "input": "Exam is somewhat underpenetrated due to patient body habitus. This makes evaluation of the lung fields suboptimal although no definite new focal consolidation is seen. There is is no large pleural effusion although trace pleural effusion is difficult to exclude. A right sided PICC courses into the SVC, distal termination site is not well seen. Cardiac and mediastinal silhouettes are stable. There is prominence of the hila which may be due to pulmonary vascular engorgement.", "output": "Exam is somewhat underpenetrated due to patient body habitus. This makes evaluation of the lung fields suboptimal although no definite new focal consolidation is seen. There is is no large pleural effusion although trace pleural effusion is difficult to exclude. A right sided PICC courses into the SVC, distal termination site is not well seen. Cardiac and mediastinal silhouettes are stable. There is prominence of the hila which may be due to pulmonary vascular engorgement." }, { "input": "PA and lateral views of the chest provided. Hilar prominence is similar to prior imaging studies with increased linear density in the right upper lobe compatible with a site of known scarring. No focal consolidation, large effusion or pneumothorax is seen. The heart is top-normal in size. The mediastinal contour appears normal. The imaged bony structures are intact. No free air below the right hemidiaphragm. Severe degenerative disease of the left shoulder noted.", "output": "Top normal heart size with stable prominence of the bilateral pulmonary hila. No evidence of pneumonia." }, { "input": "Limited study due to underpenetration. Lung volumes are low. A right PICC is seen, with the distant portion not well visualized, though likely terminating in the lower SVC. There is moderate central vascular engorgement without overt pulmonary edema. No focal consolidation, effusion or pneumothorax. Platelike atelectasis is seen in the left mid lung. Mediastinal and hilar contours are stable. Moderate cardiomegaly is unchanged, though somewhat exaggerated by technique. There is calcification of the aortic knob.", "output": "1. Moderate central vascular engorgement without overt pulmonary edema. 2. Unchanged moderate cardiomegaly." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified. Surgical clips noted in the upper abdomen.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. The patient is rotated. Mild lower lobe atelectasis is seen. Otherwise, the lungs are clear without focal consolidation, pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal. No displaced fracture is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest. No prior. The lungs are clear of focal consolidation or effusion. The cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process. No evidence of focal infiltrate." }, { "input": "Chest, PA and lateral. The lungs are clear. The hilar and mediastinal contours are normal. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal.", "output": "Normal radiograph of the chest." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "A portable frontal chest radiograph demonstrates intact sternotomy wires and mitral valve replacement. The right subclavian catheter is again seen with the tip in the right atrium, and the left jugular catheter tip is in the mid to lower SVC. The remainder of the exam is unchanged, including mild pulmonary edema, a likely small left pleural effusion, and left lower lobe atelectasis.", "output": "Unchanged chest radiograph demonstrating mild pulmonary edema, a likely small left pleural effusion, and left lower lobe atelectasis." }, { "input": "AP view of the chest. A left internal jugular central venous line ends in the right atrium. Tracheostomy is in place. Sternotomy wires and a cardiac valve are unchanged. There is slightly better aeration of the lungs with some residual interstitial edema. Small left pleural effusion is unchanged. Retrocardiac opacity is decreased.", "output": "Slight decrease in mild interstitial edema, unchanged small left pleural effusion, and slight decrease in retrocardiac opacity likely representing atelectasis." }, { "input": "Portable radiograph of the chest demonstrates well expanded, clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation. Chronic changes are noted involving the distal right clavicle.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable", "output": "No acute cardiopulmonary abnormalities" }, { "input": "PA and lateral views of the chest. Lungs are grossly clear. There is no evidence of consolidation. There is no pleural effusion or pneumothorax. The cardiac, mediastinal and hilar contours are normal. There are anterior bridging osteophytes in the thoracic spine which may represent DISH.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. Evidence of DISH is seen along the spine. There may be minimal lingular atelectasis/scarring. There has been no significant interval change since the prior study.", "output": "No significant interval change." }, { "input": "The cardiac, mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Streaky linear opacities within the lung bases most likely reflect atelectasis. No focal consolidation, pleural effusion or pneumothorax is seen. There are multilevel degenerative changes in the thoracic spine.", "output": "Bibasilar atelectasis." }, { "input": "A portable frontal chest radiograph demonstrates a normal cardiomediastinal silhouette. There is new focal increased opacity in the right lower lung. Opacities in the lingula and left lower lung have increased. No pleural effusion or pneumothorax is seen.", "output": "1. Bibasilar opacities, could represent atelectasis or pneumonia in the appropriate clinical setting" }, { "input": "The patient is status post median sternotomy and CABG. Aside from right basilar atelectasis, the lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest provided. The lungs are clear without focal consolidation, large effusion or pneumothorax. The heart size is normal. The aorta is unfolded. Bony structures are intact. Degenerative changes again noted at the shoulders.", "output": "As above." }, { "input": "The tip of the left internal jugular central venous catheter projects over the aortic arch. A dense retrocardiac opacity is present, presumed to reflect atelectasis however underlying pneumonia cannot be excluded. Small left pleural effusion. No pneumothorax identified. The size the cardiac silhouette is enlarged. Degenerative changes of the glenohumeral and acromioclavicular joints bilaterally are noted.", "output": "The tip of the left internal jugular central venous catheter projects over the aortic arch. Dense retrocardiac opacity is presumed to reflect atelectasis and a small pleural effusion. Underlying pneumonia cannot however be excluded." }, { "input": "There is stable blunting of the costophrenic angles which is unchanged since at least ___ and compatible with pleural thickening. Other bilateral areas of pleural thickening are reidentified. The lungs are otherwise clear. Heart size appears increased compared to prior study. Hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "1. Mild interval increase in heart size may represent incipient heart failure. 2. No evidence of acute cardiopulmonary process. Areas of bilateral pleural thickening are unchanged from prior." }, { "input": "Heart size is normal with a mildly tortuous aorta. Hilar contours are normal. Stable blunting of the costophrenic angles is unchanged in appearance since at least ___, and given this chronicity, this is likely due to pleural thickening rather than what was previously called pleural effusion. Significant, confluent areas of pleural thickening are present bilaterally, not significantly changed since ___. Lungs are otherwise clear. There is no pleural effusion or pneumothorax.", "output": "Significant, confluent areas of bilateral pleural thickening. What was previously called pleural effusion is likely significant pleural thickening given the long chronicity and identical appearance." }, { "input": "Mild enlargement of cardiac silhouette is re- demonstrated. The aorta is unfolded. There is mild pulmonary vascular congestion without frank pulmonary edema. Lungs remain hyperinflated. Streaky atelectasis is noted in the lung bases without focal consolidation. Blunting of the costophrenic angles posteriorly on the lateral view may reflect the presence of trace bilateral pleural effusions. No pneumothorax is present, and there is no focal consolidation. Mild moderate multilevel degenerative changes are present in the thoracic spine.", "output": "Mild pulmonary vascular congestion and probable trace bilateral pleural effusions. Mild bibasilar atelectasis." }, { "input": "Heart size is normal. Mediastinal and hilar contours are within normal limits. Lungs are clear without focal consolidation. No pleural effusion, pulmonary vascular congestion, or pneumothorax is identified. No acute osseous abnormalities are demonstrated.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Mild cardiomegaly is present, with tortuosity of the thoracic aorta noted. There is diffuse calcification of the thoracic aorta. There is perihilar haziness and vascular indistinctness compatible with mild pulmonary edema. Small bilateral pleural effusions are noted, with bibasilar airspace opacities likely reflecting atelectasis though infection or aspiration is difficult to exclude. There is no pneumothorax. Diffuse demineralization of the osseous structures is noted.", "output": "Mild pulmonary edema and small bilateral pleural effusions. Bibasilar airspace opacities may reflect atelectasis though infection or aspiration is not excluded." }, { "input": "Again noted is mild-to-moderate pulmonary edema, slightly worse compared to the prior exam. Heart remains mildly enlarged. Tortuosity of the thoracic aorta, which is diffusely calcified, is again noted. Small bilateral pleural effusions, right greater than left are again present, with bibasilar opacities likely reflecting atelectasis. No pneumothorax is identified. Diffuse demineralization of the osseous structures is present with loss of height of several lower thoracic vertebral bodies, which are age indeterminate.", "output": "Mild-to-moderate pulmonary edema, slightly worse in the interval, with persistent small bilateral pleural effusions and bibasilar airspace opacities likely reflecting atelectasis, but infection is not excluded." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. Surgical clips are noted in the upper abdomen. No evidence of pneumomediastinum is seen.", "output": "No acute cardiopulmonary process." }, { "input": "An endotracheal tube is noted in the upper trachea at 6.5 cm from the carina. Enteric tube traverses to the stomach. The lungs are clear. There is no pleural effusion or pneumothorax. No acute fractures are identified.", "output": "The endotracheal tube is in the upper trachea at 6.5 cm from the carina." }, { "input": "The lung volumes are low. The cardiac, mediastinal and hilar contours appear stable. Medial left basilar opacity suggests minor atelectasis. Otherwise, the lungs appear clear. There no pleural effusions or pneumothorax. Evaluation of bony structures is limited but no fracture is identified.", "output": "No evidence of acute cardiopulmonary disease or injury." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits aside from patchy calcification along the aortic arch. There is minimal subpleural scarring at the left lung apex. A mild interstitial process suggests congestion. There are no pleural effusions or pneumothorax. Small-to-moderate anterior osteophytes are present along the mid to lower thoracic spine. A healed old left sixth rib fracture is present.", "output": "Mild interstitial abnormality, probably due to slight fluid overload or vascular congestion." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are unremarkable. The lungs are clear. A spinal cord stimulator is incidentally noted. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Significant levoscoliosis involving the lower thoracic and lumbar spine is again noted. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Chronic interstitial changes in the bilateral lungs, greatest at the bases, are largely unchanged in could be due to chronic pulmonary disease, vascular congestion, or both. The heart is mildly enlarged. No new focal consolidation concerning for pneumonia. Significant scoliosis of the thoracic spine is unchanged.", "output": "Chronic interstitial lung changes could be due to chronic pulmonary disease, vascular congestion, or both. No focal consolidation concerning for pneumonia. NOTIFICATION: The above findings were communicated via telephone by Dr. ___ to ___ RN taking calls for Dr. ___ at ___ on ___, ___ min after discovery." }, { "input": "Evaluation is limited due to poor inspiratory effort and patient positioning. Within this limitation, the lungs are underinflated with resultant bronchovascular crowding. There is increased opacification at the right lung base which is likely due to atelectasis. No significant pleural effusion or pneumothorax is detected. The right hilum appears more dense and rounded than the left but is difficult to assess due to low lung volumes and rightward rotation. The cardiac silhouette is likely within normal limits for size allowing for low lung volumes. The trachea is slightly deviated to the right by the aortic knob, which is ill-defined. The mediastinal contours are within normal limits. The visualized upper abdomen is unremarkable. There is generalized loss of height of several thoracic vertebral bodies.", "output": "Low lung volumes. Right basilar opacity is likely atelectasis. Asymmetry of right hilar structures may be due to accentuation of vessels by rotation and low volumes, but a mass cannot be excluded radiographically. Followup PA and lateral chest radiographs are recommended with improved positioning and deeper inspiratory level when the patient's condition permits in order to re-evaluate the right hilus." }, { "input": "Scattered nodular opacities throughout the lungs are consistent with granulomas suggesting prior granulomatous disease. There is no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Mild cardiomegaly is stable. Mild to moderate pulmonary edema has worsened. Small to moderate bilateral pleural effusions larger on the left side have increased. There is no pneumothorax. Surgical chain in the right hilum is noted. Sternal wires are aligned. Patient is status post CABG and MVR. Bibasilar atelectasis have increased. Multiple wedge-shaped deformities of thoracic vertebral bodies and kyphosis is again noted.", "output": "Mild to moderate pulmonary edema." }, { "input": "The patient is status post CABG and mitral valve replacement. The heart is normal in size. The mediastinal and hilar contours are unremarkable. There is no pneumothorax or large pleural effusion. Chain suture material seen projecting over the right midlung medially. Nonspecific interstitial prominence is seen, particularly in the left lower lung. Atelectasis is also seen in the left lower lobe. There is no focal consolidation concerning for pneumonia. The overall appearance is unchanged since the reference radiograph from ___.", "output": "No pulmonary edema or effusion." }, { "input": "Overlying trauma board slightly limits assessment. The lung volumes are low. This accentuates the size of the cardiac silhouette which is mildly enlarged. There is no mediastinal widening. Crowding of the bronchovascular structures is likely related to low lung volumes. Mild atelectasis is noted within the lung bases. No focal consolidation, large pleural effusion or pneumothorax is identified. No displaced fractures are seen.", "output": "Low lung volumes with mild bibasilar atelectasis. No acute traumatic injury identified." }, { "input": "Single portable chest radiograph is provided. Patchy opacities in the right lower lung and left mid lung are present that are consistent with pneumonia. Lung volumes are low. Cardiomediastinal silhouette is notable for a tortuous aorta. Median sternotomy wires are intact.", "output": "Patchy opacities in the right and left lower lobes are most likely pneumonia." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well expanded and clear. No effusion or pneumothorax is present. The cardiac and mediastinal contours are normal.", "output": "Normal chest radiograph." }, { "input": "PA and lateral views of the chest. The lungs are clear. Cardiomediastinal silhouette is normal. No acute osseous abnormality detected.", "output": "No acute cardiopulmonary process." }, { "input": "Compared with prior radiographs on ___, there is no significant change.The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No pneumonia." }, { "input": "The heart size is normal. The cardiomediastinal silhouette is unremarkable. The lungs are clear without consolidations, effusions or pneumothorax. No acute bony abnormality.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. Left chest wall AICD is again seen with single lead extending to the region the right ventricle. Lung volumes are low limiting assessment. The heart appears normal in size. The hila appear engorged. There is probable mild interstitial pulmonary edema. No large effusion or signs of pneumonia or pneumothorax. Mediastinal contour is within normal limits. Bony structures are intact.", "output": "As above." }, { "input": "Left-sided ICD with the tip in the right ventricle. Low lung volumes with crowding of the bronchovascular markings. Right lower lung zone opacity may reflect a combination of atelectasis, crowded vessels and posterior rib, rather than pneumonia. No overt pulmonary edema. Mild cardiac enlargement. No pleural effusions or pneumothorax.", "output": "No pneumothorax. Right lower lung zone opacity is probably a combination of atelectasis, crowded vessels and posterior rib, rather than pneumonia. If there are symptoms of infection, repeat chest radiographs including oblique views should be obtained. RECOMMENDATION(S): If there are symptoms of infection, repeat chest radiographs including oblique views should be obtained." }, { "input": "Since the prior chest radiograph, there has been interval significant decrease in right sided opacity with significant decrease in right pleural effusion with small to moderate pleural effusion overlying atelectasis remaining. There is some residual right mid lung opacity. There is also streaky left base opacity, with improved aeration from prior. There is persistent fibrotic change at the medial right upper lung. The cardiac silhouette is top-normal. Mediastinal contours are unremarkable.", "output": "Interval decrease since ___ in right-sided opacity with significant decrease in right pleural effusion, with small to moderate pleural effusion with overlying atelectasis residual right mid lung opacity. Streaky left base opacity significantly decreased from prior radiograph and demonstrates improved aeration." }, { "input": "Moderate right pleural effusion with overlying atelectasis is re- demonstrated. Right juxta hilar fibrotic changes) could right upper lung atelectasis are again seen as long as right apical opacity. Right hilar mass and right lower lobe atelectasis/obstruction, better assessed on prior CT. The left lung is hyperinflated, and aside from mild left base atelectasis/ scarring, is grossly clear. Cardiac and mediastinal silhouettes are stable. No frank pulmonary edema is seen. The patient is status post median sternotomy and cardiac valve replacement. Single lead left-sided pacemaker is stable in position.", "output": "No significant interval change." }, { "input": "The right PICC terminates in the mid to lower SVC. Heterogeneous airspace opacities in the mid and lower left lung have improved. Right lower lung is also better aerated. Moderate bilateral pleural effusions right more than left, have slightly decreased. Chronic right apical pleural thickening. Cardiomediastinal silhouette is stable. Prosthetic mitral valve and sternotomy wires are noted.", "output": "Improved pulmonary edema and slightly decreased bilateral effusions." }, { "input": "The cardiomediastinal silhouette is unchanged. Median sternotomy wires are intact and in normal alignment. The patient is status post mitral valve repair. A left pacer is re-demonstrated. There is no pneumothorax or pleural effusion. Right juxta hilar triangular opacity corresponds to collapsed right upper lobe as seen on prior. Blunting of the right costophrenic angle and irregularity along the right hemidiaphragm and right heart border are sequelae of radiation fibrosis/atelectasis.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest demonstrate small right basal and apical pleural effusions. There is a small amount of atelectasis at the right base. There is persistent collapse of the right upper lobe secondary to radiotherapy. The cardiomediastinal and hilar contours are unchanged. There is no pneumothorax.", "output": "Small right basal and apical pleural effusions and small amount of atelectasis at the right base." }, { "input": "Right PICC terminates in the mid to lower SVC. A Prosthetic mitral valve is again noted. There is no pneumothorax. There is persistent right upper lobe collapse with hyperinflation of the right middle lobe. Moderate right pleural effusion has increased in size. Small to moderate left pleural effusion is stable. The left mid lung zone consolidation is unchanged. No pneumothorax.", "output": "1. Enlarging moderate right pleural effusion, stable small left effusion. 2. Persistent consolidation in the left mid lung and collapse of the right upper lobe." }, { "input": "Portable upright chest radiograph ___ at 15:42 is submitted.", "output": "There has been interval placement of a right basilar pigtail pleural catheter. No pneumothorax is seen. However, there is persistent near complete opacification of the right hemithorax which likely represents a combination of a known hilar mass, consolidated lung, and pleural collection. This is better evaluated on the recent chest CT. Patchy heterogeneous opacities in the left lower lung and lingula are better appreciated on the CT but are concerning for pneumonia. Minimal blunting of the left costophrenic angle may represent a small effusion. No pneumothorax. Single lead left-sided pacer unchanged in position. Status post median sternotomy with valve replacement. Cardiac and mediastinal contours cannot be adequately assessed due to marked patient rotation and near complete opacification of the right hemithorax." }, { "input": "A frontal chest radiograph again demonstrates two right-sided pleural catheters and a right apical pneumothorax, which is similar in size. The remainder of the exam is unchanged.", "output": "Unchanged right apical pneumothorax." }, { "input": "PA and lateral views of the chest provided. Midline sternotomy wires and prosthetic mitral valve again noted. Postsurgical changes involving the right lung again noted with extensive scarring appearing grossly stable from prior. However, on the left, there is subtle increase in overall bronchovascular opacity which could represent an atypical pneumonia in the correct clinical setting. A tiny left effusion is likely new in the interval. No pneumothorax. Overall cardiomediastinal silhouette is stable.", "output": "Stable postop changes in the right chest. Subtle increase in left bronchovascular markings which could in the correct clinical setting reflecting an atypical pneumonia." }, { "input": "PA and lateral chest views were obtained with patient in upright position. There is status post sternotomy and the metallic component of a porcine valve prosthesis is identified in mitral valve position. Cardiac enlargement is very mild, but the left atrial contours are identified both in frontal and lateral view and suggests mild enlargement of the left atrium. Pulmonary vasculature, however, is not congested and no signs of acute infiltrates are present. Rather low positioned and somewhat flattened diaphragms are noted, coinciding with increased translucency of the lung bases suggestive of some degree of COPD. There is no evidence of any pleural effusion and no signs of pneumothorax in the apical area.", "output": "Status post mitral valve replacement. No evidence of significant pulmonary congestion. No signs of pneumothorax but some general pulmonary findings suggestive of COPD." }, { "input": "A single portable frontal chest radiograph was obtained. A known right upper lobe mass widens the mediastinum. In addition, a right upper lobe ground-glass opacity is new. Elevation of the right minor fissure indicates volume loss. Linear opacities at both lung bases most likely reflects atelectasis. Rounded opacities at both lung bases are most compatible with nipple shadows. There is no pneumothorax. Bilateral pleural effusions, apparent on the subsequent CT, are no well seen on this exam. Moderate cardiomegaly is exaggerated by AP technique but may be bigger compared with the prior exam. Bilateral hilar lymphadenopathy is better seen on CT. Median sternotomy wires and valve prosthesis are intact.", "output": "Known right upper lobe mass and post-obstructive pneumonia" }, { "input": "Frontal and lateral chest radiographs redemonstrate a chronically collapsed right upper lobe, which is secondary to radiation. The right apical pneumothorax is decreased. The right chest tube has been removed. There is a small residual loculated right pleural effusion. The left lung demonstrates improved aeration and is clear, without pleural effusion or pneumothorax. The heart size is unchanged.", "output": "Decreased right apical pneumothorax and a small residual loculated right pleural effusion." }, { "input": "Median sternotomy wires and prosthetic valve are stable. The lungs are clear. There is no focal consolidation. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is stable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Left chest wall pacer is again noted with single lead extending into the right ventricle. There is a prosthetic mitral valve. Midline sternotomy wires again noted. There is complete opacification of the right hemi thorax common new from prior with mild shift of midline structures to the left. There is a tiny left pleural effusion with left lung remaining mostly clear. No pneumothorax. Bony structures appear grossly intact though patient is known to have sclerotic bony metastatic disease, which are better appreciated on CT.", "output": "Opacification of the right hemi thorax with mild shift of midline structures to the left." }, { "input": "There is redemonstration of a small right pneumothorax, not significantly changed in size compared to the prior study from ___. Two right-sided pleural catheters are unchanged in position. There is evidence of prior aortic valve replacement. Midline sternotomy wires are intact. Mild right basilar atelectasis is unchanged. There may be a small right pleural effusion. Minimal left basilar atelectasis is unchanged. There is no left pneumothorax. Improving post-operative changes in right paramediastinal region.", "output": "Unchanged small right pneumothorax, with two pleural catheters in place." }, { "input": "PA and lateral views of the chest were provided. Midline sternotomy wires as well as a prosthetic mitral valve noted. There is extensive scarring within the right lung with similar overall pattern compared with the prior imaging studies and a small loculated right pleural effusion is again seen. Otherwise, the lungs remain clear without evidence of pneumonia or CHF. No left effusion. No pneumothorax. Overall, cardiomediastinal silhouette appears stable. Bony structures are intact.", "output": "Stable appearance of the chest with extensive scarring in the right lung due to radiation fibrosis better assessed on prior CT with small right pleural effusion, loculated appearing stable." }, { "input": "The lungs are clear with no evidence of consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. No acute fractures are identified.", "output": "No acute cardiopulmonary process." }, { "input": "Moderate cardiomegaly is overall stable compared to prior exams dated back to ___. Large right pleural effusion is overall unchanged compared to the prior study with adjacent consolidation, likely secondary to atelectasis at the right lung base. There is no evidence of a pneumothorax. There is mild left basilar atelectasis. The visualized osseous structures are unremarkable.", "output": "No change. Large right pleural effusion with adjacent consolidation likely secondary to atelectasis, however an acute superimposed infectious process cannot be excluded." }, { "input": "The cardiomediastinal and hilar contours are not significantly changed and are within normal limits. Again seen is a large right pleural effusion, not significantly changed in size from the prior study. There is adjacent atelectasis at the right base. New, subtle retrocardiac opacity is likely representative of atelectasis. There is no evidence of pneumothorax.", "output": "1. Large right pleural effusion and adjacent right basal atelectasis is not significantly changed from the prior study. Superimposed infection cannot be excluded. 2. New, subtle left retrocardiac opacity is likely representative of atelectasis." }, { "input": "There has been little to no change in the moderate extent of right lateral hemi-thorax pleural thickening and adjacent fluid collection with air-fluid level. Mild right basilar atelectasis is seen. Cardiomediastinal silhouette remains unchanged.", "output": "Unchanged extent of possible residual right pleural fluid with air-fluid level and right lateral hemi-thorax pleural thickening." }, { "input": "The lungs are clear, the cardiomediastinal silhouette is normal. There is no pleural effusion and no pneumothorax. No fractures are visualized on this chest radiograph.", "output": "No acute cardiothoracic process including no evidence of fracture." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "AP portable upright view of the chest. Airspace opacity in the medial right lung base is concerning for pneumonia. Left lung is clear. No large effusion or pneumothorax. Heart size is within normal limits. The mediastinal contour is normal. Bony structures are intact.", "output": "Opacity at the right medial lung base, possibly representing pneumonia. Recommend lateral view to further localize and characterize. Followup to resolution is needed." }, { "input": "The heart size remains moderate to severely enlarged. Mediastinal contour is unchanged. Mild pulmonary edema is re- demonstrated, perhaps minimally improved in the interval. Small bilateral pleural effusions are relatively unchanged. Bibasilar airspace opacities are also similar, and again may reflect compressive atelectasis. No pneumothorax is identified. The osseous structures are diffusely demineralized.", "output": "Persistent mild pulmonary edema, minimally improved, with small bilateral pleural effusions. Similar appearing bibasilar airspace opacities, likely reflective of compressive atelectasis, but aspiration or pneumonia is not excluded." }, { "input": "Assessment is slightly limited due to patient rotation. Heart size is moderate to severely enlarged. Aorta is tortuous. There is mild pulmonary edema with vascular indistinctness. Small bilateral pleural effusions are noted. Bibasilar airspace opacities could reflect atelectasis though aspiration or infection cannot be excluded. No pneumothorax is identified. No acutely displaced fractures are seen.", "output": "Mild pulmonary edema with small bilateral pleural effusions. Bibasilar airspace opacities could reflect compressive atelectasis though aspiration or infection cannot be excluded." }, { "input": "The lung fields are clear without focal consolidation, pleural effusion, or pneumothorax. Heart and mediastinal contours are within normal limits.", "output": "Normal chest radiographs." }, { "input": "PA and lateral views of the chest. The lungs are clear of consolidation or effusion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "A single portable semi-erect chest radiograph was obtained. The exam is limited by lordotic positioning and neck flexion. A right-sided internal jugular line tip is at the cavoatrial junction. The patient has been extubated. A surgical drain in the thyroidectomy bed is seen. Bibasilar layering pleural effusions and atelectasis are larger compared to yesterday. No new consolidation or pneumothorax is present.", "output": "Worsening bibasilar effusions and atelectasis status post extubation." }, { "input": "AP and lateral chest radiographs. Lung volumes are low and the right hemidiaphragm is persistently elevated. However, there is no focal consolidation, pleural effusion, or pneumothorax. Right basilar atelectasis is stable. The heart is mildly enlarged. Leftward deviation of the trachea is from the patient's enlarged right thyroid lobe. Compression deformity of one of the upper lumbar vertebral bodies is similar to prior CT in ___.", "output": "No acute cardiopulmonary process." }, { "input": "Supine AP portable view of the chest was obtained. There has been interval placement of endotracheal tube, terminating approximately 3 cm below the carina. Nasogastric tube is seen coursing below the level of the diaphragm and terminating in the expected location of the distal stomach. The aorta is calcified and tortuous. The cardiac silhouette is not enlarged. Paratracheal opacity is again seen as also seen on the prior study. Subtle medial right base patchy opacity could relate to aspiration. No pleural effusion or pneumothorax is seen.", "output": "1. Endotracheal and nasogastric tubes in appropriate position. 2. Subtle streaky medial right base opacity could relate to aspiration depending on the clinical situation." }, { "input": "Previous right PICC line has been removed. Continued trachea deviation to the left and surgical clips consistent with previous thyroid surgery. The cardiac silhouette continues to be mildly enlarged, and aortic calcifications are stable. There is no focal consolidation, pleural effusion or pulmonary edema is seen. Right subsegmental atelectasis is seen.", "output": "No focal consolidation to suggest pneumonia is seen." }, { "input": "Portable AP chest radiograph. Right-sided PICC tip is at the cavoatrial junction. NG tube courses below the diaphragm and terminates outside the field of view. Pulmonary vascular engorgement is slightly worse than on radiograph from three hours prior and the left heart border is less conspicuous. Pleural effusions remain small. The heart size is stable. There is no pneumothorax.", "output": "Slight interval increase in vascular congestion concerning for volume overload." }, { "input": "Single portable view of the chest. Right-sided PICC is now seen with its tip in the upper SVC. Enteric tube passes below the diaphragm with tip in the gastric body, side-port past the GE junction. Endotracheal tube tip is approximately 4 cm from the carina, in appropriate position. Right basilar opacity is partially due to chronic rib changes similar to prior. The lungs are otherwise grossly clear. Cardiomediastinal silhouette is within normal limits for technique. Surgical clips seen in the neck on the right suggesting prior thyroid surgery. Trachea is deviated to the left as on prior.", "output": "No acute cardiopulmonary process. Tubes and lines as above." }, { "input": "AP upright and lateral views of the chest provided. Right hemidiaphragm is mildly elevated. No focal consolidation concerning for pneumonia. No effusion or pneumothorax. The heart is mildly enlarged. The aorta appears unfolded. No convincing evidence for edema. No free air below the right hemidiaphragm. Bony structures appear intact.", "output": "Cardiomegaly without evidence of pneumonia or overt edema." }, { "input": "No focal consolidation is seen. There is no pleural effusion or pneumothorax. Cardiac silhouette size is top-normal. Mediastinal contours are unremarkable. No overt pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "There is persistent diffuse pulmonary fibrosis, better assessed on prior CT chest from ___. No focal opacity is identified. The cardiac silhouette remains mildly enlarged. There is no pleural effusion or pneumothorax. Included upper abdomen is unremarkable.", "output": "1. Severe diffuse pulmonary fibrosis, better assessed on prior CT chest from ___. No focal consolidation. 2. Mild cardiomegaly." }, { "input": "Single portable frontal AP chest radiograph demonstrates bilateral diffuse ground glass and reticular opacities. There is no pleural effusion or pneumothorax. Heart is top normal in size. Mediastinal and hilar contour is unremarkable. Visualized osseous structures are without acute abnormalities.", "output": "Diffuse bilateral reticular and groundglass opacities for which the differential is broad. Given patient history, hypersentivity pneumonitis should be considered. Clinical correlation is recommended." }, { "input": "Coarse bilateral reticular opacities are in keeping with the known history of fibrosis. As compared to the prior chest radiograph from ___, new superimposed interstitial opacities suggest an acute process such as infection or pulmonary edema. Moderate cardiomegaly is stable. There is no pleural effusion or pneumothorax.", "output": "New diffuse interstitial opacities superimposed on chronic fibrosis may be due to exacerbation of interstitial lung disease, infection or edema. A dedicated chest CT may be performed for further evaluation if clinically warranted." }, { "input": "There has been interval progression of severe bilateral interstitial opacities. Mild cardiomegaly is unchanged. The mediastinal and hilar contours are stable. There is no pleural effusion or pneumothorax.", "output": "Interval progression of severe bilateral interstitial opacities. This could be due to sarcoidosis but superimposed chronic interstitial lung disease related to drug reaction cannot be excluded." }, { "input": "Upright AP and lateral views of the chest demonstrate low lung volumes. The lungs are clear, with no evidence of pneumothorax, pulmonary edema or focal airspace opacity. No large pleural effusion is identified. The heart is moderately enlarged, best appreciated on the lateral view. No displaced rib fractures are identified on the AP and lateral views.", "output": "1. Moderate cardiomegaly. 2. No displaced rib fractures identified on these views; however, assessment is limited secondary to body habitus. If clinical suspicion remains for occult rib fracture, dedicated rib series radiographs or chest CT is recommended." }, { "input": "Enlarged heart size is stable since ___. Mediastinal and hilar contours are unremarkable. Aorta is tortuous in course, unchanged in appearance. There are no lung opacities concerning for pulmonary edema/pneumonia. There is no pleural effusion.", "output": "Moderately enlarged heart size, stable since ___. No findings concerning for pulmonary edema or pneumonia." }, { "input": "The heart is moderately enlarged. The aortic arch is calcified. Again noted is mild prominence of the main pulmonary artery contour in the aortopulmonary window. There is no pleural effusion or pneumothorax. There is persistent minor atelectasis at the left lung base, but otherwise, the lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Low lung volumes are present. The heart size is normal. The aorta is mildly unfolded and demonstrates diffuse calcifications. The pulmonary vascularity is not engorged although there is bronchovascular crowding. Minimal atelectatic changes are noted at the lung bases. There is no focal consolidation, pleural effusion or pneumothorax. No displaced rib fractures are seen. Multilevel degenerative changes in the thoracic spine with anterior osteophyte formation is seen as well as osteophytic spurring in the right acromioclavicular joint. Several rounded soft tissue calcifications are noted in the right breast.", "output": "Low lung volumes with mild bibasilar atelectasis. No displaced rib fractures noted, though assessment is limited. If there is continued clinical concern, a dedicated rib series is recommended." }, { "input": "PA and lateral views of the chest provided. Lungs are hyperinflated and clear without focal consolidation, large effusion or pneumothorax. The nodule in the left upper lobe seen on recent CT is subtly conspicuous and appear similar. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "As above." }, { "input": "The known left upper low mass seen on prior exam is less conspicuous when compared to previous exam. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Known left upper lobe spiculated mass is partially visualized. Nipple shadows project over the lung bases bilaterally. Lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process. Known left upper lobe mass is only faintly visualized." }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The patient's previously demonstrated left upper lobe mass appears smaller and less conspicuous on today's radiograph. The cardiomediastinal contours are unchanged.", "output": "No acute cardiopulmonary process. Known left upper lobe mass is less conspicuous as compared to ___, and better evaluated on chest CT." }, { "input": "Airspace opacification seen in the posterior basal aspect of the right lower lobe. Possible peribronchovascular opacification also seen in the right middle lobe. No parapneumonic effusion. No lymphadenopathy. Pulmonary scarring in the left upper lobe unchanged. Normal heart size.", "output": "Right lower lobe pneumonia. Possible right middle lobe involvement." }, { "input": "Frontal view of the chest demonstrate persistent opacity in the right upper lobe. There is a heterogeneous opacity in the right medial lung base, which appears slightly more conspicuous since prior. There are prominent interstitial lung markings, which may reflect underlying interstitial edema. Lung volumes are low. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. Partially imaged upper abdomen is unremarkable. No pleural effusion is seen. No pneumothorax.", "output": "Persistent right upper lobe opacity. Heterogeneous right lung base opacity is slightly more conspicuous since prior, which may reflect multifocal pneumonia. Dedicated PA and lateral views would be helpful if/when patient able." }, { "input": "The opacity projecting over the right lateral mid upper hemi thorax persists but is less conspicuous compared to the prior radiograph concern like compared to the prior chest CT in ___. No pneumothorax, effusion, edema, or new focal consolidation is identified. The heart is normal in size. The mediastinal and thoracic aorta contours are similar to the prior exam. There is minimal levoconvex scoliosis of the thoracolumbar spine.", "output": "Persistent but interval decrease in the opacity projecting over the right upper hemithorax. No definite new focal opacity or consolidation." }, { "input": "Single AP portable chest radiograph was obtained. Right upper lung opacity is slightly more evident than on the previous examination. Otherwise the lungs are low in volume giving the appearance of bronchovascular crowding with mild pulmonary vascular congestion but no overt edema. Linear retrocardiac opacity could reflect atelectasis. There is no pleural effusion or pneumothorax. The heart is top-normal in size with tortuous thoracic aortic contour.", "output": "Persistent right upper lobe opacity could be due to recurrent or residual infectious process though neoplastic entities are not excluded. As such, followup chest CT as recommended on the previous chest CT in 2 months is recommended after appropriate antibiotic therapy." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are well expanded and clear without focal consolidation, pleural effusion or pneumothorax. Heart size is normal. Mediastinal silhouette and hilar contours are normal. No acute osseous abnormality is identified.", "output": "Normal chest radiographs." }, { "input": "Six total views of the chest and right ribcage were viewed. A BB marker was placed at the site of pain. The cardiomediastinal and hilar contours are normal. There is no pneumothorax or pleural effusion. Lungs are well expanded and clear. No nondisplaced rib fractures seen.", "output": "No nondisplaced rib fracture or pneumothorax." }, { "input": "PA and lateral views of the chest were provided. The heart is mildly enlarged. The lungs appear clear without signs of pneumonia or overt CHF. No effusion or pneumothorax is seen. The mediastinal contour is normal. Bony structures appear intact.", "output": "Mild cardiomegaly, otherwise normal." }, { "input": "In comparison to the recent chest radiograph performed yesterday afternoon, the right pleural effusion continues to improve. Compressive atelectasis is noted at the right lung base. There are no other significant interval changes. Bilateral pigtail catheters are unchanged in position. No evidence of pneumothorax. Cardiomediastinal silhouette is within normal limits.", "output": "Continued improvement of right pleural effusion. No evidence of pneumothorax with pigtail catheter on waterseal." }, { "input": "Compared with the prior radiograph, there has been interval placement of a left pigtail catheter. There are bilateral pleural effusions with new subcutaneous emphysema overlying the left chest wall. No change in the placement of the left IJ pacer, with its tip in the region of the right ventricle. No pneumothorax.", "output": "Interval placement of a left pigtail catheter, without identified pneumothorax. Bilateral pleural effusions are present." }, { "input": "A Swan-Ganz catheter remains in place. Sternotomy wires are intact and aligned. Moderate bilateral layering pleural effusions with associated bibasilar subsegmental atelectasis are unchanged. There is no pneumothorax. Cardiomegaly despite the projection is stable.", "output": "No significant interval change." }, { "input": "In comparison to the recent CXR performed 20 minutes earlier, there has been interval placement of a dobhoff tube, which is currently located in the mid-esophagus. There is atelectasis at the right lung base. No evidence of pneumonia or pulmonary edema. There is no pneumothorax. The bilateral pigtail catheters and IJ catheters are unchanged in position.", "output": "Dobhoff tube currently located in mid-esophagus, and should be advanced." }, { "input": "Portable AP upright chest ___ at 07:45 is submitted.", "output": "Feeding tube is seen coursing below the diaphragm. The left PICC line continues to have its tip at the cavoatrial junction. The mild pulmonary edema has improved. There are layering bilateral effusions with bibasilar consolidation suggestive of partial lower lobe atelectasis. The heart remains enlarged status post median sternotomy. Stable mediastinal contours. No pneumothorax." }, { "input": "Since the prior radiograph performed yesterday afternoon, there has been interval placement of a left-sided pigtail catheter. This has resulted in overall improvement in the left pleural effusion, though a small effusion persists. A moderately sized layering pleural effusion is also noted on the right. No pneumothorax. Other support lines interfaces are stable in position. The Swan-Ganz catheter terminates in the right pulmonary artery. Enteric tube is seen in the stomach. Left internal jugular introducer terminates in the low SVC. Median sternotomy wires are intact.", "output": "Slight interval improvement in left pleural effusion status post pigtail catheter placement. No pneumothorax." }, { "input": "Portable semi-erect chest film ___ at 16:25 is submitted.", "output": "Interval removal of right pleural pigtail catheter. Feeding tube remains in place coursing below the diaphragm with the tip not identified. Left PICC line unchanged in position. No pneumothorax is seen. Patchy bibasilar opacities, left greater the right, likely reflect partial lower lobe atelectasis. Probable small layering effusions, left greater than right. No pulmonary edema. Status post median sternotomy with stably enlarged cardiac contour." }, { "input": "It is very difficult to discern the tip of the endotracheal tube, however it appears to lie approximately 4 cm above the carina. A right IJ sheath extends the midportion of the SVC. A left-sided PICC line extends to the lower SVC. There has been little change since the chest radiograph from the prior day, with an extensive retrocardiac opacification consistent with volume loss in the left lower lobe. There are less prominent changes at the right base, which appears to be improving.", "output": "1. Retrocardiac opacity consistent with volume loss of the left lower lobe, with improving less prominent changes at the right lung base. 2. Lines and monitoring devices as described above." }, { "input": "Streaky opacities at the left costophrenic angle are thought to be due to atelectasis. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits for technique. Contour irregularities of the lower left lateral ribs suggest fractures, age indeterminate.", "output": "Left lower lateral rib fractures which could be old however clinical correlation is suggested. Otherwise, essentially unremarkable chest x-ray." }, { "input": "Compared with the radiograph from earlier on the same date, the left pigtail catheter has been removed and a left chest tube is now in place. There is a persistent large amount of left pleural fluid, with an irregular contour of the left chest wall, possibly suggesting loculation. Small right effusion unchanged. The other monitoring and support devices are unchanged in the interval.", "output": "Interval placement of a left-sided chest tube with removal of prior pigtail catheter, with a large persistent amount of left pleural fluid, which may be loculated. NOTIFICATION: The above findings were communicated via telephone by Dr. ___ to ___ (PA) on ___, ___ min after discovery." }, { "input": "Since the most recent CXR at 10:32am today, the Dobbhoff tube has been advanced post-pyloric, now terminating in the ___ portion of the duodenum. There are no other relevant interval changes. Other support lines and devices are stable in position. Minimal right lung base atelectasis. No other significant pulmonary abnormalities.", "output": "Dobbhoff tube has been advanced to the ___ part of the duodenum." }, { "input": "Since the prior radiograph performed at ___ min earlier, of the left-sided pigtail catheter has been removed. The right-sided pigtail catheter is unchanged in position. Additionally, the Dobbhoff tube has been advanced and now terminates in the proximal stomach. Again noted is mild atelectasis at the right lung base. There is no pulmonary edema or evidence of pneumothorax.", "output": "1. Interval removal of left-sided pigtail catheter. No pneumothorax. 2. New Dobbhoff tube terminates in the proximal stomach." }, { "input": "Mild cardiomegaly and mild vascular congestion, similar to ___. There is no pleural effusion and no pneumothorax. The mediastinum and hila are normal.", "output": "Mild cardiomegaly and mild vascular congestion." }, { "input": "No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable. There is stable mild prominence of the main pulmonary artery. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process. No focal consolidation to suggest pneumonia." }, { "input": "2 views were obtained of the chest. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The heart is normal in size with tortuous aortic contour.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest. There are interstitial opacities and Kerley B lines at the bases consistent with mild interstitial edema. No evidence of pneumonia. There is no pleural effusion or pneumothorax. Cardiac, mediastinal, and hilar contours are normal.", "output": "Mild interstitial edema. No evidence of pneumonia." }, { "input": "The lungs are clear. There is no effusion, consolidation, or pneumothorax. The cardiomediastinal silhouette is within normal limits. No displaced fractures identified.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Analysis is performed in direct comparison with the next preceding similar study of ___. The heart size remains normal and unchanged appearance of the moderately widened and elongated thoracic aorta. The pulmonary vasculature is not congested. There are chronic interstitial abnormalities and pleural scar formations coinciding with low positioned and flattened diaphragms, all rather typical for COPD. Patient has been evaluated for suspicious lesion in the right apical area and a transthoracic needle biopsy resulted in an apical pneumothorax which was followed on multiple examinations. Ohe last preceding of ___, the apical pneumothorax was minimal and on today's examination no pneumothorax can be identified anymore. Instead, there is now a local pleural apical density, probably a scar formation. Mild blunting of the right lateral pleural sinus persists. There is no evidence of significant pleural effusion on the bases as the diaphragms are flattened. No new pulmonary abnormalities are identified.", "output": "Complicating post-interventional pneumothorax cannot be identified anymore." }, { "input": "Portable AP chest radiograph. There is a small right pneumothorax with a small amount of air in the costophrenic sulcus. Right upper lobe nodular opacity corresponds to the biopsied lesion. Some pleural nodules in the right lower lobe correspond to abnormalities on recent PET-CT.", "output": "Small right pneumothorax. Findings were relayed by Dr. ___ to Dr. ___ by phone at 2:12 p.m. on ___ (3 minutes after discovery)." }, { "input": "PA and lateral chest radiographs. Allowing for differences in technique, the size of the right pneumothorax is not significantly changed. However, small pleural effusion is now visible. Again noted are parenchymal abnormalities throughout the right lung, better characterized on recent PET-CT. The cardiomediastinal silhouette is normal.", "output": "Small right hydropneumothorax, stable from 2 hours prior." }, { "input": "The right primary hydro pneumothorax has slightly increased in size while wall with minimal mediastinal shift to the left with the left lung is clear with.", "output": "Mild increased size of right hydropneumothorax." }, { "input": "The hydropneumothorax is slightly larger than on the study from 8:45 this morning. The lung is collapsing inward, the amount of fluid has increased.", "output": "Slight increased size of right hydropneumothorax. This change in interpretation was called to Dr. ___ at 4:15 PM at the time of recognition of the difference in reports by Dr. ___ on ___ by phone." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs are clear. There are no pleural effusions or pneumothorax. The osseous structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "Normal chest x-ray." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours are normal. The imaged osseous structures are intact. No free air is seen below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "There are small bilateral pleural effusions with overlying atelectasis, possibly new on the right. The cardiac silhouette remains top normal. Mediastinal contours are stable. No pneumothorax is seen. There is no overt pulmonary edema.", "output": "Small bilateral pleural effusions with overlying atelectasis." }, { "input": "Persistent blunting of the right lateral and posterior costophrenic angle suggests persistent small effusion, decreased since prior. There may also be trace left pleural effusion. There is no focal consolidation or overt pulmonary edema. Cardiac silhouette is enlarged, similar configuration compared to prior which on remote exam had represented a pericardial effusion.", "output": "Interval decrease in size of right pleural effusion which is now small. Possible trace left pleural effusion. Enlarged cardiac silhouette similar to prior which had previously been secondary to a pericardial effusion." }, { "input": "Frontal and lateral chest radiographs demonstrate interval decrease in size of cardiac silhouette; however, there is similar \"water bottle\" configuration to the cardiac silhouette suggesting persistent pericardial effusion. Right pleural effusion is decreased, now small to moderate in size. Faint opacification projecting over the right lower lung likely reflects residual atelectasis. No pulmonary nodules identified.", "output": "Decreased cardiac silhouette with configuration suggesting residual small pericardial effusion. Slight interval decrease in size of right pleural effusion." }, { "input": "Frontal and lateral views of the chest were obtained. The cardiac silhouette remains enlarged, similar in configuration, but is somewhat of a globular configuration. Underlying pericardial effusion is not excluded. There is bibasilar atelectasis. Slight blunting of the bilateral costophrenic angles suggests trace pleural effusions. The mediastinal contours are stable. No overt pulmonary edema is seen.", "output": "Bibasilar atelectasis. Trace bilateral pleural effusions. Persistent enlargement of the cardiac silhouette, underlying pericardial effusion not excluded. No chest tube is seen on the images." }, { "input": "Frontal and lateral views of the chest were obtained. There has been interval increase in left-sided pleural effusion, with overlying atelectasis. Left basilar consolidation is difficult to exclude. There is minor blunting of the posterior right costophrenic angle and a trace right pleural effusion may be present. The cardiac silhouette is enlarged with a somewhat globular configuration and underlying pericardial effusion is not excluded. No pneumothorax is seen.", "output": "1. Interval increase in left-sided pleural effusion with overlying atelectasis, left basilar consolidation not entirely excluded. Possible new trace right pleural effusion. 2. Enlarged cardiac silhouette in a somewhat globular configuration, underlying pericardial effusion is not excluded." }, { "input": "There are small unchanged bilateral pleural effusions and associated mild-to-moderate bibasilar atelectasis, slightly improved. A left-sided pleural catheter is unchanged in position, ending along the lateral aspect of the lower pleural space. There is no definite pneumothorax. The cardiac and mediastinal contours are unchanged, allowing for differences in lung volumes.", "output": "1. Unchanged positioning of the left-sided pleural catheter. 2. Small bilateral pleural effusions and decreased bibasilar atelectasis." }, { "input": "Lung volumes are low. This accentuates the size of the cardiac silhouette which is top normal. The mediastinal and hilar contours are unremarkable. There is crowding of the bronchovascular structures, but no overt pulmonary edema is demonstrated. There is a possible small left pleural effusion. Patchy opacity in the retrocardiac region is likely atelectasis given the low lung volumes, but an early pneumonia is not completely excluded. There is no pneumothorax. No acute osseous abnormalities seen.", "output": "Low lung volumes. Minimal patchy retrocardiac opacity may reflect atelectasis though infection cannot be completely excluded. Probable trace left pleural effusion." }, { "input": "There is blunting of the right costophrenic angle compatible with persistent small-to-moderate effusion. Increased opacity at the left costophrenic angle is thought to represent fluid within the fissure, and there is some fluid seen posteriorly on the left as well. Superiorly, the lungs are grossly clear noting low inspiratory effort. The mediastinal silhouette is unchanged. No acute osseous abnormalities.", "output": "Persistent bilateral effusions, right greater than left." }, { "input": "There is a small persistent right pleural effusion and probable trace left pleural effusion. The lungs are otherwise clear without consolidation. Cardiomediastinal silhouette is stable. No acute osseous abnormalities.", "output": "No significant interval change, no focal consolidation. Persistent small right and trace left pleural effusion." }, { "input": "PA and lateral views of the chest. The right pleural effusion has increased in size. No left pleural effusion. Heart size is top normal. Cardiomediastinal and hilar contours are normal. No focal consolidation or pneumothorax.", "output": "Increase in small-to-moderate right pleural effusion." }, { "input": "PA and lateral views of the chest were provided demonstrating interval significant increase in the size of the cardiac silhouette which were strong concern for development of a pericardial effusion. Also noted is mild pulmonary edema and small bilateral pleural effusions, right greater than left. Associated compressive lower lobe atelectasis is also likely present. No large pneumothorax. Bony structures are intact.", "output": "Significant increase in cardiac size, raising strong concern for pericardial effusion. Please correlate with echocardiogram. Also noted is pulmonary edema with small bilateral pleural effusions." }, { "input": "Heart size is normal. Left hilar contour is normal. Compared to radiograph dated ___ there is increasing fullness of the right hilus with increased rounded densities along the minor fissure as well as increased right medial lung base peribronchial opacities with bronchial wall thickening and bronchiectasis. Compared to the PET-CT from ___, these findings all appear to be present, however, are worse on today's exam. Left lung is essentially clear. There is no pleural effusion or pneumothorax.", "output": "Worsening densities in the right hilus with increase in nodular densities along the minor fissure as well as increased peribronchial opacities and bronchiectasis in the right lung base which may represent worsening primary malignancy with superimposed infection. Fissural densities may represent loculated effusion although local metastatic disease is not excluded. Results were discussed over the telephone with Dr. ___ over the telephone by ___ at 11:05 a.m. on ___ at the time of initial review." }, { "input": "An ill-defined opacity is seen in the right perihilar region, with associated elevation of the right hemidiaphragm and a small right-sided pleural effusion. Right basilar patchy opacity is identified. Otherwise, the left lung is well expanded without focal opacities. There is no left-sided pleural effusion. Cardiac size is normal. Thickening of the right paratracheal stripe likely indicates mediastinal lymphadenopathy. No pneumothorax is identified.", "output": "Right perihilar opacity likely reflects known malignancy, with small right pleural effusion. Right basilar patchy opacity could reflect atelectasis or infection. Widened right paratracheal stripe suggests lymphadenopathy. Comparison with prior imaging exams are recommended to assess for interval change." }, { "input": "Supine portable AP view of the chest provided. There has been interval placement of the endotracheal tube, which is seen extending into the right main stem bronchus. Retraction by at least 3 cm is advised. NG tube is also intervally placed extending into the left upper quadrant. There is increasing consolidation in the right lower lung which is concerning for interval aspiration. Mild pulmonary edema is increased in the interval.", "output": "Low lying ET tube entering the right main stem bronchus. Retraction by at least 3 cm is advised. Increasing pulmonary edema and right lower lung consolidation concerning for aspiration. A preliminary report was posted to the ED dashboard at the time of this dictation." }, { "input": "Portable AP upright chest radiograph provided. The chest tube projects over the right lateral hemithorax with lateralizing right pleural effusion again seen. There is right perihilar opacity which appears similar to the prior exam allowing for slight changes in patient positioning. The left lung is mostly clear, though there may be mild atelectasis at the left lung base. The heart size is unchanged. Bony structures are intact.", "output": "No significant change given slight differences in technique." }, { "input": "Frontal and lateral views of the chest were obtained. Linear atelectasis is seen in the right upper lobe adjacent to the minor fissure with volume loss. There is no focal consolidation, pleural effusion or pneumothorax. Heart size is normal. Mediastinal silhouette and left hilar contours are normal. The right hilum is slightly enlarged. No acute osseous abnormality or displaced rib fracture is seen.", "output": "Right upper lobe atelectasis with volume loss. This is due to a right hilar lesion, better assessed on the subsequent CT." }, { "input": "There has been interval retraction of the endotracheal tube with tip now positioned approximately 3 cm above the carina. No other interval change detected. Severe abnormalities in both hemithoraces better delineated on today's CT.", "output": "Satisfactory repositioning of the endotracheal tube." }, { "input": "Frontal and lateral views of the chest. Large opacification of the right hemithorax is consistent with a combination of consolidation, pleural effusion, and/or tumor progression. In particular, the pleural component appears larger. There slight leftward shift of the mediastinum. The right heart border is obscured but the heart size appears normal. The left lung is clear.", "output": "Increased opacification of the right hemithorax consistent with a combination of tumor progression, pleural effusion, and/or consolidation." }, { "input": "Increasing small left-sided pleural effusion with recent atelectasis. Clips are seen in the left upper lobe with decreasing surrounding opacity. Mild elevation and asymmetry of the left hilum can be post treatment changes. No pulmonary edema. The right lung is clear. The cardiac silhouette is not enlarged. PriorTAVR with aortic stent.", "output": "Increasing small left-sided pleural effusion." }, { "input": "The known left upper lobe mass contains fiducial markers. As compared to the prior exam, there are new bibasilar airspace opacities, more conspicuous on the left and new small bilateral pleural effusion. There is no pneumothorax or overt pulmonary edema. The cardiomediastinal silhouette is normal and unchanged.", "output": "New, bibasilar airspace opacities, greater on the left, possibly pneumonia. Small bilateral pleural effusions are also new. Left upper lobe bronchogenic carcinoma. Chronic goiter." }, { "input": "Portable semi-upright radiograph of the chest demonstrates a normal cardiomediastinal silhouette. Pulmonary edema is improved since the prior examination. Left upper lung field opacity is similar to the prior examination. No definite new consolidation identified. There is no sizable pleural effusion or pneumothorax. There is evidence of calcific tendinosis of the right shoulder.", "output": "Improvement in edema from prior examination." }, { "input": "PA and lateral views of the chest provided. There is an aortic valvular stent in place. There is a small left pleural effusion with basilar atelectasis. High other congestion is noted without frank pulmonary edema. Mild scarring in the left suprahilar region is compatible with an area of post radiation changes adjacent to a fiducial marker. No pneumothorax. The mediastinal contour stable. Bony structures appear grossly intact.", "output": "As above." }, { "input": "Portable AP upright chest radiograph ___ at 07:48 is submitted.", "output": "Left basilar chest tube remains in place with stable appearance to the left hemithorax with more focal opacity in the left suprahilar region in an area of recent ablation and a lateral pleural abnormality which may reflect loculated fluid in this patient with known lung malignancy. The right lung remains grossly clear. Heart is unchanged in size. No pulmonary edema. No pneumothorax." }, { "input": "A portable frontal chest radiograph demonstrates a replaced tracheostomy appears normally positioned, terminating in the upper thoracic trachea. A right PICC now crosses midline, now terminating in the left subclavian vein. The remainder of the exam is unchanged.", "output": "Right PICC crosses midline, terminating in the left subclavian vein. This is new compared to chest radiograph from 7 hours prior, but on followup chest radiograph 6 hours later is again appropriately positioned." }, { "input": "Cardiac silhouette size remains mildly enlarged, unchanged. Patient is status post transcatheter aortic valve replacement. Left upper lobe suprahilar opacity containing ___ fiducial markers remains grossly unchanged compared to the previous examination. The hilar contours are otherwise similar. There is a small left pleural effusion, not substantially changed in the interval. The right lung is clear. No pneumothorax is present. Marked degenerative changes are seen in the left glenohumeral and both acromioclavicular joints. There are multilevel degenerative changes also seen within the thoracic spine.", "output": "Overall, no substantial interval change in appearance of the chest from prior. Continued ill-defined opacity in the left upper lobe compatible with known lesion which has undergone prior RF ablation. Small left pleural effusion, similar to the previous study." }, { "input": "There is a new right lower lobe infiltrate. The remainder the appearance of the lungs, a ET tube, and NG tube are unchanged", "output": "New right lower lobe infiltrate" }, { "input": "Compared to ___, there has been interval removal of the chest tube. There is decreased in left upper lobe and left basal opacity. Residual left pleural effusion is small. The lateral pleural abnormality is not seen on today's exam. The right lung is grossly clear. The heart size is mildly enlarged and unchanged from prior. The mediastinal contours are unchanged from prior. Surgical clips are seen in the left upper lobe. Left subdiaphragmatic drain is seen. No pneumothorax is seen.", "output": "Improved appearance of left pleural effusion with minimal residual effusion." }, { "input": "Again seen, is a small left pleural effusion. Cardiomediastinal contour is unchanged. Also is unchanged is a rounded consolidation around the clips in the left upper lobe, likely postprocedural. No new focal consolidation is seen. Right lung is grossly clear. There is no pneumothorax. There are severe bilateral degenerative changes of the acromioclavicular joints.", "output": "1. Stable small left pleural effusion. 2. Unchanged rounded opacity adjacent to the clips in the left upper lobe. No new focal consolidation. 3. No pneumothorax." }, { "input": "AP upright and lateral views of the chest provided. Aortic valve replacement noted on the lateral projection. Tiny clips project over the left upper chest. The previously noted lines and tubes have been removed. There is left lower lobe opacity which could represent consolidation/pneumonia and likely a small left pleural effusion. Right lung is clear. No overt signs of edema. Aortic calcification noted. Degenerative changes at both shoulders noted.", "output": "Left basal opacity concerning for pneumonia and small left pleural effusion." }, { "input": "Right internal jugular dialysis catheter terminates in right atrium. Prosthetic aortic valve is noted. Tracheostomy tube is in unchanged position. There is no large pleural effusion. Cardiomediastinal silhouette is normal size. A pigtail catheter is noted overlying the mid abdomen. Mild left upper lung opacity is similar to before and may reflect asymmetric clearing of pulmonary edema or pneumonia in correct clinical setting.", "output": "Mild left upper lung opacity is similar to before and may reflect asymmetric clearing of pulmonary edema or pneumonia in correct clinical setting." }, { "input": "AP portable upright view of the chest. Tracheostomy tube projects over the superior mediastinum. An aortic valve stent is in place. Right upper extremity PICC line is seen with its tip in the lower SVC. A feeding tube extends towards the left hemidiaphragm though the tip is excluded from view. Clips are seen projecting over the left upper lung. Overlying EKG leads are present. There is near complete opacification of the right lung which is likely a combination of effusion, edema and possible pneumonia. Patchy opacity in the left lung mostly in the left upper and lower lungs may also represent foci of infection. Overall cardiomediastinal silhouette appears stable from prior. Bony structures are intact.", "output": "As above." }, { "input": "Opacity in the left upper lung with adjacent fiducial markers are unchanged. No focal consolidation, edema, or pneumothorax. No large pleural effusion. Cardiomediastinal contours are unchanged. Aortic valve replacement is similar in position and appearance. Incompletely imaged G-tube is noted. The stomach appears distended with gas and fluid contents. Extensive degenerative changes in the shoulders and AC joints are unchanged. Multilevel degenerative changes in the thoracic spine with probable calcification of the anterior longitudinal ligament is again seen. No evidence of an acute osseous abnormality on this nondedicated exam.", "output": "No acute intrathoracic process on chest radiograph. Please note that this exam is not dedicated for evaluation of rib fractures; if clinical assessment suggests fracture, dedicated rib films is recommended." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Left super and perihilar opacity is re- demonstrated. Surgical clips are again noted in the left upper lung. No large pleural effusion is seen. There is no evidence of pneumothorax. There has been interval decrease in previously seen pulmonary vascular congestion and interstitial edema. The cardiac and mediastinal silhouettes are stable. Aortic core valve is noted.", "output": "Interval decrease an pulmonary vascular congestion and interstitial edema, with none seen presently." }, { "input": "In comparison to the chest radiographs obtained 3 hours prior, the small, left pleural effusion has decreased in size. No pneumothorax. Of note, there is an approximately 2 x 3 cm right paratracheal nodule. In comparison to the recent PET-CT, this may be a summation of an FDG avid peritracheal lymph node and the adjacent azygos vein. No other significant changes from this morning are identified.", "output": "Interval decrease in small, left pleural effusion without acute complications of thoracentesis." }, { "input": "Patient is status post TAVR. Surgical clips are again seen in place in the left upper lobe. An aortic stent is again seen. There is interval development of a small left-sided pleural effusion. Stable left upper lobe lesion in the setting of post treatment changes is again noted. The lungs are clear without focal consolidation. No pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "1. Interval development of a small left-sided pleural effusion. 2. Stable, post-treatment left lung lesion." }, { "input": "The cardiomediastinal silhouette is accentuated due to AP technique, likely stable. New since prior exam is mild pulmonary edema. Left upper lobe opacities were better evaluated on prior CT chest from ___. There is no new superimposed focal lung consolidation. There is no pneumothorax or sizable pleural effusion. Surgical clips overlie the left upper thorax, as on prior exam. Irregularity of the left upper ribs is unchanged.", "output": "1. New mild pulmonary edema. 2. Left upper lobe opacities are re- demonstrated, better evaluated on prior CT chest from ___." }, { "input": "Mild enlargement of the cardiac silhouette is unchanged. Transcatheter aortic valve replacement is re- demonstrated, in unchanged position. Mediastinal and hilar contours are similar. Opacification of the left upper lobe with overlying clips is similar compared to the previous studies, better assessed on the prior CT. Patchy atelectasis is noted in the left lower lobe. No new focal consolidation, pleural effusion or pneumothorax is present. Pulmonary vasculature is not engorged. Degenerative changes of both glenohumeral and acromioclavicular joints and within the thoracic spine are unchanged. Clips are also noted projecting over left upper quadrant of the abdomen.", "output": "Unchanged left upper lobe opacity, previously assessed on prior CT. Patchy left basilar atelectasis." }, { "input": "Portable chest radiograph ___ at 04:54 is submitted.", "output": "Tracheostomy tube and dual lumen right internal jugular central line unchanged in position. Overall cardiac mediastinal contours are likely unchanged given marked patient rotation on the current study. Left apical postsurgical changes and nodular opacities are stable. Right medial lung base opacity likely reflects atelectasis, although pneumonia cannot be entirely excluded. No obvious pulmonary edema. No large effusions. Left glenohumeral degenerative joint changes." }, { "input": "Lung volumes are normal and lungs are clear. No pleural effusion, pneumothorax or focal airspace consolidation. Mediastinal and hilar contours are unremarkable. Heart is normal size.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable view of the chest. The lungs are clear without focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest views were obtained with patient in upright position. The heart size is within normal limits. No configurational abnormalities identified. Thoracic aorta mildly elongated but no local contour abnormalities or wall calcifications are seen. Lateral view does not disclose any suspicious intracardiac calcifications. Pulmonary vasculature is not congested. No signs of acute or chronic parenchymal infiltrates are present. The lateral and posterior pleural sinuses are free. No pneumothorax in the apical area. Skeletal structures of the thorax grossly within normal limits. There exists no prior chest examination in our records available for comparison.", "output": "Normal chest findings in patient with history of chest pain." }, { "input": "PA and lateral chest radiographs. Right middle lobe and lingular opacification persist and likely reflect atelectasis. Lateral view shows one of the lower lobes is also involved. There is no pleural effusion or pneumothorax. The heart size is normal.", "output": "Persistent bilateral atelectasis concerning for an obstructive process. Further evaluation with CT is recommended. Findings were submitted to the critical results dashboard." }, { "input": "Compared with the prior radiograph, interval removal of the left-sided chest tubes, with a small left apical pneumothorax. Moderate left-sided pleural effusion and left basilar consolidation, likely due to atelectasis, are unchanged. Heart size is enlarged, unchanged. Pulmonary vascular congestion has improved. Mediastinum is stable. No evidence of pneumothorax. Small amount of subcutaneous air on the left side, likely related to the prior chest tubes.", "output": "1. Small left apical pneumothorax, post chest tube removal. 2. Improved pulmonary vascular congestion." }, { "input": "The large left pleural effusion may have slightly increased compared to prior. The linear opacity within the right lower lung likely represent subsegmental atelectasis. The lungs are otherwise clear. Cardiomediastinal silhouette is stable. The pulmonary vasculature is normal. There is no pneumothorax. There are no acute osseous abnormalities.", "output": "Slightly increased size of the large left pleural effusion." }, { "input": "Chronic right middle lobe collapse is re-demonstrated. There is no new consolidation or pleural effusion. However, a mass-like opacity at the right hilus has gradually grown more prominent since ___. Bibasilar opacities have slightly improved. Moderate cardiomegaly is stable. There is no pneumothorax.", "output": "Chronic right middle lobe collapse with associated rounded contour of the right hilum. A contrast enhanced chest CT is recommended to evaluate for a hilar or endobronchial mass such as carcinoid. Stable moderate cardiomegaly. NOTIFICATION: The impression above was entered by Dr. ___ on ___ at 16:11 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "The left chest tube is unchanged in positioning. The size and distribution of the moderate-sized loculated left pleural effusion is unchanged. The right lung is clear. The pulmonary vasculature is normal. The upper mediastinum is stable in size, however the cardiac silhouette cannot be entirely evaluated due to the pleural effusion. There is no pneumothorax. The linear radiodensity projecting over the left mid lung is likely external to the patient.", "output": "1. Unchanged positioning of left chest tube. 2. Stable moderate-sized loculated left pleural effusion." }, { "input": "Frontal and lateral radiographs of the chest show increased opacification at the right lung base obscuring the right heart border, best appreciated on the corresponding lateral radiograph representing right middle lobe collapse. Linear opacities at the left lung base are new from the preceding radiographs and most likely represent atelectasis in the absence of clinical findings to suggest infection. No pleural effusion or pneumothorax is present. The pulmonary vasculature is not engorged. The cardiomediastinal silhouette is within normal limits and probably unchanged from the ___ radiograph, although the heart borders are obscured by adjacent opacities.", "output": "Right middle lobe collapse and atelectasis at the left lung base secondary to asthma, less likely pneumonia or other infection. Findings were communicated by Dr. ___ to Dr. ___ by phone at 17:00 p.m. on ___." }, { "input": "Opacification in the left lower lobe and lingula consistent with pleural effusion and consolidation as seen on the concurrent CT. Linear opacification in the right middle lobe may reflect atelectasis or consolidation. No pneumothorax. Stable heart size and mediastinal contours.", "output": "1. Consolidation and pleural effusion in the left lower lobe. 2. Atelectasis versus consolidation in the right middle lobe." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well-expanded clear lungs. The cardiomediastinal and hilar contours are unchanged. There continues to be mild tortuosity of the aorta. There is no pneumothorax, pleural effusion or consolidation.", "output": "No pneumonia." }, { "input": "PA and lateral views of the chest were obtained. There is no focal consolidation, effusion, pneumothorax. Cardiomediastinal silhouette normal. Bony structures intact. No free air below the right hemidiaphragm.", "output": "No signs of pneumonia." }, { "input": "There are only mild bibasilar atelectatic changes. The lungs are otherwise clear, the cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax.", "output": "No evidence of pneumonia." }, { "input": "Patient is status post median sternotomy and CABG. Cardiac silhouette size remains borderline enlarged. The mediastinal and hilar contours are unchanged with tortuosity and calcification of the thoracic aorta again noted. The pulmonary vasculature is not engorged. Left-sided pleural thickening and pleural calcifications with parenchymal scarring in the left lung base appear relatively unchanged. No new focal consolidation is present. No right-sided pleural effusion or pneumothorax is demonstrated. Bullous emphysematous changes are again seen within the upper lobes bilaterally.", "output": "No significant interval change from the previous study with no new focal consolidation identified." }, { "input": "The patient is status post previous median sternotomy and coronary artery bypass surgery. Heart is upper limits of normal in size and similar to the prior radiograph. Aorta is tortuous and calcified. Extensive calcifications are present along the lateral left pleural surface contiguous with pleural thickening at the left lateral costophrenic sulcus and adjacent left hemidiaphragm. Adjacent regions of parenchymal scarring are present, also appearing similar. Bilateral upper lobe predominant bullous emphysema is noted, unchanged. No acute skeletal findings.", "output": "Stable radiographic appearance of the chest with no new or progressive lung or pleural abnormalities." }, { "input": "Left lower lobe opacity with blunting of the costophrenic angle and left hemidiaphragm overall similar to the prior exam, likely reflecting atelectasis and small left pleural effusion. Dependent increased interstitial markings with indistinct assessed pulmonary vasculature is most suggestive of edema. Heart size is probably enlarged, similar the prior exam. Pulmonary vascular congestion is moderate. No pneumothorax. The right pleural effusion.", "output": "Findings consistent with volume overload - persistent, increased left pleural effusion, now with increased edema." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable. Right upper quadrant surgical clips are from presumed prior cholecystectomy.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Cardiomegaly is unchanged. The aorta is unfolded. Lungs are clear bilaterally without signs of pneumonia or edema. No large effusion or pneumothorax is seen. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "The lungs are well expanded. There is a faint focal opacity in the right upper lobe, which likely reflects atelecatis, unchanged form prior CT. Cardiomediastinal silhouette is unremarkable. There is no pneumothorax or pleural effusion. Visualized osseous structures are unremarkable. Surgical clips are noted in the right upper quadrant, which likely reflect prior cholecystectomy.", "output": "No acute cardiopulmonary process." }, { "input": "The initial image shows a Dobhoff tube positioned in the mid esophagus. Subsequent images show the tip is below the left hemidiaphragm, likely in the stomach or duodenum. Multiple rib fractures with varying degrees of healing seen. No con solid a shin or pneumothorax seen.", "output": "Slab off tube is positioned in the stomach or duodenum on the last available image." }, { "input": "There is evidence of the moderate cardiomegaly, slightly worsened compared to the exam from ___ however stable compared to the most recent exam. The previously noted vascular congestion in the upper lungs has improved; however, there appears to be an interval increase in the left perihilar opacification compared to the prior exam, suggestive of worsening aspiration. There are stable small bilateral pleural effusions. There is no evidence of pneumothorax. Heterogeneous opacification of the lung apices is likely secondary to scarring.", "output": "Interval worsening of the left perihilar opacification consistent with recent aspiration. These findings were discussed with Dr. ___ at 10:30 p.m. by Dr. ___ ___ by telephone on the day of the exam." }, { "input": "A single portable AP semi-erect view of the chest was obtained. Heart is top normal in size. Cardiomediastinal contour is unremarkable. The sternotomy wires and surgical clips are noted. Lungs are clear without focal consolidation, pleural effusion or pneumothorax.", "output": "No evidence of pneumonia." }, { "input": "The NG tube. Is in the stomach.", "output": "NG tube in stomach" }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart size is normal. The hilar mediastinal contours are normal. No focal consolidations concerning for pneumonia are identified. There is no pleural effusion or pneumothorax. Mild eventration of the right hemidiaphragm is stable.", "output": "No acute intrathoracic abnormalities identified." }, { "input": "There is a small left pleural effusion, decreased in size from ___. There is no focal consolidation or overt pulmonary edema. The cardiac and mediastinal silhouette is stable.", "output": "Small left pleural effusion, decreased from ___." }, { "input": "Lung volumes are normal, and lungs are better expanded compared to the prior study. Sternotomy wires and surgical clips overlying the heart shadow are again noted. Left lower lobe opacity seen previously has improved, and the left-sided pleural effusion appears to have resolved. Cardiomediastinal contours are stable.", "output": "Interval resolution of the left-sided pleural effusion with better expansion of the lungs bilaterally." }, { "input": "Portable semi-upright chest radiograph was obtained. Midline sternotomy wires and mediastinal clips are again noted. A left chest tube is seen entering the left lobe lateral chest wall with tip oriented at the left lung apex. Subcutaneous emphysema is noted along the chest tube insertion site at the left chest wall. There is left basal atelectasis and slight volume loss in the left lung. No pneumothorax is seen. There is blunting of the right CP angle which could indicate a small right pleural effusion. An azygos lobe is noted. Overall, cardiomediastinal silhouette appears normal. There is suture material at the left lung apex.", "output": "Status post left VATS with post-surgical changes including atelectasis and volume loss in the left lung with left chest tube positioned appropriately." }, { "input": "There is interval removal of the left-sided chest tube. There is no evidence of a pneumothorax. Sternotomy wires and surgical clips overlying the heart shadow are again noted. Cardiomediastinal contours remain unchanged. There is blunting of the left costophrenic angle with a small amount of pleural effusion, an overlying consolidation cannot be excluded which in the proper clinical context could represent pneumonia. Lung fields are otherwise clear. Bony structures are intact.", "output": "1. Interval removal of the left-sided chest tube with no evidence of pneumothorax. 2. Small left-sided pleural effusion, an overlying consolidation cannot be excluded." }, { "input": "A frontal semi-upright view of the chest was obtained portably. The lungs are well expanded and clear without focal consolidation, pleural effusion or pneumothorax. Incidentally noted is an azygous lobe. Heart size is normal. Mediastinal silhouette and hilar contours are normal. The patient is status post median sternotomy and CABG. Pulmonary vasculature is within normal limits. There is mild bibasilar atelectasis.", "output": "No acute intrathoracic process." }, { "input": "The lung bases a relatively under penetrated due to overlying soft tissue. There are low lung volumes. Given the above, patchy medial right basilar opacity most likely reflects overlap of vascular structures or possibly atelectasis. No pleural effusion is seen. There is evidence of pneumothorax. The cardiac silhouette is top-normal. Mediastinal contours are grossly unremarkable. There is no pulmonary edema.", "output": "Low lung volumes. Somewhat under penetrated due to body habitus. Given the above, subtle medial right base opacity most likely reflects overlap of vascular structures or possibly atelectasis, with aspiration or infection felt less likely." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.", "output": "No acute intrathoracic process." }, { "input": "The heart is normal in size. The aorta is mildly tortuous. Moderate anterior right hemidiaphragmatic elevation is noted with streaky opacities suggestive of minor atelectasis. Otherwise, the lungs appear clear. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. Again noted is unchanged mild to moderate relative elevation of the right hemidiaphragm with demonstration of rim-calcified cysts again visible within the right hepatic dome. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "No definite focal consolidation is seen. There is no pleural effusion or pneumothorax. Mild right middle lobe and basilar atelectasis is noted. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen. 6 mm ovoid calcification adjacent to the lateral right humeral head likely represents calcific tendinosis.", "output": "Minor atelectasis. Otherwise, no acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Lung volumes are somewhat low. Allowing for this, there is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest were obtained. Lung volumes are low on the frontal view, which somewhat limits evaluation, though allowing for this, there is no focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is stable. Bony structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "There relatively low lung volumes. No definite focal consolidation is seen. There is no pleural effusion or pneumothorax. Cardiac mediastinal silhouettes are stable. Bridging osteophyte is seen in the lower thoracic spine. No displaced fracture is identified.", "output": "No acute cardiopulmonary process." }, { "input": "Again seen is a left chest cardiac device with associated single lead appearing intact, and unchanged appropriate orientation projecting over the approximate location of the right ventricle. This appearance is similar in comparison to prior radiograph from ___. Again seen are multiple median sternotomy wires and mediastinal surgical clips. Mild cardiomegaly is stable. The bilateral hila are unremarkable. There are low lung volumes. The lungs are clear. There is no evidence of pulmonary vascular congestion. There is no pneumothorax or pleural effusion.", "output": "1. Stable appearance of left chest cardiac device with associated single lead. No evidence of lead fracture or other complication. 2. Stable mild cardiomegaly. No focal lung consolidation." }, { "input": "The patient has had prior median sternotomy and CABG. No complications of the sternal wires. Interval insertion of a left-sided defibrillator with the tip in the right ventricle. No pneumothorax. The lungs are clear. Mild-to-moderate cardiomegaly. No pleural effusions.", "output": "Left-sided defibrillator with the tip in the right ventricle in standard position. No pneumothorax." }, { "input": "Right-sided Port-A-Cath tip terminates in the mid SVC. Mild enlargement of the cardiac silhouette persists. The mediastinal hilar contours are unchanged. Pulmonary vasculature is not engorged. Patchy opacities are noted in the right lung base likely reflective of atelectasis. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormality is identified.", "output": "Right basilar atelectasis. No pulmonary edema." }, { "input": "The heart is mildly enlarged. The mediastinal and hilar contours appear unchanged. The lungs appear clear. There is no evidence for pleural effusion or pneumothorax.", "output": "Mild cardiomegaly. No evidence of acute disease." }, { "input": "Single frontal view of the chest was obtained. The heart size and cardiomediastinal contours are normal. The lungs are clear. No focal consolidation, pleural effusion, or pneumothorax. Left acromioclavicular joint degenerative changes are severe, similar to prior. No radiopaque foreign body.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well expanded, though there is minimal airspace opacity in the right infrahilar region which may reflect mild aspiration pneumonitis or developing pneumonia. The pleural surfaces are normal. The cardiac silhouette and mediastinal contours are normal. In the interim, a right IJ approach hemodialysis catheter has been removed. The pulmonary vasculature is normal.", "output": "Mild right infrahilar airspace opacity, which may reflect aspiration or infection." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There is no pleural effusion or pneumothorax.", "output": "No evidence of pneumothorax or other findings suggestive of acute cardiopulmonary disease." }, { "input": "Endotracheal tube is in stable position. Enteric tube seen with tip in the gastric fundus. There is relative elevation of left hemidiaphragm as on prior. Bilateral chest tubes are identified. Right-sided pneumothorax is only faintly visualized laterally and perhaps inferiorly with increased lucency at the right lung base. Dense consolidation seen throughout the left lung with decrease volume of the left hemi thorax and leftward mediastinal shift. No definite left-sided pneumothorax seen on this supine film. Radiopaque foreign body again projects over the right mid lung.", "output": "No significant interval change. Dense consolidation in the left lung which is largely in part due to atelectasis given degree of volume loss including leftward mediastinal shift." }, { "input": "PA and lateral views of the chest. The lungs are clear without focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormality is identified.", "output": "Normal chest x-ray." }, { "input": "PA and lateral views of the chest provided. The lungs are clear. Right hilum remains prominent within appearance that is unchanged compared with ___. Given stability over time, likely represents a prominent vascular structure. No focal consolidation, large effusion or pneumothorax. The cardiomediastinal silhouette is stable. Bony structures are intact. No free air is seen below the right hemidiaphragm.", "output": "As above." }, { "input": "Cardiac silhouette size is borderline enlarged. Mediastinal contour is unchanged. Mild pulmonary vascular congestion is noted. Patchy atelectasis is seen in the lung bases. No pleural effusion or pneumothorax is identified. No acute osseous abnormalities seen.", "output": "Mild pulmonary vascular congestion and bibasilar atelectasis." }, { "input": "There is silhouetting of the left heart border which may reflect consolidation in the lingula. There is no pleural effusion, pneumothorax or no pulmonary edema. The heart size is normal.", "output": "Silhouetting of the left heart border may reflect consolidation in the lingula." }, { "input": "Moderate enlargement of the cardiac silhouette is unchanged. The mediastinal and hilar contours are similar. There is mild pulmonary edema, not substantially changed in the interval. No overt pulmonary edema is seen. Small bilateral pleural effusions are new in the interval with patchy atelectasis noted in the lung bases, more pronounced on the left. Sutures within the left apex are re- demonstrated. Multiple old left sided rib fractures are again noted with partial resection of the left fifth posterior rib.", "output": "Mild pulmonary edema, not changed in the interval, with increased small bilateral pleural effusions." }, { "input": "Interval increase in the transverse cardiac diameter with pulmonary vascular congestion and parahilar peribronchial cuffing suggesting pulmonary edema. No obvious Kerley B lines or pleural effusions. Surgical material again noted projecting over the left lung apex.", "output": "Findings suggestive of cardiac decompensation or fluid overload. No pneumonia." }, { "input": "There is silhouetting of the left heart border with hazy increased opacity throughout the left lung on the AP view. The appearances are consistent with lingular consolidation. No other areas of consolidation are seen. No pleural effusion. The heart does appear to be mildly enlarged. No frank pulmonary edema seen however. Surgical clips and suture material seen at the left lung apex. Deformity of the left fifth rib posteriorly is presumed to be related to this prior surgery.", "output": "Findings suspicious for lingular consolidation. Recommend followup with repeat chest radiograph in ___ weeks following completion of treatment to ensure resolution." }, { "input": "Cardiomegaly and the pulmonary vascular congestion again seen, mildly improved since the previous exam of ___. There is increased opacity in both the right and left lower lobes. An underlying pneumonia or aspiration cannot be excluded. Surgical clips over the left upper ex seen as previously.", "output": "Improved CHF. Bilateral lower lobe opacities" }, { "input": "The cardiac and mediastinal silhouettes are stable and mildly enlarged. Prominence of the interstitial markings and vascular markings bilaterally suggest component of pulmonary edema. Right basilar opacity is seen which could be due to atelectasis, aspiration, infection not excluded. The left costophrenic angle not fully included on the image, thoracic spine CT earlier today, showed small left pleural effusion with overlying atelectasis. Multiple chronic right-sided rib deformities are again seen. Chronic deformity of the distal right clavicle again noted.", "output": "Cardiac and mediastinal silhouettes are stable and mildly enlarged. Prominence of the interstitial markings and vascular markings bilaterally suggest component of pulmonary edema. Right basilar opacity is seen which could be due to atelectasis, aspiration, infection not excluded. The left costophrenic angle not fully included on the image, thoracic spine CT earlier today, showed small left pleural effusion with overlying atelectasis." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is no consolidation, pleural effusion, or pneumothorax. Cardiac silhouette is mildly enlarged. Mild right lung base opacity is likely secondary to rotated position.", "output": "No acute cardiopulmonary process." }, { "input": "Hyperinflation and flattening of the diaphragms consistent with emphysema. Enlarged right pulmonary artery consistent with pulmonary hypertension. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "1. No evidence of malignancy on chest x-ray however if patient is qualified, recommend further evaluation with chest CT. 2. Emphysematous changes. 3. Pulmonary hypertension likely secondary to COPD. RECOMMENDATION: No evidence of malignancy on chest x-ray however if patient is qualified, recommend further evaluation with chest CT." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. Streaky left basilar opacity suggests minor atelectasis. Otherwise, the lungs appear clear. Bony structures are unremarkable.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Lungs are low in volume but are clear aside from incompletely evaluated faint left basal opacity with subtle obscuration of the left hemidiaphragm. Calcified granuloma or lymph node is seen in the right apex. There is no pleural effusion or pneumothorax. The heart is normal in size with normal cardiomediastinal silhouette.", "output": "Focal left basilar opacification could reflect atelectasis, aspiration or infectious pneumonia. Further assessment by PA and lateral radiographs is recommended when clinically feasible. This was discussed with Dr. ___ by Dr. ___ by phone at ___ on ___." }, { "input": "Frontal and lateral views of the chest were obtained. The cardiac silhouette is top normal. The mediastinal contours are unremarkable. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Right-sided Port-A-Cath with the tip in the mid SVC. There are low lung volumes. Minimal subsegmental atelectasis in the lung bases bilaterally. No focal consolidation. No interstitial pulmonary edema. The cardiac silhouette is compared.", "output": "No acute pneumonia, interstitial edema or effusions." }, { "input": "Streaky left basilar opacity is compatible with atelectasis. The lungs are otherwise clear. There is no effusion, consolidation or pneumothorax. Right chest wall port is again noted. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. Low lung volumes. There are bilateral lower lobe opacities, right greater than left, that may either represent pneumonia or atelectasis. Bilateral pleural effusions, right greater than left. A tiny nodule projects over the right upper hemithorax over the second anterior right rib that most likely represents a tiny granuloma. The mediastinal and hilar contours are normal.", "output": "1. Bilateral lower lobe opacities may either represent pneumonia or atelectasis. Bilateral pleural effusions, right greater than left. 2. Tiny nodule projecting over the right upper hemithorax that most likely represents a tiny granuloma." }, { "input": "Interval removal of right IJ central venous catheter. The sternotomy wires are intact without evidence of dehiscence. Moderate left pleural effusion is unchanged. No pleural effusion on the right. Bilateral lower lobe atelectasis is stable. The lungs are otherwise clear. Cardiomediastinal silhouette is unchanged.", "output": "Left pleural effusion with underlying volume loss. Small right lower lobe atelectasis. No other acute cardiopulmonary process." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax. There is no free air under the diaphragm.", "output": "No acute cardiopulmonary process. No free air under the diaphragm." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "Unremarkable chest radiographic examination." }, { "input": "Deep brain stimulator device packs are noted overlying the anterior chest walls bilaterally. Heart size is mildly enlarged. Mediastinal and hilar contours are unremarkable. No pulmonary vascular engorgement is seen. There is minimal patchy left basilar opacity likely reflective of atelectasis. Blunting of the costophrenic angles posteriorly on the lateral view suggests trace pleural effusions. No focal consolidation or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Left basilar atelectasis. Probable small bilateral pleural effusions posteriorly." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The heart is normal in size with normal cardiomediastinal contours.", "output": "No acute intrathoracic process." }, { "input": "AP and lateral views of the chest. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal contours are normal. There is no rib fracture identified.", "output": "No acute cardiopulmonary process. No displaced rib fracture, however, if there is a site of concern, dedicated rib films can be done." }, { "input": "PA and lateral views of the chest demonstrate a persistent small apical pneumothorax on the left, not significantly changed since the prior study. No pneumothorax is identified on the right. There is mild left basilar atelectasis. The cardiomediastinal silhouette is unremarkable, and there is no evidence of tension. No displaced rib fractures are identified. There is no pleural effusion or focal airspace opacity.", "output": "Small left apical pneumothorax. NOTIFICATION: The above findings were communicated to Dr. ___ (ED Resident) by Dr. ___ ___ telephone at 10:45 p.m., five minutes after discovery." }, { "input": "Two views of the chest demonstrate small residual left apical pneumothorax, with interval resolution of bilateral pleural effusions. The lungs are otherwise clear and the cardiac and mediastinal structures are stable.", "output": "Possible very minimal residual left apical pneumothorax with resolution of bilateral pleural effusions. These findings were relayed to ___ at the ___ via telephone by Dr. ___ at 1:37 p.m. on ___." }, { "input": "Heart size is normal. The mediastinal and hilar contours are stable, normal. The pulmonary vasculature is normal. Again seen is a small left hydro pneumothorax is unchanged in size from the most recent prior. Small bilateral pleural effusions and bibasilar atelectasis is not significantly changed.", "output": "1. Small left hydro pneumothorax is stable. 2. Small bilateral pleural effusions and bibasilar atelectasis unchanged." }, { "input": "There has been no significant interval change in a small left apical pneumothorax. Small left pleural effusion is persistent with adjacent mild atelectasis. The cardiomediastinal silhouette is unremarkable. No displaced rib fractures are identified. There is no focal airspace opacity.", "output": "Persistent small left apical pneumothorax, overall unchanged compared to the prior exam." }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or frank pulmonary edema. The cardiomediastinal silhouette is within normal limits. A moderately displaced fracture is noted to the mid shaft of the left clavicle, age indeterminate. Similarly, multiple contiguous posterior left-sided rib fractures are chronic appearing, but age indeterminate given the lack of comparison study.", "output": "Displaced fracture of the mid left clavicle and multiple contiguous posterior left rib fractures. If these or other areas have clinical findings suggesting acute fracture, they should be marked and evaluated with bone detail views." }, { "input": "Assessment is slightly limited by patient rotation. Cardiac silhouette size is normal. Mediastinal and hilar contours are grossly unremarkable. Lung volumes are low with crowding of bronchovascular structures. There is probable mild pulmonary vascular congestion. Patchy bibasilar airspace opacities are noted, with possible trace bilateral pleural effusions. No pneumothorax is detected. No acute osseous abnormality is present. Remote fracture of multiple left sided ribs and the left mid clavicle are re- demonstrated.", "output": "Probable mild pulmonary vascular congestion and possible small bilateral pleural effusions. Patchy bibasilar airspace opacities, nonspecific, and may reflect atelectasis though infection or aspiration cannot be excluded." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. Note is made of compression deformities of the lower thoracic vertebral bodies of indeterminate age and not well evaluated.", "output": "No acute cardiopulmonary process. Compression deformities at the thoracolumbar junction of indeterminate age. Correlate for site of point tenderness. There may also be mild compression deformities along the mid-to-lower thoracic spine, again not well assessed." }, { "input": "The lungs are well inflated and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Single portable view of the chest. No prior. The lungs are clear of focal consolidation. Linear opacity at left lung base suggestive of atelectasis. Nodular opacity projects over the anterior left first rib, potentially within it or in the left lung apex. Lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are grossly unremarkable.", "output": "No acute cardiopulmonary process or cardiomegaly. Nodular opacity projecting over the left lung apex, potentially within the rib or lung. Dedicated two-view chest with apical lordotic view suggested when patient is amenable for further characterization." }, { "input": "The reported abnormality on the prior study appears quite dense, measuring about 8 mm in diameter and continuing to overlie the left anterior first rib. This may reflect a small bone island and less likely an apical lung nodule. There has been apparent previous surgery in the left hemithorax with changes suggestive of left thoracotomy, accompanied by mild volume loss and areas of parenchymal and pleural scarring. Heart size is normal. Aorta is mildly tortuous. Right lung and pleural surfaces are clear.", "output": "Dense left apical nodular opacity is not fully localized or characterized on this study but probably reflects a small bone island or calcified right apical granuloma. As the patient has apparently had prior surgery, there are likely prior outside radiographs that could be procured for comparison. This may be helpful to document retrospective stability and to avoid the need for further imaging such as a CT scan." }, { "input": "The patient is status post median sternotomy and CABG. Heart size is mildly enlarged. The mediastinal and hilar contours are unchanged. Crowding of bronchovascular structures is likely related to low lung volumes. Streaky opacities in the lung bases likely reflect areas of atelectasis. No large pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Bibasilar streaky opacities, likely atelectasis in the setting of low lung volumes. Infection is not completely excluded in the correct clinical setting." }, { "input": "The lungs are well expanded. The right lung is clear. Linear opacity across the left lower lung field likely represents scarring vs atelectasis. There is moderate cardiomegaly and equivocal bulky hila, but the cardiomediastinal and hilar contours are unchanged from prior. There is no pleural effusion or pneumothorax. Sternotomy wires are noted in the midline and there are no other fractures.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute disease." }, { "input": "PA and lateral views of the chest provided. Midline sternotomy wires again noted. There are scattered areas of platelike atelectasis in the mid to lower lungs. Retrocardiac opacity is noted in the left lower lobe which is concerning for an early pneumonia. No large effusion or pneumothorax. The cardiomediastinal silhouette is unchanged. Bony structures are intact.", "output": "Subtle left lower lobe opacity concerning for pneumonia. Lower lung platelike atelectasis." }, { "input": "Cardiomediastinal contours are normal. Lungs and pleural surfaces are clear. No pleural effusion or acute skeletal finding.", "output": "No radiographic evidence of pneumonia." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Scarring within the lung apices appear similar. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is no focal lung consolidation. Thickening of the apical pleural margins is symmetric and not a cause of concern.", "output": "No evidence of pneumonia." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are visualized.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal lateral views of the chest. Heart size and cardiomediastinal contours are normal. The lungs are clear without focal consolidation, pleural effusion, or pneumothorax. Chronic fracture of the posterolateral left ___ rib is unchanged.", "output": "No focal consolidation or pulmonary nodule." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The heart size is normal. The mediastinal and hilar contours are normal. The lungs are clear. There is no pleural effusion or pneumothorax. Osseous structures are unremarkable.", "output": "1. No evidence of hilar or mediastinal lymphadenopathy. 2. The lungs are clear." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "PA and lateral views of the chest. The lungs are clear. There is no pneumothorax. The cardiomediastinal silhouette is normal. No displaced fractures identified.", "output": "No acute cardiopulmonary process. No visualized rib fracture on this nondedicated exam, if desired, a dedicated rib series can be performed." }, { "input": "AP single view of the chest has been obtained with patient in supine position. No preceding chest examination is available for comparison. A right subclavian approach line is seen apparently related to a most recent Port-A-Cath system placement. The line terminates at the level 6 cm below the carina, and related to the demonstrated external cardiac contours, it may have reached the upper portion of the right atrium. The heart does not appear enlarged, and no configurational abnormality is identified. There is no pulmonary vascular congestion, and no pleural effusions that are blunting the lateral pleural sinuses. No pneumothorax in the apical area. Surgical clips in the mid portion of the upper abdomen, indicative of previous surgery, type unknown.", "output": "Tip of Port-A-Cath line reaching in upper portion of right atrium. This is not an unusual finding and appears well tolerated as the Port-A-Cath lines are not very flexible. If the purpose is to terminate in the lower SVC, withdrawal of the line by 3 cm is recommended." }, { "input": "A right-sided subclavian Port-A-Cath is in-situ, the tip is at the cavoatrial junction. The trachea is central. The cardiomediastinal contour is normal. Lung volumes are within normal limits. No a atelectasis, consolidation or pneumothorax seen. The visualized bony structures are unremarkable in appearance.", "output": "No acute cardiopulmonary process seen." }, { "input": "PA and lateral views of the chest provided. Prosthetic cardiac valve projects over the heart. Mediastinal clips are noted. Lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded, clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear the heart and mediastinal structures are unremarkable in appearance. There is severe narrowing of the lower lumbar intervertebral disc which is surrounded by small to moderate-sized marginal osteophytes. There is no significant interval change.", "output": "No active cardiopulmonary disease. Degenerative changes in the lower thoracic spine." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Mild degenerative changes are noted in the lower thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Right internal jugular central venous catheter tip terminates in the lower SVC. No pneumothorax is demonstrated. There is new mild interstitial pulmonary edema. There may be small bilateral pleural effusions. Heart size remains unchanged. Posterior spinal fusion hardware within the thoracic spine is re- demonstrated.", "output": "Right internal jugular central venous catheter tip in the low SVC. No pneumothorax. Mild interstitial pulmonary edema and probable small bilateral pleural effusions." }, { "input": "Portable AP radiograph was provided. Thoracic spine fusion hardware is unchanged in alignment and position without evidence of loosening on this single view. A right PICC terminates at the confluence of the brachiocephalic vein and the SVC. Lung volumes are low. There is bibasilar atelectasis, but no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "1. Right PICC terminates at the confluence of the brachiocephalic and SVC. 2. Low lung volumes with bibasilar atelectasis." }, { "input": "Lung volumes are low. The cardiac silhouette is borderline enlarged. Pulmonary vasculature is unremarkable. There is no definite focal consolidation. No pleural effusion or pneumothorax is identified. Chronic thoracic vertebral height loss and left sided rib fractures are noted.", "output": "No acute intrathoracic abnormality." }, { "input": "Left-sided AICD/pacemaker device is noted with leads terminating in the right atrium and right ventricle. There is moderate enlargement of cardiac silhouette which is unchanged. The mediastinal and hilar contours are stable. There is no pulmonary edema. Linear opacities in the lung bases are compatible with subsegmental atelectasis. No pleural effusion or pneumothorax is seen. A screw is noted projecting over the left scapula.", "output": "Mild bibasilar atelectasis. Moderate cardiomegaly, unchanged, without pulmonary edema." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are hyperexpanded and there is mild flattening of the diaphragms, consistent with known diagnosis of COPD. There is no focal consolidation, pleural effusion or pneumothorax. Tiny dense nodule in the right lung base likely represents a calcified granuloma versus a vessel on end.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No overt pulmonary edema is seen. No displaced fracture seen.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable, as are the hilar contours. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal opacity, pleural effusion or pneumothorax. The heart size is normal. The mediastinal contours are normal. Air beneath the right hemidiaphragm represents colonic interposition better seen on the prior CT chest. No acute osseous abnormality.", "output": "Normal heart size." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion pneumothorax.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are clear with no evidence of consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. No acute fractures are identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are hyperinflated with flattening of the hemidiaphragms. The lungs are clear without focal consolidation, effusion, or edema. Mild cardiomegaly is stable compared to prior. Atherosclerotic calcifications are noted at the aortic arch. Degenerative changes seen at the right shoulder.", "output": "No acute cardiopulmonary process." }, { "input": "There has been interval placement of an endotracheal tube, terminating 6.4 cm above the level of the carina. Enteric tube courses below the level the diaphragm, inferior aspect courses off the inferior edge of the image. The lungs are clear without focal consolidation. No large pleural effusion is seen although a trace right pleural effusion is difficult to exclude. There is no pneumothorax. Cardiac and mediastinal silhouettes are stable.", "output": "Endotracheal tube terminates approximately 6.4 cm above the level of the carina. Enteric tube courses below the diaphragm, inferior aspect not included on the image." }, { "input": "PA and lateral views of the chest provided. Frontal view excludes the right CP angle limiting assessment. There is improved aeration at the right lung base with probable mild residual pleural thickening versus tiny effusion. Otherwise, lungs are clear. No large pneumothorax. No signs of pulmonary edema. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Minimal residual pleural thickening versus tiny effusion at the right lung base. Right CP angle partially excluded." }, { "input": "Patient is rotated slightly to the left. No focal consolidation is seen. There is no pleural effusion or pneumothorax. The aorta is calcified and tortuous. The cardiac silhouette is top-normal.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. There is scarring at the lung apices. There is elevation of the right hemidiaphragm, which may indicate a right hiatal hernia as previously seen. Cardiomediastinal and hilar contours are stable. No definite focal consolidation. No pleural effusion. No pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are slightly hypoinflated with bilateral lower lobe atelectasis. No pleural effusion or pneumothorax. Heart size, mediastinal contour and hila are unremarkable. Calcification of aortic arch is present. Evidence of multiple posterior right healed rib fractures with severe rib cage deformity. Previous right clavicular fracture with intact hardware. No evidence of hardware loosening. Limited assessment of the upper abdomen is within normal limits.", "output": "1. Hypoinflated lungs with bibasilar opacities which favor atelectasis although differential diagnosis includes aspiration and infectious pneumonia. Considering clinical suspicion for infection, followup PA and lateral chest radiographs may be helpful to more fully evaluate the lung bases 3. Multiple posterior healed rib fractures with severe rib cage deformity. Limited evaluation for acute fractures." }, { "input": "Single portable supine frontal chest radiograph demonstrates endotracheal tube 1.9 cm above the level of the carina in appropriate position. Limited evaluation due to patient rotation. The lungs are hypoinflated with bilateral lower lobe atelectasis. Multiple posterior right rib deformities are similar in appearance to previous examination and in the absence of trauma are consistent with healed rib fractures. No pleural effusion or pneumothorax. Heart is incompletely evaluated due to patient positioning. Mediastinal contour and hila are unremarkable. Limited assessment of the upper abdomen is unremarkable.", "output": "1. Endotracheal tube in appropriate position. 2. Chronic right rib deformity from multiple healed rib fractures. 3. Bibasilar atelectasis." }, { "input": "Frontal and lateral views of the chest are compared to previous exam from ___. Low lung volumes are seen. The lungs are clear of consolidation or effusion. The cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Low lung volumes are present. This accentuates the size of the cardiac silhouette which is top normal. The mediastinal contours are unremarkable. There is crowding of the bronchovascular structures. Patchy bibasilar airspace opacities could reflect atelectasis though infection is not excluded. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Low lung volumes limit assessment of the lung bases. Patchy bibasilar airspace opacities could reflect atelectasis but infection cannot be excluded. Consider repeat PA and lateral views with improved inspiratory effort for further assessment." }, { "input": "PA and lateral views of the chest provided. There is mild prominence of interstitial markings, which may represent interstitial pulmonary edema in the appropriate clinical setting. No overt pulmonary edema. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Equivocal prominence of interstitial markings, which may suggest mild interstitial edema in the appropriate clinical setting." }, { "input": "Right chest wall pacing leads and in the right atrium and right ventricle, unchanged. The heart is top-normal in size. Prominence of the left mediastinum is unchanged and may represent pulmonary artery enlargement. The lungs are grossly clear. There is no pneumothorax or pleural effusion.", "output": "No evidence of pneumonia." }, { "input": "Previously seen rounded opacity projecting over the right fifth posterior rib is not identified on current study, likely an external structure has since been removed. Lung volumes are normal. There is no focal consolidation, effusion or pneumothorax. Mediastinal and hilar contours are normal. Heart size normal.", "output": "No acute intrathoracic process. Previously identified rounded opacity projecting over the fifth posterior rib is no longer visualized." }, { "input": "There is a rounded opacity measuring approximately 1.2 cm in the right upper lung, projecting over the fifth posterior rib. Otherwise, the lungs are well expanded and clear. No pleural abnormality is seen. The hilar and mediastinal silhouettes are unremarkable.", "output": "Rounded opacity projecting over the right upper lung, likely due to an external structure on the skin surface. Repeat radiograph with removal of all surface objects is recommended. NOTIFICATION: The recommendations were text paged to ___, M.D. by ___, M.D. on ___ at 8:35 AM, 5 minutes after discovery of the findings." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute disease." }, { "input": "Frontal and lateral views of the chest were obtained. The heart size is normal with normal cardiomediastinal contours. There is residual opacity in the left lower lobe, decreased in size since ___, when it was seen to correspond to a cavitary lesion. There is a persistent vague opacity in the right upper lobe, seen on the previous chest CT, which may represent sequelae of prior infection or persistent inflammation. There is new opacity at the right cardiophrenic angle, which may be atelectasis but could also represent pneumonia in the appropriate clinical setting. The pulmonary vasculature is unremarkable. No pneumothorax or pleural effusion. The osseous structures are normal. There has been interval removal of a PICC. No radiopaque foreign bodies are present.", "output": "1. New right cardiophrenic angle opacity, which may represent pneumonia in the appropriate clinical setting. 2. Persistent right upper lobe and improved left lower lobe opacities." }, { "input": "There is no focal consolidation, effusion, or vascular congestion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process" }, { "input": "Frontal and lateral views of the chest demonstrate heterogeneous opacities in the left mid lung. Similar opacities are also seen in the right lung base. No pleural effusion or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. No pulmonary edema.", "output": "Multifocal pneumonia. Follow-up exam following resolution of the symptoms is recommended." }, { "input": "Lung volumes are somewhat low, which accentuates bronchovascular markings but the lungs appear clear. The cardiomediastinal and hilar contours are within normal limits. There is no focal consolidation, pleural effusion or pneumothorax identified. No osseous abnormalities are identified.", "output": "Low lung volumes. No acute cardiopulmonary abnormality." }, { "input": "In the left mid lung is a 2.9 cm rounded opacity with an air-fluid level concerning for a cavitary lesion. This was no present in the prior exam. The remainder of the lungs are unremarkable. There is no pneumothorax, pleural effusion, or edema. The cardiomediastinal silhouette is normal. No fracture is visualized.", "output": "1. 2.9-cm left-sided cavitary lesion. 2. No displaced rib fracture seen. Results were discussed with Dr. ___ at 11:00 a.m. on ___ via telephone by Dr. ___." }, { "input": "PA and lateral chest radiographs are provided. There is no focal consolidation, pneumothorax or pleural effusion. The lungs are hyperinflated. Cardiomediastinal silhouette is unremarkable. There is no free air under the right hemidiaphragm. There are no concerning osseous lesions.", "output": "No acute cardiopulmonary process." }, { "input": "On frontal view, there is an asymmetric opacification at the right lung base. There is no silhouetting of the right heart border, opacification of the right hemidiaphragm, or opacification seen on lateral view. In view of the clinical setting, a developing pneumonia at the right lung base cannot be excluded especially since this was the area of the previous pneumonia. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "A developing pneumonia at the right lung base cannot be excluded. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ ___ the ___ ___ at 10:34 AM, 5 minutes after discovery of the findings." }, { "input": "PA and lateral views of the chest provided. Airspace consolidation within the right lower lobe is consistent with pneumonia. There is mild left basal atelectasis. Otherwise the lungs are clear. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Right lower lobe pneumonia." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality. Right lower lobe pneumonia has resolved." }, { "input": "Cardiac silhouette size is normal. The mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are seen including no displaced rib fractures.", "output": "No acute cardiopulmonary abnormality. No acute fracture identified. If there is continued concern for rib fracture, consider a dedicated rib series." }, { "input": "Patient has had median sternotomy, probably in childhood given the small diameter of the sternal wires. Right aortic arch can be seen with a variety of congenital cardiac conditions. Misalignment between the second and third sternal wires could be significant an should be evaluated clinically. Low lung volumes exaggerate heart size, probably normal, and account for for the heterogeneity in vascular crowding at the lung bases. There is no good evidence for pneumonia. No effusion or pneumothorax.", "output": "No pneumonia. Possible childhood surgery for congenital heart disease. RECOMMENDATION(S): Examine sternum for any evidence of wound complications." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Minimal tenting of the left hemidiaphragm is noted with minimal streaky left basilar opacity likely reflective of atelectasis. Remainder of the lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral chest radiographs demonstrate a mild airspace abnormality on the lateral view only, without effusion or pneumothorax. A right chest MediPort is in place with its tip seen in the right atrium. Note is made of diffuse osseous metastatic disease, better evaluated on MRI performed same day. The heart size is normal, the mediastinal contours are normal.", "output": "1. Airspace abnormality posteriorly on the lateral view, suspect pneumonia. If desired, this could be confirmed with oblique views. 2. Right chest MediPort with its tip in the right atrium. 3. Osseous metastatic disease. Findings were called to Dr. ___ at 10:30pm on ___." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of normal size with normal cardiomediastinal contours. Small lingular opacity is compatible with atelectasis or an epicardial fat pad, though an infiltrate is not excluded in the appropriate clinical setting. No pleural effusion or pneumothorax. No radiopaque foreign body.", "output": "Small lingular opacity, compatible with atelectasis, although infiltrate is not excluded in the appropriate clinical setting." }, { "input": "There are low lung volumes. The lungs are clear with no evidence of nodule, mass, or consolidation. There is no pneumothorax or pleural effusion. The cardiac silhouette is top-normal in size. Osseous structures are unremarkable.", "output": "Normal chest radiographs with no acute findings." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Mild to moderate degenerative changes are noted in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal silhouette and hilar contours are within normal limits. There is persistence of low lung volumes without acute consolidation. There is no pneumothorax or pulmonary edema. Dextroconvex scoliosis is unchanged.", "output": "1. No acute cardiopulmonary process. 2. There is persistence of hypoinflated lungs, which is unusual in the setting of COPD and may represent an underlying interstitial lung disease. If there is continued clinical concern, a dedicated CT exam could be helpful for further evaluation." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lung fields are clear. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Single frontal view of the chest demonstrates an enteric tube traversing into the stomach. A right-sided dual-channel central venous catheter is in place with tip extending to the lower SVC. Patient is status post right shoulder arthroplasty, unchanged. The cardiomediastinal silhouette is mildly prominent but accentuated by AP technique and low lung volumes. Globular appearance of heart unchanged. There is no pneumothorax. Minimal pulmonary vascular congestion may be present without frank edema.", "output": "No evidence of pneumothorax. Appropriate enteric tube placement." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. There is no pulmonary edema. The heart is normal in size, and the mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "There are relatively low lung volumes and bibasilar atelectasis. Possible trace right pleural effusion is seen. Gaseous distention of bowel and stomach beneath the left hemidiaphragm is re- demonstrated.", "output": "Low lung volumes and mild bibasilar atelectasis. Possible trace right pleural effusion. No focal consolidation or pneumothorax. Re- demonstrated gaseous distension of bowel and stomach beneath the left hemidiaphragm." }, { "input": "The cardiomediastinal silhouette is stable and within normal limits. The hila are unremarkable. The lungs are clear without focal consolidation. There is no pulmonary vascular congestion or pulmonary edema. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary process. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 3:36 PM, 10 minutes after discovery of the findings." }, { "input": "A right PICC terminates at the upper SVC. The heart size remains normal. There is no pneumothorax, focal consolidation, or pleural effusion. Postsurgical changes are again seen at the left apex. Ill-defined left basilar opacity persists.", "output": "Minimal change in appearance of a persistent left basilar opacity. Postsurgical changes in the left apex are stable." }, { "input": "PA and lateral views of the chest provided. Overall, no significant change is seen with severe emphysema again noted. There has been prior resection of the left upper lobe which accounts for the left apical cap and the slight upward retraction of the left hilum. A subtle nodular opacity is seen projecting over the left mid to upper lung which measures approximately 18 mm, and is better characterized on the prior CT chest dated ___. No superimposed pneumonia, effusion or pneumothorax. Cardiomediastinal silhouette is stable. Bony structures are intact.", "output": "Stable appearance of the chest with severe emphysema, left upper lung nodule. No superimposed pneumonia." }, { "input": "A right PICC terminates at the mid SVC. The cardiac and mediastinal contours are unchanged. An ill-defined left basilar opacity is stable since ___, but has gradually become more conspicuous over multiple recent studies. There is no pneumothorax or pleural effusion. Postsurgical changes at the left apex are stable.", "output": "Postsurgical changes at the left apex. Vague opacity at the left base has gradually become more defined, suspicious for underlying consolidation." }, { "input": "No significant change compared to the prior radiograph exam. Stable appearance of the bilateral increased interstitial markings that are more prominent in the lower lungs. The left upper lung nodule is not as clearly demonstrated today due to overlapping of the ribs, but appears unchanged and is better demonstrated on the CT on ___. Stable post-surgical changes consistent with prior left upper lung resection, including left apical pleural scarring, upward retraction of the left hilus, reduced left lung volume, and slight elevation of the left hemidiaphragm. Stable hyperexpansion of the lungs with slight flattening of the diaphragms. No discrete focal consolidation, pleural effusion, or pneumothorax. Stable appearance of the cardiomediastinal silhouette and hila. Stable slightly tortuous descending aorta. No acute osseous abnormality. No sub-diaphragmatic intra-abdominal free air.", "output": "1. No acute cardiopulmonary process, including no focal consolidation to suggest pneumonia. 2. Stable chronic lung changes and post-surgical changes as above." }, { "input": "Left apical pleural cap and multiple chain sutures are noted, unchanged from the prior examination. Bibasilar airspace opacities are stable and likely represent scarring versus fibrotic changes. No new airspace opacities are identified. There is no pneumothorax or overt pulmonary edema. The cardiomediastinal silhouette is stable.", "output": "No acute cardiopulmonary process." }, { "input": "The endotracheal tube terminates 3.7 cm above the carina. An enteric tube and Dobbhoff tube tip course along the esophagus and terminates out of field of view, likely within the stomach. A right subclavian catheter and left supraclavicular catheter both terminate in the mid superior vena cava. There is unchanged mild pulmonary edema with persistent collapse of the left lower lobe. Small bilateral pleural effusions are unchanged. The cardiac silhouette remains mildly enlarged.", "output": "Satisfactory Dobbhoff position." }, { "input": "Dobbhoff tube is present and mild minimally coiled within the stomach, terminating in the gastric fundus. An endotracheal tube terminates 3.4 cm above the carina. A right and left central line are unchanged within the mid to distal superior vena cava. There is persistent left lower lobe collapse. A presumed small left pleural effusion is unchanged. The cardiac silhouette is mildly enlarged and the mediastinal contours are unchanged. Dense mitral annular calcifications are appreciated. There is a paucity of air within the imaged upper abdomen. There is no free air on this semi erect study.", "output": "Unchanged Dobbhoff tube position." }, { "input": "Enteric tube is present and courses along the esophagus, terminating a out of the field of view. A intra-aortic balloon pump is noted and is unchanged in position, terminating at the origin of the descending aorta. The endotracheal tube is in 5.8 cm above the carina. There is collapse of the left lower lobe. Mild pulmonary edema persists with improved aeration of the lung bases. There are unchanged small bilateral pleural effusions. There is no pneumothorax. The cardiac silhouette and mediastinal contours are unchanged.", "output": "Unchanged pulmonary edema and persistent small bilateral pleural effusions." }, { "input": "The heart is enlarged, not significantly changed from prior examination. Sternotomy wires and mitral valve replacement is noted. Persistent retrocardiac opacity likely relates to a moderate pleural effusion with overlying atelectasis. However, an underlying infectious process cannot be excluded. The right lung is essentially clear. No large pleural effusion on the right or pneumothorax identified.", "output": "Persistent retrocardiac opacity, likely relates to moderate pleural effusion and overlying atelectasis, however an underlying infectious process cannot be excluded." }, { "input": "A single upright frontal chest radiograph was obtained. A left-sided chest tube has been removed. There is a miniscule residual left apical pneumothorax. Retrocardiac opacity is compatible with residual atelectasis. The positions of an endotracheal tube, enteric catheter, and Swan-Ganz catheter are unchanged. There is no pulmonary consolidation, effusion, or pneumothorax. Central pulmonary vascular congestion is mild.", "output": "Miniscule left apical pneumothorax status post chest tube removal." }, { "input": "The endotracheal tube ends 3.2 cm above the carina. A left internal jugular catheter and a right supraclavicular catheter terminate in the upper superior vena cava. Bilateral small pleural effusions are slightly improved. There is persistent mild pulmonary edema which is markedly improved from ___. Persistent left lower lobe collapse is unchanged from ___. There is no pneumothorax.", "output": "Unchanged left lower lobe collapse with continued improvement in mild pulmonary edema." }, { "input": "Endotracheal tube approaches the right mainstem bronchus. NG tube terminates within the stomach. Heart size and cardiomediastinal contours are normal. Lungs are clear other than minimal right base atelectasis without focal consolidation, pleural effusion, or pneumothorax.", "output": "Endotracheal tube approaches the right mainstem bronchus and should be withdrawn. NOTIFICATION: The findings were discussed via telephone by Dr. ___ with Dr. ___ on ___ at 7:36 AM, 1 minutes after discovery of the findings." }, { "input": "PA and lateral views of the chest provided. There is borderline hyperexpansion of the lungs. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No pneumothorax." }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Lateral left lower lung opacity seen on the frontal view, not substantiated on the lateral view, may be due to atelectasis, less likely infection. The lungs are hyperinflated. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal. The aorta is calcified and tortuous. No pulmonary edema is seen. There is levo thoracic scoliosis.", "output": "Lateral left lower lung opacity on the frontal view, not substantiated on the lateral view, may be due to atelectasis, less likely infection." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. The mediastinum is not widened.", "output": "No acute cardiopulmonary process. The mediastinum is not widened." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged including mild cardiomegaly with a left ventricular configuration to the heart. There is slight blunting of the right costophrenic angle which may reflect a subpulmonic effusion. There is a new mild interstitial opacity suggesting pulmonary edema in addition to a vague but focal lateral right apical opacity, the latter unchanged.", "output": "1. Findings suggesting mild vascular congestion. 2. Focal but vague opacity in the right upper lung, which persists. When clinically feasible assessment with standard PA and lateral radiographs may be helpful. This appearance may be a focal form of edema, scarring but potentially pneumonia." }, { "input": "Cardiac silhouette is top normal in size. Mediastinal contour is normal. The lungs are grossly clear. There is minimal scarring at the left lung base. There is no evidence of pulmonary edema. There is no pneumothorax. Median sternotomy wires and mitral valve replacement are noted. There is a moderate hiatal hernia.", "output": "No evidence of pulmonary edema." }, { "input": "PA and lateral views of the chest provided. Midline sternotomy wires, prosthetic cardiac valve and mediastinal clips are again noted. A retrocardiac opacity is compatible with known hiatal hernia. Faint linear density in the left lower lung is likely atelectasis. No focal consolidation, large effusion or pneumothorax is seen. Cardiomediastinal silhouette appears normal. Bony structures are intact.", "output": "Hiatal hernia, otherwise unremarkable." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "Unremarkable chest radiographic examination." }, { "input": "Single portable view of the chest was compared to previous exam from ___. Given differences in positioning and technique compared to prior, there has been no significant interval change. There is no evidence of confluent consolidation or pulmonary vascular congestion. There is no large pleural effusion. Cardiac silhouette is stable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were obtained demonstrating no focal consolidation, effusion, pneumothorax. No definite signs of CHF. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "All the monitoring devices are unchanged. Lung volume is still low. There is a slight increase of vascular congestion, in particular in the right lung, with left base atelectasis. Heart size is still enlarged. There is no pleural effusion.", "output": "Mild increase of vascular congestion with small left base atelectasis. Unchanged all the monitoring devices." }, { "input": "All the monitoring device are unchanged and in standard position Lung volume is still low, with increased bibasilar pleural effusion and atelectasis, especially on the left base. Heart size is still enlarged.", "output": "Increased bibasilar pleural effusion with increased atelectasis at the left base" }, { "input": "All the monitoring and support devices are unchanged and in standard position. Since prior chest x-ray, there are scattered hazy opacities at the lung bases with persistent small bilateral pleural effusion, more conspicuous on the left base. If clinically correlated a new CXR can be repeated in the afternoon. Heart size is still mildly enlarged. There is no pneumothorax.", "output": "New scattered bibasilar opacities with persistent bilateral pleural effusion, could be early infection. If clinically correlated a new CXR can be repeated in the afternoon. Unchanged all the monitoring device. Findings were reported to Dr ___ by Dr ___ at 12.___" }, { "input": "ET tube ends at 7 cm from carina bifurcation and can be pulled down ___ centimeters. Right axillary pacemaker has two leads that follow a standard course ending in right atrium and right ventricle. Right IJ catheter and NG tube are unchanged and in standard position. Lung volumes are reduced, especially right base for new atelectasis and pleural effusion. Unchanged left base atelectasis. There is no sign of pulmonary edema.", "output": "New right base atelectasis with likely pleural effusion. Unchanged left base atelectasis." }, { "input": "AP portable upright chest radiograph was obtained. Low lung volumes and slightly underpenetrated technique somewhat limits the evaluation. Allowing for this, there is no definite sign of pneumonia or overt CHF. Cardiomediastinal silhouette is stable. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Limited, negative." }, { "input": "All the monitoring and support devices are in constant and standard position including the tracheostomy tube and right internal jugular vein catheter that ends in lower SVC. Constant position also of the left pectoral pacemaker and its wires that following the standard course. There are no major interval changes since prior chest x-ray except for improved lung ventilation at the bases, especially on the left. Persists right lower lobe atelectasis and minimal improvement of the mild vascular congestion, Heart size is mildly enlarged. No pneumothorax.", "output": "Improved ventilation of the left lung bases with minimal improvement of the vascular congestion. Unchanged right base atelectasis." }, { "input": "Compared with the prior studies, lung volumes are lower, causing bronchovascular crowding. However, there is no new focal consolidation, pleural effusion, or pneumothorax. A dense right lung opacity on lateral view corresponds with a calcified granuloma, as seen on lateral view, unchanged since the recent chest CT. Calcified hilar nodes are also unchanged.", "output": "No focal consolidation concerning for pneumonia. Low lung volumes." }, { "input": "AP and lateral chest or CT demonstrate interval removal of a left PICC. Lung volumes are low with no focal consolidation identified. Cardiomediastinal and hilar contours are within normal limits. Pulmonary vasculature appears normal. There is no pleural effusion or pneumothorax. There is no air under the right hemidiaphragm.", "output": "Low lung volumes without a focal consolidation convincing for pneumonia." }, { "input": "On the lateral view, there is a calcified nodular opacity measuring approximately 9 mm projecting over the anterior mid lung. Findings may represent a calcified granuloma however, is not optimally characterized. Given history of frontal tumor, follow-up chest CT suggested.No focal consolidation is seen. No pleural effusion or pneumothorax is seen. Cardiac silhouette is top-normal. Mediastinal contours are unremarkable. No pulmonary edema is seen.", "output": "9 mm calcified appearing nodule projecting over the anterior mid lung best seen on the lateral view. Finding may represent a calcified granuloma, however, given history of frontal tumor, follow-up chest CT suggested." }, { "input": "Low bilateral lung volumes. No focal consolidation, pleural effusion or pneumothorax identified. The size the cardiac silhouette is enlarged but unchanged.", "output": "Low bilateral lung volumes. No radiographic evidence of acute cardiopulmonary disease." }, { "input": "Lung volumes are low, resulting in bronchovascular crowding. The cardiac silhouette is unchanged with mils cardiomegaly. No pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "AP portable upright view of the chest. Bilateral pleural effusions are small. There is bibasilar opacity which is concerning for atelectasis though difficult to exclude aspiration or pneumonia. There is hilar engorgement with mild pulmonary edema. Heart size cannot be assessed. Mediastinal contour appears stable. Bony structures are intact.", "output": "Findings consistent with decompensated congestive heart failure, with small bilateral effusions. Difficult to exclude a superimposed pneumonia at the lung bases." }, { "input": "Moderate Cardiomegaly is a stable. Pulmonary edema has almost completely resolved. Small bilateral effusions larger on the left side have decreased in size. Marked improved aeration of lower lobes. There is no pneumothorax. Biapical asymmetric right greater than left pleuro parenchymal scarring is noted", "output": "Improved pulmonary edema and pleural effusions" }, { "input": "PA and lateral chest radiograph demonstrates stable cardiomediastinal and hilar contours. Heart is top-normal in size. There is no pleural effusion or pneumothorax. There is mild vascular congestion. No overt pulmonary edema is seen. Visualized osseous structures are without acute abnormality.", "output": "Mild vascular congestion without overt pulmonary edema. Heart is top-normal in size." }, { "input": "Heart size is mild to moderately enlarged. The aorta is tortuous and demonstrates atherosclerotic calcifications. Mild leftward deviation of the superior trachea is present, with right-sided superior mediastinal fullness, possibly attributable to an enlarged thyroid. There is mild pulmonary vascular congestion. No pleural effusion or pneumothorax is seen. Mild retrocardiac opacity could reflect atelectasis. Degenerative changes of the acromioclavicular joints are noted.", "output": "Mild pulmonary vascular congestion with retrocardiac atelectasis. Leftward deviation of the superior trachea with fullness of the right superior mediastinum could suggest the presence of enlarged right thyroid gland. Clinical correlation is recommended." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unchanged, with calcification of the aortic knob again noted. Pulmonary vasculature is normal. Lungs remain hyperexpanded. No focal consolidation, pleural effusion or pneumothorax is seen. There are multilevel degenerative changes in the spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral chest radiographs demonstrate well expanded and clear lungs. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "Normal chest radiograph. No findings to explain fevers and low oxygen saturation,." }, { "input": "PA and lateral views of the chest were provided. Suture material is again noted in the left lung apex. There is no focal consolidation, effusion, or pneumothorax on today's exam. Cardiomediastinal silhouette appears stable and normal. Bony structures intact.", "output": "No pneumothorax or other acute findings in the chest." }, { "input": "The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. Two punctate sclerotic foci in the right hemithorax are likely calcified granulomas. A right Port-A-Cath is in unchanged position with the tip in the upper SVC.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs demonstrate placement of a right-sided Port-A-Cath with its terminal end in the upper superior vena cava. There is no pneumothorax. The lungs bilaterally are grossly clear. There are 2 calcifications, the inferior of which projects over the 10th rib posteriorly and the second just superior. The cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion.", "output": "New right-sided Port-A-Cath with its terminal end in the upper superior vena cava. No pneumothorax. These findings were communicated to ___ per request by Dr. ___ ___ telephone." }, { "input": "There is mild vascular crowding, particularly at the right lung base. There is no focal consolidation or pleural effusion. The heart and mediastinum are within normal limits. There is no pneumothorax. Old healed left rib fractures are identified. There is no evidence of an acute rib fracture. No soft tissue abnormality is identified.", "output": "Grossly clear lungs. Etiology of right chest wall pain not elucidated." }, { "input": "The lungs are clear. Cardiac silhouette is normal in size. There is no pleural effusion or pneumothorax. There is no free air.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "New mediastinal venous engorgement and mild pulmonary edema is seen. Stable mild cardiomegaly. Mild aortic atherosclerotic calcifications are seen. The lung volumes are low, with left basal atelectasis. No large pleural effusion or pneumothorax is seen.", "output": "1. Mild pulmonary edema. 2. Low lung volumes, with left basal atelectasis." }, { "input": "AP and lateral views of the chest. Relatively low lung volumes are again seen. The lungs are clear of focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. Left shoulder arthroplasty changes are partially visualized. Dense atherosclerotic calcifications seen in the thoracic aorta.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is mildly enlarged. The aorta is tortuous and diffusely calcified. The mediastinal and hilar contours are otherwise unremarkable. The pulmonary vasculature is not engorged. Minimal linear opacities in the left lung base are compatible with subsegmental atelectasis. No focal consolidation, pleural effusion or pneumothorax is identified. Partially imaged left humeral head prosthesis as well as posterior spinal fusion hardware within the lumbar spine is re-demonsrated. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size and cardiomediastinal contours are normal. Lung volumes are low and there is bibasilar opacities most compatible with atelectasis, but no focal consolidation, pleural effusion, or pneumothorax.", "output": "Low lung volumes with bibasilar opacities most compatible with atelectasis." }, { "input": "Prominence can indistinctness of the hila and perihilar regions suggests pulmonary vascular engorgement and mild to moderate pulmonary edema. There are small bilateral pleural effusions. Cardiac silhouette remains similarly enlarged. A left-sided PICC terminates in the mid SVC without evidence of pneumothorax. Mediastinal contours are stable.", "output": "Mild to moderate pulmonary edema, small bilateral pleural effusions, and persistent enlargement of the cardiac silhouette." }, { "input": "AP portable supine view of the chest. There is interval placement of a right IJ central venous catheter with its tip in the low SVC. There is again noted to the complete whiteout of the left lung with shift of mediastinal structures slightly to the right. Scattered areas of calcified pleural plaque account for scattered opacities projecting over the right hemi thorax. Areas of known malignancy are poorly visualized.", "output": "1. Appropriately placed right IJ central venous catheter. 2. Complete whiteout of the left lung with persistent shift of midline structures to the right." }, { "input": "AP portable semi upright view of the chest. The relative increase in left mid - upper lung ground-glass opacity likely reflects layering pleural fluid. The volume of left pleural effusion appears increased since the PET-CT. Left basal consolidation may also be increased and could reflect increasing atelectasis versus pneumonia. Right lung grossly clear and known pulmonary nodules cannot be clearly visualized. No definite signs of superimposed pneumonia on the right. No convincing signs of edema.", "output": "As above." }, { "input": "ET tube terminates 4 cm above the carina. There is left pleural drain. Transesophageal tube courses below the diaphragm and out of view. Right internal jugular venous line terminates in low SVC. There is persistent left hemithorax opacification with contralateral mediastinal shift, unchanged from 1 hr prior. Several calcifications in the right lung are likely calcified pleural plaque is as seen on prior CT. There is pneumoperitoneum, which may be increased compared to prior chest CT.", "output": "1. Persistent left hemithorax opacification with contralateral mediastinal shift. 2. Pneumoperitoneum may be increased compared to prior chest CT. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 12:33 PM." }, { "input": "The thoracic aorta is tortuous, with aortic arch calcifications noted. Otherwise, the cardiomediastinal contours are within normal limits. The bilateral hila are unremarkable. An 8 mm opacity projecting over the left lower lung is likely a nipple shadow. Otherwise, the lungs are hyperinflated but clear without focal consolidation. There is no evidence of pulmonary vascular congestion or pulmonary edema. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary process. Hyperinflated lungs." }, { "input": "The lungs are clear with no evidence of consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. No acute fractures are identified.", "output": "Normal chest radiograph." }, { "input": "Left-sided pacemaker device is noted with leads terminating in the right atrium and right ventricle, unchanged. Moderate to severe cardiomegaly is re- demonstrated. The mediastinal contours are unchanged with tortuosity of the thoracic aorta again noted. Hilar contours are stable, and there is no pulmonary edema demonstrated. Vague focal opacity is seen within the right upper to mid lung field, which is nonspecific, but not clearly demonstrated on the previous exam. No focal consolidation, pleural effusion or pneumothorax is otherwise demonstrated.", "output": "No evidence of congestive heart failure. Vague focal opacity projecting over the right upper to mid lung field, which is nonspecific. This could potentially reflect an inflammatory or infectious focus, but follow up radiographs are recommended to assess for resolution of this finding." }, { "input": "There has been interval placement of a pacer unit over the left chest with leads terminating in the expected areas of the right atrium and the right ventricle. There is no pneumothorax. The heart size continues to be enlarged. The mediastinal contours demonstrate a tortuous aorta and prominent pulmonary arterial hump. The lungs are clear of consolidation. There is no pleural effusion.", "output": "Status post pacer units placement with leads as described above, and stable cardiomegaly." }, { "input": "Frontal and lateral chest radiographs were obtained. No focal consolidation, pleural effusion, or pneumothorax is seen. The heart is moderately enlarged but stable. Hilar contours are enlarged, possibly secondary to underlying pulmonary hypertension, but there is no pulmonary edema. A left chest pacemaker has leads in the appropriate positions in the right atrium and right ventricle.", "output": "Stable moderate cardiomegaly without pulmonary edema. No focal consolidations or pleural effusions." }, { "input": "Left-sided dual-chamber pacemaker device is noted with leads terminating in unchanged positions, within the right atrium and right ventricle. Moderate enlargement of cardiac silhouette persists. The mediastinal and hilar contours are stable. There is no pulmonary edema noted. Minimal retrocardiac opacity likely reflects atelectasis. No pleural effusion or pneumothorax is identified. No acute osseous abnormality seen.", "output": "Minimal retrocardiac opacity likely reflecting atelectasis." }, { "input": "The heart is moderately enlarged. The main pulmonary artery contour is markedly enlarged, which raises concern for underlying pulmonary hypertension. Vascular calcifications are noted along the aortic arch. Aside from a similar streaky atelectasis at the left lung base, the lungs appear clear. There is no evidence for congestive heart failure. There are no pleural effusions or pneumothorax. Mild spinal degenerative changes are similar.", "output": "No evidence of acute disease or significant change. Enlargement of the main pulmonary artery, worrisome for pulmonary arterial hypertension." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Loculated posterior right apical pleural fluid is seen now with likely associated air-fluid level, which may relate to recent drainage. There is persistent blunting of the right costophrenic angle overlying atelectasis there may be a trace right pleural effusion. The left lung is clear. Cardiac and mediastinal silhouettes are stable. There has been interval removal of a right-sided PICC.", "output": "Persistent posterior right apical loculated pleural fluid of with probable air-fluid level, air-fluid level more conspicuous as compared to the prior study, fluid component appear similar. Chest CT would provide further assessment." }, { "input": "Right apical opacity is compatible with known lung abscess, as seen on reference CT Chest from ___. Diffuse hazy opacities in the remainder of the right lung, new since ___, are due to a pleural effusion of indeterminate size. The heart size is not enlarged. The left lung appears clear. No pneumothorax.", "output": "1. Right apical lung abscess, better assessed on recent reference CT Chest from ___. 2. Indeterminate sized new right pleural effusion since ___." }, { "input": "There are 2 right chest tubes with tips oriented superiorly in the apex, similar to prior. There is mild right pulmonary vascular congestion and mild right interstitial edema. There is a small right pleural effusion. There is no focal consolidation or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Left PICC tip is in the lower SVC, similar to prior.", "output": "Chest tubes appear in similar position compared to prior. Overall no significant change since prior." }, { "input": "PA and lateral chest radiograph demonstrates opacity which is subtle at the right lung base medially, new since prior examination. Remaining lungs appear clear. There is been interval removal of a right PICC. There is no pneumothorax or pleural effusion. Cardiomediastinal and hilar contours are within normal limits. There is no evidence of pulmonary edema. There is no air under the right hemidiaphragm.", "output": "A vague opacity in the right lung base is new since prior study, nonspecific and potentially atelectasis, in the appropriate clinical setting may represent early infectious process." }, { "input": "The lungs are well expanded and clear. Emphysematous changes are noted. Bilateral pleural effusions are seen. The cardiomediastinal silhouette is slightly increased in size.", "output": "No acute cardiopulmonary process." }, { "input": "Previously seen layering right pleural effusion has increased, now moderate to large. With adjacent consolidation. The cardiomediastinal silhouette is enlarged, unchanged from the prior study. The aorta is tortuous and heavily calcified. Mild pulmonary vascular congestion is similar to the prior study, mild asymmetric pulmonary edema, worse on the right, is new. There is no pneumothorax or displaced fracture.", "output": "1. Interval increase in layering right pleural effusion, now moderate to large with adjacent consolidation concerning for pneumonia. 2. New mild pulmonary edema. NOTIFICATION: Revised impression No 1 was dicussed by Dr. ___ with Dr. ___ at 5:10PM" }, { "input": "Moderate cardiomegaly with unfolding of the thoracic aorta is unchanged. Mild central pulmonary vascular prominence. Right lower lobe pneumonia with adjacent small effusion. Small left effusion is also present. No pneumothorax. Old right humeral fracture again noted.", "output": "Right lower lobe pneumonia with small bilateral effusions." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Frontal and lateral views of the chest. There are bibasilar opacities identified. Superiorly the lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities detected.", "output": "Bibasilar opacities which may represent atelectasis noting that infection is not entirely excluded. Please correlate clinically." }, { "input": "Compared with prior radiographs on ___, there is increased vascular engorgement and early pulmonary edema. There is no large pleural effusion. Lung volumes are low, with right lower lobe atelectasis, similar to prior. There is no new focal consolidation or pneumothorax. Cardiomediastinal silhouette is similar to prior. A right IJ catheter terminates in the low SVC.", "output": "Increased vascular engorgement and early pulmonary edema. No large pleural effusion. No pneumonia." }, { "input": "Mild hyper expansion. The lungs are clear of airspace or interstitial opacity. Slight asymmetric indentation of the right lower trachea unchanged is ___, can be related to thyroid enlargement. The cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax. No acute or aggressive osseus changes.", "output": "No acute radiographic intrathoracic pulmonary disease." }, { "input": "2 AP chest x-ray shows excessive placement of a double off tube with the initial showing the tip at the gastroesophageal junction and the final x-ray showing the tip within the body of the stomach approximately 14 cm beyond the GE junction. The lungs are unchanged in appearance with mild right basilar atelectasis and possibly a small right pleural effusion. Heart size and mediastinal contour are unchanged given the slightly lower lung volumes. Right upper quadrant pigtail biliary catheters are incompletely visualized.", "output": "Successful placement of Dobhoff tube with tip in the stomach." }, { "input": "The Dobbhoff tube has its tip approximately 3.4 cm beyond the GE junction. The lungs are normally expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette and hilar contours are normal. Surgical drains project in the right upper quadrant.", "output": "Dobbhoff tube with tip 3.4 cm beyond the GE junction. Consider advancing approximately 10 cm to place all components in the stomach." }, { "input": "The heart size is normal. The hilar and mediastinal contours are unremarkable. The lungs are slightly hyperinflated, however appear to be clear. There is no evidence of pneumothorax or pleural effusions. The visualized osseous structures are unremarkable.", "output": "No acute cardiopulmonary process. Specifically, no evidence of an infiltrate suggestive of pneumonia." }, { "input": "In comparison with the study of ___, it is difficult to visualize the tip of the nasogastric tube, however it is seen on the abdominal series to be post pylorus. No pneumothorax.", "output": "In comparison with the study of ___, it is difficult to visualize the tip of the nasogastric tube, however it is seen on the abdominal series to be post pylorus. No pneumothorax." }, { "input": "The lungs are clear without overt edema, consolidation or effusion. Cardiomediastinal silhouette is stable noting that the cardiac silhouette is mildly enlarged likely due to prominent epicardial fat as seen on prior CT. No acute osseous abnormalities, posterior spinal fixation hardware is identified. Prominent loops of bowel noted in the abdomen which are incompletely evaluated. There is no free intraperitoneal air.", "output": "Possible interstitial edema without consolidation.Prominent loops of bowel noted in the abdomen which are incompletely evaluated. There is no free intraperitoneal air." }, { "input": "No pneumonia. Normal cardiomediastinal silhouette. No pulmonary edema. No pleural effusion. No pneumothorax.", "output": "Normal chest radiograph." }, { "input": "The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. Mild linear opacity at the right lung base likely represents scarring versus atelectasis. No displaced rib fracture is identified.", "output": "No focal consolidation concerning for pneumonia. No displaced rib fracture." }, { "input": "There is a left-sided pacemaker with two leads terminating in appropriate position at the right atrium and ventricle. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The heart size is top normal. Degenerative changes are noted in the thoracic spine, and lumbar posterior fusion hardware is partially visualized.", "output": "Pacemaker with leads in appropriate position. Posterior lumbar fusion hardware." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear. There is again mild relative elevation of the right hemidiaphragm.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "There is a small left pleural effusion, best identified on the lateral view. No right effusion is identified. There is no consolidation, pulmonary edema, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Small unilateral left pleural effusion." }, { "input": "The lungs are clear of opacities concerning for infection. There is a small left-sided pleural effusion. There is no pulmonary edema. Cardiac size is normal.", "output": "Small left pleural effusion." }, { "input": "Heart size is mildly enlarged. The aorta remains tortuous. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. The osseous structures are diffusely demineralized with multilevel degenerative changes.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is normal. The aorta remains markedly tortuous. Mediastinal and hilar contours are otherwise unremarkable. The pulmonary vasculature is normal and the lungs are clear. No focal consolidation, pleural effusion or pneumothorax is seen. There are mild degenerative changes in the thoracic spine. Radiopaque object is seen projecting over the medial aspect of the right breast on the frontal view, and appears external to the patient.", "output": "No acute cardiopulmonary process." }, { "input": "Marked tortuosity of the thoracic aorta appears unchanged. The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Compared to the prior radiograph, lung volumes are lower, causing bronchovascular crowding. There is left basilar atelectasis. Heart is mildly enlarged, unchanged. There is no new focal consolidation, pleural effusion, or pneumothorax.", "output": "No acute intrathoracic process." }, { "input": "A pacemaker defibrillator with right atrial and biventricular leads is again noted in unchanged position. A right internal jugular approach dialysis catheter present with tip in the right atrium. An aortic valve replacement is also noted. The patient is status post CABG. There is moderate cardiomegaly. The mediastinal and hilar contours are stable with aortic calcifications There is no pleural effusion or pneumothorax. The lungs are well-expanded with increased interstitial markings, consistent with mild edema. There is no focal consolidation concerning for pneumonia.", "output": "Moderate cardiomegaly with mild edema. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 8:01 AM." }, { "input": "No consolidation, pleural effusion or pulmonary edema is seen, and the cardiac silhouette continues to be mildly enlarged. Right-sided cardiac device is stable in position with appropriate lead placement unchanged. Median sternotomy wires are intact.", "output": "Resolution of previously seen pneumonia." }, { "input": "There is no significant interval change since the prior radiograph performed yesterday evening. A biventricular pacer defibrillator is visualized. The hemodialysis catheter is unchanged in position and terminates in the right atrium. There is persistent mild pulmonary vascular congestion accompanied by interstitial pulmonary edema. No new areas of focal consolidation are identified. Left lung base opacity is probably due to a combination of a small pleural effusion and adjacent atelectasis. A small right pleural effusion is also noted. Stable cardiomegaly.", "output": "1. Stable pulmonary vascular congestion and interstitial edema. 2. Left lung base opacity is probably due to a combination of small left pleural effusion and adjacent atelectasis." }, { "input": "PA and lateral views of the chest. Diffuse interstitial opacities have not significantly changed from prior. Posterior costophrenic angles are sharp. Thickening along 1 of the major fissures may represent fluid or pleural thickening. Cardiac silhouette is enlarged but stable in configuration. Right chest wall dual lead pacing device is again seen. There is a new right chest wall tunneled dual lumen catheter with distal tip in the right atrium. There is no new confluent consolidation. No acute osseous abnormality detected.", "output": "No significant interval change since prior. Diffusely increased interstitial markings compatible with interstitial edema versus chronic changes. No superimposed acute process." }, { "input": "Compared to the most recent prior study of ___, the appearance of the chest is unchanged. The patient is status post median sternotomy with multiple mediastinal surgical clips compatible with prior CABG. A mitral valve prosthesis is unchanged in position or appearance. The cardiac silhouette is mildly enlarged but stable. The mediastinal contours are within normal limits and stable with minimal calcification of the aortic knob. Mild pulmonary vascular congestion is unchanged. No significant pleural effusion is present. On the lateral radiograph, there is opacification along the fissure of the left lung corresponding to left basilar opacification on the frontal radiograph. This finding is unchanged from the prior study and may represent partial lobar collapse or fluid trapped within the fissure. No pneumothorax is detected.", "output": "Persistent mild edema and left lower lobe atelectasis vs fluid in the fissure. Unchanged from ___. Bronchial obstruction cannot be excluded." }, { "input": "There continues to be moderate cardiomegaly and volume loss at both bases. There is a small left effusion. There is no focal infiltrate. Pacemaker and mitral valve replacement and sternotomy wires are unchanged", "output": "No significant change." }, { "input": "There is a biventricular pacer/ICD with leads terminating in the coronary sinus and right ventricle. The right atrial lead takes an unusual course, directed posteriorly. While this appears unchanged from the prior study on the frontal view, an aberrant location should be considered. There is no evidence of lead fracture or displacement. Aortic valve prosthesis is again noted. Sternotomy wires and mediastinal clips are present. Moderate cardiomegaly is unchanged. There has been further improvement in the mild pulmonary edema. Further aeration of the left lung base is consistent with resolving atelectasis and pleural effusions. There is no pneumothorax.", "output": "Lead intended for the right atrium is directed unusually posteriorly. While this lead is likely in the right atrium, correlation with electrophysiology measurements would be helpful. These findings were discussed with Dr. ___ by Dr. ___ at 10:50 AM on ___ by telephone ___ minutes after discovery." }, { "input": "PA and lateral chest radiographs were obtained. Aeration of the lungs has improved since the last exam. Retrocardiac opacity in the left lower lobe is persistent. Severe cardiomegaly has not changed. The positions of biventricular pacing leads are stable.", "output": "Stable appearance of severe cardiomegaly and non-specific retrocardiac opacity which could represent atelectasis or infection." }, { "input": "Sternal wires, valve prosthesis, cardiac device, and mild cardiomegaly are unchanged. There is new left lower lobe infiltrate and small left effusion. There is also a small right effusion.", "output": "New left lower lobe infiltrate and effusion." }, { "input": "Left-sided pacer device is stable in position. Left-sided central venous catheter is also stable in position. Enlarged cardiomediastinal silhouette is again seen. Patient is status post median sternotomy and cardiac valve replacement. There is mild pulmonary vascular congestion/interstitial edema and a small left pleural effusion. Trace right pleural effusion is difficult to exclude. Evidence of old left-sided rib fractures is seen.", "output": "Left-sided pacer device is stable in position. Left-sided central venous catheter is also stable in position. Enlarged cardiomediastinal silhouette is again seen. Patient is status post median sternotomy and cardiac valve replacement. There is mild pulmonary vascular congestion/interstitial edema and a small left pleural effusion. Trace right pleural effusion is difficult to exclude. Evidence of old left-sided rib fractures is seen." }, { "input": "PA and lateral views of the chest. Triple lead pacing device along the right chest wall is again noted with leads in unchanged position. Mitral valvular replacement again noted. Prominence of the interstitial markings are again seen without evidence of focal consolidation or overt pulmonary edema. There is no large pleural effusion noting persistent probable fluid within the major fissure on the lateral. Degree of cardiomegaly has not changed. No acute osseous abnormalities detected.", "output": "Findings is compatible with mild interstitial edema." }, { "input": "The patient is status post median sternotomy, CABG, and mitral valve replacement. The heart is mildly enlarged. The mediastinal contours are unchanged with calcification of the aortic knob again noted. Mild pulmonary edema appears progressed compared to the prior exam with small bilateral pleural effusions, also minimally increased compared to the prior exam. Left basilar opacification likely reflects atelectasis. There is no pneumothorax. No acute osseous abnormalities are identified.", "output": "Slight interval worsening of mild pulmonary edema with small bilateral pleural effusions. Left basilar opacity likely reflects atelectasis." }, { "input": "Right chest wall triple lead pacing device is again seen as well as a dual lumen right-sided central venous catheter. Prosthetic mitral valve is noted. Degree of cardiomegaly is unchanged. Persistent mild pulmonary edema is again noted. Retrocardiac opacity may be accentuated by portable technique, grossly unchanged from prior. There is no large effusion. Old healed left lateral rib fractures identified.", "output": "Persistent mild pulmonary edema. More confluent retrocardiac opacity potentially due to atelectasis accentuated by portable technique. Consider PA and lateral if patient is amenable to further characterize." }, { "input": "Moderate cardiomegaly is unchanged. Pacer leads are in stable position. Hemodialysis catheter terminates in the right atrium, unchanged. The lungs are essentially clear, and the right lung base is partially obscured by the overlying pacemaker generator. Prosthetic valves and sternal wires are unchanged. Blunting of left costophrenic angle likely indicates a small pleural effusion.", "output": "1. Stable moderate cardiomegaly and a likely small left pleural effusion. 2. Hemodialysis catheter terminating in the right atrium." }, { "input": "There has been previous median sternotomy and mitral valve replacement. A right internal jugular dialysis catheter continues to terminate in the right atrium, and biventricular pacer/ICD leads are unchanged in position as well. Stable cardiomegaly accompanied by worsening interstitial edema. Additionally, a more confluent area of opacity is present in the left lower lobe, partially obscuring the left hemidiaphragm. This is concerning for developing pneumonia. Small pleural effusions are present bilaterally.", "output": "1. Left lower lobe consolidation suspicious for pneumonia. 2. Worsening interstitial edema and small pleural effusions." }, { "input": "The heart is mildly enlarged. The mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. Streaky opacity along the lateral right upper lobe appears unchanged and suggests chronic scarring.", "output": "Mild cardiomegaly. No evidence of acute cardiopulmonary disease." }, { "input": "The lungs are clear without consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications are noted at the aortic arch. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Right greater than left basal opacities have increased. Also linear opacity in the left lower lobe. No significant effusions. Minimal fluid along the major fissure. Mild biapical scarring. No pneumothorax. Mild to moderate cardiomegaly. Implantable altered device in the left anterior chest wall.", "output": "Right lower lobe pneumonia. Moderate cardiomegaly." }, { "input": "The patient is rotated to the left. Bibasilar, more conspicuous on the right, opacities appears slightly increased on the right. Prominence of the perihilar pulmonary vasculature is also slightly more conspicuous. No large pleural effusion is seen although a pleural effusion would be difficult to exclude on the left. There is no evidence of pneumothorax. The cardiac and mediastinal silhouettes are stable with the cardiac silhouette mild to moderately enlarged.", "output": "Persistent cardiomegaly. Mild to moderate pulmonary vascular congestion. Increase conspicuity of right lower lobe opacity worrisome for persistent pneumonia, with left base opacity also seen. No pneumothorax seen." }, { "input": "In comparison to the chest radiograph obtained approximately 2 weeks prior, right greater than left basal opacities are minimally improved, though increased in comparison to approximately 3 weeks prior. There is faint extension of these opacities into the midlung fields. Mild cardiomegaly is unchanged. No pulmonary edema or pleural effusions.", "output": "Bilateral parenchymal opacities may be consistent with an infectious process, chronic changes from recurrent pulmonary edema, or other inflammatory process. Recommend CT chest for further evaluation when fluid status is optimized. RECOMMENDATION(S): Recommend CT chest for further evaluation when fluid status is optimized. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 1:23 PM, approximately 90 minutes after discovery of the findings." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Cardiomediastinal silhouette is within normal limits. Lungs are clear. There is no pleural effusion or pneumothorax. Bones are grossly unremarkable.", "output": "1. No acute intrathoracic abnormality. 2. Although no acute fracture or other chest wall lesion is seen, conventional chest radiographs are not sufficient for detection or characterization of most such abnormalities. If the demonstration of trauma to the chest wall is clinically warranted, the location of any referrable focal findings should be clearly marked and imaged with either bone detail radiographs or Chest CT scanning." }, { "input": "The adjusting for changes in position, there appears to be a new right lower lung opacity. Increasing left pleural effusions likely still present but is now layering on this portable film. No pneumothorax. Cardiomediastinum is relatively unchanged adjusting for changes in position.", "output": "New right lower lung opacity concerning for pneumonia, however could be atelectasis. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 11:28 AM, 1 minutes after discovery of the findings." }, { "input": "The lungs are normally expanded without evidence of pneumonia. Heart size is normal. The mediastinal and hilar contours are normal. There is slight prominence of interstitial markings reflecting pulmonary vascular congestion without frank pulmonary edema. There is no pleural effusion or pneumothorax.", "output": "Increased interstitial markings could reflect mild pulmonary vascular congestion. There is no evidence of pneumonia." }, { "input": "The right Port-A-Cath has been removed in the interim. Otherwise, no significant interval change. The lungs are clear. No focal consolidation, effusion, edema, or pneumothorax. The heart is normal in size. The mediastinum is not widened. The hila are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well expanded. A small right pleural effusion with overlying atelectasis and a trace left pleural effusion are unchanged from 2 days prior. There is no evidence for pulmonary edema. Heart is normal size. The mediastinal and hilar structures are unremarkable. There is no pneumothorax or focal airspace consolidation worrisome for pneumonia.", "output": "No appreciable change from ___." }, { "input": "There is no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. There is no displaced rib fracture.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear.The cardiac, hilar and mediastinal contours are normal.No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Midline sternotomy wires are unchanged. The heart size is at the upper limits of normal. The mediastinal and hilar contours appear unremarkable. Opacity at the right lung base is compatible with components of atelectasis of the anterior-basal segment of the right lower lobe as well as a small right pleural effusion. Mild blunting of the left costophrenic angle suggests a trace amount of pleural fluid in that location. There is no pneumothorax. No displaced rib fracture is noted.", "output": "Small right pleural effusion with right lower lobe anterior-basal segment collapse; trace left pleural effusion." }, { "input": "Frontal and lateral views of the chest were obtained. The patient is status post median sternotomy. There are small bilateral pleural effusions with overlying atelectasis. No overt pulmonary edema is seen. The cardiac silhouette remains top normal to mildly enlarged.", "output": "Small bilateral pleural effusions with overlying atelectasis." }, { "input": "PA and lateral chest radiographs. The lungs are clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. Mild dextroscoliosis of the thoracic spine is noted.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "Lucency at the left lung apex is seen; however, no definite pneumothorax is present. There is no focal consolidation or pleural effusion. Cardiomediastinal silhouette is notable for a tortuous aorta. Bony structures are intact.", "output": "Lucency at the left lung apex without definite pneumothorax. If clinically concerned, repeat radiograph can be performed in a less lordotic position." }, { "input": "The lungs are hyperinflated. There is no pleural effusion, pneumothorax or focal airspace consolidation. The cardiac and mediastinal contours are normal. The hilar structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are normal. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "Right base atelectasis is seen without definite focal consolidation. There may be minimal pulmonary vascular congestion, improved since the prior study. The patient is status post median sternotomy and CABG. The cardiac and mediastinal silhouettes are stable. No pneumothorax is seen.", "output": "No pneumothorax identified." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Mild degenerative changes are noted in the imaged thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There has been interval removal of the chest drains. There is a small left pleural effusion. There is improved aeration of the left lung base. No pneumothorax seen. A right internal jugular catheter terminates in the mid SVC. Mild cardiomegaly with prominence of the bilateral hila consistent with a degree of congestive heart failure. Previous median sternotomy noted.", "output": "No pneumothorax seen after chest drain removal." }, { "input": "Interval removal of a prior right IJ CVL. The patient is status post median sternotomy. Cardiomegaly is unchanged. Probable trace bilateral pleural effusions. Bibasilar atelectasis without lobar consolidation, pneumothorax, or overt pulmonary edema.", "output": "Moderate cardiomegaly and mild central pulmonary vascular congestion." }, { "input": "PA and lateral views the chest were provided. The heart is top-normal in size. The lungs are clear bilaterally. No pneumothorax or effusion is seen. No overt signs of pneumonia. Mild hilar congestion difficult to exclude. Bony structures are intact. There is a mild pectus excavatum deformity of the sternum.", "output": "Mild cardiomegaly. Mild hilar congestion likely present." }, { "input": "The patient is rotated somewhat to the right. The cardiac silhouette is top-normal. There is prominence indistinctness of the hila likely due to mild to moderate central pulmonary vascular congestion. No focal consolidation is seen. There is no pleural effusion or pneumothorax. Mediastinal contours are grossly unremarkable.", "output": "Prominence of the central pulmonary vessels likely due to mild to moderate vascular congestion. No focal consolidation to suggest pneumonia." }, { "input": "There is moderate hyperexpansion suggesting underlying COPD. Bibasilar airspace opacities most likely represent atelectasis given the rapid progression compared with the recent prior study. There is no pulmonary vascular congestion or pneumothorax. Widening of the upper mediastinum is unchanged from recent prior chest radiographs and chest CT is again recommended.", "output": "1. Bibasilar airspace opacities most likely represent atelectasis. 2. Hyperexpansion consistent with COPD. 3. Upper mediastinal widening for which contrast-enhanced chest CT is again recommended. RECOMMENDATION(S): Nonemergent chest CT with contrast is recommended to evaluate the upper mediastinum." }, { "input": "There is chronic tracheal deviation of trachea and thyroid mass that remains grossly unchanged. Tracheal stent is not well visualized on this study. There are bilateral pleural effusions remains unchanged from earlier same-day exam. There is no pneumothorax.", "output": "Trachea stent is not well visualized. Stable bilateral pleural effusions and tracheal deviation when compared to earlier same day study." }, { "input": "Persistent right basilar opacity due to underlying effusion with atelectasis. More faint right basilar opacity likely due to combination of effusion and atelectasis. Superiorly, lungs are clear. Prominence of the upper mediastinum in the region of the thoracic inlet is again noted. Endotracheal tube tip is now 3.4 cm from the carina. Enteric tube passes below the field of view, side-port potentially in the region of the gastroesophageal junction.", "output": "ET tube tip 3.4 cm from the carina. Enteric tube side port in the region of the GE junction and could be advanced for more optimal positioning. Otherwise, no change." }, { "input": "Endotracheal tube tip is just above carina, should be pulled back. Large known thyroid mass, with tracheal deviation to the right is stable. Stable left basilar consolidation, more prominent lingular opacity, consider pneumonitis, aspiration. Tiny pleural effusions are less apparent. Mild right basilar atelectasis is stable. Heart size at the upper limits are normal. Normal pulmonary vascularity. Thoracolumbar curve", "output": "Left basilar consolidation, with mildly worsened lingular opacity, consider pneumonitis, aspiration, with probable component of basilar atelectasis. Endotracheal tube tip is just above carina, should be pulled back." }, { "input": "AP portable upright view of the chest. Lungs are hyperinflated and clear. Overlying EKG leads are present. No large effusion or pneumothorax. The heart appears mildly enlarged. The mediastinal contour is unchanged with atherosclerotic calcifications along the thoracic aorta. The hila are mildly prominent and unchanged. Bony structures are intact.", "output": "As above." }, { "input": "The cardiomediastinal silhouette is stable compared with ___ study with a top normal heart size and widened superior mediastinum secondary to known thyroid mass. Bilateral moderate layering pleural effusions and bibasilar atelectasis, left greater than right, appears stable when compared with the most recent study. Small pulmonary vascular congestion is stable. ETT appears to have been advanced further when compared with ___ study now projecting 1.7 cm superior to the carina.", "output": "1. Interval advancement of ETT now projecting 1.7 cm to the carina. 2. Stable bilateral moderate layering pleural effusions. 3. Bibasilar atelectasis left greater than right. 4. Mild pulmonary vascular congestion." }, { "input": "Endotracheal tube tip 2 cm above carina. Mild pleural effusions, new or worsened. Left basilar consolidation, worsened, likely atelectasis. Patchy lower lung opacities are worsened, atelectasis versus pneumonitis. Heart size is increased. Pulmonary vascularity within normal limits. Surgical clips low left neck. Trachea is now midline. No pneumothorax.", "output": "Pleural effusions. Basilar opacities, likely atelectasis, component of pneumonitis cannot be excluded if clinically appropriate." }, { "input": "The lungs are well expanded but there is increased retrocardiac opacity which may indicate left lower lobe atelectasis. There is also increased haziness over the left hemithorax suggesting small to moderate moderate left pleural effusion. haziness over the right base is improved. The heart is enlarged. ET tube is above the carina. The distal portion of the NG tube is in the stomach.", "output": "Persistent left effusion and possible left lower lobe atelectasis. Improved right lower lung aeration." }, { "input": "No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable and stable. No pulmonary edema is seen. No displaced fracture is identified.", "output": "No acute cardiopulmonary process." }, { "input": "Single AP upright portable view of the chest was obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. The cardiac silhouette is not enlarged.", "output": "No acute cardiopulmonary process. Specifically, the cardiac silhouette is not enlarged." }, { "input": "A single portable supine chest radiograph was obtained. An endotracheal tube terminates 7 cm above the carina. An orogastric tube extends inferiorly into the stomach. The lungs are well expanded. The moderate right hilar opacity obscures the right hilar contour. Otherwise the cardiac and mediastinal contours are normal. Prominence of upper lobe vasculature indicates mild fluid overload.", "output": "Right hilar opacity of uncertain etiology. Mild pulmonary venous congestion." }, { "input": "No interval change in right pleural effusion since ___ Chest CT. Two small rounded lung nodules, one in the right upper lobe and one in the right lower lobe are better characterized on chest CT. No change in mild bibasilar atelectasis. Interval decrease in vascular congestion. No pneumothorax or new focal opacity. Heart size, mediastinal and hilar contours are normal. No bony abnormality.", "output": "1. Stable mild bibasilar atelectasis. 2. No interval change in small right pleural effusion as seen on chest CT, ___. 3. No pneumonia." }, { "input": "Portable chest radiograph demonstrates a new opacity within the left lower lobe and lingula concerning for developing pneumonia. The right lung is largely clear. There is a small left-sided pleural effusion. There is no pneumothorax. The cardiomediastinal and hilar contours are stable and within normal limits. There is a discete density overlying the postero-lateral ___ rib consistent with bony island as identified on Chest CT ___. There is re- demonstration of supraclavicular catheter which terminates at the cavoatrial junction.", "output": "New left lower lobe opacification concerning for developing pneumonia. These findings were discussed with Dr. ___ by Dr. ___ ___ telephone at 11:28 on ___." }, { "input": "Frontal and lateral views of the chest were obtained. The tip of the right-sided central venous catheter is difficult to assess due to multiple overlying structures, but may be within the right atrium. Round sclerotic focus projecting over the anterior lateral right third rib is again seen. Additionally, there is now a 9 mm ovoid density projecting over the region of the posterior right ninth, anterior right fifth rib, which may be osseous, pulmonary, or external to the patient. The left lung is clear. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Two rounded densities projecting over the right chest, one seen previously in the anterior lateral right third rib. An additional one projecting over the anterior right sixth rib, unclear whether external to the patient, osseous, or pulmonary in nature. Suggest repeat with nipple markers for further evaluation." }, { "input": "There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema identified. Heart size, mediastinal and hilar contours are normal. Redemonstrated is a stable, rounded opacity seen overlying the right anterior 3rd rib, which correlates with a bone island on the patient's most recent chest CT examination.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "Since the most recent chest radiograph, there has been removal of the right-sided central venous catheter, and lung volumes are reduced. Mild bibasilar atelectasis versus aspiration in the left infrahilar region. Cardiomediastinal contours are normal. No pleural effusion or pneumothorax.", "output": "Mild bibasilar atelectasis. Left infrahilar opacity may also represent aspiration." }, { "input": "Frontal and lateral views of the chest were obtained. There is bibasilar atelectasis. No discrete focal consolidation is seen. The cardiac silhouette is enlarged. The aorta is calcified and tortuous. No large pleural effusion or pneumothorax. No overt pulmonary edema. There are degenerative changes along the spine. There are also degenerative changes at the right acromioclavicular joint. No displaced fracture is identified. Rounded calcific structures in the right upper to mid abdomen, partially imaged, may represent gallstones or fecal material.", "output": "Enlarged cardiac silhouette. Bibasilar atelectasis. No definite focal consolidation or displaced fracture is seen. Rounded calcifications in the right upper quadrant, at the inferior aspect of the images, most likely represent gallstones versus fecal material." }, { "input": "Comparison is made to the chest radiograph from ___. There has been interval placement of a Swan-Ganz catheter, with its tip in a relatively distal branch of the left pulmonary arterial system. An intra-aortic balloon pump a is noted, with its tip projecting over the inferior aspect of the aortic arch. There is a left-sided pacemaker with associated right atrial and right ventricular leads. Moderate bilateral pleural effusions are now layering given the patient's supine position, complicating comparison to the prior study from ___. There is at least mild to moderate interstitial pulmonary edema. Mild to moderate cardiomegaly is unchanged. There is no definite pneumothorax.", "output": "1. Swan-Ganz catheter ends within a branch of the left pulmonary artery. Repositioning should be considered. 2. Borderline high positioning of the intra-aortic balloon pump. 3. Bilateral layering moderate pleural effusions. 4. Mild to moderate interstitial pulmonary edema. NOTIFICATION: Findings and recommendations were discussed with Dr. ___ by Dr. ___ at 09:47 via telephone on the day of the study, ___ min after discovery." }, { "input": "AP upright and lateral views of the chest were provided. Heart is enlarged, allowing for technique. The lung volumes are low with bronchovascular crowding obscuring the lung bases. The upper lungs appear well aerated. No pneumothorax is seen. Bony structures are intact.", "output": "Limited exam with cardiomegaly and lower lung bronchovascular opacities in the setting of low lung volumes. If strong clinical concern for pneumonia, recommend repeat with more optimal inspiratory effort." }, { "input": "Frontal and lateral views of the chest were obtained. Dual-lead left-sided pacemaker is again seen with leads extending to the expected positions of the right atrium and right ventricle, unchanged. There are significant perihilar and bibasilar opacities consistent with large bilateral pleural effusions as well as pulmonary edema. The cardiac silhouette is enlarged. The aorta is tortuous.", "output": "Bilateral pleural effusions, pulmonary edema and cardiomegaly suggest CHF." }, { "input": "Frontal views of the chest were obtained. Radiographs demonstrate the Dobbhoff tube to be coiled within the stomach with the tip initially terminating within the esophagus and subsequently terminating at the gastroesophageal junction. Cardiomediastinal contours are stable. Lung volumes are low. No focal consolidation, pleural effusion, or pneumothorax. There is asymmetric density of the costochondral junctions.", "output": "Malpositioned Dobbhoff coiled in stomach with tip terminating at the gastroesophageal junction. Findings were communicated via phone call by ___ to Dr. ___ on ___ at 12:45 p.m." }, { "input": "Dobhoff tube tip is still at the thoracoabdominal junction. The Dobbhoff tube curls into the stomach with the tip is still at the thoracoabdominal junction. No focal consolidation, pleural effusion, or pneumothorax is present. Again seen is the leftward mass effect on the trachea and right paratracheal opacity caused by the patient's known thyroid goiter. Bibasilar opacities are likely due to atelectasis.", "output": "Dobbhoff tip at the thoracoabdominal junction. Further advancement is needed for proper positioning in the stomach." }, { "input": "The cardiac, mediastinal and hilar contours are unchanged, with the heart size appearing borderline enlarged. The pulmonary vascularity is normal. No focal consolidation, pleural effusion or pneumothorax is seen. Mild degenerative changes are noted within the upper and mid thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Relatively low lung volumes are noted. Streaky bibasilar opacities are likely secondary to atelectasis. The lungs are otherwise clear. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "AP and lateral views of the chest are compared to previous exam from ___. The lungs remain clear. There is no effusion or pneumothorax. Cardiomediastinal silhouette appears normal. No free air is seen below the diaphragm.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. The heart size is normal. There is no pulmonary edema. There is no free air under diaphragms.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "Lungs are fully expanded and clear. No pleural abnormalities. Heart size is normal. Cardiomediastinal and hilar silhouettes are normal.", "output": "Normal chest." }, { "input": "Lines and Tubes: There is an new right-sided hemodialysis catheter with tip terminating in the distal right atrium. Lungs: Haziness overlying the right hemi thorax likely reflect presence of a fairly large right pleural effusion. Diffuse vascular prominence and bibasilar atelectasis noted. Pleura: Large right pleural effusion, likely smaller left pleural effusion. No pneumothorax. Mediastinum: There is cardiomegaly and curvilinear aortic knuckle calcification. Bony thorax: Mild diffuse osteopenia and degenerative changes of the thoracic spine noted.", "output": "Diffuse prominence of lung vasculature associated with bilateral pleural effusions, right greater than left and cardiomegaly reflect fluid overload and pulmonary edema. Likely bibasilar atelectasis." }, { "input": "There is no focal consolidation or pneumothorax. Small bilateral pleural effusions are unchanged since the prior exam. Prominence of the hila bilaterally which may be due to hilar congestion is also unchanged. Mitral annular calcifications are noted. The heart remains moderately enlarged. Unchanged degenerative changes of the thoracic spine.", "output": "No change since the prior radiograph in probable small bilateral pleural effusions and bilateral hilar prominence, likely due to vascular congestion." }, { "input": "AP upright and lateral views of the chest provided. Low lung volumes limits assessment. The heart is moderately enlarged. There is curvilinear dense calcification projecting over the heart likely representing mitral annular calcifications. There is a tiny left pleural effusion possibly tiny right pleural effusion also present. There is mild central hilar engorgement. No frank pulmonary edema. No pneumothorax. Mediastinal contour is normal. Bony structures are intact.", "output": "1. Cardiomegaly and hilar congestion. 2. Tiny bilateral pleural effusions. 3. Calcified mitral annulus." }, { "input": "No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac silhouette is top-normal to mildly enlarged. The aorta is calcified and somewhat tortuous. Mild apical pleural thickening is seen. There is no pulmonary edema. There is moderate compression of a mid thoracic vertebral body of indeterminate age without priors for comparison.", "output": "No focal consolidation to suggest pneumonia. Top-normal to mildly enlarged cardiac silhouette. Moderate compression of a mid thoracic vertebral body of indeterminate age, no priors for comparison." }, { "input": "Portable semi-erect chest film ___ at 05:52 is submitted.", "output": "Tracheostomy tube and right subclavian PICC line are unchanged position. The heart remains stably enlarged. Mediastinal contours are unchanged. Overall, the diffuse airspace opacities are improving suggesting resolving but persistent moderate pulmonary and interstitial edema. There is likely a layering left effusion. No pneumothorax." }, { "input": "Portable semi-erect chest film ___ at 05:31 is submitted.", "output": "Tracheostomy tube and right subclavian PICC line remain in place. Stable postoperative changes are seen in the left hemithorax. Overall, there is worsening severe pulmonary edema and there are likely associated layering effusions. No pneumothorax is seen. Overall cardiac and mediastinal contours are difficult to assess given the diffuse airspace process and patient rotation on the current study." }, { "input": "The patient is status post interval thoracotomy with placement of two left apical chest tubes and a mediastinal drain. There is no obvious pneumothorax. A nasogastric tube enters the stomach, distal tip not visualized. An endotracheal tube ends in the lower trachea above the carina. The heart is mildly enlarged despite the projection. A moderate layering right pleural effusion has increased. Widespread bilateral interstitial and airspace opacities have slightly increased. Left lateral chest wall skin ___ and small postoperative subcutaneous emphysema are new.", "output": "Status post interval thoracotomy with interval increase in moderate layering right pleural effusion. Slightly increased bilateral interstitial and airspace opacities which are likely due to pulmonary edema." }, { "input": "As compared to the recent chest radiograph performed approximately 3 hours earlier, there is no significant interval change. The support lines and devices including the endotracheal tube, left subclavian line, 2 left chest tubes and the left mediastinal drain are unchanged in position. The tip of the enteric tube is now visualized and terminates within the stomach. Stable appearance of loculated right pleural effusion, and small left pleural effusion. There is no pneumothorax. Cardiomediastinal silhouette is stable in appearance.", "output": "No significant interval change compared to the prior radiograph performed earlier today at 12:04PM. Stable loculated right pleural effusion, and small left pleural effusion." }, { "input": "Since the prior radiograph performed earlier this morning, there has been interval placement of a new left subclavian line that terminates at the cavoatrial junction. Remainder of the support lines and devices are unchanged. Endotracheal tube terminates 2.7 cm above the carina. The enteric tube is seen in the stomach, but the tip extends beyond the inferior margin of this image. There are two left-sided chest tubes and a left mediastinal drain. There is a loculated right pleural effusion that has increased since yesterday morning's CXR. Additionally, there is slightly worsening opacification of the left lung base, which is probably due to a combination of atelectasis and a small left pleural effusion. Interval improvement in extent of underlying pulmonary edema since yesterday. There is no pneumothorax.", "output": "1. Left subclavian line terminates at the cavoatrial junction. 2. Interval worsening of loculated right pleural effusion, and a small left pleural effusion. 3. Pulmonary edema has improved." }, { "input": "Portable supine chest film ___ at 22:33 is submitted.", "output": "Tracheostomy tube and right subclavian PICC line are unchanged in position. Overall cardiac and mediastinal contours are difficult to assess due to the bilateral diffuse airspace and interstitial process which appears to have slightly worsened likely reflecting worsening pulmonary edema, although a worsening pneumonia should also be considered. There are likely layering effusions. No pneumothorax is appreciated, although the sensitivity to detect pneumothorax is diminished given supine technique. A gastrostomy tube is in place. Residual contrast is seen within non-distended transverse colon." }, { "input": "AP portable supine view of the chest. An endotracheal tube is seen with its tip residing 2.9 cm above the carina. As seen on same-day chest CT, there is cardiomegaly with perihilar opacities and prominence of the mediastinum. Scattered opacities within the lungs likely represent edema with small bilateral pleural effusions noted. No supine evidence for pneumothorax. The stomach is gas distended. No bony injuries are seen.", "output": "Endotracheal tube positioned appropriately. Cardiomegaly with perihilar opacities better assessed on same day chest CT." }, { "input": "AP portable supine view of the chest. Endotracheal tube unchanged in position with its tip located 3.2 cm above the carina. There has been interval placement of a left chest tube which is seen projecting over the left lung base. Also noted is a orogastric tube with its tip just beyond the GE junction. Recommend advancement for more optimal positioning. Otherwise, no change.", "output": "Interval placement of an orogastric tube which needs to be advanced for more optimal positioning. Left chest tube in place. Endotracheal tube positioned appropriately. Stable cardiopulmonary opacities." }, { "input": "Since the prior radiograph performed earlier this morning, the patient has been extubated and a new tracheostomy tube has been placed. The enteric tube has been removed. Right-sided PICC line is unchanged in location and terminates at the cavoatrial junction. There are no significant interval changes. There is severe alveolar pulmonary edema, unchanged in appearance since the prior study. There is no pneumothorax. Cardiomediastinal silhouette remains enlarged.", "output": "1. Appropriately positioned tracheostomy tube. 2. Unchanged appearance of severe alveolar pulmonary edema." }, { "input": "Bilateral chest tubes and the left mediastinal drain remain unchanged in position. Left subclavian line terminates at the low SVC. Tip of the enteric tube is seen in the stomach. Endotracheal tube terminates 2.8 cm above the carina. Bilateral pleural effusions continue to improve. Specifically, the loculated right pleural effusion is significantly better compared to yesterday's radiograph at 13:30, and mildly improved since the radiograph at 16:54. There is no pneumothorax. Cardiomediastinal silhouette is stable.", "output": "1. Continued interval improvement in bilateral pleural effusions. 2. Support lines and devices are appropriately positioned." }, { "input": "The heart is at the upper limits of normal size to mildly enlarged. The aorta is partly calcified. The mediastinal and hilar contours appear unchanged. On the prior CT, there was a substantial hiatal hernia which is not well visualized on this examination. Small bilateral pleural effusions are present and better seen on the lateral view. The lungs are hyperinflated. Fissures are minimally thickened, which may suggest slight fluid overload. However, the lungs appear clear. Small anterior osteophytes are noted throughout the visualized thoracolumbar spine. Leftward convex curvature along the upper lumbar spine is probably similar and associated with compression deformity of an upper lumbar vertebral body that may be similar, although not optimally characterized.", "output": "Slightly thickened fissures and small pleural effusions, which may suggest mild congestion or fluid overload; otherwise unremarkable." }, { "input": "Frontal and lateral views of the chest were obtained. There are small bilateral pleural effusions with overlying atelectasis. No pneumothorax is seen. The aorta is calcified. The cardiac silhouette is not enlarged. Degenerative changes are seen along the spine.", "output": "Small bilateral pleural effusions." }, { "input": "Cardiac, mediastinal and hilar contours are normal. The lungs are clear. The pulmonary vascularity is normal. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Since the radiographs obtained ___, pulmonary vascular congestion and edema have resolved. Moderate cardiomegaly is unchanged and there are no pleural effusions. There is prominent calcification of the mitral annulus. Lungs are fully expanded and clear without consolidations. Cardiomediastinal and hilar silhouettes are normal. Multilevel compression fractures appear grossly unchanged since CT chest dated ___.", "output": "Unchanged moderate cardiomegaly without radiographic evidence of acute decompensation." }, { "input": "AP upright and lateral views of the chest provided. The heart is mildly enlarged. There is mild pulmonary edema. Small effusions likely present. No pneumothorax. No acute bony injury.", "output": "Cardiomegaly with mild pulmonary edema. Likely small bilateral pleural effusions." }, { "input": "This exam is compromised by patient habitus and technique. There is stable small bilateral pleural effusions, but mediastinum is wider probably due to vascular engorgement. Severe cardiomegaly is chronic and stable. Moderate bilateral basal atelectasis is unchanged. Minimally improved interstitial opacities may be due to improved lung volumes and not necessarily improvement of moderate pulmonary edema. Intraaortic pump has not migrated, though 3 cm higher than conventional positioning. Otherwise, the remaining monitoring and support lines are appropriate in positioning. There is no pneumothorax.", "output": "Minimal improvement in lung volume. Stable mild pulmonary edema. Progressive mediastinal widening probably due to vascular engorgement." }, { "input": "In comparison with chest radiograph 1 day earlier, there is mild improvement in pulmonary edema. The intra-aortic balloon pump tip sits underneath the roof of the aortic arch and should be pulled more distally approximately 3 cm. NG tube extends into the proximal stomach in of the field-of-view. Right internal jugular line terminates at the level of the lower SVC. The ET tube tip terminates approximately 3 cm above the carina. Mediastinal and hilar contours are stable. Severe cardiomegaly is unchanged.", "output": "1. Intra-aortic balloon pump tip sits underneath the roof of the aortic arch and should be pulled more distally approximately 3 cm. Remaining cardiopulmonary support devices are in standard placement. 2. Mildly improved pulmonary edema. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 12:08 PM, 3 minutes after discovery of the findings." }, { "input": "The lungs are clear. Nodular opacities projecting over the lung bases are compatible with nipple shadows. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. A new heterogeneous opacity is seen in the retrocardiac posterior left lower lobe suggestive of early infiltrate. The right lung is clear. The heart size is unchanged. There is no pulmonary edema, pleural effusions or pneumothorax. The cardiac, mediastinal, and hilar contours are normal. The mild compression deformities of two mid thoracic vertebral bodies are stable. No new fractures.", "output": "New left lower lobe early pneumonia. These findings were discussed with Dr. ___ at 11:35 a.m. on ___ by telephone." }, { "input": "PA and lateral views of the chest were provided. The lungs are hyperinflated with upper lobe lucency compatible with known underlying emphysema. There is no focal consolidation, effusion, pneumothorax. No signs of CHF. Cardiomediastinal silhouette is stable. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Emphysema without superimposed pneumonia." }, { "input": "Enlargement of bilateral hila has mildly progressed compared to the prior study of ___, suggestive of pulmonary hypertension. CT could be performed for further evaluation, if clinically indicated. There is no suspicious mass, focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits. Old, well healed left-sided rib fractures and a bone island in the posterior left fifth rib are incidentally noted.", "output": "1. Mild progression of bilateral hilar enlargement, suggestive of pulmonary hypertension. CT could be performed for further evaluation, if clinically indicated. 2. No evidence of acute cardiopulmonary process. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ On the telephone on ___ at 3:41 PM, 10 minutes after the discovery of the findings." }, { "input": "Lung volumes are low. This slightly limits assessment of the lung bases. Hazy ill-defined opacity within the right lung base is suspicious for an area of infection. A streaky opacity in the left lung base likely reflects atelectasis. There is no pleural effusion or pneumothorax. Heart size is top normal, and the mediastinal and hilar contours are unremarkable. There is no pulmonary vascular congestion.", "output": "Hazy right basilar opacity is suspicious for an area of infection." }, { "input": "PA and lateral views of the chest were obtained. Lung volumes are low. Heart is normal in size and cardiomediastinal contour is unremarkable. Bibasilar linear opacities likely represent atelectasis; however, developing consolidation at the right base is not excluded. A small right pleural effusion is noted on the lateral view. There is no pneumothorax.", "output": "1. Low lung volumes and bibasilar atelectasis. Developing consolidation at the right base, not excluded. 2. Small right pleural effusion." }, { "input": "The lungs are clear without focal consolidation. There is slight blunting of the bilateral posterior costophrenic angle suggesting trace pleural effusions. No pneumothorax is seen peer The cardiac and mediastinal silhouettes are stable. No pulmonary edema is seen.", "output": "Trace bilateral pleural effusions. Grossly stable enlargement of the cardiac silhouette given differences in inspiration. No overt pulmonary edema." }, { "input": "The lungs are clear.The cardiac, hilar and mediastinal contours are normal.No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "AP and lateral images of the chest demonstrate clear lungs bilaterally. The cardiomediastinal and hilar contours are within normal limits. There is no pleural effusion or pneumothorax. Visualized osseous structures are without acute abnormalities.", "output": "No acute intrathoracic abnormality." }, { "input": "No focal opacity to suggest pneumonia is seen. No pleural effusion, pulmonary edema or pneumothorax is present. The heart size is normal.", "output": "No evidence of acute cardiopulmonary process. Normal heart size." }, { "input": "PA and lateral views of the chest were obtained demonstrating clear well-expanded lungs without focal consolidation, effusion, or pneumothorax. No signs of CHF. Cardiomediastinal silhouette is normal. Chronic-appearing left mid rib cage deformity is noted laterally. Otherwise, the imaged osseous structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Partially imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Portable AP upright chest radiograph obtained. Dialysis catheter resides in the right subclavian with tip in the mid SVC. Lungs are clear without signs of pneumonia or CHF. No effusion or pneumothorax. Cardiomediastinal silhouette is stable. Bony structures are intact. A stable soft tissue calcification resides adjacent to the left humeral neck.", "output": "No signs of pneumonia." }, { "input": "Left subclavian central venous catheter tip terminates in the proximal right atrium. The heart is mildly enlarged. Aorta is unfolded. The pulmonary vascularity is normal and hilar contours are within normal limits. The lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral radiographs of the chest were acquired. There has been interval removal of a left tunneled dialysis catheter with interval placement of a right tunneled dialysis catheter, with its tip ending in the high right atrium. There is engorgement of the pulmonary vasculature without frank interstitial pulmonary edema. There is no focal consolidation. The heart size is top normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen. There is increased sclerosis of the vertebral body endplates throughout the thoracic spine, best appreciated on the lateral projection, suggestive of renal osteodystrophy.", "output": "1. Pulmonary vascular congestion without frank interstitial edema. 2. No focal consolidation." }, { "input": "Right-sided central venous catheter tip terminates in the lower SVC. The heart size is normal. Mediastinal and hilar contours are unremarkable. There is no pulmonary vascular congestion. Streaky opacity within the left lung base likely reflects atelectasis. There is no focal consolidation, pleural effusion or pneumothorax. \"Rugger ___\" spine is compatible with renal osteodystrophy.", "output": "Minimal left basilar atelectasis." }, { "input": "The lungs are relatively well expanded and clear. There is no pleural effusion or pneumothorax. The heart is likely normal in size with tortuous aortic contour. Moderate hiatal hernia is also suggested.", "output": "Retrocardiac opacity in expected location of moderate hiatal hernia. This could be further evaluated on PA and lateral views if no history of such. No acute intrathoracic process." }, { "input": "The lungs are well expanded and clear without focal consolidation, pleural effusion or pneumothorax. Heart size is normal. Mediastinal silhouette and hilar contours are normal.", "output": "Normal chest radiographs." }, { "input": "The lungs are clear with no evidence of consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. No acute fractures are identified. No free air is noted under the hemidiaphragms.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without a consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. Surgical clips are noted in the left chest wall from a prior breast surgery.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. There is tortuosity of the descending aorta. Lungs are hyperinflated and there are coarsened interstitial markings which could relate to chronic lung disease. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest views were obtained with patient in upright position. The heart size is normal. No configurational abnormality is identified. Unremarkable appearance of thoracic aorta. No mediastinal abnormalities are present. The pulmonary vasculature is not congested. No signs of acute or chronic parenchymal infiltrates are present, and the lateral and posterior pleural sinuses are free. No pneumothorax in the apical area on frontal view. Skeletal structures of the thorax grossly unremarkable. Our records do not include a previous chest examination available for comparison.", "output": "Normal chest findings in ___-year-old female patient with history of shortness of breath." }, { "input": "PA and lateral views of the chest. No prior. Linear opacity at the left lung base is most suggestive of atelectasis as it is not well seen on the lateral. Elsewhere, the lungs are clear, there is no effusion. Cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "The cardiac silhouette is top-normal in size. The pulmonary vasculature is unremarkable. The the lungs are clear. There is no definite pleural effusion or pneumothorax. No displaced rib fracture is identified. Vertebral body heights are maintained. Plain radiographs, however, are limited for of evaluation for traumatic injury. .", "output": "No acute intrathoracic abnormality. RECOMMENDATION(S): Plain radiographs are limited for evaluation for traumatic injury. If there is persistent concern, films of the symptomatic region can be obtained. Alternatively, CT can be considered." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. No definite large pleural effusion, pneumothorax or focal consolidation.", "output": "No overt evidence for pneumonia or pulmonary edema." }, { "input": "The lungs are clear. Cardiomediastinal silhouette and hilar contours are unremarkable. There may be a small left pleural effusion. Mild compression deformity of a mid-thoracic vertebral body is of indeterminate age.", "output": "Small left pleural effusion. No evidence of pneumonia or edeam." }, { "input": "Compared with prior radiographs on ___, the right hemidiaphragm is not sharply seen. There is a small right pleural effusion and atelectasis at the right lung base. There is no new focal consolidation to suggest pneumonia. There is no edema or pneumothorax. Cardiomediastinal silhouette is unchanged.", "output": "Small right pleural effusion and a basilar atelectasis." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Bronchovascular crowding in the lower lungs in the setting of low lung volumes. No convincing evidence for pneumonia, edema, effusion or pneumothorax. Heart appears mildly prominent. Mediastinal contour unremarkable. Bony structures intact. No free air below the right hemidiaphragm.", "output": "Bronchovascular crowding in the lower lungs. Mild cardiomegaly." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "A nasogastric tube is seen extending below the diaphragm positioned appropriately within the stomach. The stomach demonstrates significant distention, consistent with patient's known small bowel obstruction. Heterogeneous opacities at the right lung base and more confluent left basilar opacification is likely secondary to atelectasis, and overall similar to the prior exam. There is no large pleural effusion. There is no evidence of pneumothorax. Cardiomediastinal contours are stable compared to exams dated back to at least ___.", "output": "1. Nasogastric tube extends below the diaphragm with the tip located within the body of the stomach. Distention of the stomach and visualized small bowel loops is consistent with patient's known small bowel obstruction as seen on the CT of the abdomen performed on ___ at 7:30 p.m. 2. Bibasilar atelectasis, while due in part to elevated diaphragm, could also be due to aspiration." }, { "input": "Abandoned pacer leads projecting over the left lateral chest wall anteriorly appear unchanged. A single-lead pacemaker device terminates in the right ventricle, as before. Moderate globular cardiac enlargement is similar. The mediastinal and hilar contours appear unchanged. There is persistent left basilar opacification that may probably reflect a small-to-moderate effusion with increased opacification of the left lower lobe, which is nonspecific as to etiology. Although the opacity may consist of a combination of atelectasis and pleural effusion, a pneumonic consolidation is noted excluded. There is no pneumothorax or definite pleural effusion on the right side. Mild degenerative changes are similar along the thoracic spine. Cholecystectomy clips project over the right upper quadrant.", "output": "Increasing opacification in the left lower lobe, which may primarily reflect an increase in pleural effusion but extensive atelectasis or pneumonic consolidation are additional possibilities to consider." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. Again seen is cardiomegaly which is essentially stable from prior. The lungs remain clear. There is a small left pleural effusion. Pacemaker wires are in stable position. There are surgical clips in the upper abdomen, potentially from prior cholecystectomy.", "output": "Small left pleural effusion. Stable cardiomegaly." }, { "input": "PA and lateral views of the chest. The lungs are clear without focal consolidation. There is a large hiatal hernia. Biapical scarring is noted. The cardiomediastinal silhouette is otherwise within normal limits. No acute osseous abnormality is identified.", "output": "Large hiatal hernia without acute cardiopulmonary process." }, { "input": "In comparison to the chest radiograph obtained 1 day prior, there is a new right lower lobe consolidation. Lungs are otherwise normally expanded and clear without any significant changes. Small, bilateral pleural effusions. No pneumothorax. Heart size is top-normal and cardiomediastinal silhouette is unchanged. Mild pulmonary vascular congestion has resolved. Continued appearance of a bowel containing hiatal hernia projecting over the inferior left chest.", "output": "New right lower lobe consolidation concerning for new pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 12:15 PM, approximately 60 minutes after discovery of the findings." }, { "input": "In comparison to the radiograph obtained 1 day prior, of the right lower lobe consolidation has substantially improved. There has been interval intubation and the ETT terminates 3.7 cm above the carina. Heart size is top-normal. No pulmonary vascular congestion or pulmonary edema.", "output": "Substantial improvement of right lower lobe consolidation. An ET tube terminates 3.7 cm above the carina." }, { "input": "The cardiomediastinal silhouette is unremarkable. Since the most recent examination, there appears to been interval development of vascular congestion. Possible septal lines are noted. These findings are likely exaggerated due to supine technique. No definite consolidation is identified.Evaluation for pleural effusion no pneumothorax is limited on supine evaluation. Again seen is what appears to be transverse colon and well left chest.", "output": "1. Interval development of pulmonary vascular congestion, consistent with edema. 2. H iatal hernia containing large bowel." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits, unchanged. The descending thoracic aorta is tortuous. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac silhouette size is normal. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is present. There are mild degenerative changes seen in the thoracic spine. Clips are noted in the right upper quadrant of the abdomen compatible prior cholecystectomy.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral chest views were obtained with patient in upright position. The heart size is within normal limits. No configurational abnormality is identified. Unremarkable appearance of thoracic aorta and mediastinal structures. The pulmonary vasculature is not congested. There exists a small area of poorly delineated parenchymal infiltrates projecting partially over the left heart border identified on the lateral view to occupy the posterior segment of the left lower lobe. No other acute pulmonary parenchymal infiltrates are present and the lateral and posterior pleural sinuses are free of any fluid accumulation. No pneumothorax seen in the apical area. Skeletal structures of the thorax grossly unremarkable. Our records do not include a previous chest examination available for comparison.", "output": "Small poorly delineated patchy infiltrate in the left lower lobe posterior segment consistent with peribronchial pneumonia. No other pulmonary abnormalities are seen. Followup after successful treatment is recommended." }, { "input": "Cardiac, mediastinal and hilar contours are normal. The pulmonary vasculature is normal. There is continued patchy opacification within the left lower lobe. No new areas of focal consolidation are seen, and the right lung remains clear. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Left lower lobe patchy opacity remains concerning for pneumonia, not significantly changed in the interval. Followup radiographs 4 weeks after treatment are recommended to ensure resolution of this finding." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Increased density in the right hilum and retrocardiac region are concerning for an infectious process. There is no large pleural effusion or pneumothorax.", "output": "Right hilum and retrocardiac opacities, concerning for pneumonia. But interval followup is recommended upon completion of treatment to document resolution." }, { "input": "The heart is normal in size. The cardiomediastinal contour is within normal limits. Lung volumes are low, causing some bronchovascular crowding. There is no focal consolidation identified. Opacity at the right hilum is similar appearing to the prior examination, given differences in inspiration.Mild diffuse interstitial changes are present. There is no evidence of pleural effusion or pneumothorax.", "output": "Low lung volumes. No acute cardiopulmonary abnormality." }, { "input": "As compared to chest radiograph from earlier same day, the tip of the endotracheal tube is 5 cm from the carina. The feeding tube tip remains at the gastroesophageal junction. The nasogastric tube tip is not visualized. The right IJ catheter in similar position. Extensive subcutaneous emphysema has not significantly changed. Slight interval increase in bibasilar opacities. Widespread airspace opacities are otherwise unchanged. Right apical lucency concerning for small pneumothorax.", "output": "Endotracheal tube 5 cm from the carina. Right apical lucency concerning for a new small pneumothorax. Slight increase in bibasal opacities likely atelectasis." }, { "input": "Of note this dictation was lost in the system and is being Re dictated on ___ As compared to ___, no relevant change is seen. No pneumothorax. Extensive air collection in the soft tissues remain constant. Constant appearance of the widespread opacity in the lung parenchyma. Unchanged appearance of the cardiac silhouette.", "output": "No significant interval change." }, { "input": "Persistent low lung volumes. Multifocal areas of the opacity are new in the right upper lobe, new in the right middle lobe and worse in the left perihilar region. The heart is top-normal in size. The aorta is unfolded. There is mild interstitial edema.", "output": "New right upper lobe and lingula opacities are consistent with pneumonia in the correct clinical setting. Treatment for pneumonia and follow-up radiographs in 6 weeks are recommended. If the opacities do not resolve CT is recommended. RECOMMENDATION(S): New right upper lobe and lingula opacities are consistent with pneumonia in the correct clinical setting. Treatment for pneumonia and follow-up radiographs in 6 weeks are recommended. If the opacities do not resolve CT is recommended." }, { "input": "As compared to ___, there is new subcutaneous emphysema in the right neck asymmetrically greater than the left. There is also new lucencies surrounding the thoracic inlet, mediastinum and left heart border suggestive of pneumo mediastinum and pneumopericardium. Widespread airspace opacities have slightly improved, most pronounced in the lingula and right lower lobe. Small bilateral pleural effusions persist. Endotracheal tube is 7 cm from the carina. Right internal jugular catheter in the mid SVC. The nasogastric tip is within the body of the stomach. A second feeding tube with the tip in the cardia of the stomach has pulled back since the prior.", "output": "New subcutaneous emphysema and pneumomediastinum/pneumopericardium. Slight improvement in widespread airspace opacities. Feeding tube is near the GE junction/cardia of the stomach." }, { "input": "Monitoring and support equipment is unchanged in position compared to the prior study. Extensive subcutaneous emphysema continues, limiting assessment of the lung parenchyma. Bilateral ill-defined airspace opacities are grossly unchanged. No definite pneumothorax seen.", "output": "No significant interval change when compared to the prior study." }, { "input": "Low lung volumes are again noted. Superimposed on atelectasis and bronchovascular crowding are diffuse bilateral parenchymal opacities throughout the lungs which given differences in technique have not significantly changed since yesterday's exam. The cardiomediastinal silhouette is grossly within normal limits. No acute osseous abnormalities.", "output": "Bilateral parenchymal opacities which could be seen in the setting of pneumonia, potentially atypical, versus edema." }, { "input": "As compared to ___, no relevant change is seen. No pneumothorax. Extensive air collection in the soft tissues remain constant. Constant appearance of the widespread opacity in the lung parenchyma. Unchanged appearance of the cardiac silhouette. The monitoring and support devices are in constant position with the endotracheal tube 5.6 cm from the carina and esophageal probe at the GE junction.", "output": "Widespread airspace opacities have not significantly changed, however in review of chest radiograph from ___ and ___ CT thorax, there is suggestion of chronic interstitial lung disease. In this setting if infection was not clearly the cause for this admission, AIP or rapidly progressive interstitial lung disease could be considered. The monitoring and support devices are in constant position with the endotracheal tube 5.6 cm from the carina." }, { "input": "Extensive subcutaneous emphysema continues to limit assessment. The diffuse patchy airspace opacities throughout both lungs are unchanged. No convincing evidence of a pneumothorax. These supportive a monitoring equipment is unchanged in position when compared to the prior study.", "output": "No significant interval change when compared the prior study." }, { "input": "There is extensive subcutaneous emphysema which limits assessment. No definite free air under the diaphragm seen however dedicated decubitus radiographs may be helpful to clarify. Persistent patchy airspace opacities are noted in the bilateral lungs. A right internal jugular catheter terminates in the proximal SVC.", "output": "No significant interval change compared to the prior study." }, { "input": "Again seen is extensive subcutaneous air tracking along the pectoralis muscles bilaterally. This limits assessment of the pulmonary parenchyma. An endotracheal tube is in-situ, the tip terminates 3.5 cm above the level the carina. A right internal jugular catheter terminates in the proximal SVC. Widespread bilateral airspace opacities are similar in extent when compared to the prior study. No evidence of clearing.", "output": "No significant interval change when compared to the prior study." }, { "input": "PA and lateral views of the chest. No focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. The lungs are clear without effusion or consolidation. The cardiomediastinal silhouette is within normal limits. Mitral annular calcifications are also noted. Accentuated kyphosis again noted. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormalities detected.", "output": "Normal chest x-ray." }, { "input": "PA and lateral views of the chest were provided. There is no free air below the right hemidiaphragm. The lungs are clear bilaterally. There is no focal consolidation, effusion or pneumothorax. The heart and mediastinal contours appear normal. The imaged osseous structures are intact.", "output": "No acute findings including no evidence of pneumoperitoneum." }, { "input": "Lungs are clear. No signs of pneumonia or edema. No pleural effusion or pneumothorax. An azygous fissure is noted. Heart and mediastinal contours are normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process, specifically no signs of pneumothorax." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation or pneumothorax. The hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Partially imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "2 views were obtained of the chest. The lungs are low in volume but clear. There is no pleural effusion or pneumothorax. The heart is normal in size with normal mediastinal and hilar contours.", "output": "No acute intrathoracic process." }, { "input": "Single frontal view of the chest. Left PICC terminates in the lower SVC. Heart size and cardiomediastinal contours are stable. Lung volumes have slightly improved, though still hypoinflated. There is bibasilar atelectasis without focal consolidation, pleural effusion, or pneumothorax.", "output": "Left PICC terminates in the lower SVC." }, { "input": "A left-sided PICC line terminates at the cavoatrial junction. The lung volumes are low with mild relative elevation of the right hemidiaphragm that appears unchanged. The cardiac, mediastinal, and hilar contours appear stable including mediastinal and left hilar lymphadenopathy. There is no definite pleural effusion or pneumothorax. There is a persistent medial left basilar opacity with a rounded contour, suggesting a pleural-based mass concerning for malignancy. Smaller nodules are not well depicted on radiographs.", "output": "Stable appearance of the chest including lymphadenopathy and a left lower lobe opacity worrisome for malignancy." }, { "input": "The lungs are relatively hyperinflated. Right lower lobe opacity is worrisome for pneumonia. The left lung is clear. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Right lower lobe pneumonia. Recommend followup to resolution." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There are slightly low lung volumes. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema identified. The heart size is normal. Mediastinal contours are normal. No bony abnormalities are detected.", "output": "No radiographic evidence of an acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable, as are the hilar contours.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. There is no pleural effusion, pneumothorax or focal airspace consolidation. The heart is normal size. The mediastinal and hilar structures are unremarkable. There is no displaced rib fracture seen.", "output": "No displaced rib fracture. If concern persists, dedicated rib views could be performed." }, { "input": "The lungs are clear without focal opacity, pulmonary edema, pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal. There is no free air beneath the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "The lungs are poorly expanded, but there are no focal opacities. Cardiomediastinal and hilar contours are unchanged, with a left ventricular predominance again seen. The aorta is tortuous. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Lung volumes remain slightly low with bronchovascular crowding. Nonetheless, there appears to be mild to moderate central edema. Moderate cardiomegaly is unchanged. No pleural effusion. No pneumothorax. Retrocardiac opacity may reflect atelectasis in the setting of lower lung volumes and moderate edema.", "output": "Low lung volumes with probable mild-to-moderate moderate edema." }, { "input": "The lungs are well inflated. The right lung is clear while the left lung demonstrates a retrocardiac opacity that is confirmed in the lateral view. The cardiomediastinal and hilar contours are unremarkable. There is no evidence of pleural effusion or pneumothorax.", "output": "Retrocardiac opacity might represent atelectasis versus consolidation secondary to infectious/inflammatory process." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Portable AP image through the chest demonstrates clear lungs bilaterally. Patient is status post endotracheal tube placement, its terminal end 3.7 cm above the level of the carina in appropriate position. An enteric tube is seen descending along the expected course of the esophagus, its terminal end out of the field of view. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax or pleural effusion.", "output": "Clear lungs bilaterally. Status post intubation with endotracheal tube in appropriate position." }, { "input": "There is no lobar consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is unchanged in appearance.", "output": "No acute cardiopulmonary process." }, { "input": "Left mid lung linear atelectasis/ scarring is seen. Subtle hazy opacity projecting over the right upper lung could be due to pneumonia. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. Right VP shunt catheter is seen projecting over the right hemi thorax, not well assessed at the inferior right hemi thorax.", "output": "Patchy right upper lung opacity could be due to pneumonia. Discoid left mid lung atelectasis/scarring." }, { "input": "Right upper lung scarring is re- demonstrated. Opacity along the periphery of the right major fissure correlates to fat on the previous CT. No evidence of pneumonia are new. The cardiac, hilar and mediastinal contours are normal.No pleural effusion, pulmonary edema, or pneumothorax. VP shunt catheter and IVC filter are incompletely imaged. Right breast prosthesis is also noted.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. There is known right paratracheal lymphadenopathy. There is scarring in the right upper lobe medially as seen on the chest CT. The lungs are otherwise clear. There is no focal consolidation, pneumothorax, or effusion.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is a moderate to large right pleural effusion, re- demonstrated, with overlying atelectasis. Mild left base atelectasis is also seen. There is pulmonary vascular congestion. No pneumothorax is seen. The cardiac silhouette is is mildly enlarged. Mediastinal contours are stable.", "output": "Moderate to large right pleural effusion. Bibasilar atelectasis. Mild pulmonary vascular congestion." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette is stable. There is no pleural effusion or pneumothorax. Visualized upper abdomen is unremarkable.", "output": "No focal consolidation." }, { "input": "AP upright and lateral views of the chest provided. Persistent small right pleural effusion with mild right basal atelectasis is noted. Left lung remains clear. Cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "Small persistent right pleural effusion." }, { "input": "Lung volumes are low. Heart size is mildly enlarged. The mediastinal contour is unchanged. There has been interval increase in size of the pleural effusion on the right, now moderate, with associated right basilar opacity likely reflective of compressive atelectasis. Patchy left basilar opacity may also reflect atelectasis. Crowding of bronchovascular structures is demonstrated without overt pulmonary edema. No acute osseous abnormality is detected.", "output": "Low lung volumes. Increased size of right pleural effusion, now moderate with bibasilar patchy airspace opacities, likely atelectasis." }, { "input": "In comparison to the prior radiograph, lung volumes are reduced, accentuating the pulmonary vasculature and cardiac contour. With there is consideration, there appears to be pulmonary vascular congestion, but no pleural effusions. No evidence of pneumonia.", "output": "Low lung volumes with suggestion of pulmonary vascular congestion, but no pleural effusion." }, { "input": "Hypoinflated lungs with perihilar interstitial prominence consistent with vascular crowding. No pleural effusion pneumothorax. Prominence of the heart is likely related to low lung volume. New left lower lobe and retrocardiac opacity is noted. Mediastinal contour and hila are otherwise unremarkable. Visualized osseous structures are unremarkable and upper abdomen is within normal limits.", "output": "1. New left lower lobe and retrocardiac opacities most consistent with atelectasis however superinfection cannot be excluded. Clinical correlation is recommended. 2. Hypoinflated lungs." }, { "input": "The lungs are clear. There is no evidence of pneumonia, pneumothorax, or pleural effusion. Cardiac silhouette is normal in size.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Large right pleural effusion has worsened. Right basilar consolidation, similar. Shallow inspiration accentuates heart size, pulmonary vascularity. More prominent retrocardiac atelectasis.", "output": "Large right pleural effusion, worsened" }, { "input": "Cardiac silhouette size is normal. Mediastinal and hilar contours are unchanged. No overt pulmonary edema is present. There is persistent small right pleural effusion with associated right basilar atelectasis. Left lung is clear. No pneumothorax is present. No acute osseous abnormalities demonstrated.", "output": "Small right pleural effusion, not substantially changed in the interval, with associated right basilar atelectasis." }, { "input": "Heart size is top-normal. The mediastinal and hilar contours are similar. There is mild pulmonary vascular congestion without frank pulmonary edema. A small right pleural effusion is decreased in size compared to the previous study. Patchy opacity within the right lower lobe may reflect atelectasis, but infection is not excluded in the correct clinical setting. No additional focal consolidation, left-sided pleural effusion, or pneumothorax is detected. There are no acute osseous abnormalities.", "output": "Mild pulmonary vascular congestion with small right pleural effusion, decreased in size compared to the prior exam, and associated right basilar atelectasis. Please note that infection in the right lung base cannot be excluded in the correct clinical setting." }, { "input": "A moderate size right pleural effusion is new in the interval with associated right basilar opacity, likely compressive atelectasis though infection cannot be excluded. Heart size is difficult to assess given the presence of the pleural effusion that appears at least mildly enlarged. The mediastinal and hilar contours remain unchanged with no pulmonary edema noted. The left lung is clear. No pneumothorax is identified.", "output": "New moderate size right pleural effusion with right basilar opacity likely reflective of compressive atelectasis but infection cannot be excluded." }, { "input": "AP upright and lateral views of the chest provided. There is a large right pleural effusion with associated atelectasis in the right lower lung. Please note, pneumonia difficult to exclude. Lung volumes are low. No convincing signs of pneumonia in the left lung. Heart size is difficult to assess. Mediastinal contour is unchanged. Bony structures are intact.", "output": "Large right pleural effusion with consolidation in the right lower lung concerning for atelectasis and/or pneumonia." }, { "input": "Compared to chest radiographs from ___, lung volumes have improved, as well as left pleural effusion and bibasilar atelectasis. No appreciable effusion on the right. Moderate cardiomegaly is unchanged. There is no central vascular congestion or overt pulmonary edema. No focal consolidation. No pneumothorax. Significant dilatation of the descending thoracic aorta is consistent with known thoracic aortic aneurysm, better assessed on prior CT.", "output": "1. Significantly improved left pleural effusion and bibasilar atelectasis. 2. Stable moderate cardiomegaly. 3. Stable appearance of dilated descending thoracic aorta, consistent with known thoracic aortic aneurysm, better characterized on prior CT." }, { "input": "There is enlargement of the proximal descending aorta/aortic knob, consistent with known aortic aneurysm, stable since radiograph performed earlier today. No pulmonary edema is seen. There is bibasilar and left mid lung atelectasis/scarring. No pleural effusion or pneumothorax is seen.", "output": "Enlargement of the aortic knob/ proximal descending aorta, consistent with known aortic aneurysm. Bibasilar atelectasis." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette and hilar contours are normal. There is no pleural effusion or pneumothorax. No definite rib fracture is identified. There is no free air under the diaphragm. A sclerotic lesion is seen at the left humerus, partially visualized and likely represents an enchondroma.", "output": "No acute cardiopulmonary process. No definite rib fracture seen. Dedicated rib series may be performed if indicated. RECOMMENDATION(S): Dedicated rib series if further evaluation is needed." }, { "input": "The patient is status post median sternotomy and CABG. The cardiac silhouette size is top normal. Mediastinal and hilar contours are within normal limits. There is calcification of the aortic knob. The pulmonary vasculature is normal. Linear opacities in the left lung base likely reflect subsegmental atelectasis. No pleural effusion, focal consolidation or pneumothorax is identified. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Portable AP chest radiograph. Mild interstitial edema is unchanged, but small bilateral pleural effusions have slightly increased in the interim. Median sternotomy wires are intact. There is no pneumothorax. Heart size remains normal.", "output": "Stable mild interstitial pulmonary edema with slight interval increase in pleural effusions." }, { "input": "The patient is status post median sternotomy and CABG. Cardiac and mediastinal silhouettes are stable. There are aortic calcifications. No focal consolidation, pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "AP view of the chest provided. Since prior study from 1 day ago, bibasilar opacities have decreased. Cardiomediastinal and hilar structures are otherwise stable. There are no pleural effusions.", "output": "Substantial iimprovement in bibasilar opacities since 1 day ago." }, { "input": "Median sternotomy wires and vascular clips are again demonstrated. A small calcified granuloma projects over the right lung apex, stable in size and appearance. Lung volumes are somewhat low and there are bibasilar opacities, which may represents atelectasis however infection should be considered in the appropriate clinical setting. There is no large effusion or pneumothorax.", "output": "Low lung volumes with bibasilar, somewhat nodular opacities which are concerning for bronchopneumonia. Consider repeat chest radiographs (PA and lateral, with improved inspiration. NOTIFICATION: ." }, { "input": "No consolidation, pleural effusion or pulmonary edema is seen, and the cardiac and mediastinal contours are normal. Aortic calcifications are seen. Median sternotomy wires are intact, and left basilar atelectasis is seen.", "output": "No acute cardiopulmonary disease including pneumonia." }, { "input": "AP upright and lateral views of the chest provided. Midline sternotomy wires and mediastinal clips are again seen. A tiny calcified granuloma projects over the right lung apex. The left heart border is partially obscured likely due to the presence of a fat pad. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The patient is status post coronary artery bypass graft surgery. The cardiac, mediastinal and hilar contours are stable. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The patient is status post CABG as well as median sternotomy. Aortic knob is calcified. Left lower lobe atelectasis is stable. Cardiac size is normal. Hilar contours are unremarkable. No pleural effusion, pneumothorax, evidence of pneumonia.", "output": "No acute cardiopulmonary process." }, { "input": "Compared with ___ at 05:05, there may have been minimal improvement in the bibasilar left-greater-than-right opacities, but the overall appearance is similar. No new opacity and no gross effusion is identified. Upper zone redistribution, without other evidence of CHF, not significantly changed. Cardiomediastinal silhouette, with sternotomy wires, unchanged.", "output": "Minimal interval improvement in bibasilar left-greater-than-right opacities." }, { "input": "Portable upright view of the chest demonstrates normal lung volumes without pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unchanged. Heart size is top normal. No pulmonary edema. Patient is status post medial sternotomy.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs were obtained. The lung volumes are decreased since the most recent exam, which accentuates the pulmonary vascular markings. Otherwise, the lungs are clear. Heart and mediastinal contours are normal. The patient is status post coronary artery bypass. Midline sternotomy wires are intact. Minimal aortic arch calcifications are identified.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs demonstrate clear lungs. Opacity at the left base likely reflects minimal atelectasis. There is no pleural effusion, or pneumothorax. The cardiac silhouette is top normal in size, the mediastinal contours are unchanged. Median sternotomy wires remain in place.", "output": "Clear, well-expanded lungs with the exception of minimal left greater than right basilar atelectasis." }, { "input": "PA and lateral chest radiographs demonstrate low lung volumes. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "An esophageal stent, new since prior study extends from the sternal notch to the level of the mid esophagus 4cm below the carina. A right upper extremity PICC terminates in the upper SVC, as before. A left main stem bronchus stent appears to have migrated cranially since ___ with the proximal end now situated within the lower trachea 1cm above the carina. Lungs are well inflated and clear. Cardiomediastinal silhouette and hilar contours are stable. There is no pleural effusion or pneumothorax. Visualized upper abdomen is unremarkable.", "output": "1. Interval placement of an esophageal stent extending from the sternal notch to the level of the mid esophagus 4cm below the carina. 2. Slight cranial migration of the left mainstem bronchus stent with the proximal end now situated in the lower trachea 1cm above the carina. NOTIFICATION: Findings were discussed with Dr.___ by Dr.___ ___ telephone at 2:40pm on ___, 20 minutes following discovery." }, { "input": "An esophageal stent appears unchanged. There is also a stent along the left mainstem bronchus that appears unchanged. The cardiac, mediastinal and hilar contours appear stable there is no pleural effusion or pneumothorax. The lungs appear clear. The chest is hyperinflated. There has been no significant change.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Heart size is normal. The aorta is mildly tortuous and demonstrates mild atherosclerotic calcifications. Mediastinal and hilar contours are otherwise within normal limits. The pulmonary vasculature is normal. Lungs are hyperinflated suggestive of COPD. Volume loss in the right lung with elevation of the right hemidiaphragm is new compared to the prior study and compatible with a history of the right lower lobe wedge resection. Streaky opacities are seen within the right lung base which may reflect atelectasis or scarring. No focal consolidation, pleural effusion or pneumothorax is identified. No acute osseous abnormalities detected.", "output": "Streaky right basilar opacities may reflect atelectasis and/or scarring. Hyperinflation of the lungs suggestive of underlying COPD." }, { "input": "The lungs are clear however hyperexpanded. Suggestion of the right lower lobe nodule was better evaluated on the concurrently obtained CT. No evidence of pneumonia, pulmonary edema, effusions. No subdiaphragmatic free air.", "output": "Clear, hyperinflated lungs with suggestion of right lower lobe nodule better evaluated on the concurrently obtained CT." }, { "input": "Since the prior radiograph, the IABP has been removed. ET tube, NG tube, and left PICC line catheter are unchanged. A Swan-Ganz catheter tip is seen in the right main pulmonary artery. Again seen are bilateral diffuse hazy opacities with haziness at the bases, which could represent pleural effusion. The cardiomediastinal silhouette is grossly unchanged.", "output": "Removal of IABP. Otherwise, no significant change." }, { "input": "Frontal and lateral views of the chest. There is new focal opacity at the left cardiophrenic angle. Elsewhere, the lungs are clear without effusion or pulmonary vascular congestion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is detected.", "output": "Focal opacity in the lingula which may represent pneumonia. Recommend repeat after treatment to document resolution." }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified. There is no free intraperitoneal air.", "output": "No acute cardiopulmonary process." }, { "input": "No previous images. The heart is normal in size and the lungs are clear without vascular congestion or pleural effusion.", "output": "No acute radiographic abnormality." }, { "input": "Suspected trace pleural unilateral pleural effusion is seen on lateral view only, probably on the left side. No focal consolidation or pneumothorax is detected. Heart and mediastinal contours are within normal limits.", "output": "Suspected trace unilateral pleural effusion, which is highly non-specific although can be seen with pulmonary embolism. Discussed with ___ by ___ by phone at 2:42 p.m. on ___ at time of initial review of the study." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. On the lateral view, there is a somewhat nodular opacity projecting over mid thoracic vertebral body. There is no definite corresponding abnormality on the frontal view. The lungs otherwise appear clear. There is mild cardiomegaly. There is tortuosity of the descending thoracic aorta. No acute osseous abnormality is identified.", "output": "Vague rounded opacity projecting over a mid thoracic vertebral body, the location of this is uncertain, potentially within the bone or overlying lung parenchyma. Non-urgent low-dose chest CT suggested for further characterization." }, { "input": "Heart size is top-normal with mildly tortuous aorta with atherosclerotic calcifications. Hilar contours are normal. Small bilateral pleural effusions are unchanged with stable bibasilar opacities. There is no pneumothorax.", "output": "Stable small bilateral effusions with unchanged bibasilar opacities. Infection cannot be excluded given the appropriate clinical circumstance. Lateral views of the chest would help to distinguish the extent of parenchymal opacities over effusion." }, { "input": "The heart is mildly enlarged with a left ventricular configuration. Indistinct prominent pulmonary vascularity suggests mild fluid overload. The lungs are hyperinflated. Small bilateral pleural effusions are suspected. In addition, referring medial right lower lobe, and perhaps with medial left lower lobe opacity as well, there is a fairly confluent opacity suggestiveof pneumonia in the appropriate clinical setting, although substantial atelectasis could be considered. Fissures appear thickened. Findings are new since the recent prior examination.", "output": "Findings suggesting vascular congestion. Basilar opacities, pneumonia versus atelectasis." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. There is mild calcification of the aortic knob. There is mild tortuosity of the descending aorta. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable view of the chest. There are new regions of consolidation at the lung bases in the retrocardiac region and silhouetting the descending thoracic aorta as well as the right lung base medially. Superiorly the lungs are grossly clear. The cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications noted at the arch. No acute osseous abnormalities detected.", "output": "Bibasilar regions of consolidation compatible with infection in the proper clinical setting. Recommend repeat after treatment to document resolution." }, { "input": "Portable AP upright chest radiograph obtained. Overlying EKG leads are present, which somewhat limit the evaluation. The lungs appear clear. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is normal. Faint atherosclerotic calcification again noted along the aortic knob. Bony structures intact.", "output": "No acute findings in the chest." }, { "input": "Cardiomediastinal and hilar contours are normal. Lungs demonstrate stable hyperinflation without paucity of the upper lung zones to suggest COPD. Lungs are clear. No pleural effusion or pneumothorax evident.", "output": "Stable hyperinflation of lungs. No focal opacifications. Please note chest radiographs are not sensitive for subtle interstitial lung disease or endobronchial lesions. If continued clinical concern, recommend evaluation with HRCT." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is no focal consolidation.", "output": "No evidence of pneumonia or pneumothorax." }, { "input": "There are relatively low lung volumes. There is persistent blunting of the costophrenic angle suggesting trace pleural effusions. Minimal bibasilar atelectasis is seen. There is no focal consolidation or pneumothorax. The cardiac and mediastinal silhouettes are stable and unremarkable.", "output": "Low lung volumes with persistent blunting of the costophrenic angles may be due to trace pleural effusions. Minimal bibasilar atelectasis." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. The lungs are clear. Cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable. No free air is seen below the diaphragm.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest are provided. Lung volumes are low with basilar atelectasis noted. No signs of pneumonia or CHF. No large pleural effusions are seen. There is blunting of the CP angles, which could indicate tiny effusions. Cardiomediastinal silhouette appears grossly stable. Bony structures are intact. No free air is seen below the right hemidiaphragm.", "output": "Low lung volumes with basilar atelectasis and tiny effusions." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear unchanged. The lung volumes are low. Plate-like opacities at the lung bases are most consistent with minor atelectasis or scarring. There is no definite pleural effusion or pneumothorax, however.", "output": "No evidence of acute disease." }, { "input": "An endotracheal tube terminates 3.6 cm above the carina. A left subclavian catheter courses to the level of the caval atrial junction. An enteric tube is seen coursing into the stomach and out of the field of view. The lungs are well expanded. There has been no change in the widespread pneumonia from yesterday evening. No pneumothorax or definite pleural effusion. Cardiac silhouette is mildly enlarged and slightly bigger from yesterday evening, probably related to volume status. Mild pulmonary edema is unchanged. Small bilateral effusion are presumed. The mediastinal and hilar contours are unchanged.", "output": "Minimal increase in mild cardiomegaly without change in mild pulmonary edema from yesterday evening." }, { "input": "Portable AP upright chest film dated ___ at 05:47 is submitted.", "output": "Tracheostomy tube unchanged in position. Bilateral diffuse parenchymal opacities are more confluent in the left upper lung and in the right mid and lower lung. When compared to the prior study, there is no significant interval change given differences in technique and positioning. No pleural effusions or pneumothoraces are seen. Overall cardiac and mediastinal contours are likely stable given patient rotation on the current study." }, { "input": "Portable supine chest film ___ at 05:04", "output": "The tracheostomy tube remains in satisfactory position. There continues to be bilateral diffuse parenchymal opacities with more focal confluent area in the left upper lung. Overall, the aeration may have slightly improved in the left upper lung when compared to the most recent prior study. No pleural effusions. No large pneumothorax, although the sensitivity to detect pneumothorax is diminished given supine technique. Overall cardiac and mediastinal contours are unchanged given patient rotation." }, { "input": "The ET tube and NG tube are unchanged. There is improved aeration bilaterally with interval clearing of the alveolar edema. There is tiny bilateral pleural effusions.", "output": "Improved appearance to the chest." }, { "input": "Portable AP upright chest film ___ at 16 59 is submitted.", "output": "Tracheostomy tube is unchanged in position. The bilateral diffuse parenchymal opacities with more confluent consolidation in the left upper lobe and at the right base do not appear to be significantly changed. There is some prominence of the interstitium peripherally in the right lung but this also does not appear to be changed. No large effusions and no pneumothorax. Overall cardiac and mediastinal contours are likely stable given marked patient rotation to the left." }, { "input": "There is air under the right hemidiaphragm which could the due to recent instrumentation (PEG tube placement). The left upper lung opacity is more prominent as compared to prior. The right lower lung opacity is less prominent. There has been interval removal of the NG tube and left subclavian line.", "output": "Air under the right hemidiaphragm likely related to recent instrumentation. Left upper lung opacity is more prominent while the right lower lung opacity abutting the hemidiaphragm is slightly improved." }, { "input": "A tracheostomy tube terminates at midline. Bilateral diffuse parenchymal opacities have improved with more confluent consolidation seen at the left upper lobe and right lung base. No large pleural effusion or pneumothorax is identified. The cardiomediastinal and hilar contours are stable.", "output": "Persistent improvement of diffuse bilateral parenchymal opacities." }, { "input": "PA and lateral chest radiograph demonstrate clear lungs bilaterally. Cardiomediastinal and hilar contours are within normal limits. There is no pleural effusion or pneumothorax. There is no evidence of pulmonary edema.", "output": "No acute intrathoracic abnormality." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Cardiac and mediastinal silhouettes are stable and unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were obtained. Heart is normal in size, and cardiomediastinal silhouette is stable. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "The endotracheal tube tip is at the level of the right mainstem bronchus orifice. Orogastric tube tip is within the stomach as is the sideport. Heart size is normal. Mediastinal and hilar contours are unremarkable. Minimal patchy opacity in the right lung base likely reflects atelectasis. There is no pleural effusion or pneumothorax. No pulmonary vascular congestion is present.", "output": "1. Endotracheal tube tip is at the orifice of the right mainstem bronchus. 2. Standard position of the orogastric tube. 3. Probable atelectasis in the right lung base." }, { "input": "The endotracheal tube has been withdrawn with tip now lying approximately 3.8 cm from the carina. An orogastric tube again remains within the stomach. The cardiac, mediastinal and hilar contours are unchanged. Patchy opacities are present within both lung bases, likely atelectasis. No pleural effusion or pneumothorax is seen.", "output": "Interval withdrawal of the endotracheal tube with tip now in standard position." }, { "input": "Since ___, bilateral chest tubes have been removed. Linear atelectasis is noted in the bilateral lower lungs following wedge resections. A small right apical pneumothorax is noted. No pleural effusions are seen. The cardiomediastinal silhouette is normal. An epidural is seen on the left.", "output": "1. Small right apical pneumothorax is noted. 2. Bilateral linear atelectasis in the lower lungs. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the ___ ___ at 12:16 PM, 10 minutes after discovery of the findings." }, { "input": "Chest PA and lateral radiograph demonstrates interval removal of a left-sided chest tube without evidence of pneumothorax. Cardiomediastinal and cardiac silhouettes are unremarkable. Stable plate-like atelectasis noted in the left lower lobe. The known left lower lobe pulmonary nodules are below the level of resolution of chest radiograph. No pleural effusion evident. No osseous abnormalities are identified.", "output": "Interval removal of left-sided chest tube without development of pneumothorax." }, { "input": "The lung volumes are normal. Normal size of the cardiac silhouette. Normal hilar and mediastinal structures. . No pneumonia, no pulmonary edema. No pleural effusions.", "output": "Normal chest radiograph without pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 11:18 AM, 5 minutes after discovery of the findings." }, { "input": "Lung volumes remain low although slightly improved compared to the prior study. A calcified thyroid nodule is again noted. A right-sided PICC terminates in the upper right atrium/cavoatrial junction. There are patchy airspace opacities throughout the left lung, similar in appearance when compared to the prior study. Opacities in the right lung are less conspicuous than on the prior study. No definite pleural effusion, no pneumothorax seen.", "output": "Persistent bilateral airspace opacities with slight improvement in aeration of the right lung." }, { "input": "A calcified thyroid nodule is noted to the left of the trachea. A right sided PICC terminates in the distal SVC. The cardiomediastinal contour is unchanged. The previously seen right basal airspace opacity has now resolved. There is persistence of the left basal airspace opacity, this may reflect asymmetric pulmonary edema or infection. No pneumothorax seen. No definite pleural effusion.", "output": "Improvement in the right basal consolidation when compared to the prior study, persistent left basal consolidation." }, { "input": "Portable AP chest radiograph demonstrates an left IJ catheter terminating in the right atrium. The lungs are clear. There is mild cardiomegaly. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process. Results were relayed to Dr. ___." }, { "input": "PA and lateral views of the chest. Right PICC line ends in the low SVC. The lungs are clear. No evidence of pneumonia. Mild cardiomegaly is stable. Mediastinal and hilar contours are normal. No pleural effusions or pneumothorax.", "output": "No evidence of pneumonia. These findings were discussed with Dr. ___ at 3:30pm on ___ by telephone." }, { "input": "Right PICC line terminates in the proximal right atrium. Lung volumes are low. There is no focal consolidation or effusion. No pneumothorax or pneumomediastinum. Mediastinal and hilar contours are stable. Heart size is normal. Anterior compression fracture of L2 vertebral body is unchanged.", "output": "No acute intrathoracic process." }, { "input": "Since ___, multifocal bilateral opacities are improved, left greater than right, with mild bibasilar atelectasis. Lung volumes are somewhat low, but not significantly changed since prior exams. No new definite opacity is seen. The heart is top normal in size. No pleural effusions or pneumothorax. A calcified left thyroid nodule is again noted. Right PIC line is identified with the tip in the right atrium.", "output": "1. Multifocal pneumonia is improved. 2. The tip of the PICC line projects over the right atrium. 2 repositioned at the cavoatrial junction, the line needs to be pulled back by approximately 1-2 cm." }, { "input": "PA and lateral radiographs of the chest demonstrate clear lungs. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal. The hilar and cardiomediastinal contours are normal. The Hickman catheter positioning is unchanged, with the catheter tip terminating in mid SVC.", "output": "Normal radiograph of the chest. NOTE: Findings were communicated to Dr. ___ by Dr. ___ ___ telephone on ___ at 10:53 a.m." }, { "input": "In comparison to prior radiograph, the left-sided central line has been retracted and now the tip is located at the confluence of the right and left subclavian and left brachiocephalic. Lung volumes are relatively low. Cardiomediastinal silhouette and hilar contours appear unremarkable. No focal opacities are noted to be concerning for an infectious process. There is no pneumothorax. The bones are intact.", "output": "Retracted central line as described above. Otherwise, no acute cardiopulmonary process." }, { "input": "Left-sided PICC line with its tip oriented superiorly within the azygous vein (confirmed with ___ CT) and should be withdrawn 2 cm. Mediastinal, hilar and cardiac contours are unremarkable. Lungs are clear with interval improved aeration of the retrocardiac space. No pleural effusion or pneumothorax evident. Stable calcifications identified within the region of the left thyroid lobe and correlated with ___ chest CT.", "output": "Left PICC line is kinked and oriented superiorly within the azygous vein and should be withdrawn 2 cm to terminate in the mid superior vena cava. ___ discussed these ___ with Dr ___ at 13:00 on ___." }, { "input": "ET tube is 2.0 cm above the level of the carina. NG tube with side port at level of left hemidiaphragm with tip in proximal stomach. No pneumothorax or pleural effusion. Stable healed fractures of lateral left sixth and seventh ribs. No additional bony abnormality.", "output": "NG tube with side ports at level of left hemidiaphragm, would need to be advanced 5cm to place side ports below diaphragm." }, { "input": "The lungs are well expanded. There is scattered mild cuffing of the airways, which is consistent with a history of asthma. The lungs are otherwise clear. Cardiomediastinal silhouette is unremarkable. There is no pneumothorax or pleural effusion. Visualized osseous structures are unremarkable.", "output": "No acute cardiopulmonary process. No evidence of pneumonia or fluid overload." }, { "input": "Low lung volumes cause bronchovascular crowding. There is no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal contour is normal.", "output": "Low lung volumes. No acute cardiopulmonary process." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. The pulmonary vascularity is normal. Streaky opacities in both lower lobes likely reflect atelectasis. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormalities are detected.", "output": "Mild bilateral lower lobe atelectasis. Otherwise no acute cardiopulmonary abnormality." }, { "input": "PA and lateral upright chest radiograph demonstrates no focal opacity convincing for pneumonia. Cardiomediastinal and hilar contours are within normal limits. There is no evidence of overt pulmonary edema. There is no pleural effusion or pneumothorax. Osseous structures demonstrate no acute abnormality.", "output": "No acute intrathoracic abnormality." }, { "input": "There is a small right pleural effusion seen. There is right greater than left vascular congestion with left lower lobe atelectasis. Findings are consistent with mild vascular congestion secondary to increased volume status. Cardiomediastinal silhouette demonstrates tortuous calcified aorta otherwise is within normal limits. Pleural surfaces are unremarkable. Dense bilateral calcifications of the carotids are seen. Study is somewhat limited by a number of overlying wires and cables.", "output": "Bilateral mild vascular congestion with small right pleural effusion. No evidence of pneumonia." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. A pigtail drainage catheter has been placed in the lower left pleural space. The large majority of a loculated pleural effusion has been drained with a moderate residual quantity and parenchymal opacity which can probably be attributable to atelectasis, although an infectious etiology is not excluded by this study. Elsewhere, the lungs remain clear. A small pleural effusion on the right is unchanged. There is no pneumothorax.", "output": "Marked improvement in left pleural effusion following placement of catheter." }, { "input": "Left pigtail pleural catheter remains in place in the lower left hemithorax, but a moderate-to-large partially loculated pleural effusion has increased in size since the previous study. Additionally, there is a suggestion of a tiny pneumothorax at the left lung apex. New airspace opacities are present in the left perihilar region, and could reflect reexpansion edema considering that the prior study was obtained immediately after placement of pigtail catheter with associated large reduction in volume of left pleural effusion. Persistent blunting of right lateral costophrenic sulcus consistent with small pleural effusion. Adjacent patchy opacity at right base may reflect atelectasis or early pneumonia.", "output": "Enlarging loculated left pleural effusion. Left perihilar airspace opacity, possibly due to reexpansion edema considering recent large volume reduction in pleural fluid one day earlier." }, { "input": "Large left upper to mid lung consolidation and medial right mid to lower lung consolidation most consistent with multifocal pneumonia. Difficult to exclude trace right pleural effusion. No large left pleural effusion is seen. There is no pneumothorax. The cardiac silhouette is not enlarged. Slight prominence at the AP window may be due to underlying mediastinal lymph node. The superior mediastinum is otherwise not widened.", "output": "Multifocal pneumonia possible AP window lymphadenopathy. Recommend followup to resolution." }, { "input": "An enteric tube is seen with its proximal port in the midesophagus, terminating approximately at the GE junction. Linear opacities in bibasilar lungs, right worse, are likely from atelectasis, increased from prior. Small left pleural effusion is likely. Heart size is unchanged. There is no evidence for pulmonary edema or pneumothorax.", "output": "1. Increased bibasilar atelectasis. 2. Enteric tube terminating in GE junction and should be advanced at least 10 cm to be in the stomach to move all the side ports into the stomach. RECOMMENDATION(S): Enteric tube terminating in midesophagus and should be advanced at least 10 cm to be in the stomach. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the ___ ___ at 1:48 PM, 20 minutes after discovery of the findings." }, { "input": "There relatively low lung volumes. Bibasilar atelectasis is seen. Bibasilar opacities may be due to atelectasis although underlying mild aspiration is not excluded. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. No evidence of free air beneath the diaphragms.", "output": "Relatively low lung volumes and bibasilar atelectasis. Mild basilar aspiration not excluded. No evidence of free air beneath the diaphragms." }, { "input": "Linear retrocardiac opacity likely represents atelectasis. The lungs are otherwise clear and the cardiomediastinal contours are normal. Heart size is top normal. No pleural effusion or pneumothorax. No subdiaphragmatic free air is seen.", "output": "Left lung base opacity likely represents atelectasis. No evidence of pneumonia. Heart size is top normal." }, { "input": "There is severe cardiomegaly. Aortic knob calcifications are noted. There is no pneumothorax. Small bilateral pleural effusions are likely. Severe pulmonary edema is present. Underlying pneumonia cannot be excluded. The upper abdomen is unremarkable.", "output": "Severe pulmonary edema with severe cardiomegaly. Small pleural effusions are likely present. Pneumonia is not excluded." }, { "input": "PA and lateral views of the chest provided. Lungs are well inflated and grossly clear. No pleural effusion or pneumothorax. Hilar and cardiomediastinal contours are normal.", "output": "Normal chest radiograph." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for pneumonia. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No acute intrathoracic abnormalities identified." }, { "input": "PA and lateral chest radiographs were provided. There is no focal consolidation, pneumothorax or concerning lung lesions. The previously seen very small pleural effusions have resolved. The cardiomediastinal silhouette is normal. The osseous structures are unremarkable.", "output": "No evidence of pleural effusions or intrathoracic abnormality." }, { "input": "Single portable view of the chest. No prior. Endotracheal tube tip is seen 3.5 cm from the carina. The lungs are grossly clear. The cardiomediastinal silhouette is within normal limits, noting a tortuous descending thoracic aorta. The osseous structures are grossly unremarkable. Surgical clips are seen in the right axillary region.", "output": "Endotracheal tube tip 3.5 cm from the carina. No definite acute cardiopulmonary process." }, { "input": "The when compared to ___ chest radiograph, both lung volumes are low. There is interval development of small (left greater than right) pleural effusions. However there are no consolidations nor opacities to suggest pneumonia. The cardiomediastinal and hilar contours are normal. There is no pneumothorax.", "output": "1. There is interval development of small (left greater than right) pleural effusions when compared to ___ chest radiograph. However there are no consolidations nor opacities to suggest pneumonia." }, { "input": "PA and lateral views of the chest were obtained. Lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax. The heart size is normal. Mediastinal contour is unremarkable. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process, specifically normal heart size." }, { "input": "The lungs are clear without consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal. No free subdiaphragmatic gas or pneumomediastinum the", "output": "No pneumothorax or other evidence of complication." }, { "input": "PA and lateral chest radiographs were obtained. The tip of a right chest Port-A-Cath terminates at the cavoatrial junction. The lungs are well expanded. There is minimal bibasilar atelectasis. There is no effusion or pneumothorax. Cardiomegally is mild There are no abnormal cardiac or mediastinal contours.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. There has been interval removal of the right-sided internal jugular central venous catheter. There are small bilateral pleural effusions with overlying atelectasis. Minimal pulmonary vascular congestion may also be present, but improved since the prior study. The cardiac silhouette is top normal. The mediastinum is unremarkable. Multilevel degenerative changes are seen along the spine.", "output": "Small bilateral pleural effusions are seen on the lateral view with overlying atelectasis. Pulmonary vascular congestion, but improved since the prior study." }, { "input": "Again is seen a left-sided PICC terminating in the lower SVC. The heart and mediastinal contours are within normal limits. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "Left PICC tip in low SVC." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. Anchor screw is noted overlying the right humeral head. There are degenerative changes along the spine.", "output": "No acute cardiopulmonary process." }, { "input": "The left PICC tip persists at the lower SVC. There has been interval placement of a right-sided central venous catheter whose tip terminates at the upper SVC. There has been interval placement of an endotracheal tube that sits 6 cm above the carina. No endogastric tube is seen projecting over the stomach and it is not definitively seen coursing along the central chest. Otherwise, the heart size and mediastinal contours are within normal limits. The lungs demonstrate bibasilar atelectasis. A left pleural effusion is present, the extent of which is difficult to approximate on a supine exam. Assessment for pneumothorax is limited by positioning as well. The visualized portion of the upper abdomen demonstrates a stent in the right upper quadrant as well as embolization coil material and clips.", "output": "Lines and tubes as described above; advancement of the endotracheal and endogastric tubes is advised with followup radiograph. Findings were discussed with the ordering team at 4 p.m. on ___ by ___ ___ over the phone." }, { "input": "The lungs are well-expanded and clear. No focal consolidation, effusion, or edema. No pneumothorax. The heart is normal in size. The mediastinum is not widened. The hila and pleura are unremarkable. No acute osseous abnormality. Surgical clips project over the left upper abdomen. There appears to be diffuse idiopathic skeletal hyperostosis of the thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is at the upper limits of normal size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There is a suspected trace pleural effusion on the left, but probably not on the right. There is no pneumothorax. A surgical clip projects along the right upper quadrant of the abdomen. Small osteophytes are present along the mid-to-lower thoracic spine.", "output": "Possible trace left-sided pleural effusion, but no evidence of pneumonia." }, { "input": "A right PICC ends in the low SVC. A Dobhoff tube course below the level of the diaphragm and off the inferior aspect of the film. A second enteric tube terminates in the region of the stomach. The cardiomediastinal silhouette is unremarkable. There is no pneumothorax. Lung fields are clear.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Nasogastric tube terminates in the body of the stomach with side-port near the estimated location of the gastroesophageal junction. Post pyloric Dobhoff tube is seen coursing into the jejunum with distal tip out of view. Other support lines, left pleural effusion, and left lower lobe opacification are unchanged.", "output": "Nasogastric tube with side-port at the expected location of the gastroesophageal junction. Advancing the tube by 5 cm is recommended. NOTIFICATION: The wet read was discussed with Dr. ___, M.D. by ___, M.D. on the telephone on ___ at 2:00 PM, at the time of discovery of the findings." }, { "input": "Frontal and lateral views of the chest. Heart size and cardiomediastinal contours are normal. The lungs are clear without focal consolidation, pleural effusion, or pneumothorax. Surgical clips at the hiatus are unchanged.", "output": "No focal consolidation." }, { "input": "In comparison with chest radiograph from a few hours earlier, there has been placement of a nasogastric tube that terminates in the proximal stomach. Right PICC tip terminates in the low SVC. Mild bibasilar atelectasis, more prominent on the left, is unchanged. Otherwise, there is no other relevant change.", "output": "Nasogastric tube terminates in the proximal stomach." }, { "input": "Single portable view of the chest. The lungs are clear of consolidation where not obscured by overlying cardiac leads. The cardiomediastinal silhouette is within normal limits. Surgical clips project over the lower chest/upper abdomen in the midline. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "New nasogastric tube with the first port at the gastroesophageal junction. Dobhoff tube is in the proximal small bowel. Increasing pulmonary vascular congestion and small left pleural effusion. No pneumothorax.", "output": "Nasogastric tube first side port at the gastroesophageal junction." }, { "input": "As compared to chest radiograph from the same day, triangular retrocardiac opacity has not substantially changed, more suggestive of left lower lobe atelectasis. Linear subsegmental atelectasis also has not substantially changed. Small left pleural effusion. Heart size is top normal. Right-sided PICC terminates in the low SVC. Dobhoff tube is only partially imaged below the diaphragm.", "output": "Probable left lower atelectasis and small effusion." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Hilar contours are stable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest demonstrate clear lungs. The cardiac and mediastinal contours are unchanged from the prior radiograph. No pleural abnormality is detected.", "output": "No acute infectious process." }, { "input": "There is again evidence of mild pulmonary venous hypertension. Small pleural effusions have resolved, however. Mediastinal structures are stable.", "output": "Resolution of small pleural effusions." }, { "input": "Lungs are clear. There is no consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. Median sternotomy wires are intact. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Moderate severe cardiomegaly is stable. Widened mediastinum has minimally increased. Mild pulmonary edema has minimal increased. Retrocardiac atelectasis are new. If any there is a small left effusion. ET tube is in standard position. Swan-Ganz catheter tip is in the takeoff of the main pulmonary artery. NG tube tip is out of view below the diaphragm.", "output": "Pulmonary edema. No pneumothorax" }, { "input": "Compared to chest radiographs from ___, there is no significant change. Patient is status post CABG with median sternotomy wires in place. There is no focal consolidation, pleural effusion or pneumothorax. No central vascular congestion or overt pulmonary edema. Mediastinal and hilar contours are stable. Moderate cardiomegaly is unchanged.", "output": "1. No acute intrathoracic process. 2. Stable moderate cardiomegaly." }, { "input": "PA and lateral views of the chest provided. Midline sternotomy wires and mediastinal clips are again noted. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is stable with top-normal heart size. . Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Lung volumes are slightly low, with blunting of the costophrenic angles bilaterally, representative of small pleural effusions, and adjacent atelectasis. There is slight thickening of the horizontal and oblique fissures, and mild pulmonary venous congestion with peribronchial cuffing. The heart size is stable. There is no pneumothorax.", "output": "Mild fluid overload with bilateral pleural effusions." }, { "input": "PA and lateral radiographs were acquired. The lungs are clear. The cardiac and mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen.", "output": "No acute process." }, { "input": "Lung volumes are low. No focal consolidation, pleural effusion, or pneumothorax is seen. Low lung volumes exaggerate the cardiac silhouette. Mediastinal contours are within normal limits.", "output": "Low lung volumes without radiographic evidence for acute cardiopulmonary process." }, { "input": "Lungs are well-expanded and clear. Cardiomediastinal silhouette is unremarkable. There is no pleural effusion, pulmonary edema, pneumothorax, or focal consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well expanded and clear bilaterally with increased opacity in the lower lung fields most likely secondary to breast tissue attenuation. The previously seen right-sided PICC has been removed. Cardiomediastinal silhouette is unchanged and within normal limits. The pleural surfaces are unremarkable. No osseous abnormalities are identified.", "output": "No evidence of infection or malignancy." }, { "input": "Cardiomediastinal silhouette and hilar contours are normal. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "Normal chest radiograph; specifically, no evidence of pneumonia." }, { "input": "The left internal jugular central venous catheter tip projects in the 3.3 cm below the cavoatrial junction. Mild pulmonary vascular engorgement without interstitial pulmonary edema is stable. There are no new focal opacities. There are no pleural effusions or pneumothorax. The cardiomediastinal and hilar contours are stable, demonstrating left atrial enlargement. The right approach PICC has been removed.", "output": "1. No evidence of focal pneumonia. 2. The tip of the central venous catheter is 3.3cm below the cavoatrial junction." }, { "input": "Single portable view of the chest. The lungs are essentially clear, noting that the retrocardiac region is not well assessed, likely due to overlying soft tissues/technique. The cardiomediastinal silhouette is stable. Atherosclerotic calcifications again noted at the arch.", "output": "No definite acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. Relatively low lung volumes are again noted. The lungs are clear consolidation or effusion. Left chest wall single lead pacing device is identified. Cardiomediastinal silhouette is unchanged. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "Left-sided AICD is stable in position. Cardiac and mediastinal silhouettes are stable. No focal consolidation is seen. No pleural effusion or pneumothorax. No pulmonary edema is seen.", "output": "No significant interval change." }, { "input": "The lung volumes are low. The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Mild wedging of a thoracolumbar vertebral body appears likely chronic.", "output": "No evidence of acute disease." }, { "input": "The cardiac silhouette size is normal. The mediastinal and hilar contours are unchanged, with the aorta demonstrating diffuse calcifications. The hilar contours are normal, and the pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest demonstrate the lungs are well expanded and clear. The cardiomediastinal silhouette is unremarkable. There is no pleural effusion, pulmonary edema, pneumothorax, or focal opacification within the lungs. The aorta is somewhat tortuous and aortic knob calcifications are noted. No displaced fractures are identified.", "output": "No acute cardiopulmonary process. No evidence of fracture." }, { "input": "Lower lung volumes seen on the frontal exam when compared to prior with secondary right basilar opacity compatible with atelectasis. On the lateral view the lungs are clear. There is no focal consolidation or large effusion. The cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications noted within the thoracic aorta which is tortuous. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest demonstrate normal heart size, mediastinal and hilar contours. No pleural effusion or pneumothorax. The lungs are hyperinflated but clear.", "output": "No pneumonia." }, { "input": "The field of view is tailored to visualization of a nasogastric tube and does not completely image the lung parenchyma. A nasogastric tube passes into the stomach where it makes a single coil. To the extent visualized, the cardiac, mediastinal, and hilar contours appear unchanged. The partly visualized left costophrenic sulcus shows slight blunting so there may be a small pleural effusion.", "output": "Nasogastric tube terminating in the stomach, where it makes a single coil. Possible small left-sided pleural effusion but not well assessed." }, { "input": "Frontal and lateral radiographs of the chest demonstrate severe thoracic spine kyphosis. Small bilateral pleural effusions are seen, right greater than left. The cardiac contour is enlarged. There is prominence of the azygos vein resulting in fullness of the right mediastinum. No focal consolidation concerning for pneumonia is seen. No pneumothorax is appreciated. Surgical clips are noted overlying the right breast.", "output": "Small bilateral pleural effusions with no focal consolidation. Vascular congestion with enlarged cardiac silhouette." }, { "input": "There are moderate bilateral pleural effusions with overlying atelectasis, underlying basilar consolidation is not excluded in the appropriate clinical setting. The cardiomediastinal silhouette is grossly stable. There is minimal pulmonary vascular congestion. No evidence of pneumothorax is seen.", "output": "Bilateral pleural effusions with overlying atelectasis, underlying consolidation not excluded. Possible mild vascular congestion." }, { "input": "Frontal and lateral views of the chest demonstrate normal cardiomediastinal silhouette. The lungs are clear. There is no pneumothorax, vascular congestion, or pleural effusion. No displaced osseous injury is appreciated.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well expanded and clear. There is no focal consolidation, effusion, or pneumothorax. Cardiac and mediastinal contours are normal.", "output": "Normal chest radiograph." }, { "input": "Frontal and lateral views of the chest were obtained. There is subtle increase in interstitial markings bilaterally which could be due to mild interstitial edema or atypical infection. No airspace consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Mild increase in interstitial markings bilaterally could relate to mild interstitial edema, although atypical infection is not excluded. Alternatively, it could relate to underlying chronic lung disease. However, this appears increased compared to ___." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for infection. No pleural effusions or pneumothoraces are identified. The visualized osseous structures are unremarkable.", "output": "No acute intrathoracic abnormality is identified." }, { "input": "The previously moderate left pleural effusion has improved, and is now small. There is no right-sided effusion. Pulmonary edema and pulmonary vascular congestion have resolved. There is stable cardiomegaly. A stent projects over the aortic outflow tract in unchanged position. There is no focal consolidation or pneumothorax.", "output": "Small left pleural effusion, improved." }, { "input": "PA and lateral views of the chest were provided. The lung are clear and well inflated without focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. The imaged osseous structures are intact. No displaced rib fracture is identified.", "output": "No acute findings." }, { "input": "Lungs are clear, the cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax. There is minimal right basilar atelectatic change.", "output": "No acute cardiothoracic process." }, { "input": "Frontal and lateral views of the chest. Equivocal retrocardiac opacity appears to project over the lower thoracic spine on the lateral view. No pleural effusion or pneumothorax. Heart size and cardiomediastinal contours are normal.", "output": "Equivocal retrocardiac opacity could represent atelectasis or pneumonia in the appropriate clinical setting." }, { "input": "PA and lateral chest radiograph demonstrates clear lungs bilaterally. There is no pleural effusion or pneumothorax. Cardiomediastinal and hilar contours are within normal limits. Visualized osseous structures are without acute abnormality.", "output": "No acute intrathoracic abnormality." }, { "input": "Within the left retrocardiac region, projecting lateral to the costochondral calcifications, there is a 5.6 x 2.8 cm radiodense structure of uncertain etiology, possibly related to summation of normal thoracic structures. The lungs are otherwise clear. The heart is top normal in size. The mediastinal contours are normal. There are no definite pleural effusions. No pneumothorax is seen. Marked dextroscoliosis of the thoracic spine is noted.", "output": "1. No acute cardiac or pulmonary process. 2. Indeterminate 5.6 cm amorphous structure projecting over the left retrocardiac region. While this may be related to summation of normal thoracic structures, further evaluation with dedicated PA and lateral radiographs is recommended. Pertinent findings and recommendations were discussed with Dr. ___ by Dr. ___ at 3:35 p.m. via telephone on the day of the study." }, { "input": "AP portable upright chest radiograph obtained. Lung volumes are low. Heart size is enlarged though appears stable with an LV configuration. The lungs appear clear without definite signs of pneumonia or CHF. No large effusion or pneumothorax is seen. Aortic knob calcifications are again noted. Bony structures are intact. Scoliotic deformity of the thoracolumbar spine is again noted.", "output": "Cardiomegaly with LV configuration, unchanged. Scoliosis. No signs of pneumonia." }, { "input": "Cardiac silhouette size is normal. Mediastinal and hilar contours are normal. There is minimal atherosclerotic calcification at the aortic knob. Pulmonary vasculature is normal. Lungs are clear. No focal consolidation, pleural effusion or pneumothorax is demonstrated. Minimal is scarring is noted in the lung apices. There are mild multilevel degenerative changes within the mid thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Portable semi-upright radiograph of the chest demonstrate low lung volumes resulting in bronchovascular crowding. There is no pneumothorax, pleural effusion, or consolidation. The cardiomediastinal contours are unchanged. A right-sided internal jugular central venous line ends in the mid to distal SVC.", "output": "Right-sided internal jugular central venous line ends in the mid to distal SVC" }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is widespread patchy opacity in the left lower lobe consistent with pneumonia. Otherwise, the lungs appear clear. There are no pleural effusions or pneumothorax. The bony structures are unremarkable.", "output": "Findings suggesting pneumonia in the left lower lobe." }, { "input": "Pneumoperitoneum is confirmed and of unclear etiology. No pneumothorax or pneumomediastinum evident. Findings consistent with trapped lung again identified on the left with pleural thickening decreased intercoastal spaces. Multiple opacities in the left upper lobe, lingula and left lower lobe are stable. Decreased density projecting over the left lung may reflect improved inspiratory effort, decreased pulmonary edema .", "output": "1. Pneumopertoneum. This finding was discussed with ___ via telephone at 12:15 on ___ at the time of confirmation. 2. Findings consistent with trapped lung again identified. Minimally decreased left lower lung opacification may reflect decreased atelectasis and possibly decreased pulmonary edema." }, { "input": "Streaky left basilar opacity with volume loss is compatible with scarring as seen on prior exams. Elsewhere, the lungs are clear without consolidation. Cardiomediastinal silhouette is stable. No acute osseous abnormalities.", "output": "Chronic changes at the left lung base. No definite acute cardiopulmonary process." }, { "input": "Left pleural thickening and narrowing of the intercostal spaces are again noted, consistent with trapped lung. There is persistent medial left upper lobe consolidation and small left pleural effusion. Nodular opacity projecting over the left mid lung appears similar and may correspond to the pleural mass seen on chest CT. No new focal consolidation, right pleural effusion, or pneumothorax is detected. There has been interval resolution of radiographically detectable pneumoperitoneum.", "output": "Persistent evidence of trapped left lung, medial left upper lobe consolidation, and small left pleural effusion." }, { "input": "Compared with prior radiographs on ___, a previously seen oval opacity in the mid left lung is no longer visualized.The lungs are clear without focal consolidation. There is chronic fibrosis of the left left lower lung. There are post radiation changes in the right upper lobe. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No pneumonia, pleural effusion, or evidence of progression of intrathoracic metastatic disease." }, { "input": "Portable chest radiograph demonstrates bilateral low lung volumes with assymetry reduction in the left lung volume as well as assymetric increased opacification of left lung density. In the setting of notable left pleural thickening and decreased intercostal spacing, findings are consistent with trapped lung. Focal opacification noted within the lingula corresponds with atelectasis and scarring identified on the ___ CT. No focal opacification evident within the right lung though there may be a small amount of pulmonary edema. The apparent widening of the mediastinum is likely due to medial pleural thickening. The hilar and heart size are unremarkable. Left partial mastectomy evident.", "output": "No pneumothorax. Findings associated with trapped left lung due to thickened pleura." }, { "input": "Single AP upright portable view of the chest was obtained. The patient is status post median sternotomy. Several sternal wires are fractured including the superior to inferior rows as well as the second inferior more wire. There is increased reticulonodular opacity at the lung bases bilaterally, which could be due to aspiration or possibly infection. Dedicated PA and lateral views would be helpful for further evaluation. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Subtle reticulonodular increase in opacity at the lung bases bilaterally, which could be due to aspiration or infection. Dedicated PA and lateral views may be helpful for further evaluation. Possible also focal patchy opacity at the lateral left upper lobe, which could also be related to infection." }, { "input": "PA and lateral views of the chest were obtained demonstrating sternotomy wires. The lungs are hyperinflated and clear. No focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. There is no free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Patient is status post median sternotomy. The cardiomediastinal and hilar contours are within normal limits. As compared to prior chest radiograph from ___, there has been interval improvement of bibasilar opacities. However, subtle basilar opacities persist and may be due to aspiration, underlying emphysema, underlying infectious process is not entirely excluded. There is no pneumothorax or large pleural effusion.", "output": "Improved bibasilar opacities, however subtle basilar opacities persists and these could be due to aspiration, underlying emphysema, underlying infectious process not excluded. Dedicated PA and lateral views would be helpful for further evaluation. If concern for a pulmonary lesion, a non urgent chest CT would be more sensitive." }, { "input": "Cardiomediastinal contours are normal. Lungs are hyperexpanded but grossly clear. New minimal blunting of left costophrenic sulcus may represent a small pleural effusion or focal pleural thickening. Scoliosis is noted.", "output": "No evidence of pneumonia. New minimal blunting of left costophrenic sulcus may represent a small pleural effusion or focal pleural thickening." }, { "input": "PA and lateral views of the chest were obtained demonstrating clear well-expanded lungs without focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours appear normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest were obtained. The heart size and cardiomediastinal contours are normal. The lungs are clear. No focal consolidation, pleural effusion, or pneumothorax. Sternotomy wires and mediastinal clips are intact and unchanged in position.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low. The heart size is top normal and accentuated at due to low lung volumes. The aorta is mildly unfolded. The mediastinal and hilar contours are unremarkable. The pulmonary vasculature is normal. There are minimal linear opacities within the lung bases compatible with subsegmental atelectasis. No focal consolidation, pleural effusion or pneumothorax is seen. There are mild degenerative changes in the thoracic spine.", "output": "Low lung volumes with mild bibasilar atelectasis." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No signs of pneumonia or other acute intrathoracic process." }, { "input": "PA and lateral views of the chest demonstrate the lungs are well expanded, with no evidence of pneumothorax, overt pulmonary edema, or focal consolidation concerning for pneumonia. Coarse interstitial markings are noted bilaterally. The mediastinum is shifted towards the right, likely due to known history of transposition of the great vessels, status post repair. Multiple surgical clips are noted in the left upper quadrant, presumably from prior gastroesophageal hernia repair.", "output": "1. No evidence of pneumonia. 2. Interstitial opacities at the lung bases may reflect atelectasis or chronic changes." }, { "input": "As before, the mediastinal structures are shifted to the right which is a chronic finding. The cardiomediastinal silhouette is unchanged. Prominence of the hila bilaterally is similar. No focal consolidation or pneumothorax is identified. Blunting of the right costophrenic angle is unchanged and no pleural effusion is otherwise identified. Linear atelectasis is seen within the left lung base. Multiple clips are again seen in the left upper quadrant of the abdomen. There are no acute osseous abnormalities demonstrated.", "output": "No interval change from prior with no evidence of pneumonia." }, { "input": "There is increased opacification at the right lung base with progressive rightward shift of mediastinal structures suggesting volume loss. The patient also has history of transposition of the great vessels status post repair. The cardiac silhouette is enlarged but stable. A small right pleural effusion is present. Moderate pulmonary vascular congestion and mild interstitial edema is increased from ___. No pneumothorax is seen. Multiple surgical clips in the left upper quadrant are presumably related to prior GE junction surgery.", "output": "1. Increased right basilar atelectasis and small right pleural effusion. 2. Worsening moderate pulmonary vascular congestion and mild pulmonary edema from ___. 3. Cardiomegaly." }, { "input": "The patient remains intubated. The endotracheal tube terminates about 5 cm above the carina. A left subclavian venous catheter terminates in the superior vena cava. An orogastric tube courses through the stomach. The left costophrenic sulcus is excluded. There is some question of mild congestion, noting cuffed airways and slight interstitial prominence. There is no definite pleural effusion or pneumothorax.", "output": "Perhaps slight pulmonary congestion. Unchanged lines, tubes, and drains." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Single AP portable view of the chest. The lungs are grossly clear. Cardiomediastinal silhouette is within normal limits. Descending thoracic aorta is tortuous. No displaced fractures are identified. Degenerative changes seen at the acromioclavicular joints.", "output": "No definite acute cardiopulmonary process." }, { "input": "Dobbhoff terminates in the distal esophagus. There is no consolidation, pleural effusion, or pneumothorax. Cardiac silhouette is moderately enlarged. Aortic contour is tortuous. Oral contrast is in the colon.", "output": "Dobbhoff terminates in the distal esophagus." }, { "input": "Increased opacification of the right lung base without silhouetting of the heart border or the right hemidiaphragm could reflect a lateral segment right middle lobe pneumonia the proper clinical setting. The right-sided hemodialysis catheter ends within the right atrium. There is moderate cardiomegaly. There is no pleural effusion, pneumothorax, or pulmonary edema.", "output": "Right lung base opacification which could represent right middle lobe pneumonia." }, { "input": "PA and lateral views of the chest. No prior. The lungs are clear. Cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process. No evidence of cardiomegaly." }, { "input": "Moderate to severe cardiomegaly is unchanged. The aortic knob remains calcified. Mediastinal and hilar contours are similar. Moderate size left pleural effusion appears minimally increased compared to the prior study. Opacification of the left lung base likely is due to compressive atelectasis. Mild pulmonary vascular congestion appears similar. Trace right pleural effusion is relatively unchanged. No pneumothorax is identified.", "output": "Slight interval increase in size of moderate left pleural effusion. Left basilar opacity likely reflects atelectasis. Trace right pleural effusion also noted. Mild pulmonary vascular congestion, similar compared to the prior study." }, { "input": "PA and lateral views of the chest provided. The right lung is clear and well inflated with possible tiny effusion. There is a small left pleural effusion with associated compressive lower lobe atelectasis. Overall, cardiomediastinal silhouette appears normal. No pneumothorax. No pulmonary edema. Bony structures are intact.", "output": "Small left effusion with left basilar atelectasis. Possible tiny right effusion." }, { "input": "Small to moderate left pleural effusion persists and appears increased with overlying atelectasis. Trace right pleural effusion may also be present. There is moderate enlargement of the cardiac silhouette. Aortic knob is calcified. Minimal prominence of the interstitial markings may be due to minimal interstitial edema.", "output": "Moderate left pleural effusion and likely trace right pleural effusion. Moderate enlargement of the cardiac silhouette and slight prominence of the interstitial markings may be due to mild interstitial edema." }, { "input": "Mild to moderate enlargement of the cardiac silhouette is re- demonstrated. The mediastinal and hilar contours are within normal limits lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest were performed. There is no pleural effusion, pneumothorax, or focal airspace consolidation. A linear opacity at the left lung base is unchanged, likely reflecting scarring. The heart size is normal. The hilar and mediastinal structures are unremarkable. Kyphoplasty changes are again seen in the thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal contours are normal. Unchanged tortuous aorta. The lungs are clear. There is no pneumothorax or pleural effusion. There are mild degenerative changes in the thoracic spine several vertebroplasties and compression fracture of lower thoracic vertebral bodies are unchanged.", "output": "No acute cardiopulmonary abnormalities or evidence of amiodarone toxicity" }, { "input": "PA and lateral views of the chest were obtained. Linear plate-like atelectasis or scarring in the left mid and right lower lung is unchanged. There is no focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette appears stable and normal. Bony structures appear intact. Unchanged mid thoracic vertebroplasty changes are again noted. A wedge compression deformity in the lower thoracic spine is again noted.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear besides right basilar atelectasis. The cardiomediastinal silhouette is stable. Thoracic dextroscoliosis and multiple vertebroplasty changes are again noted.", "output": "No acute cardiopulmonary process." }, { "input": "Small foci of linear scarring are seen in the right middle and left lower lobes. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema identified. A stable, mild area of indentation is seen along the right lateral aspect of the trachea, likely secondary to the patient's known enlarged thyroid. The heart size is normal. Mediastinal and hilar contours are normal. Redemonstrated are several thoracic vertebroplasties, unchanged and appearance from the prior examination.", "output": "No radiographic evidence for acute pulmonary process." }, { "input": "The lungs are clear without focal consolidation. There is linear right basilar atelectasis versus scarring. The cardiomediastinal and hilar contours are within normal limits. There is no pneumothorax or pleural effusion. Multilevel vertebroplasty changes and thoracic dextroscoliosis are again noted.", "output": "No acute cardiopulmonary process." }, { "input": "There has been no substantial change compared to exam from six hours prior with persistent widespread parenchymal consolidations. A right PICC, endotracheal tube and upper enteric tube are all unchanged and appropriately positioned. There is no large effusion or pneumothorax.", "output": "No significant change compared to six hours prior with persistent global opacities worrisome for multifocal infection." }, { "input": "", "output": "Large foci of consolidation in right upper, right lower, and left mid lungs, not improving since ___, worsened significantly after ___. Pneumonia is most likely, pulmonary hemorrhage a possibility. Mild pulmonary edema and small bilateral pleural effusions are unchanged since ___. Heart size is normal. Endotracheal tube tip at the upper margin of the clavicles is approximately 4.5 cm above the carina, should not be withdrawn any further. Sharp margination of the tube cuff suggests secretions pooling above it. Right PICC line ends at a level of 52 mm below the carina, and would need to be withdrawn 2.5 cm inferior to the located low in the SVC. No pneumothorax. An upper enteric drainage tube ends in the mid portion of the nondistended stomach." }, { "input": "", "output": "AP chest at 23:18 compared to ___ a.m. Previously symmetric largely interstitial severe infiltrative pulmonary abnormality on ___ accompanied by small bilateral pleural effusions was probably pulmonary edema. Today edema has improved somewhat but there are now large areas of consolidation in the right upper lobe anterior segment, left juxta hilar midline and right lung base. These findings suggest widespread pneumonia. Pleural effusions are smaller today. Heart is not enlarged. ET tube is in standard placement. Right PIC line ends below the SVC and an upper enteric drainage tube ends in the mid portion of moderately distended stomach. There is no pneumothorax." }, { "input": "Chest, upright AP and lateral. The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal. There is minimal biapical scarring, which is stable.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is status post median sternotomy and CABG with multiple bypass grafts stents again demonstrated. The cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. The aorta is mildly diffusely calcified. There is minimal atelectasis in the left lung base, but no focal consolidation, pleural effusion or pneumothorax is visualized. Pulmonary vasculature is not engorged. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The patient is status post median sternotomy and CABG, with multiple bypass graft stents noted. Heart size is borderline enlarged with mild prominence of the right ventricle, unchanged. Aortic knob is calcified. Mediastinal and hilar contours are unchanged, and there is no pulmonary edema seen. No focal consolidation, pleural effusion or pneumothorax is identified. No acute osseous abnormalities are seen.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is at the upper limits of normal. Cardiomediastinal silhouette is within normal limits for age. A calcified aortopulmonary window lymph node is noted, suggesting prior granulomatous disease. No CHF, focal infiltrate, or effusion is identified. Equivocal minimal blunting of the posterior costophrenic angles. The right hemidiaphragm is eventrated. Along the right paratracheal region, there is a thin vertical linear density -- this may represent the wall of bulla. No conventional apical pneumothorax is detected.", "output": "1. No CHF or focal infiltrate 2. Calcified mediastinal node consistent with prior granulomatous disease. 3. Linear lucency in the right paratracheal region --? bulla" }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Chest PA and lateral radiograph demonstrates unremarkable mediastinal, hilar and cardiac contours. Bibasilar atelectasis noted. There is mild pulmonary vascular congestion and mild interstitial edema. No focal consolidation, pleural effusion or pneumothorax evident. Left-sided AICD has leads are positioned in the expected positions of the right atrium and right ventricle.", "output": "Mild pulmonary vascular congestion/interstitial edema." }, { "input": "PA and lateral views of the chest were obtained. Heart is normal in size and cardiomediastinal contours are unremarkable. A heterogeneous density occupying the right hemithorax with a mottled appearance inferiorly in comparison to the recent CT represents the gastric pull-through. The lungs are clear. There is no pleural effusion or pneumothorax. The NG tube tip is probably in the distal aspect of the gastric pull-through.", "output": "NG tip is in the distal aspect of the gastric pull-through." }, { "input": "AP view of the chest. An enteric tube ends in the gastric pull-through. There is no evidence of the barium within the intrathoracic stomach. Again seen is colon in the lower hemithorax on the left, unchanged. Atelectasis bilaterally is again seen. No pneumothorax. Heart size is normal.", "output": "No transit of barium compared to prior study." }, { "input": "Suture material projecting vertically over the right lung on the frontal view is compatible with the patient's esophageal conduit. An air-fluid level in the right lung apex is also related to the conduit. There is no definitive evidence of pneumothorax. Complete opacification of the right lung base suggests right lower lobe collapse. Mild left basilar atelectasis is new from the prior exam. A small-to-moderate right pleural effusion is probably not changed from ___. A left pleural effusion is small, if any. The pulmonary vasculature is not engorged, and there is no overt pulmonary edema. The cardiomediastinal contours are within normal limits. The right hilus is obscured by opacification in the right chest. The left hilar contours are within normal limits.", "output": "1. Right lower lobe collapse and small-to-moderate right pleural effusion. 2. Mild left basilar atelectasis, new from prior. 3. No definite pneumothorax, although evaluation is limited due to esophageal conduit on the right." }, { "input": "Portable AP semi-upright view of the chest provided. As seen on prior exam, an NG tube is seen terminating in the lower chest with contrast residua seen within the distal aspect of the gastric pull-through. In this patient with diaphragmatic hernias, better assessed on prior CT, air-filled loops of colon project over the left lung base. The mid-to-upper lungs remain grossly clear. No large effusions are detected. The heart size is difficult to assess due to subjacent hernia. No pneumothorax.", "output": "Contrast residua within the lower portion of the gastric pull-through with NG tube terminating in this region. Large diaphragmatic hernia accounting for opacities projecting over the lower lungs, consisting of intra-abdominal fat and loops of bowel." }, { "input": "The barium remains in the stomach. There is no evidence of transit of barium. Colon is again seen in the left lower hemithorax. There is less atelectasis in the lungs bilaterally. A nodule in the right mid hemithorax measuring 1.5 cm was present on the CT on ___. Small right pleural effusion is again seen. NG tube ends in the stomach.", "output": "No evidence of transit of barium." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs which are clear without evidence of active or latent tuberculosis. There is no pleural effusion or pneumothorax.", "output": "Normal chest radiograph without evidence of active or latent tuberculosis." }, { "input": "The lungs are hyperinflated. Relative lucency projecting over the apices, right worse than left with adjacent fibrotic changes and scarring is unchanged from ___. There is no new consolidation. Cardiomediastinal silhouette is within normal limits. Dense atherosclerotic calcifications noted in the thoracic aorta.", "output": "Chronic changes of the lungs including hyperinflation and biapical scarring. No superimposed acute cardiopulmonary process." }, { "input": "The lungs are mildly hyperinflated. There is no focal consolidation, pleural effusion or pneumothorax. The heart is normal in size with normal cardiomediastinal contours.", "output": "No acute intrathoracic process." }, { "input": "Single portable view of the chest. No prior. Hazy linear opacities at the left lung base are most suggestive of atelectasis. There is right lateral scarring versus atelectasis also seen. Elsewhere, lungs are clear and there is no large effusion. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No definite acute cardiopulmonary process. Findings most suggestive of left basilar atelectasis; however, clinical correlation is suggested. Repeat PA and lateral may offer additional detail." }, { "input": "PA and lateral views of the chest demonstrate normal lung volumes. There is no focal consolidation, pleural effusion or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are clear. Heart size and mediastinal contours are normal. There is no pleural effusion or pneumothorax. Osseous structures are intact.", "output": "Normal chest radiographs" }, { "input": "Mild enlargement of the cardiac silhouette is demonstrated. The aortic knob calcifications are present. The mediastinal contours otherwise are unremarkable. Lungs are hyperinflated, but otherwise clear without focal consolidation. No pleural effusion or pneumothorax is seen. There is no pulmonary edema. No acute osseous abnormalities demonstrated.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is status post median sternotomy and CABG and coronary artery stenting. The cardiac and mediastinal silhouettes are stable. There appears to be a small left pleural effusion. No definite focal consolidation is seen. There is no pneumothorax. Mild anterior compression of a mid thoracic vertebral body.", "output": "Small left pleural effusion." }, { "input": "PA and lateral views of the chest. The sternotomy wires are intact. Coronary artery stents and/or calcifications are seen. Mediastinal clips are seen. There is prominence of epicardial fat on the left. No focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "The endotracheal tube terminates 2.9 cm from the carina. An enteric tube courses below the diaphragm and outside of the field of view within the stomach. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is normal.", "output": "1. Endotracheal tube and enteric tube are well positioned. 2. No acute cardiopulmonary process." }, { "input": "AP portable upright view of the chest. Port-A-Cath resides over the right chest wall with catheter tip extending to the low SVC unchanged. Extensive pleural calcified plaque is again seen. A small right pleural effusion is unchanged. Left lung is grossly clear. There is no free air below the right hemidiaphragm.", "output": "1. Extensive calcified pleural plaque re- demonstrated. 2. Small right pleural effusion. 3. No free air seen below the right hemidiaphragm." }, { "input": "Compared to the prior study there is no significant interval change", "output": "No change" }, { "input": "Portable semi-erect chest film ___ at 05:06 is submitted.", "output": "Marked right pleural calcifications encasing most of the lung limiting evaluation. However, overall appearance has not changed. The previously noted interstitial edema has improved. There is blunting of the left costophrenic angle which may reflect a small effusion. Several calcified nodular opacities in the left lower lung and at both apices are suggestive of prior granulomatous infection. No definite new airspace consolidation is appreciated. Overall cardiac and mediastinal contours are stable given differences in patient rotation. A nasogastric tube is seen coursing below the diaphragm with the tip not identified. Endotracheal tube and right central line are unchanged in position." }, { "input": "There is biapical scarring and extensive right sided calcified pleural plaques which somewhat obscures evaluation of the underlying lung parenchyma. The left lung is clear besides a calcified granuloma at the lung base. Cardiomediastinal silhouette is stable. Atherosclerotic calcifications are noted in the thoracic aorta. No acute osseous abnormalities.", "output": "No definite acute cardiopulmonary process. Right-sided calcified pleural plaques." }, { "input": "PA and lateral views of the chest provided. A Port-A-Cath resides over the right chest wall with catheter tip extending to the mid SVC region unchanged. Extensive bilateral calcified pleural plaque is again noted right greater than left. A calcified granuloma projects over the left lower lung. No convincing evidence for pneumonia though evaluation of the right lung is limited. Heart remains mildly enlarged. The patient's kyphotic positioning somewhat limits assessment of the mediastinum. Bony structures appear intact though demineralized.", "output": "Extensive calcified pleural plaque limits assessment. No definite sign of pneumonia." }, { "input": "Frontal supine portable radiograph of the chest. The ET tube ends 6 cm above the carina and could be advanced to be in more secure position. An NG tube with the stomach. The Port-A-Cath is in unchanged position. There has been interval removal of the left PICC and left pleural catheter. Moderate left pleural effusion is stable to perhaps slightly smaller. Heavy right pleural calcification is unchanged. Stable appearance of the cardiomediastinal silhouette. No pneumothorax.", "output": "1. ET tube and 6 cm above the Carina and could be advanced to be in more secure position 2. Interval removal of left pleural catheter with stable to slightly decreased left pleural effusion" }, { "input": "The patient has been intubated. An endotracheal tube terminates about 6 cm above the carina. An orogastric tube courses into the stomach, where it terminates. The stomach is mildly distended. There is mild but increased left basilar opacity and elevation of the left hemidiaphragm suggesting atelectasis. Otherwise, evaluation of the lung parenchyma is obscured by a large pleural plaque involving the right hemithorax. There is no pneumothorax.", "output": "Status post endotracheal intubation. Mild gastric distention, but orogastric tube in place. Suspected mild but increased left basilar volume loss." }, { "input": "Patient is mildly rotated. Port-A-Cath over the right mid chest terminates at the cavoatrial junction. Mild enlargement of the cardiac silhouette is likely related to technique. Heterogeneous opacification over the right mid lung is most consistent with pleural plaques. Bibasilar opacities may represent atelectasis. A small left pleural effusion is likely present. No pneumothorax.", "output": "1. Heterogeneous right lung opacifications predominantly relates to large pleural plaques. 2. Bibasilar opacities, possibly atelectasis, and a small left pleural effusion." }, { "input": "Right chest wall Port-A-Cath is again seen. Calcified pleural plaques again seen on the right is well as bilateral calcified granulomas. Appearance of lungs has not significantly changed noting that the right is obscured due pleural calcifications. The left lung is clear. The cardiac silhouette is enlarged but stable. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well-expanded and clear. No focal consolidation, effusion, edema, or pneumothorax. The heart size is normal. The ascending and descending thoracic aorta are tortuous and/or ectatic. No acute osseous abnormality.", "output": "1. No pneumonia. 2. Tortuous and/or ectatic thoracic aorta." }, { "input": "The aorta is ectatic and/or tortuous. Heart size is within normal limits. The lung fields are clear. Soft tissues are unremarkable.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiac silhouette size is normal. The aorta is mildly unfolded. Mediastinal and hilar contours are normal. Pulmonary vascularity is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities demonstrated.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are unremarkable. Mild calcifications are noted at the aortic knob. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax. Degenerative changes at the right shoulder.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Compared with the prior study, lung volumes remain severely decreased causing bronchovascular crowding. Bibasilar atelectasis is mild. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is unchanged since the prior study. A calcified aortic arch is also stable in appearance.", "output": "Low lung volumes cause bronchovascular crowding. No focal consolidation concerning for pneumonia." }, { "input": "Lung volumes are severely decreased, leading to crowding of the bronchovascular structures. Again, bibasilar atelectasis is noted. There is no lobar consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette appears unchanged in the prior examination. Calcifications are again seen at the aortic arch.", "output": "Low lung volumes and bibasilar atelectasis." }, { "input": "There relatively low lung volumes and mild basilar atelectasis. No definite focal consolidation is seen. There is no large pleural effusion. No evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. The lateral view is somewhat suboptimal due the patient's overlying arms and due to low lung volumes. Degenerative changes at the bilateral glenohumeral joints are noted.", "output": "Low lung volumes and a mild basilar atelectasis without definite focal consolidation." }, { "input": "Lung volumes are low. Heart size is top normal. The aorta is diffusely calcified. Mediastinal and hilar contours are unremarkable. Lung volumes are low. Crowding of bronchovascular structures is demonstrated without overt pulmonary edema. Patchy atelectasis seen in the lung bases. No focal consolidation, pleural effusion or pneumothorax is present. Marked degenerative changes are seen in both glenohumeral joints.", "output": "Lung volumes are low with bibasilar atelectasis." }, { "input": "The lateral view is suboptimal as the patient's arms obscure assessment of the parenchyma. Heart size is normal. The mediastinal and hilar contours are unremarkable and unchanged. The pulmonary vascularity is normal. No focal consolidation, pleural effusion or pneumothorax is present. Multilevel degenerative changes are seen in the imaged thoraco- lumbar spine. Severe degenerative changes of the right glenohumeral joint are also noted.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lung volumes are low leading crowding of the bronchovascular structures. The right hemidiaphragm is mildly elevated. There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "Low lung volumes. No evidence of acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours are normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. There is no pulmonary edema. Consolidative opacities are seen within the left lower lobe and right upper lobe compatible with multifocal pneumonia. No pleural effusion or pneumothorax is identified. There are no acute osseous abnormalities. Surgical anchors are seen within the right humeral head.", "output": "Multifocal pneumonia. Follow up radiographs after treatment are recommended to ensure resolution of this finding." }, { "input": "The patient is status post interval spinal fusion involving the upper to mid thoracic spine. The patient is intubated. Lines, tubes, and drains appear otherwise unchanged aside from placement of a new right internal central jugular venous catheter that terminates in the superior vena cava. A pacemaker device and right-sided chest tube appear unchanged. There is mild congestion, but substantially improved without evidence for pleural effusion or pneumothorax. The cardiac, mediastinal and hilar contours appear unchanged. No unanticipated foreign body is demonstrated. There is a fracture of the right clavicle with displacement by half shaft width.", "output": "No evidence for radiodense foreign body. Discussed with Dr. ___ ___ after the study by telephone." }, { "input": "Portable chest radiograph evaluation is somewhat limited by rotation. Interval removal of right-sided chest tube with possible interval development of a small right pneumothorax. Increased opacification of right upper lobe may reflect degree of associated collapse. There has been notable interval improvement of aeration of the bilateral lung bases with residual atelectasis in the left lung base and small bilateral pleural effusions. Stable cardiac enlargement with improved but persistent vascular congestion.", "output": "Interval removal of right-sided chest tube with development of small right apical pneumothorax with new right upper lobe opacification, possibly representing degree of collapse. Improved vascular congestion and aeration of lung bases." }, { "input": "A right-sided chest tube has been placed with interval improvement of right pleural effusion. There is persistent cardiomegaly and diffuse pulmonary edema, likely cardiogenic. Transvenous right atrial and ventricular pacers are unchanged in position. There is also a moderate left pleural effusion. There is no pneumothorax.", "output": "1. Interval placement of a right chest tube with improvement of right pleural effusion. 2. Moderate left pleural effusion." }, { "input": "Cardiac, mediastinal and hilar contours are unchanged and the heart size is within normal limits. The pulmonary vasculature is normal. Small bilateral pleural effusions are re- demonstrated, not substantially changed in the interval. There is minimal bibasilar atelectasis. Remainder of the lungs are clear. No focal consolidation, pleural effusion or pneumothorax is present. Multilevel degenerative changes are seen in the imaged thoracic spine.", "output": "Small bilateral pleural effusions, not substantially changed in the interval." }, { "input": "Compared to the prior radiograph there has been no significant change. There is no focal consolidation or pneumothorax. Linear opacity in the right lung base is most consistent with atelectasis. Small bilateral pleural effusions are stable. The cardiomediastinal silhouette is unchanged.", "output": "Stable small bilateral pleural effusions. No significant change." }, { "input": "Blunting of the lateral and posterior costophrenic angles compatible with pleural small pleural effusions which are new since prior. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "New small bilateral pleural effusions. Otherwise, no acute cardiopulmonary process." }, { "input": "The cardiac and mediastinal silhouettes are stable with the cardiac silhouette mild to moderately enlarged. Mediastinal contours are unremarkable. No focal consolidation is seen. There is no pleural effusion or pneumothorax. There may be mild pulmonary vascular congestion.", "output": "Cardiomegaly with possible mild pulmonary vascular congestion. No focal consolidation to suggest pneumonia." }, { "input": "Compared with prior radiographs on ___, there has been interval placement of an NG tube, which is looped in the stomach, with the tip terminating near the gastroesophageal junction. The visualized portions of the lung bases appear unchanged. Mediastinal silhouette is unchanged.", "output": "NG tube is looped in the stomach, with the tip terminating near the gastroesophageal junction, and should be repositioned. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephoneon ___ at 9:58 AM, 10 minutes after discovery of the findings." }, { "input": "The cardiac silhouette is mildly enlarged. There is mild pulmonary edema with possible small left pleural effusion. No focal consolidation or pneumothorax.", "output": "Mild pulmonary edema" }, { "input": "Low lung volume accentuates the heart size and pulmonary vasculature. Heart size is upper limits of normal. Mediastinal and hilar contours are unremarkable. There is no evidence for pulmonary consolidation or pleural thickening. There is moderate right pleural effusion. Compression fracture of T9 is better evaluated on thoracic spine radiograph and MRI from ___.", "output": "1. No findings to suggest pulmonary TB. 2. Moderate right pleural effusion, likely on the basis of cirrhosis. 3. T9 compression fracture, better evaluated on prior exams." }, { "input": "There is opacity at the right lung base, which is suspicious for pneumonia. There is no pleural effusion or pneumothorax. Cardiac silhouette is top normal in size.", "output": "There is opacity at the right lung base, which is suspicious for pneumonia." }, { "input": "A left pectoral dual-chamber pacemaker has been placed with dual leads terminating in the right atrium and right ventricle. The right ventricular lead is oriented superiorly with the tip projecting towards the free wall of the right ventricle. The course of the leads is unremarkable. The lungs are clear without focal consolidation, pleural effusion, or pneumothorax. There is no overt pulmonary edema. The cardiomediastinal and hilar contours are within normal limits.", "output": "Status post pacemaker placement without pneumothorax." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. Left chest wall dual lead pacing device is seen with lead tips in the right atrium and right ventricle. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The aorta is tortuous. The cardiomediastinal silhouette is otherwise normal. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. No pulmonary edema. Right middle lobe atelectasis. No suspicious pulmonary nodules or masses. No pleural effusions. Spondylotic changes of the thoracic spine.", "output": "Right middle lobe atelectasis. RECOMMENDATION(S): Follow-up imaging in 10 days advised. If non resolution a CT of the chest is recommended. NOTIFICATION: The findings were discussed with ___ ___, M.D. by ___ ___, M.D. on the telephone on ___ at 4:28 PM, 2 minutes after discovery of the findings." }, { "input": "The cardiac silhouette is mildly enlarged, unchanged. Mediastinal hilar contours are within normal limits. Left basal atelectasis is again noted. There is no focal consolidation to suggest pneumonia. No pleural effusion or pneumothorax. Old bilateral rib fractures identified.", "output": "Unchanged mild cardiomegaly and basilar atelectasis. No evidence of pneumonia or pneumothorax." }, { "input": "Lung volumes are normal. Bronchial wall thickening in the lower lobes has not worsened, though the degree of bronchitis cannot be fully assessed. There is no focal consolidation, effusion or pneumothorax. Mediastinal and hilar contours are stable. There is mild vascular engorgement with minimal interstitial pulmonary edema. Borderline mild cardiomegaly is unchanged. Old bilateral rib fractures with associated scarring in the left and right mid-zones.", "output": "1. No evidence of pneumonia. 2. Persistent bronchial wall thickening in the lower lobes has not worsened, though the degree of bronchitis cannot be fully assessed. 3. Mild vascular engorgement with minimal interstitial pulmonary edema. Borderline cardiomegaly is unchanged. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 1:58 PM, 3 minutes after discovery of the findings." }, { "input": "Cardiac silhouette size is mildly enlarged, unchanged. Mediastinal and hilar contours are similar, with unchanged prominence of the right hilum. Pulmonary vasculature is normal. Linear opacities in both lung bases are compatible with areas of subsegmental atelectasis. No focal consolidation, pleural effusion or pneumothorax is identified. Remote right-sided rib fractures are re- demonstrated. There are mild degenerative changes in the thoracic spine.", "output": "Bibasilar subsegmental atelectasis. No focal consolidation to suggest pneumonia." }, { "input": "Right middle lobe atelectasis has decreased and probably essentially resolved on the lateral view. No new focal consolidation is seen. No large pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are stable. Hilar contours are stable. Mild pulmonary vascular congestion is seen.", "output": "Mild vascular congestion. Interval decrease in right middle lobe atelectasis probably essentially resolved on the lateral view." }, { "input": "There is some hilar prominence unchanged from radiograph dating to ___. Additionally the cardiomediastinal silhouette is unchanged. There is no pneumothorax.", "output": "No radiographic signs for pneumonia are seen. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 1:30 PM, a few minutes after discovery of the findings." }, { "input": "Lungs are clear. There is no focal consolidation, effusion, or pneumothorax. There is bronchial wall thickening in the left lower lobe, suggestive of bronchitis. Old bilateral rib fractures with associated scarring in the left and right mid-zones are again seen. Mediastinal and hilar contours are normal. Heart size is borderline enlarged, with associated prominence of the pulmonary vascularity but no overt pulmonary edema", "output": "No evidence of pneumonia. Bronchial wall thickening in the lower lobes, suggestive of bronchitis." }, { "input": "The lungs are clear. There is no effusion or pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormalities.", "output": "Normal chest x-ray." }, { "input": "Since the chest radiograph is obtained approximately 1 week ago, the left lower lobe pneumonia has resolved. There is minimal associated, residual bronchiectasis. The lungs are otherwise fully expanded and clear. Heart size is normal. Cardiomediastinal hilar silhouettes are normal. Pleural surfaces are normal.", "output": "Interval resolution of the left lower lobe pneumonia." }, { "input": "The lung volumes are normal. Normal size of the cardiac silhouette. Normal hilar and mediastinal structures. No pneumonia, no pulmonary edema. No pleural effusions.", "output": "Normal chest radiograph without evidence of pneumonia." }, { "input": "Since ___, there is a new focal opacity in the left retrocardiac region better appreciated in the infrahilar region on lateral view concerning for left lower lobe pneumonia. Lung volumes are normal. Right lung is grossly clear. No pneumothorax. No pleural effusion. Cardiomediastinal borders and hilar structures are normal", "output": "Probable left lower lobe pneumonia, new since ___. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 1:23 PM, 5 minutes after discovery of the findings." }, { "input": "Single AP upright image through the chest demonstrates clear lungs bilaterally. Patient is rotated to her right. Allowing for this, the cardiomediastinal and hilar contours appear within normal limits. There is no large pleural effusion. There is no pneumothorax. Surgical clips are noted in the lower neck in the anticipated location of the thyroid bed.", "output": "No acute intrathoracic abnormality." }, { "input": "Frontal and lateral views of the chest demonstrate unchanged linear areas of scarring in the left mid lung with adjacent pleural thickening. The lungs are otherwise well expanded and clear. Mild cardiomegaly is unchanged. Hilar contours are normal. There is no pneumothorax or pleural effusion. There are degenerative changes about the right acromioclavicular joint.", "output": "Stable scarring in the left midlung. No pleural effusion." }, { "input": "Assessment is slightly limited by patient rotation. Lung volumes are slightly low. Heart size is normal. Mediastinal and hilar contours are grossly unremarkable. Patchy opacities in the lung bases may reflect areas of atelectasis in the setting of low lung volumes. No pulmonary edema, pleural effusion or pneumothorax is present. No acute osseous abnormality is visualized.", "output": "Low lung volumes with mild patchy opacities in the lung bases, potentially atelectasis. Infection or aspiration cannot be excluded in the correct clinical setting." }, { "input": "PA and lateral radiographs of the chest show well-inflated lungs without consolidation or nodules. There is no pleural effusion or pneumothorax. Cardiomediastinal silhouette is normal.", "output": "No signs of acute cardiopulmonary process." }, { "input": "There is slightly increased density of the right hemithorax on the frontal view, which is more pronounced than on prior examinations. On the lateral view, there is not an obvious correlative focus of consolidation. The cardiac and mediastinal silhouettes appear unchanged overall and within normal limits given technique. There is no evidence of pleural effusion or pneumothorax. Osseous structures appear unremarkable.", "output": "Vaguely increased opacity of the right hemithorax is suspicious for early or atypical infection. A gross consolidative opacity is not apparent on this examination. This was discussed with by telephone with urgent care at the time of interpretation, 13:45, ___." }, { "input": "Right lower lobe opacity, best seen on the lateral radiograph, is concerning for aspiration or infection. There is no pleural effusion or pneumothorax. The heart is normal in size, and there is no pulmonary edema.", "output": "Right lower lobe opacity, best seen on the lateral radiograph, concerning for aspiration or infection." }, { "input": "PA and lateral views of the chest provided. Low lung volumes and mild patient motion limit the assessment. Underpenetration on the lateral view also limits assessment significantly. Allowing for limitations, there is no overt sign of pneumonia. A subtle pneumonia would be impossible to exclude given technical limitations. No large effusion or pneumothorax. The cardiomediastinal silhouette appears stable. Prominence of the central pulmonary hilar bronchovascular markings likely reflects technique. Bony structures are intact.", "output": "Limited exam without overt signs of pneumonia or edema. If there is further concern a repeat exam with more optimized technique is advised." }, { "input": "Heart size is stable. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No evidence of aspiration or pneumonia." }, { "input": "Cardiomediastinal silhouette is stable. Lung volumes are slightly low. Increased perihilar opacities may be accentuated by the technique but the indistinctness of the more distal pulmonary vessels is suggestive of mild edema. Retrocardiac opacitiesmay likely represent a combination of edema and atelectasis however superimposed consolidation cannot be excluded. There is no large pleural effusion or pneumothorax. Bones and the upper abdomen are grossly unremarkable.", "output": "1. Interval development of mild pulmonary interstitial edema. 2. Increased retrocardiac opacification may relate to a combination of edema atelectasis however superimposed consolidation cannot be excluded." }, { "input": "The lung volumes are low. The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Upright and lateral views of the chest were provided. The lungs are essentially clear, though lung volumes are low. The heart is mildly enlarged. No pneumothorax or effusion is seen. No definite bony abnormality is seen, though upon second review of prior CT chest from two days ago, there is a minimally displaced anterior rib fracture, involving the right fifth rib.", "output": "Right fifth rib fracture better seen on the prior CT. No pneumothorax. Cardiomegaly redemonstrated. Findings were flagged and posted to the ED dashboard at the time of this dictation." }, { "input": "Lung volumes are low but the lungs are clear with no evidence of a consolidation, effusion, or pneumothorax. There is mild stable cardiomegaly. No acute fractures are identified.", "output": "No acute cardiopulmonary process." }, { "input": "Left chest wall transvenous pacing device with lead ending in the right atrium, as expected. A right pleural effusion has increased from prior, although the exact size is difficult to discern given a probable subpulmonic component. Heart is top-normal in size. Mediastinal contour is normal. Lungs are clear.", "output": "Right pleural effusion, increased from ___." }, { "input": "There is no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute pulmonary process. Sternotomy wires and T-spine degenerative changes noted." }, { "input": "AP portable upright view of the chest. Bilateral pleural effusions are present, small to moderate in size. The hila appear congested and there is at least mild to moderate pulmonary edema. No large pneumothorax is seen. Heart size cannot be assessed. Aortic calcifications are noted. Bony structures are grossly intact.", "output": "As above." }, { "input": "Frontal and lateral views of the chest were obtained. There is no focal consolidation, pleural effusion, or evidence of pneumothorax. The lungs are relatively hyperinflated. The aorta is calcified and tortuous. The cardiac silhouette is top normal to mildly enlarged. No overt pulmonary edema is seen.", "output": "Top normal to mildly enlarged cardiac silhouette without overt pulmonary edema." }, { "input": "The cardiac silhouette is mildly enlarged. The aorta is tortuous. There is slight blunting of the posterior right costophrenic angle which may be due to a trace pleural effusion. No pneumothorax is seen. No focal consolidation is seen in the right lung. Subtle opacity at the left lung base may relate to overlap of vascular structures versus early/focal pneumonia.", "output": "Trace right pleural effusion. Subtle opacity at the left lower lung may represent overlap of structures or focal pneumonia." }, { "input": "Compared with prior chest radiograph on ___, there is new ill-defined opacity adjacent to the right hilum. There is linear atelectasis in the right upper lung.The left lung is clear. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "New ill-defined opacity adjacent to the right hilum, which may represent early/focal pneumonia in the appropriate clinical setting. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 10:39 AM, 15 minutes after discovery of the findings." }, { "input": "Interval decrease in heart size, now normal with stable tortuosity of the aorta. No focal consolidation, pleural effusion or pneumothorax. No pulmonary edema.", "output": "No acute process" }, { "input": "Cardiac silhouette size is normal. Mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormality seen. Levoscoliosis of the thoracic spine is unchanged.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is increased streaky opacification at the right lung base greater than the left lung base most compatible with atelectasis. The lungs are otherwise clear without focal consolidation concerning for pneumonia. No significant pleural effusion or pneumothorax is detected. The cardiac silhouette is normal in size. The mediastinal contours are slightly prominent due to unfolding of the thoracic aorta but otherwise within normal limits. The hilar contours are unremarkable. The trachea is midline. There is no free air beneath the right hemidiaphragm. No displaced rib fractures are detected.", "output": "Bibasilar atelectasis on the right greater than the left. No displaced rib fracture or pneumothorax." }, { "input": "Bibasilar opacities are most consistent with atelectasis, right greater than left. Cardiomediastinal hilar contours are unremarkable. No pneumothorax, pleural effusion, or consolidation. No acute displaced rib fractures identified. Right shoulder replacement hardware is re- demonstrated.", "output": "No acute displaced rib fractures identified. If there is ongoing concern for rib fractures, recommend dedicated rib radiographs with a BB marker placed over the area of pain. RECOMMENDATION(S): No acute displaced rib fractures identified. If there is ongoing concern for rib fractures, recommend dedicated rib radiographs with a BB marker placed over the area of pain." }, { "input": "The cardiac silhouette is normal in size. Lung volumes are decreased accentuating the bronchovascular structures. There is no focal consolidation, pleural effusion or pneumothorax. Retrocardiac air-fluid level is secondary to a moderate hiatal hernia.", "output": "Decreased lung volumes. No acute cardiopulmonary process." }, { "input": "The lungs are well-expanded without focal consolidation. Moderate cardiomegaly is stable. The mediastinum is normal. Linear opacification overlying the right lung is consistent with scarring. No pleural effusion.", "output": "No significant interval change." }, { "input": "In comparison to prior radiograph, there is no overall change. There is thickening of the minor fissure with volume loss in the right lower lobe. There is no pleural effusion or pneumothorax. Cardiomediastinal silhouette is slightly enlarged. The lungs are clear for opacities concerning for infectious process.", "output": "No evidence of acute process or change since ___." }, { "input": "PA and lateral views of the chest demonstrate well expanded lungs. The right upper lobe and right middle lobe opacities seen on chest CT are not visualized on this exam. Again seen is some thickening of the minor fissure with some volume loss in the right lower lobe. The lungs are otherwise clear. There is no pleural effusion or pneumothorax. Cardiomediastinal silhouette is unremarkable.", "output": "Thickened minor fissure with some volume loss in the right lower lobe. Previously visualized right upper lobe and right middle lobe opacities on CT are not seen on this exam." }, { "input": "Lungs are fully expanded and clear. No pleural abnormalities. Heart size is normal. Cardiomediastinal and hilar silhouettes are normal.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal silhouettes are unchanged and normal in appearance. The bilateral hila are normal. The elevation and contour of the right hemidiaphragm, as well as depression of the minor fissure, is consistent with known right lower lobectomy, and is unchanged in appearance as compared to prior radiograph. There are no new focal lung consolidations. There is no pulmonary vascular congestion. There are no pneumothoraces or effusions.", "output": "Stable appearance of lung status post right lower lobectomy. No evidence of acute cardiopulmonary process. NOTIFICATION: The above findings were discussed over the phone by Dr. ___ with Dr. ___, on ___ at 15:15, approximately 5 minutes after review of radiograph." }, { "input": "PA and lateral chest radiographs were obtained. A focal consolidation in the right upper lobe is associated with thickening of the right minor fissure. The opacity has become slightly more radiopaque since the preceding exam days ago. No additional consolidations, nodules, effusion, or pneumothorax is present. Post-operative pleural thickening at the right costophrenic angle is unchanged. The heart and mediastinal contours are normal.", "output": "Slight interval increased size of right upper lobe opacity associated with adjacent pleural reaction. Although the short-interval evolution suggests an infectious process, chest CT is recommended for further evaluation. Findings were discussed with Dr. ___ by telephone at noon on ___." }, { "input": "The lungs are well inflated. Blunting of the right costophrenic angle is stable after prior right lower lobectomy. Distal to periphery of R hilum, new parenchymal patchy opacities are seen just above slightly thickened minor fissure. No effusion, or pneumothorax is present. The cardiac and mediastinal contours are normal.", "output": "New non-specific right upper lobe parenchymal opacity associated with a thickened minor fissure. Repeat chest radiographs could be obtained in ___ weeks after trial of treatment for a potential infectious etiology. If no resolution, further evaluation is warranted, especially given the patients history of prior neoplasia." }, { "input": "In comparison to the most recent prior study, the inspiratory lung volumes are slightly decreased. The lungs are clear without focal consolidation concerning for pneumonia, pleural effusion or pneumothorax. The pulmonary vasculature is not engorged. The cardiac silhouette is normal in size. The mediastinal and hilar contours are within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well inflated. There is no consolidation. There is no pleural effusion. The mediastinum is normal. The heart size is borderline. A pacemaker is noted.. The patient has median sternotomy closures and mediastinal clips consistent with coronary artery bypass graft.", "output": "Postoperative change. No acute disease." }, { "input": "The heart size is normal. Fullness in the right upper mediastinum is again seen and may reflect a goiter. The hilar contours are unremarkable. There is no pleural effusion or pneumothorax. The lungs are well-expanded clear without focal consolidation. Pulmonary vasculature is within normal limits. Left axillary dual lead pacemaker is noted with leads in stable positions. Median sternotomy wires are intact. The upper abdomen is unremarkable.", "output": "1. No acute cardiopulmonary process. 2. Fullness in the right upper mediastinum is noted, which may reflect a goiter. Physical exam is recommended with consideration to additional imaging if clinically indicated." }, { "input": "Compared to ___ there is no interval change in location of endotracheal tube, enteric tube, right-sided central line or pacemaker and pacer wires. Multiple EKG leads overlie the chest wall. Lower lung volumes with no evidence of pulmonary edema. Stable cardiomegaly.", "output": "No significant interval change, compared to ___." }, { "input": "Interval extubation and removal of enteric tube. Right Swan-Ganz catheter has been removed, sheath terminates in the right atrium. Left mid chest wall pacemaker and pacer wires are intact. Well inflated clear lungs. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is unchanged. Unchanged appearance of sternal sutures.", "output": "Line tip, sheath in the right IJ terminates low in the right atrium. Rest as above." }, { "input": "Portable upright frontal view of the chest. The tracheostomy tube is in unchanged position. The previously seen left central line has been removed. Linear left lung opacites represent scarring that is better characterized on the prior chest CT. The cardiac contour is normal. Right multifocal consolidation and pleural thickening are unchanged. Right lower paratacheal mediastinal buldge likely represents a combination of lymphadopathy and the azygous/right superior intercostal veins.", "output": "Right pleural thickening and right lung opacities remain concerning for aspiration or infection that is relatively unchanged since ___." }, { "input": "Portable semi-upright radiograph of the chest demonstrates interval increase in bilateral parenchymal opacities, right greater than left, with persistent moderate-sized right pleural effusion. The cardiomediastinal and hilar contours are unchanged. There is no pneumothorax. The endotracheal tube ends 5.5 cm from the carina. Right-sided PICC line ends at the upper SVC. The nasogastric tube courses into the stomach and out of the field of view.", "output": "Interval increase in bilateral parenchymal opacities, right greater than left, with stable appearing moderate-sized right pleural effusion." }, { "input": "Single frontal view of the chest. Tracheostomy is in stable position. Heart size and upper mediastinal contours are stable. Widening of the upper mediastinum is likely a combination of lymphadenopathy and azyos engorgement. Right lung multifocal consolidation and pleural thickening have slightly increased since the prior exam with increased fluid in the right major fissure. Less severe consolidations in the left lung are similar to prior.", "output": "Slight interval increase in bilateral multifocal consolidations and right pleural fluid." }, { "input": "PA and lateral views of the chest. The lungs are clear, without focal consolidation or effusion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well expanded and clear. There is no focal consolidation, effusion, pneumothorax. Cardiac and mediastinal contours are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Portable AP upright chest radiograph was obtained. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The heart is normal in size with tortuous aortic contour. Rightward tracheal deviation is likely due to thyroid goiter. No displaced rib fractures are identified.", "output": "No acute intrathoracic process." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are normal. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for pneumonia. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No acute intrathoracic abnormalities identified." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. Lungs are clear despite low lung volumes. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs are clear. Cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is a been interval placement of a right internal jugular approach hemodialysis catheter, with tip terminating in the right atrium. The cardiomediastinal and hilar contours are within normal limits. There is no pleural effusion or pneumothorax. Lung volumes are slightly low with atelectasis at the right base. The upper abdomen is unremarkable.", "output": "Right basilar atelectasis. No focal consolidation concerning for pneumonia." }, { "input": "The lungs are well-expanded and clear. No focal consolidation, effusion, edema, or pneumothorax. The heart is normal in size. The mediastinum is not widened. The hila and pleura are unremarkable. No acute osseous abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Lung volumes are low limiting evaluation. There is mild elevation of the right hemidiaphragm unchanged. No large pleural effusion is seen. Hilar congestion is noted with mild interstitial pulmonary edema. The heart size is stable. Mediastinal contour is unchanged. Bony structures are intact.", "output": "Pulmonary vascular congestion with mild interstitial pulmonary edema, bibasilar atelectasis." }, { "input": "There is an opacity in the right lung base involving the right middle lobe with associated right lung volume loss and elevation of the right hemidiaphragm, consistent with atelectasis although cannot completely exclude a component of pneumonia or aspiration in the appropriate clinical setting. The previously seen right upper lobe rounded opacity has resolved from prior exam. Trace pleural effusions may be present. There is no pneumothorax. The cardiomediastinal silhouette is enlarged, similar prior exam.", "output": "1. Opacity in the right lung base with associated right lung volume loss, consistent with atelectasis although cannot completely exclude a component of pneumonia or aspiration in the right clinical setting. 2. Possible trace bilateral pleural effusions. NOTIFICATION: Findings communicated to Dr. ___ at 05:15 p.m. on ___ by phone." }, { "input": "Previous opacity at the right base is significantly improved. There is minimal bibasilar atelectasis. Faint opacities in the right mid lung similar to prior are likely reflect sequela of prior pneumonia. Heart size is top-normal as before. The mediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. There are degenerative changes in the right AC and partially imaged left AC joints.", "output": "No new focal airspace opacity to suggest pneumonia. Bibasilar atelectasis." }, { "input": "Endotracheal tube remains in unchanged position. The enteric tube tip terminates at the level of the gastroesophageal junction, unchanged, and should be advanced by approximately 13 cm such that the side port is within the stomach. There is interval improvement in aeration of the right upper lobe with continued atelectasis noted. Patchy left upper lobe and bibasilar airspace opacities otherwise appear grossly unchanged, concerning for aspiration. No pleural effusion or pneumothorax is present. The cardiac and mediastinal contours are relatively unchanged.", "output": "1. Interval improvement in aeration of the right upper lobe. 2. Persistent patchy left upper lobe and bibasilar airspace opacities compatible with aspiration. 3. Standard positioning of the endotracheal tube. 4. Enteric tube tip terminates at the gastroesophageal junction and should be advanced by approximately 13 cm." }, { "input": "AP portable supine view of the chest. ETT positioned with its tip 3.3 cm above the carina. A nasogastric tube descends along the thoracic midline with its tip at the EG junction. Right upper lobe collapse is noted. The heart is mildly enlarged. No acute osseous abnormalities.", "output": "As above." }, { "input": "PA and lateral views of the chest are obtained. Lung volumes are low. Plate-like left basilar atelectasis is noted. Aside from this, lungs are clear. No pleural effusion or pneumothorax. No signs of CHF. Heart size is enlarged mildly with a left ventricular configuration, new from prior radiographs. Mediastinal contours are unremarkable. Bony structures appear grossly intact, though the lower thoracic spine is suboptimally assessed on the lateral projection.", "output": "1. Mild cardiomegaly with an LV configuration, new from ___, radiograph. 2. Left basilar plate-like atelectasis." }, { "input": "Previously identified opacity projecting over the lateral mid right lung has nearly completely resolved. No new focal opacity. Severe emphysema, most pronounced in the right lower lobe is unchanged. Small left pleural effusion is unchanged. Heart size is normal. Cardiomediastinal hilar silhouettes are unremarkable.", "output": "Near resolution of a lateral mid right lung opacity. Severe emphysema again noted." }, { "input": "PA and lateral views of the chest provided. There is a persistent tiny right apical pneumothorax. In addition, there is a moderate in size loculated appearing posterior hydropneumothorax. No significant residual left pleural effusion. Persistent right lower lung opacity could reflect atelectasis, difficult to exclude pneumonia.", "output": "Persistent small right pneumothorax. Loculated right pleural effusion with hydro pneumothorax and right basal opacity concerning for atelectasis with possible pneumonia." }, { "input": "PA and lateral views of the chest provided. Lungs are hyperinflated. There are no parenchymal opacities suggestive of pneumonia. There is bilateral bronchial wall thickening, reflective of nonspecific inflammatory airway disease. Heart size is normal. There are no pleural effusions. Pulmonary vasculature is normal.", "output": "Chronic pulmonary disease. No acute pneumonia." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are hyperinflated and there is flattening of the diaphragms, suggestive of COPD. There is lower lobe predominant emphysema. There are no focal consolidations, pleural effusions, pulmonary edema or pneumothorax. There is mild scoliosis.", "output": "1. Typical findings of chronic obstructive pulmonary disease with lower lobe predominant emphysema, distribution suggestive of alpha 1 antitrypsin deficiency. 2. No radiographic evidence of an acute cardiopulmonary process." }, { "input": "There is a new opacity along the right upper lobe with adjacent fissural thickening. The pulmonary nodules characterize on the prior CT from ___ are not well seen on this exam. The heart size is normal. The hilar and mediastinal contours are normal. There is no pleural effusion or pneumothorax.", "output": "New small opacity is seen in the right upper lobe along the minor fissure. This is concerning for pneumonia. Previously characterized pulmonary nodules on CT are not well seen on this exam. D/w Dr. ___ by phone on day of the exam." }, { "input": "There is diffuse emphysema. Right lower lobe consolidation versus atelectasis is as before. Linear scarring versus atelectasis is seen in the left lower lobe. Moderate-sized right pleural effusion is unchanged. A right sided pigtail catheter is in good position. Cardiomediastinal silhouette is normal. There is diffuse demineralization. Dextro convex curvature of the mid to lower thoracic spine and a levoconvex curvature of the lower thoracic spine noted.", "output": "Unchanged diffuse prominence of lung vasculature, right lower lobe consolidation versus atelectasis and unchanged moderate-sized right pleural effusion with a right-sided chest tube in good position." }, { "input": "A right pleural effusion has increased in size and is now associated with a small apical pneumothorax component and moderate loculated posterior hydro pneumothorax. A component of the fluid is loculated within the right major fissure. A left pleural effusion has nearly resolved in the interval. Cardiomediastinal contours are stable. Left lower lobe consolidation has improved, but a left perihilar opacity has worsened in the interval. Worsening right middle and lower lobe opacities may reflect atelectasis associated with the enlarging right effusion but coexisting pneumonia is also possible.", "output": "1. Small right apical pneumothorax and moderate loculated posterior hydro pneumothorax with associated enlargement of right pleural effusion since ___. 2. Improved left lower lobe consolidation and decreased left pleural effusion. NOTIFICATION: As the ordering provider was not available by pager or phone, the impression and recommendation above was entered by Dr. ___ on ___ at 08:01 into the Department of Radiology critical communications system for direct communication to the referring provider. The office of hematology oncology was also phoned with these results directly, and an addendum will be issued to this report when direct communication is made with a provider." }, { "input": "The lungs are hyperinflated compatible the patient's known COPD. Regions of architectural distortion particularly in the right upper lung. There is a slightly increased opacity in the right suprahilar region which could represent infection. No other new focal region of consolidation. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "Findings compatible with COPD. Increased opacity in the right suprahilar region potentially due to infection. Consider repeat after treatment to document resolution." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Analysis is performed in direct comparison with the next preceding similar study of ___. Heart size remains normal. The same holds for the thoracic aorta. No mediastinal abnormalities are present. Similar as on the preceding examination, low positioned and flattened diaphragms coincide with emphysematic translucency of the lung bases. Pulmonary vasculature with central prominence and peripheral attenuation typical for rather advanced COPD. Comparison with the next preceding study does not establish any new pulmonary parenchymal infiltrate that might represent an overlying acute pneumonia.", "output": "Stable chest findings with advanced COPD, but no new acute infiltrate identified." }, { "input": "The lung volumes are unchanged. The abscess at the base of the right hemithorax is unchanged. Slight worsening of left lower lobe and right middle lobe atelectasis. Otherwise the cardiomediastinal and hilar silhouette are stable. A minimal right apical pneumothorax may be present. No hydro pneumothorax. New moderate amount of right chest wall subcutaneous emphysema. The left pleural surfaces are stable. The osseous structures, including the severe thoracolumbar scoliosis, is unchanged.", "output": "1. Minimal right apical pneumothorax may be present. 2. Slight worsening of bilateral atelectasis. 3. New right chest wall subcutaneous emphysema likely secondary to chest tube placement/removal. 4. Unchanged right basilar abscess." }, { "input": "The cardiomediastinal silhouette is unremarkable. An opacity projecting over the lateral right mid lung is new from prior examination. Basilar predominant emphysema suggests alpha-1 antitrypsin deficiency. Previously present left mid and lower lung opacities have partially cleared. A small left pleural effusion persists.", "output": "A focal opacity in the right midlung is concerning for a new focus of pneumonia. Left mid and lower lung opacities have improved since ___." }, { "input": "Interval placement of a right basal a pigtail catheter. The size of the right pleural effusion has decreased. A small right apical pneumothorax is unchanged. There are however persisting opacities in the right lower lung zone. A small amount of atelectasis and volume loss is also present in the left lower lobe. The appearance of the cardiomediastinal silhouette is unchanged.", "output": "Interval placement of a right pleural pigtail catheter without significant change in the size of the right apical pneumothorax. Persisting opacity in the right lower lobe." }, { "input": "Lungs are hyperinflated. There is no parenchymal consolidation. Since ___, there is a stable left upper lobe opacity which may represent a parenchymal nodule. Bilateral perihilar bronchial wall thickening is indicative of chronic inflammation. Cardiomediastinal silhouette is normal. No pleural abnormality is seen.", "output": "1. Hyperinflated lungs compatible with chronic obstructive pulmonary disease, but no acute focal consolidation. 2. Persistent left upper lobe opacity may represent a parenchymal nodule and further evaluation via non-urgent Chest CT should be considered if not already further evaluated." }, { "input": "When compared to prior, there has been no significant interval change. The lungs are hyperinflated but clear of focal consolidation. The cardiomediastinal silhouette is within normal limits. Mild mid thoracic vertebral body height loss is unchanged. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "There is persistent right basilar opacity which is somewhat improved when compared to the most recent x-ray. Linear bibasilar opacities may be due to a combination of atelectasis or scarring. There is no large pleural effusion although blunting of the right lateral and posterior costophrenic angles could represent small residual effusion, potentially in part loculated laterally. Persistent left lower lobe atelectasis medially is also less conspicuous. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. Left PICC is seen with tip in the upper right atrium.", "output": "Persistent right basilar opacity although improved since ___. This is likely due to known underlying pulmonary abscess/consolidation. Suspected residual small effusion on the right as well as left lower lobe atelectasis. Left PICC tip projects over the upper right atrium." }, { "input": "As compared to ___, there is unchanged. Lower lobe predominant emphysema and hyperinflation is unchanged. Mild biapical pleural scarring. The lungs are otherwise clear. The cardiomediastinal contours are unchanged. No pleural effusions. Multiple wedge compression fractures involving the mid thoracic spine.", "output": "Severe lower lobe predominant emphysema. No acute cardiopulmonary process." }, { "input": "he lungs are hyperinflated with lower lobe predominant severe panlobular emphysema in keeping with alpha 1 antitrypsin deficiency. The cardiac and mediastinal contours are stable. Dextroscoliosis in the thoracic spine is noted.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiograph demonstrates clear lungs bilaterally. Lungs demonstrate emphysematous changes and hyperinflation, predominantly within bilateral lower lobes. No focal consolidation concerning for pneumonia. The cardiomediastinal and hilar contours are within normal limits, unchanged since prior examination. There is no pleural effusion or pneumothorax. Visualized osseous structures are without acute abnormality.", "output": "No acute intrathoracic abnormality." }, { "input": "Frontal and lateral chest radiograph demonstrates hyperinflated lungs with flattening of the diaphragms and basilar predominance.Persistent left upper lobe opacity may represent a component of overlapping shadows however cannot exclude pulmonary nodule. Areas of bronchial wall thickening and bronchiectasis are similar to previous examination. No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable. Limited assessment of the upper abdomen is within normal limits.", "output": "1. Hyperinflated lungs with basilar predominance is most consistent with emphysema and areas of air trapping in the lower lobes however differential includes also 1 antitrypsin deficiency. 2. Persistent left upper lobe opacity may represent overlapping shadows however cannot exclude pulmonary nodule. Recommend shallow oblique views for further evaluation. 3. Areas of bronchial wall thickening and bronchiectasis, similar to previous examination can be seen with small airway disease and/or bronchitis in the appropriate clinical setting. 4. No evidence of pneumonia. RECOMMENDATION(S): The impression above was entered by Dr. ___ on ___ at 10:20 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Analysis is performed in direct comparison with the next preceding single view chest examination of ___. Heart size remains normal. No configurational abnormality is seen. Ordinary ___ of thoracic aorta with a few calcium deposits in the wall at the level of the arch. No mediastinal abnormalities are seen. The pulmonary vasculature is characterized by absence of any congestion, but rather irregular vascular distribution with changing individual vessel diameters and areas of increased translucency. These happened to be most prominent in the lower lobe areas and coincide with rather low positioned diaphragms which appear flattened. There is no evidence of pleural effusion in either lateral or posterior pleural sinuses. Acute pulmonary parenchymal infiltrates cannot be identified; however, there exists a few scattered small diameter rounded densities, one of which is located in the right lower lobe in supradiaphragmatic position and appears unchanged. Skeletal structures of the thorax are characterized by a mild degree of S-shaped scoliosis in the thoracolumbar spine and moderately diffuse demineralization of the thoracic spine with moderately accentuated kyphotic curvature. There is no evidence of new rib abnormalities as can be identified on these standard PA and lateral chest views.", "output": "No cardiac enlargement or pulmonary congestion, rather typical findings of chronic pulmonary obstructive airway disease with basal emphysema but no acute parenchymal infiltrates." }, { "input": "There is retrocardiac opacity and right middle and lower lobe ill-defined opacities, concerning for pneumonia. Blunting of the costophrenic angle on the left may also reflect small pleural effusion. There is no pneumothorax. There is mild left apical scarring. The cardiac and mediastinal silhouettes are stable.", "output": "Multifocal pneumonia with a small left pleural effusion." }, { "input": "PA and lateral views of the chest are provided. Heart is mildly enlarged. The lungs appear essentially without definite signs of pneumonia or overt CHF. Calcific density projecting over the mediastinum may represent vascular calcifications, though is somewhat atypical in distribution. There is an unfolded thoracic aorta noted. The bony structures appear intact.", "output": "Cardiomegaly, with unfolded thoracic aorta. Calcifications projecting over the mediastinum likely correspond with the thoracic aorta, though distribution is somewhat atypical. Consider non-emergent CT to further assess." }, { "input": "Frontal and lateral views chest demonstrate decreased lung volumes. There is dense left retrocardiac opacity which may represent atelectasis, infection or aspiration. There is blunting of the left costophrenic angle which may represent a small pleural effusion. No pneumothorax is identified. The right hilum is prominent but stable compared to multiple prior radiographs. The aorta is ectatic and tortuous and the heart is mildly enlarged. There are degenerative changes in the thoracic spine.", "output": "1. Left retrocardiac opacity could represent atelectasis, infection or aspiration. 2. The left costophrenic angle is blunted. A small left pleural effusion is not excluded." }, { "input": "The lungs are clear without evidence of consolidation or edema. There is no pleural effusion or pneumothorax. The aorta is tortuous with mild atherosclerotic calcifications. Moderate cardiomegaly is stable.", "output": "1. No acute cardiopulmonary process. 2. Stable moderate cardiomegaly." }, { "input": "The lungs are well expanded. No focal opacities are identified. A prominent right hilum is unchanged from prior exam. Moderate cardiomegaly appears unchanged from prior. A tortuous aorta is present. Atherosclerotic calcifications of the aortic knob are re-identified. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary process. Unchanged cardiomegaly and right hilar prominence." }, { "input": "Lower lung volumes are seen on the current exam and the lateral view is also limited by motion. Linear left basilar opacity is likely atelectasis. There is no definite consolidation or effusion. Cardiac silhouette is enlarged but grossly unchanged. Aortic arch calcifications are noted.", "output": "Cardiomegaly without definite acute cardiopulmonary process." }, { "input": "Semi-upright AP view of the chest. The lung volumes are low. No focal opacity concerning for pneumonia is seen. Left pleural thickening is unchanged since ___. No pneumothorax is identified. The right hilum is prominent, but unchanged since ___. Moderate cardiomegaly is also stable.", "output": "No opacities concerning for pneumonia. Chronic cardiomegaly and left pleural thickening is unchanged since ___." }, { "input": "Portable AP upright chest film ___ at 751 is submitted.", "output": "The cardiac and mediastinal contours are stable with stable cardiac enlargement. There is possibly a small hiatal hernia. Overall, there is increasing opacity at the left base which is felt to more likely reflect an increasing left effusion, although airspace consolidation cannot be entirely excluded. No evidence of pulmonary edema or pneumothorax. Right lung is grossly clear. Prominent right hilum most likely reflects prominent vasculature suggesting underlying pulmonary arterial hypertension in the setting of known emphysema when correlated with a chest CT dated ___." }, { "input": "There is grossly stable prominence of the right hilum. There is slight blunting of the left costophrenic angle which may be due to overlying soft tissue although trace pleural effusion is difficult to exclude. The lateral view also suggests posterior basal consolidation, although not well seen on the frontal view, could be in the left lower lung. The aorta remains calcified and tortuous. The cardiac silhouette is stable. No overt pulmonary edema is seen.", "output": "Posterior basilar opacity best seen on the lateral view, raises concern for underlying consolidation which may be due to infection or aspiration. Not well appreciated on the frontal view." }, { "input": "The lungs are clear. There is no pleural effusion, pneumothorax or focal airspace consolidation. The heart is normal size. The mediastinal and hilar contours are unremarkable. There is no rib fracture seen.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is borderline in size. Patchy calcification is noted along the aortic arch. There is no pleural effusion or pneumothorax. There is a mild interstitial abnormality mostly characterized by mild peribronchial cuffing. There is no upper zone redistribution of pulmonary vasculature and the pulmonary vessels appear distinct. Neither hilum appears congested. The left cardiac apex is slightly obscured on the frontal view but probably due to a fat pad rather than a pulmonary opacity.", "output": "Mild interstitial abnormality suggestive of airway inflammation or atypical pneumonia." }, { "input": "Heart size is top-normal with re- demonstration of unfolding of the thoracic aorta. Hilar contours are unremarkable. Lungs are grossly clear. Pleural service are clear without effusion or pneumothorax. Right clavicular and multiple rib fractures are unchanged.", "output": "No acute cardiopulmonary abnormality. Right clavicular and multiple rib fractures unchanged." }, { "input": "The lungs are clear with normal volumes. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. No pneumothorax, pneumonia, pleural effusion, or pulmonary edema. The known clavicular, scapular, and multiple rib fractures are unchanged since ___. Atelectasis.", "output": "1. Unchanged clavicular, scapular, and multiple rib fractures since ___. 2. No acute cardiopulmonary process." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unremarkable. The lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities. A gastric lap band is imaged in the left upper quadrant of the abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes remain low leading to crowding of the bronchovascular structures. There is no evidence of focal consolidation, pleural effusion, pneumothorax, or frank pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Portable AP semi-upright chest radiograph demonstrates clear lungs without pleural effusion or pneumothorax. The cardiac silhouette is normal in size, the mediastinal contours are normal. Healed rib fractures are noted in the posterior right sixth and seventh ribs.", "output": "No acute chest pathology." }, { "input": "Overlying trauma board slightly limits assessment. The cardiac silhouette is normal in size. The mediastinal and hilar contours are unchanged. There are low lung volumes with patchy bibasilar airspace opacities, possibly reflective of atelectasis though infection is not excluded. There is crowding of the bronchovascular structures without overt pulmonary edema. No large pleural effusion or pneumothorax is is identified. There is a suggestion of subcutaneous emphysema within the left lateral chest wall. No displaced fractures are visualized. Remote right-sided posterior rib fractures are re- demonstrated.", "output": "1. Suggestion of subcutaneous emphysema in the left chest wall raises concern for a rib fracture though none are clearly seen. 2. Low lung volumes. Bibasilar patchy opacities may reflect atelectasis but infection or aspiration is not excluded." }, { "input": "PA and lateral radiographs of the chest demonstrate clear lungs without pleural effusion, focal consolidation concerning for pneumonia or pneumothorax. The pulmonary vasculature is not engorged. The cardiac silhouette is normal in size. The mediastinal and hilar contours are within normal limits. The thoracic aorta is mildly tortuous. Healed fractures are noted in the posterolateral right sixth and seventh ribs.", "output": "No radiographic evidence of pneumonia." }, { "input": "PA and lateral views of the chest were provided. The lungs are clear bilaterally without focal consolidation, effusion, pneumothorax. The heart and mediastinal contours are normal. Bony structures are intact.", "output": "No acute findings in the chest." }, { "input": "The heart size is normal. Smoothly marginated opacity at the right cardiophrenic angle is noted. The mediastinal and hilar contours otherwise are unremarkable and the pulmonary vascularity is not engorged. There is no focal consolidation, pleural effusion or pneumothorax. No acute osseous abnormalities seen.", "output": "1. Right cardiophrenic opacity is of unclear etiology, and could reflect a pericardial abnormality such as a pericardial cyst. An epicardial fat pad is considered less likely. Follow up chest CT is recommended for further evaluation. 2. No focal consolidation to suggest pneumonia." }, { "input": "PA AND LATERAL VIEWS OF THE CHEST. There is a small left pleural effusion. No right pleural effusion. The lungs are clear. No evidence of pneumonia. The cardiac, mediastinal, and hilar contours are stable. No pneumothorax. Median sternotomy wires are in place in appropriate position.", "output": "1. No evidence of pneumonia. 2. Small left pleural effusion." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lung volumes are low. There is minimal bibasilar atelectasis with no evidence of focal consolidation. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Minimal bibasilar atelectasis with no evidence of focal consolidation." }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs. The lungs are clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Normal chest radiographs." }, { "input": "The lungs are clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is elongation of the descending aorta. No pulmonary edema, pleural effusions, or pneumothorax. No focal consolidations are seen.", "output": "No pneumonia or acute cardiopulmonary process." }, { "input": "The heart size is normal. The aorta remains tortuous, with the mediastinal and hilar contours otherwise unchanged. The pulmonary vascularity is normal. No pleural effusion or pneumothorax is present. Elevation of the left hemidiaphragm is chronic. No displaced rib fractures are identified, and no acute osseous abnormalities are detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is mildly enlarged. The aorta is tortuous. Mediastinal and hilar contours are otherwise unremarkable. Chronic elevation of left hemidiaphragm is again noted. Lungs are clear. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormalities seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Single AP upright portable view of the chest was obtained. Nodular calcified structure projecting over the right lower lobe most likely represents calcified granuloma or relates to costochondral calcification. A calcified lymph node is again seen in the AP window. No focal consolidation, large pleural effusion, or evidence of pneumothorax is seen. Evidence of hiatal hernia is again seen. Cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable view of the chest. Right PICC is identified . The tip is not clearly delineated however may be in the region of the superior SVC. There are increased densities projecting over the anterior 2nd ribs bilaterally. Thought to be external in nature, potentially patient's hair. The lungs are otherwise clear. Cardiomediastinal silhouette is stable.", "output": "Right PICC tip not clearly delineated. The line is only well seen to the region of the superior SVC." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The heart size is top normal. The aorta is mildly tortuous. The pulmonary vascularity is not engorged. Minimal streaky opacities in lung bases likely reflect atelectasis. No pleural effusion, focal consolidation or pneumothorax is identified. Mild loss of height of a mid and lower thoracic vertebral body are age indeterminate.", "output": "1. Mild bibasilar atelectasis. 2. Mild loss of height anteriorly of ___ mid and lower thoracic vertebral bodies, which are age indeterminate." }, { "input": "Compared to chest radiographs from ___, there has been interval removal of a right-sided chest tube and small right apical pneumothorax has resolved. Mild effusion on the right with a loculated appearance has mildly improved and could represent postoperative hematoma or loculated effusion. Tiny effusion on the left persists. Mild bibasilar atelectasis has improved. Cardiomediastinal silhouette is stable. Right innominate artery stent is again noted.", "output": "1. Interval removal of right-sided chest tube with resolved small right apical pneumothorax. 2. Mild decrease in fluid within the right pleural space with loculated appearance, which could represent postoperative hematoma or loculated effusion. 3. Persistent small left pleural effusion. 4. Improved mild bibasilar atelectasis." }, { "input": "A right chest tube is present. A stent graft projects between the clavicular heads. There is no focal consolidation, pleural effusion or pneumothorax identified. The size the cardiomediastinal silhouette is within normal limits.", "output": "A right chest tube is present. No pneumothorax is identified." }, { "input": "There is a new small right 8 apical pneumothorax, new compared with ___. The right-sided again seen is a right-sided chest tube. Hazy opacity at the right lung base laterally is new and could represent atelectasis or, alternatively, layering pleural fluid. An additional atelectasis is present in the right cardiophrenic region/medial lung base. At the left lung base left hemidiaphragm is slightly elevated, with subsegmental atelectasis. No definite consolidation. No gross effusion. No focal infiltrate or pneumothorax. Small tubular density projecting between the medial clavicular heads over the lower trachea, compatible with a stent graft, as again noted.", "output": "New small right apical pneumothorax, compared with ___. Right-sided chest tube in place. Hazy opacity at the right base could reflect a small to moderate amount of atelectasis and/or pleural fluid. NOTIFICATION: The presence of the new right apical pneumothorax was discussed with covering physician ___, ___.D. by ___, M.D. on the telephone on ___ at 17:06 PM, ___ min minutes after discovery of the findings." }, { "input": "Since the prior study the right PICC is been removed. The lungs are clear with no consolidation to suggest pneumonia. No pulmonary edema or pleural effusions. Heart size and mediastinal contours are normal. No pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest views were obtained with patient in upright position. The heart size is normal. No configurational abnormality is identified. Thoracic aorta mildly widened and elongated but no other local contour abnormalities or wall calcifications are present. The pulmonary vasculature is not congested. No signs of acute or chronic parenchymal infiltrates are present and the lateral and posterior pleural sinuses are free. No pneumothorax in the apical area on the frontal view. Skeletal structures of the thorax grossly within normal limits. When comparison is made with the next preceding available chest examination of ___, no significant interval change can be identified.", "output": "No evidence of acute pneumonic infiltrate in patient with clinical history of bronchitis." }, { "input": "Portable semi-upright radiograph of the chest demonstrates well expanded, clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation. Right-sided PICC line ends at the cavoatrial junction. A vague linear opacity projects over the left axilla and is less concerning for retained foreign body on this radiograph.", "output": "A vague linear opacity projects over the left axilla and is less concerning for retained foreign body on this radiograph. If clinical concern for foreign body remains high, recommend repeat radiograph without gown or sheets covering the patient." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "PA and lateral views of the chest were obtained demonstrating no focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. There is no free air below the right hemidiaphragm.", "output": "No signs of pneumonia." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. Left-sided PICC is no longer seen. Lungs are essentially clear noting minimal left basilar opacity compatible with atelectasis on the frontal view. Costophrenic angles are sharp. Cardiomediastinal silhouette is normal, as are the osseous and soft tissue structures.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. The lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. The imaged bony structures are intact. No free air is seen below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest were obtained. The heart is normal in size and cardiomediastinal silhouette is stable. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "The lungs are well-expanded and clear. The cardiomediastinal silhouette is unremarkable. The hilar and pleural surfaces are normal.", "output": "Normal chest." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded, clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest are obtained. No focal consolidation, pleural effusion, or definite evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No overt pulmonary edema is seen. No displaced fracture is identified.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable view of the chest compared to previous exam from ___. Low lung volumes again noted. Linear opacity at the right lung base most suggestive of atelectasis. The lungs are otherwise clear. Cardiomediastinal silhouette is within normal limits. Degenerative changes noted at both acromioclavicular and glenohumeral joints.", "output": "No definite evidence of acute cardiopulmonary process." }, { "input": "Lung volumes are low. The heart size is normal. Mediastinal and hilar contours are unremarkable, and there is no pulmonary edema. Minimal linear atelectasis in the right lung base is seen. No focal consolidation, pleural effusion or pneumothorax is identified. Multilevel degenerative changes are again seen in the thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. The lungs are now clear without focal consolidation or effusion. Cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. Vague nodular opacity projecting over the right lower lung represents atelectasis, less likely pneumonia. No large effusion or pneumothorax is seen. The cardiomediastinal silhouette is stable. Imaged osseous structures appear intact. No free air is seen below the right hemidiaphragm.", "output": "Vague nodular opacity projecting over the right lower lung is most likely secondary to atelectasis. Consider repeat radiograph with more optimal inspiratory effort to further assess." }, { "input": "Multifocal patchy opacities in the right middle, right upper, and bilateral lower lobes are concerning for pneumonia. The most severe consolidation is in the right middle lobe. The lungs are without pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal.", "output": "Multifocal pneumonia most severe in the right middle lobe. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 2:07 PM, 5 minutes after discovery of the findings." }, { "input": "Frontal and lateral views of the chest are obtained. The patient is status post median sternotomy and aortic valve replacement. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac silhouette is top normal. The aorta is slightly tortuous. No overt pulmonary edema is seen. Minimal degenerative change is seen at the right acromioclavicular joint. No displaced fracture is identified.", "output": "No evidence of acute intrathoracic injury." }, { "input": "The heart is normal in size. Incidental note is made of an azygos fissure, which is a common normal variant. The mediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. The lungs appear clear. Suture anchors are present within the left humeral head.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "A small left pleural effusion is new. There is no focal consolidation, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "1. New small left pleural effusion. 2. No focal consolidation, pneumothorax, or pulmonary edema." }, { "input": "The lungs are clear. There is no pneumothorax. The heart and mediastinum are within normal limits. Regional bones and soft tissues are unremarkable. Mild elevation of the right hemidiaphragm is stable.", "output": "Clear lungs." }, { "input": "The lungs are well-expanded and clear. Blunting of the left costophrenic angle is consistent with trace pleural effusion. No right pleural effusion. No pneumothorax. Heart size and hila are unremarkable. A tortuous aorta is noted. There is bulging of the right mediastinal contour suggestive of an ascending aortic aneurysm.", "output": "1. Findings worrisome for ascending aortic aneurysm. 2. No pneumonia." }, { "input": "Right PICC terminates in the mid-to-lower superior vena cava. Heart size is normal, and lungs are grossly clear.", "output": "Standard positioning of right PICC." }, { "input": "The lungs are clear without consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. Central venous catheter is seen with tip at the cavoatrial junction.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation, pleural effusion, or pneumothorax is seen. Heart and mediastinal contours are within normal limits.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Both lungs are well expanded and clear. There are no lung opacities concerning for latent or active tuberculosis. Heart size, mediastinal and hilar contours are normal. There is no pleural abnormality.", "output": "No evidence of latent or active tuberculosis." }, { "input": "PA and lateral views of the chest were reviewed. Compared to the most recent prior, left lower lobe atelectasis and mild cardiomegaly are unchanged. Otherwise the lungs are clear and the mediastinal and pleural surfaces are normal.", "output": "No acute cardiopulmonary process. Mild cardiomegaly unchanged." }, { "input": "A left PICC line is with the tip in the lower SVC. The moderate cardiomegaly is unchanged from prior exam. Previously identified opacities have resolved with no new focal consolidation. Previous pulmonary vascular congestion has also improved. There are no pleural effusions or pneumothorax.", "output": "Resolution of prior bilateral pulmonary opacities." }, { "input": "The right hemidiaphragm continues to be elevated and there is volume loss/early infiltrate at the right base compared to the prior study the amount of opacity at the right base is increased and given history and early infiltrate is of concern. A right Port-A-Cath is unchanged in position with the tip terminating in the proximal right atrium.", "output": "Question early infiltrate right lower lobe." }, { "input": "The heart size remains mildly enlarged. Mediastinal and hilar contours are unremarkable. The pulmonary vascularity is normal. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is identified. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Right subclavian catheter remains in standard position, and cardiomediastinal contours are within normal limits and without change. Lungs are clear except for a linear focus of opacity in the right middle lobe. There are no pleural effusions or acute skeletal findings. Scoliosis is incidentally noted.", "output": "___ evidence of pneumonia." }, { "input": "There is mild to moderate persistent elevation of the right hemidiaphragm compared to the left, which is unchanged from the prior study. A right Port-A-Cath is unchanged in position with the tip terminating in the proximal right atrium. There is no focal opacity concerning for pneumonia, pleural effusion, or pneumothorax. A streaky opacity on the lateral radiograph in the anterior lung base likely represents minor atelectasis. The pulmonary vasculature is not engorged. The cardiac silhouette is mildly enlarged but stable. The mediastinal and hilar contours are within normal limits. The trachea is midline.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "New opacities in both lower lobes may be reflective of consolidations and/or atelectasis. Small bilateral pleural effusions. No pneumothorax identified. The size the cardiomediastinal silhouette is within normal limits.", "output": "New opacities in both lower lobes may be reflective of pneumonia/atelectasis. Small bilateral pleural effusions." }, { "input": "An AP upright chest radiograph shows new airspace consolidation in the right mid lung field, probably in the superior segment of the right lower lobe and the findings, together with the patient's clinical history, suggests pneumonia. The cardiac silhouette is large, and, even taking into account AP projection may be slightly larger than on the persists patient's previous study but central pulmonary vasculature is not congested. A small right pleural effusion may be present superimposed on known the pleural thickening and calcified plaques.", "output": "Pneumonia" }, { "input": "Previously present right lower lobe consolidation has nearly resolved. A small amount of residual consolidation is present in the superior segment right lower lobe. Cardiomediastinal contours are stable in appearance. Widespread calcified pleural plaques are again demonstrated. Interval decrease in size of small right pleural effusion with residual small effusion remaining. No substantial left pleural effusion. Lungs are hyperexpanded suggestive of COPD.", "output": "Marked improvement in right lower lobe pneumonia with residual focus of opacity in the superior segment. Additional followup chest x-ray in four weeks is suggested to document complete resolution. At that time, a small right residual pleural effusion can be re-assessed for resolution as well." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes. Extensive calcified pleural plaques are seen bilaterally. Blunting of costophrenic angles may reflect small pleural effusions or pleural thickening. Hilar and mediastinal silhouettes are unremarkable. Tortuosity of the descending aorta is noted. Mild-to-moderate cardiomegaly is unchanged. There is no pulmonary edema. There is no focal consolidation to suggest pneumonia. Rounded opacities are seen bilaterally, which may represent pulmonary nodules.", "output": "1. No evidence of pneumonia. 2. Round bilateral opacities, may represent pulmonary nodules. Further assessment with CT is recommended. 3. Diffuse bilateral pleural calcifications, compatible with asbestos exposure. 4. Blunting of bilateral costophrenic angles, suggestive of small pleural effusions or pleural thickening." }, { "input": "Frontal and lateral views of the chest were obtained. Again, bilateral pleural plaques are extensive obscuring the lung fields and it is somewhat difficult to discern whether there is new focal consolidation, although none is definitely seen. Slight blunting of the posterior costophrenic angles in the right costophrenic angle may be due to pleural thickening, although a trace right pleural effusion is difficult to entirely exclude. The cardiac silhouette is mildly enlarged. The aorta is calcified and tortuous.", "output": "Extensive bilateral pleural plaques suggest prior asbestos exposure and partially obscure the lung fields making it difficult to accurately discern whether there is underlying new underlying opacities, though no definite new focal consolidation. Blunting of the right costophrenic angle may be due to a small pleural effusion." }, { "input": "Frontal and lateral radiographs of the chest show stable air space consolidation the right mid lung field, consistent with pneumonia. The cardiac silhouette appears slightly smaller on this exam, likely secondary to technique. Small right sided pleural effusions is superimposed on known pleural thickening, and has increased slightly over the interval. There is blunting of the left costophrenic angle. No pneumothorax. .", "output": "Right lower lobe pneumonia." }, { "input": "Parenchymal scarring related to prior asbestosis exposure is relatively unchanged since ___. Pleural plaques are again noted. Blunting of the right costophrenic angle may represent a tiny pleural effusion or chronic pleural scarring. There is no focal opacity, pulmonary edema or pneumothorax.", "output": "Parenchymal scarring and pleural calcifications are unchanged. No concerning findings. RECOMMENDATION(S): Clinical followup. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 1:42 PM, 5 minutes after discovery of the findings." }, { "input": "Single frontal view of the chest demonstrates interval placement of an NG tube with tip in the stomach and a side port likely above the GE junction. This could be advanced by 5 or 6 cm to achieve standard positioning. Prominent cardiac silhouette is somewhat increased as compared to prior exam but likely exaggerated by AP technique. There is stable perihilar vascular congestion and bibasilar opacities. There is no apical pneumothorax or large pleural effusion. The extreme right costophrenic angle is not and compressed.", "output": "NG tube with tip in the stomach and side port slightly above the GE junction. Recommend advancement by 5 cm to achieve standard positioning. Findings reported to Dr.___ ___ phone at approximately 11:00 on ___." }, { "input": "Single frontal view of the chest demonstrates a prominent cardiac silhouette, likely accentuated by AP technique. The mediastinal and hilar contours are within normal limits. There is new increased left greater than right bibasilar opacities, which could reflect developing pneumonia in the appropriate clinical setting, alternatively aspiration could have a similar appearance. There may be trace left effusion. There is no pneumothorax. Pulmonary vascular congestion is mild.", "output": "New left greater than right bibasilar opacities could reflect infection versus aspiration. Findings paged to Dr. ___ at pager #___ at 17:30 on ___." }, { "input": "Lung volumes are low. The heart size is mildly enlarged. The mediastinal and hilar contours are unchanged, with the aorta appearing mildly tortuous. The pulmonary vascularity is not engorged. Streaky bibasilar airspace opacities likely reflect atelectasis. No focal consolidation, pleural effusion or pneumothorax is identified. No acute osseous abnormalities are seen.", "output": "Mild bibasilar atelectasis." }, { "input": "AP upright and lateral views of the chest provided.There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest were performed. There is no pleural effusion, pneumothorax or focal airspace consolidation. The cardiac and mediastinal contours are normal. The hilar and pleural structures are unremarkable. The imaged upper abdomen is normal. There are no acute osseous abnormalities appreciated.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lung fields are clear. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Lungs are well-expanded and clear without focal consolidation concerning for pneumonia. Mild left basilar atelectasis is noted. There is no pneumoperitoneum. Surgical clips are noted in the right upper abdomen as well as a CBD stent.", "output": "Mild left basilar atelectasis.No acute cardiopulmonary process." }, { "input": "Cardiac, mediastinal and hilar contours are unchanged and unremarkable with the heart size within normal limits. Pulmonary vasculature is normal. Minimal atelectasis is noted in the lung bases without focal consolidation. No pleural effusion or pneumothorax is present. Multiple clips and a CBD stent are noted within the right upper quadrant of the abdomen. There are mild degenerative changes seen in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Since ___, mild pulmonary congestion and left retrocardiac atelectasis from severely elevated left hemidiaphragm, which may be due to eventration or diaphragmatic paralysis, are unchanged. Moderate cardiomegaly is stable. No evidence of pneumothorax or pneumonia. Narrow appearing trachea may be seen in patients with chronic lung disease.", "output": "1. Mild pulmonary congestion and left retrocardiac atelectasis from severely elevated left hemidiaphragm, which may be due to eventration or diaphragmatic paralysis, are unchanged since ___. 2. Narrow appearing trachea may be seen in patients with chronic lung disease. Please correlate with patient history." }, { "input": "Right chest wall port is again seen with catheter tip at the lower SVC. Diffuse bilateral pulmonary nodules are partially visualized, particularly overlying the lung bases. There are increased perihilar opacities bilaterally. Cardiomediastinal silhouette is stable. No acute osseous abnormalities.", "output": "Increased perihilar opacities since prior, better characterized by subsequent CTA as progression of disease." }, { "input": "PA and lateral chest radiographs are limited by patient's body habitus and inability to raise arms. The lungs are well expanded. The right hilar opacities are also visible to bronchovascular markings. There is no definite consolidation, effusion or pneumothorax. Cardiac and mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "AP portable upright view of the chest. Overlying EKG leads are present. Hila appear congested and there is mild interstitial pulmonary edema. Mild left basal atelectasis is also noted. No large effusion or pneumothorax. Heart is mildly enlarged. Mediastinal contour is stable. Bony structures are intact.", "output": "Mild edema. Mild cardiomegaly." }, { "input": "The lungs are clear. There is no consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low accentuating the pulmonary vasculature. There is a trace left pleural effusion. A small amount of right basilar atelectasis is unchanged. Diaphragmatic elevation is likely due to ascites. Cardiac silhouette and mediastinal contours are normal.", "output": "Low lung volumes, with trace left effusion and right base atelectasis." }, { "input": "PA and lateral views of the chest provided. Lungs are hyperinflated and lucent suggesting underlying emphysema. No focal consolidation effusion or pneumothorax. No signs of edema or congestion. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "A portable view of the chest demonstrates no focal consolidation to suggest pneumonia. The heart is mildly enlarged. Mediastinal and hilar contours are normal. There is no pneumothorax, pulmonary edema, or pleural effusion. The patient is status post median sternotomy.", "output": "Normal chest radiograph. No evidence of pulmonary edema." }, { "input": "There are again seen multiple median sternotomy wires and surgical clips, unchanged. There is evidence of a recent aortic valve replacement. Right-sided PICC line is again seen with distal tip projecting over the mid SVC. Cardiomediastinal silhouettes are grossly unchanged in comparison to prior radiograph. There is interval improvement in multiple right lung confluent airspace opacities as seen on chest x-ray from ___. The prior left apical pneumothorax has resolved. There is stable appearance of small left pleural effusion.", "output": "Improvement in multiple right lung confluent airspace opacities. Resolved left apical pneumothorax. Stable small left pleural effusion." }, { "input": "There is no focal consolidation, pleural effusion, or pneumothorax. Prominence of interstitial markings is unchanged from the prior radiograph from ___ and consistent with interstitial disease as seen on the CT chest. The cardiomediastinal silhouette is unchanged and mild cardiomegaly is stable. Osseous structures are intact.", "output": "No acute cardiopulmonary process. Prominence of interstitial markings is unchanged from prior study." }, { "input": "PA and lateral views of the chest demonstrates stable cardiomegaly. Fibrotic changes particullary at the periphery of the lung parenchyma are stable. There is no evidence of pleural effusion. No focal consolidation is seen. There is moderate tortuosity of the thoracic aorta", "output": "Fibrotic changes of the lungs with cardiomegaly, stable from 2 days prior." }, { "input": "Evaluation is slightly limited by technique. Within this limitation, the inspiratory lung volumes remain low. The coarse reticular markings in the lung parenchyma are increased from the prior study, more pronounced in the lung bases. In particular, there is decreased aeration of the right lung base, which may represent atelectasis or developing airspace disease. The pulmonary vasculature is unchanged. No pneumothorax is detected. The cardiac silhouette is enlarged but stable. The mediastinal and hilar contours are within normal limits. Partial calcification of the aortic knob is re-demonstrated. No acute osseous abnormality is detected.", "output": "1. Increased opacification of the right lung base may reflect atelectasis or developing airspace disease. Recommend clinical correlation. 2. Increased interstitial opacities suggest chronic background fibrotic changes of the lungs with superimposed pulmonary edema. 3. Stable cardiomegaly." }, { "input": "As compared to prior chest radiograph from ___, small bilateral pulmonary effusions have resolved. There is no overt pulmonary edema. The heart is top normal in size. A left-sided AICD/pacemaker device is noted with leads terminating in the right atrium and right ventricle, expected locations. Patient is status post median sternotomy and CABG. There is diffuse demineralization of the osseous structures.", "output": "Resolved bilateral pleural effusions with no overt pulmonary edema." }, { "input": "Left-sided AICD/pacemaker device is noted with leads terminating in right atrium and right ventricle. The patient is status post median sternotomy and CABG. The heart remains mildly enlarged. Aortic knob is calcified. There is mild interstitial pulmonary edema and small bilateral pleural effusions, new compared to the prior exam. Patchy opacities in the lung bases could reflect atelectasis but aspiration and infection cannot be excluded. No pneumothorax is identified. There is diffuse demineralization of the osseous structures.", "output": "Mild congestive heart failure with small bilateral pleural effusions. Patchy bibasilar airspace opacities could reflect atelectasis but infection and aspiration are not excluded." }, { "input": "The ET tube terminates in the standard position. The NG tube terminates outside the field of view in the region of the stomach. However, the side port still terminates in the region of the GE junction. Median sternotomy wires and CABG clips are again noted with a slight decrease in the heart size. Bilateral parenchymal opacities have significantly improved from ___, indicating marked improvement in pulmonary edema. Nondisplaced left seventh rib fracture is again noted. There is no pneumothorax or pleural effusion.", "output": "1. Marked improvement in pulmonary edema. 2. NG tube sidehole still terminates in the region of the GE junction." }, { "input": "A nasogastric tube courses below the diaphragm, into the stomach, with side hole well below the gastroesophageal junction. Multiple air-filled loops of distended bowel are present in the mid abdomen, better characterized on recently obtained CT. No pneumatosis or subdiaphragmatic free air is identified. The lungs are well-expanded and clear. The cardiomediastinal silhouette is unremarkable.", "output": "NG tube in appropriate position. Clear lungs. No subdiaphragmatic free air." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are normal. There is no pleural effusion or pneumothorax. The lungs are clear.", "output": "No acute intrathoracic abnormality." }, { "input": "Chest PA and lateral radiograph demonstrates unremarkable mediastinal, hilar and cardiac contours. Lungs are clear. No pleural effusion or pneumothorax evident.", "output": "No acute intrathoracic process." }, { "input": "The heart is mildly enlarged. Streaky opacities in the left mid lung and right lung base are nonspecific but most suggestive of minor atelectasis or scarring (no prior studies available for comparison). Particularly along the right lateral chest wall, there are small horizontal subpleural lines, which may reflect subtle evidence for mild fluid overload or pulmonary venous congestion, but there is no frank evidence for congestive heart failure. There is no pneumothorax or definite pleural effusion.", "output": "1. Findings which may suggest slight vascular congestion. 2. Streaky multifocal opacities in the lower lungs, suggestive of chronic scarring, although acuity is difficult to judge without prior comparisons. Correlation with prior radiographs may be helpful if available. Otherwise, depending on the level of clinical concern for subtle early pneumonia, short-term follow-up radiographs, preferably with PA and lateral technique, if possible, could be considered." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, signs of edema, pneumothorax. Tiny pleural effusions are present bilaterally. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Tiny pleural effusions, otherwise unremarkable." }, { "input": "The heart is normal in size. A moderate hiatal hernia projects over the lower mediastinum in the midline. There is also a very small eventration suspected along the right hemidiaphragm. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute disease. Moderate hiatal hernia." }, { "input": "The left Port-A-Cath tip terminates in the mid SVC, unchanged since ___. A prior small left pleural effusion has resolved. No pneumothorax. Lungs are clear without focal consolidation concerning for pneumonia. Cardiomediastinal silhouettes are stable. A small focus of fat is seen at the right cardiophrenic angle.", "output": "The left Port-A-Cath tip terminates in the mid SVC, unchanged since ___." }, { "input": "The catheter of a left chest wall port terminates in the mid SVC. Increased opacities in the lung bases may represent atelectasis but pneumonia cannot be excluded. No pleural effusion or pneumothorax. Heart size and cardiomediastinal contours are normal.", "output": "Bibasilar opacities are consistent with atelectasis, but pneumonia cannot be excluded in the appropriate clinical setting." }, { "input": "New right-sided pleural drainage with interval decrease in right-sided pleural effusion which is now moderate. Small new apical pneumothorax. The left lung is unchanged. Right-sided Port-A-Cath with the tip in the right atrium.", "output": "Small right apical pneumothorax post thoracentesis." }, { "input": "Compared with prior radiographs on ___, there is increased opacity at the left lung base, likely representing atelectasis or aspiration. Right-sided basilar atelectasis and effusion are unchanged. Cardiomediastinal silhouette is unchanged. There is no pneumothorax. Left Port-A-Cath and right-sided PICC line are unchanged in appearance.", "output": "Increased left basilar atelectasis or aspiration." }, { "input": "AP portable upright view of the chest. Left chest wall Port-A-Cath again seen with catheter tip in the region of the mid SVC. Lung volumes are low. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process" }, { "input": "Portable upright chest radiograph ___ at 10:04 is submitted.", "output": "Right subclavian PICC line and left subclavian Port-A-Cath unchanged in position. Persistent low volumes with bibasilar patchy opacities suggestive of atelectasis. Interval removal of one of the two right basilar pleural pigtail catheters. No pneumothorax is seen. No pulmonary edema. Overall cardiac and mediastinal contours are stable." }, { "input": "Compared with prior radiographs on ___, and there is collapse of the right middle lobe, and a moderate right pleural effusion with fluid in the minor fissure. Overall lung volumes are low. There is left basilar atelectasis and a probable small left pleural effusion. A left Port-A-Cath terminates in the mid SVC. The right-sided PICC line terminates in the low SVC. A hepatic drain is seen below the level of the diaphragm.", "output": "Right middle lobe collapse and moderate right pleural effusion. Left basilar atelectasis and probable small left pleural effusion." }, { "input": "No significant interval change. The lungs are well-expanded. No focal consolidation, edema, effusion, or pneumothorax. The heart is top-normal in size, unchanged. Mediastinal and hilar contours are unchanged. No acute osseous abnormality.", "output": "No pneumothorax. No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top normal. The mediastinal and hilar contours are unremarkable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "A single portable frontal view of the chest was obtained. The patient is status post endotracheal tube placement with tip approximately 2.5 cm above the carina. Enteric tube is subdiaphragmatic but the tip is excluded from the image. Lung volumes remain low. Increased bilateral opacities likely reflect pulmonary vascular crowding and mild edema. pulmonary edema has improved. Cardiomediastinal silhouette is stable. There is no large effusion or pneumothorax.", "output": "1. Status post endotracheal tube placement in appropriate position. 2. Persistent low lung volumes. 3. Better aeration of both lungs and decreased atelectasis and edema." }, { "input": "Frontal and lateral radiographs of the chest show biapical pleural thickening with irregular contours, unchanged from ___. The lungs are otherwise clear without focal consolidation, pleural effusion, or pneumothorax. The pulmonary vasculature is not engorged. The cardiac silhouette is normal in size. The mediastinal and hilar contours are within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear, without pleural effusion or pneumothorax. The cardiac silhouette is normal in size, the mediastinal contours are normal. The pulmonary vasculature is normal in appearance. There is no osseous abnormality.", "output": "No acute chest pathology." }, { "input": "There is no focal consolidation, edema, or effusion. There is a 9 mm nodular opacity projecting over the left lung apex suggestive above the clavicular head not seen on prior. Cardiac silhouette is mildly enlarged. Thoracolumbar S-shaped scoliosis is noted without acute osseous abnormalities. Surgical clips noted in the upper abdomen.", "output": "No acute cardiopulmonary process. 9 mm nodular opacity projecting over left lung apex. Nonurgent chest CT is suggested for evaluation of this and for documentation of stability of the previously described nodules from ___ as previously recommended." }, { "input": "The patient is status post median sternotomy with unchanged fracture of the superior most sternotomy wire. Moderate cardiomegaly is unchanged, with persistent enlargement of the pulmonary arteries compatible with pulmonary artery hypertension. Mild pulmonary vascular engorgement is noted. No focal consolidation, pleural effusion or pneumothorax is identified. No acute osseous abnormalities are seen.", "output": "Persistent enlargement of the pulmonary arteries compatible with pulmonary artery hypertension, unchanged. Mild pulmonary vascular congestion and continued moderate cardiomegaly." }, { "input": "Severe cardiomegaly is unchanged. Patient is post ASD repair. Previously seen right pleural effusion has resolved. Lungs are clear without focal consolidation or pneumothorax. Median sternotomy wires are intact.", "output": "1. No focal consolidation concerning for pneumonia. 2. Severe cardiomegaly is unchanged. Post ASD repair." }, { "input": "There is cardiomegaly, mild to moderate and increased pulmonary vascular engorgement, although no frank edema. The hilar counters are normal. There is no pleural effusion or pneumothorax.", "output": "Cardiomegaly and pulmonary engorgement, consistent with early failure." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. There is minimal atelectasis in the lung bases without focal consolidation. No pleural effusion or pneumothorax is visualized. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Patient is status post median sternotomy and aortic valve replacement. Heart size remains mildly enlarged, unchanged. Mediastinal and hilar contours are similar. Lung volumes are low with mild crowding of the bronchovascular structures but no overt pulmonary edema. Patchy opacities in the lung bases likely reflect areas of atelectasis. No pleural effusion or pneumothorax is clearly visualized. A right-sided PICC tip terminates in the low SVC.", "output": "Low lung volumes with probable bibasilar atelectasis." }, { "input": "There is relative elevation of left hemidiaphragm as on prior. The lungs are clear without focal consolidation, effusion, or edema. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. Surgical clips in the right upper quadrant suggest prior cholecystectomy.", "output": "No acute cardiopulmonary process." }, { "input": "Linear left basilar opacity is likely atelectasis. Elsewhere, the lungs are clear without consolidation, effusion or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. Clips in the right upper quadrant suggest prior cholecystectomy.", "output": "No definite acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest were obtained. Heart size and mediastinal contours are unchanged. No pleural effusion, focal consolidation or pneumothorax. Linear opacity in the right middle lobe consistent with atelectasis.", "output": "No evidence of pneumonia." }, { "input": "Heart size is mildly enlarged. The aorta is mildly tortuous. Mediastinal and hilar contours are otherwise unremarkable. Pulmonary vasculature is normal. Streaky retrocardiac opacity likely reflects atelectasis. No focal consolidation, pleural effusion or pneumothorax is otherwise demonstrated. No acute osseous abnormality is seen. There are mild degenerative changes in the thoracic spine.", "output": "Streaky retrocardiac opacity, likely atelectasis." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Normal chest radiograph." }, { "input": "Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is no focal lung consolidation. No acute osseous abnormality is seen.", "output": "No radiographic explanation for chest pain." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable view of the chest. The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "There is no pleural effusion, pneumothorax or focal airspace consolidation. The cardiac silhouette is normal in size. There is unchanged appearance of the mediastinum with no new prominence of the ascending aorta. The hilar contours are unremarkable. Nipple shadows are seen bilaterally.", "output": "No acute cardiopulmonary process. Dr. ___ was unable to be paged." }, { "input": "The lungs are clear. Nodular opacities overlying the lung bases bilaterally are compatible with nipple shadows. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified. Chronic likely posttraumatic changes identified at the right acromioclavicular joint.", "output": "No acute cardiopulmonary process." }, { "input": "Left PICC tip position in mid SVC. There is no malpositioning or kinking of the PICC throughout its course. Cardiac size is normal. Tortuous aorta. The lungs are clear. There is no pneumothorax or pleural effusion.", "output": "No malpositioning or kinking of the left PICC which terminates in the mid SVC." }, { "input": "The lungs are hyperinflated with flattening of the diaphragms suggestive of COPD. Heart size is normal. The aorta remains aneurysmally dilated and tortuous, unchanged. Pulmonary vascularity is not engorged. Ill-defined patchy opacity within the right lower lobe is concerning for pneumonia, and is new compared to the prior exam. Left lung is clear. No pleural effusion or pneumothorax is identified. Posttraumatic changes of the right acromioclavicular joint are re- demonstrated. There are no acute osseous abnormalities.", "output": "Right lower lobe pneumonia. Follow up radiographs after treatment are recommended to ensure resolution of this finding." }, { "input": "Cardiac and mediastinal silhouettes are stable. Again, the aorta is markedly tortuous, dilated with a stent graft, similar to prior study. Thoracic scoliosis is noted. No new focal consolidation is seen. No pneumothorax is seen. There is slight blunting of the costophrenic angles which may be due to the lungs being hyperinflated, trace pleural effusions not excluded.", "output": "Slight blunting of the posterior costophrenic angles, trace pleural effusions not excluded. Otherwise, no significant interval change from the prior study." }, { "input": "The lungs are well expanded and clear. There is no infiltrate, pulmonary edema, or pleural effusion. The endovascular grafting of enlarged tortuous descending thoracic aorta is unchanged in position. Mild-to-moderate cardiac enlargement is stable since the prior study.", "output": "No infiltrate, effusion, or pulmonary edema. Stable appearance since prior study." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "There has been interval placement of an endotracheal tube, terminating approximately 6 cm above the level of the carina. The cardiac and mediastinal silhouettes are stable. Status post median sternotomy and stenting of the descending aorta again noted. There is improved aeration of the left lung base. The lungs remain hyperinflated. No large pleural effusion is seen although trace pleural effusion would be difficult to exclude. No pneumothorax. No pulmonary edema.", "output": "Status post endotracheal tube placement, with tube terminating approximately 6 cm above the level are the carina. Improved aeration of the left lung base. No large pleural effusion is currently seen although trace pleural effusion would be difficult to exclude." }, { "input": "Endovascular graft in the tortuous descending thoracic aorta has an unchanged configuration since ___. Previously described ill-defined opacity in the right lower medial lung, which raised concern for pneumonia has substantially resolved. There are no other new opacities. No pleural effusion. Mild to moderately enlarged heart size is unchanged.", "output": "Previously described right lower medial lung opacity, concerning for pneumonia has substantially improved. No new opacities in the lungs." }, { "input": "PA and lateral views of the chest demonstrate unchanged degree of cardiomegaly and stable appearance of large and tortuous intrathoracic aorta with large endovascular stent graft. The lungs are hyperinflated and there is relative flattening of the hemidiaphragms, not significantly changed since prior study. There is no pneumothorax. The costophrenic angles are not well seen on the lateral images, possibly reflecting trace bilateral pleural effusions or atelectasis.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well-expanded. There is no focal consolidation, pleural effusion or pneumothorax. Again seen is a markedly tortuous dilated aorta with a stent graft unchanged in size and configuration since prior studies. The cardiomediastinal silhouette is unchanged.", "output": "No acute cardiopulmonary process or change from the prior study." }, { "input": "A stent along the course of the aorta is again noted. The heart is moderately enlarged. Tortuosity of the aorta appears similar. Mediastinal and hilar contours appear unchanged. There is a new consolidation in the right lower lobe, worrisome for pneumonia. It is difficult to exclude a small coinciding pleural effusion. The left lung appears clear. There is no pneumothorax.", "output": "Findings consistent with pneumonia in the right lower lobe. Discussed with Dr. ___ on ___, by telephone." }, { "input": "Tracheostomy tube, multiple median sternotomy wires, right mediastinal clips, and descending thoracic aorta stent and graft appears similar to the prior exam. The lungs are hyperexpanded. No significant interval change from the prior exam. No pneumothorax. No focal consolidation, edema, or large pleural effusion. Slight blunting of the bilateral costophrenic angles may reflect scarring or trace effusions. Appearance of the cardiomediastinal silhouette is overall unchanged. Deformity of the right posterior a lateral ninth rib may reflect healed prior rib fracture.", "output": "No evidence of hemothorax on radiograph." }, { "input": "A left PICC terminates in the SVC. Tracheostomy tube is in standard position. The aortic stent graft extending from the aortic arch to the diaphragmatic hiatus is stable in position. A Dobhoff tube ends in the proximal stomach. The cardiac silhouette is normal in size. Mild widening of the upper mediastinum corresponds to enlarged ascending aorta, which has been previously repaired. Small dependent pleural effusions and mild bibasilar atelectasis are decreased. There is no pneumothorax. The lungs are well expanded and clear. A small nodular opacity in the right middle lobe was seen on recent chest CT. There is no pneumoperitoneum. Dextroscoliosis centered in mid thoracic spine is unchanged. Median sternotomy wires are intact and aligned.", "output": "1. Interval improvement in small bilateral pleural effusions and basal atelectasis. 2. Dobhoff tube ends in the proximal stomach. RECOMMENDATION(S): Advancement of the Dobhoff tube by several cm is recommended for more optimal positioning." }, { "input": "When compared to prior, there has been no significant interval change. The lungs are clear of consolidation, effusion, or edema. Thoracic aortic stent graft is again seen. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Single AP upright portable view of the chest was obtained. The aortic stent graft in a tortuous aorta is again seen. Patient is status post sternotomy. In the interval since the prior study, there has been interval increase in bibasilar opacities, right greater than left, worrisome for pneumonia. However, findings could also relate to aspiration. There are likely small bilateral pleural effusions. The cardiac silhouette remains enlarged. Cardiac and mediastinal silhouettes are stable.", "output": "Interval increase in right basilar opacity and to a lesser extent, left basilar opacity could be due to infection and/or aspiration. Small bilateral pleural effusions." }, { "input": "Tracheostomy tube is in unchanged position. Left PICC terminates in upper SVC. Transesophageal tube has been removed. Descending thoracic aorta stent graft is stable. Sternotomy wires are intact. Bibasilar opacities have improved, likely reflecting improved atelectasis. Moderately enlarged cardiac silhouette and is unchanged. There is no pulmonary edema.", "output": "Improved bibasilar atelectasis. No pulmonary edema." }, { "input": "The cardiac silhouette is severely enlarged and there is a stent graft within the known thoracic aortic aneurysm. The lungs are grossly clear without large confluent consolidation.", "output": "No definite acute cardiopulmonary process." }, { "input": "Tracheostomy tube is in unchanged position. Left PICC terminates in mid SVC. Transesophageal tube terminates in the stomach. Sternotomy wires are intact. Descending aortic stent graft is in unchanged position. Widened upper mediastinum is consistent with known ascending aortic aneurysm. Previously seen right middle lobe nodular opacity is not well visualized on current exam. Mild bibasilar opacity are likely due to atelectasis. There is no large pleural effusion. Borderline pulmonary edema is noted in the left lung.", "output": "Small right pleural effusion is slightly increased. Borderline pulmonary edema." }, { "input": "In comparison with the study of ___, the monitoring and support devices are unchanged. The nasogastric tube can be advanced approximately 5 cm. The thoracic aorta stent graft is also unchanged. The pneumomediastinum has not significantly changed when compared to the prior. There is continued enlargement of the cardiac silhouette with worsening pulmonary vascular congestion. There is worsening opacity in the left and right lower lobes, that can represent consolidation/atelectasis.", "output": "Mild interstitial edema with worsening lower lobe atelectasis/consolidation." }, { "input": "AP upright and lateral views of the chest were provided. Since the prior exam, there is development of lower lung opacities which could represent pneumonia with associated pleural effusions, right greater than left. Mild pulmonary vascular congestion. The heart remains enlarged. There is a stent coursing through the entire descending thoracic aorta, unchanged. Midline sternotomy wires and mediastinal clips are again seen. The imaged osseous structures appear intact with a mild scoliosis again seen.", "output": "Probable mild pulmonary edema with bilateral lower lobe opacities, which could represent an early pneumonia. Small bilateral effusions, right greater than left. Stable cardiomegaly and post-surgical changes in the descending thoracic aorta." }, { "input": "AP portable upright view of the chest. Midline sternotomy wires again noted as well as metallic stent within the descending thoracic aorta. There is subtle opacity at the left lung base likely representing atelectasis with adjacent effusion though cannot exclude pneumonia. The lungs are otherwise clear. The cardiomediastinal silhouette is stable. Bony structures are intact.", "output": "Subtle opacity in the left lung base concerning for effusion with atelectasis/pneumonia. Extensive aortic graft in place." }, { "input": "Portable semi-upright frontal view of the chest. The endotracheal tube has been removed. The right lung is clear. Left lower lobe atelectasis persists. Left lower pleural mass and lower lobe consolidation appear unchanged. Clips project over the left hemithorax. Left lower rib irregularity is due to known metastatic disease. Normal size heart. No pleural effusion or pneumothorax.", "output": "Unchanged left lower lobe atelectasis and left pleural mass/consolidation better characterized on the prior chest CT." }, { "input": "AP portable chest x-ray shows stable left base opacification due to a combination of pleural mass and left lower lobe consolidation, unchanged since prior chest x-ray. No new consolidation. Cardiomediastinal silhouette is unchanged. No pneumothorax.", "output": "No changes since prior CXR." }, { "input": "Again seen is of dense retrocardiac opacity. Most compatible with left lower lobe infiltrate. There is probably a small associated pleural effusion. However there is minimal if any vascular redistribution and therefore this is felt to be more likely infectious than due to pulmonary edema. The heart continues to be severely enlarged there is a large bore right IJ line with tip in the right atrium", "output": "Continued large left infiltrate." }, { "input": "Lung volumes are decreased from prior exam. There are increased interstitial markings consistent with increased mild pulmonary edema. There is increased opacity in the left lung base, which may reflect atelectasis, pneumonia, or aspiration and possibly an element of pleural effusion. There is no pneumothorax. A right-sided central line is again seen terminating in the right atrium. The cardiomediastinal silhouette is severely enlarged, similar to prior exam.", "output": "1. Increased mild pulmonary edema. 2. Increased left lung base consolidation, which may reflect atelectasis, pneumonia, or aspiration, with possible left pleural effusion. NOTIFICATION: Findings were communicated to Dr. ___ at 2:15 p.m. on ___ by phone." }, { "input": "The heart is moderately enlarged. The lung volumes are low. The cardiac, mediastinal and hilar contours appear stable. New opacification of the left lung base is concerning for pneumonia and are probably a small coinciding left pleural effusion. There is no evidence for pulmonary edema.", "output": "New left basilar opacification concerning for pneumonia and probably a pleural effusion." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No acute intrathoracic process seen." }, { "input": "PA and lateral views of the chest. The lungs are clear without consolidation, effusion or pulmonary vascular congestion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "Single upright AP radiograph of the chest demonstrates a left basilar opacity with obscuration of the left hemidiaphragm. There are also diffuse peripheral interstitial opacities, greater on the right than the left. There is an unusual curvilinear lucency in the right upper quadrant of the abdomen, lateral to the liver, though no definite free air is noted under the diaphragm. The aorta is tortuous. The cardiac silhouette is not enlarged. No pneumothorax or pleural effusion. Remote right sided rib fractures are noted. There is an acute distal left clavicular fracture.", "output": "1. Left basilar opacity which is non-specific, but may represent atelectasis, aspiration, or pneumonia. 2. Minimally displaced distal left clavicular fracture. 3. Ill-defined curvilinear lucency in the right upper quadrant of the abdomen, lateral to the liver, of unclear significance. 4. Peripheral interstitial opacities greater on the right than the left which may represent chronic changes. The case was discussed by Dr. ___ with Dr. ___ by phone at 11:56 a.m. on ___." }, { "input": "There has been previous surgery in the left lung with clips just below the left main bronchus, unchanged in appearance. Associated mild volume loss in left hemithorax appears stable. Cardiomediastinal contours are unchanged. Lungs are clear, and there are no pleural effusions or acute skeletal findings.", "output": "Stable post-operative appearance of the chest with no findings of disease recurrence. However, CT would be more sensitive for detecting recurrent disease and may be considered if there is strong clinical suspicion." }, { "input": "There are moderate bilateral pleural effusions. Fluid is also seen tracking along the right-sided fissures. There is moderate interstitial pulmonary edema. No pneumothorax is seen. The cardiac silhouette is top-normal. Mediastinal contours are unremarkable.", "output": "Moderate bilateral pleural effusions and moderate pulmonary edema." }, { "input": "There is blunt right posterior costophrenic angle raising concern for a small pleural effusion. No definite focal consolidation is seen. There is no pneumothorax. The right hemidiaphragm is mildly elevated. No overt pulmonary edema is seen. The cardiac and mediastinal silhouettes are unremarkable. Degenerative changes are seen along the spine.", "output": "Small right pleural effusion." }, { "input": "Portable semi-erect chest film ___ at 08:05 is submitted.", "output": "There are increasing bilateral layering effusions with worsening mild perihilar pulmonary and interstitial edema. Overall cardiac and mediastinal contours are stable. Bibasilar opacities, left greater than right, likely reflect compressive atelectasis, although pneumonia cannot be excluded. No pneumothorax." }, { "input": "Portable AP upright chest film ___ at 18:38 is submitted.", "output": "There are bilateral layering effusions, right greater than left, which may not be significantly changed given differences in positioning. Bibasilar opacities, left greater than right, likely reflect partial lower lobe compressive atelectasis, although superimposed infection cannot be excluded. There has been interval appearance of mild interstitial edema. Overall cardiac and mediastinal contours are stable. No pneumothorax." }, { "input": "Portable upright frontal view of the chest shows clear lungs with no focal consolidation, pleural effusion or pneumothorax. The heart and mediastinal contours are normal.", "output": "Clear lungs." }, { "input": "Lung volumes are slightly decreased. Streaky in bibasilar atelectasis is more notable on the left. There is a small left effusion. There is no evidence of focal consolidation,pneumothorax, or pulmonary edema. Allowing for patient rotation, the cardiomediastinal silhouette is within normal limits. A moderate hiatal hernia is noted.", "output": "Bibasilar atelectasis and small left pleural effusion." }, { "input": "The cardiac silhouette is mildly enlarged. There is evidence of prior CABG. Midline sternal wires are intact and well aligned. The central pulmonary vasculature is somewhat congestion, without overt edema. There is no pleural effusion or pneumothorax. The lungs are grossly clear without definite consolidation.", "output": "No acute intrathoracic abnormality identified." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The endotracheal tube terminates above the clavicles, 8.2 cm above the carina, more superior than on ___. Right internal jugular central venous catheter appears unchanged. No pneumothorax. Mediastinal contours and heart borders are slightly more prominent than on previous examination. Diffuse increased opacifications suggests mild worsening of pulmonary edema. Bibasilar atelectasis is improved. No significant pleural effusion.", "output": "1. Endotracheal tube is too high, 8.2 cm above the carina. 2. Slightly worsening pulmonary edema. RECOMMENDATION(S): Repositioning endotracheal tube is recommended. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 12:12 PM, 15 minutes after discovery of the findings." }, { "input": "Dobhoff tube terminates in the mid to lower esophagus. NG tube terminates in the stomach with proximal side port beyond the gastroesophageal junction. Lung volumes are low and the lungs are clear. No substantial pleural effusion or pulmonary edema.", "output": "Dobhoff tube terminates in the mid to lower esophagus. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 2:34 PM, 2 minutes after discovery of the findings." }, { "input": "An ET tube is present, tip approximately 3.3 cm above the carina. An orogastric type tube is present, tip extending beneath diaphragm, off film. A right IJ central line tip overlies the mid to distal SVC. No pneumothorax is detected. Inspiratory volumes remain low, with the right hemidiaphragm elevated with respect to the left. Again seen is associated atelectasis. No gross right effusion, though a small effusion might not be evident. Hazy increased retrocardiac density, similar to the prior study, consistent with left lower lobe collapse and/or consolidation. Subtle air bronchograms in the retrocardiac region are more apparent on the current examination.", "output": "Compared with ___, no gross change is detected." }, { "input": "There has been interval removal of the endotracheal tube. Right internal jugular central venous catheter is unchanged. A Dobhoff tube terminates in the ___ portion of the duodenum. Lung volumes are improved with stable mild right basilar atelectasis adjacent to unchanged elevation of the right hemidiaphragm. No substantial pleural effusions. No pneumothorax.", "output": "1. Dobhoff tube in the ___ portion of the duodenum. 2. Improved lung volumes post extubation with mild residual right basilar atelectasis." }, { "input": "The ET tube lies 3.8 cm above the carinal. Right IJ line tip overlies distal SVC near SVC/RA junction. An orogastric tube is present with tip extending beneath the diaphragm and off the film. Inspiratory volumes are quite low, with relative elevation the right hemidiaphragm. The degree of vascular plethora, which itself is likely accentuated by low lung volumes, may be slightly worse. Otherwise, the appearance of the cardiomediastinal silhouette and lungs is similar to the prior film. Cardiomediastinal silhouette is unchanged. There is bibasilar atelectasis, likely also accentuated by low inspiratory volumes. No gross left effusion. No obvious right effusion. Allowing for low lung volumes, no focal consolidation identified.", "output": "Vascular plethora may be slightly worse. Otherwise, no significant change identified compared with 1 day earlier." }, { "input": "The patient is intubated. The endotracheal tube terminates approximately 5 cm above the carina. An orogastric tube terminates near the inlet to the stomach and a sidehole marker projects over the distal esophagus. A right internal central jugular venous catheter terminates at the cavoatrial junction. There are probably small-to-moderate bilateral layering pleural effusions. The heart is probably normal in size. Mild fullness of central pulmonary vessels suggests venous hypertension. Streaky left basilar opacities are probably due to minor atelectasis. There is no pneumothorax.", "output": "1. Status post endotracheal intubation. Orogastric tube terminating probably in the cardia of the stomach. Advancing the tube is suggested if better seating is desired clinically. At present, the sidehole marker projects above the gastroesophageal junction. 2. Findings suggesting mild vascular congestion. 3. Bilateral pleural effusions." }, { "input": "Since prior, Dobbhoff tube has been advanced and now ends in the stomach. Lines and tubes are otherwise unchanged in position. Vascular congestion is stable. The appearance of the heart and mediastinum is also unchanged.", "output": "Dobbhoff tube ends in the stomach. Otherwise, no interval change." }, { "input": "Lung volumes are low. Mild bibasilar opacities are likely atelectasis. There is no pneumothorax or pleural effusion. Cardiac silhouette is exaggerated by low lung volumes. Sternal wires are intact.", "output": "Mild bibasilar atelectasis." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Previously seen metastatic lung lesions are not well seen on this exam. There is a left Port-A-Cath terminating at the cavoatrial junction. There is no acute focal consolidation, pleural effusion or pneumothorax. The heart size is normal. The mediastinal contours are normal.", "output": "No acute cardiopulmonary process. Previously seen metastatic lesions are not well seen on this exam." }, { "input": "Right-sided Port-A-Cath tip terminates in the upper SVC. Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is not engorged. Streaky opacity in the left lung base likely reflects atelectasis and is not substantially changed in the interval. Remainder of the lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. Scarring is seen in the lung apices.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The previously noted left lung base opacity has substantially improved, likely representing resolving post-procedure hemorrhage. No new areas of consolidation are identified. No pneumothorax or large pleural effusions. Right port-a-cath terminates at the lower SVC. Endotracheal tube has been removed. Cardiomediastinal silhouette is stable.", "output": "Interval improvement of left lung base opacity, possibly representing resolving hemorrhage. Interval improvement and now new opacity due to underlying infection or new hemorrhage, is not excluded." }, { "input": "There is nearly complete opacification of the hemithorax but without substantial net shift of mediastinal structures. This may reflect a large pleural effusion with associated atelectasis or pneumonia but is incompletely characterized. Patchy opacification is noted in the right mid to lower lung with a suspected small pleural effusion on the right. The pulmonary vascularity in the right lung is mildly prominent, suggesting mild fluid overload.", "output": "Nearly complete opacification of the left hemithorax with balanced mass effect, suggesting a large pleural effusion among other potential causes, including the possibility of malignancy. Chest CT may be useful to evaluate further if clinically indicated." }, { "input": "Single portable view of the chest. No prior available for comparison. Endotracheal tube is seen with tip approximately 4 cm from the carina, in appropriate position. Right-sided PICC line is seen with tip in the right brachiocephalic vein, relatively close to the superior SVC. Enteric tube seen with tip off the inferior field of view and the sideport is seen below the GE junction. There is dense retrocardiac opacity identified silhouetting the hemidiaphragm, which could be due to any combination of effusion, atelectasis, or consolidation. The lungs are otherwise grossly clear. The cardiomediastinal silhouette is notable for median sternotomy wires and mediastinal clips. Degenerative changes noted at the left shoulder with heterotopic ossification in the adjacent soft tissues.", "output": "1. Endotracheal tube in appropriate position. Right PICC line seen with tip likely in the distal right brachiocephalic vein, in close proximity to the upper SVC. 2. Dense retrocardiac opacity which could be due to any combination of effusion, atelectasis, and/or infiltrate." }, { "input": "No focal consolidation is seen. There may be very trace pleural effusions. No pneumothorax is seen. The cardiac silhouette is moderately enlarged. There may be minimal pulmonary vascular congestion. Mediastinal contours are unremarkable.", "output": "Moderate cardiomegaly and possible minimal pulmonary vascular congestion. Possible trace pleural effusions." }, { "input": "Single upright portable view of the chest demonstrates mild cardiomegaly. There is increased vascular congestion as compared to before. There may be a small right pleural effusion. No focal opacities concerning for pneumonia at this time. No pneumothorax.", "output": "Mild vascular engorgement." }, { "input": "The lungs are well-expanded. No pleural effusion, pneumothorax, or focal consolidation. Heart size, mediastinal contour, and hila are unremarkable.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Post CABG changes are stable. Swan-Ganz catheter is stable in position. Central and chest drains in situ. The ETT has been removed. Mild subglottic edema. Lung volumes remains stable. Bibasal atelectasis unchanged. No pneumothorax. The cardiomediastinal shadow is enlarged, but unchanged. No pulmonary edema. No new areas of airspace consolidation", "output": "No significant interval change." }, { "input": "Endotracheal tube well positioned. A nasoenteric tube ends in the stomach. Heart size is enlarged. There is a dense retrocardiac opacity. Right lung is grossly clear. There is calcification of the aortic knob. There is no pneumothorax. There is a small left pleural effusion.", "output": "1. Appropriate positioning of lines and tubes. 2. Left basilar consolidative opacity, concerning for pneumonia. 3. Moderate left pleural effusion. 4. Grossly clear right lung." }, { "input": "Feeding tube in situ with the tip in the distal stomach. Low lung volumes. The cardiomediastinal shadow is unchanged. Atelectatic changes in the lower lungs with possible associated effusions. Left-sided PICC line in situ with the tip at the cavoatrial junction. Left apical pneumothorax measuring 7 mm in diameter. Left pigtail chest drain in situ. Central chest drain in situ. The right-sided chest drain has been removed. No right-sided pneumothorax.", "output": "Small left apical pneumothorax. The rest of the drains and tubes remain unchanged." }, { "input": "DH tube in situ with the tip in the stomach. Swan-Ganz catheter in situ with the tip in the left main pulmonary artery, still within the cardiomediastinal shadow. Post CABG changes with prosthetic aortic valve in situ. Low lung volumes. Right-sided chest drain in situ. Bilateral basal airspace opacification (most likely atelectasis) appear similar compared to previous imaging.", "output": "DH tube in situ with the tip in the stomach." }, { "input": "AP and lateral views of the chest. Right-sided dialysis catheter is seen in stable position. Given limitation of scan from overlying soft tissues, there is no evidence of large confluent consolidation. Linear bibasilar opacities are most suggestive of atelectasis. There is no visualized pneumothorax or large effusion. Cardiomediastinal silhouette is within normal limits. The bones are not well assessed.", "output": "No definite acute cardiopulmonary process." }, { "input": "Frontal chest radiograph demonstrates the right PICC has been removed. Right-sided tunneled dialysis catheter tip terminates in the right atrium. Lung volumes are persistently low with mild pulmonary vascular congestion, interstitial edema and right basilar atelectasis. There is no large pleural effusion or pneumothorax. The cardiomediastinal silhouette is stable. Incidentally noted, the splenic flexure of the colon is dilated, measuring 6.6 cm.", "output": "Mild pulmonary edema, worsened compared to ___." }, { "input": "PA and lateral views of the chest were provided demonstrating no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Portable upright chest radiograph excludes the right costophrenic angle. An NG tube is in place, the tip of which is superimposed upon the expected region of the body of the stomach. Note is made of an intrathoracic stomach fundus, better appreciated on CT performed same day, new since ___. The lungs are clear. The cardiac silhouette is normal in size, the mediastinal contours are normal.", "output": "Interval placement of an NG tube, the tip of which is in the expected region of the stomach, with a similar appearance to intrathoracic stomach compared with CT earlier this evening. New transdiaphragmatic herniation of gastric fundus suggests acute exacerbation of chronic left central diaphragmatic rupture or hernia." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion or evidence of pneumothorax is seen. There is minor left basilar linear atelectasis. The cardiac and mediastinal silhouettes are stable. Anchors are noted projecting over the right humeral head from presumed prior rotator cuff repair.", "output": "No acute cardiopulmonary process." }, { "input": "A left-sided chest tube has been removed. Overlying emphysema along the chest wall is similar. There is no definite pneumothorax, however. There is mild elevation of the left hemidiaphragm with streaky opacifications suggesting minor atelectasis. Elsewhere, the lungs appear clear. There is no pleural effusion. Mild degenerative changes are similar along the thoracic spine.", "output": "No definite pneumothorax following removal of chest tube from the left hemithorax." }, { "input": "Only trace residual left pneumothorax remains after placement of a chest tube. Retrocardiac opacity likely represents persistent atelectatic lung and some smaller component of the previously large pleural effusion. The right lung is clear.", "output": "Tiny residual left pneumothorax status post chest tube placement. Retrocardiac density likely secondary to persistent atelectatic lung." }, { "input": "There is a large left hydropneumothorax with near-complete collapse of the left lung. The mediastinum is midline without any evidence of tension. The right lung is clear.", "output": "Large left hydropneumothorax with near-complete left lung collapse and large effusion. Findings were communicated immediately after identification with Dr. ___ via telephone at 2:50 p.m., at which time the finding had been identified by the ED and a chest tube was placed." }, { "input": "PA and lateral chest radiographs were obtained. A tiny left apical pneumothorax is not apparent on this study. Left chest tube remains in place. Minimal left basilar atelectasis is unchanged. The right lung is clear. No abnormal cardiac or mediastinal contours noted. Left flank subcutaneous emphysema is unchanged.", "output": "No residual left apical pneumothorax." }, { "input": "Frontal and lateral chest radiographs demonstrate a tiny residual left apical pneumothorax. There is a small left pleural effusion. A left chest tube remains in place with its tip and sidehole projecting over the left mid lung. A small amount of left subcutaneous emphysema is noted along the lateral thoracic wall. There is a small amount of left basilar atelectasis. The lungs are otherwise clear. The cardiac silhouette and mediastinal contours are normal. The pulmonary vasculature is normal.", "output": "Unchanged appearance of left chest tube, with small apical pneumothorax and subcutaneous emphysema. Minimal left basilar atelectasis and small left pleural effusion." }, { "input": "There are no infiltrates. Strand of atelectasis or fibrosis right lung base. Normal heart size, pulmonary vascularity. No effusions.", "output": "No infiltrates" }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. The left-sided Port-A-Cath catheter ends in the upper/mid SVC, in unchanged position compared with prior exam.", "output": "Unremarkable chest radiographic examination. Unchanged position of the left-sided port, with the catheter ending in the upper/mid superior vena cava." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are unremarkable. Again appreciated is a left-sided subclavian approach single-lumen port with the tip terminating at the upper-to-mid SVC. The port catheter is without sharp kinks or breaks. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "Left subclavian single-lumen port appropriately positioned without breaks or sharp kinks. Results were conveyed over the telephone with ___ of the IV team by Dr. ___ at 10:31 a.m. on ___ at time of initial review." }, { "input": "Frontal lateral views of the chest. Left chest wall port is again seen with catheter tip unchanged in position. The lungs are clear of focal consolidation or effusion. There is a linear lucency projecting just deep to the right lateral ribs. The cardiomediastinal silhouette is normal. No acute osseous abnormalities detected.", "output": "Linear lucency projects over the right lateral chest just medial to the ribs. This could represent superimposed skin fold from the arm however repeat exam with the arms out is suggested to exclude pneumothorax or subcutaneous gas. Findings discussed with Dr. ___ at approximately 9:40 pm on ___ at time of interpretation." }, { "input": "PA and lateral views of the chest demonstrate hyperexpansion of the lungs and relative flattening of the hemidiaphragms, consistent with emphysema. There is persistent eventration of the right hemidiaphram or diaphragmatic hernia, unchanged since the prior study. There is no evidence of pleural effusion, pulmonary edema or focal opacity. The cardiomediastinal silhouette is stable in appearance.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are hyperinflated with flattening of the diaphragms consistent with patient's history of COPD with underlying pulmonary emphysema. There is mild pulmonary vascular congestion which is improved from comparison study. There are opacities at the lung bases which could represent infection, bronchiectasis, or pulmonary edema. There is persistent eventration of the right hemidiaphragm.", "output": "1. Mild pulmonary edema, which is improved from chest xray ___. 2. Opacities at bilateral lung bases may represent infection, pulmonary edema, bronchiectasis in proper clinical setting. 3. Severe COPD." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are hyperinflated with flattening of the diaphragms consistent with chronic obstructive pulmonary disease and underlying pulmonary emphysema. There is persistent eventration of the right hemidiaphragm or posterior diaphragmatic hernia, unchanged since priors. No definite focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable, as are the hilar contours.", "output": "Pulmonary emphysema without acute cardiopulmonary process seen." }, { "input": "The lungs are hyperexpanded with flattened diaphragms and stable chronic interstitial changes consistent with emphysema. Hila and mediastinal contours are stable. No focal consolidation is identified.", "output": "Emphysema without evidence of pneumonia." }, { "input": "AP portable upright view of the chest. New airspace consolidation is seen in the right lung base concerning for pneumonia. COPD changes are noted in both lungs. Mild left basal atelectasis. Cardiomediastinal silhouette is stable. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Right basal opacity concerning for pneumonia. Followup to resolution to exclude underlying malignancy." }, { "input": "Hyperinflation, flattening of the diaphragms, and reticular interstitial opacities are unchanged from prior studies and consistent with chronic obstructive pulmonary disease. Ill-defined opacities at bilateral lung bases could represent infection, aspiration, or pulmonary edema in the proper clinical setting. Differentiation of these entities is difficult due to underlying extensive pulmonary parenchymal disease. Eventration of the right hemidiaphragm is unchanged. Pleural effusions are small if present at all. Cardiomediastinal silhouette and mild levoscoliosis of the thoracic spine are unchanged.", "output": "1. Opacities at bilateral lung bases may represent infection, aspiration, or pulmonary edema in the proper clinical setting. 2. Severe underlying chronic obstructive pulmonary disease." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is a persistent patchy left basilar opacity. Given the lack of change, the appearance may be chronic. More generally, there is mild interstitial prominence, perhaps due to slight fluid overload or congestion, but not specific; other possibilities include atypical infection, airway inflammation, or possibly interstitial lung disease.", "output": "Mild suspected background interstitial abnormality and unchanged focal left infrahilar opacity, accordingly suggestive of longer chronicity. Clinical correlation is recommended. If shortness of breath were to continue and the possibility of an underlying interstitial process is of potential clinical concern, dedicated chest CT could be considered." }, { "input": "PA and lateral views of the chest. The lungs are clear. There is no pneumothorax. The cardiomediastinal silhouette is normal. Scattered atherosclerotic calcification is seen at the aortic knob. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes. Diffuse interstitial abnormality worst at the lung bases and periphery persists. There are increased interstitial markings compared to the ___ exam, suggestive of superimposed volume overload. Small bilateral pleural effusions are also new since prior. Heart size has mildly increased. Pulmonary artery remains prominent, suggestive of possible underlying pulmonary hypertension. Aortic arch calcifications are again noted. There is no pneumothorax. Mediastinal silhouettes are unchanged. Degenerative joint changes of the thoracic spine are unchanged.", "output": "In comparison to ___ exam, diffuse interstitial abnormalities have progressed with interval development of small pleural effusions and mild enlargement of the cardiac size. The above findings most likely reflect worsening pulmonary edema superimposed on chronic interstitial lung disease." }, { "input": "PA and lateral views of the chest. There are innumerable rounded opacities of different sizes throughout both lungs which are new from prior study. Heart is normal in size. There is calcification of the aortic knob. No significant pleural effusions. No pneumothorax.", "output": "Multiple masses throughout the lungs bilaterally consistent with metastases." }, { "input": "The heart size is top normal. The aorta is tortuous and diffusely calcified. The hilar contours are normal and the pulmonary vascularity is not engorged. The lungs are clear. No pleural effusion or pneumothorax is present. Slightly decreased height of an upper lumbar vertebral body is age indeterminate.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest were obtained. There is mild compression of superior endplate of a mid thoracic vertebral body of indeterminate age but new since ___. The patient is rotated to the right. Given this, the aorta remains unfolded. The cardiac silhouette is top normal to mildly enlarged. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The aorta is calcified.", "output": "No findings to suggest pneumonia. Mild compression of the superior endplate of a mid thoracic vertebral body of indeterminate age, but new since ___." }, { "input": "Frontal and lateral views of the chest were obtained. The patient is status post median sternotomy and CABG. Single-lead left-sided pacemaker is again seen with lead extending to the expected position of the right atrium. The cardiac silhouette remains enlarged. The aorta remains calcified and tortuous. Bilateral interstitial opacities and central vascular prominence is stable compared to the prior study suggesting mild interstitial edema. Posterior basilar opacity on the lateral view is grossly similar as compared to the study from ___ and may represent atelectasis/scarring although infection is not excluded in the appropriate clinical setting. The right costophrenic angle remains blunted on the frontal image. Mild biapical pleural thickening with calcification. No definite fracture is seen, although evaluation is not optimal for such. This study does not well assess the spine. If there is clinical concern for spine or rib fracture, dedicated imaging of the spine or ribs should be obtained.", "output": "Bilateral interstitial opacities and central vascular prominence is stable compared to the prior study suggesting mild interstitial edema. Posterior basilar opacity on the lateral view is grossly similar as compared to the study from ___ and may represent atelectasis/scarring although infection is not excluded in the appropriate clinical setting. No definite fracture seen, although evaluation is not optimal for such. This study does not well assess the spine. If there is clinical concern for spine or rib fracture, dedicated imaging of the spine or ribs should be obtained." }, { "input": "There are decreased lung volumes bilaterally. The patient is status post CABG, with sternotomy wires prior noted to be well aligned. There is a single lead ICD overlying the left chest, with its lead extending into the right ventricle. There has been interval worsening of bibasilar opacities, suggesting of either aspiration or atelectasis. Redemonstrated is stable, pulmonary vascular congestion with interstitial edema. There are new, small, bilateral pleural effusions identified. The patient's known left lower lobe mass is obscured on this radiograph, and better characterized on the recent CT chest examination. There is stable enlargement of the cardiomediastinal silhouette.", "output": "1. Worsening bibasilar opacities, suggestive of aspiration or atlectasis given rapid change from recent CT of ___. 2. Stable pulmonary vascular congestion and interstitial edema. 3. Small bilateral pleural effusions." }, { "input": "A portable frontal view of the chest demonstrates unchanged moderate cardiomegaly with mild pulmonary edema. There is increased opacity at the right lung base with inferior displacement of the major fissure. There are likely small bilateral pleural effusions. There is no pneumothorax. Calcifications are seen within the aorta and right upper lung. Left-sided AICD is present with a lead terminating in the right ventricle. Sternotomy wires and mediastinal clips are again noted. Heterotopic calcification is seen within the right glenohumeral joint.", "output": "1. Unchanged moderate cardiomegaly with mild pulmonary edema. 2. Right lower lower lobe partial atelectasis. Coexisting pneumonia cannot be excluded in this region. Follow up CXR is recommended to ensure resolution." }, { "input": "There is crowding of the pulmonary vasculature with mild engorgement, consistent with mild pulmonary congestion. Focal opacity at the lung bases seen on the lateral projection is most likely atelectasis; however, infection cannot be excluded. There is blunting of the costophrenic angles bilaterally likely due to small pleural effusions. The cardiomediastinal silhouette is top normal. Left chest wall pacemaker is seen with lead in the right ventricle. Median sternotomy wires are intact. Osseous structures are unremarkable.", "output": "1. Mild pulmonary edema and possible small bilateral pleural effusions. 2. Focal basilar opacity is likely atelectasis; however, infection cannot be excluded." }, { "input": "AP and lateral views of the chest. Since the prior study there has been increase in interstitial opacities bilaterally most consistent with mild interstitial pulmonary edema. Sternotomy wires and mediastinal clips are again seen. Left AICD is present with the lead terminating in right ventricle. Again seen is moderate cardiomegaly. Mild bibasilar atelectasis versus scarring.", "output": "Mild interstitial pulmonary edema." }, { "input": "The heart is mildly enlarged. The aorta is moderately tortuous. The pulmonary vasculature shows upper zone redistribution suggesting pulmonary venous hypertension, but no congestive heart failure. There is no pleural effusion or pneumothorax. Moderate anterior osteophyte formation and mild narrowings among several mid thoracic interspaces are noted.", "output": "Findings suggesting pulmonary venous hypertension but no definite acute process." }, { "input": "The lungs are well inflated and clear bilaterally with no masses or lesions identified. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is stable and within normal limits. The pleural surfaces are unremarkable.", "output": "No evidence of pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. Low lung volumes results in bronchovascular crowding. Mild pulmonary edema is increased from ___. There is no focal consolidation, pleural effusion or pneumothorax. Moderate cardiomegaly is unchanged.", "output": "Mild pulmonary edema. No pneumonia." }, { "input": "Lung volumes are persistently low. This accentuates the size of the cardiac silhouette which appears mild to moderately enlarged but unchanged. Widening of the superior mediastinal contour is due to low lung volumes, an aortic knob remains distinct. Is crowding of the bronchovascular structures as a result of low lung volumes without with mild pulmonary vascular congestion. Patchy opacities are noted in the lung bases which likely reflect areas of atelectasis in the setting of low lung volumes. No pleural effusion or pneumothorax is identified. No acute osseous abnormality is detected.", "output": "Low lung volumes. Mild pulmonary vascular congestion and bibasilar patchy opacities, likely atelectasis." }, { "input": "Frontal and lateral views of the chest were obtained. There are relatively low lung volumes. Basilar atelectasis/scarring is seen on the lateral view without frank focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are stable.", "output": "Basilar atelectasis/scarring without definite focal consolidation." }, { "input": "The lungs are low in volume without focal consolidation. No definite effusion or pneumothorax is seen; however, the left base is not well evaluated. The frontal view is unremarkable, though on the lateral a subtle basilar opacity or trace effusion cannot be fully excluded. The heart is normal in size. Normal cardiomediastinal silhouette.", "output": "No acute intrathoracic process but lateral view is suboptimal and a repeat lateral view with improved inspiration is recommended when the patient's clinical status allows." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion, or pneumothorax. The heart is top normal in size. Mediastinal contour is normal. Bony structures are intact. DISH-related changes of the T-spine noted.", "output": "No evidence of pneumonia." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. No signs of congestion or edema. The cardiac and mediastinal silhouettes are unremarkable. No acute bony abnormalities. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is seen. Scarring within the lung apices is demonstrated. No acute osseous abnormality is visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Peripheral consolidation in right lower lobe has slightly improved with better visualization of the right hemidiaphragm contour. Adjacent small right pleural effusion is again demonstrated. Left lung and pleural surfaces are clear. Cardiomediastinal contours are within normal limits and without change.", "output": "Slight improvement in right lower lobe consolidation likely due to history of pulmonary contusion. Adjacent small pleural effusion." }, { "input": "Frontal and lateral chest radiograph demonstrate a focal opacity in the right lower lobe. The left lung is clear with no focal consolidation. There is no pleural effusions or pneumothorax. The cardiomediastinal and hilar contours are unremarkable.", "output": "Right lower lobe pneumonia. These findings were communicated to the ordering physician, ___. ___, by Dr. ___, ___ telephone per physician request at 12:36 on ___." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. Heart and mediastinal contours are within normal limits. No acute rib fracture is detected although the sensitivity of routine chest radiography for rib fractures is low.", "output": "No acute findings. Routine chest radiography is insensitive for chest cage trauma." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. The bony structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute injury in the chest." }, { "input": "There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits. Surgical clips within the right aspect of the neck suggest prior right hemithyroidectomy. Widening of the left acromioclavicular normal suggests interval resection of the distal portion of the left clavicle.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac silhouette size is normal. The aortic knob demonstrates mild atherosclerotic calcifications. Mediastinal and hilar contours are otherwise unchanged, with prominence of the right paratracheal stripe possibly reflecting tortuous vessels. Pulmonary vascularity is normal and the hilar contours are unremarkable. There is no focal consolidation, pleural effusion or pneumothorax. No acute osseous abnormalities are visualized. Multiple clips are re- demonstrated within the right lower neck, likely reflective of prior thyroid surgery.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral chest radiographs were obtained. No focal consolidation, pleural effusion, pneumothorax or pulmonary edema is seen. Heart size is normal. Again seen is a widened right paratracheal stripe, likely represents tortuous brachiocephalic vessels. Surgical clips are again visualized in the right lower neck. No bony abnormality is detected.", "output": "No acute cardial pulmonary process. Widened right peritracheal stripe likely represents tortuous brachiocephalic vessels. Correlate with physical exam findings." }, { "input": "Heart size is normal. The aorta is mildly tortuous, unchanged. Mediastinal and hilar contours are similar. Multiple clips are noted within the right neck compatible with prior right thyroidectomy. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion, focal consolidation or pneumothorax is present. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The patient is rotated somewhat to the right.Mild lateral left atelectasis is seen without definite focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. Loss of height of the L1 vertebral body is again seen, query slightly progressed compared to the prior study.", "output": "No acute cardiopulmonary process.Loss of height of the L1 vertebral body is again seen, query slightly progressed compared to the prior study." }, { "input": "PA and lateral views of the chest were provided. Lung volumes are low, though given this, there is no definite evidence of pneumonia or CHF. There is likely bibasilar atelectasis and bronchovascular crowding. No large effusion or pneumothorax is seen. The cardiomediastinal silhouette appears normal. Imaged osseous structures are intact. Anchors are noted in the left humeral head. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "Lung volumes are low. No focal consolidation is seen. No pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are stable.", "output": "Low lung volumes without lobar consolidation identified." }, { "input": "PA and lateral views of the chest. Relative elevation of the right hemidiaphragm is again seen. The lungs are clear of focal consolidation or effusion. The cardiomediastinal silhouette is within normal limits. Orthopedic hardware is seen in the left humerus.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs were obtained. Patient is slightly rotated to her left. Allowing for this, the cardiomediastinal and hilar contours are within normal limits. Lungs are clear bilaterally with no consolidation concerning for pneumonia. Incidental note is made of eventration of the right hemidiaphragm. Visualized osseous structures are unremarkable. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes. There is no pleural effusion, focal consolidation or pneumothorax. Fullness of the AP window is often seen in normal young women; otherwise, hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Partially imaged upper abdomen is unremarkable. There is a fullness of the retrosternal space.", "output": "No evidence of acute cardiothoracic process." }, { "input": "Frontal and lateral views of the chest were obtained. Increased right base opacity may be due to atelectasis although in the appropriate clinical setting, an early consolidation cannot be excluded. Minimal left base atelectasis is seen. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "Minimal right base opacity may represent atelectasis, although in the appropriate clinical setting an early consolidation would not be excluded." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. The lungs are clear. Cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable view of the chest is compared to previous exam from earlier the same day. There is a new right-sided pigtail catheter identified projecting over the right mid thorax. Right-sided pneumothorax is not clearly identified based on this portable supine film. Lungs are again notable for faint bibasilar opacities compatible with laceration/contusions. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "New right pigtail catheter. No visualized pneumothorax on this portable supine film." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "There are low lung volumes. There is a tortuous thoracic aorta. Heart size is top-normal. The hila are within normal limits. Linear opacities at the right mid lung and right lower lobe may represent platelike atelectasis, however it is difficult to exclude developing or interstitial pneumonia. Otherwise, the lungs are clear. There is no pneumothorax or pleural effusion.", "output": "1. Linear opacities in the right middle and lower lobes are nonspecific, possibly platelike atelectasis, however developing, especially interstitial pneumonia (e.g. viral or atypical bacterial), could also give this appearance 2. No evidence of diffuse interstitial lung abnormality." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is not engorged. Lungs are hyperinflated without focal consolidation. No pleural effusion or pneumothorax is identified. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest were obtained. In comparison to the prior exam, the lung volumes are slightly lower. The small right-sided pleural effusion has slightly increased in size. There is associated right basilar atelectasis. A small left-sided pleural effusion appears stable. There are no new consolidations, pulmonary edema, or pneumothorax. Right upper lobe ill-defined focal opacity is unchanged, likely reflective of a metastasis. Other previously noted pulmonary nodules are better assessed on the prior CT. The cardiac size is at the upper limits of normal. The mediastinal contours are normal. A large mass which results in expansile destruction of the left second and third ribs is unchanged.", "output": "1. Slight increase in size of right pleural effusion and stable small left pleural effusion. 2. Unchanged osseous metastasis involving the left second and third rib." }, { "input": "Cardiomediastinal and hilar contours are stable. There is worsening moderate right pleural effusion and associated basilar atelectasis. There is also a small left pleural effusion. The lungs are otherwise clear. There is a lytic lesion of the left second rib with additional bony destruction associated with the known left apical mass.", "output": "Increasing bilateral pleural effusions, right worse than left, with associated right basilar atelectasis." }, { "input": "Bilateral lung volumes are low. Bibasilar lung opacities likely atelectasis, left side more than right, and mild to moderate left pleural effusion is present. Because of the left lower lung opacities obscuring the cardiac margin, assessment of heart was limited. Mediastinal and hilar contours are normal.", "output": "Bibasilar atelectasis, left side more than right, and minimal-moderate left pleural effusion." }, { "input": "Frontal and lateral radiographs of the chest were acquired. Multiple bilateral pulmonary nodules were fully described on recent CT from ___. A left apical soft tissue mass is not significantly changed in size compared to recent CT, measuring up to ___.5 cm. This mass causes marked destruction of the posterolateral portions of the left second and third ribs, as before. Smaller right apical nodule with destruction of the posterior 4th rib also seen, as before. A moderate right pleural effusion is substantially increased compared to the prior chest radiograph from ___, but was present on recent CT from ___, although a size comparison of this effusion between modalities is difficult. Heterogeneous opacities at the right lung base are likely secondary to compressive atelectasis, although a concomitant infiltrate cannot be excluded. There is minimal left lower lung atelectasis. There is no definite left pleural effusion. The heart size is normal. The mediastinal contours are normal. There is no pneumothorax.", "output": "1. Moderate right pleural effusion, probably not significantly changed compared to recent CT from ___. 2. Right lower lung compressive atelectasis. Concomitant infection at the right lung base cannot be excluded. 3. Bilateral pulmonary nodules and large left apical soft tissue mass with adjacent rib destruction, all of which was fully described on the recent CT torso report from ___." }, { "input": "Endotracheal tube tip is low lying and terminates approximately 2.3 cm from the carina. A nasogastric tube tip appears to be within the stomach. A catheter likely reflecting a chest tube is seen entering via a right basilar approach, with tip terminating adjacent to the right hilum. Lung volumes are low. The heart size is normal. The aorta remains tortuous and diffusely calcified. There is no pulmonary vascular congestion. Previously noted small right pleural effusion appears slightly decreased in the interval. The right costophrenic angle however is excluded from the field of view. Blunting of left costophrenic angle is unchanged compared to the prior study, and is likely reflective of a small left pleural effusion. Retrocardiac opacification appears progressed when compared to the prior study, and could reflect infection, atelectasis, or aspiration. Expansile metastatic lesion involving the left ___ and 3rd ribs with osseous destruction is again noted as well as a metastatic lesion involving the right 4th rib. There is no definite pneumothorax.", "output": "1. Interval decrease in size of the right pleural effusion which is small, though not completely assessed as the right costophrenic angle is excluded from the field of view. 2. Worsening opacification in the retrocardiac region which could reflect worsening atelectasis, aspiration, or infection. 3. Small left pleural effusion. 4. Low lying endotracheal tube terminates approximately 2.3 cm from the carina, and should be withdrawn for optimal placement. 5. Unchanged metastatic lesions involving the left ___ and 3rd ribs as well as the right 4th rib." }, { "input": "Single AP upright view of the chest demonstrates a very small right apicolateral pneumothorax. There has been interval placement of a right pleural catheter with distal tip projecting adjacent to the right heart border and interval improvement in the right-sided pleural effusion. The previously seen left apical mass with bony destruction of the left second and third ribs is again seen.", "output": "Very small right apicolateral pneumothorax. Right pleural catheter in place. Interval improvement in right pleural effusion. The above findings were communicated to Dr. ___ by Dr. ___ ___ telephone at ___ on ___, 5 minutes after the discovery was made." }, { "input": "Lung volumes are low. Cardiac silhouette is normal in size allowing for this factor, but demonstrates left ventricular configuration. Aorta is tortuous and calcified. Pulmonary vascularity is normal. Bibasilar atelectasis has developed, involving the right lung base greater than the left. There are also new small bilateral pleural effusions. A 5 cm diameter, elliptical extraparenchymal opacity (pleural or extrapleural) in the upper left hemithorax is new since ___, but is in retrospect similar to preoperative chest radiograph of ___. On today's study, there is a question of adjacent rib destruction at the third left anterolateral rib level associated with this opacity.", "output": "5 cm elliptical opacity in the left upper hemithorax, with apparent adjacent focal rib destruction. As this finding is new since ___, it is concerning for a possible focus of metastatic disease in this patient with history of primary renal malignancy. CT may be helpful for further characterization. Dr. ___ has been notified of this finding by telephone at 8:30 a.m. on ___ at the time of discovery." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "AP and lateral views of the chest were provided. Vertebroplasty changes are noted in the lumbar spine. There is no definite sign of pneumonia or CHF. There is likely mild atelectasis or bronchovascular crowding, accounting for subtle reticular opacities in the lower lungs. No effusion or pneumothorax is seen. Cardiomediastinal silhouette is stable and normal. Bony structures appear unchanged. Mild wedging of a mid thoracic vertebral body is unchanged from ___.", "output": "No acute findings in the chest." }, { "input": "Single frontal view of the chest was obtained. Moderate sized bilateral effusions, right greater than left, are new since ___. Vague bibasilar lung opacities could represent atelectasis versus pneumonia. No pneumothorax. Heart size and cardiomediastinal contours are stable. Changes of lumbar spine kyphoplasty are similar to prior.", "output": "New moderate-sized bilateral pleural effusions, right greater than left. Bilateral lung base opacities could represent either pneumonia or atelectasis." }, { "input": "Cardiac silhouette size is normal. The mediastinal and hilar contours are unchanged. Pulmonary vasculature is not engorged. Persistent patchy interstitial opacities are noted at the lung bases, not substantially changed in the interval. No pleural effusion or pneumothorax is seen. No acute osseous abnormality is identified.", "output": "Persistent patchy interstitial opacities in both lung bases concerning for ongoing pneumonia, not substantially changed in the interval." }, { "input": "Prominent interstitial lung markings, are diffuse. Reticular opacities are noted at the left lung base. The cardiomediastinal silhouette is within normal limits. Osseous structures are unremarkable.", "output": "1. Reticular opacities at the left lung base may represent pneumonia, possibly aspiration. 2. Diffuse interstitial lung markings may represent mild edema or atypical infection." }, { "input": "PA and lateral views of the chest. Pacemaker is seen with leads in appropriate position. There are sternotomy wires seen. There is cardiomegaly with increased interstitial opacities consistent with mild pulmonary edema. No pleural effusions are seen. No pneumothorax.", "output": "Cardiomegaly with mild pulmonary edema is consistent with congestive heart failure. No pleural effusions." }, { "input": "New compared to prior older exam is hazy right midlung opacity seen on the frontal view. Increased opacity projecting over the hilar region on the lateral view is also new and may correspond a finding on the frontal view. Biapical scarring is grossly unchanged. The cardiac silhouette is enlarged but similar compared to prior. Markedly tortuous thoracic aorta is noted. Left chest wall dual lead pacing device is again noted. Right-sided dual lumen central venous catheter seen with tip projecting over the proximal right atrium. There is no pleural effusion. Compression deformity in the mid thoracic spine is new since ___ but is age indeterminate.", "output": "Hazy right midlung opacity which could represent infection in the proper clinical setting. Severe mid thoracic compression deformity new since ___ but age indeterminate, to be correlated clinically." }, { "input": "A left sided pacemaker is seen with intact leads in appropriate position. A right sided central line is noted, in adequate position. Median sternotomy wires are similar to prior exam. The lungs are well expanded. Scarring is seen at the bilateral lung apices, similar to prior exam. Part of the left lung base obscured pacemaker. There is a hazy right midlung opacity. The cardiomediastinal silhouette mildly enlarged, similar prior exam.", "output": "There is hazy right midlung opacity, the which could represent infection in the proper clinical setting. Part of left lung base is obscured by pacemaker." }, { "input": "A left chest wall pacemaker is present with leads in the right atrium and right ventricle. The lungs are well expanded. There has been improvement in the previously noted pulmonary edema. There is scarring at the lung apices bilaterally. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiac silhouette is mildly enlarged as seen previously. The bones are intact.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is status post median sternotomy, CABG, and Corevalve placement. The heart size is mildly enlarged. Mediastinal contours are unchanged. Left-sided dual-chamber pacemaker leads terminating in the right atrium and right ventricle are in unchanged positions. There is mild pulmonary congestion vascular congestion with small to moderate size bilateral pleural effusions, which are increased in size compared to the previous exam. Bibasilar airspace opacities likely reflect atelectasis though infection cannot be completely excluded. There is no pneumothorax.", "output": "Mild pulmonary vascular congestion and small to moderate size bilateral pleural effusions. Bibasilar airspace opacities likely reflecting atelectasis, though infection cannot be excluded." }, { "input": "Frontal and lateral views of the chest were obtained. There is blunting of the posterior costophrenic angle suggesting small pleural effusions. No overt pulmonary edema is seen. There is no focal consolidation. The patient is status post median sternotomy and CABG and aortic valve replacement. Dual-lead left-sided pacemaker is again seen, unchanged in position, with leads extending to the expected positions of the right atrium and right ventricle. The cardiac and mediastinal silhouettes are stable.", "output": "Small bilateral pleural effusions." }, { "input": "A frontal and lateral view of the chest demonstrates transvenous pacer leads ending in the right atrium, right ventricle, with a third lead within the left ventricle. There are small bilateral pleural effusions. Tracheal deviation to the left likely relates to enlarged right thyroid seen on neck CT in ___. The cardiomediastinal silhouette is stable. There is no pneumothorax.", "output": "Pacer leads end in the right atrium, right ventricle, and left ventricle. No evidence of pneumothorax." }, { "input": "Frontal and lateral chest regressed demonstrates bilateral pleural effusions, left greater than right. The lungs are clear with no focal opacification. There is bibasilar atelectasis. Heart size is top-normal. There is no pulmonary edema or pneumothorax. Mediastinal and hilar contours are stable in appearance.", "output": "No acute cardiopulmonary process." }, { "input": "The patient is status post median sternotomy, CABG, and aortic valve repair. Left-sided dual-chamber pacemaker device with leads terminating in the right atrium and right ventricle are in unchanged positions. The heart size is normal. Pulmonary vasculature is normal. Mediastinal and hilar contours are unremarkable. Small bilateral pleural effusions are unchanged. There is minimal atelectasis in both lung bases. No focal consolidation or pneumothorax is present. There are mild degenerative changes noted in the thoracic spine.", "output": "Small bilateral pleural effusions, similar compared to the previous exam." }, { "input": "PA and lateral views the chest were provided. Midline sternotomy wires and mediastinal clips are again noted. Dense contrast material is seen within loops of bowel in the upper abdomen. Small bilateral pleural effusions are seen with mild engorgement of the pulmonary hila suggesting mild congestion. There is no frank pulmonary edema or signs of pneumonia. No pneumothorax is seen. Heart size and mediastinal contour are within normal limits. The imaged osseous structures are intact. No free air below the right hemidiaphragm.", "output": "Small bilateral pleural effusions with mild hilar engorgement compatible with mild pulmonary vascular congestion." }, { "input": "Aleft axillary pacemaker generator is seen with two intact leads following an appropriate course to the right atrium and proximal right ventricle respectively. The lungs are clear. The cardiomediastinal silhouette and hilar contours are unchanged. The pleural surfaces are normal without effusion or pneumothorax.", "output": "Pacemaker and leads in appropriate position. No evidence of complications." }, { "input": "Endotracheal tube tip is in standard position, terminating approximately 4 cm from the carina. No pneumothorax is detected. Again demonstrated is mild pulmonary edema with moderate layering bilateral pleural effusions. Bibasilar airspace opacities likely reflect compressive atelectasis but infection cannot be excluded. The cardiac, mediastinal and hilar contours are unchanged.", "output": "Standard positioning of the endotracheal tube." }, { "input": "The lungs are hyperinflated compatible with chronic obstructive pulmonary disease. No focal consolidations are noted. A millimetric calcified nodule in the right lower lobe is noted. Cardiac size is normal. Trachea is midline. No pneumothorax or pleural effusion.", "output": "Hyperinflation, otherwise no evidence of acute cardiopulmonary process." }, { "input": "The lungs are well-expanded and clear. No focal consolidation, effusion, edema, or pneumothorax. The heart size is normal. Mediastinal and hilar contours are normal. No acute osseous abnormality.", "output": "Normal chest radiograph. No pneumonia." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are unremarkable. There is no pleural effusion or pneumothorax. No focal consolidation is seen.", "output": "No acute intrathoracic abnormality." }, { "input": "The nasogastric tube ends in the distal esophagus and could be advanced. Cardiomegaly was present in ___. Bilateral lower lobe opacities most likely represent atelectasis. No large pleural effusion or pneumothorax. The mediastinum is widened, likely due to positioning.", "output": "The nasogastric tube ends in the distal esophagus and could be advanced. Marked cardiomegaly stable since ___." }, { "input": "Dextroscoliosis of the upper thoracic spine is unchanged from prior exams. The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. Cardiac silhouette is mildly enlarged, also unchanged from prior exams. Flowing anterior osteophytes are present in the thoracic spine, likely secondary to DISH.", "output": "1. No acute cardiopulmonary process. 2. Stable mild cardiomegaly." }, { "input": "Portable frontal radiograph of the chest demonstrate ET tube, NG tube and left internal jugular central venous catheter in unchanged satisfactory position. Worsening multifocal opacities in the bilateral lungs could represent pneumonia or aspiration. Likely small left pleural effusion is unchanged. Stable heart size and mediastinal contours.", "output": "Worsening bilateral multifocal opacities could reflect multifocal pneumonia or aspiration. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 9:05 AM, 10 minutes after discovery of the findings." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable", "output": "No acute cardiopulmonary abnormalities" }, { "input": "Heart size is normal with mild unfolding of the thoracic aorta. Cardiomediastinal silhouette and hilar contours are otherwise unremarkable. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette is unremarkable. Osseous structures are intact.", "output": "No acute cardiopulmonary process." }, { "input": "An NG tube is present --___ tip overlies the gastric fundus. The side port is not well delineated, but appears to overlie the lower mediastinum proximal to the GE junction. Heart size is at the upper limits of normal, not significantly changed compared with ___. No CHF, focal infiltrate or effusion detected. Right upper lobe ground-glass opacity described on the ___ chest CT and right upper lobe nodule prior described on most recent prior chest x-ray are not definitively identified. No pneumothorax detected. No free air seen beneath the diaphragms.", "output": "NG tube tip over gastric fundus. Side-port probably overlies the distal esophagus, proximal to the GE junction. No acute pulmonary process identified ." }, { "input": "Lungs: The lungs are well inflated. A 6 mm nodule seen in the right upper lobe between the anterior aspects of the right first second rib. This nodule was not present previously and therefore needs further workup with CT scan. Pleura: No pleural effusion is seen. Heart: The heart is not enlarged. Mediastinum and hila: There is no mediastinal mass. Osseous structures: The osseous structures are normal for age. Other findings: None", "output": "No pneumonia. Chest CT recommended to evaluate 6 mm right upper lobe nodule." }, { "input": "The loculated pneumohydrothorax/ pyopneumothorax is unchanged. The right lung has not re-expanded. The left lung is clear. Rright bronchus intermedius stent in situ.", "output": "No interval change" }, { "input": "The right-sided ICD appears in the appropriate position. There is no significant interval decrease in size of the loculated right-sided pleural collection. Air locule within this collection suggesting a hydropneumo/ pyopneumothorax. Persistent subcutaneous emphysema is seen in the right lateral chest wall as well as mild swelling of the chest wall. Atelectatic changes of the right lung with mild volume loss of the right hemithorax. Compensatory hyperinflation of the left lung. The left lung is clear.", "output": "The right-sided ICD appears to be in appropriate position, but there is no significant interval decrease in size of the right-sided loculated air containing pleural collection." }, { "input": "The right chest tube has been advanced slightly. The loculated hydropneumothorax is unchanged. The right lower lobe consolidation is unchanged. Left lower lobe atelectasis is unchanged. No left pleural effusion. No left pneumothorax. Cardiomediastinal silhouette is unchanged.", "output": "Stable chest radiograph with right chest tube being slightly advanced." }, { "input": "There is complete whiteout of the right hemithorax without significant mediastinal shift. The right heart border is obscured. The left lung appears well expanded and clear. There is no large pneumothorax.", "output": "Complete whiteout of the right hemi thorax without significant mediastinal shift likely reflecting combination of effusion and atelectasis. This preliminary report was reviewed with Dr. ___, ___ radiologist." }, { "input": "A loculated hydropneumothorax or pyopneumothorax is stable. A right chest tube remains in place. The left lung remains clear. Mediastinal structures are unchanged. There are no concerning bone findings.", "output": "No significant change." }, { "input": "Right basilar chest tube is unchanged in position. There is extensive pleural abnormality with pronounced pleural thickening on the right, encasing the minimally aerated right lung, unchanged. Left lung is essentially clear, without consolidation, effusion or pneumothorax. Heart is likely enlarged. Subcutaneous emphysema is unchanged in appearance.", "output": "1. Extensive pleural abnormality with diffuse thickening and encasing the right lung, is unchanged. 2. Left lung is clear." }, { "input": "A right chest tube is present is a new right bronchial stent. No significant interval change in the loculated right pleural effusion as well as the right basal a pneumothorax. The size and appearance of the cardiomediastinal silhouette is unchanged. The left lung is grossly clear without a pleural effusion or pneumothorax.", "output": "Interval placement of a right bronchial stent. No other significant interval change since the prior examination." }, { "input": "Interval exchange of right chest tube. The right-sided hydropneumothorax with underlying volume loss is unchanged. The the left lung parenchyma is unchanged. The cardiomediastinal silhouette is unchanged.", "output": "Interval exchange of right chest tube. Overall stable chest radiograph." }, { "input": "Loculated right hydro pneumothorax, with right basilar pneumothorax component slightly increased. Small volume right chest wall emphysema. Single right chest tube. Left lung clear. Stable right basilar consolidation.", "output": "Loculated right hydro pneumothorax. Minimally increased right basilar pneumothorax component. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 10:00 PM, 5 minutes after discovery of the findings." }, { "input": "The patient is rotated to the right. A loculated right hydro pneumothorax appears stable. There is continued evidence of volume loss/consolidation in the underlying right lung. The right chest tube remains in place. There is no significant change.", "output": "Stable examination." }, { "input": "The right chest tube is in unchanged position. The large right pleural effusion is unchanged. Previously seen pleural air along the tract of the chest has decreased. The left lung is clear. No pneumothorax. The visualized cardiomediastinal silhouette is unchanged. The subcutaneous emphysema has improved slightly.", "output": "1. The large right pleural effusion is unchanged. 2. The chest tube is in unchanged position. 3. The subcutaneous emphysema has improved." }, { "input": "There has been interval placement of a right basilar chest tube place decreased amount of right pleural fluid. A small central region of aerated right lung is now seen. Loculated pleural fluid remains. There is subcutaneous emphysema on the right. There is no pneumothorax. At the left lung is clear. The right cardiomediastinal border is obscured by the loculated pleural process.", "output": "Interval placement of a right basal chest tube with decreased amount of pleural fluid. A small amount of aerated right lung is now seen." }, { "input": "Single right chest tube. Right basilar pneumothorax, stable. Moderate right pleural effusion, stable. Right basilar consolidation, stable. Mild interstitial prominence left lungs, more prominent.", "output": "Stable right basilar pneumothorax. Stable right pleural effusion, basilar consolidation NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 9:56 PM, 5 minutes after discovery of the findings." }, { "input": "The right chest tube is in unchanged position. The right loculated hydropneumothorax is unchanged. No new consolidation in the aerated right lung. The left lung is clear. No left pleural effusion or pneumothorax. The cardiomediastinal silhouette is unchanged.", "output": "Right chest tube in unchanged position. No significant change with the right loculated hydropneumothorax." }, { "input": "The study is made available for my interpretation at today, ___. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Jewelry overlies the left lower hemi thorax.", "output": "No acute cardiopulmonary process." }, { "input": "Supine portable AP view of the chest provided. Evaluation limited due to severe dextroscoliotic deformity and kyphotic angulation of the chest. Allowing for this, no definite signs of pneumonia or overt CHF. No large effusion or pneumothorax is seen. Overall, cardiomediastinal silhouette appears essentially stable.", "output": "Limited, negative." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "AP and lateral views of the chest were obtained. Cervical spinal hardware is again noted. The heart is mildly enlarged with no significant change. There is mild pulmonary edema without large effusions or pneumothorax. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Stable cardiomegaly with mild pulmonary edema." }, { "input": "Frontal and lateral views of the chest are compared to previous exam from ___. There has been no significant interval change, pulmonary vascular engorgement and indistinctness of the vasculature has not significantly changed from prior. Lateral views demonstrate probable small bilateral pleural effusions. The cardiac silhouette is stable. Osseous structures notable for cervical spinal fixation hardware. Osseous and soft tissue structures are otherwise unremarkable.", "output": "Stable findings suggestive of pulmonary edema and probable small bilateral pleural effusions." }, { "input": "PA and lateral views of the chest provided. Lung volumes are low limiting assessment. There is mild left basal atelectasis. No convincing signs of pneumonia, edema, effusion or pneumothorax. Cardiomediastinal silhouette appears normal. No acute bony abnormalities. No free air below the right hemidiaphragm.", "output": "Mild left basal atelectasis, no convincing signs of pneumonia or edema." }, { "input": "Patient has been extubated. The right IJ central venous catheter has been removed. The right upper extremity PICC terminates at the mid SVC. Enteric tube is partially visualized but the tip is not included in the field of view. The lung volumes remain extremely low with vascular congestion. The left pleural effusion and atelectasis has much improved since the prior study. Atelectasis in the left mid lung is unchanged. There is no pneumothorax.", "output": "1. Mild vascular congestion. Interval improvement in left pleural effusion and atelectasis." }, { "input": "Markedly rotated and lordotic positioning, which makes comparison to the prior film challenging. Inspiratory volumes are slightly low. An ET tube is present, the tip lies approximately 3.7 cm above the carina. An NG tube is present, the tip extends beneath the diaphragm and overlies the gastric fundus. A right IJ sheath is seen. Allowing for rotation, this probably similar to the prior study. No pneumothorax is detected. The cardiac silhouette is quite difficult to assess due to extreme differences in positioning. Likely vascular plethora and scattered parenchymal opacities. On the right, the appearance is probably similar to the prior study. No gross right effusion. On left, comparison to the prior study is quite difficult due to differences in positioning. No definite interval change on the left. No gross left effusion. Right and left hemidiaphragms remain well defined.", "output": "Lines and tubes as described. No pneumothorax detected. Likely vascular plethora and scattered parenchymal opacities. Comparison to the prior film is quite limited due to differences in position and technique. No definite worsening. Possible slight improvement in the left upper zone. Hemidiaphragms remain well-defined. No gross effusion detected on either side." }, { "input": "Heart size and mediastinum unremarkable. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "Heart size and mediastinum unremarkable. Lungs are clear. There is no pleural effusion or pneumothorax" }, { "input": "The lungs are normally expanded and clear. The cardiomediastinal silhouette and hilar contours are normal. There is no pleural effusion or pneumothorax. The airways appear patent without evidence of radiopaque foreign body.", "output": "No evidence of acute cardiopulmonary abnormality. No radiopaque foreign body detected, but cartilaginous fish bones are generally not radioopaque. There are no indirect signs of a retained bone, but if clinical findings warrant, contrast swallow would be required." }, { "input": "A VP shunt catheter can be seen coursing through the right side of the neck and torso. The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. This study was made available for my interpretation today, ___ at 8 p.m. The patient is status post median sternotomy and CABG. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. Surgical clips are seen in the upper abdomen.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable AP view of the chest. The heart is severely enlarged. Compared to prior study, there is decrease in pulmonary vascular congestion and there is mild pulmonary edema. No focal infiltrate. No pneumothorax or pleural effusion. Low lung volumes.", "output": "Improvement in pulmonary edema, now mild interstitial edema. Severe cardiomegaly." }, { "input": "Single portable supine frontal image of the chest. Pacemaker, leads, median sternotomy wires, and mediastinal surgical clips are stable. Lung volumes are low. There has been interval increase in bilateral interstitial markings, which could be due differences in technique or to mild pulmonary edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is stable from prior exam.", "output": "Interval increase in bilateral interstitial markings, which could be due differences in technique or to mild pulmonary edema. If clinical concern for pulmonary edema exists, could obtain upright radiographs for better assessment of lungs." }, { "input": "Single portable upright frontal image of the chest. Pacemaker, leads, median sternotomy wires, and mediastinal surgical clips are stable. The lung volumes are low with associated bronchovascular crowding. The lungs are clear. There is no large pleural effusion or pneumothorax. The cardiomediastinal silhouette is unchanged from prior exam.", "output": "No acute cardiopulmonary process." }, { "input": "AP view of the chest. A left-sided implanted cardiac device ends with its leads in appropriate position. Sternotomy wires and mediastinal clips are stable. The lungs are clear. Mild cardiomegaly is stable. The mediastinal and hilar contours are normal. No pleural effusion or pneumothorax.", "output": "Interval placement of left cardiac device with leads in appropriate position and no evidence of pneumothorax." }, { "input": "Left internal jugular central catheter has been removed since ___. Interval improvement in diffuse pulmonary opacification is consistent with improved pulmonary edema. Small left pleural effusion with associated bibasilar atelectasis is unchanged from ___. Heart size slightly smaller since ___ with moderate chronic cardiomegaly. No pneumothorax.", "output": "Interval improvement in pulmonary edema since ___ with persistent left pleural effusion and associated atelectasis." }, { "input": "AP portable upright view of the chest. Lung volumes are low. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process" }, { "input": "Lung volumes are low. No focal consolidation, large effusion or pneumothorax. Cardiomediastinal silhouette is normal. Vascular stents are noted in the region of the left subclavian and right upper arm. No free air seen below the right hemidiaphragm. Pleural thickening noted laterally along the lower lungs compatible with prominent extrapleural fat.", "output": "No acute findings." }, { "input": "Interval decrease in lung volumes, small to moderate right-sided effusion has increased. Probable small left effusion. Increasing linear basilar opacities likely worsening atelectasis. No pneumothorax. Mild to moderate cardiomegaly. Left-sided subclavian stent again visualized.", "output": "Increasing pleural effusions and bibasilar atelectasis." }, { "input": "Pleural effusions layering along the lateral chest wall are unchanged from the prior study. Pulmonary vascular congestion has increased slightly from the prior study. The cardiomediastinal silhouette is unchanged. There is no focal consolidation or pneumothorax.", "output": "1. Slight interval increase in pulmonary vascular congestion. No focal consolidation. 2. Unchanged bilateral pleural effusions." }, { "input": "Lung volumes remain low. Pulmonary edema has improved since the prior study, now mild. The amount of mediastinal engorgement has also decreased. The cardiac silhouette is top normal. There is no pleural effusion or pneumothorax. Calcifications of the aortic arch are unchanged. Chronic right pleural thickening is again noted.", "output": "Interval improvement in pulmonary edema, now mild." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged including cardiomegaly. The lung volumes are low. The right costophrenic angle is obscured suggesting a small pleural effusion. Right lateral pleural thickening appears stable. There is probably also a small pleural effusion on the left side. Patchy opacity at the left lung base has decreased and probably is due to minor atelectasis or scarring. A mild interstitial process is similar to the prior study and could be seen with mild pulmonary edema, although chronicity is uncertain since it is not a substantial change. Carotid bulb calcifications are present bilaterally.", "output": "Similar mild interstitial abnormality suggesting mild pulmonary edema although, given the lack of change, acuity is uncertain." }, { "input": "Frontal and lateral views of the chest. The lungs are clear of consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. The descending thoracic aorta is tortuous with atherosclerotic calcifications. No displaced rib fractures identified. Degenerative changes seen at the shoulders.", "output": "No displaced rib fractures. If desired, dedicated rib series could be performed." }, { "input": "The lungs are well inflated and clear. No lobar consolidation present. Mild prominence of hilar vasculature as before. Cardiomediastinal silhouette is unremarkable. No pleural effusion or pneumothorax noted. Bony thorax is unremarkable.", "output": "No lobar consolidation or pleural effusion present." }, { "input": "The lungs are better aerated with interval resolution of the left lower lung collapse. Left lower and mid thoracic rib fractures appear slightly more displaced as compared to prior. Bilateral patchy lung opacities could represent either consolidation or asymmetric edema; contusion is considered less likely. A very small left apical pneumothorax is noted. Cardiomediastinal silhouette is unchanged given changes in positioning. Multiple contiguous left rib fractures appear more displaced as compared to the previous radiograph of ___", "output": "1. Multifocal patchy airspace opacities could represent multifocal aspiration, developing infection, or asymmetrical edema. Contusions is considered less likely given new and progressive course of most of the opacities compared to ___. 2. Interval resolution of left lower lung collapse." }, { "input": "PA and lateral views of the chest provided. Lungs are clear without focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the diaphragm.", "output": "No acute findings in the chest." }, { "input": "PA and lateral chest radiographs demonstrate no focal consolidation. Cardiomediastinal silhouette is within normal limits. Several left-sided rib fractures are identified which include lateral fifth sixth and seventh ribs as well as the seventh rib posteriorly. There is no evidence of a pneumothorax. Blunting of the left costophrenic angle may reflect atelectasis though a small pleural effusion cannot be excluded. Increased density within the soft tissues is likely reflective of focal hematoma as in association with the rib fractures. The upper abdomen is unremarkable.", "output": "Several left-sided rib fractures with associated chest wall hematomas. Blunting of the left costophrenic angle is suggestive of a small pleural effusion and/or atelectasis. No evidence of pneumothorax. NOTIFICATION: Findings were communicated via telephone with the ordering physician doctor ___ by Dr. ___ at 14:53 on ___." }, { "input": "There has been interval development of a moderate-sized left pleural effusion. Peribronchial cuffing is seen bilaterally. The left hilar vasculature is poorly defined. Left mid and lower thoracic rib fractures are unchanged. There is no definite pneumothorax. Cardiomediastinal silhouette is midline.", "output": "New peribronchial cuffing and left moderate effusion is consistent with asymmetric pulmonary edema. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 12:04 PM, 5 minutes after discovery of the findings." }, { "input": "A right subclavian approach Port-A-Cath tip is new and its tip projects over the expected region of the distal left brachiocephalic vein just at its confluence with the SVC. The lungs are hyperexpanded and hyperlucent, consistent with emphysema. No pneumothorax, pleural effusion, or focal consolidation. The heart is mildly enlarged, increased from the prior exam. There is pulmonary vascular congestion but no over pulmonary edema. Prominent reticular scarring at the bilateral apices is probably similar to the prior exam and better characterized on the prior chest CT. No obvious pulmonary mass. No acute osseous abnormality.", "output": "1. Right Port-A-Cath tip ends in the left brachiocephalic vein just prior to the SVC confluence. 2. No obvious pulmonary mass. Given the patient's history, dedicated Chest CT would be recommended evaluate for metastatic lesions. 3. Persistent prominently biapical calcified micronodular pattern, better characterized on the prior chest CT from ___. 4. Emphysema. 5. Mild cardiomegaly and pulmonary vascular congestion but no overt edema." }, { "input": "Heart size and cardiomediastinal contours are normal. There is mild hyperinflation, consistent with emphysema. Heterogeneous opacities in the lung apices are consistent with apical scarring. Similar smaller opacities are seen in the right upper and bilateral lower lobes. No lobar consolidation, pleural effusion, or pneumothorax.", "output": "Prominent apical scarring and emphysema. No focal consolidation. In light of the abdominal findings, a chest CT is recommended for staging purposes." }, { "input": "Frontal and lateral radiographs of the chest show persistent low inspiratory lung volumes. The lungs are clear without focal consolidation, pleural effusion, or pneumothorax. No pulmonary edema is present and the pulmonary vasculature is not engorged. The cardiac silhouette is normal in size. The mediastinal and hilar contours are within normal limits. Multiple surgical clips are noted in the right upper quadrant of the abdomen consistent with prior surgery.", "output": "No acute cardiopulmonary process." }, { "input": "There is stable enlargement of the cardiac silhouette without pulmonary vascular congestion or focal pulmonary opacities. There is asymmetry at the right lung base, which could reflect developing consolidation in the appropriate clinical setting. There is unchanged blunting of the left costophrenic angle on the frontal view.", "output": "1. New asymmetry at the right lung base could reflect developing consolidation in the appropriate clinical setting. 2. Stable mild enlargement of the heart." }, { "input": "Once again, the heart is enlarged. There is prominence of the bilateral hila and pulmonary vasculature with prominent interstitial markings. Overall, the appearances are consistent with pulmonary vascular congestion. ___ B-lines noted at the right lung base. Small nodular opacities, most prominent in the right upper lobe may represent early pulmonary edema. No definite areas of consolidation seen. Degenerative changes throughout the thoracic spine.", "output": "Findings consistent with pulmonary vascular congestion and possibly early pulmonary edema. No definite focal pneumonia." }, { "input": "Frontal and lateral chest radiographs again demonstrate moderate cardiomegaly. The previously noted ill-defined opacity at the right lung base is no longer well appreciated. There is no focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "Previously noted ill-defined opacity at the right lung base is no longer well appreciated. No new focal consolidation." }, { "input": "The lung volumes are normal. There are no pleural effusions. Normal size of the cardiac silhouette. Moderate tortuosity of the thoracic aorta. No hilar or mediastinal lymph node enlargements. Normal appearance of the lung parenchyma, without evidence of fibrosis or micronodules.", "output": "No radiologic evidence of sarcoidosis." }, { "input": "A new electronic device resides in the subcutaneous soft tissues overlying the left mid chest. Allowing for differences in technique, the only other change is an apparent increase in the size of the heart, which now appears mildly enlarged. Streaky lingular opacity suggests minor scarring. Otherwise, the lungs appear clear. There is no pleural effusion or pneumothorax.", "output": "New mild cardiomegaly. No evidence of acute disease." }, { "input": "No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "A right-sided chest tube remains in unchanged position. There is a small right-sided apical pneumothorax which is slightly decreased in size since prior examination. Subcutaneous emphysema surrounding the right lateral chest wall and right neck is slightly improved. Again seen are multiple opacities within the bilateral lungs also improved. The cardiomediastinal silhouette is stable.", "output": "1. Small right apical pneumothorax and subcutaneous emphysema of the right chest wall and right neck slightly improved. 2. Improving bilateral parenchymal opacities." }, { "input": "Frontal and lateral views of the chest. The degree of interstitial abnormality has slightly improved on the left when compared to prior with persistent infrahilar and retrocardiac opacities. Hazy opacity projects in the right lung somewhat overall conspicuous compared to prior however appears more diffuse in distribution. There is no effusion. The cardiomediastinal silhouette is unchanged. No acute osseous abnormality is detected.", "output": "Improvement in the appearance of the left lung with residual infrahilar retrocardiac opacity compared to prior. Opacities in the right lung overall appear less dense when compared to prior but are more extensive in distribution. Findings again compatible with chronic underlying lung disease with potentially superimposed acute component or infection on the right." }, { "input": "PA and lateral views of the chest provided. Central perihilar ground-glass opacity is similar to prior and may reflect changes related to known hypersensitivity pneumonitis. No significant change from prior. No large effusion or pneumothorax. Overall cardiomediastinal silhouette is grossly stable. No acute bony abnormalities.", "output": "Similar pattern of perihilar ground-glass opacity likely reflects known hypersensitivity pneumonitis. Difficult to exclude a subtle superimposed process." }, { "input": "The lungs are clear without consolidation or edema. There is no pneumothorax, pneumomediastinum or pleural effusion. The cardiomediastinal silhouette is normal. Dextroscoliosis is unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "Compared to the prior film, inspiratory volumes are lower. The cardiomediastinal silhouette is more pronounced, likely accentuated by low lung volumes. There is patchy opacity in both at both bases, more pronounced medially. There is minimal blunting of both costophrenic angles, consistent with small effusions. Mild vascular plethora is likely accentuated by low inspiratory volumes. Doubt overt CHF.", "output": "New patchy opacity at both lung bases most likely represents atelectasis in the setting of lower lung volumes. However, the differential diagnosis could include areas of aspiration or early infectious infiltrate. Small bilateral effusions are likely now present." }, { "input": "Heart size is normal. A coronary artery stent is noted. Mediastinal and hilar contours are within normal limits. Lungs are clear. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is present. Mild degenerative changes are noted in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "A right-sided PICC terminates in the mid SVC, unchanged in position compared the prior study. Lung volumes are slightly low resulting crowding of the pulmonary bronchovascular markings and an apparent mild increase in heart size. No pneumothorax, consolidation or pleural effusion seen. Visualized bony structures are unremarkable in appearance.", "output": "No significant interval change when compared to the prior study." }, { "input": "There has been no significant interval change. Evidence of old lateral right-sided rib fractures is again seen. No focal consolidation is seen. There is no pleural effusion or pneumothorax. Thin linear radiopaque structure projecting over the posterior inferior thorax at the level of the posterior diaphragms, best seen on the lateral view was also present on the prior study from ___ and CT from ___ and seen to be intimately associated with right-sided posterior ninth rib.", "output": "No acute cardiopulmonary process." }, { "input": "Right-sided PICC has migrated, withdrawn and now terminates in the right axilla.No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable..", "output": "Right-sided PICC now terminates in the right axilla, this is not in appropriate position, presuming this is a PICC. NOTIFICATION: Discussed with Dr. ___ at 12:30PM on ___ via telephone." }, { "input": "No focal opacity to suggest pneumonia is seen. No pleural effusion, pulmonary edema, or pneumothorax is present. The heart size is normal. Apparent fullness of the right hilum on one of the frontal radiograph is likely secondary to rotation. A dense nodule in the left lateral mid-thorax is felt to likely represent a calcified granuloma. There is a linear radiodense foreign body projecting beneath the right hemidiaphragm on the frontal radiograph and posteriorly on the lateral view.", "output": "1. No evidence of acute cardiopulmonary process. 2. Radiodense foreign body with the appearance of a sewing needle is most likely outside of the patient. However, if this cannot be confirmed, a repeat radiograph is recommended to ensure it is no longer present. Findings discussed with Dr. ___ by telephone at 10:15 pm ___." }, { "input": "Right PICC tip in the mid SVC. Heart size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is. Punctate calcified granuloma is seen in the peripheral aspect of the left mid lung field, unchanged. Lungs are otherwise clear. No pleural effusion or pneumothorax is seen. No acute osseous abnormality is demonstrated.", "output": "Right PICC tip in the mid SVC. No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest are compared to previous exam from ___. Right PICC is no longer seen. The lungs are clear of consolidation or effusion. The cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or frank pulmonary edema. The cardiomediastinal silhouette is within normal limits. Healed lateral right rib fractures new since ___.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The heart is normal in size. There is a right PICC which terminates in the distal SVC.", "output": "Right PICC terminates in the distal SVC. No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest show interval fiducial placement within a small pulmonary mass in the left lower lobe. A small left apical pneumothorax is present which is new from the preceding studies. A large spiculated mass with a central fiducial projects over the right upper lung. No large pleural effusion or focal consolidation is present. Opacification extending along the right mediastinum is unchanged and related to known gastric pull-through for esophagectomy of prior esophageal carcinoma. Left mediastinal surgical clips are unchanged. The cardiomediastinal silhouette is within normal limits and unchanged.", "output": "Small left apical pneumothorax, status post fiducial placement within left lower lobe pulmonary mass. Findings were communicated by Dr. ___ to Dr. ___ by page at 16:46 p.m. on ___." }, { "input": "As compared with the prior examination dated ___, there has been no significant interval change. Redemonstrated are spiculated pulmonary nodules within the right upper lobe and left lower lobe with associated fiducial markers, without definitive change. The patient is status post esophagectomy and a neoesophagus is noted. Blunting of the bilateral costophrenic angles may represent a small bilateral effusions, larger on the left. Chronic prominent interstitial markings within the right lower lobe are unchanged. There is no pneumothorax or overt pulmonary edema identified. Moderate cardiomegaly is stable. Multiple retrocardiac surgical clips are again seen in unchanged position.", "output": "1. No definitive evidence of acute cardiopulmonary process. 2. Chronic, moderate cardiomegaly. 3. Small left greater than right bilateral pleural effusions. 4. Stable, bilateral pulmonary nodules and extensive chronic postoperative changes, as above." }, { "input": "PA and lateral views of the chest. Again seen are bilateral lung nodules with fiducial markers, not definitely changed. Associated distortion is seen in the right paramediastinal region is unchanged. Right basilar heterogeneous opacity has not significantly changed since the prior exams. Chronic blunting of the left costophrenic angle may be due to underlying effusion or scarring. Elsewhere, the lungs are grossly clear. Biapical right greater than left pleural thickening is again seen. The cardiomediastinal silhouette is enlarged. Surgical clips seen in the retrocardiac region and along the mediastinum. No acute osseous abnormality is identified.", "output": "No definite acute cardiopulmonary process. Chronic changes as above, noting that right basilar opacity could potentially be infectious, although it is unchanged from prior." }, { "input": "PA and lateral views of the chest provided. There is no evidence for rib fractures on this chest x-ray. Multiple pulmonary nodules; one in the right upper lung and the other in the left lower to mid lung, which have fiducial markers, and are unchanged in appearance. The cardiomediastinal silhouette is unchanged. Previously seen left pleural effusion is now trace. Patient is post esophagectomy with gastric pull-through.", "output": "1. No evidence of rib fractures. 2. Stable pulmonary nodules. Decreased left pleural effusion. 3. Post esophagectomy with gastric pull-through." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of normal size with normal cardiomediastinal contours. The lungs are clear. No pleural effusion, focal consolidation, or pneumothorax. No radiopaque foreign body.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top normal. The mediastinal and hilar contours are unremarkable. Mild thoracolumbar scoliosis is noted.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac silhouette is within normal limits. The hilar and mediastinal contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar silhouettes are normal. No evidence of focal consolidation, pleural effusion, or pneumothorax.", "output": "No acute cardiopulmonary process. Specifically, no evidence of pneumothorax." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable with diffuse calcification of the thoracic aorta again noted. The pulmonary vascularity is not engorged. Chain sutures are seen within the right lung base. There is minimal streaky opacity in the lung bases likely reflective of atelectasis. No focal consolidation, pleural effusion or pneumothorax is identified. Multilevel degenerative changes are seen within the thoracic spine. On the lateral view, dilated loops of small bowel are partially imaged.", "output": "Mild bibasilar atelectasis." }, { "input": "Frontal and lateral radiographs of the chest. The cardiomediastinal silhouette and hilar contours are stable. The left-sided pacemaker and leads are in unchanged position with leads in expected location of right atrium and right ventricle The lungs are clear. No pleural effusion or pneumothorax. No displaced rib fracture identified. Enlarged right paratracheal stripe is unchanged and may reflect patient's known enlarged thyroid. There are unchanged aortic knob calcification.", "output": "Unchanged position of a left-sided pacemaker and leads." }, { "input": "Left-sided cardiac pacing device with dual leads following their expected courses to the right atrium and right ventricle. Lungs are clear. There is no focal consolidation, effusion or pneumothorax. There is no central vascular congestion or overt pulmonary edema. Enlargement of the right paratracheal stripe is stable and may reflect patient's known thyromegaly. Cardiomediastinal silhouette is stable. There is mild unfolding of thoracic aorta with moderate calcification at the aortic knob.", "output": "No evidence of pneumonia." }, { "input": "PA and lateral views of the chest. There are low lung volumes. There is a left-sided pacemaker which is unchanged in position. No evidence of focal consolidation, pleural effusion or pneumothorax. Again seen is an enlarged right paratracheal stripe which may represent patient's known enlarged thyroid. Cardiomediastinal and hilar contours are normal. There are unchanged aortic knob calcifications.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well inflated and clear. There is no effusion or pneumothorax. Cardiac silhouette is top-normal in size. No displaced acute fractures identified. Chronic right posterior third rib fractures noted.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal silhouette is normal. The hila and pleura are unremarkable. No focal opacities, pleural effusions, pulmonary edema, or pneumothorax are seen.", "output": "No evidence of pneumonia or pulmonary nodules." }, { "input": "Lungs are fully expanded and clear. No pleural abnormalities. Heart size is normal. The ascending aorta appears somewhat prominent, possibly related to mild dilation or tortuosity.", "output": "Prominence of the ascending aorta may reflect tortuosity or mild dilation." }, { "input": "The lungs are clear. The cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax. Calcified left axillary lymph projects over the anterior mediastinum on the lateral view.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Heart size is normal with unremarkable cardiomediastinal silhouette and hilar contour. A new nodular opacity in the left lower lung is visible only on the PA projection without a lateral correlate and is likely extrathoracic. Again appreciated is bronchiectasis with bronchial wall thickening and slight nodular opacities particularly in the right upper lung unchanged from prior exam. Persistent leftward deviation of the trachea at the level of thoracic inlet is likely due to goiter.", "output": "1. Nodular opacity projecting over the left lung base, visible only on the PA view, is likely extrathoracic. If symptoms persist, the exam may be repeated with careful disrobing along with a check by radiologist to ensure exam adequacy. 2. Chronic bronchiectasis." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded, clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "Compared with ___ and allowing for differences in technique, the cardiomediastinal silhouette is unchanged. Within the limits of plain film radiography, no hilar or mediastinal enlargement and no pulmonary nodules are detected. No CHF, focal infiltrate, or effusion is identified. The minor fissure of the right lung is visible.", "output": "No acute pulmonary process identified. In particular, no evidence of pneumonia is identified." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures appear intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "Increased opacity adjacent to the right cardiac border is secondary to visualized pectus excavatum. Otherwise, cardiomediastinal hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax. There is no evidence of latent or active TB.", "output": "No acute cardiopulmonary process." }, { "input": "The heart appears mild to moderately enlarged. Diffuse opacification is mildly asymmetric, somewhat more prominent in the left mid lung than right, but most likely due overall to pulmonary edema. Opacity also obscures the posterior left hemidiaphragm, which shows upward tenting. This type of appearance could be seen with atelectasis, although infection is not entirely excluded by this examination. Fissures are thickened. There are no definite pleural effusions.", "output": "Diffuse opacification and cardiomegaly suggesting pulmonary edema. Patchy focal left posterior lower lobe opacity, which can probably be explained by atelectasis, although pneumonia is not excluded. In addition to correlation with clinical presentation, short-term followup radiographs may be helpful to reassess." }, { "input": "Cardiac, mediastinal, and hilar contours are within normal limits. There is a consolidation in the basal left lower lobe, similar in location but smaller than on ___. There may be another small consolidation in the anterior basal right lower lobe. There is no evidence for pulmonary edema or pleural effusion. There is no pneumothorax. There are degenerative changes in the thoracic spine.", "output": "Consolidation in the basal left lower lobe, similar in location but smaller than on ___. Possible additional small consolidation in the anterior basal right lower lobe. These findings are compatible with pneumonia. NOTIFICATION: Results were reported over the telephone on ___ at 17:10, ___ min after discovery, by Dr. ___ to" }, { "input": "Adenopathy is present in both hila, right greatere than left, and in at least the right lower paratracheal and AP window stations of the mediastinum. Lungs are clear, pulmonary vasculature is not engorged and the cardiac silhouette is normal size. The trachea is midline.", "output": "1. Bilateral hilar and mediastinal adenopathy, most likely sarcoidosis. 2. No acute cardiopulmonary process." }, { "input": "There is again bilateral hilar enlargement, compatible with lymphadenopathy, which has worsened since the prior radiograph, more so in the right. Increasing micronodular opacities in the right upper and lower lung may represent worsening sarcoid, less likely superimposed pneumonia. Elevation of the right hemidiaphragm is unchanged. No large pleural effusion or pneumothorax. Heart size is normal.", "output": "1. Increased right perihilar micronodules may represent worsening sarcoid, however infection is also a possibility. 2. Increased bilateral hilar prominence consistent with lymphadenopathy." }, { "input": "PA and lateral images of the chest. The lungs are well expanded. There is a small rounded opacity overlying the mid right lung laterally which was not apparent on prior imaging, and which may represent a small pneumonia in the right clinical setting. The lungs are otherwise clear. There is no pleural effusion or pneumothorax. Prominent hilar lymphadenopathy is again seen, suggestive of sarcoidosis and unchanged from prior exam. The cardiomediastinal silhouette is unremarkable.", "output": "Small rounded opacity overlying the mid right lung laterally which was not apparent on prior imaging, and which may represent a small pneumonia in the right clinical setting. If opacity does not clear with antibiotics, CT is recommended to further evaluate." }, { "input": "PA and lateral views of the chest. There again seen is bilateral hilar enlargement consistent with lymphadenopathy as well as mediastinal lymphadenopathy. Heart size is normal. Focal opacity in the right mid lung is consistent with known sarcoid nodule on prior CT from ___. No acute focal consolidation, pleural effusion or pneumothorax.", "output": "Unchanged findings consistent with sarcoidosis. No acute cardiopulmonary process." }, { "input": "Bilateral hila are enlarged, compatible with hilar lymphadenopathy. The right hilum has increased in size relative to the prior study of ___. Several small ill defined opacities in the right lung have mildly increased from prior study correlating with progression of sarcoidosis. The right paratracheal stripe is enlarged, compatible with mediastinal adenopathy. There is no pleural effusion, pneumothorax, or pulmonary edema.", "output": "1. Enlarged hila and increased right parenchymal opacities compatible with progression of sarcoidosis. Lung involvement and lymphadenopathy was evaluated in prior CT ___ 2. No evidence of acute cardiopulmonary process." }, { "input": "AP portable upright view of the chest. Overlying EKG leads are present. Lung volumes are low. Allowing for limitations, the lungs are clear. No signs of pneumonia or edema. No large effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest demonstrate an ill-defined opacity within the posterior left lower lobe, compatible with pneumonia in the appropriate clinical setting. The lungs are otherwise well expanded with no evidence of pulmonary edema, pleural effusion or pneumothorax. The aorta is tortuous, and unchanged. Additionally, a small hiatal hernia is re- demonstrated. The heart size is stable. Multiple healed left-sided rib fractures are again identified.", "output": "Ill-defined opacity in the posterior left lower lobe, could represent pneumonia in the appropriate clinical setting." }, { "input": "Heart size is top normal. Small hiatal hernia is re- demonstrated. The aorta is mildly tortuous and demonstrates atherosclerotic calcifications diffusely. Hilar contours are stable, and no pulmonary vascular congestion is seen. No focal consolidation, pleural effusion or pneumothorax is present. Minimal linear opacities in the lung bases likely reflect subsegmental atelectasis. No acute osseous abnormalities demonstrated. Mild loss of height of an upper lumbar vertebral body is unchanged, as are several remote left-sided rib fractures.", "output": "Mild bibasilar linear atelectasis. Small hiatal hernia." }, { "input": "The heart size is normal. The mediastinal contour is unchanged with a small to moderate size hiatal hernia again noted. The aorta remains tortuous and diffusely calcified. Hilar contours are normal. There is no pulmonary vascular congestion. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. Multiple old left-sided rib fractures are again demonstrated.", "output": "No acute cardiopulmonary process." }, { "input": "There is increased opacity at both bases compatible with volume loss within without associated underlying infection. Old rib fractures, hiatal hernia, and are again visualized. The heart is normal in size. Aortic calcifications are again seen.", "output": "Bilateral lower lobe volume loss/infiltrates." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes. There is no pleural effusion or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. Bibasilar patchy and linear opacities are noted. Multiple remote left-sided rib fractures are seen. There is a large hiatal hernia. No pulmonary edema.", "output": "1. Bibasilar opacities, which may represent atelectasis, aspiration or infection in the appropriate clinical setting. 2. Hiatal hernia." }, { "input": "Frontal and lateral views of the chest. There is no large confluent consolidation identified nor effusion. Indistinct pulmonary vascular markings are seen throughout with somewhat more prominent bibasilar markings potentially due to scarring given persistence over time. The cardiomediastinal silhouette is unchanged. Multiple old healed posterior left rib fractures are again seen.", "output": "Possible moment mild pulmonary vascular congestion without evidence of new consolidation." }, { "input": "The lungs are clear without consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified.", "output": "Normal chest x-ray." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.The previous right central venous catheter is longer present.", "output": "No focal consolidation concerning for pneumonia." }, { "input": "Lung volumes are low and exaggerate pulmonary vascular markings. The lungs are clear with no evidence of consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. The aorta appears tortuous, but stable. Degenerative changes are again noted at bilateral glenohumeral joints.", "output": "No acute cardiopulmonary process." }, { "input": "Skinfold overlies the left mid-to-lower hemithorax. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable, with the aorta tortuous and the cardiac silhouette top normal. No overt pulmonary edema is seen. There is anterior wedge compression of a vertebral body at the thoracolumbar junction, similar compared to CT torso from ___.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable view of the chest is compared to previous exam from ___. Linear left basilar opacity is seen most suggestive of atelectasis especially given elevation of the left hemidiaphragm. The lungs are otherwise clear. The cardiomediastinal silhouette is stable denoting a tortuous aorta. Degenerative changes noted at the left glenohumeral joint and bilateral acromioclavicular joints.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Borderline cardiomegaly is unchanged. Mediastinal contour is normal. There is no pleural effusion or pneumothorax. There is no focal consolidation.", "output": "No evidence of pneumonia." }, { "input": "2 views were obtained of the chest. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. Minimal biapical pleural thickening is noted. The heart is normal in size with normal cardiomediastinal contours.", "output": "No acute intrathoracic process." }, { "input": "The heart is at the upper limits of normal size. The mediastinal and hilar contours appear unchanged. There is new patchy opacity involving the superior segment of the left lower lobe and probably also the left upper lobe to a lesser degree. Minimal streaky opacification also projects over the right upper lobe. These findings suggest pneumonia. There is no pleural effusion or pneumothorax. Bony structures appear within normal limits.", "output": "Opacities suggesting pneumonia, particularly within the left lower lobe including retrocardiac opacification. Within eight weeks, following treatment, follow-up radiographs are suggested to show resolution." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or focal consolidation", "output": "No acute cardiopulmonary process." }, { "input": "More densely consolidated retrocardiac opacity with scattered nodular opacities bilaterally is concerning for multifocal pneumonia or aspiration in the proper clinical setting. There is no pneumothorax. Mild prominence of the hila may be due to vascular engorgement, can not exclude underlying lymphadenopathy. There may be a trace left pleural effusion or left pleural thickening at the costophrenic angle. The cardiomediastinal silhouette is within normal limits.", "output": "Multifocal opacities are concerning for multifocal pneumonia, although underlying aspiration or central vascular engorgement are not excluded in the proper clinical setting." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. Hypertrophic changes are noted in the spine.", "output": "No acute cardiopulmonary process." }, { "input": "Stable, borderline cardiomegaly. Normal mediastinal and hilar contours. Normal pleural surfaces. Fully expanded, clear lungs. Degenerative disease of the thoracic spine.", "output": "No evidence of active or latent tuberculosis." }, { "input": "Heart size is top normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are normally expanded and clear. Heart size is normal. The mediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. NO free intraperitoneal air.", "output": "No acute cardiopulmonary abnormality." }, { "input": "A chest tube has been placed into the left hemithorax since the prior study. A central venous catheter appears unchanged. The lung has mostly reexpanded with a suspected small residual pneumothorax primarily suggested by minimal lucency remaining at the left lung base. There is no shift of midline structures. There is patchy opacification in the left lower hemithorax, but suggesting atelectasis associated with a recent pneumothorax that has improved.", "output": "Status post chest tube placement with small suspected residual pneumothorax. Continued radiographic followup suggested." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The aorta is tortuous somewhat unfolded. The cardiac silhouette is top-normal.", "output": "No focal consolidation to suggest pneumonia." }, { "input": "Prominence of the cardiac contour is likely due to prominent mediastinal fat, obscuring the left lung base on the PA view. Heart size is top normal. No evidence of pleural effusion on the lateral view. Lungs are mildly hyperexpanded.", "output": "No evidence for current pneumonia. Hyperexpanded, but clear lungs. No pleural effusions." }, { "input": "The lungs are clear. There is no evidence of pneumonia, pneumothorax, or pleural effusion. Cardiac silhouette is normal in size.", "output": "No evidence of acute cardiopulmonary process. No specific radiographic evidence of active TB." }, { "input": "AP portable semi upright view of the chest. Cardiomegaly noted with hilar congestion and moderate pulmonary edema. No pneumothorax. Lower lung opacities, left greater than right likely reflect pleural effusions, and atelectasis, difficult to exclude pneumonia. Aortic calcification noted. Bony structures are intact.", "output": "Pulmonary edema, pleural effusions, possible lower lung pneumonia." }, { "input": "New right-sided internal jugular catheter terminates in the right atrium. Nasogastric tube tip is in the body of the stomach. Low lung volumes with subsegmental atelectasis. No pulmonary edema, pleural effusion or pneumothorax. Heart size is normal.", "output": "Right internal jugular catheter in the right atrium." }, { "input": "Frontal and lateral radiographs of the chest demonstrate clear lungs. The cardiac and mediastinal contours are normal. Thyroid enlargement with impression on right aspect of trachea. No pleural abnormality is detected.", "output": "No evidence of pneumonia." }, { "input": "The heart is mildly enlarged and is increased in size since the previous chest radiograph of ___ and probably since the more recent portable radiograph of ___ as well. Pulmonary vascularity is normal, and lungs and pleural surfaces are clear. Surgical clips are present in the thymic bed consistent with previous thyroid resection.", "output": "Mildly enlarged cardiac silhouette may reflect mild cardiomegaly or pericardial effusion. No evidence of pulmonary edema or pneumonia." }, { "input": "The lung volumes are low. The heart is normal in size. The aortic arch is partly calcified. The mediastinal and hilar contours appear unchanged. Streaky linear opacity projecting over the left mid lung suggests minor atelectasis or scarring that is unchanged. There are no pleural effusions. No pneumothorax is identified. No rib fracture is identified in this single limited view. Mild-to-moderate rightward convex curvature is again centered along the lower thoracic spine.", "output": "No radiographic evidence of injury." }, { "input": "PA and lateral chest radiograph demonstrates clear lungs bilaterally. No focal consolidation convincing for pneumonia is identified. Cardiomediastinal and hilar contours are within normal limits. There is no pleural effusion or pneumothorax. Visualized osseous structures are without an acute abnormality.", "output": "No evidence of pneumonia." }, { "input": "AP upright and lateral views of the chest provided. The lungs appear relatively clear without convincing signs of pneumonia or edema. No pleural effusion or pneumothorax is seen. The heart and mediastinal contours appear unchanged. There may be minimal hilar congestion. Bony structures appear grossly intact.", "output": "As above." }, { "input": "PA and lateral views of the chest. No prior. The lungs are clear. Costophrenic angles are sharp. Incidental note is made of an azygos fissure. Cardiomediastinal silhouette is within normal limits. Hypertrophic changes seen in the spine. Osseous and soft tissue structures are otherwise unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest demonstrate slightly low lung volumes which results in bronchovascular crowding. There are new small bilateral pleural effusions with minimal adjacent atelectasis. The cardiomediastinal and hilar contours are unchanged. There is no pneumothorax.", "output": "New small bilateral pleural effusions." }, { "input": "There are mild increased retrocardiac opacities. Mild increase interstitial findings are noted and may represent minimal pulmonary edema. The patient is status post mitral valve surgery with intact median sternotomy wires and mitral valve prosthesis. The lungs are clear with no evidence of a focal consolidation. There is no pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are normal. No acute fractures are identified.", "output": "Mild left baisilar opacities likely representing atelectasis, though an early overlying infectious process must be excluded in proper clinical setting. Minimal pulmonary edema." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Partially imaged upper abdomen is unremarkable. Clavicular fracuture seen on the shoulder radiographs of the same date is obscured.", "output": "No evidence of acute cardiopulmonary process, including no evidence of pneumothorax." }, { "input": "Frontal and lateral chest radiographs demonstrate low lung volumes, accentuating the pulmonary vasculature. There is no effusion or pneumothorax. The heart size is accentuated by portable technique. The mediastinal contours are unremarkable.", "output": "No acute chest pathology." }, { "input": "AP single view of the chest has been obtained with patient sitting in semi-upright position. Comparison is made with the next preceding PA and lateral chest examination of ___. An NG tube is again identified and seen to terminate in a location compatible with the body of the stomach. In comparison with the next preceding chest examinations of yesterday, the patient has developed a pulmonary vascular congestive pattern and it appears as if the heart shadow has increased moderately in size. Noted is the distention of the azygos vein shadow indicating venous congestion. No pneumothorax is seen and no new discrete parenchymal infiltrates have developed.", "output": "NG tube remains in unchanged appropriate position terminating in the stomach." }, { "input": "Frontal and lateral chest radiographs demonstrate clear lungs without effusion or pneumothorax. There is minimal left base atelectasis. The cardiac silhouette is normal in size. The mediastinal contours are normal.", "output": "No acute chest abnormality." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. The lungs appear clear. There are no pleural effusions or pneumothorax.", "output": "No evidence of acute disease." }, { "input": "Comparison is made to previous study from ___. Heart size is stable and within normal limits. Lungs are grossly clear. There are no focal consolidations or pleural effusions. There is minimal wedging of several mid thoracic vertebral bodies, stable. No pneumothoraces are seen.", "output": "No signs for acute cardiopulmonary process." }, { "input": "Portable upright chest radiograph is obtained. There is interval placement of an NG tube that is located below the diaphragm with the tip not clearly visualized. Heart is top normal size and cardiomediastinal contours are unchanged. Lungs are well expanded with evidence of mild pulmonary vascular congestion. Small bibasilar atelectasis. No significant pleural effusions and no pneumothorax.", "output": "1. Tip of NG tube is below the level of the diaphragms, but exact location cannot be established due to underpenetration. Abdominal or repeat chest radiograph with increased penetration and lower centering could be obtained to assess tip location if clinically indicated. 2. Mild pulmonary vascular congestion." }, { "input": "PA and lateral views of the chest provided. Lung volumes are low limiting assessment with bronchovascular crowding at the lung bases noted. No convincing signs of pneumonia. No effusion or pneumothorax. Cardiomediastinal silhouette appears stable. Bony structures are intact.", "output": "Limited, negative." }, { "input": "Upright PA and lateral views of the chest reviewed and compared to the most recent prior study. The lungs are clear without focal consolidation, signs of acute congestive heart failure, pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal. There are no concerning osseous or soft tissue lesions.", "output": "Normal chest radiograph, unchanged compared to the prior study. COMMENT: These findings were communicated by telephone to Dr. ___ ___ by Dr. ___ at ___, ___, 20 minutes after the time of discovery." }, { "input": "Subtle patchy left base opacity is seen, which may be due to atelectasis, but but an early/mild pneumonia is not excluded in the appropriate clinical setting. No pneumothorax is seen. There is no large pleural effusion. Cardiac and mediastinal silhouettes are stable and unremarkable.", "output": "No evidence of pneumothorax. Subtle right base opacity could be due to atelectasis, but an early/mild pneumonia is not excluded in the appropriate clinical setting." }, { "input": "A small focal opacity is seen in the right lower lung, concerning for pneumonia. The cardiomediastinal silhouette and pleural surfaces are normal. No pneumothorax or pleural effusion.", "output": "1. A small focal opacity is seen in the right lower lung, concerning for pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the ___ ___ at 2:05 PM, 20 minutes after discovery of the findings." }, { "input": "Lungs are fully expanded and clear without consolidations or effusions. Heart size is normal. Cardiomediastinal and hilar silhouettes are normal. Pleural surfaces are normal.", "output": "No radiographic evidence of pneumonia or other significant cardiopulmonary abnormalities." }, { "input": "The previously seen right lower lung opacity has slightly improved. No other consolidation. The hila and pulmonary vasculature are normal. No pleural abnormalities or pneumothorax. The cardiomediastinal silhouette is normal. No fractures.", "output": "Slightly improved right lower lung opacity." }, { "input": "Lungs demonstrate nonspecific interstitial opacities, which have been more fully characterized by prior CT of ___. Additionally, a faint opacity in the right upper lobe above the level of the minor fissure is apparently new compared to prior chest radiographs. There is no central vascular congestion or overt pulmonary edema. Mediastinum, hila and pleural surfaces are unremarkable. Heart size is normal.", "output": "A new focal opacity in the right upper lobe may represent an early pneumonia. Nonspecific interstitial abnormality, which is been more fully evaluated by chest CT. NOTIFICATION: The impression and recommendation above was entered by Dr. ___ on ___ at 15:28 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "The lungs are clear. Cardiac silhouette is normal in size. No pleural effusion, pneumothorax, pulmonary edema or evidence of pneumonia. Dilated or tortous ascending aorta is unchanged since ___.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is moderately enlarged. Mitral calcifications are prominent along the annulus. The cardiac, mediastinal and hilar contours appear unchanged including tortuosity of the aorta and calcification along the arch. There is no pleural effusion or pneumothorax. The lungs appear clear. Moderate rightward convex curvature centered along the mid thoracic spine. The bones are probably demineralized.", "output": "Unchanged cardiac enlargement. No evidence of acute disease." }, { "input": "The inspiratory lung volumes are appropriate. There is moderate dextroconvex curvature of the mid-to-lower thoracic spine with resultant asymmetry of the rib cage. The cardiac silhouette remains mildly enlarged. The thoracic aorta is tortuous, but the mediastinal contours are stable. There is partial calcification of the aortic knob. No pulmonary edema, focal consolidation, pleural effusion or pneumothorax is seen. Dense mitral valve annular calcifications are re-demonstrated.", "output": "No evidence of acute heart failure or volume overload." }, { "input": "The lungs are grossly clear. There is no focal consolidation. Blunting of the posterior costophrenic angles suggests small bilateral pleural effusions. Cardiac silhouette is mildly enlarged. Median sternotomy wires are intact. No acute osseous abnormalities.", "output": "Trace bilateral pleural effusions. Otherwise, no acute cardiopulmonary process." }, { "input": "An endotracheal tube terminates 4.8 cm above the carina. An enteric tube courses below the diaphragm, the tip is not visualized in this examination. A right PICC terminates at the mid SVC. The cardiac silhouette is mildly enlarged. Lung volumes are low and there is mild pulmonary vasculature congestion. No pneumothorax or pleural effusion is identified.", "output": "1. Endotracheal tube terminates 4.8 cm above the carina, standard position. 2. Mild cardiomegaly and pulmonary vascular congestion." }, { "input": "A tracheostomy tube is seen midline and a right-sided PICC line terminates at the mid to distal SVC. Orogastric tube in seen coursing below the diaphragm, the tip is not included in this examination. As compared to prior chest radiograph from ___, lung volumes remain low and there has been slight improvement of right basilar opacity. Retrocardiac opacity persists and there are probable persistent bilateral pleural effusions. An underlying infectious process however cannot be excluded. An area of linear atelectasis is now seen at the right lung base. Moderate pulmonary edema persists. The cardiomediastinal and hilar contours are stable.", "output": "Moderate pulmonary edema with probable bilateral pleural effusions and persistent retrocardiac opacity for which an underlying infectious process cannot be excluded." }, { "input": "Supine portable AP view of the chest provided. Tracheostomy tube, right upper extremity PICC line and NG tubes are again seen. The NG tube appears to descend into the left upper abdomen, though the tip is poorly visualized. There is a new left IJ central venous catheter with its tip at the expected level of the left brachiocephalic vein. There is increasing opacity within both lungs, though this could, in part, reflect underpenetrated technique. The heart remains enlarged. No pneumothorax is seen.", "output": "1. Left external jugular catheter tip in the region of the left brachiocephalic vein. 2. Increasing pulmonary airspace opacity likely represents worsening edema." }, { "input": "Lung is still not well ventilated. The consolidation at the right base has increased with increased pleural effusion. The left base atelectasis is unchanged. The mild pulmonary edema is stable. The mild cardiomegaly is stable. Tracheostomy chest tube is in standard placement. Left IJ catheter has been removed. There is no pneumothorax. Right subclavian catheter is unchanged with tip ending in upper SVC. NG tube is unchanged in standard position.", "output": "Increased atelectasis and pleural effusion at the right base. Persistent left base atelectasis and mild pulmonary edema. The left IJ catheter has been removed." }, { "input": "The ET tube terminates approximately 2.9 cm from the carina. There is an OG tube which traverses below the diaphragm with the tip out of view from this radiograph. The Swan-Ganz catheter appears to be in appropriate position. Again seen is moderate enlargement of the heart, overall stable compared to the prior exam. There appears to be slight interval increase in focal consolidation at the left lung base compared to the prior exam. The left upper and mid lung zones appear to be overall well aerated, unchanged compared to the prior exam. There has been slight interval improvement in the right lung field which is obscured by a moderate-to-large right pleural effusion. No evidence of pneumothorax.", "output": "Slight interval increase in focal consolidation at the left lung base compared to the prior exam, likely secondary to worsening small left pleural effusion. No evidence of pneumothorax." }, { "input": "Lung volumes continues to be low. The heart continues to be moderately enlarged with unchanged mild to moderate edema. Moderate bilateral, right greater than left, pleural effusions are unchanged. ET tube is in appropriate position, and the gastric tube ends in the stomach. Left central venous line is in appropriate position. Right PICC line ends at the lower SVC.", "output": "Unchanged low lung volumes, mild pulmonary edema and bilateral moderate pleural effusions." }, { "input": "The lung volumes are low. The cardiac silhouette is enlarged, likely exaggerated due to low lung volumes. Aortic arch calcifications are seen. An endotracheal tube is noted, terminating 3.5 cm above the carina. A transesophageal tube is seen, with the side port at the GE junction. No definite focal consolidation is identified. There is no pleural effusion or pneumothorax.", "output": "1. Endotracheal tube terminates 3.5 cm above the carina. 2. Transesophageal tube with the side port at the GE junction. Advancement is recommended." }, { "input": "Lung volumes remain low with bronchovascular crowding, but have improved since ___. Bilateral pleural effusions are small. Retrocardiac opacity may reflect atelectasis, similar the prior exam, although concurrent infection cannot be excluded. No pneumothorax. Cardiomediastinal silhouette is unchanged with mild to moderate cardiomegaly. Aortic knob calcifications are moderate, overall unchanged. Elevation of the right hemidiaphragm is overall unchanged. There appears to be significant compression deformity and marked loss of vertebral body height of an upper lumbar spine vertebral body, not clearly appreciated of prior chest radiograph and may correspond to the L3 compression deformity on the lumbar spine CT from ___, but has progressed in the interim.", "output": "1. Low lung volumes with bilateral small pleural effusions. 2. Retrocardiac opacity may reflect atelectasis and/or concurrent infection. 3 increased (>___%) loss of vertebral body height of a lumbar vertebral body (perhaps L3), progressed since ___. Correlate with focal exam findings and consider cross sectional imaging to further evaluate. 4. Prominent pulmonary artery may reflect sequelae of chronic pulmonary hypertension." }, { "input": "AP and lateral views of the chest. Left-sided subclavian line is no longer visualized. There is blunting of the posterior costophrenic angles suggestive of small effusion. Mildly indistinct pulmonary vascular markings are seen. There is no confluent consolidation. Cardiac silhouette is enlarged but stable in configuration. Tortuous descending thoracic aorta is noted. Degenerative change is seen at the shoulders bilaterally.", "output": "Small bilateral effusions and mild interstitial edema without confluent consolidation." }, { "input": "AP upright and lateral views of the chest provided. There is a layering small right pleural effusion. Mild hilar congestion noted. No convincing signs of pneumonia. No overt edema. No pneumothorax. Heart size is top-normal. Mediastinal contour is stable. Bony structures are intact.", "output": "Small right pleural effusion with hilar congestion." }, { "input": "The heart is mild to moderately enlarged. The main pulmonary artery contour, as well as central pulmonary arteries appear again enlarged. The aortic arch is calcified. There is a small pleural effusion on the left with associated opacity probably due to atelectasis. The opacity in the medial right lower lung is probably due to a atelectasis in the costophrenic sulcus. There is probably a very mild degree of vascular congestion but less striking than on the prior study.", "output": "Cardiomegaly and marked enlargement of central pulmonary arteries; pulmonary vascular congestion appears very mild, however. Opacities at the lung bases probably due to atelectasis with a small left-sided pleural effusion." }, { "input": "AP upright and lateral views of the chest were provided. Mild cardiomegaly is again noted with partially layering bilateral pleural effusions and lower lobe compressive atelectasis. Additionally there is hilar engorgement compatible with edema. Given the lower lung opacity, pneumonia difficult to exclude. Calcification of the aortic arch is noted. There is no pneumothorax. Imaged osseous structures appear intact. There is a calcific density abutting the left humeral head concerning for tendinopathy.", "output": "Pulmonary edema with small bilateral effusions and lower lobe compressive atelectasis. Pneumonia in the lower lungs difficult to exclude in the right clinical setting. Followup imaging post diuresis may be helpful to further assess." }, { "input": "The lungs remain hyperinflated, consistent with chronic obstructive pulmonary disease. No focal consolidation, large pleural effusion, or evidence of pneumothorax is seen. There is persistent mild blunting of the right costophrenic angle. The cardiac and mediastinal silhouettes are stable and unremarkable. Aortic knob calcification is seen.", "output": "COPD. No acute cardiopulmonary process." }, { "input": "The cardiac silhouette size is normal. The aorta is mildly tortuous with calcifications is noted at the aortic knob. Calcified granulomas are re- demonstrated in the left upper lobe medially. The pulmonary vascularity is normal and the hilar contours are unremarkable. Lungs are hyperinflated compatible with emphysema as seen previously. Ill-defined nodular and branching opacities are noted within the left lung base, which could reflect bronchial inflammation or infection or infection as seen on the prior chest CT. The. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Findings suggestive of an inflammatory or infectious process involving the airways within the left lung base." }, { "input": "There has been interval placement of an endotracheal tube, which is appropriately placed with its tip projecting 5 cm above the carina. There is also interval placement of an NG tube with the tip in the distal stomach, which is excluded on imaging. There is otherwise no significant interval change compared to exam from six hours prior.", "output": "Appropriate positioning of endotracheal tube and NG tube." }, { "input": "The heart is normal in size. The mediastinal and hilar contours are within normal limits. There is marked hyperexpansion of the lungs, in keeping with a known history of asthma. There is however no consolidation or pleural effusion.", "output": "1. No evidence of pneumonia. 2. Pulmonary hyperexpansion, compatible with a asthma." }, { "input": "Frontal and lateral views of the chest were obtained. External artifact overlies the left lower hemithorax as well as the lateral right upper quadrant. Per the radiology technologist, the patient refused to remove blankets overlying her. Given this, no focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac silhouette is not enlarged. The aortic knob is calcified.", "output": "No focal consolidation. Suboptimal evaluation of the left inferior hemithorax due to overlying external artifact. If high concern in this location, consider repeat after removal of the external artifact." }, { "input": "Lungs remain hyperinflated. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. No displaced fracture is seen.", "output": "No acute cardiopulmonary process. No significant interval change." }, { "input": "AP portable upright view of the chest. The patient is intubated and the endotracheal tube tip resides 3.4 cm above the carina. Endogastric tube extends into the left upper abdomen though the tip is excluded from view. There is retrocardiac opacity which could represent atelectasis/aspiration, difficult to exclude pneumonia. Otherwise lungs are clear.", "output": "Appropriate tube position." }, { "input": "Single frontal view of the chest. Heart size and cardiomediastinal contours are normal. Lungs are clear without focal consolidation, pleural effusion, or pneumothorax.", "output": "Normal chest radiograph." }, { "input": "PA and lateral views of the chest provided. Lung volumes are somewhat low with bibasilar atelectasis noted. There is no convincing sign of pneumonia or CHF. No large effusion or pneumothorax is seen. The heart size appears grossly normal though difficult to assess on the frontal projection. The mediastinal contour appears normal. The bony structures are intact. No free air below the right hemidiaphragm is seen. On the lateral projection, gas filled dilated small bowel is present.", "output": "1. No free air below the right hemidiaphragm. 2. Bibasilar atelectasis. 3. Gas-filled dilated small bowel in the upper abdomen for which dedicated radiograph or CT may be performed to further assess." }, { "input": "There is new airspace opacification in the right lung base with associated air bronchograms concerning for right lower lobe pneumonia. Small bilateral pleural effusions are present on the right greater than the left. Scarring of the right lung apex is unchanged. No pneumothorax is present. The pulmonary vasculature is not engorged. The cardiac silhouette is top normal in size but stable. The mediastinal and hilar contours are unchanged with prominence and tortuosity of the thoracic aorta, which is unchanged. The trachea is slightly deviated from midline most likely related to patient head positioning.", "output": "Right lower lobe pneumonia and bilateral pleural effusions on the right greater than the left." }, { "input": "No pleural effusions. Known fibrotic changes are again noted in the right upper lung. There is suggestion of borderline prominent pulmonary vascular markings. Otherwise, the lungs are without focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is at the upper limits of normal.", "output": "1. No acute cardiopulmonary process. 2. Fibrotic changes in the right upper lung appear relatively stable." }, { "input": "Lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There has been interval improved aeration at the left lung base. No focal consolidation, pneumothorax, or pulmonary edema is seen. Mild blunting of the right costophrenic angle may be secondary to small effusion or scarring. Lung volumes are slightly low, which may exaggerate heart size; heart and mediastinal contours appear stable with mild cardiomegaly. Median sternotomy wires are again noted.", "output": "Improved aeration at the left lung base without evidence for acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Lungs are fully expanded and clear without consolidations or effusions. Heart size is normal. Cardiomediastinal and hilar silhouettes are normal. Pleural surfaces are normal.", "output": "No radiographic evidence of pneumonia or other significant cardiopulmonary abnormalities. NOTIFICATION: The findings were discussed by Dr. ___ with ___ ___, RN on the telephone on ___ at 4:24 PM, approximately 25 minutes after discovery of the findings." }, { "input": "PA and lateral views of the chest were provided demonstrating clear well-expanded lungs without focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Left-sided Port-A-Cath tip terminates at the SVC/right atrial junction, unchanged. Heart size remains mildly enlarged. Mediastinal and hilar contours are unchanged and within normal limits. Lungs are clear. No pleural effusion, pneumothorax, or pulmonary vascular congestion is present. The osseous structures are unremarkable.", "output": "No acute cardiopulmonary abnormality. Unchanged position of the left-sided Port-A-Cath with tip at the junction of the SVC and right atrium." }, { "input": "The patient is status post median sternotomy. Heart size is normal. Mediastinal and hilar contours are unremarkable. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is visualized. No acute osseous abnormality seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest are provided. There is bilateral upper lobe scarring and upward retraction of the hila. Otherwise the lungs appear clear. No pleural effusion or pneumothorax. Heart size is normal. Calcific dencity in the left upper quadrant may represent large left kidney stone.", "output": "1. Significant bilateral upper lobe scarring like infection or inflammation. Please correlate clinically and CT if needed to further assess. 2. No signs of pneumonia or CHF. 3. Stone within the left kidney." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. Calcified left perihilar granuloma are present, unchanged as compared to ___. Calcified left hilar lymph node is most likely present as well. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear besides minimal left basilar atelectasis. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is seen.", "output": "No acute cardiopulmonary process. No displaced fracture seen. If clinical concern for rib fracture persists, consider dedicated rib series which is more sensitive." }, { "input": "There is no focal consolidation, pleural effusion, pneumothorax, or frank pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "Normal chest radiograph." }, { "input": "The right IJ central line terminates at the superior cavoatrial junction. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "1. Right IJ terminates at the superior cavoatrial junction. 2. No acute cardiopulmonary process." }, { "input": "In comparison with the study of ___, the Dobbhoff tube has been removed. The left subclavian catheter extends to the mid portion of the SVC. Ventriculoperitoneal shunt is again seen. The heart remains within normal limits in size and there is no vascular congestion or pleural effusion. Specifically, no acute focal pneumonia. The nodular density overlying the first rib in the right apex is unchanged from the study of ___. It is unclear whether this represents a calcified granuloma or possibly a bone island in the first rib.", "output": "No evidence of acute pneumonia." }, { "input": "The cardiomediastinal contours and hilar contours are stable. There is no pleural effusion or pneumothorax. Left basilar opacity is worsened on the current study. Again seen is a rounded calcific density overlying the posterior third rib, likely a bone island. ET tube has been withdrawn, now terminating approximately 7 cm above the carina. Enteric tube is present with tip in the stomach pointing towards the pylorus.", "output": "1. ET tube terminating about 7 cm from the carina. 2. Worsened left basilar opacity, which is consistent with aspiration or pneumonia in the correct clinical setting." }, { "input": "Single portable chest radiograph was provided. A left PICC continues to be within the lower right atrium and should be retracted for better positioning. Nasogastric tube courses below the diaphragm and terminates in the stomach. Lungs are clear without focal consolidation, pleural effusion or pneumothorax. The heart is mildly enlarged, likely projectional. Bones are intact. Imaged upper abdomen is unremarkable.", "output": "Left PICC continues to be in the low right atrium. Recommend retracting 3-4 cm for better positioning." }, { "input": "PA and lateral views of the chest shows normal lung volumes without consolidation or nodules. Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax.", "output": "Normal chest x-ray without sign of active or latenet TB." }, { "input": "Moderate cardiomegaly is stable. Mild pulmonary edema has improved. Bibasilar atelectasis larger on the right side are grossly unchanged. Bilateral calcified granulomas in the upper lobes are again noted. Moderate bilateral effusions larger on the right side are minimally increased. There is no pneumothorax. Left PICC tip is in the mid SVC. Sternal wires are aligned.", "output": "Improved mild pulmonary edema." }, { "input": "Frontal and lateral radiographs of the chest demonstrate moderate to severe pulmonary edema with stable moderate cardiomegaly. Smal bilateral pleural effusions are present. No pneumothorax.", "output": "Moderate to to severe pulmonary edema." }, { "input": "The heart is normal in size. The aortic arch is partly calcified. The lungs are hyperinflated. The mediastinal and hilar contours are otherwise unremarkable. Slight subpleural scarring is noted at each lung apex. There is no pleural effusion or pneumothorax. There is patchy opacity projecting over the left mid to lower lobe suggesting pneumonia, not well seen on the lateral view but suspected to reside primarily in the left lower lobe but perhaps involving the lingula.", "output": "Findings compatible with pneumonia in the left lower lung." }, { "input": "The lungs are grossly clear were in not obscured by overlying devices, specifically a right chest wall dual lead pacing device and a left-sided vagal nerve stimulator. The cardiomediastinal silhouette is within normal limits. Calcified hilar/mediastinal nodes are suspected based on the lateral view. Atherosclerotic calcifications are noted in the thoracic aorta. Posterior fixation lower thoracic/ upper lumbar hardware is visualized.", "output": "No acute cardiopulmonary process." }, { "input": "Since ___, left peripheral basilar opacity with small pleural effusion correlates to the region of known pulmonary embolus. The cardiomediastinal silhouette is unchanged. No pneumothorax, pneumonia, or pulmonary edema. The known left lower lobe nodule is not as well seen on today's exam and is better assessed on recent CT chest from ___.", "output": "1. Left peripheral basilar opacity with small left pleural effusion correlates to the region of known pulmonary embolus. 2. The known left lower lobe nodule is not as clearly seen on today's exam, and is better assessed on recent CT Chest from ___." }, { "input": "The lungs are grossly clear without focal consolidation, pleural effusion or pneumothorax. There is no pulmonary edema. The heart is normal in size, and the mediastinal contours are normal.", "output": "No acute pulmonary process identified." }, { "input": "A right upper extremity PICC line terminates at the cavoatrial junction. There is no evidence of focal consolidation, pleural effusion, pneumothorax, or frank pulmonary edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities are detected.", "output": "Right PICC line terminating at the CA junction." }, { "input": "Lungs are relatively hyperinflated and there is relative lucency projecting over the right upper lung with changes in the underlying parenchyma raising the possibility of emphysema. There is also left apical scarring. There is no focal consolidation or edema. Moderate-sized hiatal hernia is noted. No acute osseous abnormalities. Right shoulder arthroplasty changes are noted.", "output": "Hiatal hernia and findings suggestive of emphysema. No acute cardiopulmonary process." }, { "input": "No focal opacity to suggest pneumonia is seen. No pleural effusion, pulmonary edema or pneumothorax is present. The heart, mediastinal and pleural surface contours are normal. Surgical clips project over the lower neck on the left", "output": "No radiographic evidence of acute intrathoracic process." }, { "input": "A tracheostomy tube is unchanged in position. A left PICC terminates at the lower SVC. Multiple intact sternal wires are again demonstrated. Extensive widespread pulmonary opacities have improved since ___. No new opacity is detected. Tiny pleural effusions are stable. There is no pneumothorax.", "output": "Interval improvement of extensive bilateral pulmonary opacities. No new focal opacity detected." }, { "input": "No focal consolidation concerning for pneumonia. No large effusion or pneumothorax. Heart is mildly prominent. Hila appear slightly engorged. There is likely mild interstitial pulmonary edema. The mediastinal contour is normal. Bony structures are intact.", "output": "Hilar congestion with mild interstitial pulmonary edema. Mild cardiomegaly." }, { "input": "Indwelling support and monitoring devices are stable and in standard position. Postoperative mediastinum, hila, cardiac silhouette are normal. No pleural effusion, pulmonary edema, or pneumothorax.", "output": "No significant interval change. No pleural effusion or pneumothorax." }, { "input": "Transverse cardiomegaly. Atherosclerotic changes of the thoracic aorta. Prominent pulmonary vasculature with indistinctness of the vessels and peribronchial cuffing in keeping with pulmonary edema. Peripheral ___ B lines also noted. Small left-sided effusion. No airspace consolidation.", "output": "Cardiomegaly. New moderate pulmonary edema and small left-sided pleural effusion." }, { "input": "ET tube is in unchanged position. Left PICC terminates in lower SVC. Right internal jugular Swan-Ganz catheter terminates at the proximal right pulmonary artery. A transesophageal tube terminates in the stomach. A feeding tube courses below the diaphragm and out of view. Sternotomy wires are intact. Pulmonary edema is resolved in the right lung. Left lung pulmonary edema is persistent. Left lung base opacities increased, likely reflecting increased atelectasis and pleural effusion. Small right pleural effusion is stable. Mildly enlarged cardiac silhouette is stable.", "output": "Increased left lung base atelectasis and pleural effusion. Pulmonary edema is improved in the right lung and persistent in the left lung." }, { "input": "Lungs are hyperinflated. Mild bibasilar opacities likely reflect atelectasis. Prominent pulmonary vessels are unchanged. Enlarged cardiac silhouette is unchanged. There is no pneumothorax or large pleural effusion.", "output": "Hyperinflated lungs with stable prominence of pulmonary vessels." }, { "input": "The patient is rotated to the left. Diffuse bilateral reticular opacities and bilateral pleural effusions, greater on the right, persist. These may have improved slightly in the interval. There is no pneumothorax. The patient is status post median sternotomy as before. The heart and mediastinal structures are unchanged. A tracheostomy tube and 2 left-sided central venous catheters remain in place.", "output": "Possible slight interval improvement in pulmonary edema. Otherwise stable examination." }, { "input": "Cardiomegaly and pulmonary edema again seen with no significant change. No pneumothorax. Tracheostomy tube in place. Left central line in mid to lower SVC. Right IJ line in right innominate vein. NG tube in the stomach", "output": "Persistent pulmonary edema." }, { "input": "Diffuse bilateral reticular opacities which are consistent with edema persist. These increasing density in the right lung base consistent with an increasing pleural effusion. Blunting of the role left costophrenic sulcus is consistent with pleural fluid as well and is unchanged. The heart and mediastinal structures are stable. The patient is status post median sternotomy as before. A tracheostomy tube and 2 left-sided central venous catheters remain in place.", "output": "Interval increase in right pleural effusion. No other significant change." }, { "input": "The right superior mediastinum at the expected area of the ascending aorta appears widened, demonstrating an outwardly convex bump compared to preoperative imaging. ETT in situ at the level of the medial clavicles. Swan-Ganz catheter position unchanged. Feeding tube in the stomach. Left-sided PICC line in situ with the tip at the cavoatrial junction. No new areas of airspace opacification. No pleural effusions. No pneumothoraces.", "output": "The right superior mediastinum appears widened with a prominent bump. Swan-Ganz catheter in the appropriate position. NOTIFICATION: Dr. ___ ___ ___:21." }, { "input": "A tracheostomy is in place. Sternotomy wires appear intact and appropriately aligned. A left PICC terminates in the low SVC. There are extensive multifocal opacities throughout the lungs bilaterally. Heart size is normal. The mediastinal and hilar contours are normal. There may be small bilateral pleural effusions. No pneumothorax.", "output": "1. Appropriate position of lines and tubes. 2. Extensive multifocal opacities throughout the lungs bilaterally, for which the differential includes multifocal pneumonia, extensive aspiration, alveolar pulmonary edema, or ARDS." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Normal cardiomediastinal and hilar contours. Clear lungs. No pneumothorax or pleural effusion.", "output": "No evidence of pneumonia. NOTIFICATION: The findings were communicated to Dr. ___ by Dr. ___ ___ text ___ on ___ at 2:39 PM, 5 minutes after discovery of the findings." }, { "input": "The heart size and mediastinal contours are normal. The lungs are clear; specifically, a linear density projecting over the lower lobes on the lateral view has been unchanged since prior exam. There is no pleural effusion or pneumothorax.", "output": "No evidence of pneumonia." }, { "input": "AP and lateral views of the chest demonstrate low lung volumes which exaggerate the bronchovascular structures as well as cause bibasal atelectasis. Heart size is mildly enlarged. The patient is status post median sternotomy and CABG. There are no focal opacities which are concerning for pneumonia. There is no overt pulmonary edema and there is no pleural effusion. There is no free air.", "output": "No evidence of acute cardiopulmonary process given low lung volumes." }, { "input": "Frontal radiograph of the chest demonstrates interval removal of Swan-Ganz catheter. Bilateral pulmonary vascular congestion is again noted with continued bibasilar atelectasis and pleural effusions. There is slight interval increase in the left pleural effusion which is small and right pleural effusion which is small to moderate. Stable cardiomegaly which is consistent with postoperative appearance. No pneumothorax is identified.", "output": "Slight interval worsening in left pleural effusion with continued moderate pulmonary edema and enlarged cardiac silhouette." }, { "input": "Left PICC is malpositioned, now coiling in the left internal jugular vein before making an inferior turn at the junction of the left internal jugular and left brachiocephalic veins at the level of the medial aspect of the clavicle. This information was communicated with ___ by Dr. ___ on ___ at 8:28 a.m. at the time of discovery. Stable cardiomegaly.", "output": "Worsening bibasilar opacities, likely due to atelectasis, accompanied by small right and small-to-moderate left pleural effusions." }, { "input": "The left-sided chest tube and mediastinal drains have been removed. There is a small left apical pneumothorax. Right IJ line with tip in the right atrium is again seen. There is volume loss in both lower lungs left greater than right", "output": "Tiny left apical pneumothorax after removal of chest tube." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Compared with prior radiographs performed the same day on ___ at 10:26, a right-sided PICC line, which previously terminated in the jugular venous system, has been repositioned and now terminates in the mid SVC. There is otherwise no change.", "output": "Right-sided PICC line terminates in the mid SVC." }, { "input": "Frontal and lateral chest radiographs demonstrate interval development of a large predominantly gas-containing hydropneumothorax. No right-sided effusion or pneumothorax evident. Lungs are clear. Cardiomediastinal and hilar contours are unremarkable. New ICD lines are well positioned and continuous.", "output": "New large left hydropneumothorax, predominantly gas. Well-positioned lines. ___ discussed these findings with interventional pulmonary fellow, at 10:30 a.m. on ___ at time of interpretation." }, { "input": "The lungs are hyperinflated but clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are stable. There is no pleural effusion or pneumothorax. There is no lung nodule or mass. There is no focal consolidation concerning for pneumonia. Pulmonary vasculature is within normal limits.", "output": "No pulmonary lesion or other acute abnormality." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal mediastinal silhouette and well-aerated lungs without focal consolidation, pleural effusion, or pneumothorax. Pneumomediastinum is noted along the right infrahilar region as well as the aortic knob, and posterior to the heart on lateral view. Pneumopericardium is noted anteriorly. No intraperitoneal free air is seen. Retroperitoneal free air seen on CT from the same day is not appreciated on this exam.", "output": "Pneumomediastinum and pneumopericardium, as partially seen on CT abdomen/ pelvis from the same day. No focal consolidation." }, { "input": "The lung volumes are low. The heart is not enlarged. Faint opacity at the left base likely reflects atelectasis. The right lung is relatively clear. The mediastinal and hilar contours are normal. There is no large pleural effusion or pneumothorax.", "output": "Faint opacity at the left base may reflect atelectasis. There is no convincing evidence of pneumonia. If confirmation is desired then formal PA and lateral radiographs are recommended." }, { "input": "The cardiomediastinal contour is normal. The lungs are grossly clear. No good evidence of a pneumonia.", "output": "No good evidence of pneumonia" }, { "input": "There has been an increase in the moderate left pleural effusion and fluid within the left major fissure. A left pleural catheter is in place.The right lung is clear other than minimal basilar atelectasis. There is no new cardiac and mediastinal contour.", "output": "Increasing size of left pleural effusion since ___ and ___. Presence of superimposed infection cannot be excluded." }, { "input": "There is elevated left hemidiaphragm with a left pleural effusion. In addition, there is abnormal opacity at the left pulmonary hilum with perihilar reticulation raising strong clinical concern for malignancy. CT correlation is strongly advised. The right lung is clear. The heart cannot be clearly assessed. Bony structures appear grossly intact.", "output": "Findings in the left hemithorax concerning for malignancy and correlation with CT is strongly advised." }, { "input": "There is a new right middle lobe opacity concerning for pneumonia. As compared to the prior CT, left lower lobe opacities may represent scarring or residual infection.The cardiac, hilar and mediastinal contours are normal.No pleural abnormality is seen.", "output": "New right middle lobe pneumonia. Residual opacities at the left lung base may represent scarring or residual infection. Follow-up after treatment is recommended." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is an increasing opacity in the right middle lobe suggesting pneumonia as well as an increased left lower lobe opacity that is best depicted on the frontal view. Involvement of the right lower lobe is also possible. There are no definite pleural effusions. There is no pneumothorax.", "output": "Worsening pneumonia in the left lower lobe and right middle lobe." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The previously seen left basilar nodular opacity has resolved. The cardiomediastinal silhouette is normal. Notably, there is no pericardial abnormality.", "output": "No acute cardiopulmonary process; specifically, no evidence of pneumonia. Results were discussed with ___'s assistant at 1:20 p.m. on ___ via telephone by Dr. ___ at the time the findings were discovered." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute chronic process. NOTIFICATION: These findings were communicated to ___ at 1:29 p.m. on ___ by phone." }, { "input": "No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Previously seen lingular opacity has essentially resolved in the interval.", "output": "No acute cardiopulmonary process." }, { "input": "Subtle lingular opacity is worrisome for pneumonia No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Subtle lingular opacity is suspicious for pneumonia." }, { "input": "PA and lateral chest views were obtained with patient in upright position. The heart size is normal. No typical configurational abnormality is seen. Thoracic aorta and mediastinal structures are unremarkable. The pulmonary vasculature is not congested. On the right lung base, there is a parenchymal density occupying the cardiophrenic angle on the frontal view and projecting into the medial lower segment of the right middle lobe. An additional local parenchymal infiltrate is seen on the left base partially in retrocardiac position and located in the posterior segment of the left lower lobe on the lateral view. Pleural spaces are free and thus no evidence of pleural effusion. No pneumothorax in the apical area. When comparison is made with the next preceding chest examination of ___, the patient had, at that time, small peripheral parenchymal infiltrates on the left base. The now diagnosed pneumonic infiltrate in the right middle lobe did not exist and the parenchymal densities on the left base are larger than they were at that time.", "output": "Multifocal parenchymal infiltrates consistent with acute infection. Followup examination after treatment is recommended. Referring physician, ___, was paged and reached at 5:15 p.m." }, { "input": "Frontal and lateral radiographs of the chest demonstrate clear lungs. The heart, mediastinal and hilar contours are normal. No pleural abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well-expanded and clear. The cardiomediastinal silhouette is unremarkable. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is persistent severe enlargement of the cardiac silhouette. The cardiac and mediastinal silhouettes are stable. Patient is status post median sternotomy and cardiac valve replacement. Dual lead left-sided pacer device is stable in position. No focal consolidation is seen. There is no pleural effusion or pneumothorax. No overt pulmonary edema is seen.", "output": "Persistent enlargement of the cardiomediastinal silhouette. Stable position of left-sided pacer device." }, { "input": "Since ___, there has been interval placement of a left pectoral pacemaker with transvenous leads seen in the right atrium, right ventricle, and a left coronary vein. The lungs are clear. Mild to moderate bibasilar atelectasis is noted. No pneumothorax. The median sternotomy wires are intact and aligned. Patient is status post aortic valve and mitral valve repair.", "output": "Left pectoral pacemaker with transvenous leads in the RA, RV, and a left coronary vein. No pneumothorax." }, { "input": "Severe cardiomegaly is stable. Pacer leads are in standard position in the right atrium, right ventricle and through the coronary sinus. There is no pneumothorax. There is no pleural effusion. Patient is status post aortic valve and mitral valve repair", "output": "No pneumothorax" }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "There has been interval improvement in pulmonary edema, which is now minimal. Lung volumes are persistently low. Heart size is stably enlarged. Aortic calcification is noted. No pleural effusion or pneumothorax is seen. CoreValve hardware projects in a similar location. Right internal jugular approach pacing wire tip has repositioned, with tip above the diaphragm and coursing to the left of midline, likely in the right ventricle.", "output": "1. Slight interval repositioning of the pacing wire, likely in the right ventricle. Discussed with ___ by ___ by phone at 11 a.m. on ___ after attending radiologist review. 2. Interval improvement in pulmonary edema." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. No radiopaque foreign body is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are hyperinflated, suggesting chronic obstructive pulmonary disease. An azygos lobe is re- demonstrated.No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "AP portable supine view of the chest. Patient is rotated significantly to her right limiting evaluation. Previously noted feeding tube has been removed. Cardiomediastinal silhouette is shifted to the right and difficult to assess. Opacity at the right lung base likely reflects atelectasis and effusion. Difficult to exclude pneumonia. Haziness of the left lung base likely reflects bronchovascular markings given rotation.", "output": "Limited due to patient rotation. Probable right basal effusion and atelectasis. Difficult to exclude lung base pneumonia." }, { "input": "There is no focal consolidation to suggest pneumonia. Small bilateral pleural effusions are new. No pneumothorax. Heart size is mildly enlarged. Aorta is tortuous.", "output": "1. No focal pneumonia. 2. New small bilateral pleural effusion." }, { "input": "Portable upright chest radiograph ___ at 09:53 is submitted.", "output": "Nasogastric tube unchanged in position. Overall cardiac and mediastinal contours are stable given differences in patient positioning. There are small to moderate layering bilateral effusions, right greater than left, and worsening bilateral interstitial disease consistent with mild to moderate pulmonary and interstitial edema. Probable associated bibasilar compressive atelectasis. No pneumothorax." }, { "input": "Diffuse hazy opacification of the left lung field and right upper lung has increased slightly compared with the prior study. Pleural effusions are similar. The cardiomediastinal silhouette is unchanged. Rightward obliquity of the radiograph is similar to multiple prior studies. There is no pneumothorax.", "output": "Slight interval increase in hazy opacification of the left lung and right upper lung most likely representing increased pulmonary interstitial edema. Widespread infectious process is possible in the proper clinical circumstances, but thought to be less likely. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 3:46 AM, 1 minutes after discovery of the findings." }, { "input": "As on yesterday's exam the patient is rotated but to a lesser degree. Lung volumes are increased and there is no mild hyperexpansion. There are no focal airspace opacities to suggest pneumonia. Mild cardiomegaly is unchanged. The mediastinum appears normal. Tortuosity of the aorta is re- demonstrated. There is no pneumothorax or pleural effusion.", "output": "1. Mild hyperexpansion is compatible with COPD. There is no evidence of pneumonia. 2. Mild cardiomegaly is unchanged." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is normal. Osseous structures are unremarkable.", "output": "Normal chest x-ray." }, { "input": "On the initial image, the ET tube is high, at the thoracic inlet, 10 cm above the carina. By the ___ image this was lower, 6.6 cm above the carina. The NG tube tip is in the stomach", "output": "ET tube and NG tube in good position" }, { "input": "Lung volumes are low. Central pulmonary vascular congestion has increased, now moderate. No large pleural effusion, pneumothorax, or lobar consolidation. Moderate cardiomegaly is unchanged.", "output": "Cardiomegaly with pulmonary vascular congestion." }, { "input": "A lung volumes are slightly low, which may in part be secondary to lack of full inspiration. The lungs are clear. No focal consolidation, pleural effusion, or pneumothorax. The heart is moderately to severely enlarged. The descending aorta is slightly tortuous or ectatic. The pulmonary vessels are slightly prominent bilateral but not overtly enlarged.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest were reviewed and compared to the prior studies. Multiple new rounded opacities are scattered throughout both lungs, the largest is located in the left lower lung. The smaller ones are located in the right lung apex and left mid lung. Given the clinical history of cancer and the rapid rate of growth, these lesions are consistent with metastatic disease. Assessment of the cardiac and mediastinal contours is limited due to these lesions; however, both are relatively unchanged. There is no vascular congestion, pleural effusion, or pneumothorax. No definite rib fracture.", "output": "Multiple bilateral round opacities of varying sizes, consistent with metastatic disease. No definite rib fracture. If there is continued clinical concern for a rib fracture oblique views are recommended." }, { "input": "There is stable low lung volume seen bilaterally, with bronchovascular crowding and hilar prominence, but no evidence of pleural effusion, focal consolidations, or pneumothorax. Also seen is stable severe thoracic kyphosis with associated stable degenerative changes in the thoracic spine. No acute abnormalities are seen. There is no gross evidence of rib abnormalities and the appearance of the sternum is unchanged as compared to previous several studies.", "output": "No evidence of acute fracture. If sternal symptoms persist, recommendation is made to further evaluate with CT." }, { "input": "The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax or pneumomediastinum. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "Normal radiographs of the chest." }, { "input": "The cardiac silhouette is mildly enlarged without vascular congestion or edema. Mediastinal silhouette and hilar contours are unremarkable. Lungs are clear without focal consolidation worrisome for pneumonia. There is no pleural effusion or pneumothorax. A left humeral head replacement is incompletely imaged.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs remain hyperinflated consistent with COPD but clear of any focal opacities concerning for an infectious process. Surgical clips are noted in the mediastinum at the site of the patient's prior mediastinal mass. Hilar and paratracheal adenopathy is again present, although improved. A calcified mitral annulus is present. There is no pleural effusion and no pneumothorax.", "output": "No evidence of acute cardiopulmonary process. Improving hilar and paratracheal adenopathy." }, { "input": "Single frontal view of the chest was obtained. The cardiac and mediastinal silhouettes are stable. No focal consolidation, large pleural effusion, or evidence of pneumothorax is seen. There is no overt pulmonary edema.", "output": "Stable cardiomediastinal silhouette without overt pulmonary edema." }, { "input": "The lungs are well expanded. There are no focal opacities. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic process." }, { "input": "AP upright and lateral views of the chest are reviewed. Compared to the prior study, the pulmonary edema has completely resolved. The small right and moderate left pleural effusions are unchanged. The lung volumes are low. Linear opacities in the left lower lung likely represent atelectasis. Otherwise, the lungs are clear without focal consolidations or pneumothorax. Moderate cardiomegaly is unchanged. The hila are minimally enlarged bilaterally which could correspond to lymphadenopathy seen on the prior chest CT performed ___. New focal punctate hyperdensities over the thoracic spine likley represent prior vertebroplasty.", "output": "1. Unchanged small right and moderate left pleural effusions. 2. Unchanged moderate cardiomegaly. 3. Minimally enlarged hila bilaterally could correspond to lymphadenopathy seen on the prior CT performed in ___." }, { "input": "Portable upright chest radiograph demonstrates interval increase in bibasilar opacities, likely reflecting atelectasis. There is mild pulmonary edema. Multiple new nodules are not well appreciated on plain radiograph. The patient's known lymphadenopathy is better appreciated on chest CT. Surgical clips are seen adjacent to the trachea.", "output": "Bibasilar atelectasis and mild pulmonary edema. Refer to chest CT performed subsequently for further information." }, { "input": "AP single view of the chest has been obtained with patient in sitting semi-upright position. Comparison is made with the next preceding AP and lateral chest examination of ___. The present frontal view again demonstrates the previously described marked cardiomegaly. Appearance of pulmonary vasculature has changed markedly with now prominent perivascular haze mostly over the bases with general distended pulmonary vasculature (plethora) indicating development of pulmonary congestion since the next preceding examination. Mild blunting of the left lateral pleural sinus may have increased slightly, indicating small amounts of pleural effusions. There is no evidence of pneumothorax. There is some evidence of contrast material location in a vertebral body of the upper thoracic spine, but skeletal detail on this portable chest examination is suboptimal.", "output": "Development of more advanced CHF since next preceding examination. No pneumothorax." }, { "input": "The lungs are well inflated. The lungs are clear. There is no pleural effusion, pneumothorax or focal airspace consolidation. Heart is normal size. Mediastinal and hilar structures are unremarkable. There is no pulmonary edema.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size, mediastinal, and hilar contours are normal.The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.No pulmonary opacity to correlate with the finding from the prior left shoulder radiograph is identified.", "output": "1. No acute cardiopulmonary process. 2. No opacity to correlate with the findings from the prior left shoulder radiograph." }, { "input": "As compared to the prior examination performed 6 hr earlier, there has been no significant interval change. There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The cardiomediastinal silhouette is stable. The aorta is moderately tortuous. The patient status post median sternotomy with wires intact. Previously seen opacities in the right upper and right lower lobes are almost completely resolved.", "output": "Previously seen opacities in the right upper and right lower lobes are almost completely resolved." }, { "input": "A left IJ catheter tip projects over the expected region of the mid to low SVC. The patient is status post median sternotomy and the wires appear intact. Opacity in the right upper lung could reflect focal pneumonia in the appropriate clinical situation. Opacities in the right perihilar and infrahilar region may reflect atelectasis. Opacity of the left retrocardiac region and loss of definition of the left medial hemidiaphragm may be secondary to consolidation as seen with infection and/or atelectasis, although a mass cannot be excluded. The heart is probably top-normal in size even on this AP view. The patient is presumed semi upright, however there appears to be layering small bilateral pleural effusions in the lung apices. Aortic knob calcifications are mild. No acute osseous abnormality. Small amount of fluid tracks in the minor fissure.", "output": "Right upper lobe opacity could reflect pneumonia in the appropriate clinical situation, however, pulmonary mass cannot be excluded. Close interval follow-up after treatment for resolution and/or Chest CT could be performed to further evaluate." }, { "input": "Bilateral airspace opacities are similar in extent when compared to the prior study. Left lower lobe atelectasis. A right internal jugular catheter terminates in the mid to low SVC. Median sternotomy wires are unchanged in appearance. Probable bilateral pleural effusions.", "output": "No significant interval change when compared to the prior study." }, { "input": "Right lung is clear. Small retrocardiac opacity is noted. Trace left pleural effusion has decreased since prior examination. No right pleural effusion. Heart is top-normal in size. Mediastinal contour and hila are unremarkable with prominence of the right paratracheal stripe which is unchanged since ___. Intact median sternotomy wires are noted.", "output": "1. Left lower lobe atelectasis rather than pneumonia. 2. Trace residual left pleural effusion has significantly decreased since prior examination." }, { "input": "Lung volumes are low. Streaky linear left basilar opacities extend to the hilum and likely represent atelectasis. The right lung demonstrates linear right basilar atelectasis and is otherwise grossly clear. There is no right pleural effusion, pneumothorax, or frank pulmonary edema. The cardiomediastinal silhouette appears unchanged from the prior several examinations.", "output": "Waxing and waning left lower lobe airspace opacity which demonstrates a morphological appearance suggestive of atelectasis, although superimposed infection or aspiration is difficult to exclude." }, { "input": "There is worsening opacity in the right upper lobe abutting the minor fissure. Left lower lobe opacification is also worsened. There is a background of developing mild pulmonary edema bilaterally. Small left pleural effusion is slightly larger. Mild cardiomegaly is not appreciably changed. Right central venous catheter terminates in the mid to low SVC.", "output": "1. Worsening opacities in the right upper lobe and left lower lobe suggest multifocal pneumonia 2. Mild cardiomegaly is unchanged. There is developing mild pulmonary edema. 3. Probable small left pleural effusion is slightly larger." }, { "input": "Right internal jugular central venous catheter tip terminates in the mid SVC. The patient is status post median sternotomy. Mild to moderate enlargement of the cardiac silhouette is unchanged. The mediastinal contour is similar. There is mild pulmonary vascular congestion, unchanged. Focal consolidation in the right upper lobe is concerning for pneumonia. Persistent bibasilar opacities and may reflect atelectasis or additional sites of infection. Small left pleural effusion is unchanged. No pneumothorax is detected.", "output": "1. Right upper lobe pneumonia. 2. Persistent bibasilar airspace opacities which may reflect atelectasis but infection cannot be excluded. Small left pleural effusion unchanged. 3. Mild pulmonary vascular congestion, similar to the previous study." }, { "input": "There has been interval removal of the right IJ catheter. The right PICC terminates in the upper SVC. No pneumothorax is seen. Left basilar effusion and atelectasis is unchanged. There is increased opacity in the right upper lobe concerning for a pneumonia. Bilateral pulmonary edema is stable. Moderate cardiomegaly is stable.", "output": "1. Worsening opacity in the right upper lobe concerning for pneumonia. 2. Bilateral pulmonary edema and moderate cardiomegaly is stable. 3. Interval removal of the right IJ catheter. No pneumothorax." }, { "input": "AP portable upright chest radiograph obtained. Midline sternotomy wires and mediastinal clips are unchanged. The lungs appear clear bilaterally without focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette appears grossly stable. Bony structures are intact. No free air is seen below the right hemidiaphragm.", "output": "No acute intrathoracic process. Post-CABG changes." }, { "input": "PA and lateral chest radiographs were provided. There is no focal consolidation, pleural effusion or pneumothorax. Scarring is noted in the right apex. The cardiomediastinal silhouette is normal. Clips are noted in the left upper quadrant and in the mid abdomen. The bones are intact without evidence of compression fractures or significant degenerative change.", "output": "1. No acute cardiopulmonary process. 2. Scarring in the right upper lobe. Recommend CT for further evaluation unless correlation with clinical history demonstrates prior prior radiation or infection." }, { "input": "PA and lateral views of the chest provided. Left chest wall Port-A-Cath is seen with catheter tip in the region of the low SVC. Multiple surgical clips are noted in the left upper quadrant. A small left pleural effusion is present, significantly improved from prior CT. The lungs are clear without focal consolidation, large effusion or pneumothorax. The cardiomediastinal silhouette is stable. Bony structures appear intact. Outline of a right breast implant noted.", "output": "Small left pleural effusion. Otherwise unremarkable. Please note, small nodules seen on prior CT are not visible on radiograph." }, { "input": "Cardiac, mediastinal and hilar contours are normal. The pulmonary vasculature is not engorged. Curvilinear opacity is in the right lung base likely reflects an area of subsegmental atelectasis. No focal consolidation, pleural effusion or pneumothorax is seen. There is no subdiaphragmatic free air.", "output": "Subsegmental right basilar atelectasis. Otherwise, no acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral radiographs of the chest were acquired. Ill-defined opacities in the right lower lung are not well seen on the lateral projection and likely represent mild atelectasis, although infection cannot be excluded. The lungs are otherwise clear. The heart is mild to moderately enlarged. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen. Mild wedging of a lower thoracic vertebral body is noted. Note is made of a left side pacemaker with right atrial and ventricular leads.", "output": "1. Mild right lower lung atelectasis, less likely infection. 2. Mild to moderate cardiomegaly." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process. Specifically, no pneumothorax." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest. No prior. The lungs are clear. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are grossly unremarkable. Metallic density projects over the left glenohumeral region for which clinical correlation suggested as this could be external to the patient. No free air seen below the diaphragm.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear except for unchanged focal scarring in the right middle lobe. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal. The mediastinal contours are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well expanded and clear. There is minimal left basilar linear atelectasis. Blunting of the right costophrenic angle is a chronic finding. There is no focal consolidation effusion or pneumothorax. Median sternotomy wires are intact. The mitral valve ring projects over stable position in the chest.", "output": "No acute cardiopulmonary process." }, { "input": "Since prior, there has been interval placement of an endotracheal tube with tip approximately 6.5 cm from the carina. Enteric tube seen passing below the inferior field of view. Diffuse bilateral parenchymal opacities have somewhat progressed ___ more confluent at the lung bases. Cardiomediastinal silhouette is unchanged given differences in technique.", "output": "Diffuse bilateral parenchymal opacities predominate the lung bases, potentially due to progression of edema, bilateral infection, or ARDS." }, { "input": "Mild cardiomegaly is unchanged. The aorta is tortuous. ET tube is in standard position. Left PICC tip is in the cavoatrial junction. NG tube tip is difficult to visualize below the diaphragm. Diffuse opacities in the lungs have improved consistent with improving of the component of pulmonary edema. Bibasilar opacities larger on the left side have also improved. There is no pneumothorax", "output": "Improved pulmonary edema and bibasilar consolidation" }, { "input": "The previously seen left PICC has been removed. The heart and mediastinal contours appear normal. There is been marked interval improvement in the previously described left basal opacity and in the right perihilar and lower lobe opacities. No pleural effusion or pneumothorax.", "output": "Marked interval improvement in the previously described left basal opacity and in the right perihilar and lower lobe opacities." }, { "input": "PA and lateral views of the chest were provided. Linear basilar opacities are most compatible with atelectasis. There is no definite sign of pneumonia or CHF. No large effusion or pneumothorax is seen. Cardiomediastinal silhouette appears normal. Bony structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Streaky lower lung opacities most compatible with atelectasis. No convincing signs of pneumonia." }, { "input": "Mild prominence of vasculature suggests mild pulmonary vascular congestion. Opacity projecting over the bilateral mid to lower lungs may relate to vascular congestion, however, multifocal infection and mid could be present. No pleural effusion or pneumothorax is seen. The cardiac mediastinal silhouettes are stable.", "output": "Pulmonary vascular congestion with possible bibasilar consolidations which could be due to infection." }, { "input": "Portable supine chest film ___ at 12:46 is submitted.", "output": "Given differences in technique, the bilateral diffuse airspace process is not significantly changed. There are likely layering bilateral effusions. Nasogastric tube and left internal jugular central line are unchanged in position. The endotracheal tube now has its tip approximately 6 cm above the carina." }, { "input": "Portable upright chest film ___ at 05:32 is submitted.", "output": "Endotracheal tube, nasogastric tube and left internal jugular central line unchanged in position. Overall cardiac and mediastinal contours are stable. Overall, there continues to be a diffuse bilateral airspace process but it appears to be somewhat improved suggesting resolving edema and/or an improving pneumonia. Clinical correlation is advised. There is likely a layering left effusion. No pneumothorax is appreciated." }, { "input": "Continued improvement in bilateral pulmonary opacities. No new focal consolidation seen. No focal consolidation seen on the current study. No pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "AP portable view of the chest. The endotracheal tube ends 2.1 cm from the carina. The left subclavian line ends in the low SVC. The lungs are clear. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is not enlarged. Mediastinal contours are unremarkable. Query hiatal hernia. There is a oval shaped density projecting over the lower thorax in the midline seen on the frontal view, not substantiated on the lateral view, may be artifactual. Patient's overlying arm partially obscures the lateral view.", "output": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is not enlarged. Mediastinal contours are unremarkable. Query hiatal hernia. There is a oval shaped density projecting over the lower thorax in the midline seen on the frontal view, not substantiated on the lateral view, may be artifactual. Patient's overlying arm partially obscures the lateral view." }, { "input": "Tracheostomy ends 3.6 cm from the carina in appropriate position. The right PICC ends in the mid SVC. A left subclavian central venous line ends in the low SVC. The cardiomediastinal and hilar contours are normal. No focal consolidation, pleural effusion or pneumothorax. No mediastinal widening.", "output": "No acute cardiopulmonary process. Right PICC ends in the mid SVC." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. No subdiaphragmatic free air.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Postsurgical changes in the right upper hemithorax are again seen with mild volume loss of the right lung and shift of mediastinum to the right. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No radiopaque foreign body is seen aside from stable appearing surgical clips over the right mediastinum.", "output": "Postoperative changes again seen. No new radiopaque foreign body is seen." }, { "input": "The lungs are well expanded and clear. The cardiomediastinal silhouette, hilar contours, pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "Normal radiograph of the chest." }, { "input": "There is stable moderate cardiomegaly. The mediastinal contour is stable. There is a persistent right pleural effusion with associated atelectasis. There is also some mild left base atelectasis as well as mild interstitial edema.", "output": "Persistent right pleural effusion and atelectasis." }, { "input": "PA and lateral views of the chest were provided. Since the prior exam, there is increased opacity at the right lung base which could represent a combination of atelectasis and effusion, though underlying pneumonia is difficult to exclude in the correct clinical setting. Lung volumes and evaluation for mild pulmonary edema is limited. There is no overt edema. No pneumothorax is seen. Bony structures appear intact.", "output": "Increased opacity at the right lung base, likely a combination of effusion and atelectasis, though underlying pneumonia difficult to exclude." }, { "input": "Frontal and lateral views of the chest were obtained. Cardiac and mediastinal silhouettes are stable with the cardiac silhouette mild-to-moderately enlarged. There is mild pulmonary vascular congestion. No pleural effusion or pneumothorax is seen. Degenerative changes are seen along the spine.", "output": "Mild pulmonary vascular congestion. Cardiomegaly. Pulmonary nodules documented on CT from ___ are better appreciated on that study." }, { "input": "AP portable erect AP view of the chest. Diffuse bilateral mainly basilar parenchymal opacities consistent with moderate pulmonary edema. Small bilateral pleural effusions. Cardiomegaly is stable. Mediastinum is still slightly widened due to mediastinal venous engorgement.", "output": "Moderate pulmonary edema and small bilateral pleural effusions and cardiomegaly consistent with congestive heart failure." }, { "input": "The visualized lungs are clear of focal consolidation, pleural effusions or pneumothoraces. A rounded left pleural-based density is compatible with a lipoma noted on prior CT. The cardiac mediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Portable AP upright chest radiograph is obtained. Lung volumes are markedly low limiting evaluation. The upper lungs appear clear. Evaluation for effusion is limited, though no definite effusion is seen. No large pneumothorax. Heart size cannot be assessed. Bony structures appear grossly intact.", "output": "Markedly limited study without definite signs of acute abnormality. Recommend repeat if there are strong clinical concerns." }, { "input": "PA and lateral views of the chest provided. Lungs are hyperinflated though appear clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Portable frontal radiographs of the upper abdomen and lower chest were obtained. The first image labeled \"For NGT #1\" demonstrates the enteric tube curled within the upper esophagus pointing superiorly. The second image labelled \"for NGT #2\" with a later time stamp demonstrates the Dobbhoff tube with the weighted tip within the stomach. There is otherwise little change from the prior study with stable cardiomegaly and bibasilar opacities. The lung apices and right costophrenic angle are excluded from this image.", "output": "Final image demonstrating the Dobbhoff tube within stomach" }, { "input": "The right PICC is unchanged in position, ending in the low SVC. Left lower lobe collapse persists. There is mild right lower lung atelectasis. There may be mild pulmonary edema. Moderate cardiac enlargement is unchanged. The mediastinal contours are unchanged. There is no pneumothorax.", "output": "1. Unchanged left lower lobe collapse. 2. Unchanged moderate cardiac enlargement. 3. Possible mild pulmonary edema." }, { "input": "The NG tube extends to the level of the distal esophagus. Right-sided PIC line terminates in the mid SVC. There is a right-sided IJ which terminates in the upper SVC. Small-to-moderate left pleural effusion is unchanged. There is no evidence of pneumothorax. Please note that the right lung is only partially evaluated as parts have been cut off from this film.", "output": "NG tube extends to the level of the mid-to-distal esophagus." }, { "input": "Compared to the prior study there is no significant change. The ET tube, NG tube and right internal jugular lines are in unchanged position. A right PICC ends deep in the right atrium. Stable moderate cardiomegaly in a configuration which could suggest a pericardial effusion. Substantial retrocardiac atelectasis and small bilateral pleural effusions are unchanged. Mild fluid overload persists.", "output": "1. Right PICC ends deep in the right atrium and could be pulled back by approximately 4 cm to be in the lower SVC 2. Stable moderate enlargement of the cardiac silhouette with a configuration that could suggest pericardial effusion. Recommend correlation with echocardiogram if not recently performed. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 10:08 AM, 10 minutes after discovery of the findings." }, { "input": "Right PICC line terminates in the mid SVC. The NG tube appears to be coiled within the midline and must be removed for re-attempt at placement. There is a right-sided IJ which terminates in the upper SVC. Moderate left pleural effusion is persistent. There is small bibasilar atelectasis. Mild pulmonary edema is unchanged. Moderate cardiomegaly is stable. There is no evidence of pneumothorax.", "output": "NG tube appears to be coiled within the midline and must be removed for re-attempt at placement. Findings were discussed with Dr. ___ by Dr. ___ by phone on the day of the exam immediately after discovery." }, { "input": "Right-sided central lines appear to be unchanged in position. There is an enteric tube which extends below the diaphragm with the tip in the body of the stomach. Small right-sided pleural effusion is persistent. The patient's known moderate left-sided pleural effusion is not well seen on this exam. There is no evidence of pneumothorax. The visualized osseous structures are unremarkable.", "output": "Enteric tube extends below the diaphragm with the tip in the body of the stomach." }, { "input": "Single supine portable AP view of the chest was provided. The endotracheal tube is seen with its tip residing approximately 5.2 cm above the carina. A left arm PICC line is seen with its tip in the mid SVC. NG tube courses inferiorly along the thoracic midline extending into the left upper quadrant. The heart appears mildly enlarged. Lower lobe opacities likely reflect atelectasis. The mid to upper lungs appear well aerated. The mediastinal contour is widened, though this is likely due to position. The bony structures are intact.", "output": "Appropriately positioned lines and tubes. Bibasilar atelectasis and mild cardiomegaly." }, { "input": "The lungs are hyperinflated. Enlarged cardiomediastinal silhouette is grossly stable. There is bibasilar atelectasis without definite focal consolidation. No large pleural effusion. No evidence of pneumothorax. No overt pulmonary edema. No gross evidence of free air beneath the diaphragms.", "output": "Persistent enlargement of the cardiomediastinal silhouette. Mild basilar atelectasis." }, { "input": "Since ___, there has been interval removal of an endotracheal tube. The left subclavian line is unchanged in position. There is minimal pulmonary vascular congestion. The heart is stably enlarged without significant vascular congestion, suggesting underlying cardiomyopathy or pericardial effusion. The degree of inspiration is somewhat better today with increased aeration of the left lung.", "output": "Interval ETT removal. Improved aeration of left lung." }, { "input": "There is some improved aeration in the right lower lobe with continued dense consolidation in the retrocardiac region. . There is no change in the ET tube or left-sided PICC line", "output": "Improved aeration in the right lower lobe." }, { "input": "Minimal streaky bibasilar airspace opacities may reflect atelectasis, though infection is not fully excluded. No focal consolidation, pleural effusion or pneumothorax is noted. The pulmonary vasculature is not engorged and there is no overt pulmonary edema. The cardiac silhouette is normal in size. The mediastinal and hilar contours are within normal limits.", "output": "Bibasilar streaky opacities, possibly atelectasis but infection is not excluded." }, { "input": "There is focal opacity in the right lower lobe, partially obscuring the right hemidiaphragm. The lungs are hyperinflated with decreased upper pulmonary vasculature, may indicate COPD in the right clinical setting. Heart size is within normal limits.Mediastinal and hilar contours are unremarkable. There is no evidence for pulmonary edema, pleural effusion, or pneumothorax.", "output": "Focal right lower lobe pneumonia. RECOMMENDATION(S): Follow up in 4 weeks after antibiotic therapy is recommended for evaluation of resolution. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the ___ ___ at 2:14 PM, 5 minutes after discovery of the findings." }, { "input": "The lungs are clear with no evidence of a consolidation, effusion, or pneumothorax. Cardiac and mediastinal silhouettes are normal. Mild degenerative changes are noted throughout the thoracic spine but no acute fractures are identified.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Upper lung lucency may reflect mild emphysema. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No displaced rib fractures are seen. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process. No pneumothorax." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process. No pneumothorax seen." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. The osseous structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs are clear. There are no pleural effusions or pneumothorax. Spinal osteophytes appear unchanged. Cholecystectomy clips project over the right upper quadrant.", "output": "No evidence of acute disease." }, { "input": "Frontal and lateral radiographs of the chest demonstrate mild elevation of the right hemidiaphragm, unchanged from prior. Normal heart size, mediastinal and hilar contours. No focal consolidation, pleural effusion or pneumothorax.", "output": "No acute process." }, { "input": "PA and lateral views of the chest are provided. There is slightly elevated right hemidiaphragm, as seen previously. Lungs are clear without signs of pneumonia or CHF. No pleural effusion or pneumothorax. Cardiomediastinal silhouette appears stable. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "The cardiomediastinal and hilar contours are stable. There is no pneumothorax or large pleural effusion. The lungs are well-expanded with no focal consolidation concerning for pneumonia. A moderate to large hiatal hernia is again noted. Dextroscoliosis centered in the midthoracic spine is present.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. The hilar mediastinal contours are normal. No focal consolidations concerning for pneumonia are identified. There is no pleural effusion, or pneumothorax. The visualized osseous structures are unremarkable.Soft tissue clips above the thoracic inlet, may be secondary to a prior thyroidectomy.", "output": "No acute intrathoracic abnormalities identified." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Normal heart size, mediastinal and hilar contours. No focal consolidation, pleural effusion or pneumothorax.", "output": "Normal chest radiograph" }, { "input": "The bibasilar consolidations that were seen on the prior radiograph have largely resolved and there are only minimal residual opacities. There are no new areas of consolidation, pleural effusions or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "Previously visualized bibasilar opacities have largely resolved. Recommend repeating chest x-ray in 4 weeks to document complete resolution." }, { "input": "There are bibasilar opacities, right greater than left. There is no large effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "Bibasilar opacities, right greater than left compatible with infection in the proper clinical setting." }, { "input": "PA and lateral views of the chest. No prior. There is patchy opacity identified at the left lung base, in the lower lobe. Elsewhere, the lungs are clear. There is no pleural effusion. Cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "Left lower lobe pneumonia." }, { "input": "Linear opacities are present in the left lower lung zone, likely reflective of atelectasis. No focal consolidation, pleural effusion or pneumothorax identified. The size of the cardiomediastinal silhouette is within normal limits. Note is made of free air under both hemidiaphragms, presumed to be secondary to the recent PEG tube placement.", "output": "Left basilar atelectasis. Free air under both hemidiaphragms, presumed to be secondary to the recent PEG tube placement." }, { "input": "Normal cardiomediastinal and hilar contours. Low lung volumes bilaterally with clear lungs. Normal pleural surfaces. Lucency in the midline and left subdiaphragmatic region likely represents intraluminal air, but extraluminal air cannot be definitively excluded. Gaseous distention of bowel.", "output": "Lucency in the midline and left subdiaphragmatic region likely represents intraluminal air, but extraluminal air cannot be definitively excluded. Consider left lateral decubitus radiographs for further evaluation. RECOMMENDATION(S): Lucency in the midline and left subdiaphragmatic region likely represents intraluminal air, but extraluminal air cannot be definitively excluded. Consider left lateral decubitus radiographs for further evaluation. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 11:38 AM, 5 minutes after discovery of the findings." }, { "input": "Endotracheal tube terminates approximately 2 cm above level the carina. Enteric tube courses into the left hemi thorax, terminating in the midline below the diaphragm. Please note that on subsequent CT, the enteric tube is seen terminating in the proximal stomach. However, the side port may remain high in position. Low lung volumes persist in there increased bibasilar opacities since the prior study which may be due to atelectasis and/or aspiration. No large pleural effusion is seen. Cardiac and mediastinal silhouettes are stable.", "output": "Endotracheal tube terminates approximately 2 cm above level the carina. Enteric tube courses into the left hemi thorax terminating the low the diaphragm in the midline; please note that on subsequent CT, the enteric tube is seen terminating in the proximal stomach. However, the side port may remains high in position. Mildly increased bibasilar opacities may be due to worsening atelectasis and/ or aspiration." }, { "input": "Frontal and lateral chest radiographs demonstrate clear lungs, without pleural effusion or pneumothorax. The cardiac silhouette is normal in size, the mediastinal contours are normal. The pulmonary vasculature is normal.", "output": "No acute chest abnormality." }, { "input": "There is no focal consolidation, pleural effusion, or pneumothorax. The heart size is normal. The cardiomediastinal silhouette is within normal limits.", "output": "Normal chest radiographs." }, { "input": "The right hemidiaphragm is markedly elevated. There is slight blunting of the posterior right costophrenic angles may be due to a trace pleural effusion and/ or atelectasis. No definite focal consolidation is seen. There is minimal left base atelectasis. There is no pneumothorax. The aortic knob is calcified. Cardiac silhouette is not enlarged.", "output": "Marked elevation of the right hemidiaphragm; elevation of the right hemidiaphragm was likely present on scout radiograph from abdominal pelvic CT from ___. Mild left base atelectasis. No focal consolidation seen." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Analysis is performed in direct comparison with the next preceding similar study of ___. A marked right-sided convex scoliosis in the mid portion of the thoracic spine accounts for asymmetric presentation of the chest on the frontal view. The degree of scoliosis is unchanged since ___. The heart size remains normal as well as the thoracic aorta which follows the scoliotic curvature in its descending portion remains within normal limits. The pulmonary vasculature is not congested. No signs of acute or chronic parenchymal infiltrates are found and the lateral and posterior pleural sinuses are free. No evidence of pneumothorax in the apical area. With the exception of the described scoliosis which includes mild degenerative changes mostly in the mid portion of the thoracic spine, no other gross skeletal abnormalities can be identified.", "output": "Stable chest findings, no evidence of cardiac enlargement, pulmonary congestion or acute infiltrates in this female patient with history of two weeks of cough." }, { "input": "Relatively low lung volumes are noted with bibasilar atelectasis. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are seen.", "output": "No acute cardiopulmonary process." }, { "input": "Moderate cardiomegaly is stable. Pacer leads are in standard position. Bilateral pleural effusions with adjacent atelectasis are probably unchanged allowing the difference in positioning of the patient. Mild pulmonary edema has markedly improved.", "output": "Improved pulmonary edema. Stable bilateral effusions with adjacent atelectasis" }, { "input": "Lung volumes are mildly decreased, and there continues to be a right lower lobe rounded opacity which corresponds with a Bochdalek hernia noted on prior CT. A hiatal hernia is again seen. The cardiac silhouette is stable in size, and a cardiac pacing device and its leads are in stable position. No focal consolidation, pleural effusion or pneumothorax is seen. No overt pulmonary edema is noted.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Right chest wall PICC pacer device is seen with pacer leads extending into the region of the right atrium and right ventricle. There is bandlike right lower lung opacity most compatible with atelectasis. A rounded density projecting at the right medial lung base on the frontal projection is without correlate opacity on the lateral view and therefore indeterminate. There is a retrocardiac opacity with subtle central air lucency which could represent a hiatal hernia. Cardiomediastinal silhouette appears normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "1. Right basal atelectasis, with probable hiatal hernia. 2. Rounded density projecting at the right medial lung base, indeterminate, for which CT of the chest is recommended to further assess." }, { "input": "Right sided dual-chamber pacemaker device is re- demonstrated with leads in the right atrium and right ventricle. Lung volumes are low. Heart size is mildly enlarged. Widening of the superior mediastinal contour is likely due to low lung volumes. Crowding of bronchovascular structures is present without overt pulmonary edema. Bibasilar airspace opacities may reflect atelectasis, however infection or aspiration cannot be excluded. No large pleural effusion or pneumothorax is present. Large hiatal hernia is re- demonstrated.", "output": "Low lung volumes with bibasilar airspace opacities, possibly atelectasis, but infection or aspiration cannot be excluded. Large hiatal hernia." }, { "input": "Frontal and lateral chest radiographs demonstrate sternotomy wires and a pacemaker with leads terminating in the region of the left atrium and ventricle. A left lower lobe opacity is unchanged compared to multiple radiographs from ___ and ___ and may represent persistent atelectasis or recurrent pneumonia. A small left pleural effusion is unchanged. There is a new small right pleural effusion. Mild to moderate cardiomegaly is slightly worse compared to prior radiographs. No pneumothorax or bony abnormality is seen.", "output": "1. A left lower lobe opacity, also seen on multiple prior radiographs, likely represents persistent atelectasis or possibly recurrent pneumonia. 2. Small right pleural effusion, new since ___. Unchanged small left pleural effusion. 3. Mild-to-moderate cardiomegaly is slightly worse since ___. These findings were communicated via telephone by Dr. ___ to Dr. ___ at ___ on ___." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Single AP upright radiograph demonstrates an enlarged heart. Perihilar patchy opacity, cephalization of vessels, and vascular congestion are suggestive of pulmonary edema. There is likely a small left pleural effusion. There is no pneumothorax. Patient is status post sternotomy, wires which appear intact. Numerous clips are noted along the left mediastinal border. A left clavicular deformity appears chronic. No acute osseous abnormalities detected.", "output": "Enlarged heart with evidence to suggest moderate pulmonary edema." }, { "input": "Patient is status post median sternotomy and CABG. Dual lead left-sided pacer device is stable in position. Bibasilar atelectasis is seen without definite focal consolidation. There may be minimal vascular congestion. There is no large pleural effusion or pneumothorax. The cardiac silhouette is top-normal to mildly enlarged. Mediastinal contours are stable. No displaced rib fracture seen.", "output": "Bibasilar atelectasis without definite focal consolidation." }, { "input": "There is a small left pleural effusion. A density seen obscuring the left hemidiaphragm on the lateral view may represent segmental atelectasis or fluid is seen within the fissure. The cardiac silhouette remains mildly enlarged. The mediastinal contours and hilar structures are unremarkable. A left-sided pacemaker is present history injury to right ventricle. Sternotomy wires and mediastinal clips are again noted.", "output": "Opacity within the left lower lobe may reflect fluid in the fissure from a small left pleural effusion versus segmental atelectasis or consolidation. Further clarification with oblique views is recommended. These findings were discussed with Dr. ___ by Dr. ___ at 13:17 on ___ by telephone at the time of discovery." }, { "input": "Left chest wall pacemaker has two leads terminating in the right atrium and right ventricle in stable position. Median sternotomy wires appear intact. There is a chronic left retrocardiac opacity. The lungs are otherwise clear. Mild to moderate cardiomegaly is unchanged. There is no pleural effusion or pneumothorax.", "output": "1. Stable mild to moderate cardiomegaly. 2. Chronic opacities in the retrocardiac region are of unclear etiology, possibly atelectasis. If patient's symptoms persist a CT should be considered." }, { "input": "The ET tube terminates 2.8 cm from the carina. The OG tube has been withdrawn partially and the side port terminates near the GE junction. The lungs are well expanded. The cardiac silhouette is smaller and mild pulmonary edema is improved. The mediastinal silhouette is normal. There is no pneumothorax or large pleural effusion.", "output": "1. The ET tube terminates 2.8 cm from the carina. 2. The OG tube should be advanced about 6 cm to place all side ports safely in the stomach. 3. The heart is smaller since yesterday and mild pulmonary edema is improved." }, { "input": "Supine portable chest radiograph was obtained. Orogastric tube and endotracheal tube are in satisfactory positions. Mild pulmonary edema may be present without focal consolidation. There is no pleural effusion or pneumothorax. The heart is normal in size with normal cardiomediastinal contours.", "output": "Mild pulmonary edema" }, { "input": "Left-sided pacer device is stable in position. Large-bore left-sided central venous catheter is seen, difficult to discern where the distal tip is due to overlying pacer wires. The cardiac silhouette remains mildly enlarged. The aortic knob is calcified. The aorta is likely tortuous. There is a moderate left pleural effusion, with overlying atelectasis. Minimal to no right pleural fluid is seen.Minimal pulmonary vascular congestion is seen. No evidence of pneumothorax.", "output": "Moderate left pleural effusion with overlying atelectasis." }, { "input": "The heart remains moderately enlarged. There is no pleural effusion or pneumothorax. The lungs are well expanded with interstitial edema, which is new since the prior study.", "output": "New interstitial pulmonary edema with stable moderate cardiomegaly." }, { "input": "Left axillary dual lead pacemaker is present with tip terminating in the right atrium and right ventricle as expected. Moderate cardiomegaly is again noted. The mediastinal and hilar contours are stable. There is no pleural effusion or pneumothorax. The lungs are well-expanded without focal consolidation concerning for pneumonia. Mild vascular congestion is present. Multiple healed rib fractures in the right posterior ribcage are noted.", "output": "1. Mild vascular congestion. 2. Stable moderate cardiomegaly." }, { "input": "There is left basilar atelectasis and slight blunting of the left costophrenic angle. Aeration of the left lower lobe is improved. Platelike atelectasis is again seen at the level of the left hila. The heart remains enlarged. The aorta is tortuous. There is no pneumothorax. Median sternotomy wires are intact. The right internal jugular central venous line has been removed over the interval.", "output": "Improved aeration of left lower lobe, with mild persistent atelectasis and blunting of the left costophrenic angle." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "", "output": "Possible developing opacity in the right midlung zone. This may represents a pneumonia. Recommend short interval followup with a repeat chest radiograph in 12 hours. TECHNIQUE: Single upright AP view of the chest. COMPARISON: Chest radiograph from ___. FINDINGS: The lungs are hyperexpanded. There is a possible developing opacity in the right mid lung zone. There is no pulmonary edema. Blunting of the right costophrenic angle is likely due to the small pleural effusion, which was better assessed on the lateral chest radiograph from one day earlier. There is no definite left pleural effusion. There is no pneumothorax. The cardiomediastinal silhouette is normal. The slight apparent enlargement of the heart is likely due to the AP technique." }, { "input": "The lungs are mildly hyperexpanded. There is no focal opacity or pulmonary edema. There is a small right pleural effusion. There is no left pleural effusion or pneumothorax. The aorta is tortuous. The cardiomediastinal silhouette is otherwise normal. The bones are diffusely demineralized with multiple compression deformities in the thoracic spine, which are likely chronic, though no prior exams are available for comparison.", "output": "Hyperexpanded lungs and small right pleural effusion. No evidence of pneumonia." }, { "input": "Lungs are clear. Cardiac silhouette is within normal limits for technique. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "No focal opacity to suggest pneumonia is seen. No pleural effusion, pulmonary edema or pneumothorax is present. The cardiomediastinal silhouette is normal.", "output": "No radiographic evidence of acute intrathoracic process." }, { "input": "Compared with prior radiographs on ___, there is no significant change in bilateral lower lobe consolidations. There is no pleural effusion or pulmonary edema. No pneumothorax.", "output": "No significant change in bilateral lower lobe consolidations compared with prior given the limitations of a portable radiograph. PA and lateral upright views, if able to be obtained, would provide better evaluation." }, { "input": "There are opacities at the right and left lung bases. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Bilateral lower lobe pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephoneon ___ at 4:10 PM, 25 minutes after discovery of the findings." }, { "input": "Heart size is borderline enlarged. Mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. Lung volumes somewhat low. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest. The lungs are clear. There is no consolidation, pneumothorax, or pleural effusion. The cardiac, mediastinal, and hilar contours are normal. There is no pulmonary vascular congestion.", "output": "Normal radiographic examination of the chest. These findings were discussed with ___ at 11:15 a.m. on ___ by telephone." }, { "input": "PA and lateral views of the chest provided demonstrate a vague opacity at the right lung base which could represent superimposed bronchovascular structures though the possibility of pneumonia is not excluded. Correlate with physical exam. Otherwise, the lungs are clear. No effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "Somewhat irregular opacity at the right lung base could represent overlapping bronchovascular structures though correlation with exam to exclude pneumonia. Consider repeat exam with oblique projections." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Clear lungs bilaterally without pleural effusion or pneumothorax. Heart size, mediastinal contour and hila are normal. No bony abnormality.", "output": "Normal chest radiograph." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is no focal lung consolidation. A nasoenteric tube ends in the stomach with the side port at the gastroesophageal junction.", "output": "Nasoenteric tube ends in the stomach with the side port at the gastroesophageal junction" }, { "input": "A biventricular pacemaker projects over the left upper chest with leads in expected location. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. There is moderate globular cardiomegaly.", "output": "1. No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. 2. Biventricular pacemaker leads project in expected locations. 3. Moderate globular cardiomegaly." }, { "input": "Prominent pulmonary vessels are similar to before. Mildly enlarged cardiac silhouette is similar to before. There is no consolidation, pneumothorax, or large pleural effusion.", "output": "No radiographic evidence of pneumonia." }, { "input": "Heart size remains mild to moderately enlarged. The aorta is tortuous mediastinal and hilar contours are unchanged. The pulmonary vasculature is normal. Emphysematous changes are noted within the lung apices. No focal consolidation, pleural effusion or pneumothorax is present. There are mild degenerative changes noted in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The heart appears borderline enlarged. In addition to calcification, there is moderate unfolding along the thoracic aorta. The pulmonary vasculature is mildly prominent centrally as well as the interstitium, suggesting very mild fluid overload. The right hemidiaphragm shows mild-to-moderate elevation. There is no pleural effusion or pneumothorax. The bones are probably demineralized to some extent.", "output": "Findings suggesting mild vascular congestion. No definite evidence for pneumonia or aspiration." }, { "input": "AP upright and lateral views of the chest provided. Mild cardiomegaly again noted with hilar congestion and mild interstitial edema. No large effusion or pneumothorax. No signs of pneumonia. Mediastinal contour is stable. Bony structures are intact.", "output": "Mild cardiomegaly and mild congestion and edema." }, { "input": "2 views of the chest demonstrates a right chest wall pacemaker generator with right atrial and ventricular leads, unchanged in position since the prior study. Posterior fixation rods and pedicle screws in the thoracic spine are unchanged since the prior study. Heart size is top normal. Hilar and mediastinal contours are within normal limits. The lung volumes are decreased since the prior study. Right lung base atelectasis is noted. No pleural effusion or pneumothorax.", "output": "Interval decrease in lung volume and right lung base atelectasis." }, { "input": "There is no consolidation, pleural effusion, or pneumothorax. Cardiomediastinal and hilar silhouettes are normal size.", "output": "No acute cardiopulmonary process." }, { "input": "A left upper lobe lung nodule is again seen, and minimally increased in size, now measuring 11 mm. There is no effusion or pneumothorax. The cardiac silhouette and mediastinal contours are normal.", "output": "1. No acute chest abnormality. 2. Left upper lobe nodule, essentially unchanged over a ___-year period." }, { "input": "The visualized mediastinal structures are unremarkable. There is no cardiomegaly. The lungs fields are clear. No focal consolidations are noted. No pneumothoraces or effusions are appreciated.", "output": "No evidence of pneumonia or other acute cardiopulmonary process. NOTIFICATION: The above findings were discussed with Dr. ___, by Dr. ___ ___ the phone on ___ at 17:02" }, { "input": "Subtle opacity at the left upper to mid lung, projecting over the anterior left better in rib is slightly less conspicuous as compared to the prior study; findings may represent overlap of structures, however an underlying pulmonary nodule is not excluded. No focal consolidation is seen elsewhere. There is no pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are stable and unremarkable.", "output": "Subtle opacity projecting over the anterior left third rib, may represent overlap of structures but a pulmonary nodule or a tiny consolidation not excluded. Recommend shallow obliques or nonemergent chest CT for further assessment. RECOMMENDATION(S): Subtle opacity projecting over the anterior left third rib, may represent overlap of structures but a pulmonary nodule or a tiny consolidation not excluded. Recommend shallow obliques or nonemergent chest CT for further assessment." }, { "input": "The lungs are clear.The cardiac, hilar and mediastinal contours are normal.No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear unchanged. There is no pleural effusion or pneumothorax. There is a patchy new opacity in the right lower lobe suggesting pneumonia, probably better appreciated on the lateral than frontal view. A moderate anterior wedge compression deformity of a mid thoracic vertebral body appears probably chronic, but was probably not present on the prior radiographs noting that loss in height is apparent on the frontal view on this study but not on the prior one. However, a previous lateral view is not available for optimal comparison.", "output": "1. Right lower lobe opacity suggesting pneumonia. 2. New mild-to-moderate anterior wedge compression deformity, probably new since the prior study, but unlikely to represent an acute finding; correlation with clinical history is recommended." }, { "input": "Aside from minimal left basilar atelectasis, the lungs are clear. The cardiac and mediastinal contours are normal. There are no pleural effusions. Mild biapical pleural thickening is unchanged. Cervical fusion hardware is incompletely evaluated.", "output": "No acute cardiac or pulmonary process." }, { "input": "Portable upright frontal view of the chest. The left lung is clear. Opacity in the right lung base most likely represents atelectasis or overlapping soft tissues; however, underlying consolidation or focal pulmonary edema cannot be excluded. The cardiac and mediastinal contours are normal. Cervical spine hardware is seen.", "output": "Opacity over the right lower lung zone most likely represents atelectasis however infection or focal pulmonary edmea is not excluded. Further evaluation with deeper inspiration could be obtained if there is continued clinical concern for pneumonia or congestive heart failure." }, { "input": "Patient is status post median sternotomy and CABG. Heart remains mildly enlarged. Mediastinal hilar contours are within normal limits. Pulmonary vasculature remains mildly engorged , but improved compared to the prior exam. No focal consolidation, pleural effusion or pneumothorax is seen. No acute osseous abnormality seen.", "output": "Mild pulmonary vascular congestion, improved compared to the prior exam. No focal consolidation to suggest pneumonia." }, { "input": "Portable AP upright chest radiograph provided. Midline sternotomy wires and mediastinal clips are again noted. The previously noted dialysis catheter has been removed. There is severe pulmonary edema, increased from prior exam. Retrocardiac opacity could represent pleural effusion, though superimposed pneumonia is difficult to exclude. Followup radiograph post-diuresis is advised. The heart remains enlarged. Mediastinal contour is stable. Hilar vascular engorgement is present. Bony structures are intact.", "output": "Pulmonary edema, cardiomegaly, probable left pleural effusion. Post-diuresis films may be helpful to exclude underlying left lower lobe pneumonia." }, { "input": "Low lung volumes are noted with crowding of the bronchovascular markings with mild superimposed pulmonary vascular congestion. There is no confluent consolidation or effusion. The cardiomediastinal silhouette is stable. Median sternotomy wires and mediastinal clips are again noted. No acute osseous abnormalities.", "output": "Mild pulmonary vascular congestion. No focal consolidation." }, { "input": "The patient is status post CABG. Median sternotomy wires are unchanged. There is moderate to severe cardiomegaly. The mediastinal and hilar contours are unchanged. There is no pleural effusion or pneumothorax. The lungs are mildly hypoinflated with moderate vascular congestion. There is no focal consolidation concerning for pneumonia.", "output": "Moderate vasculature congestion. No focal consolidation concerning for pneumonia." }, { "input": "Lung volumes are normal. There is mild to moderate interstitial pulmonary edema, improved from ___. Small bilateral pleural effusions are best appreciated on the lateral view. The heart is mildly enlarged but unchanged. There is no pneumothorax or focal airspace consolidation worrisome for pneumonia. Sternotomy wires and CABG clips are noted.", "output": "Mild to moderate pulmonary edema, improved from ___." }, { "input": "AP upright and lateral chest radiograph demonstrates moderate cardiomegaly. Bilateral patchy opacities and central pulmonary vascular congestion is suggestive of mild pulmonary edema. There is no pleural effusion. A right central line is seen, its tip terminating in similar position in anticipated location of the right atrium. Patient is status post median sternotomy, the wires appear intact. No acute osseous abnormality is detected.", "output": "Stable cardiomegaly with bilateral patchy opacities and central pulmonary vascular congestion suggestive of mild pulmonary edema." }, { "input": "Frontal and lateral views of the chest. Relatively low lung volumes are seen with crowding of the bronchovascular markings. There is blunting of the posterior costophrenic angles suggesting small effusions. The cardiac silhouette is enlarged but stable in configuration. Median sternotomy wires and mediastinal clips are again seen. No acute osseous abnormalities. Superimposed mild pulmonary vascular congestion is suspected.", "output": "Pulmonary vascular congestion and small effusions. No evidence of focal consolidation." }, { "input": "Right hemodialysis catheter terminates in the right atrium. Median sternotomy wires appear intact. Multiple clips project along the anterior left mediastinum. Moderate cardiomegaly is unchanged. There are equivocal trace bilateral pleural effusions blunting the costophrenic sulci posteriorly. There is no pneumothorax. Lung volumes are slightly low. There is pulmonary vascular congestion without overt edema. There is no convincing evidence of pneumonia. Evaluation of the osseous structures is limited on this study, however no displaced rib fractures detected.", "output": "1. Pulmonary vascular congestion without overt edema. Equivocal trace pleural effusions. 2. Limited evaluation of the osseous structures, however no displaced rib fracture is detected. If further evaluation is desired a dedicated rib series or CT may be obtained." }, { "input": "Moderate cardiomegaly has been stable compared to exams dated back to ___. There is pulmonary vascular congestion otherwise the hilar and mediastinal contours are unremarkable. Mild-to-moderate pulmonary edema has increased compared to the prior exam from ___. There are small bilateral pleural effusions. There is no evidence of pneumothorax.", "output": "Evidence of heart failure with interval increase in mild-to-moderate pulmonary edema and small bilateral pleural effusions." }, { "input": "Portable supine AP view of the chest was provided. The right IJ central venous catheter has been removed and a right subclavian dialysis catheter is now in place with its tip residing within the right atrium. A right upper extremity PICC line is unchanged in position with its tip residing in the mid SVC region. A feeding tube courses into the left upper abdomen. Cardiomegaly is unchanged, with midline sternotomy wires and mediastinal clips again noted. There is left basilar opacity with effusion. Pulmonary edema persists. No pneumothorax is seen on the supine radiograph. Bony structures are intact. There is a subtle nodular peripheral opacity projecting over the right upper lung which appears stable from prior imaging studies and as per prior CT chest, likely represents loculated pleural fluid.", "output": "Interval replacement of right IJ central venous catheter with a right subclavian dialysis catheter. Persistent cardiomegaly, pulmonary edema, pleural effusions, left greater than right." }, { "input": "AP portable upright view of the chest. The heart is mildly enlarged. The patient is post CABG. There is central pulmonary vascular congestion with mild pulmonary edema, slightly worsened since ___, with increased small bilateral pleural effusions. There is no pneumothorax.", "output": "Central pulmonary vascular congestion with mild pulmonary edema and small bilateral pleural effusions have slightly worsened since ___." }, { "input": "AP portable upright view of the chest was obtained. Lung volumes are low. There is mild hilar engorgement with right lower lobe opacity which may represent pneumonia, right greater than left. Small effusions are not excluded. There is no pneumothorax. No bony abnormality is identified.", "output": "Mild pulmonary edema with small effusions and RLL opacity concerning for pneumonia." }, { "input": "When compared to prior, there has been no significant interval change. There is mild pulmonary vascular congestion. Possible trace effusions are identified. Degree of cardiomegaly is unchanged. Median sternotomy wires and mediastinal clips again noted.", "output": "Mild pulmonary vascular congestion and trace effusions." }, { "input": "There is a new left IJ line with tip at the cavoatrial junction. The heart is mildly enlarged. There is pulmonary vascular redistribution and hazy alveolar infiltrate and a few ___ B-lines.", "output": "Pulmonary vascular congestion." }, { "input": "The central catheter with its tip in the right atrium is unchanged in position from ___. Median sternotomy wires are again demonstrated and are unchanged. Vascular clips consistent with prior cardiac surgery are stable. Mild cardiomegaly is stable the cardiomediastinal and hilar contours are within normal limits. There is no focal consolidation, pleural effusion or pneumothorax. Mild pulmonary vascular congestion is present but interstitial edema has improved from most recent prior radiograph on ___.", "output": "Pulmonary vascular congestion. No evidence of pneumonia." }, { "input": "A portable frontal chest radiograph again demonstrates multiple intact sternal wires, mediastinal clips, and a central line terminating in the upper right atrium. Heart size remains severely enlarged. Retrocardiac opacity is persistent but improved compared to chest radiograph from the day prior. Previously seen mild pulmonary edema is improved as well. There is no focal consolidation or appreciable pleural effusion or pneumothorax.", "output": "Pulmonary edema resolved. No appreciable atelectasis, pleural effusion, or evidence of pneumothorax. Stable normal postoperative cardiomediastinal silhouette." }, { "input": "AP single view of the chest was provided. All the monitoring devices are unchanged and in standard position. Lung volume is still low, with interval increase of lower lung opacification for increased dependent lung edema. Heart size is minimally larger since prior CXR, this interval increase might be due to pericardial effusion. Minimal enlargement of the upper mediastinal border is normal postoperative appearance after cardiac surgery. There is a new, small left pleural effusion. There is no pneumothorax. Focal atelectasis in the periphery of the right upper lobe is stable. Bibasilar atelectasis is unchanged.", "output": "Increased pulmonary edema, especially in the lung bases and new left small pleural effusion. Interval increase of heart size might be due increased pericardial effusion. Echocardiography is recommended. Finidngs were paged at 5:56 pm to Dr ___, by Dr ___" }, { "input": "Single AP portable view of the chest was obtained. A large bore right-sided central catheter is seen terminating in the proximal right atrium/cavoatrial junction. The patient is status post median sternotomy and CABG. The cardiac silhouette is moderately enlarged. The mediastinal contours are unremarkable. Left base opacity is seen, with obscuration of the diaphragm concerning for a pleural effusion with overlying atelectasis. There is also hazy opacity at the right lung base, which could relate to layering effusion with atelectasis; however, consolidation is not excluded in the appropriate clinical setting in either lung base.", "output": "1. Cardiomegaly. 2. Bibasilar opacities on the left could be due to pleural effusion and atelectasis, although consolidation due to infection is not excluded at either lung base." }, { "input": "AP portable upright view of the chest. The patient is post CABG. Central vascular congestion and mild pulmonary edema have improved since the ___ examination. A small left pleural effusion remains stable. A right pleural effusion appears resolved. The heart is mildly enlarged.", "output": "1. Improved mild central pulmonary vascular congestion and pulmonary edema. 2. Resolved right pleural effusion. 3. Unchanged small left pleural effusion." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Pulmonary vascularity is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. No acute osseous abnormalities are present.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Pulmonary vascular congestion and mild to moderate pulmonary edema are present. Possible small bilateral pleural effusions are noted. There is no lobar consolidation or pneumothorax. The patient is status post CABG and the heart is moderately enlarged. No acute osseous abnormalities are detected.", "output": "1. Cardiomegaly accompanied by mild to moderate pulmonary edema. 2. Small bilateral pleural effusions." }, { "input": "There is mild to moderate pulmonary vascular congestion and interstitial edema. The cardiac silhouette remains mildly enlarged. There are trace bilateral pleural effusions. No pneumothorax is identified. A right subclavian approach dialysis catheter terminates within the right atrium in unchanged position. Median sternotomy wires are surgical clips are again noted. No acute osseous abnormality is identified.", "output": "Mild to moderate pulmonary vascular congestion and interstitial edema. Stable cardiomegaly." }, { "input": "No focal consolidation is seen. Minimal basilar atelectasis is seen. There is no large pleural effusion or pneumothorax. Metallic fragment in the right chest wall it is re- demonstrated. The cardiac and mediastinal silhouettes are stable and unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Hyperinflation, likely reflecting COPD. No focal infiltrate, effusion, edema, or pneumothorax. Heart size normal. Cardiac pacer is present. Degenerative changes of the thoracic spine.", "output": "Possible COPD. No acute pulmonary disease." }, { "input": "There has been no significant interval change compared to the prior radiograph on ___. Biapical pleural parenchymal scarring is stable. No focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal contours are normal. Stable elevation of the left hilus. Pacer leads terminate in the right atrium and right ventricle, as expected. Several air-fluid levels are noted in the upper abdomen, a nonspecific finding.", "output": "1. No evidence of pneumonia. 2. Incidental note is made of multiple air-fluid levels in the upper abdomen, which is a nonspecific finding. Recommend correlation with abdominal pain." }, { "input": "AP upright and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "Compared to prior examination and there is the removal of the endotracheal tube and placement of a tracheostomy tube which is in standard position. A right-sided subclavian central venous catheter remains at the cavoatrial junction. There is subtle opacity at the bilateral lung bases greater on the right similar to prior study. The lung apices are clear. There is no pleural effusion or pneumothorax.", "output": "1. Subtle right greater than left basal opacities similar to prior which could represent aspiration. 2. Tracheostomy tube in standard position." }, { "input": "Tracheostomy tube is midline in appropriate position. The lungs are clear without consolidation, pleural effusion or pulmonary edema, and the cardiac, mediastinal and hilar contours are normal.", "output": "No evidence of acute cardiopulmonary disease to preclude procedure." }, { "input": "As compared to prior chest radiograph from ___, there has been interval removal of a right-sided subclavian central venous catheter. Tracheostomy tube remains in standard position. The cardiomediastinal and hilar contours are within normal limits. The lungs are well-expanded. There is no pleural effusion or pneumothorax. There is decreased opacity of the right lung base. Subtle left lung base opacity persists and could relate to aspiration.", "output": "Subtle left basilar opacity could represent aspiration." }, { "input": "An endotracheal tube terminates 4.1 cm above the carina. An enteric tube courses below the diaphragm, the tip is not included in this image. However, the side port is within the gastric fundus. The cardiomediastinal and hilar contours are normal. There are new bibasilar opacities, which may reflect an early infectious process in the appropriate clinical setting. There is no definite pneumothorax or pleural effusion.", "output": "New bibasilar opacities which may reflect aspiration or pneumonia in the appropriate clinical setting." }, { "input": "PA and lateral chest radiograph demonstrates clear lungs. Heart size is top-normal. Mediastinal and hilar contours are otherwise unremarkable. Elevation and flattening of the left diaphragmatic pleural surface, is due to pleural scarring, reflected in blunting of the pleural sulcus and calcification.", "output": "No pneumonia. Left pleural scarring." }, { "input": "PA and lateral views of the chest provided. Port-A-Cath resides over the left chest wall with catheter tip in the region of the mid to low SVC. Surgical clips project over the right chest wall. The lungs appear clear without focal consolidation, large effusion or pneumothorax. Diffuse sclerotic appearance of the bony structures is consistent with metastatic disease as seen on prior CT. No definite sign of pathological fracture.", "output": "Osseous metastatic disease. No acute intrathoracic process." }, { "input": "Left-sided Port-A-Cath terminates in the low SVC without evidence of pneumothorax. There are low lung volumes. No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Surgical clips overlie the right lower hemi thorax. Extensive heterogeneity of the osseous structures is consistent with history of osseous metastatic disease.", "output": "No acute cardiopulmonary process." }, { "input": "There is a left chest wall port catheter tip terminating at the cavoatrial junction. There is no focal consolidation or pneumothorax. There is mild elevation of the left hemidiaphragm and small bilateral pleural effusions. The imaged upper abdomen is unremarkable. The bones are intact.", "output": "Small bilateral pleural effusions." }, { "input": "Small pleural effusions are new since ___. There is no consolidation or pneumothorax. Cardiomediastinal and hilar silhouettes are normal size. Right infusion port terminates at the cavoatrial junction. Surgical ___ in right hilar region and lung base are unchanged in position. Diffuse sclerotic changes of the bones are consistent with metastatic disease. Degenerative changes are noted in bilateral acromioclavicular joints.", "output": "Small bilateral effusions new over five days. Lungs are clear." }, { "input": "Mild cardiomegaly is stable. Mild to moderate pulmonary edema is stable. There is no pneumothorax . Retrocardiac opacities are likely atelectasis. Bilateral effusions are less conspicuous compared to prior study on the left. Central catheter tip is in the cavoatrial junction. Patient has known osseous metastasis", "output": "Stable pulmonary edema" }, { "input": "PA and lateral views of the chest. The right-sided consolidation has resolved. No focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal and hilar contours are normal. Sclerosis involving thoracic vertebral bodies is unchanged.", "output": "Right lower lobe pneumonia cleared since ___. No new consolidations." }, { "input": "Compared with prior radiographs on ___, there has been interval worsening of moderate pulmonary edema, which is also accentuated by low lung volumes. There is a small left pleural effusion and bibasilar atelectasis. No pneumothorax. Cardiomegaly is stable. A left subclavian Port-A-Cath is at the cavoatrial junction.", "output": "Interval worsening of moderate pulmonary edema. Small left pleural effusion." }, { "input": "There is a Port-A-Cath projecting over the left upper lung with the tip in the cavoatrial junction. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Patchy opacities are noted within the lung bases, more so on the right. No pleural effusion or pneumothorax is demonstrated. There are no acute osseous abnormalities.", "output": "Patchy opacities in the lung bases, more so on the right, concerning for pneumonia or aspiration." }, { "input": "There are patchy opacities involving bilateral lung bases, increased compared to ___. The finding is concerning for worsening pneumonia. There is no pleural effusion or pneumothorax. Cardiac silhouette is borderline enlarged.", "output": "Findings concerning for progressive pneumonia at bilateral lung bases compared to ___" }, { "input": "The lungs are well expanded and clear. Hila and cardiomediastinal contours and pleural surfaces are normal.", "output": "Normal. No evidence of pneumonia or pneumothorax. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 2:52 PM, 2 minutes after discovery of the findings." }, { "input": "The lungs are well expanded. There is no focal consolidation, pleural effusion or pneumothorax. There is biapical scarring, worse on the left. There are linear opacities peripherally in the left lower lung which may also represent atelectasis or scarring. The cardiomediastinal silhouette is notable for tortuous aorta. The imaged upper abdomen is unremarkable. The bones are intact.", "output": "No acute cardiopulmonary process." }, { "input": "AP single view of the chest has been obtained with patient in semi-upright position. Comparison is made with the next preceding similar study obtained five hours earlier during the same day. Evidence of left-sided pleural effusion obliterating the entire left-sided diaphragm as before. Aeration of left upper lobe area has slightly improved. Right hemithorax unremarkable as before. A Dobbhoff line is identified,reaching well below the diaphragm and the tip of the line having a caudal direction before it escapes the lower image border. In comparison with the next preceding study, the position of the Dobbhoff line is completely unchanged. Previously described right internal jugular approach central venous line terminates in unchanged position in the lower SVC.", "output": "Mildly improved aeration of left upper lobe but persisting sizable pleural effusion and probably atelectasis in left lower lobe area. Dobbhoff line in unchanged position." }, { "input": "ETT tube has been placed and the tip ends at 2,5 cm cm from the carina. The cardiomegaly is unchanged. The Dobbhoff tube is still in place and extends below the diaphragm ending in mid gastric cavity. Lung volumes are reduced with new biapical opacities. Due the single Ap projection and semi-supine position of the patient, a new CXR in erect position is recommended for fully characterize these opacities. The left basilar pleural effusion seems mildly increased. There is no pneumothorax", "output": "ET tube is correctly positioned, there is no pneumothorax. There are new biapical opacities concerning for pneumonia that can be better characterized with CXR in erect position The left pleural basal effusion is increased" }, { "input": "Portable single frontal chest radiograph was obtained with the patient in upright position. The patient is status post extubation. A right IJ terminates in the right atrium. There is significant left lower lobe volume loss with complete obscuration of the left hemidiaphragm and leftward shift of the mediastinum. A lucency is present over the left mid lung, possibly a luculated pocket of air. There is also a moderate left pleural effusion. There is mild right basilar atelectasis with a small layering pleural effusion. Heart size is difficult to assess given parenchymal abnormalities.", "output": "1. Significant left lower lobe volume loss with large area of opacification and layering left pleural effusion. In the appropriate clinical setting, this could be pneumonia. 2. Focal lucency over left mid lung concerning for loculated air. Recommend repeating chest radiograph for confirmation. Findings were communicated with Dr.___ ___ telephone by Dr.___ at 3pm on ___." }, { "input": "There is stable mild cardiomegaly. The hilar and mediastinal contours are unremarkable. Note is made of stable biapical scarring, worse on the left. There is a tortuous aorta. No focal consolidations concerning for infection are identified. There has been interval worsening of left lung base atelectasis. There may be a small left pleural effusion. The Dobhoff extends below the diaphragm with the tip in the body of the stomach.", "output": "1. Dobbhoff tube extends below the diaphragm with the tip likely in the body of the stomach. 2. New left retrocardiac consolidation likely secondary to atelectasis." }, { "input": "Lower lung volumes seen on the current exam. The lungs are clear of consolidation or effusion. The cardiomediastinal silhouette is within normal limits. Left chest wall dual lead pacing device is again noted. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs demonstrate interval removal of a tunneled right IJ hemodialysis catheter. There is mild-to-moderate pulmonary edema. There is a tiny left pleural effusion seen on the lateral view. The heart size is moderately enlarged, the mediastinal contours are otherwise unremarkable.", "output": "Mild-to-moderate pulmonary edema with a tiny left pleural effusion." }, { "input": "Left sided dual-chamber pacemaker is noted with leads again terminating in the right atrium and right ventricle. Moderate cardiomegaly persists. The aorta remains tortuous and diffusely calcified. Lung volumes are lower compared to the prior study. There is likely mild pulmonary vascular congestion. Retrocardiac opacification is present, with small bilateral pleural effusions, left greater than right noted. There is no pneumothorax. The lungs are hyperinflated with widening of the AP diameter suggestive of underlying COPD. Diffuse demineralization of the osseous structures with multiple remote rib fractures again noted.", "output": "1. Mild pulmonary vascular congestion with small bilateral pleural effusions. 2. Retrocardiac opacification could reflect atelectasis but pneumonia is not excluded." }, { "input": "Retrocardiac opacity and small-to-moderate bilateral pleural effusions are similar to the prior study three days ago. Cardiomegaly is unchanged. Two pacing leads from a left chest generator terminate in appropriate positions, overlying the right atrium and right ventricle. The generator of a stimulator device is seen in the left upper quadrant of the abdomen.", "output": "Small to moderate bilateral pleural effusions and retrocardiac opacity are similar to ___." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Upright portable radiograph of the chest demonstrates persistent elevation of the left hemidiaphragm, with low lung volumes bilaterally. There is unchanged displacement of the trachea towards the right secondary to a very tortuous intrathoracic aorta. The heart is borderline enlarged in size, unchanged since the prior study. There is no evidence of pulmonary edema. There is no evidence of subdiaphragmatic free air. No pneumothorax is present.", "output": "No acute cardiopulmonary process. No evidence of subdiaphragmatic free air." }, { "input": "Frontal and lateral views of the chest are obtained. Bilateral nipple shadows should not be confused for pulmonary nodules. There is mild left base atelectasis. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Subtle opacity in lateral left upper hemithorax is stable since ___ and likely since ___, suggesting benignity. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No significant interval change. No acute cardiopulmonary process." }, { "input": "Endotracheal tube tip ends approximately 3 cm above the carina and right PICC line tip is at cavoatrial junction/lower SVC. Over the last 24 hours, there have not been much changes in the lungs. Bibasal atelectasis and small bilateral pleural effusions are unchanged. There is no pulmonary edema or pneumonia. No pneumothorax.", "output": "Bilateral small pleural effusion and bibasal small atelectasis is unchanged over last 24 hours; however, any concurrently associated infection cannot be ruled out and its interpretation should be done in conjunction with the clinical history." }, { "input": "AP single view of the chest has been obtained with patient in sitting semi-upright position. Analysis is performed in direct comparison with the next preceding similar study of ___. There is no significant interval change between these two studies obtained with a ___-hour interval. The left-sided basal density with obscuration of the left-sided diaphragmatic contour persists. This is explained by patient's pancreatitis. No increased pulmonary vascular congestion and no evidence of new parenchymal infiltrates. Right-sided PICC line in place. High contrast image clearly identifies its termination in the lower third of the SVC. A gas-distended stomach can be identified and overlying drainage tubes are seen in the upper abdominal area, however, more detailed analysis of the abdomen can be performed.", "output": "Stable chest findings, no new infiltrates or increased CHF." }, { "input": "ET tube and right PICC line are unchanged in position. Since the most recent prior radiograph, there is no new parenchymal infiltrate or no significant interval change. Opacification of the left base with mild blunting of both costophrenic angles most likely represent small amount of fluid and atelectasis. There is no pneumothorax. Cardiomediastinal silhouette is unremarkable.", "output": "No significant interval change. Left lower lung opacity may be due to atelectasis, however infectious process cannot be ruled out. Stable small bilateral pleural effusions." }, { "input": "New tracheostomy is in place. A left-sided PICC tip seats at the cavoatrial junction. The heart size is within normal limits. The mediastinal and hilar contours are also within normal limits. Ill-defined opacity and blurring of the left hemidiaphragm are most compatible with small-to-moderate left pleural effusion and basilar atelectasis. There is no pneumothorax. A gastrotomy tube projects over the left upper abdomen.", "output": "Small-to-moderate left pleural effusion with associated atelectasis." }, { "input": "Endotracheal tube tip is 3 cm above the carina and is normal. Right-sided PICC line tip is at mid SVC. Both lung volumes are low. Bilateral small effusions and accompanying bibasilar atelectasis, left side more than right side have not really changed much since ___. Previously positioned left-sided pigtail catheter has been removed. No pneumothorax. Cardiomediastinal silhouette is unremarkable.", "output": "Bilateral small pleural effusion and accompanying atelectasis, left side more than right, have not really changed since ___. Left pigtail catheter has been removed and there is no pneumothorax." }, { "input": "Lung volumes are low. There is a persistent left basilar retrocardiac opacity with air bronchograms and a moderate left-sided pleural effusion. There is also a suspected small right-sided pleural effusion, although not definitive. Elsewhere, the lungs appear clear. A left subclavian central venous catheter terminates in the superior vena cava. A pigtail drainage catheter projects over the left lower quadrant. There is also a balloon associated with gastrojejunostomy tube projecting over the left mid abdomen.", "output": "Persistent left basilar opacity with pleural effusion. Differential considerations include pneumonia, although atelectasis associated with pleural effusion could explain the appearance." }, { "input": "Single portable view of the chest is compared to previous exam from ___. Left PICC is in stable position with tip in the mid SVC. Tracheostomy tube is also seen with tip approximately 5.5 cm from the carina. Low lung volumes are again noted. There is silhouetting of the left hemidiaphragm consistent with pleural effusion which may be smaller when compared to prior. There is probably underlying atelectasis. Superiorly, the lungs are grossly clear. Cardiomediastinal silhouette is stable. Osseous and soft tissue structures are otherwise notable for a PEG tube in the left upper quadrant. Suggestion of right basilar atelectasis seen projecting over the hemidiaphragm.", "output": "Probable interval decrease in size of left-sided pleural effusion with underlying atelectasis or consolidation. Otherwise, no significant interval change." }, { "input": "Endotracheal tube tip is 3.4 cm above the carina and right PICC line ends at lower SVC, appropriately positioned. Increased left lower lung opacity which is likely combination of atelectasis and/or consolidation and mild-to-moderate left pleural effusion is unchanged over last 24 hours. Minimal right lung base atelectasis is also similar. Upper lungs are clear. Heart size, mediastinal and hilar contours are unremarkable.", "output": "Left lower lung opacity from atelectasis and/or consolidation and mild-to-moderate left pleural effusion and minimal right lung base atelectasis are unchanged over last 24 hours." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The inspiratory lung volumes are appropriate. The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The pulmonary vasculature is not engorged. The cardiomediastinal and hilar contours are within normal limits. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest are provided. Lung volumes are low. Though allowing for this, lungs are clear. No definite consolidation, effusion, or pneumothorax is seen. The heart appears within normal limits of size. The imaged bony structures of the chest appear intact.", "output": "Limited, negative." }, { "input": "There are new bilateral diffuse opacities, predominantly at the bases. There is obscuration of both the right and the left heart border. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal in size. No fracture is identified. There is no free air below the hemidiaphragms. A right-sided Port-A-Cath is present with the tip near the atriocaval junction.", "output": "1. Bilateral diffuse opacities are new from ___. The differential diagnosis is broad and includes infection or pulmonary edema. In the setting of trauma, contusion or aspiration cannot be excluded. 2. No evidence of fracture." }, { "input": "Heart size is mildly enlarged. The aorta is tortuous and calcified. The mediastinal and hilar contours are unremarkable. There is crowding of bronchovascular structures with mild pulmonary vascular engorgement. Emphysematous changes are noted within the lung apices. Patchy opacities in the lung bases likely reflect areas of atelectasis. No pleural effusion or pneumothorax is present. A surgical anchor is noted within the left humeral head.", "output": "Low lung volumes with probable bibasilar atelectasis and mild pulmonary vascular engorgement." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. Linear calcifications in the right upper hemithorax are unchanged There is no pneumothorax or pleural effusion. The lungs are hyperinflated. There are healed rib fractures bilaterally", "output": "No acute cardiopulmonary abnormalities probably COPD." }, { "input": "Compared with the prior radiograph, increased bibasilar opacities reflect atelectasis. Heart size is top normal. Mediastinal and hilar silhouettes are normal. Lungs are otherwise clear without focal consolidation, pleural effusion, or pneumothorax. Linear calcifications overlying the right lung apex are unchanged. Healed bilateral rib fractures are unchanged in appearance. A left-sided presumed pacer device is unchanged in appearance and position.", "output": "No evidence of pneumothorax." }, { "input": "Compared to prior exam, there is slightly increased pulmonary vascular congestion. A small focus of consolidation is seen projecting over the right lower lung. A second small focus is seen in the medial right lower lung. No pleural effusion or pneumothorax is seen. Heart size is enlarged, slightly increased compared to prior. Aortic calcification is noted.", "output": "1. Increased cardiomegaly and minimal pulmonary vascular congestion without overt edema. 2. Small right lower lung opacities which could represent early infection." }, { "input": "Lungs: There is been considerable improvement in the right basilar parenchymal process. Some residual disease remains. The pulmonary vasculature is prominent. Pleura: There is no pleural effusion. Mediastinum: No mediastinal mass is seen on this AP examination. Heart: The heart is enlarged. Electronic device projects over the left chest.. Osseous structures: The osseous structures are normal for age. Additional findings: Monitor leads overlie the chest.", "output": "Significant improvement in the right basilar parenchymal process. The pulmonary vasculature remains prominent. Cardiomegaly" }, { "input": "There is pulmonary vascular congestion with mild interstitial pulmonary edema. Heterogeneous opacity at the right lung base could be atelectasis or pneumonia. Moderate cardiomegaly is slightly decreased compared to ___. The mediastinal contours are normal. Aortic calcifications are noted. There are no definite pleural effusions. No pneumothorax is seen. Carotid artery calcifications are noted.", "output": "1. Mild interstitial pulmonary edema. 2. Decreased moderate cardiomegaly. 3. Heterogeneous right basilar opacity could be atelectasis or pneumonia." }, { "input": "Interval placement of a left central venous catheter, the tip projecting over the left brachiocephalic/ SVC confluence. Small left pleural effusion with adjacent atelectasis. Prominent pulmonary vasculature without frank pulmonary edema. The appearance of the cardiomediastinal silhouette is unchanged. An implantable loop recorder again projects over the left hemithorax.", "output": "Interval placement of a left central venous catheter, the tip projecting over the confluence of the left brachiocephalic and SVC. Small left pleural effusion and adjacent atelectasis." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Linear calcifications projecting over the right lung apex which may be vascular, stable since prior study. Battery pack again overlies the left mid hemithorax. Evidence of prior left-sided rib fractures are again seen.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is mild-to-moderately enlarged. The lungs appear clear aside from minimal vascular prominence and widespread peribroncial cuffing. There is no pleural effusion or pneumothorax.", "output": "Slight vascular prominence with peribronchial cuffing, but otherwise unremarkable." }, { "input": "Cardiac silhouette size is mild to moderately enlarged, decreased from the previous study. The mediastinal contours are unchanged. Mild pulmonary edema with perihilar haziness and vascular indistinctness is present, similar compared to the previous exam. There may be small bilateral pleural effusions, though the left costophrenic angle is excluded from the field of view. No large pneumothorax is detected.", "output": "Mild pulmonary edema, similar compared to the prior exam, with possible small bilateral pleural effusions." }, { "input": "PA and lateral views of the chest provided. Cardiomegaly is noted. Underpenetration in the setting of large body habitus limits assessment. No convincing evidence for pneumonia. No overt CHF no large effusion or pneumothorax. Difficult to exclude mild congestion/edema. Mediastinal contour appears grossly within normal limits. Bony structures are intact.", "output": "1. Slightly enlarged heart size with possible mild congestion. 2. No convincing signs of pneumonia." }, { "input": "The cardiac, mediastinal and hilar contours appear stable including mild-to-moderate cardiomegaly. There is no pleural effusion or pneumothorax. The prominence of the interstitium has increased suggesting mild pulmonary edema superimposed on patchy opacities in both upper lungs that persist but with shifeing morphology, possibly due to scarring or atelectasis, but a relatively new finding, not present on remote prior films.", "output": "1. Findings suggesting mild pulmonary edema. 2. Persistent upper lobe opacities with mixed nodular and streaky morphologies, probably scarring but not present on remote prior films. Accordingly, it may be appropriate to consider follow-up radiographs within ___ months to show stability of this appearance." }, { "input": "PA and Lateral views of the chest show well expanded and symmetric lungs. Cardiomediastinal silhouette including mild cardiomegaly is unchanged. In comparison to the prior examination, however, there is increased diffuse bilateral opacities with perihilar predominance, consistent with worsening mild pulmonary edema. A horizontal linear band of opacification in the mid left lung likely represents a focus of atelectasis. There is no focal consolidation. There is no pleural effusion or pneumothorax.", "output": "1. Mild cardiomegaly, unchanged. 2. Mild diffuse pulmonary edema has increased." }, { "input": "Penetration is poor secondary to body habitus. The lower lungs are particularly difficult to see and a lateral view would be very helpful in assessment. Pulmonary edema present in ___ has cleared. There may be new consolidation in the right lower lobe. Left lower lobe is obscured by soft tissue and cardiac silhouette, and the cardiac apex is obscured by the abdomen. Heart is probably not enlarged, but upper lobe vascular redistribution is an indication of borderline cardiac dysfunction. If there pleural effusions they are not large.", "output": "Possible right lower lobe pneumonia. Lateral view strongly recommended. Increased left atrial pressure, but no pulmonary edema or cardiomegaly. NOTIFICATION: Dr. ___ reported the findings to Dr ___ by telephone on ___ at 9:18 AM, 10 minutes after discovery of the findings." }, { "input": "PA and lateral views of the chest provided. Cardiomegaly is again noted with moderate pulmonary edema. No large effusions or pneumothorax seen. A subtle superimposed pneumonia is difficult to exclude though no asymmetric opacities are identified. Mediastinal contour is prominent though this could be due to technique. Bony structures are intact.", "output": "Cardiomegaly with moderate pulmonary edema. Difficult to exclude and a subtle superimposed pneumonia. Followup post diuresis." }, { "input": "The film is limited by exposure and body habitus. With this limitation in mind, there is no pneumothorax or pleural effusions. The right paratracheal stripe is enlarged, indicative of lymphadenopathy also seen on the CT of the chest from the same day. There is no obvious consolidation. Cardiac is normal in size.", "output": "Limited exam without evidence of acute process. Please referred CT chest report for full details." }, { "input": "AP portable upright view of the chest. The heart size is normal. The hilar and mediastinal contours are within normal limits. There is no pneumothorax, focal consolidation, or large pleural effusion.", "output": "No acute intrathoracic process" }, { "input": "Lung volumes are unchanged compared to the prior study. The trachea is central. The cardiomediastinal contour is unchanged with mild cardiomegaly. Mild prominence of pulmonary vasculature is noted but no frank pulmonary edema. No consolidation or pneumothorax seen. The visualized bony structures are unremarkable in appearance.", "output": "Findings consistent with mild congestive heart failure, no overt pulmonary edema appreciated." }, { "input": "Moderate to severe cardiomegaly is re- demonstrated, unchanged. The mediastinal contour appears similar. Perihilar haziness is present along with mild to moderate pulmonary edema, similar to that seen on the prior study. No large pleural effusion, focal consolidation, or pneumothorax is present. There is probable bibasilar atelectasis. No acute osseous abnormalities detected.", "output": "Unchanged moderate to severe cardiomegaly with mild to moderate pulmonary edema." }, { "input": "PA and lateral views of the chest provided. Cardiomegaly is again noted with hilar congestion and mild pulmonary edema. No large effusion is seen. There is no pneumothorax. No convincing signs of pneumonia. The mediastinal contour is stably prominent. Bony structures are intact.", "output": "Cardiomegaly with hilar congestion and mild pulmonary edema." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. Mild to moderate cardiomegaly is similar to prior. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. Heart is mildly enlarged. No edema or congestion. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Mild cardiomegaly, otherwise unremarkable." }, { "input": "Prior left-sided central venous catheter is no longer visualized. The lungs are clear. There is no focal consolidation, effusion or edema. The cardiomediastinal silhouette is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear. A left subclavian PIC line tip is seen in the mid SVC. The cardiomediastinal silhouette, hilar contours and pleural surfaces are normal. No pneumothorax or pleural effusion.", "output": "1. Left subclavian PIC line is seen in the mid SVC. No acute cardiopulmonary process." }, { "input": "In the interval since the prior study, a right-sided PICC is been removed and a right internal jugular catheter has been placed. This terminates in the distal SVC. The trachea is central. The cardiomediastinal contour is normal. The heart is not enlarged. No consolidation, pneumothorax or pleural effusion seen. The visualized bony structures are unremarkable in appearance. No free air seen under the diaphragm.", "output": "No acute cardiopulmonary process seen." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Right-sided central line terminates at the cavoatrial junction.The lungs remain hyperinflated. No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Right-sided central venous line terminates at the cavoatrial junction without evidence of pneumothorax." }, { "input": "The heart is mildly prominent. Mediastinal and hilar contours are within normal limits. There is no evidence for pulmonary edema, pulmonary consolidation, or pleural effusion. Visualized bones are grossly unremarkable.", "output": "No evidence for active cardiopulmonary disease." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The heart is normal in size. Re- demonstrated is a right peritracheal and bilateral hilar soft tissue densities consistent with adenopathy associated with the patient's known sarcoidosis. Compared to chest radiograph on ___, the adenopathy appears stable. Lung volumes are slightly low. There is no pleural effusion or pneumothorax. There is subtle pulmonary opacity involving the mid right lung as well as increased density over the lower thoracic spine seen on the lateral view without a definite correlate on the frontal view.", "output": "Subtle pulmonary opacities involving the mid right lung and over the lower thoracic spine on the lateral view concerning for areas of infection." }, { "input": "Symmetric hilar enlargement and widened or bulging mediastinal contours indicate adenopathy in both paratracheal, the subcarinal and paraesophageal stations, and both hila. There is a suggestion of mild interstitial abnormality consisting of tiny nodules and thickening of lymphatics in the mid and lower lungs as well as at least one sub cm nodule projecting over the left ___ anterior rib. Heart is normal size. There is no evidence of pericardial or pleural effusion.", "output": "Symmetric adenopathy in the mediastinum and hila, numerous small pulmonary opacities, and probable lymphatic infiltration, best explained by sarcoidosis. At least one discrete subcentimeter pulmonary nodule, also most likely due to sarcoidosis. Comparison to any prior chest radiographs is recommended to establish chronicity of these findings." }, { "input": "PA and lateral views of the chest. Show a right paratracheal and by a hilar lobular soft tissue density consistent with adenopathy associated with the patient's known sarcoidosis. There is no increase in the size or extent of adenopathy when compared to the ___ plain films. No new parenchymal consolidation is seen and faint parenchymal nodular densities are all noted on the prior study.", "output": "Hilar and mediastinal adenopathy consistent with patient's diagnosis of sarcoidosis appears unchanged compared to ___ with no new superimposed parenchymal consolidation." }, { "input": "The heart is normal in size. The mediastinal and hilar contours are unremarkable aside from streaky right suprahilar opacity most suggestive of minor atelectasis. There is no pleural effusion or pneumothorax. The lungs appear otherwise clear. Bony structures are unremarkable.", "output": "Streaky right upper lobe, probably atelectasis." }, { "input": "A single frontal portable radiograph of the chest was acquired. The endotracheal tube is appropriately positioned, ending 3.1 cm above the level of the carina. An enteric catheter courses below the level of the diaphragm and out of the field of view inferiorly. There is a right internal jugular central venous catheter ending in the mid-to-low SVC. There is redemonstration of complete opacification of the left hemithorax with rightward displacement of the mediastinal structures, not significantly changed. There is minimal right lower lung atelectasis. The heart size cannot be assessed on this radiograph but was seen to be normal on the outside hospital CT dated ___. There is no definite pneumothorax. No right pleural effusion is seen.", "output": "1. Appropriately positioned endotracheal tube. 2. Unchanged complete opacification of the left hemithorax with rightward shift of the mediastinal structures, seen to be secondary to a combination of consolidation and effusion on the outside hospital CT from ___. An obstructing endobronchial or peribronchial lesion cannot be excluded." }, { "input": "Heart size, mediastinal and hilar contours are normal. Lungs and pleural surfaces are clear.", "output": "No radiographic evidence of pneumonia." }, { "input": "AP single view of the chest was obtained with patient in semi-upright position. A Dobbhoff line is identified and seen to reverse in the lower portion of the esophagus, so that its tip is located in the epipharynx. The appearance of chest has not undergone any significant interval change since the next preceding examination obtained nine hours earlier during the same day. Referring physician ___ was paged for stat report.", "output": "Inappropriately placed Dobbhoff, requiring adjustment." }, { "input": "A single portable AP chest radiograph was obtained. A nasogastric tube loops in the mid esophagus. Moderate pulmonary edema is unchanged. Left basilar opacity and small effusion are unchanged. A right sided PICC line tip terminates in the mid SVC.", "output": "Persistent coiling of the NG tube in the mid esophagus. Findings were discussed with Dr. ___ ___ telephone at approximately ___ on ___." }, { "input": "Endotracheal tube terminates at the inferior margin of the clavicles. Partial right upper lobe collapse with elevation of the minor fissure is new since the exam 24 hours ago. There is a new contour irregularity of the left main stem bronchus at the takeoff of the left upper lobe bronchus. Left basilar atelectasis is similar. No effusion or pneumothorax is present.", "output": "New right upper lobe partial collapse and contour abnormality of the left main stem bronchus suggests the possibility of mucous plugging causing the atelectasis. A bronchoscopy may be helpful to identify and clear potential mucous plugging. Findings were discussed via telephone with Dr. ___ at 10:30 on ___." }, { "input": "There are diffuse airspace opacities throughout the left lung as well as a more focal airspace opacity in the right mid lung. There is a small to moderate left pleural effusion and pulmonary vascular congestion. Apparent elevation of left hemidiaphragm could reflect a subpulmonic component of the effusion. There is no pneumothorax. . Heart size is top normal and note is made of distension of the azygos vein. There is no acute osseus abnormality.", "output": "1. Asymmetrically distributed airspace opacities predominantly affecting the left lung, concerning for massive aspiration in the setting of recent overdose. Asymmetrical distribution of pulmonary edema is considered less likely. 2. Pulmonary vascular congestion and small to moderate left pleural effusion." }, { "input": "Portable AP upright chest radiograph is obtained. EKG lead and external pacer leads are noted as well as midline sternotomy wires and mediastinal clips. The lung volumes are low, but the lungs appear clear. No definite sign of pneumonia or CHF. No pleural effusion or pneumothorax is seen. A retrocardiac density is compatible with known hiatal hernia. Imaged osseous structures appear intact.", "output": "Hiatal hernia, otherwise unremarkable study." }, { "input": "Portable upright frontal chest radiograph demonstrates low lung volumes without consolidation, effusion, or pneumothorax. The heart remains top normal in size. The mediastinal contours are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is mildly enlarged. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is not engorged. Hazy ill-defined opacity is noted within the left mid lateral lung field. Small bilateral pleural effusions, right greater than left are demonstrated. Streaky linear opacities within the right lung base likely reflect atelectasis. There is no pneumothorax. Right type 3 AC joint separation history is age indeterminate.", "output": "1. Hazy ill-defined opacity in the left mid lateral lung field. This may reflect pneumonia, and followup radiographs after treatment are recommended to ensure resolution of this finding. 2. Small bilateral pleural effusions. 3. Right basilar atelectasis." }, { "input": "The lungs are relatively well expanded. Heart size is stable. There is a new focal consolidation in the left lower lobe posteriorly. No pleural effusion or pneumothorax is noted. There is no pulmonary edema.", "output": "Left lower lobe consolidation is compatible with pneumonia in the appropriate clinical setting." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs are clear. There are no pleural effusions or pneumothorax. The bony structures are unremarkable. There has been no significant change.", "output": "No evidence of acute disease." }, { "input": "Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is no focal lung consolidation.", "output": "No evidence of pneumonia." }, { "input": "PA and lateral views of the chest were obtained demonstrating clear well expanded lungs without focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Mild transverse cardiomegaly. Pulmonary vascular congestion with mild interstitial thickening. Small left-sided pleural effusion. Left lower lobe atelectasis. Unfolded aortic arch and rotation contribute to a widened mediastinum. Degenerative bony changes.", "output": "Pulmonary vascular congestion with associated interstitial edema and a small left-sided pleural effusions suggest fluid overload/ cardiac decompensation. Left lower lobe atelectasis. Unfolded aortic arch and rotation are most likely responsible for the widened mediastinum, but correlation with a PA erect, non rotated radiograph is advised." }, { "input": "", "output": "AP chest compared to ___, read in conjunction with a subsequent torso CTA, ___. FINDINGS: Since pulmonary vascular congestion and mild cardiomegaly are new since ___, I am tempted to attribute the region of new peribronchial opacification at the right lung base to dependent edema, exacerbated by elevation of the right hemidiaphragm and bronchovascular crowding in the right lower lobe. Even so, this area should be watched carefully for an alternative diagnosis, concurrent pneumonia. Severe degenerative changes noted at both shoulders. No appreciable left pleural effusion. No pneumothorax." }, { "input": "Lung volumes are normal. No focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal contours are normal. No acute osseous abnormalities identified. There is no subdiaphragmatic free air.", "output": "Normal chest radiograph." }, { "input": "Upright frontal chest radiograph demonstrates clear lung fields. There is no pneumothorax or evidence of free intraperitoneal air. Cardiomediastinal silhouette is normal.", "output": "Normal chest radiograph." }, { "input": "PA and lateral views of the chest. The lungs are clear. The cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. There are fibrotic changes at the right mid lung with right paratracheal opacity and retraction of the right hilum in this patient status post right lobectomy and lung volume loss. There is also mild elevation of the right hemidiaphragm. Recommend comparison with prior radiographs to assess for interval change. Surgical clip is noted in the right mediastinum projecting over the right paratracheal region. The left lung is clear. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac silhouette is not enlarged.", "output": "Right perihilar opacity with fibrotic changes and loss of volume in the right lung in this patient status post lobectomy. Comparison with prior chest radiographs suggested for interval change. No focal consolidation or evidence of pneumothorax." }, { "input": "There has been interval placement of an endotracheal tube, terminating approximately 1.5 cm above the level of the carinal, recommend withdrawal by approximately a 1-2 cm for more optimal positioning. Enteric tube is seen coursing below the diaphragm, inferior aspect not included on the image. In the interval since the prior study, there has been significant in bilateral opacities worrisome for severe/pulmonary edema, underlying aspiration not excluded. No large pleural effusions are seen although trace pleural effusions are difficult to exclude. The cardiac silhouette remains mildly enlarged. The aorta is calcified and tortuous.", "output": "Endotracheal tube terminates approximately 1.5 cm above the chronic recommend withdrawal by approximately 1 to 2 cm for more optimal positioning. Interval development of severe bilateral pulmonary opacities worrisome for flash pulmonary edema. Underlying aspiration not excluded. Above findings discussed with Dr. ___ on ___ at ___:___ via telephone." }, { "input": "Since prior, there is a new moderate right pleural effusion. Lung volumes are low. There is right perihilar streaky opacity and a subtle retrocardiac opacity which may reflect pneumonia in the correct clinical setting. There is no pneumothorax. Cardiomediastinal and hilar contours are unchanged. Calcifications are noted in the aortic knob. A ___ right humeral and clavicular fracture is noted.", "output": "Moderate right pleural effusion. Subtle retrocardiac and right perihilar opacities may represent pneumonia in the correct clinical setting." }, { "input": "The lungs are clear without infiltrate or effusion. The cardiac and mediastinal silhouettes are normal. There is no focal infiltrate or effusion.", "output": "Normal chest." }, { "input": "Frontal and lateral views of the chest were obtained. There is right middle lobe opacity. There is eventration of the anterior right diaphragm. Findings may in part relate to atelectasis, findings are concerning for pneumonia given clinical scenario. The left lung is clear. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Right middle lobe consolidation worrisome for pneumonia." }, { "input": "The radiograph obtained at 00:52 hours shows new small bilateral pleural effusions, left greater than right. Lung volumes remain low. However, there is evidence of new mild pulmonary edema. There is no pneumothorax. The cardiomediastinal silhouette is stable. The known right ___ thoracic rib fracture is not seen on this exam. The followup radiograph of 05:29 hours shows increased elevation of the right hemidiaphragm, likely due to a combination of worsening atelectasis and pleural effusion. An endotracheal tube has also been placed, terminating at the level of the clavicles. There is increased opacification along the right paratracheal location, which could be due to a developing hematoma. The left lung is clear. There is no pneumothorax.", "output": "Increased opacification along the right paratracheal location may be due to a developing hematoma. A repeat CTA chest is recommended when clinically feasible. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 11:42 AM, 30 minutes after discovery of the findings." }, { "input": "The radiograph obtained at 00:52 hours shows new small bilateral pleural effusions, left greater than right. Lung volumes remain low. However, there is evidence of new mild pulmonary edema. There is no pneumothorax. The cardiomediastinal silhouette is stable. The known right ___ thoracic rib fracture is not seen on this exam. The followup radiograph of 05:29 hours shows increased elevation of the right hemidiaphragm, likely due to a combination of worsening atelectasis and pleural effusion. An endotracheal tube has also been placed, terminating at the level of the clavicles. There is increased opacification along the right paratracheal location, which could be due to a developing hematoma. The left lung is clear. There is no pneumothorax.", "output": "Increased opacification along the right paratracheal location may be due to a developing hematoma. A repeat CTA chest is recommended when clinically feasible. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 11:42 AM, 30 minutes after discovery of the findings." }, { "input": "Lung volumes are decreased, MDCT and there are linear bibasilar opacities which likely represent atelectasis. No large pleural effusion or pneumothorax. Cardiomediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low leading to crowding of the bronchovascular structures. Bibasilar atelectasis is noted. The upper lungs are clear without focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is unchanged in appearance.", "output": "Low lung volumes without overt cardiopulmonary process." }, { "input": "Compared to ___, there is no relevant change. There is no evidence of edema, pneumonia, pleural effusion, or pneumothorax. Heart size is top-normal. Osseous structures are intact.", "output": "No evidence of pneumonia." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The ETT appears to be high terminating 8 cm above the carina, which is unchanged in comparison to the prior radiograph. There is a left PICC line with the tip terminating in the low SVC. There is a right IJ ECMO cannula, which appears unchanged in comparison to the prior radiograph. There is improved aeration of the lower lobes bilaterally, although there is a persistent combination of bilateral pleural effusions and bibasilar atelectasis. The upper lungs appear clear bilaterally. The mediastinal and hilar contours are normal. There is no pneumothorax.", "output": "1. ET tube continues to be high. PICC line and ECMO cannula in appropriate positioning. 2. Improving bilateral pleural effusions and bibasilar atelectasis." }, { "input": "Endotracheal tube terminates 8 cm above the carina. Left subclavian catheter terminates at the cavoatrial junction. NG tube forms a loop in the stomach. Position of the left pleural drain is unchanged. ECMO cannula overlies the right border of the lower thoracic spine. Low lung volumes. Resolution of pulmonary edema. Stable left lower lobe atelectasis.", "output": "ECMO cannula overlies the right border of the lower thoracic spine. Resolution of pulmonary edema." }, { "input": "Endotracheal tube, left chest tube and left central line remain unchanged in position. The left chest tube side port remains within the thorax. There is persistence of the moderate right pleural effusion and small to moderate left pleural effusion with adjacent bibasilar atelectasis. There is no evidence of pneumothorax. The cardiomediastinal silhouette is unchanged.", "output": "Persistent bilateral effusions right greater than left with adjacent bibasilar atelectasis." }, { "input": "Endotracheal tube tip terminates approximately 4 cm from the carina. An enteric tube tip courses below the left hemidiaphragm with tip off the inferior borders of the film. Near total opacification of the left hemithorax is new and concerning for left lung atelectasis/collapse. The heart size is difficult to assess given the near complete opacification of the left hemi thorax, though minimal visualization of the right heart border suggests that there may be minimal leftward shift of mediastinal structures. Patchy opacities in the right lung base reflect areas of atelectasis. No large pneumothorax is demonstrated. The extreme right lateral chest is excluded from the field of view. Previously seen right anterior rib fractures are not evident on the current exam. Cervical spinal fusion hardware is incompletely assessed.", "output": "1. Endotracheal and enteric tubes in standard positions. 2. Near complete opacification of the left hemithorax most likely due to left lung atelectasis/collapse. 3. Right basilar atelectasis. Known right-sided rib fractures are better assessed on the previous CT." }, { "input": "The tip of the endotracheal tube remains approximately 11 cm from the carina and needs to be advanced. There is slight further improvement of the bibasal atelectasis. No interstitial edema. No significant effusions or pneumothorax.", "output": "The tip of the endotracheal tube remains approximately 11 cm from the carina and needs to be advanced." }, { "input": "The support apparatus is unchanged and in good position. Scattered areas of basal atelectasis have slightly improved and right lower lobe. Left lower lobe collapse has improved post streaky and subsegmental atelectasis. Interval enlargement of bilateral hila could represent mild pulmonary vascular congestion. There is a small left pleural effusion, slightly increased. No pneumothorax. The heart is not significantly enlarged.", "output": "Interval enlargement of bilateral hila could represent mild pulmonary vascular congestion. Interval improvement of bibasal atelectasis, left greater than right." }, { "input": "The right-sided PICC remains in the low SVC. The tip of the endotracheal tube is 7.5 cm from the carina. The lung volumes remain low with subsegmental worsening linear atelectasis in the lung bases. . No acute focal consolidation or interstitial edema. No significant pleural effusions or pneumothorax.", "output": "The lung volumes remain low with worsening multifocal atelectasis. No acute focal consolidation or interstitial edema." }, { "input": "An endotracheal tube is in-situ, the tip remains relatively high in position approximately 8 cm above the level of the carina, this could be advanced for more stable positioning. A nasogastric tube is in-situ, the tip is not clearly visualized on this study but appears to be below the left hemidiaphragm. A large bore catheter projects over the right side mediastinum and along the right heart border, this is unchanged in appearance and consistent with an ECMO catheter. This appears to extend into the IVC. Left basilar atelectasis with an adjacent left chest drain, a side hole of the chest strain is close to the chest wall, this could be advanced. Right basilar atelectasis also noted.", "output": "1. No significant interval change when compared to the prior study. 2. A left-sided chest drain is unchanged in position except note that a side hole is very close to the chest wall and the catheter drain be advanced for more secure seating. 3. The endotracheal tube remains high in position above the level of the carina." }, { "input": "Interval development of left hemi-thorax near complete opacification and leftward shift of mediastinal structures is consistent with near complete left lung collapse. The endotracheal tube remains 7 cm above the carina. Enteric tube appears in similar position. The left chest tube appears well-positioned with its side port in the thoracic cavity. A right layering pleural effusion again noted.", "output": "Interval development of near complete left lung collapse, likely due to mucous plugging. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ ___ on the telephone on ___ at 9:57 AM, 5 minutes after discovery of the findings." }, { "input": "Tip of the Dobhoff tube remains in the stomach. A right PICC line terminates at the cavoatrial junction. Tracheostomy tube is in unchanged positions. Lung volumes are low with bibasilar atelectasis. Mild vascular congestion has developed since the prior examination.", "output": "Mild vascular congestion has developed since the prior examination. Persistent bibasal atelectasis." }, { "input": "Portable up right chest film ___ at 04:43 is submitted.", "output": "Interval intubation with the tip of the endotracheal tube 6.5 cm above the carina. A second small diameter tube is seen paralleling the feeding tube with the tip projecting 2 cm above the carina. A feeding tube is seen coursing below the diaphragm with tip not identified. Overall cardiac and mediastinal contours are stable. There are persistent bibasilar opacities, which on the left is associated with an effusion. This would favor atelectasis, although pneumonia or aspiration should also be considered. No pneumothorax." }, { "input": "Lines and tubes are unchanged in position as compared to chest radiograph completed at 08:52. There has been minimal interval re-expansion of the left upper lobe, however there is still substantial atelectasis throughout the left lower and mid lung. A moderate left pleural effusion is now seen. The right layering pleural effusion is unchanged. Visualization of the heart is obscured by left lung atelectasis.", "output": "1. Improved aeration of left upper lobe, with considerable residual atelectasis of the left lower and mid lung. 2. Stable right pleural effusion. Moderate left pleural effusion." }, { "input": "Endotracheal and enteric tubes remain in unchanged positions. There has been interval placement of a left basilar chest tube. There is continued near complete opacification of the left hemi thorax with probable leftward shift of mediastinal structures suggestive of atelectasis/collapse. Patchy opacity in the right lung base also likely reflects an area of atelectasis. No overt pulmonary edema or large pneumothorax is present. Known fractures of the right anterior ribs are not well assessed on the current radiograph", "output": "Interval placement of left basilar chest tube. Otherwise no substantial interval change in the near complete opacification of left hemithorax likely related to atelectasis/collapse." }, { "input": "Portable upright chest radiograph ___ at 06:23 is submitted", "output": "Lung volumes are low with crowding of the vasculature and bibasilar patchy opacities likely reflecting atelectasis rather than aspiration or pneumonia. Clinical correlation is advised. Probable small layering left effusion. Overall cardiac and mediastinal contours are stable. A feeding tube is seen coursing below the diaphragm with the tip not identified. Endotracheal tube has its tip approximately 6 cm above the carina. No pneumothorax." }, { "input": "Left subclavian catheter ends in the lower SVC. Right ECMO cannula is in unchanged position. Left pleural drain is in unchanged position. Endotracheal tube ends 8 cm above the carina and could be advanced by 2 cm to achieve standard placement. NG tube coils in the stomach. Normal mediastinal and hilar contours. Normal heart size. Stable, bilateral pleural effusions, moderate on the right and small on the left. Atelectasis is considerable in the left lower lobe, stable since at least ___ and is probably worsening on the right.", "output": "Endotracheal tube ends 8 cm above the carina and could be advanced by 2 cm to achieve standard placement. Stable, bilateral pleural effusions, moderate on the right and small on the left. Severe left lower lobe atelectasis stable since ___, probably substantial an worsening on the right. RECOMMENDATION(S): Advance endotracheal tube by 2 cm. NOTIFICATION: Findings and recommendations were communicated to ___ at 12:12." }, { "input": "Endotracheal, enteric, and left basilar chest tubes remain in unchanged positions. Lung volumes remain low. Heart size is moderately enlarged but likely exaggerated due to low lung volumes. Widening of the superior mediastinal contour is unchanged. There is improved aeration of the left lung with continued opacity in the retrocardiac region likely reflective of residual atelectasis. Mild pulmonary vascular engorgement is also likely present. Aeration of the right lung base also appears slightly improved with residual atelectasis. Known right-sided rib fractures are not well assessed on this exam.", "output": "Slight interval improvement in aeration of the left lung and right lung base with continued left basilar opacity, likely residual atelectasis." }, { "input": "Portable upright chest radiograph ___ at 02:37 is submitted.", "output": "Layering bilateral effusions with associated patchy bibasilar airspace disease likely reflecting compressive atelectasis. Persistent mild pulmonary and interstitial edema. Cardiac and mediastinal contours are likely unchanged. Lung volumes remain low. No pneumothorax." }, { "input": "The heart is moderately enlarged. There are bilateral small pleural effusions. There is no focal airspace opacities. The pulmonary vasculature is unremarkable. No pneumothorax.", "output": "Bilateral pleural effusions and cardiomegaly are moderate, however improved from the prior examination." }, { "input": "Perihilar opacity is due to pulmonary edema. Lung volumes are lower.Compared to the prior radiograph at 03:48, there is increased basal opacification due to moderate pleural effusions and dependent edema, though compared to 2:02 , there is no significant change. The variation over such a short period of time is probably due to positioning and level of inspiration. Upper lobe vascular congestion and moderate cardiomegaly are stable. There is focal consolidation or pneumothorax.", "output": "Moderate, bilateral pleural effusion and moderate pulmonary edema, unchanged from 02:02 on ___." }, { "input": "The lungs volumes are slightly low but clear. The cardiomediastinal silhouette, hilar contours and pleural surfaces are normal. There is no pleural effusion or pneumothorax. Hyperdense material within partially imaged bowel in the mid abdomen likely reflects retained barium.", "output": "Slightly low lung volumes. No evidence of aspiration." }, { "input": "Frontal and lateral radiographs of the chest demonstrate low lung volumes with bibasilar atelectasis and accentuation of the cardiac and pulmonary vasculature. Elevated left hemidiaphragm is again noted. Small bilateral pleural effusions. No focal consolidation concerning for pneumonia. No pneumothorax. Cardiac and mediastinal contours are grossly normal.", "output": "Bibasilar atelectasis, worse on the left with continued low lung volumes." }, { "input": "Right PICC line ends in the mid-to-low SVC. As compared to prior chest radiograph from ___, lung volumes are improved. Right pleural effusion may be smaller. There is minimal if any change on the left, including unchanged left basal atelectasis and a small pleural effusion. There is no pneumothorax. Substantial distention of gas-containing viscus in the left upper quadrant is likely the stomach. There is evidence of cervical fusion.", "output": "1. Probable decrease of small right pleural effusion. 2. Unchanged appearance of left lung, with left basilar atelectasis and small pleural effusion." }, { "input": "An anterior cervical spinal fusion device is present. The right PICC tip terminates at the low SVC. The lung volumes are low with a prominent gastric bubble seen beneath the left hemidiaphragm resulting in atelectasis, more prominent on the left than the right. There is no large pleural effusion or pneumothorax. The heart size and mediastinal contours are within normal limits.", "output": "Low lung volumes with atelectasis, worse on the left than the right, although in the appropriate clinical setting, left-sided pneumonia is a possibility." }, { "input": "AP and lateral radiographs of the chest provided. The lungs are clear. The hilar cardiomediastinal contours are normal. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary process." }, { "input": "Vague opacity at the right lung base on the frontal view is likely atelectasis as there is no correlate on the lateral. The lungs are clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Low lung volumes exaggerates heart size which is probably top-normal. There is no focal consolidation, pleural effusion or pneumothorax. Air-filled loops of bowel noted in the left upper quadrant.", "output": "No acute cardiopulmonary process." }, { "input": "Swan-Ganz catheter remains in place. The lungs are clear. There is no pneumothorax. The heart and mediastinum are within normal limits despite the projection.", "output": "Clear lungs." }, { "input": "Minor right middle lobe atelectasis is seen without definite focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The endotracheal tube is 4.1 cm above the carina. A right internal jugular catheter courses to the level of the mid SVC. Enteric tube overlies the stomach, however, the tip was not imaged. The lung volumes remain low. Diffuse prominence of markings is indeterminate on this supine film. Retrocardiac opacity is unchanged and is presumably atelectasis. No pleural effusion or pneumothorax detected.", "output": "Endotracheal tube 4.1 cm above the carina. No pneumothorax detected. Presumed atelectasis, but an underlying infiltrate would be difficult to exclude in this setting." }, { "input": "The trachea is poorly delineated. Allowing for this, the tip of the ET tube lies approximately 4.6 cm above the carina. An NG type tube is present, extending beneath the diaphragm, off the film. A right IJ central line is again seen, tip overlying mid SVC. The cardiomediastinal silhouette is unchanged. Allowing for low lung volumes, no definite CHF. Bibasilar atelectasis. No gross effusion. No pneumothorax detected.", "output": "ET tip approximately 4.6 cm above the carina. There is some obscuration of the tracheal air column and proximal left mainstem bronchus distal to this. Low lung volumes with bibasilar atelectasis. Atelectasis." }, { "input": "There is a new pacemaker lead terminating in the right ventricle as expected. The aorta is tortuous and calcified, but stable compared to prior. There is moderate stable cardiomegaly. There is still a moderate right pleural effusion with associated atelectasis which is stable compared to the most recent prior study. The lungs are hyperinflated with flattened diaphragms. There is stable indentation upon the right aspect of the trachea with fullness of the superior mediastinum correlating to known goiter.", "output": "1. New pacemaker lead with tip terminating in the right ventricle as expected. 2. Stable moderate right pleural effusion with associated atelectasis. 3. Lung hyperinflation with flattened hemidiaphragms." }, { "input": "PA and lateral views of the chest were provided. Dual lead pacemaker is unchanged with leads extending to the region of the right ventricle. A thorax catheter is again seen at the left lung base. Pleural effusions appear similar to prior exam without significant change. Mild basilar opacities likely reflect compressive atelectasis. No new consolidation. Cardiomediastinal silhouette appears stable with atherosclerotic calcification along the aortic knob. The bony structures appear stable. No free air below the right hemidiaphragm.", "output": "No significant change in small bilateral pleural effusions with left chest tube in place." }, { "input": "PA and lateral radiographs were acquired. As before, there is a left pacemaker with an associated right ventricular lead, not significantly changed in position. There is a new moderate right pleural effusion with evidence of lateral loculation. Fluid extends into the minor fissure. There is associated right basilar compressive atelectasis. Additional heterogeneous opacities in the right mid-to-lower lung, best seen on the PA projection, is concerning for an infectious process. The lungs are otherwise clear. There is no pneumothorax. The heart is moderately enlarged, not significantly changed in size. The mediastinal contours are unchanged with fullness of the superior mediastinum and indentation upon the right aspect of the trachea, possibly due to a substernal goiter, unchanged. Aortic calcifications are seen. Bilateral carotid artery calcifications are noted.", "output": "1. Moderate, partially loculated, right pleural effusion. 2. Heterogeneous right basilar opacities, possibly representing compressive atelectasis, though pneumonia may also be present." }, { "input": "The moderate right pleural effusion is unchanged since the prior exam. The air in the pleural space has resolved. Opacity at the left base is stable. The heart size is unchanged. The pacemaker with leads in the appropriate position.", "output": "Resolution of right basilar pneumothorax with stable right pleural effusion." }, { "input": "Frontal and lateral views of the chest. Pulmonary vascular markings are indistinct, consistent with mild to moderate pulmonary edema. Moderate bilateral pleural effusions are similar to prior with adjacent opacities. Heart size and cardiomediastinal contours are stable. Leads of a left chest wall pacer are in stable position. Chronic left rib fractures are similar to prior.", "output": "Mild to moderate pulmonary edema with moderate bilateral pleural effusions and adjacent opacities consistent with atelectasis, aspiration, or infection." }, { "input": "", "output": "PA and lateral radiographs of the chest. FINDINGS: There has been interval decrease in the amount of pulmonary edema and removal of right chest tube. There has been interval increase in volume of the right pleural effusion with accompanying increase in right lower lobe atelectasis. The left lung is unremarkable. The aorta is tortuous and calcified. There is moderate cardiomegaly with normal hilar and mediastinal contours. The pleural surfaces are unremarkable. IMPRESSION: Interval improvement in pulmonary edema. Interval increase in amount of right pleural effusion." }, { "input": "Frontal and lateral chest radiographs demonstrate stable bilateral pleural effusions with bibasilar opacifications, left greater than right, likely representing atelectasis and less conspicuous than on ___. A left Pleurx catheter is again seen with smaller likley loculated pneumothorax inferiorly as well as trace at the apex as wellNo new opacification concerning for pneumonia identified. Stable cardiomegaly noted. Mediastinal and hilar contours are unchanged.", "output": "Stable examination with bilateral pleural effusions and likely adjacent atelectasis. No new focal opacification concerning for pneumonia identified. Left Pleurex catheter with small residual pneumothorax as on prior. Findings were emailed to ___ nurses on ___ by Dr. ___ at 9:15 am." }, { "input": "After thoracentesis there has been interval decrease of right base pleural effusion, now small. There is also new small pneumothorax at the right costophrenic angle. Increased opacification at the right lung base is likely related to moderate post-procedural edema. The lung is otherwise clear except for linear opacity at the left lung base compatible with atelectasis. Heart size still moderately enlarged.", "output": "Interval decrease of right base pleural effusion with mild reexpansion pulmonary edema and small right lung base pneumothorax." }, { "input": "AP upright and lateral views of the chest are provided. Patient is rotated to the left on the frontal view. The heart is mildly enlarged. No convincing sign of pneumonia, or effusion. No large effusion is seen. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Limited exam with patient rotation. Mildly enlarged heart. Dedicated PA and lateral views would be helpful to further evaluate." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. No visible rib fracture is present. There is asymmetry of the breast with surgical clips in the left axilla. Hardware from a prior shoulder replacement is present in the right humerus.", "output": "1. No evidence of pneumonia. 2. No visualized rib fractures." }, { "input": "The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Lungs are well-expanded without focal consolidation concerning for pneumonia. Biapical scarring is present. Mildly increased slightly nodular interstitial markings are noted throughout both lungs, which may represent acute infection or inflammation in the correct clinical setting. Increased soft tissue density overlying the right apex with inferior displacement of the right clavicle is consistent with known mass better seen on same date neck CT.", "output": "1. Mildly increased interstitial markings, which may represent acute small airways infection or inflammation in the correct clinical setting. 2. Please note that chest radiograph is not sensitive for evaluation of metastatic disease." }, { "input": "Heart size is top normal. Mediastinal and hilar contours are within normal limits. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is demonstrated. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest. Heart size and cardiomediastinal contours are normal. Lungs are clear without focal consolidation, pleural effusion, or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No evidence of pneumonia." }, { "input": "SUBTLE LINEAR CALCIFICATION IS NOTED ALONG THE LATERAL LEFT LOWER HEMI THORAX OF UNCLEAR CLINICAL SIGNIFICANCE, UNCLEAR WHETHER PLEURAL, WITHIN SUBCUTANEOUS TISSUE, OR EXTERNAL TO THE PATIENT. . LAST ADDITIONAL POSSIBLE LINEAR CALCIFICATION IS SEEN PROJECTING OVER THE RIGHT UPPER HEMI THORAX. NO DEFINITE FOCAL CONSOLIDATION IS SEEN. THERE IS NO PLEURAL EFFUSION OR PNEUMOTHORAX. THE AORTA IS TORTUOUS. THE CARDIAC SILHOUETTE IS TOP-NORMAL.", "output": "NO FOCAL CONSOLIDATION TO SUGGEST PNEUMONIA. OUPLE SCATTERED FOCI OF LINEAR CALCIFICATION PROJECTING OVER THE CHEST, UNCLEAR WHETHER PLEURAL, WITHIN SUBCUTANEOUS TISSUE, OR EXTERNAL TO THE PATIENT. NO PRIOR CHEST STUDIES FOR COMPARISON." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. There are degenerative changes in the spine.", "output": "No pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephoneon ___ at 12:02 PM, 10 minutes after discovery of the findings." }, { "input": "The heart is normal in size. There is mild tortuosity along the descending aorta. Streaky left infrahilar opacities are most suggestive of minor atelectasis or bronchopneumonia in the lingula. There is no pleural effusion or pneumothorax.", "output": "Lingular opacity suggesting pneumonia versus atelectasis." }, { "input": "The NG tube is been removed. There are new bilateral lower lobe infiltrates and small bilateral pleural effusions right greater than left. There continues to be right sided subcutaneous emphysema that is decreased in amount compared to prior", "output": "Increased infiltrate/effusion right greater than left lower lobe." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs without focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Portable AP upright chest radiograph ___ at 12:34 is submitted.", "output": "Right subclavian PICC line in the proximal SVC. Overall cardiac and mediastinal contours are stable. There has been interval improvement in the patchy opacities predominantly within the right lung but also scattered in the left lung. Findings are consistent with resolving edema rather than an infectious process. No pneumothorax." }, { "input": "Cardiac silhouette is upper limits normal in size. There small bilateral pleural effusions. Compared to the study from the prior day the aeration in the lower lobes is improved. However, there is still an area of increased opacity in the right lower lung that may represent a small area of atelectasis versus infiltrate", "output": "Slight improved appearance of the lungs." }, { "input": "There are small bilateral pleural effusions. There is a right basilar opacity medially on the frontal view, not confirmed on the lateral. The lungs are otherwise clear. There is no focal consolidation. The cardiomediastinal silhouette is within normal limits. Left sided PICC is seen with tip in the lower SVC.", "output": "Small bilateral effusions. Right basilar opacity medially only on the frontal view is most likely atelectasis." }, { "input": "There is interval improvement in pulmonary vascular congestion. Minimal streaky density is consistent with subsegmental atelectasis. The would be difficult to exclude a focal infiltrate in the retrocardiac area. There is no definite effusion. The patient is status post median sternotomy and CABG. Allowing for differences technique, mediastinal structures are stable. An endotracheal tube and nasogastric tube have been withdrawn. A mediastinal drain and bilateral chest tubes remain in place. A right internal jugular catheter is unchanged in position.", "output": "No definite pleural effusion. There appears to be some interval improvement in vascular congestion." }, { "input": "There is a small left apical pneumothorax which was not apparent previously. The left lung apex now lies approximately 15 mm below the inferior margin of the left first rib. There is minimal streaky density at the lung bases consistent with subsegmental atelectasis. The lungs appear otherwise clear mediastinal structures are stable. Bilateral chest tubes, a mediastinal drain and a right internal jugular catheter remain in place.", "output": "Clearing of mild vascular congestion. There is interval development of a small left apical pneumothorax. No other significant change." }, { "input": "Interval removal of right IJ central venous catheter. The lungs are well expanded and clear. The hila and pulmonary vasculature are normal. Left pleural effusion is mild. No right-sided pleural effusion. No pneumothorax. The cardiomediastinal silhouette is stable.", "output": "Small left pleural effusion. Otherwise no acute cardiopulmonary process." }, { "input": "There is interval decrease in a very small left pneumothorax, which is now barely visible. The lungs remain otherwise essentially clear. The heart and mediastinal structures are unchanged. A mediastinal drain and chest tubes have been removed. A right internal jugular catheter remains in place.", "output": "Interval decrease in small left apical pneumothorax. No other change." }, { "input": "There is severe cardiomegaly, similar compared to remote prior exam. There are small bilateral effusions, larger on the left. There is superimposed mild pulmonary edema. Linear left mid lung opacity may be impart due to fluid in the fissure or atelectasis, focal infection is possible. No acute osseous abnormalities identified. Median sternotomy wires are noted. Atherosclerotic calcifications seen at the aortic arch.", "output": "Cardiomegaly and small bilateral effusions with mild pulmonary edema. Left lung opacity potentially atelectasis or fluid in the fissure although superimposed infection is possible." }, { "input": "The patient is status post coronary artery bypass graft surgery. A dual-lead pacemaker/ICD device with three leads appears unchanged. The heart is moderately enlarged. The cardiac, mediastinal and hilar contours appear unchanged. The lungs appear clear. There are no pleural effusions or pneumothorax. Mild degenerative changes are similar along the thoracic spine.", "output": "No evidence of acute disease." }, { "input": "Compared to the prior study, there has been some interval partial clearing of the alveolar infiltrate; however, there continues to be moderate cardiomegaly, pulmonary vascular redistribution, perihilar haze, and dense retrocardiac opacity. The ET tube, pacemaker, right IJ line, and NG tube are unchanged.", "output": "Slight improvement in pulmonary edema." }, { "input": "A single portable AP chest radiograph was obtained. There is mild improvement in moderate pulmonary vascular congestion. Moderate-to-severe cardiomegaly is unchanged. There is no new consolidation, large effusion, or pneumothorax. A right internal jugular dialysis catheter terminates in the right atrium. Biventricular and atrial pacing leads terminate in appropriate positions and connect with a left chest generator. Mediastinal clips and sternal wires are intact.", "output": "Mildy improved pulmonary vascular congestion." }, { "input": "Frontal and lateral views of the chest were compared to previous exam from ___. When compared to prior, there is more prominent central pulmonary vascular engorgement and indistinct pulmonary vasculature suggestive of pulmonary edema. There is no large effusion. Cardiac silhouette is enlarged but stable in configuration. Triple-lead pacing device is seen in stable position. Median sternotomy wires and mediastinal clips again noted. Osseous and soft tissue structures are unremarkable.", "output": "Findings suggestive of mild failure, similar to previous exam." }, { "input": "The three ICD leads are in place with unchanged position since prior radiograph on ___, extending to the expected positions of the right atrium, right ventricle, and coronary sinus. The patient is status post median sternotomy and coronary artery bypass surgery. The cardiomediastinal silhouette is enlarged, unchanged from prior chest x-ray. The lungs are clear. A calcified granuloma is noted in the right lower lobe, unchanged. A more peripheral focal opacity may represent an area of atelectasis.", "output": "1. Stable placement of ICD leads. 2. No acute cardiopulmonary abnormality." }, { "input": "The patient is status post coronary artery bypass graft surgery. There is a dual-lead pacemaker/ICD device that appears unchanged. A dual-lumen catheter terminates at the cavoatrial junction, as before. There is a PICC line coursing into the superior vena cava whose distal course is not well delineated on this examination, although it probably terminates in the superior vena cava. The patient has been extubated and an orogastric tube removed. The heart is moderately enlarged, as before. The mediastinal and hilar contours appear unchanged. Lung volumes are decreased and there is a new mild-to-moderate interstitial abnormality with perihilar fullness suggesting mild pulmonary edema. Persistent opacification of the left lung base has improved. It is difficult to exclude a pleural effusion on the left side. There is no pneumothorax.", "output": "Status post extubation. Findings suggesting mild pulmonary edema. Persistent left basilar opacification, but somewhat improved." }, { "input": "Mild pulmonary edema has minimally worsened since ___. Left pectoral ICD device with leads in standard position. Patient is following CABG and there is evidence of median sternotomy and intact sternal sutures. Moderately enlarged heart size is stable. Mediastinal and hilar contours are unchanged. Increased retrocardiac density reflecting left lower lung atelectasis or consolidation and small to moderate left pleural effusion is new. There is no pneumothorax.", "output": "1. Mild pulmonary edema has minimally worsened since ___. 2. Left lower lung and increased retrocardiac density reflecting atelectasis and/or consolidation and small to moderate left pleural effusion is new." }, { "input": "Heart size is top-normal with mild unfolding of the thoracic aorta. Hilar contours are unremarkable. Lung volumes are low accentuating the cardiac silhouette and pulmonary vasculature. There is mild left base atelectasis. Lungs are otherwise clear. Pleural surfaces are clear without effusion pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Large loculated left pleural effusion is seen with associated volume loss in the left lung. Small right pleural effusion. There is mild pulmonary edema. Right chest wall deformity with area of associated pleural opacity corresponds to pleural parenchymal scarring on CT. The bones are diffusely demineralized. Severe T8 wedge compression deformity was better evaluated on the CT.", "output": "1. Large loculated left pleural effusion with associated volume loss. 2. Small right pleural effusion. 3. Mild pulmonary edema." }, { "input": "Chest PA and lateral radiographs demonstrate slightly improved right lower lobe hazy opacity. No new focal opacifications evident. No pleural effusions or pneumothorax present. Stable cardiomediastinal and hilar contours. Unchanged mid thoracic compression fracture again noted.", "output": "Slightly improved right lower lobe opacification consistent with resolving pneumonia." }, { "input": "The heart size is within normal limits. The mediastinal contours demonstrate an unfolded aorta. Subtle opacity with air bronchograms coursing through in the right lung base is present. There is no large pleural effusion or pneumothorax. A mid-thoracic vertebral body compression fracture has been stable since ___.", "output": "Findings concerning for right lower lobe pneumonia; additional considerations include pulmonary hemorrhage or aspiration. Follow-up imaging to document resolution is recommended." }, { "input": "Right-sided chest tube is seen. There is no pleural effusion or pneumothorax noted. Post surgical changes noted in the right juxtahilar location including surgical clips and focal atelectasis or expected hemorrhage following wedge resection. The heart is normal in size. Normal cardiomediastinal silhouette. Focus of subcutaneous gas is seen in the right lateral chest.", "output": "No pneumothorax with expected post-surgical changes." }, { "input": "A left chest wall Port-A-Cath terminates in the right atrium. Numerous pulmonary metastatic lesions are seen within the lungs bilaterally. Given the size and number of these lesions, it is difficult to exclude an underlying pneumonia. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "1. Numerous pulmonary metastatic lesions bilaterally. Given the size and number of these lesions, it is difficult to exclude an underlying pneumonia. 2. No evidence of pulmonary edema." }, { "input": "PA and lateral views of the chest provided. Port-A-Cath resides over the right chest wall with catheter tip in the low SVC. Bilateral breast implants again noted. Left basal opacity likely represents atelectasis, the cannot exclude pneumonia, slightly increased from prior. No large effusion or pneumothorax. Cardiomediastinal silhouette is stable.", "output": "Left basal atelectasis, difficult to exclude a superimposed pneumonia." }, { "input": "PA and lateral views of the chest provided. Faint linear densities in the lower lungs, right greater than left likely represent areas of platelike atelectasis. No convincing evidence for pneumonia or edema. No effusion or pneumothorax is seen. The heart size appears normal. Mediastinal contour is unremarkable. The imaged bony structures are intact. Surgical clips are noted in the right upper quadrant.", "output": "Platelike atelectasis in the lower lungs without evidence of edema or pneumonia." }, { "input": "Since the prior radiograph, there has been a substantial decrease in size of the left pleural effusion which is almost completely resolved. There is no pneumothorax. A hazy opacity overlying the right upper lobe is unchanged and most likely represents an infection, although asymmetric edema could be considered. There is no right pleural effusion. A right PICC ends in the low SVC. The cardiomediastinal silhouette is normal and unchanged.", "output": "1. No pneumothorax. 2. Right upper lobe opacity is most likely pneumonia, although asymmetric edema can be considered." }, { "input": "The lungs are well aerated and grossly clear without evidence of focal consolidation. There is no pulmonary edema, pleural effusion, or pneumothorax. The cardiomediastinal silhouette hilar contours are normal.", "output": "No acute cardiopulmonary process" }, { "input": "AP and lateral views of the chest. No prior. The lungs are clear. Cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Compared to the prior study, there is a new retrocardiac and left lower lobe opacity opacity which may represent atelectasis, aspiration or pneumonia in the appropriate clinical setting.The cardiac, hilar and mediastinal contours are normal.No pneumothorax.", "output": "New left lower lobe and retrocardiac opacities may represent atelectasis or pneumonia." }, { "input": "There is flattening of the hemidiaphragms, which is consistent with chronic pulmonary disease. The mediastinal and cardiac silhouettes remain stable. There is no pleural effusion or pneumothorax. There is no new parenchymal opacification. Again noted is mild dextroscoliosis.", "output": "1. Stable chest radiograph with no acute changes." }, { "input": "NG tube is malpositioned with tip ending in upper esophagus. It has to be pushed down at least 25 cm. Lung volumes are lower with increased linear opacities especially in the upper lobe, as for emphysema. New linear opacities in the left retrocardiac region is likely linear atelectasis. There is no pleural effusion or pneumothorax. Cardiomediastinal silhouette is unchanged. There is no pneumothorax.", "output": "NG tube is malpositioned, ending in the upper esophagus and has to be pushed down. There is no new consolidation suggestive for acute cardiopulmonary process. Findings were discussed Dr. ___ with the nurse on service at 1 pm." }, { "input": "Single portable view of the chest. The lungs are hyperinflated. Diffusely increased interstitial markings are again seen suggestive of chronic underlying lung disease. Postoperative changes of left upper lobectomy are again noted. Enteric tube is seen with tip in the gastric fundus. Widening of the right AC joint and right lateral subluxation of one of the upper lumbar vertebral bodies is as seen on CT chest from ___.", "output": "No definite acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. The lungs are hyperinflated. Although on the frontal view the right lung base is unchanged, on the lateral there is slightly increased opacity in the retrocardiac region. Blunting of the costophrenic angles suggests small pleural effusions. Cardiomediastinal silhouette is unchanged. Superior retraction of the left hilum with surgical chain sutures in the suprahilar region are again seen. Cardiomediastinal silhouette is unchanged.", "output": "Better seen on the lateral view is slightly increased opacity in the retrocardiac region, potentially could be infectious, and followup will be necessary given patient's history." }, { "input": "PA and lateral views of the chest. The lungs are hyperinflated. Lung nodules better seen on prior exam. There is no confluent consolidation. No new effusion. Cardiomediastinal silhouette is unchanged. No acute osseous abnormality detected.", "output": "Hyperinflation without acute cardiopulmonary process." }, { "input": "The NG tube tip is in the stomach. There is dense retrocardiac opacity compatible with volume loss/infiltrate/effusion. There is diffuse increase in interstitial markings, right greater than left and it is unclear if this is secondary to asymmetric pulmonary edema or an infectious process. There is volume loss in the right lower lobe as well. The heart is moderately enlarged and is larger than on the prior study. There are bilateral effusions, left greater than right.", "output": "Asymmetric pulmonary edema versus infection." }, { "input": "The lungs appear hyperinflated and somewhat lucent suggesting underlying emphysema. There is retrocardiac opacity which in the correct clinical setting may represent pneumonia or atelectasis. There is tiny left pleural effusion. Chain sutures in the left suprahilar region reflect prior resection. The cardiomediastinal silhouette is stable. No pneumothorax. No bony injury.", "output": "Emphysema with subtle opacity in the left lower lobe possibly pneumonia or atelectasis. Postsurgical changes at the left suprahilar region." }, { "input": "The cardiac silhouette size is normal. Mediastinal and hilar contours are unchanged, with evidence of prior left upper lobectomy and volume loss in the left lung. The lungs are hyperinflated with emphysematous changes again demonstrated. Focal patchy opacity in the right upper lobe was present on the prior CT from ___, and may reflect persistent or residual pneumonia. Additional previously noted areas concerning for early adenocarcinoma on prior CT particularly within the right lower lobe are not well seen on the current radiograph. No new areas of new focal consolidation are present. There is no new pneumothorax or pleural effusion. No pulmonary edema is present.", "output": "1. Persistent patchy opacity in the right upper lobe, which was present on the prior CT, and may reflect persistent or residual pneumonia. 2. Emphysema. 3. Other areas of potential early adenocarcinoma within particularly the right lower lobe are better assessed on the previous CT." }, { "input": "PA and lateral views of the chest. There is right lower lobe consolidation. There may also be subtle opacity in the retrocardiac region on the left on the frontal view as well. Superiorly the lungs are clear. Cardiomediastinal silhouette is normal. No acute osseous abnormality detected.", "output": "Right lower lobe consolidation compatible with pneumonia. Potential retrocardiac opacity as well. Recommend repeat after treatment is suggesteded to document resolution." }, { "input": "The heart is normal in size, and there is a right subclavian Port-A-Cath which terminates at the cavoatrial junction. Increased opacity seen in the right perihilar opacity with possible architectural distortion and suspected surgical chain sutures projecting over the mid lung. There is also focal opacity projecting over the left midlung. The lungs are clear of focal consolidation, pleural effusion or pneumothorax. There is mild central pulmonary vascular congestion.", "output": "Increased right perihilar opacity with possible postsurgical changes. Additional left midlung opacity. In light of patient's history of metastatic breast cancer, dedicated cross-sectional imaging by CT is suggested unless recent scan was performed elsewhere for further evaluation. No definite acute cardiopulmonary process. RECOMMENDATION(S): In light of patient's history of metastatic breast cancer, dedicated cross-sectional imaging by CT is suggested unless recent scan was performed elsewhere for further evaluation." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well expanded and clear. There is no consolidation, effusion, or pneumothorax. Cardiac and mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "There has been interval removal of the malpositioned Dobbhoff tube. There is no evidence of pneumothorax. Small bilateral pleural effusions are likely. The cardiomediastinal and hilar contours are normal. Lung volumes are low, but there is no focal consolidation concerning for pneumonia. Right PICC line is again noted, tip terminating in the mid SVC. The upper abdomen is unremarkable in appearance.", "output": "Interval removal of the malpositioned Dobbhoff tube with no evidence of pneumothorax or other complication." }, { "input": "A newly placed NG tube terminates in the stomach. The Swan-Ganz catheter has been removed. Small bilateral pleural effusions with minimal bibasilar subsegmental atelectasis are unchanged. There is no pneumothorax. Mild cardiomegaly despite the projection is unchanged.", "output": "Newly placed NG tube terminates in the stomach. No other significant interval change." }, { "input": "There has been interval removal of the prior enteric tube with attempted placement of a Dobbhoff tube, with the first image showing the Dobbhoff tube terminating in the right lower lobe bronchus, and the second showing the Dobbhoff tube in the left main bronchus. A right PICC line is present with tip terminating in the mid SVC. The heart is borderline enlarged. Mediastinal and hilar contours are unremarkable. There is no large pleural effusion or pneumothorax. Biapical pleural scarring is again noted. Please note that the right costophrenic angle is not captured on this exam. Lung volumes are low, and there is no focal consolidation concerning for pneumonia.", "output": "Malpositioned Dobbhoff tube into the bronchial tree. At the time of this report, subsequent imaging shows removal of malpositioned Dobbhoff." }, { "input": "Again identified are bilateral mid and lower zone patchy opacity, unchanged compared to the prior radiograph. There is a new small right pleural effusion. No pneumothorax present. Unchanged cardiomegaly. Bony thorax is unchanged.", "output": "New small right pleural effusion with unchanged bilateral mid and lower lobe opacities compatible with atelectasis and/ or aspiration pneumonitis in the right clinical setting. Stable cardiomegaly." }, { "input": "The endotracheal and nasogastric tubes have been removed. The right IJ central venous catheter has also been removed. Swan-Ganz catheter terminates in the right pulmonary artery. There is no pneumothorax. There is no significant interval change in basilar subsegmental atelectasis and small bilateral pleural effusions. Moderate cardiomegaly despite the projection is also unchanged.", "output": "Status post removal of right IJ central venous line, endotracheal and nasogastric tubes with no other significant interval change." }, { "input": "A right internal jugular central venous catheter ends in the upper aspect of the right atrium, unchanged. A left-sided Swan-Ganz catheter ends within the interlobar portion of the right pulmonary artery. The endotracheal tube is appropriately positioned, ending 3.6 cm above the level of the carina. An enteric catheter passes below the level of the diaphragm, ending within the stomach. There is mild to moderate pulmonary edema, slightly worse. There are small bilateral pleural effusions. The cardiomediastinal silhouette is unchanged.", "output": "1. Slight worsening mild to moderate pulmonary edema. 2. Small bilateral pleural effusions. 3. Unchanged positioning of Swan-Ganz catheter, with its tip within the interlobar portion of the right pulmonary artery. This catheter could be withdrawn a few centimeters for standard positioning." }, { "input": "Heart is upper limits of normal in size. Pulmonary vascular congestion is accompanied by bilateral perihilar and basilar hazy opacities as well as more confluent opacification at the right base. Small to moderate bilateral pleural effusions are also demonstrated.", "output": "Perihilar and bibasilar opacities are most suggestive of pulmonary edema in the setting of pulmonary vascular congestion and pleural effusions. However, followup radiographs after diuresis may be helpful to ensure resolution and to exclude coexisting pneumonia at the right lung base." }, { "input": "Frontal and lateral views of the chest. The lungs are hyperinflated. There is anopacity projecting over the left lung base on the frontal and perhaps correlates with a vague opacity overly the spine on the lateral. The lungs are otherwise clear of focal consolidation, noting bi-apical partially calcified scarring. Cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications noted at the aortic arch. No acute osseous abnormalities are seen.", "output": "Hyperinflation. Increased opacity projecting over the left lung base. Repeat PA and lateral suggested to further characterize and if persists, CT scan may be necessary." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of normal size with normal cardiomediastinal contours. The lungs are clear without focal or diffuse abnormality. No pleural effusion or pneumothorax. Pulmonary vasculature is unremarkable. Mild degenerative changes of the right acromioclavicular and glenohumeral joints are present. Osseous structures are otherwise unremarkable. No radiopaque foreign bodies.", "output": "No acute cardiopulmonary process." }, { "input": "Right IJ terminates in the mid SVC. No pneumonia. No pulmonary edema. Stable appearance of the cardiomediastinal silhouette. No pleural effusion. No pneumothorax.", "output": "Right IJ terminates in the mid SVC." }, { "input": "AP upright and lateral views of the chest provided.The lungs appear grossly clear though volumes are low. No large effusion or pneumothorax. The cardiomediastinal silhouette appears within normal limits. Bony structures are intact.", "output": "No acute intrathoracic process." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable", "output": "No acute cardiopulmonary abnormalities" }, { "input": "Frontal and lateral views of the chest. There is a focal opacity at the left lung base laterally, not clearly identified on the lateral view. Elsewhere, the lungs are clear. No pleural effusion, pneumothorax or pulmonary vascular congestion. The cardiac silhouette is normal in size. No acute osseous abnormality is identified.", "output": "Focal opacity at the left lung base laterally, potentially atelectasis, although infection cannot be entirely excluded. Clinical correlation is suggested." }, { "input": "Frontal and lateral views of the chest were obtained. There is mild bibasilar atelectasis. Lungs remain hyperinflated with faint reticular interstitial opacity, stable since the prior study, suggesting preexisting chronic obstructive pulmonary disease. No new focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The very inferior posterior costophrenic angles are excluded from the lateral view. The cardiac and mediastinal silhouettes are stable.", "output": "No significant interval change." }, { "input": "No evidence of pneumothorax. Mediastinal and hilar contours are normal. Volumes are persistently low, however, lungs appear stable with focal linear opacities at the bases that likely represent atelectasis. No pleural effusion is seen. No free air under the diaphragms.", "output": "No evidence of pneumothorax. Persistently low lung volumes with bibasilar atelectasis." }, { "input": "Left-sided AICD is noted with leads terminating in the region of right atrium and right ventricle, unchanged. Heart size is mildly enlarged. Mediastinal hilar contours are unremarkable. Pulmonary vasculature is. Lungs are clear except for subsegmental atelectasis in the right lung base. No focal consolidation, pleural effusion is. Acute osseous abnormalities are seen", "output": "No acute cardiopulmonary abnormality. AICD leads in unchanged positions." }, { "input": "AP upright and lateral views of the chest provided. Right IJ access Port-A-Cath is again noted with catheter tip in the region of the low SVC. Low lung volumes limits assessment. There is basilar atelectasis and bronchovascular crowding. No large effusion, pneumothorax. No convincing signs of pneumonia or edema. The heart appears enlarged though this in part could reflect technique. Mediastinum appears prominent also likely due to technique. Bony structures appear intact.", "output": "As above." }, { "input": "The lungs are well expanded, without focal opacities. There is mild vascular upper redistribution. The heart is moderately enlarged, mostly from right ventricular contribution. There is no pleural effusion or pneumothorax.", "output": "Volume overload in the setting of moderate cardiomegaly mostly from right ventricular enlargement." }, { "input": "The cardiac silhouette is markedly enlarged, possibly slightly increased as compared to the prior study. No overt pulmonary edema is seen. No pleural effusion or focal consolidation, or evidence of pneumothorax is seen. Mediastinal contours are stable.", "output": "Marked enlargement of the cardiac silhouette, possibly slightly increased as compared to the prior study given differences in technique." }, { "input": "There is evidence of right lung volume loss with tenting of the right hemidiaphragm and opacification in the right apex compatible prior right upper lobectomy. Ill-defined focal opacification within the right upper lung field appears progressed compared to the prior radiograph from ___ but is unchanged compared to the radiograph performed earlier the same day. The cardiac silhouette is normal in size. The aorta is slightly unfolded. There is no pulmonary vascular congestion. Left lung is clear. No pleural effusion or pneumothorax is identified. Degenerative changes are seen within the thoracic spine.", "output": "IStatus post right upper lobectomy with ill-defined opacification within the right upper lung field which could reflect post treatment changes, though infection or neoplasm is not excluded. Comparison with prior cross sectional imaging is recommended, and if none are available, a dedicated chest CT is suggested." }, { "input": "The heart is normal size and cardiomediastinal contours are within normal limits. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No evidence of pneumonia." }, { "input": "The patient is status post placement of a single lead ICD, with the tip of the lead overlying expected location of the right ventricle. However, precise location is difficult to confirm due to marked patient rotation and single view technique. With this in mind, standard PA and lateral chest radiograph may be helpful to confirm location when the patient's condition permits. There is no evidence of pneumothorax. Cardiac silhouette is enlarged, and the aorta is tortuous, both grossly without change allowing for rotation. Lungs are clear except for minimal linear atelectasis in the right lower lobe. Questionable small right pleural effusion, which can be confirmed or excluded by PA and lateral chest radiograph as well.", "output": "ICD lead overlies expected location of right ventricle with no visible pneumothorax. Standard PA and lateral chest radiograph may be helpful to confirm lead placement when the patient's condition permits." }, { "input": "There is a small left pleural effusion with blunting of the lateral and posterior costophrenic angles. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. Compression deformity of a mid/lower thoracic vertebral body is noted.", "output": "Small left pleural effusion. Compression deformity of a mid thoracic vertebral body, age indeterminate to be correlated clinically." }, { "input": "As compared to prior chest radiograph from ___, there has been no significant change. Endotracheal tube terminates 7 cm above the carina. A right subclavian catheter terminates in the mid-to-lower SVC. Nasogastric tube terminates in the gastric fundus. The cardiomediastinal and hilar contours are within normal limits. Lungs are clear. There are no pleural effusions or pneumothorax.", "output": "No radiographic evidence of acute cardiopulmonary process." }, { "input": "An endotracheal tube terminates 5 cm above the carina. A right subclavian catheter terminates in the mid to lower SVC. Nasogratric tube terminates in the gastric fundus. As compared to prior chest radiograph, there has been no significant change. Cardiomediastinal and hilar contours are within normal limits. Lungs are essentially clear. Note is made of a small granuloma in the lateral aspect of the left upper lung. There are no pleural effusions or pneumothorax.", "output": "No radiographic evidence of an acute cardiopulmonary process." }, { "input": "Frontal AP and lateral views of the chest were obtained. Low lung volumes result in bronchovascular crowding. There is no focal consolidation, pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes and hilar contours are stable with mild cardiomegaly. Loss of vertebral body height at multiple levels in the thoracic spine is unchanged.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear.The cardiac, hilar and mediastinal contours are normal.No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs are clear. There is no effusion or pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormality detected.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. There is no effusion or pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac silhouette size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is not engorged. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is demonstrated. No acute osseous abnormality is visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. There is likely a small left pleural effusion with minimal adjacent atelectasis. No focal consolidation or pneumothorax is identified. Surgical clips and the stent are identified in the upper abdomen.", "output": "Likely small left pleural effusion minimal adjacent atelectasis." }, { "input": "Small left pleural effusion with overlying atelectasis persists. No right pleural effusion is seen. The right lung appears clear. There is no evidence of pneumothorax. The cardiac and mediastinal silhouettes are stable.", "output": "Persistent small to moderate left pleural effusion with overlying atelectasis." }, { "input": "AP upright and lateral views of the chest provided. There is a small left pleural effusion with compressive atelectasis in the left lower lung. A tiny right pleural effusion is also noted. The right lung is clear. Cardiomediastinal silhouette is normal. Bony structures are intact. A CBD metallic stent projects over the right upper quadrant. Clips are noted in the upper abdominal midline. No free air below the right hemidiaphragm. Gas-filled loops of small bowel in the upper abdomen noted, question mild ileus.", "output": "Pleural effusions, left greater than right, both small. Possible mild adynamic ileus in the upper abdomen. Please correlate clinically." }, { "input": "There is moderate cardiomegaly with moderate pulmonary edema, progressed since ___. Right internal jugular access central line ends at the cavoatrial junction. There are small bilateral pleural effusions. No pneumothorax.", "output": "1. Moderate cardiomegaly and pulmonary edema, progressed since ___, 2. Right IJ line ends at the ___ junction." }, { "input": "The lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. The aorta is tortuous. Atherosclerotic calcifications are seen in the aortic arch. There is no pleural effusion or pneumothorax. No fracture is identified.", "output": "Unremarkable chest radiographic examination." }, { "input": "There is persistent moderate-sized right pleural effusion with compressive atelectasis. No left pleural effusion is seen. Right lower lung underlying consolidation cannot be excluded. No pneumothorax is seen. Heart size is likely enlarged but difficult to evaluate in the setting of overlying right pleural effusion. Right upper quadrant pigtail catheter seen. Diffuse osteopenia is noted. Lower thoracic vertebral body compression deformity is unchanged compared to multiple recent prior exams.", "output": "Persistent moderate-sized right pleural effusion. Underlying consolidation cannot be excluded." }, { "input": "AP and lateral views of the chest ___ at 11:20 are submitted.", "output": "Lung volumes are slightly low. No focal airspace consolidation is seen to suggest pneumonia. No pulmonary edema, pleural effusions or pneumothorax. Overall cardiac and mediastinal contours are within normal limits given AP technique. Opacity in the right cardiophrenic angle most likely reflects a prominent pericardial fat pad. Degenerative changes are seen in the thoracic spine." }, { "input": "The lungs are clear of focal consolidation or effusion. The cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. Heart size and cardiomediastinal contours are normal. Multifocal pneumonia has virtually cleared since ___. Lungs are otherwise clear and there is no pleural effusion.", "output": "Nearly resolved pneumonia. No new consolidation or pleural effusion. No indication for radiographic followup." }, { "input": "PA and lateral chest radiographs demonstrate right basilar opacification with obscuration of the right heart border and right hemidiaphragm, consistent with pneumonia of the right middle and lower lobes. There is no pleural effusion or pneumothorax. The heart size is normal.", "output": "Right middle and right lower lobe pneumonia." }, { "input": "The lungs are hyperexpanded, diffusely radiolucent, with well-delineated vasculature suggestive of COPD. No focal opacities are present. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary process. The mediastinum is not widened." }, { "input": "PA and lateral views of the chest. The lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormality detected.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. The heart and mediastinal structures are unremarkable. The bony thorax is grossly intact.", "output": "No active disease." }, { "input": "Single frontal view of the chest demonstrates normal cardiomediastinal silhouette allowing for AP technique and slightly low lung volumes. The lungs are clear without pneumothorax or pleural effusion. There is no definite confluent consolidation to reflect pneumonia. Multiple left rib deformities are consistent with remote fractures.", "output": "No definite evidence of pneumonia." }, { "input": "The patient is status post median sternotomy and CABG. The aorta is calcified and tortuous. The cardiac silhouette is top-normal in size. Minimal left basilar atelectasis is seen. There is no focal consolidation, pleural effusion, or evidence of pneumothorax. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac, mediastinal and hilar contours are normal. The lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities seen.", "output": "No acute cardiopulmonary process." }, { "input": "A focal opacity is noted in the right lower lobe, concerning for infection. Mild patchy opacity is also noted in the left lung base, potentially atelectasis or additional site of infection. The cardiomediastinal silhouette and hilar contours are unremarkable. No pulmonary edema or pneumothorax.", "output": "Right lower lobe pneumonia. Additional patchy opacity in the left lung base could reflect atelectasis or additional site of infection." }, { "input": "The cardiac, mediastinal and hilar contours appear stable including fullness of the upper mediastinal contour to the left of midline, reflecting a combined shadow of the aorta and main pulmonary artery, which is probably borderline enlarged. This area did not show involvement for malignancy on the prior PET-CT but the trachea does appear splayed somewhat more towards the right with a more horizontal configuration to the left main stem bronchus. Possibly, this could indicate developing mediastinal lymphadenopathy. An irregular mass at the left lung apex appears unchanged allowing for differences in technique. Streaky opacities at the left lung base indicates minor atelectasis or scarring. There is no pleural effusion or pneumothorax. There are three new mild compression deformities since remote prior radiographs from ___, although somewhat difficult to compare to more recent studies such as radiographs from ___, although the indication is that at least the lower two, which probably relate to the T10 and T11 vertebral bodies, are new since ___ and similar but more likely increased since the more recent PET-CT dated ___.", "output": "1. No evidence of acute cardiopulmonary disease. 2. Mild change in the configuration of the mediastinum, which raises concern for developing lymphadenopathy. 3. Several mild compression fractures of the thoracic spine, the lower two of which (probably involving T10 and T11), likely acute or subacute." }, { "input": "Cardiomediastinal silhouette is stable. Lungs are clear without focal consolidation, pleural effusion, or pneumothorax.", "output": "No focal consolidation concerning for aspiration and/or pneumonia." }, { "input": "The lungs are well inflated and clear. There is slight elevation of the left hemidiaphragm with air-filled loops of large bowel underneath the diaphragm. There is no pleural effusion or pneumothorax. Heart size and mediastinal contours are normal. Osseous structures are intact.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is mildly enlarged. The mediastinal and hilar contours are unremarkable. Pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is present. Minimal atelectasis is noted in lung bases. There are no acute osseous abnormalities degenerative changes are seen within the right acromioclavicular joint and thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear. There is no consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no pleural effusion, focal consolidation or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Analysis is performed in direct comparison with the next preceding similar study of ___. Chest findings are completely unaltered between the two examinations of ___ and ___. Thus, there is no evidence of any rib fracture or detectable chest wall injury. The patient underwent a right-sided specific rib cage examination on ___, again with negative results. The patient's character of symptoms may call for repeat of a dedicated rib examination.", "output": "Unremarkable chest findings, no evidence of chest wall or rib injury in right lower hemithorax." }, { "input": "No consolidation, pleural effusion or pulmonary edema is seen, and the cardiac and mediastinal contours are normal. No rib fractures are visualized.", "output": "No acute cardiopulmonary disease including pneumonia." }, { "input": "The heart is borderline in size. The mediastinal and hilar contours are unremarkable. The chest is hyperinflated. The lungs appear clear. There is no pleural effusion or pneumothorax. Surgical clips project along the left axilla.", "output": "Hyperinflation. No definite evidence for acute cardiopulmonary disease." }, { "input": "Right pleural effusion has increased and left pleural effusion appears unchanged. Bibasilar atelectasis is seen. No pneumothorax is seen. Heart and mediastinal contours are stable. Aortic stent graft is again noted. Right internal jugular catheter is similarly positioned.", "output": "Bilateral pleural effusions with adjacent atelectasis, increased on the right." }, { "input": "Right internal jugular line ends at upper SVC. There is an aortic stent graft extending from the level of the aortic arch to the mid descending thoracic aorta. Mild-to-moderate left pleural effusion has minimally increased whereas right-sided small pleural effusion associated with right basal atelectasis is new. Heart size, mediastinal and hilar contours are within normal limits. Upper lungs are clear.", "output": "Mild-to-moderate left pleural effusion associated with left lower lung atelectasis has worsened whereas small right pleural effusion and mild right basilar atelectasis is new since ___. Stable cardiomediastinal silhouette." }, { "input": "Compared with the prior study of ___, numerous left-sided rib fractures have become moderately displaced with inward collapse at the fracture site. No definite pneumothorax is appreciated. Increased density of both lung bases is likely related to compression atelectasis from the partial chest wall collapse. There may be small bilateral pleural effusions.", "output": "1. New moderate displacement and angulation of multilevel rib fractures. 2. Increased bibasilar opacification likely due to compressive atelectasis. 3. No definite pneumothorax. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ On the telephone on ___ at 4:32 PM, 10 minutes after the discovery of the findings." }, { "input": "A tiny left apical pneumothorax is unchanged. Opacity left lower lobe corresponds to a known hemothorax in the left lower lobe contusion. Cardiomegaly is stable. The aortic knob is calcified. Multiple rib fractures are better characterized on the prior CT chest.", "output": "Tiny left apical pneumothorax is unchanged." }, { "input": "PA and lateral radiographs of the chest demonstrate clear lungs and normal hilar and cardiomediastinal contours. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal.", "output": "Normal radiographs of the chest." }, { "input": "Frontal and lateral views of the chest. The lungs are clear without focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. Mid-to-lower thoracic dextroscoliosis is noted. No displaced rib fracture is identified.", "output": "No acute cardiopulmonary process. No rib fracture identified on this non-dedicated exam. If desired, a rib series can be performed." }, { "input": "The lungs are well-expanded and clear. The cardiomediastinal silhouette is unremarkable. There is no pleural effusion, pulmonary edema, pneumothorax, or focal consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is a patchy right infrahilar opacity within the right lower lobe with suggestion that it may be due to atelectasis, although it is not completely specific. Elsewhere, the lungs appear clear. There is no evidence for pulmonary edema. No pleural or pericardial effusions are seen. The osseous structures are unremarkable.", "output": "Patchy non-specific right infrahilar opacity, which could be seen with atelectasis, although the possibility of pneumonia is not excluded in the appropriate setting." }, { "input": "There is a new consolidation at the right lung apex with sharp margins representing the fissure compatible with right upper lobe collapse. The extreme right lung apex is partially aerated. Hazy opacification at the right lung base likely reflects a small layering pleural effusion. The left lung base shows a small pleural effusion and mild degree of atelectasis, as before. The known right mediastinal mass is not well visualized due to right upper lobe collapse. No pneumothorax is appreciated. The cardiomediastinal silhouette is incompletely evaluated but likely unchanged.", "output": "1. New right upper lobe collapse. 2. Small bilateral pleural effusions and left basilar atelectasis, similar to ___. NOTIFICATION: Findings were communicated by Dr. ___ to Dr. ___ ___ telephone at 1:30 p.m. on ___." }, { "input": "Single portable view of the chest. Low lung volumes are noted. Known right hilar mass is redemonstrated. Linear right basilar opacity is likely due to atelectasis superimposed on a right-sided effusion which has not significantly changed. Left upper lung nodular opacities concerning for metastatic disease as previously seen on CT. There is no definite new consolidation. Azygos lobe is again noted.", "output": "Known right perihilar mass and right pleural effusion with associated atelectasis. No definite superimposed acute process based on this portable film with low lung volumes." }, { "input": "Since prior, there remains a large right pleural effusion with an air-fluid level suggesting a component of hydropneumothorax. Right perihilar mass is again seen. A retrocardiac nodule is redemonstrated. There is no left pleural effusion. Cardiomediastinal silhouette is unchanged.", "output": "No significant change to large right pleural effusion with an air-fluid level suggesting a component of hydropneumothorax." }, { "input": "AP upright and lateral views of the chest were obtained. A large ovoid mass extends from the right hilus toward the right upper lobe. Cardiomediastinal contour is otherwise unremarkable. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "Large right hilar mass. CT is recommended for further evaluation." }, { "input": "There is increased opacification of the at the right lung suggesting complete right lung collapse and opacification of the previously noted small aerated portion of the right upper lobe. The left lung appears relatively well aerated. The mediastinum appears shifted to the left despite the collapse suggesting a large right pleural effusion.", "output": "Increased right lung collapse, now with complete collapse. The mediastinum is however shifted to the left suggesting that there is substantial right pleural effusion." }, { "input": "There is stable mild cardiomegaly. The mediastinum and hilar silhouettes are unremarkable. The lungs are clear without evidence of focal consolidations, pleural effusions or pneumothorax. There is relatively large prominence of the pulmonary arteries bilaterally the unchanged studies. The aorta is tortuous and calcified which is unchanged from previous studies", "output": "No acute intrathoracic findings." }, { "input": "PA and lateral views of the chest. The lungs are clear. There is no effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormality detected. Surgical clips in the right upper quadrant suggest prior cholecystectomy.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs are clear. The cardiomediastinal silhouette is within normal limits. Thoracic aorta is tortuous with calcifications at the aortic arch. No acute osseous abnormalities. Surgical clips noted in the upper abdomen.", "output": "No acute cardiopulmonary process." }, { "input": "Single AP view of the chest demonstrates clear lungs. The cardiac, mediastinal, and hilar contours are normal. No pleural abnormality is seen. No subdiaphragmatic free air is noted. The osseous structures are normal.", "output": "No evidence of cardiopulmonary process or pneumoperitoneum." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes. There is no pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Mild tortuosity of the descending aorta is noted. Heart size is normal. There is no pulmonary edema.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of normal size with normal cardiomediastinal contours. Lung volumes are low. Subtle nodular densities in the right mid lung inferior to the right scapula are new since the prior exam. The lungs are otherwise clear without focal consolidation. There is no pneumothorax or pleural effusion. As previously noted, there is DISH of the thoracic spine. The osseous structures are otherwise unremarkable. No radiopaque foreign bodies are present.", "output": "1. No acute cardiopulmonary process. 2. Subtle right mid lung nodular densities. A chest CT may be obtained on a non-emergent basis for further evaluation. Findings were communicated by ___ to Dr. ___ via phone on ___ at ___." }, { "input": "2 views of the chest. The lungs are well expanded with mild basal atelectasis. There is no pleural effusion or pneumothorax. The heart and mediastinal contours are unremarkable. No displaced rib fractures are identified.", "output": "No acute intrathoracic process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Focal opacity in the left lower lobe obscuring the left hemidiaphragm consistent with pneumonia. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Left lower lobe pneumonia NOTIFICATION: The findings were discussed with ___, Practice assistant by ___, M.D. on the telephone on ___ at 4:23 PM, 15 minutes after discovery of the findings." }, { "input": "The lung volumes are normal. Normal size of cardiac silhouette. No pleural effusions. Interval improvement and resolution of left lower lobe pneumonia. No focal opacities. No pulmonary edema. No pneumothorax. Normal hilar and mediastinal contours. The osseous structures are stable.", "output": "Interval resolution of left lower lobe pneumonia." }, { "input": "There is no large pulmonary mass or nodule. Streaky opacification at the right base is likely atelectasis. There is no pulmonary edema, pleural effusion or pneumothorax. The thoracic aorta is tortuous or minimally dilated. The cardiac size is normal.", "output": "1. No evidence of pulmonary malignancy. 2. Right basilar atelectasis." }, { "input": "Compared with the prior study and allowing for technical differences, no definite change. Again seen is left-sided pacemaker with lead tips over the right atrium and right ventricle, sternotomy wires, and prosthetic tricuspid and mitral valves. Unusual configuration of wires over the superior mediastinum is unchanged compared with ___ in appears to reflect the presence of a sternal defect. Again seen is cardiomegaly and CHF, with vascular plethora and interstitial edema. There is bibasilar atelectasis, similar to prior. No gross effusion. As before, the pulmonary arteries are enlarged, suggestive of pulmonary hypertension. Incidental note is again made of deformity of the right humeral head, which may reflect an old fracture.", "output": "Cardiomegaly with CHF and bibasilar atelectasis, similar to ___. No effusions identified." }, { "input": "There is a left-sided chest wall pacemaker with leads projecting over the right atrium and right ventricle. The heart is moderately enlarged. There is moderate pulmonary edema. Blunting of the right costophrenic angle could reflect a small amount of pleural fluid. There is no pneumothorax.", "output": "Moderate cardiomegaly and moderate pulmonary edema." }, { "input": "Lungs are fully expanded without focal opacity. Retrocardiac atelectasis is improved. Pulmonary edema has increased, but remains mild. Moderate cardiomegaly is unchanged. No pleural effusion. A left pectoralis dual-chamber pacemaker, prostatic cardiac valve, and median sternotomy wires, some of which are fractured, are again noted and unchanged. Dense aortic arch calcifications are again noted.", "output": "Increased, but mild pulmonary edema." }, { "input": "AP portable upright view of the chest. Midline sternotomy wires and prosthetic cardiac valve again noted. There is a left chest wall pacemaker with leads extending to the region the right atrium and right ventricle as on prior. There is persistent mild cardiomegaly with hilar congestion and mild pulmonary edema. No large effusion or pneumothorax seen. Bony structures are intact.", "output": "Stable cardiomegaly with hilar congestion and mild edema." }, { "input": "Mild pulmonary edema is increased since the prior study. Dilatation of the bilateral pulmonary arteries is compatible with pulmonary arterial hypertension. Cardiac silhouette is moderately enlarged. No focal consolidation, pleural effusion, or pneumothorax is seen. A left chest pacemaker and leads are in unchanged positions. Tricuspid and mitral valves replacements are again seen.", "output": "Mild pulmonary edema and enlargement of the pulmonary arteries." }, { "input": "PA and lateral views of the chest provided. Midline sternotomy wires and mediastinal clips are noted. The lungs are hyperinflated though appear clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process" }, { "input": "Heart size is borderline enlarged. Mediastinal and hilar contours are within normal limits. Pulmonary vasculature is normal patchy opacities are noted in the lung bases which may reflect areas of atelectasis. No pleural effusion, focal consolidation or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Patchy opacities in lung bases may reflect atelectasis, though early infection is not excluded in the correct clinical setting." }, { "input": "Venous catheter tip mid SVC. Decreased pulmonary vascularity. Mild interstitial prominence, improved. No pleural fluid. Normal heart size.", "output": "Interval improvement." }, { "input": "Heart size is top normal. The mediastinal and hilar contours are unremarkable. No pulmonary edema is present. There is no focal consolidation, pleural effusion or pneumothorax. Streaky left lower lobe opacity may reflect atelectasis. No acute osseous abnormalities seen.", "output": "Streaky left lower lobe opacity likely reflects minimal atelectasis." }, { "input": "Compared with the immediate prior study there is new right lower lobe airspace opacity consistent with pneumonia. There is no pleural effusion, pneumothorax, or significant pulmonary edema. The cardiomediastinal silhouette is stable. A right PICC terminates in the cavoatrial junction.", "output": "New right lower lung pneumonia. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 1:53 PM, 2 minutes after discovery of the findings." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest demonstrate normal cardiomediastinal silhouette. The lungs are clear, without pneumothorax, confluent consolidation, or pleural effusion. The airway is midline. Osseous structures appear intact.", "output": "No evidence of pneumonia." }, { "input": "The endotracheal tube ends 2.9 cm above the level of the carina. The NG tube ends at the level of the gastroesophageal junction, although the side port is in the distal esophagus. Lung volumes are low. There is minimal bibasilar atelectasis. Heart size is normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen. The bony thorax is grossly intact.", "output": "1. No acute cardiac or pulmonary process. 2. NG tube side port ends in the distal esophagus. Recommend advancing." }, { "input": "There is a moderate to large left pleural effusion with overlying atelectasis. The right lung is clear. The size of the cardiomediastinal silhouette is enlarged but unchanged. Multiple compression deformities of the thoracic spine, age indeterminate. Chronic appearing right posterior rib fractures.", "output": "Moderate to large left pleural effusion with overlying atelectasis, not significantly changed from prior. Age indeterminate thoracic vertebral body compression deformities." }, { "input": "Right PICC line tip projected over medial right clavicle. Patchy bibasilar opacities, stable. Tiny pleural effusions. More prominent heart size. Normal pulmonary vascularity. Aortic calcification. Stable osseous findings.", "output": "Right PICC line tip projected over medial right clavicle" }, { "input": "There has been interval placement of a right basilar chest tube with marked interval decrease in size of the right pleural effusion, now with only a residual small right pleural effusion remaining. No pneumothorax is clearly identified. Layering moderate left-sided pleural effusion is unchanged with associated left basilar atelectasis. Moderate enlargement of cardiac silhouette is re- demonstrated with tortuosity of the thoracic aorta again noted. There is mild pulmonary vascular congestion. Right axillary vascular stent is re- demonstrated.", "output": "Marked interval decrease in size of the right pleural effusion, now small, with right basilar chest tube in place. No pneumothorax identified. Persistent moderate layering left pleural effusion with left basilar opacity, likely atelectasis." }, { "input": "Portable upright radiograph of the chest again demonstrates median sternotomy wires. There is no evidence of pleural effusion, pulmonary edema, pneumothorax or focal pneumonia within the bilateral lungs. The cardiomediastinal silhouette is unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "Overall appearance is similar to the immediate prior study. A moderate layering left pleural effusion is unchanged with associated atelectasis. A right basilar chest tube is in unchanged location with a slight interval increase in the right pleural effusion. Mild pulmonary vascular congestion and cardiac enlargement are stable. There is no pneumothorax or focal consolidation. A calcified tortuous aorta is unchanged. Multiple surgical clips and midline sternotomy wires there is unchanged.", "output": "1. Slight interval increase in small right pleural effusion with pigtail catheter in place. 2. No pneumothorax." }, { "input": "The patient is status post median sternotomy and coronary artery bypass grafting. Marked cardiomegaly is unchanged. There is mild pulmonary vascular engorgement without frank edema. There is no pleural effusion identified. Lung volumes are low. Bibasilar opacities likely represent atelectasis. Within the right upper lung is a rounded nodule measuring approximately 1.2 cm. There is no pneumothorax.", "output": "1.2 cm nodular opacity in the right upper lung should be further evaluated with CT to exclude the possibility of a small focus of lung cancer. NOTIFICATION: Findings discussed with Dr. ___ ___ telephone at 07:56 on ___ by Dr. ___ ___." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. Prominent mid to lower thoracic scoliosis is re- demonstrated.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral view of the chest. Patient is rotated Surgical clips overlie the left axilla and breast. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Significant dextroconvex scoliosis of the lower thoracic spine is re- demonstrated.", "output": "No acute intrathoracic process." }, { "input": "Heart size is normal. Right mainstem bronchial stent is not well visualized on the current examination. Previously noted right hilar mass on chest radiograph has markedly decreased in size, and the right paratracheal adenopathy has also apparently resolved. Left hilum is normal. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. Central venous catheter within the inferior vena cava terminates in the right atrium. Multiple clips are noted in the upper abdomen as well as within the left chest wall and axilla. Dextroscoliosis of the thoracolumbar spine is re- demonstrated.", "output": "Marked interval reduction in size of right hilar mass and apparent resolution of the right paratracheal lymphadenopathy compared to the previous chest radiograph from ___. No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Dextroscoliosis of the T-spine again noted with compensatory levoscoliosis of the lumbar spine. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear without focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits. Moderate to severe dextroscoliosis is centered within the lower thoracic spine, and appears similar to ___.", "output": "No acute intrathoracic process." }, { "input": "When compared to ___ chest radiograph, the previously seen small right and left pleural effusions have resolved. There is diffuse interstitial opacification extending to the bilateral periphery, unchanged from prior study, however this finding is concerning for some type of interstitial lung disease process. There is also some parenchymal scarring noted in the right lung base. The cardiomediastinal silhouette, hila, and pleural surfaces are normal. There are no acute bony abnormalities. A pacemaker is visualized on the left chest wall. Pacer wires terminate in the right atrium and right ventricle.", "output": "1. The previously seen bilateral small pleural effusions have resolved. 2. Diffuse interstitial opacity extending to bilateral lung periphery concerning for interstitial lung disease process. Recommend chest CT for further evaluation. RECOMMENDATION(S): Recommend chest CT for further evaluation." }, { "input": "There are small bilateral pleural effusions. An opacity at the right lung base adjacent to the effusion may represent atelectasis. Heart size is normal. No abnormal mediastinal widening.", "output": "Small bilateral pleural effusions with probable adjacent atelectasis at the right lung base." }, { "input": "New dual lead pacer with the tips in the right atrium and right ventricle. Mild pulmonary edema has improved. Small left effusion persists. Small right-sided pleural effusion has decreased as well as adjacent atelectasis.", "output": "No pneumothorax. New dual lead pacer with the tips in the right atrium and right ventricle Improved pulmonary edema." }, { "input": "Lung volumes are well inflated. A left-sided pacing device with dual leads follow the expected course to the right atrium and ventricle, respectively. No focal consolidation or pneumothorax. Blunting of the left costophrenic angle may be due to a small pleural effusion or chronic pleural thickening. No large effusion on the right. There is no central vascular congestion or pulmonary edema. Diffuse interstitial opacification extending to the periphery bilaterally is unchanged since prior study and likely reflects a chronic interstitial process. There is stable mild parenchymal scarring at the right lung base. Unchanged tortuosity of the thoracic aorta is re- demonstrated with atherosclerotic calcifications. Otherwise, mediastinal and hilar contours are unchanged. Heart size normal.", "output": "1. No pulmonary edema. 2. Possible trace left pleural effusion versus pleural thickening. No large effusion on the right. 3. Similar mild diffuse interstitial opacities, suggestive of a chronic interstitial process." }, { "input": "Cardiac and mediastinal silhouettes are stable. No focal consolidation is seen. There is no pleural effusion or evidence of pneumothorax. No displaced fracture is identified. Gaseous distention of loops of bowel is partially imaged. Evidence of DISH is seen along the thoracic spine.", "output": "No acute intrathoracic process. Gaseous distention of loops of bowel partially imaged and not well assessed on this study." }, { "input": "Heart size is top normal. Mediastinal and hilar contours are unchanged. Pulmonary vasculature is not engorged. Lungs are clear. No pleural effusion, focal consolidation or pneumothorax is present. Moderate multilevel degenerative changes are seen in the thoracic spine. Diffuse gaseous distention of colonic loops of bowel is noted.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. Lung volumes are low, decreased from chest radiograph ___. There is no focal consolidation, pleural effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Distended air-filled loops of colon are noted overlying the left and right upper quadrants, minimally changed from ___ and ___.", "output": "1. No acute intrathoracic abnormality. 2. Gaseous distended loops of colon are minimally changed dating back to a chest radiograph ___." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications are noted at the arch. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Lower lung volumes seen on the current exam. There is no focal consolidation or effusion. The cardiomediastinal silhouette is within normal limits. Degenerative changes are noted at the left glenohumeral joint. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low. The cardiomediastinal silhouette is unchanged and unremarkable since the prior examination. The aorta is unfolded. There is no focal consolidation. No pleural effusion or pneumothorax is identified. Air-filled colon is seen in the subdiaphragmatic region.", "output": "No acute intrathoracic abnormality." }, { "input": "The lungs are well-expanded and clear. The cardiac silhouette is top-normal in size. The aorta is tortuous. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low and projection is AP, causing bronchovascular crowding and accentuation of heart size. Lungs are grossly clear without focal consolidation, effusion, or pneumothorax. Overall, similar radiographic appearance compared with the prior 2 radiographs.", "output": "No acute cardiopulmonary process, allowing for limitations of an AP portable view." }, { "input": "An ET tube is present, tip approximately 2.2 cm above the Carina. A left subclavian central line is present, tip over distal SVC. No pneumothorax is detected. Cardiomediastinal silhouette is unchanged although it appears slightly prominent this may be accentuated by technique and positioning. There is minimal atelectasis at both bases, slightly more pronounced. No frank consolidation or effusion is identified. No CHF.", "output": "As above." }, { "input": ".", "output": "Heart size is normal. Mediastinum is normal. Minimal bibasal linear opacities are present potentially representing areas of atelectasis but infectious process in particular viral or a typical mycoplasma pneumonia cannot be excluded. No pleural effusion or pneumothorax is present. Followup of the patient 4 weeks after completion of antibiotic therapy is recommended" }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No evidence of residual or recurrent pneumonia." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There is no pleural effusions or pneumothorax.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The patient is status post median sternotomy and aortic valvular replacement. Mild cardiomegaly is re- demonstrated. Mediastinal and hilar contours are unchanged with dense atherosclerotic calcification of the aortic knob noted. Mild pulmonary vascular congestion is similar compared to the prior study. More focal patchy opacity in the retrocardiac region could reflect an area of atelectasis though infection is not completely excluded. No large pleural effusion or pneumothorax is identified. Marked degenerative changes of both acromioclavicular joints are seen. High riding right humeral head suggests underlying rotator cuff disease. Remote right eighth rib fracture is again seen.", "output": "Mild pulmonary vascular congestion. Retrocardiac opacity likely reflects atelectasis but infection is not excluded in the correct clinical setting." }, { "input": "AP supine radiograph of the chest demonstrate low lung volumes with prominent interstitial markings compatible with pulmonary mild pulmonary edema. The heart appears enlarged overall unchanged in size when compared to examination dated ___. The hilar and mediastinal silhouettes are stable in appearance. Patient is status post median sternotomy and aortic valve repair. The lungs are without a focal opacity. There is no left-sided pleural effusion. A possible small right-sided pleural effusion as evidenced by obscuration of the right hemidiaphragm. There is a fracture through the lateral aspect of the ___ right rib. No pneumothorax is identified.", "output": "1. Cardiomegaly, stable in appearance since prior examination dated ___. 2. Mild interstitial pulmonary edema. 2. Right 8th rib fracture with small left sided pleural effusion. No pneumothorax." }, { "input": "The chin obscures the right apex. The heart is mildly enlarged. The hilar and mediastinal contour course are unchanged. Pediatric sternal wires and a cardiac valve are unchanged in orientation. There is new pulmonary vascular congestion with mild edema and new small bilateral pleural effusions.", "output": "New pulmonary vascular congestion and mild pulmonary edema, with new small bilateral pleural effusions." }, { "input": "Pediatric sternal wires are present. A prosthetic cardiac valve is unchanged in configuration. The heart size is top-normal. The aortic arch is moderately calcified. There is no pneumothorax or pleural effusion. The central pulmonary vessels are prominent, without edema or congestion. There persistent left retrocardiac opacity is again seen, slightly more exaggerated on the current examination due to lower lung volumes, likely reflecting atelectasis, although underlying consolidation cannot be entirely excluded.", "output": "Minimal change since the ___ chest radiograph. Persistent left retrocardiac opacity is difficult to differentiate between atelectasis and small consolidation." }, { "input": "The feeding tube tip is seen in various positions between the trachea and the right middle lobe bronchus and right segmental lower lobe bronchus. Moderate cardiomegaly is stable. The mediastinal and hilar contours are normal. Pulmonary vasculature congestion is improved since 2 days ago. Edema is resolved. No focal consolidation, pleural effusion, or pneumothorax. Sternotomy wires and prosthetic aortic valve are unchanged in appearance.", "output": "1. The feeding tube is in the airway rather than the esophagus. 2. Pulmonary vasculature congestion is improved since 2 days ago. NOTIFICATION: The findings were discussed with Dr. ___ on the telephone on ___ at 9:39 AM." }, { "input": "The lungs are well expanded without opacities concerning for pneumonia or inflammatory process. Linear atelectasis in the left lung base is present. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion pneumothorax. No rib fractures are identified.", "output": "No evidence of acute cardiopulmonary process. No rib fractures are identified. However, this is a suboptimal exam for detection of rib fractures. If there is high clinical concern dedicated rib views should be performed." }, { "input": "Portable semi-upright radiograph of the chest demonstrates tiny bibasilar pleural effusions with adjacent atelectasis, right greater than left. Cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax or consolidation. Nasogastric tube courses into the stomach and out of the field of view.", "output": "Tiny bibasilar pleural effusions with adjacent atelectasis, right greater than left." }, { "input": "The lungs are clear with no evidence of consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. No fractures are identified. There is slight indentation of the superior trachea in the region of the thryoid gland.", "output": "1. No acute cardiopulmonary process. 2. Slight indentation of the superior trachea in the region of the thryoid gland. A dedicated thyroid ultrasound is recommended for further evaluation." }, { "input": "Lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable. The mediastinum is not widened. There is no overt pulmonary edema. No displaced fracture is seen.", "output": "No acute cardiopulmonary process. The mediastinum is not widened." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. The lungs appear clear of confluent consolidation. There is mild blunting of the posterior costophrenic angles, potentially a small effusion versus atelectasis. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No evidence of consolidation or other findings to explain patient's chest pain. Possible tiny pleural effusion." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "Round mass centered in the right middle lobe is again seen. Linear opacity at the left lung base is suggestive of atelectasis. The lungs are otherwise clear. Cardiac silhouette is within normal limits. No acute osseous abnormalities identified. Surgical clips in the right upper quadrant suggest prior cholecystectomy.", "output": "Right middle lobe round mass lesion as seen on prior PET. No superimposed acute cardiopulmonary process." }, { "input": "PA and lateral chest views were obtained with patient in upright position. There is status post sternotomy and history of previous Bentall aortic valve procedure. Moderate cardiac enlargement with prominence of the left ventricle to the left and posteriorly, but there is presently no evidence of marked left atrial enlargement or significant pulmonary vascular congestion. Surgical clips are overlying the area of the operated ascending aorta, but in the arch, the descending vascular contours are well delineated and there is no evidence of local aneurysmatic bulge. Moderate amount of aortic wall calcifications are also noted. There is minor blunting of the right lateral pleural sinus, but this does not extend into the posterior area. On the left side, no evidence of pleural thickening is present. Nowhere in the lung fields can one identify any acute pulmonary infiltrates and there is no evidence of pneumothorax in the apical area as seen on the frontal view. Comparison is made with the next preceding available chest examination in our records dated ___. This examination constituted the last postoperative examination at the time when the patient underwent aortic valve replacement in our institution.", "output": "Status post aortic valve surgery with moderate cardiac enlargement and elongated thoracic aorta, but presently no evidence of pulmonary congestion or acute pulmonary infiltrates. Minimal pleural scar on right base. No pneumothorax." }, { "input": "Linear left basilar opacity is most likely atelectasis. Lungs are otherwise clear without consolidation or large effusion. Posterior costophrenic ankle on the right is excluded from the field of view. Aortic core valve device is again seen. Mild cardiomegaly and tortuosity of the descending thoracic aorta is unchanged. Median sternotomy wires and mediastinal clips again noted.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. The lungs are well expanded and clear of focal consolidation. Subtle asymmetric left basilar opacity is compatible with scarring, unchanged. Cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No evidence of active infection." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. There is trace atelectasis at the base of the left lung. The lungs are otherwise clear without focal consolidation, pleural effusion or pneumothorax. No intraperitoneal free air is seen on this portable radiograph.", "output": "Trace atelectasis at the base of the left lung. No focal consolidation or pleural effusion. No large free intraperitoneal air." }, { "input": "The lungs are clear. There is no effusion, edema, or pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormalities.", "output": "Normal chest x-ray." }, { "input": "Cardiac size cannot be evaluated. ET tube is in standard position. Right PICC tip is in the cavoatrial junction. NG tube tip is out of view below the diaphragm. Large pleural effusions and adjacent atelectasis have increased", "output": "Increase large bilateral pleural effusions" }, { "input": "Portable semi supine chest film ___ at 05:20 is submitted", "output": "Endotracheal tube, nasogastric tube, right internal jugular central line and right subclavian PICC line are unchanged in position. There continue be layering moderate to large pbilateral leural effusions. Bibasilar patchy opacities are seen likely reflecting partial lower lobe atelectasis. There is now some peribronchial cuffing suggesting the presence of superimposed mild perihilar edema. No large pneumothorax." }, { "input": "Right-sided IJ line is been removed. An OG tube/Dobbhoff appears in good position. The ETT position is difficult to define but is probably lies in good position about 3 cm above the chronic. There probably is substantial bilateral effusions accounting for the majority of the increased opacification. No significant pulmonary edema. What appears to be a pancreatic stent is observed at the lower end of the film.", "output": "Improved pulmonary edema. Persistent bilateral effusions." }, { "input": "AP portable upright view of the chest. Overlying EKG leads are present. The heart is markedly enlarged. Hila are congested and there is mild pulmonary edema. No large effusions. No pneumothorax. No convincing evidence for pneumonia. Bony structures are intact. Mediastinal contour is normal. No free air is seen below the right hemidiaphragm.", "output": "Cardiomegaly, congestion and mild edema." }, { "input": "Hyperinflation of the lungs and interstitial prominence consistent with emphysema. There is no mediastinal widening. The cardiomediastinal silhouette and hila are normal. There is no pleural effusion or pneumothorax. There is unchanged blunting of the right costophrenic angle, likely due to scarring or pleural thickening.", "output": "1. Hyperinflation of the lungs likely due to emphysema. 2. No mediastinal widening." }, { "input": "The lungs are essentially clear. There is no effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded, clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation. No displaced rib fractures identified.", "output": "No acute cardiopulmonary process. No displaced rib fractures identified." }, { "input": "PA and lateral views of the chest were provided. There is a catheter traversing the right chest wall extending into the upper abdomen. The lungs are clear. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. Cardiomediastinal silhouette is within normal limits. No evidence of pneumomediastinum. No acute osseous abnormalities are identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process. No significant interval change." }, { "input": "PA and lateral views of the chest demonstrate the lungs are well expanded and clear. The cardiomediastinal silhouette is unremarkable. The heart is top normal in size. There is no pleural effusion, pulmonary edema, pneumothorax, or focal airspace opacity.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral images of the chest. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views the chest provided demonstrate no focal consolidation, effusion or pneumothorax. The heart size is top-normal. Mediastinal contours unremarkable. Bony structures are intact.", "output": "No acute findings. Top-normal heart size." }, { "input": "Heart size is mildly enlarged. The mediastinal and hilar contours are unremarkable. Pulmonary vasculature is not engorged. Chain sutures are noted along the peripheral aspect of the left mid lung field. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. Moderate multilevel degenerative changes are seen in the thoracic spine. Multiple left-sided rib deformities are present, likely from prior thoracotomy. Degenerative changes are also noted within both acromioclavicular and glenohumeral joints.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities seen.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest are provided. The lung volumes are low. The lungs appear clear without focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours are normal. Bony structures are intact.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is bilateral lower lobe atelectasis. The lungs are otherwise clear. Note is made of an azygos fissure. The hilar and cardiomediastinal contours are normal. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal. No displaced rib fracture is seen.", "output": "No evidence of pneumothorax or displaced rib fracture." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. There is no pulmonary edema. The heart is normal in size, and the mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of chest demonstrate well expanded clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is at the upper limits of normal size. The aortic arch is partly calcified. The mediastinal and hilar contours are otherwise unremarkable. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable.", "output": "Heart at the upper limits of normal size. No evidence of acute disease." }, { "input": "PA and lateral views of the chest provided. Dual lead pacer is unchanged with leads extending to the region the right atrium and right ventricle. The heart remains mildly enlarged. There is prominence of the right pulmonary hilum which appears new from the prior exam and may in part reflect patient's position. Upper lung lucency suggest emphysema. No focal consolidation, large effusion or pneumothorax is seen. No signs of edema or congestion. Bony structures are intact.", "output": "Findings suggestive of emphysema. Prominence of the right pulmonary hilum which may be further assessed on a nonemergent chest CT exam. Stable cardiomegaly. Otherwise remarkable." }, { "input": "There is no pleural effusion or pneumothorax. Cardiomediastinal and hilar silhouettes are normal size. Mild opacity is identified in the medial right lung base on frontal view obscuring the right cardiac silhouette is likely due to superimposed pulmonary vessels. Mild pleural thickening is noted in the posterior left or right lung base on the lateral view.", "output": "No radiographic evidence of pneumonia is identified." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unchanged. Pulmonary vasculature is not engorged. Loculated pleural fluid along the left major fissure has increased in the interval. There is patchy opacity in the left lung base which may reflect atelectasis. The right lung is grossly clear. No right-sided pleural effusion is present. No pneumothorax is seen. There are no grossly displaced fractures.", "output": "Increased amount of pleural fluid loculated within the left major fissure. Patchy left basilar atelectasis. No displaced fracture or pneumothorax identified." }, { "input": "The heart and mediastinal contours are within normal limits. The lungs are clear. A retrocardiac triangular-shaped opacity correlates with fluid in the left major fissure, and is unchanged from prior exam. There is no pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs demonstrate unremarkable cardiomediastinal and hilar contours. Lungs are clear. No pleural effusion or pneumothorax evident. No displaced rib fracture is identified. There is straightening of the normal thoracic kyphosis.", "output": "No rib fractures. Straightening of normal thoracic kyphosis." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lung volumes are decreased. There is an area of increased opacity at the left lung base. There is also fluid accumulating in the left major fissure. There is no pneumothorax.", "output": "Increased density at the left lung base concerning for pneumonia with fluid layering in the left major fissure. Short interval followup is recommended upon completion of treatment to document resolution." }, { "input": "AP portable upright view of the chest. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process" }, { "input": "Linear opacity in the left lung base most likely represents atelectasis. No focal opacity, pulmonary edema, pleural effusion or pneumothorax identified. The heart size is normal. The aorta is unfolded. No rib fractures identified. Hypertrophic changes noted in the spine.", "output": "1. Clear lungs. 2. No rib fractures identified. If there are focal areas of pain, dedicated views of those areas are recommended." }, { "input": "Again seen is mild cardiomegaly and tortuous thoracic aorta without interval change. The bilateral hila are normal in appearance. There is stable appearance of faint residual right middle lobe opacity. There again is seen right greater than left biapical pleuro-parenchymal scarring. There is no pulmonary vascular congestion. There are no new focal lung consolidations. There are no pneumothoraces or effusions.", "output": "No new focal lung consolidations. Stable chest x-ray." }, { "input": "Frontal and lateral views of the chest were obtained. Overall, there has been no significant interval change since the radiographs from ___, with nodular and irregular opacities seen in the right lung apex/right upper lobe, similar in appearance to prior. There is evidence of mild volume loss of the right lung. The left lung is clear. The cardiac and mediastinal silhouettes are stable, with mild to moderate enlargement of the cardiac silhouette and aortic tortuosity. No pleural effusion or pneumothorax is seen. No overt pulmonary edema is seen. There is slight loss of height of a lower thoracic vertebral body, stable, particularly from prior CT from ___.", "output": "No significant interval change since chest radiographs of ___." }, { "input": "The lungs are clear with no evidence of a consolidation, effusion, or pneumothorax. Cardiac and mediastinal silhouettes are normal. No acute fractures are identified. Mild degenerative changes are noted throughout the thoracic spine.", "output": "No acute cardiopulmonary process." }, { "input": "A frontal supine view of the chest was obtained portably. The endotracheal tube ends 2.4 cm above the carina. Bibasilar opacities are atelectasis on subsequent chest CT. Widening of the mediastinum is due to mediastinal lipomatosis on subsequent CT. The nasogastric tube within the esophagus is displaced to the right, ending in the stomach, with the side port at the gastroesophageal junction. There is no effusion or large pneumothorax.", "output": "Endotracheal tube ends 2.4 cm above the carina. Nasogastric tube side port is at the gastroesophageal junction and could be advanced. Bibasilar atelectasis." }, { "input": "Again seen is moderate to moderately severe cardiomegaly, similar to prior. Previously seen TAVR is not well visualized on this study, on either the frontal or lateral view. Question due to underpenetration. Clinical correlation is requested. There is residual CHF, but patchy opacities at the lung bases have improved. Bilateral pleural effusions are also is smaller.", "output": "TAVR not well visualized. Clinical correlation requested. Cardiomegaly similar to prior. Residual CHF. Bibasilar patchy opacities and bilateral pleural effusions are improving." }, { "input": "Transverse cardiomegaly unchanged. The decidual pulmonary edema shows mild interval improvement. Interval decrease in size of the right-sided subpulmonic effusion.", "output": "Mild interval improvement in the interstitial pulmonary edema and right-sided pleural effusion." }, { "input": "Endotracheal tube tip is 2.3 cm above carina. Valve prosthesis in place. Heart size, pulmonary vascularity is increased, has worsened since prior exam. Bilateral interstitial opacities, likely edema, worsened. Bibasilar opacities, likely atelectasis, mildly worsened. Small right pleural effusion, similar. Probable small left pleural effusion, new or more prominent. Degenerative arthritis of bilateral shoulders is present.", "output": "Interval worsening of cardiopulmonary findings" }, { "input": "The size of the cardiomediastinal silhouette is enlarged but unchanged. Interval apparent decrease in extent of the bilateral pleural effusions however there is persisting lower lobe atelectasis/consolidation, greater on the left. No pneumothorax identified. Pulmonary vascular congestion is present. Interval removal of the left PICC line. The patient is status post TAVR.", "output": "Pulmonary vascular congestion. Interval apparent decrease in the in the extent of the bilateral pleural effusions however there is persisting bilateral lower lobe atelectasis/consolidation, greater on the left." }, { "input": "Persistent moderate right pleural effusion is noted. There is pulmonary vascular congestion without overt edema. Streaky right midlung and left lung base opacities suggestive of atelectasis. There is no consolidation worrisome for infection. Moderate cardiac enlargement is noted as well as atherosclerotic calcifications at the aortic arch. No acute osseous abnormalities.", "output": "Persistent moderate right pleural effusion. No definite superimposed acute cardiopulmonary process." }, { "input": "The lung volumes are unchanged. Unchanged mild pulmonary edema. Stable cardiomediastinal contours. Slightly worsened bibasilar atelectasis, right greater than left. Unchanged bilateral pleural effusions. Status post TAVR. Stable calcifications of the aortic arch.", "output": "Unchanged mild pulmonary edema and bilateral pleural effusions." }, { "input": "Unchanged hilar congestion and prominent interstitial marking. There is new blunting of the right costophrenic angle which may reflect a small pleural effusion. No pneumothorax identified. The size the cardiac silhouette is enlarged but unchanged. Degenerative changes of both shoulders.", "output": "Persisting pulmonary edema with a small right pleural effusion. Cardiomegaly." }, { "input": "Worsening right lower lobe consolidation and small pleural effusion. Probable small left pleural effusion. Significant interval improvement in bilateral pulmonary edema. Cardiac size is enlarged but unchanged. No pneumothorax. Severe degenerative joint disease of the right shoulder noted. Interval removal of ET tube. Valve prosthesis in place.", "output": "Worsening right lower lobe consolidation and right pleural effusion. Substantial improvement in pulmonary edema bilaterally." }, { "input": "PA and lateral views of the chest provided. There is mild cardiac enlargement with hilar congestion noted. There is likely mild interstitial pulmonary edema. Small bilateral pleural effusions are present. Mediastinal contour appears within normal limits. The imaged bony structures appear intact. Degenerative changes at the shoulders partially visualized.", "output": "Mild cardiomegaly, small pleural effusions and mild pulmonary edema with congestion." }, { "input": "The lungs are noted to be hyperinflated, compatible with the patient's known chronic obstructive pulmonary disease. There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The previously described multiple sub-4 mm right upper lobe pulmonary nodules are not well visualized on this examination. The cardiomediastinal silhouette is stable. No acute bony abnormality is detected.", "output": "1. No acute cardiopulmonary process. 2. COPD." }, { "input": "PA and lateral views of the chest provided demonstrate clear, well-expanded lungs without focal consolidation, effusion, or pneumothorax. Heart and mediastinal contours are normal. Bony structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute findings in the chest." }, { "input": "Normal heart size, mediastinal and hilar contours. No focal consolidation, pleural effusion or pneumothorax.", "output": "No acute process." }, { "input": "PA and lateral views of the chest. No prior. The lungs are clear. Costophrenic angles are sharp. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal silhouette is within normal limits. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic process." }, { "input": "Pulmonary edema has substantially worsened from the prior study. Again seen is moderate cardiomegaly and mediastinal/pulmonary vascular engorgement. There may be some left retrocardiac atelectasis and there are likely small bilateral pleural effusions.", "output": "Substantially worsened pulmonary edema. These findings were communicated to Dr. ___ by telephone at 09:18 on ___ at the time of discovery by Dr. ___" }, { "input": "Single upright AP image of the chest. The lungs are well expanded there is a retrocardiac opacity with an air-fluid level consistent with a hiatal hernia. No focal mass or consolidation is seen in the lungs. There is no right pleural effusion there is a small left pleural effusion. No pneumothorax is seen. The cardiomediastinal silhouette is unremarkable. There is a fracture of the distal right clavicle which is widely separated, with 2.1 cm inferior distraction of the distal fracture fragment. The glenohumeral joint is still congruent.", "output": "1. No acute cardiopulmonary process. 2. Widely separated acute fracture of the distal right clavicle. 3. Hiatal hernia." }, { "input": "The right mid and lower lungs demonstrate heterogeneous airspace opacity, concerning for pneumonia. No pleural effusion or pneumothorax is seen. Cardiomediastinal silhouette is normal.", "output": "Right lower lobe pneumonia. Radiographic followup recommended after completion of treatment to assess for resolution." }, { "input": "Consolidation in of the right lower lobe and retrocardiac similar in appearance to ___. The previously seen consolidation in the right middle lobe has resolved. Normal heart size. No pleural effusion or pneumothorax.", "output": "Right lower lobe and retrocardiac opacification could reflect recurrent lower lobe pneumonias; however, given the lack of clearing between ___ and the current exam cannot exclude a chronic process including lipoid pneumonia and a pneumonic presentation of the lung adenocarcinoma. RECOMMENDATION(S): Recommend follow-up chest radiograph in 4 weeks after treatment to document resolution . If the opacities do not clear at that time, a chest CT would be warranted. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 7:24 AM, 10 minutes after discovery of the findings." }, { "input": "An ET tube terminates 3 cm above the carina. And NG tube passes inferiorly off the image in the expected region of the stomach. The lungs are well expanded. Diffusely increased interstitial markings are again seen, along with engorged pulmonary vasculature and cardiomegaly and bilateral pleural effusions, consistent with moderate pulmonary edema. Increased opacity at the left lung base compared to prior likely reflects atelectasis. No focal consolidation is seen. There is no pneumothorax.", "output": "1. ET tube terminates 3 cm above the carina. 2. Moderate pulmonary edema with bilateral pleural effusions." }, { "input": "The right IJ central venous catheter has been removed. There is no pneumothorax. Mild to moderate pulmonary edema has increased since the prior exam. Small bilateral pleural effusions are unchanged. The patient is status post median sternotomy with stable cardiomegaly. There is generalized osteopenia.", "output": "Interval worsening of pulmonary edema with stable small bilateral pleural effusions. Stable cardiomegaly." }, { "input": "A new right IJ central line terminates in the mid to low SVC. The ET tube and NG tube are unchanged from prior exam. The lungs are well expanded. Diffusely increased interstitial markings are again noted in the lungs bilaterally, along with engorged pulmonary vasculature, cardiomegaly, and bilateral pleural effusions, consistent with moderate pulmonary edema, similar to prior exams. Opacity at the left lung base is again noted, consistent with atelectasis. No focal consolidation is seen and there is no pneumothorax.", "output": "1. Right IJ central line terminates in the mid to low SVC. 2. Moderate pulmonary edema with bilateral pleural effusions." }, { "input": "The lungs are well expanded. Diffusely increased interstitial markings, pulmonary vasculature engorgement, cardiomegaly, and small bilateral pleural effusions are seen, consistent with moderate pulmonary edema. No focal consolidation is seen. There is no pneumothorax.", "output": "Moderate pulmonary edema with small bilateral pleural effusions." }, { "input": "Frontal and lateral views of the chest are obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. No overt pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiograph demonstrates clear lungs bilaterally. Cardiomediastinal and hilar contours are within normal limits. There is no pleural effusion, pneumothorax, or evidence of pulmonary edema. Imaged osseous structures and upper abdomen are without an acute abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Trace bilateral pleural effusions, right greater than left are re- demonstrated with mild bibasilar atelectasis. No focal consolidation or pneumothorax is present. Hyperdense material within the right upper quadrant of the abdomen correlates to prior TACE procedure within the liver. No acute osseous abnormality is detected.", "output": "Small bilateral pleural effusions, right greater than left with bibasilar atelectasis." }, { "input": "Single portable frontal chest radiograph demonstrates hypoinflated lungs with crowding of vasculature and right lower lobe atelectasis. No focal opacity. No pleural effusion or pneumothorax. Heart size is top-normal due to patient positioning and low lung volumes. Mediastinal contour and hila are unremarkable. Curvilinear lucency along the right hemidiaphragm is most consistent with atelectasis.", "output": "Right lower lobe atelectasis. No pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 1:08 PM, 5 minutes after discovery of the findings." }, { "input": "AP portable semi upright view of the chest. Cervical spinal hardware is again noted. Overlying EKG leads are present. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No displaced rib fracture is seen.", "output": "No acute intrathoracic process" }, { "input": "AP upright portable chest radiograph is obtained. Overall, there is no significant change from the recent CT performed ___ with innumerable metastatic nodularity involving both lungs and large consolidation occupying the right lower lung with a small to moderate right pleural effusion. There is no new area of atelectasis or new area of confluent opacity to suggest a superimposed pneumonia, though given the extensive underlying lung disease, a subtle acute process would be impossible to exclude. Heart size cannot be assessed. Mediastinal contour is stable. No pneumothorax is seen. Bony structures appear stable. Known metastatic lesions involving the inferior scapulae are not clearly visualized as well as the recently diagnosed nondisplaced fracture involving the right posterior eighth rib.", "output": "Overall stable exam with extensive metastatic disease to the lungs with right pleural effusion and right basal consolidation." }, { "input": "Single portable upright frontal chest radiograph demonstrates bilateral interstitial markings with cephalization of vessels and central vascular engorgement. Obscuration of bilateral diaphragmatic angles may represent bilateral small pleural effusions, although a component of atelectasis or a consolidation cannot be excluded. There is no pneumothorax. Heart size is enlarged. Visualized osseous structures are without acute abnormality.", "output": "Vascular congestion and interstitial markings compatible with interstitial edema. Obscuration of bilateral costophrenic angles compatible with pleural effusions, although component of atelectasis or focal consolidation cannot be excluded." }, { "input": "There has been significant interval improvement in large left effusion with a small amount of remnant fluid and associated compressive atelectasis as well as a linear streak of atelectasis in the lingula. Remainder of the lungs is clear. There is no pneumothorax. Cardiomediastinal silhouette and hilar contours are normal.", "output": "Small remnant left pleural effusion status post thoracentesis without evidence of pneumothorax." }, { "input": "Cardiomediastinal silhouette and hilar contours are unchanged from immediate prior exam. The left moderate to large pleural effusion is slightly increased in size with associated atelectasis and either fluid tracking up the left major fissure or bandlike atelectasis present in the left mid lung. The right lung is clear. There is no pneumothorax.", "output": "Stable cardiac silhouette. Increasing left moderate to large pleural effusion with associated atelectasis." }, { "input": "There has been interval development of a large left pleural effusion with associated compressive atelectasis which shifts the cardiac silhouette to the right and shifts the left hemidiaphragm downward. Cardiac silhouette cannot be accurately gauged due to obliteration of the left cardiac border by the large effusion. The right lung is clear. There is no pneumothorax. No distracted bony injury is identified.", "output": "Interval development of a large left pleural effusion. If there is history of recent trauma, hemothorax should be considered. Other causes include infection or malignancy and malignancy, but the latter is less likely given the short interval time of development. Results were discussed over the telephone with Dr. ___ by ___ ___ at 9:40 on ___ at time of initial review." }, { "input": "Frontal and lateral views of the chest demonstrate normal heart size and unremarkable mediastinal and hilar contours. A subsegmental atelectasis in the left lower lobe is decreased since prior exam. A small left pleural effusion is also slightly improved with mild persistent left basilar atelectasis. The lung volumes are persistently low. There is no pneumothorax or vascular congestion.", "output": "Improving small left pleural effusion and subsegmental atelectasis in the left lower lobe." }, { "input": "Cardiac silhouette size is normal. Mediastinal and hilar contours are unchanged. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process. No focal consolidation to suggest pneumonia." }, { "input": "The lungs are clear.The cardiac, hilar and mediastinal contours are normal.No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "There is thoracic scoliosis. The left hilar/mediastinal calcified nodes likely relate to prior granulomatous disease. The cardiac silhouette is top-normal to mildly enlarged. The aorta is tortuous. No focal consolidation is seen. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Portable upright chest radiograph ___ at 08:37 is submitted.", "output": "Nasogastric tube seen coursing below the diaphragm with the tip not identified. Right internal jugular central line, endotracheal tube, and dual lead left-sided pacer unchanged in position. Overall cardiac and mediastinal contours are stable. There are layering bilateral effusions with bibasilar patchy opacities suggestive of atelectasis, although pneumonia cannot be entirely excluded. Patchy opacities in the right lung are essentially stable and are concerning for an infectious process. Clinical correlation is recommended. No pneumothorax." }, { "input": "PA and lateral views of the chest provided. Opacity in the left lower lung is slightly improved though minimal opacity persists. There is a tiny left pleural effusion. Heart size remains enlarged. Aorta is unfolded.", "output": "As above." }, { "input": "New dual lead pacemaker with the tip in the right atrium and right ventricle. Moderate cardiomegaly. Linear opacity in the left upper lobe is likely a skin fold as lung markings are seen beyond. No pneumothorax. No new mediastinal widening. No overt pulmonary edema. Healing right-sided surgical neck and proximal humeral fracture again demonstrated.", "output": "No pneumothorax. Dual lead pacer in standard position." }, { "input": "There is a small area of consolidation in the left lower lobe concerning for pneumonia. Scoliosis of thoracic spine. Tortuous aorta. Top normal heart size without evidence of pulmonary edema or pleural effusions. No pneumothorax. Mediastinal borders and hilar structures are normal.", "output": "Left lower lobe pneumonia. Scoliosis of thoracic spine. Tortuous aorta." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is stable. Tortuosity of the thoracic aorta is noted. There is a lower lumbar dextroscoliosis and chronic proximal right humeral fracture.", "output": "No acute cardiopulmonary process." }, { "input": "A large left pleural effusion and small right pleural effusion are again noted, similar compared to the prior chest CT. The aerated portions of the lungs are grossly clear, with mild atelectasis in the bases. The heart is mildly enlarged, stable since the prior examinations. A left chest wall pulse generator device is unchanged in position, with leads terminating in the right atrium and right ventricle. There is no evidence of pneumothorax or overt pulmonary edema. No displaced rib fractures are noted. A partially imaged healed right proximal humerus fracture is again seen.", "output": "1. Large left and small right pleural effusions, with adjacent atelectasis. 2. Mild cardiomegaly is stable." }, { "input": "The lungs are well inflated and clear. Skin fold projects over the right lung superolaterally. The cardiomediastinal silhouette is within normal limits. No displaced fractures identified.", "output": "No acute cardiopulmonary process." }, { "input": "A disconnected left vagus nerve stimulator lead is in place. Chest: Cardiac, mediastinal, and hilar contours are within normal limits. There is no evidence for pulmonary consolidation, pulmonary edema, pleural effusion, or pneumothorax. There are endplate degenerative changes in the thoracic spine and a mild dextroconvex curvature in the upper thoracic spine. Neck: The contours of the aerodigestive tract are unremarkable. There are multilevel degenerative changes in the cervical spine, including minimal retrolisthesis at C3-C4 and C4-C5, and bilateral uncovertebral spurring from C4-C5 through C6-C7.", "output": "1. A disconnected left vagus nerve stimulator lead is in place. 2. Degenerative changes in the cervical and thoracic spine." }, { "input": "Frontal and lateral views of the chest demonstrate well expanded clear lungs. The cardiomediastinal hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "Portable supine AP view of the chest was provided. Underlying trauma board is in place. The lungs appear clear bilaterally. No supine sign for pneumothorax. No large effusion. Cardiomediastinal silhouette appears normal. No bony deformities are seen.", "output": "No acute findings." }, { "input": "Lungs are fully expanded and clear. No pleural abnormalities. Heart size is normal. Cardiomediastinal and hilar silhouettes are normal.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Moderate degenerative changes are seen within the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is no focal lung consolidation.", "output": "No radiographic explanation for chest pain." }, { "input": "Cardiomediastinal silhouette is normal. There is no pleural effusion or pneumothorax. There is no focal lung consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were obtained demonstrating clear well-expanded lungs without focal consolidation, effusion or pneumothorax. There is no sign of pulmonary edema or vascular congestion. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest. The lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormality is detected. Surgical clips seen in the right upper quadrant.", "output": "No acute cardiopulmonary process." }, { "input": "AP portable upright view of the chest. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process" }, { "input": "PA and lateral chest radiographs are provided. There is no focal consolidation, pleural effusion, or pneumothorax. Cardiomediastinal silhouette is unremarkable. Osseous structures are intact.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were reviewed and compared to the prior study. There is a retrocardiac opacity. Mild blunting of the left costophrenic angle could represent a tiny pleural effusion or pleural thickening. Cardiac and mediastinal contours are normal and there is no vascular congestion or pneumothorax. There are no concerning osseous or soft tissue lesions.", "output": "Retrocardiac opacity consistent with left lower lobe pneumonia." }, { "input": "There are small bilateral pleural effusions, larger on the left, with associated atelectasis. Superiorly, the lungs are clear. There is enlargement of the cardiac silhouette with a configuration raising concern for underlying pericardial effusion. No acute osseous abnormalities.", "output": "Bilateral pleural effusions. Enlargement of the cardiac silhouette with a configuration raising concern for underlying pericardial effusion." }, { "input": "AP single view of the chest has been obtained with patient in sitting semi-upright position. Patient is intubated. The ETT is seen to terminate in the trachea 4 cm above the level of the carina. No pneumothorax is identified in the apical area. An NG tube is seen reaching far below the diaphragm. Extensive diffuse haze exists on the lung bases and obliterates the contours of the diaphragms as well as major portion of the heart shadow. This finding most likely represents pleural effusion layering in the posterior and dependent portion of the pleural space in this semi-erect position patient. Heart shadow is difficult to assess but some cardiac enlargement is likely. A looping line is noted in the left-sided subclavian area. It could represent an abandoned subclavian line, but is possibly external. Another ellipsoid shaped structure is overlying the right upper lobe area but is most likely external. There is no conclusive evidence for any acute pulmonary discrete infiltrate of pneumonia type; however, such process cannot be excluded in the lower lung fields which are clouded by the diffuse pleural hazy density. A sharply delineated linear density on the right base represents the minor fissure which is slightly widened and confirms the assumption that the patient has pleural effusions.", "output": "ETT in appropriate position, bilateral basal haze representing pleural effusions. NG tube in place, no evidence of acute pneumonic infiltrate. Several overlying external structures on this single view portable chest examination." }, { "input": "Cardiomediastinal contours are within normal limits and without change. Lungs are clear except for a focal area unchanged scarring within the lingula. There are no pleural effusions or acute skeletal findings.", "output": "No radiographic evidence of pneumonia." }, { "input": "No focal consolidation, pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process" }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are unremarkable. There is no pleural effusion or pneumothorax. The lungs are clear.", "output": "No acute intrathoracic abnormality." }, { "input": "Streaky left retrocardiac atelectasis is noted. The lungs are otherwise grossly clear without evidence for consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is unchanged from prior exam. Diffuse idiopathic skeletal hyperostosis is noted within the visualized thoracic spine. No acute fracture is seen. A right-sided Port-A-Cath is again noted with the tip terminating in the mid SVC. Surgical clips overlie the right upper quadrant.", "output": "Left retrocardiac atelectasis without evidence for acute cardiopulmonary process." }, { "input": "Right chest subcutaneous port with catheter tip in the mid SVC is stable from prior. Right upper quadrant surgical clips, presumably from patient's previous cholecystectomy, are seen. Heart size is normal. The hilar contours are normal. Prominent ascending aortic contour appears similar to prior. The pulmonary vasculature is normal. No focal consolidation, pleural effusion, or pneumothorax. Healed rib fractures on the left.", "output": "Right chest subcutaneous port with catheter tip in the mid SVC is stable from prior." }, { "input": "Right pectoral infusion port terminates in mid SVC. There is no consolidation, pleural effusion, or pneumothorax. Cardiomediastinal and hilar silhouettes are normal size.", "output": "No radiographic evidence of pneumonia." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well inflated and clear. No focal consolidation, effusion, or pneumothorax is present. A Port-A-Cath tip terminates in the mid SVC. Surgical clips project over the right upper quadrant, gastroesophageal junction, and diaphragmatic hiatus.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well inflated and clear. No focal consolidation, effusion, pneumothorax is present. The cardiac and mediastinal contours are normal. A right-sided Port-A-Cath tip terminates in the mid SVC. There are surgical clips at the gastroesophageal junction and mid abdomen.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Right Port-A-Cath ends at the mid SVC. Surgical clips in the right upper quadrant are unchanged. A subtle retrocardiac opacity could represent early infection. No pneumothorax. Hilar and cardiomediastinal contours are normal.", "output": "A subtle retrocardiac opacity could represent focal atelectasis, aspiration, or early pneumonia. Short-term followup radiograph could be helpful for further evaluation if warranted clinically." }, { "input": "Right chest wall port is again seen with tip projecting over the mid SVC. The lungs are clear without focal consolidation, effusion, or edema. Cardiomediastinal silhouette is within normal limits. Old left lateral rib fractures are again noted. Surgical clips noted in the upper abdomen.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low. This accentuates the size of the cardiac silhouette which appears at least mildly enlarged. The aorta is tortuous. The mediastinal and hilar contours are otherwise unremarkable. There is no pulmonary edema. Minimal streaky opacity in the left lower lobe likely reflects atelectasis. No pleural effusion or pneumothorax is identified. Mild degenerative changes are seen throughout the thoracic spine.", "output": "Low lung volumes with left lower lobe atelectasis." }, { "input": "The lungs are normally expanded. Faint, ill-defined opacities at the lung bases are improved since ___. The heart is top normal. The mediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. There is no confluent consolidation to suggest pneumonia.", "output": "Faint opacities at the lung bases are improved since ___, possibly chronic atelectasis. There is no convincing evidence of pneumonia." }, { "input": "Lungs are well-expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation. Note is made of calcifications along the aortic knob.", "output": "No acute cardiopulmonary process." }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are hyperinflated but clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The lungs are mildly hyperinflated with flattening of the hemidiaphragms, suggesting COPD. The cardiomediastinal silhouette is normal. The patient is status post midline sternotomy with intact sternal wires. Multiple clips are seen within the mediastinum. Anterior osteophytes in the upper thoracic spine are consistent with possible diffuse idiopathic skeletal hypertrophy (DISH).", "output": "1. No acute cardiopulmonary process. 2. Mild COPD." }, { "input": "Moderate cardiomegaly is relatively unchanged. The aorta is unfolded and diffusely calcified. There is crowding of the bronchovascular structures with mild pulmonary vascular engorgement. No focal consolidation, pleural effusion or pneumothorax is identified. There are mild degenerative changes in the thoracic spine.", "output": "Mild pulmonary vascular engorgement." }, { "input": "Since the prior exam, a new right internal jugular central venous catheter has been placed. The tip terminates in the low SVC. There is no pneumothorax. There continues to be mild engorgement of the pulmonary vasculature, but no overt edema. There is no consolidation or pleural effusion. The cardiac silhouette remains severely enlarged. The mediastinal contours are normal.", "output": "1. New right internal jugular central venous catheter in the low SVC. No pneumothorax. 2. Stable mild vascular engorgement. 3. Stable severe cardiomegaly." }, { "input": "The lung volumes are low. The cardiac, mediastinal and hilar contours appear stable. There is a moderate-sized hiatal hernia. The lungs appear clear within the limitations of technique. No pleural effusion is identified.", "output": "No evidence of acute disease. Moderate hiatal hernia." }, { "input": "Frontal and lateral radiographs of the chest were acquired. Lung volumes are slightly low. Previously seen ill-defined opacities at the right lung base on the study from ___ have resolved. There is minimal left lower lung streaky atelectasis. There is no focal consolidation. Mild cardiomegaly is not significantly changed. The descending thoracic aorta is mildly tortuous, unchanged. There is a moderate hiatal hernia, as before. There are no pleural effusions. No pneumothorax is seen. Mild multilevel degenerative changes of the thoracolumbar spine are noted.", "output": "1. No acute cardiac or pulmonary process. 2. Interval resolution of right lung base ill-defined opacities. 3. Unchanged mild cardiomegaly." }, { "input": "There is moderate interstitial edema. No focal consolidation is identified. Bilateral small pleural effusions are present. The cardiac silhouette is within normal limits. There is no pneumothorax.", "output": "Moderate interstitial edema with bilateral small pleural effusions. No focal consolidation." }, { "input": "There is a 10 mm round opacity projecting over the left lower lung, which likely represents a nipple shadow. Otherwise, the lungs are hyperinflated but clear. No focal consolidations. No pulmonary edema. Normal appearance of the cardiomediastinal silhouette. No pleural effusion. No pneumothorax. Degenerative changes are seen within the right shoulder. There is pectus excavatum.", "output": "1. Hyperinflation, but no evidence of pneumonia. 2. 10 mm round opacity projecting over the left lower lung, likely a nipple shadow, however a repeat chest radiograph with nipple markers is recommended. NOTIFICATION: The findings were communicated with ___, M.D. by ___, M.D. via page on ___ at 8:16 AM, 30 minutes after discovery of the findings." }, { "input": "Nodule seen at the left lung base on prior exam is compatible with nipple shadow. Lungs are otherwise clear. Cardiomediastinal silhouette is within normal limits. Severe degenerative changes seen at the right shoulder. No acute osseous abnormalities. Pectus excavatum again noted.", "output": "Nodular opacity at the left lung base is compatible with nipple shadow." }, { "input": "Frontal and lateral views of the chest were obtained. Lung volumes are low, exaggerating heart size. The cardiomediastinal contours are otherwise normal. The lungs are clear. No focal consolidation, pleural effusion, or pneumothorax. No radiopaque foreign body.", "output": "No acute cardiopulmonary process. See report of concurrent Chest CT for important findings not visible on conventional CXR." }, { "input": "The left PICC is barely visible but appears to be terminate in the low SVC. There is mild cardiomegaly. Hyperexpansion and diaphragmatic flattening suggests emphysema. Surgical clips are overlying the upper abdomen. There is no focal consolidation or pneumothorax. There are small bilateral pleural effusions. There is no pulmonary vascular congestion.", "output": "No evidence of pneumonia. Small bilateral pleural effusions." }, { "input": "The heart is mildly enlarged. Moderate unfolding of the thoracic aorta and calcification appear similar. This study shows a streaky opacity in the left lower lung suggesting minor atelectasis or scarring. Otherwise, the lungs appear clear. There are no pleural effusions or pneumothorax. Small osteophytes are present along the mid thoracic spine. Surgical clips again project over the right upper quadrant.", "output": "No evidence of acute disease." }, { "input": "Moderate enlargement of the cardiac silhouette is unchanged. The mediastinal and hilar contours are within normal limits. Pulmonary vasculature is not engorged. Apart from mild bibasilar atelectasis, the lungs are clear without focal consolidation. There may be trace bilateral pleural effusions noted posteriorly on the lateral view. No pneumothorax is identified. Moderate degenerative changes of the thoracic spine are re- demonstrated.", "output": "Moderate cardiomegaly with bibasilar atelectasis, but no pulmonary edema. Possible trace bilateral pleural effusions." }, { "input": "Frontal and lateral views of the chest were obtained. There are small bilateral pleural effusions. The cardiac silhouette is moderately enlarged. Mediastinal contours are unremarkable. There is mild pulmonary vascular congestion. No pneumothorax is seen. Evidence of DISH is seen along the visualized spine.", "output": "Small bilateral pleural effusions, mild pulmonary vascular congestion and enlarged cardiac silhouette suggest CHF." }, { "input": "There is moderate enlargement of the cardiac silhouette as on prior. Lungs are clear without consolidation, effusion, or edema. Hypertrophic changes seen throughout the spine. No acute osseous abnormalities.", "output": "Cardiomegaly without superimposed acute cardiopulmonary process." }, { "input": "The lungs are clear. The heart size is normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen.", "output": "No acute cardiac or pulmonary findings." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Analysis is performed in direct comparison with the next preceding similar chest examination of ___. The heart size is unchanged and remains within normal limits. No change in the appearance of mediastinum and thoracic aorta. The pulmonary vasculature is not congested. The, on previous examination identified, scattered multiple parenchymal patchy infiltrates mostly located to right upper and lower lung fields as well as mid portion of left lung have regressed moderately. Some faint patchy infiltrates remain, however. As before, there is no evidence of pneumothorax or pleural effusion as the lateral and posterior pleural sinuses are free. Metallic ring shaped pressed ornaments are seen as before and unchanged in position.", "output": "Persistent evidence of scattered pneumonic infiltrates in patient with history of HIV. Comparison demonstrates that the infiltrates have regressed during the latest five days examination interval." }, { "input": "PA and lateral chest radiographs were obtained. An inferior right upper lobe peripheral opacity and bibasilar opacities are new since ___. No effusion or pneumothorax is present. Cardiac and mediastinal contours are normal. Bilateral nipple rings could not be removed for this exam.", "output": "Multifocal pneumonia including right upper lobe involvement. No specific pathogen is suggested by the appearance." }, { "input": "A new right internal jugular line ends in the mid superior vena cava. The the lung volumes are low. There is no focal opacity, pleural effusion or pneumothorax. The mediastinum is widened which may be positional. The heart size is normal. Apparent widening of the descending aortic contours represents a fat pad seen on the prior chest CT.", "output": "A new right internal jugular line ends in the mid superior vena cava. No pneumothorax." }, { "input": "There is interval increase in bilateral airspace opacity and interstitial markings. There is no effusion or pneumothorax. The cardiac silhouette and mediastinal contours are unchanged.", "output": "Interval increase in bilateral airspace opacity in this patient with bilateral pneumonia." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs without focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal silhouettes are normal. The bilateral hila are normal. There is stable elevation of the right hemidiaphragm as compared to prior radiograph which may represent diaphragmatic eventration. There are no focal lung consolidations, calcifications, or other changes indicative of latent or prior TB infection. There is no evidence of pulmonary vascular congestion, pneumothorax, or effusion.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are hyperinflated but clear. There is no pleural effusion or pneumothorax. Tortuosity of the thoracic aorta is stable. The heart size is normal. There is marked thoracic kyphosis with anterior wedge compression deformities of 2 adjacent mid thoracic vertebral bodies. Compression deformity of a lower thoracic vertebral body is new since ___.", "output": "1. Compression deformity of a lower thoracic vertebral body is new since ___. 2. Clear lungs." }, { "input": "Single portable view of the chest. ET tube tip is 2.7 cm from the carina. The lungs are clear of confluent consolidation noting that the right lung base laterally is excluded from the field of view. Cardiomediastinal silhouette is within normal limits for technique and position. Surgical clips seen within the neck on the left. Osseous structures are grossly unremarkable.", "output": "ET tube tip 2.7 cm from the carina. No acute cardiopulmonary process." }, { "input": "There is moderate pulmonary edema and small bilateral pleural effusions. There is no pneumothorax. Calcifications of the aortic arch are seen.", "output": "Moderate pulmonary edema." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. Heart size is top normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Aortic arch calcifications are mild though progressed since prior.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. Lateral view somewhat limited due to motion artifact. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral radiographs of the chest demonstrating a left chest wall pacemaker generator with appropriately positioned right atrial and ventricular leads. No pneumothorax is seen. The course of the pacemaker leads is uncomplicated. The lungs are otherwise clear and the cardiac and mediastinal contours are within normal limits. No pleural abnormality is detected.", "output": "Satisfactory positioning of left chest wall pacemaker generator, right atrial and ventricular leads with no pneumothorax." }, { "input": "Single portable view of the chest. The lungs are clear. Cardiomediastinal silhouette is stable. No acute osseous abnormality detected.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. There is no focal consolidation, pleural effusion, or pneumothorax. Very minor atelectasis/scarring is seen at the lingula. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest radiographs demonstrate clear lungs. There is no pleural effusion, pulmonary vascular engorgement, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are well expanded clear. Mediastinal contours hila, and cardiac silhouette are normal. There is pleural effusion or pneumothorax. There within the transverse colon is seen.", "output": "No pneumonia." }, { "input": "The heart size, mediastinal, and hilar contours are normal.The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.", "output": "No acute cardiopulmonary process or focal consolidation concerning for pneumonia." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax. Visualized upper abdomen is unremarkable. Osseous structures are grossly intact.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. The aorta is tortuous. The mediastinal and hilar contours are otherwise unchanged, and no pulmonary vascular congestion is present. Except for mild bibasilar atelectasis, the lungs are clear without focal consolidation. No pleural effusion or pneumothorax is identified. Diffuse demineralization of the osseous structures is re- demonstrated. Degenerative changes of both glenohumeral joints are partially imaged.", "output": "Mild bibasilar atelectasis. No focal consolidation to indicate pneumonia." }, { "input": "PA and lateral chest radiographs demonstrate bibasilar opacities right greater than left. The aorta is tortuous. The cardiomediastinal silhouette is otherwise normal.", "output": "Bibasilar opacities, larger on the right are likely atelectasis. In the proper clinical setting, this can represent pneumonia." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. No radiopaque foreign bodies are identified.", "output": "No acute cardiopulmonary abnormality. No radiopaque foreign bodies are visualized." }, { "input": "The lungs remain clear, without focal consolidation to suggest pneumonia. There is no pleural effusion. There is no pneumothorax. Hilar and cardiomediastinal contours are unchanged, with persistent tortuosity of the descending aorta. There is no pulmonary vascular congestion or edema. The pleural surfaces are smooth. Degenerative changes are again seen in the thoracic spine.", "output": "No evidence of pneumonia. No evidence of malignancy within the limitations of chest radiograph." }, { "input": "The cardiomediastinal silhouettes are within normal limits. The bilateral hila are unremarkable. The lungs are clear. There is no pulmonary vascular congestion. There is a right apical pneumothorax measuring approximately 1.8 cm in largest extent. There is no left pneumothorax. There is no pleural effusion.", "output": "Small right apical pneumothorax measuring 1.8 cm in largest extent." }, { "input": "Compared with prior radiographs on ___, there has been interval resolution of a small right apical pneumothorax.The lungs are clear without focal consolidation. There is no pleural effusion. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Interval resolution of a small right apical pneumothorax." }, { "input": "Small right apical pneumothorax measuring up to 2.3 cm in greatest extent has slightly increased in size compared to the previous study. Remainder of the lungs are clear. The cardiac, mediastinal and hilar contours are unchanged, and no leftward shift of mediastinal structures is present. There is no pleural effusion. No acute osseous abnormality is visualized.", "output": "Small right apical pneumothorax, minimally increased in size compared to the previous study." }, { "input": "The lungs are well expanded and clear. Cardiac size is top normal. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. Patient is status post cardiac surgery. Sternotomy wires are intact. Mediastinal clips are again identified. An ICD generator is seen within the left thorax with three leads in unchanged position compared with prior exam.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest. Triple lead left chest wall pacing device is again seen. The lungs remain clear. Cardiomediastinal silhouette is stable. Hypertrophic changes again noted in the spine.", "output": "No acute cardiopulmonary process." }, { "input": "A left pectoral placed ICD/pacemaker is unchanged with leads terminating in the right atrium, right ventricle and past the coronary sinus. There is no evidence of lead fracture. Orthopedic hardware is seen in the right humerus. There is no pleural effusion, pneumothorax or focal airspace consolidation. The cardiac silhouette is mildly enlarged. The pulmonary vasculature is normal. The hilar and mediastinal structures are unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. Left-sided pacemaker is in appropriate position. Sternotomy wires and mediastinal clips are unchanged. Cardiomediastinal and hilar contours are normal. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac silhouette is moderately enlarged similar to prior examination with re-demonstration of a tortuous calcified thoracic aorta. Patient is status post CABG with median sternotomy wires in place. Hilar contours are unremarkable without evidence of overload or interstitial edema. A small left-sided effusion with associated compressive atelectasis is improved compared to prior examination. The remainder of the lung fields are clear. There is no pneumothorax.", "output": "Improving small left pleural effusion with compressive atelectasis. No evidence of fluid overload or interstitial edema." }, { "input": "Frontal and lateral chest radiographs were obtained. Lung volumes remain very low. A persistent tiny left apical pneumothorax remains without evidence of tension. Bilateral small pleural effusions are present with compressive atelectasis at the bases. Postoperative cardiomediastinal silhouette and hilar contours are stable.", "output": "1. Persistent tiny left apical pneumothorax. 2. Small bilateral pleural effusions with compressive atelectasis." }, { "input": "A small left pleural effusion is stable, and likely represents irritation from patient's known pancreatitis. Bibasilar atelectasis is unchanged and still persists on the right. There is no pleural effusion on the right. Lung volumes are larger than in the previous chest x-ray, which makes the cardiac silhouette appear more normal. There is no definite enlargement of the cardiac size in today's examination. There is no congestion or pulmonary edema. There is no pneumothorax.", "output": "1. Stable small left pleural effusion. 2. Stable bibasilar atelectasis." }, { "input": "A small pleural effusion is present at the left base with some associated left basilar linear atelectasis. It is likely similar is size accounting for differences between the PA and AP images. The lungs are otherwise clear without consolidation or edema. There is no pneumothorax. The cardiomediastinal silhouette is unchanged. The aortic arch appears more prominent, likely due to rotation.", "output": "Stable small left pleural effusion with associated atelectasis." }, { "input": "Portable frontal radiographs demonstrate a nasogastric tube with its tip terminating within the expected location of the jejunum. There is no pneumothorax. The heart and lungs remain normal.", "output": "Nasogastric tube with its tip terminating in the expected location of the jejunum." }, { "input": "Heart size is top normal with a mildly tortuous aorta that is large but not focally aneurysmal. Hilar contours are normal. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process; specifically, no evidence of pneumonia. Results were discussed over the telephone with Dr. ___ by ___ at 4:14 p.m. on ___ at time of initial review." }, { "input": "AP upright and lateral views of the chest provided. Cardiomegaly is stable and mild. The lungs are clear without focal consolidation, effusion or pneumothorax. No signs of congestion or edema. Mediastinal contour is normal. Bony structures are intact.", "output": "Stable mild cardiomegaly. Otherwise unremarkable." }, { "input": "Persistent layering bilateral pleural effusions with associated bibasilar atelectasis is unchanged. Mild interstitial edema particularly at the lung bases is noted. Left retrocardiac opacities obscure the left hemidiaphragm. There is no pneumothorax.", "output": "Left retrocardiac opacities may be due to atelectasis or effusion, however, infection cannot be excluded given the appropriate clinical circumstance. Mild interstitial edema. Persistent bilateral layering effusions and bibasilar atelectasis." }, { "input": "The heart size is mildly enlarged. There are moderate bilateral pleural effusions. There is pulmonary vascular redistribution and alveolar edema bilaterally. There is volume loss/infiltrates in both bases. Compared to the prior study the amount of fluid over load has increased.", "output": "Worsened CHF." }, { "input": "Cardiomediastinal silhouette and hilar contours are normal. Again appreciated is a 1 cm left apical nodule and better characterized on recent CT of the C-spine. There is bibasilar atelectasis and bilateral layering pleural effusions. There is no evidence of interstitial edema.", "output": "Bibasilar atelectasis and bilateral layering pleural effusions without frank interstitial edema." }, { "input": "The heart size is normal. The aorta remains unfolded. The mediastinal and hilar contours are unremarkable. Lungs remain hyperinflated. There is no focal consolidation, pleural effusion or pneumothorax. There are mild degenerative changes of the imaged thoracolumbar spine. Retained oral contrast is seen within colonic loops of bowel in the left hemi-abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral chest radiographs. Pneumoperitoneum below both hemidiaphragms was present on PET-CT from three days prior. This is most likely from the patient's PEG tube placement. The HD dialysis catheter has been removed. There is no focal consolidation, pleural effusion, or pneumothorax. The lungs are expanded but clear. The cardiomediastinal silhouette is normal.", "output": "1. Pneumoperitoneum is likely post-procedural from PEG tube placement on ___. 2. No pneumonia. Findings were discussed by Dr. ___ with Dr. ___ by phone at 1:29 p.m. (2 minutes after discovery) on ___." }, { "input": "Frontal and lateral chest radiographs were obtained. A right subclavian line terminates in the mid SVC. There is no evidence of complication or pneumothorax. The lungs are fully expanded and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion.", "output": "Right subclavian line terminates in the mid SVC without evidence of complication." }, { "input": "Left lower lobe collapse and the associated pleural effusion have worsened since the prior exam. A small stable right pleural effusion is present. The right basilar atelectasis is slightly improved. Again noted is severe cardiomegaly and widened mediastinum, which is unchanged. The sternal wires are intact. A right internal jugular central venous catheter is in unchanged position with the tip in the upper SVC.", "output": "1. Worsening left lower lobe collapse and pleural effusion. 2. Stable right pleural effusion with improving right basilar atelectasis." }, { "input": "Frontal and lateral views of the chest were obtained. Low lung volumes result in bronchovascular crowding. Pulmonary vasculature engorgement is increased from ___. Bilateral pleural effusions, left larger than right, with adjacent atelectasis are better seen on subsequent CT. Cardiomediastinal silhouette is unchanged. No pneumothorax. Median sternotomy wires are intact.", "output": "1. Bilateral pleural effusions, left larger than right, with adjacent atelectasis. 2. Mild pulmonary edema, increased from ___." }, { "input": "Please note that the study is now being interpreted on ___ due to the original transcription being lost. The heart size is mildly enlarged. The aorta is tortuous and there are mild aortic knob calcifications. The pulmonary vascularity is not engorged. Streaky bibasilar airspace opacities likely reflect atelectasis. Small bilateral pleural effusions are present, new in the interval. There is no pneumothorax. No acute osseous abnormality is detected.", "output": "Mild bibasilar atelectasis with small trace bilateral pleural effusions." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The lung volumes are normal. Normal size of the cardiac silhouette. Normal hilar and mediastinal structures. Unchanged appearance of the spine on the lateral chest radiograph. No pneumonia, no pulmonary edema. No pleural effusions.", "output": "Normal chest radiograph" }, { "input": "PA and lateral views of the chest. Relatively low lung volumes seen with linear bibasilar opacities, potentially due to atelectasis. Superiorly, the lungs are clear. There is no effusion. The cardiomediastinal silhouette is within normal limits. Median sternotomy wires are noted. No acute osseous abnormality is identified.", "output": "Low lung volumes with streaky bibasilar opacities, most likely atelectasis. Otherwise, no acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were compared to previous exam from ___ and CT chest from ___. Again seen are multiple bilateral spiculated nodules in the lungs. There is also fullness of the right hilum compatible with previously identified hilar mass. There is no new confluent consolidation or effusion. The cardiomediastinal silhouette is stable as are the osseous and soft tissue structures. Right chest wall port is seen with catheter tip in the lower SVC.", "output": "Multiple bilateral spiculated nodules, similar to most recent exams without evidence of new confluent consolidation." }, { "input": "PA and lateral chest radiographs demonstrate no focal consolidation, pleural effusion, or pneumothorax. The heart size is normal. The cardiac, hilar, and mediastinal contours are within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are clear without focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Subtle left base retrocardiac opacity most likely represents combination of overlap of vascular structures and atelectasis, less likely consolidation. No definite focal consolidation seen elsewhere. No large pleural effusion is seen although there is a possible trace left pleural effusion. Cardiac silhouette remains mild to moderately enlarged. Mediastinal contours are stable. No overt pulmonary edema is seen. Subtle appearance of evolving H-shaped vertebra, finding in sickle cell patients.", "output": "Subtle left base retrocardiac opacity most likely represents combination of overlap of vascular structures and atelectasis, less likely consolidation. No large pleural effusion, possible trace left pleural effusion, similar to prior. Persistent cardiomegaly." }, { "input": "Cardiac and mediastinal silhouettes are stable with the cardiac silhouette mildly enlarged. No focal consolidation is seen. There is no large pleural effusion although trace pleural effusions are difficult to exclude. No evidence of pneumothorax is seen. No overt pulmonary edema.", "output": "No large pleural effusion, but possible trace pleural effusions. No definite focal consolidation." }, { "input": "Frontal and lateral chest radiograph demonstrate hypoinflated lungs with crowding of vasculature and left lower lobe atelectasis. Small right pleural effusion is noted. No left pleural effusion. Stable mild cardiomegaly. Mediastinal contour and hila are unremarkable. Limited assessment of the upper abdomen is within normal limits. Persistent H shaped vertebrae is consistent with known history of sickle cell disease.", "output": "1. Small right pleural effusion. 2. No pneumonia. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 8:10 AM." }, { "input": "Lung volumes are low. The lungs are grossly clear. Mediastinum and hila are normal. There is moderate cardiomegaly, stable from ___. There is no pneumothorax. Small left pleural effusion is associated with adjacent atelectasis", "output": "Stable moderate cardiomegaly without evidence of pulmonary edema." }, { "input": "In comparison to the prior radiographs, there is no substantial change. Moderate cardiomegaly and mediastinal contours are stable. Hazy opacity in the posterior sulcus is unchanged and related to mild atelectasis and trace pleural effusions on the prior CT. There is no pneumothorax. H-shaped vertebral bodies are consistent with reported history of sickle cell disease.", "output": "No substantial change compared to the prior examination." }, { "input": "Moderate cardiomegaly is again seen. The lungs are clear without focal consolidation or large pleural effusion. H-shaped vertebra and sclerosis the humeral heads suggesting avascular necrosis are compatible with patient's history of sickle cell disease.", "output": "Cardiomegaly. No focal consolidation." }, { "input": "New from ___ is right mid and lower lung opacity, likely combination of pleural effusion and atelectasis. Superimposed consolidation cannot be excluded. A small left pleural effusion is suspected. Pulmonary vascular congestion is slightly increased without significant pulmonary edema. The cardiomediastinal silhouette, including moderate to severe cardiomegaly, is otherwise stable.", "output": "1. New right mid and lower lung opacity likely combination of pleural effusion and atelectasis. CONCURRENT consolidation cannot be excluded. A lateral view could be useful to delineate the extent of the pleural effusions. 2. Slightly increased pulmonary vascular congestion without frank pulmonary edema. 3. Probable small left pleural effusion. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 1:20 AM, 1 minutes after discovery of the findings." }, { "input": "Moderate cardiomegaly is unchanged. Cardiomediastinal silhouette and hilar contours are otherwise normal. Subtly increased opacity compared to prior at the left lung base adjacent to the heart border with the posterior basal lateral correlate. Lungs are otherwise clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "Subtly increased density at the posterior left lung base suspicious for pneumonia versus acute chest syndrome." }, { "input": "Moderate cardiomegaly and pulmonary vascular congestion are similar to the prior study. Hazy opacifications the posterior sulcus is also unchanged from multiple prior studies and previously characterized as atelectasis and small pleural effusions on CTA of the chest dated ___.", "output": "Moderate cardiomegaly and moderate pulmonary vascular congestion, similar to the prior study. No focal consolidation or frank pulmonary edema." }, { "input": "There is faint retrocardiac opacity focally silhouetting the hemidiaphragm. Elsewhere, the lungs are grossly clear. The cardiac silhouette is top-normal. No acute osseous abnormalities. Increased sclerosis at the bilateral humeral heads is likely due to avascular necrosis. H-shaped vertebral bodies are again noted. Surgical clips in the right upper quadrant suggest prior cholecystectomy.", "output": "Very slight retrocardiac opacity which is potentially atelectasis. If persistent clinical concern, consider PA and lateral for further characterization." }, { "input": "Mild to moderate cardiomegaly is unchanged. There is no evidence of pulmonary edema. There is no focal consolidation to suggest pneumonia. Mediastinal contour is normal. Morphologic changes of the vertebral bodies with endplate concavity is consistent with patient's history of sickle cell, and are unchanged from prior.", "output": "1. Unchanged mild to moderate cardiomegaly. 2. Morphologic changes of the vertebral bodies consistent with patient's history of sickle cell." }, { "input": "There is moderate cardiomegaly and pulmonary vascular congestion. No focal consolidation is identified. There are likely small bilateral pleural effusions. No pneumothorax is seen.", "output": "Bilateral small pleural effusions. Moderate cardiomegaly without focal consolidation." }, { "input": "Heart size is enlarged. The mediastinal and hilar contours are normal. The pulmonary vasculature is minimally engorged. Lung volumes are slightly low which accentuate bronchovascular markings. Given that, there is subtle opacity at the base of the right lung which could represent atelectasis or infection in the appropriate clinical setting. No pleural effusion or pneumothorax is seen. The is made of some sclerosis in the left humeral head.", "output": "Slightly low lung volumes. Subtle opacity at the base of the right lung could represent atelectasis however infection should be considered in the appropriate clinical setting. Recommend followup chest radiograph for further evaluation if clinically indicated." }, { "input": "A portable frontal chest radiograph demonstrates an enlarged cardiac silhouette. Increased opacity bilaterally is consistent with mild pulmonary edema and increased vascular markings consistent with a high flow state. Increased opacity at the bases likely reflects small bilateral pleural effusions with associated atelectasis. There is no pneumothorax or focal consolidation. Sclerosis of the humeral heads is consistent with avascular necrosis.", "output": "Mild pulmonary edema, increased vascular markings, and small bilateral pleural effusions with associated atelectasis." }, { "input": "No definite focal consolidation is seen. No large pleural effusion. The cardiac silhouette is at least mildly enlarged. No pneumothorax. No overt pulmonary edema. Subtle early appearance of eight-shaped vertebra involving the thoracic spine, correlate with history of sickle cell disease. Right upper quadrant surgical clips are from presumed cholecystectomy.", "output": "Mildly enlarged cardiac silhouette without overt pulmonary edema." }, { "input": "There is new right chest wall port with catheter tip in the region of the RA/SVC junction. The lungs are clear of consolidation or effusion. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "Marked enlargement of cardiac silhouette, slightly increased since ___ in association with pulmonary vascular congestion and diffuse interstitial edema. No pleural effusion or focal lung consolidation.", "output": "Marked enlargement of cardiac silhouette accompanied by pulmonary vascular congestion and new interstitial edema." }, { "input": "Compared to ___, there is no significant change. The lungs are well expanded and clear. Moderate cardiomegaly is stable, though substantially decreased since ___. There is no pleural abnormality. Mediastinal and hilar contours are unchanged. Left-sided single chamber ICD is unchanged in positioning.", "output": "No significant interval change since ___. No pneumothorax, pleural effusion." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are mildly hyperinflated. A nasoenteric tube lies with the tip below the left hemidiaphragm in the expected location of the stomach. Small bilateral pleural effusions are unchanged in appearance. No consolidation or pneumothorax seen. Surgical clips in the right upper quadrant consistent with prior cholecystectomy clear", "output": "The tip of a nasoenteric tube is in the stomach. Stable bilateral pleural effusions." }, { "input": "The tip of the Dobhoff tube is in the body of the stomach on the subsequent chest radiograph. No pneumothorax. Bilateral small pleural effusions have slightly decreased go The lungs remain hyperinflated. Basal opacities and slightly decreased. Prior cholecystectomy.", "output": "Dobhoff tube with the tip in the body of the stomach." }, { "input": "The lungs remain hyperinflated. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Hilar contours are stable. No displaced fracture is identified.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest provided. The lungs are clear though hyperinflated. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Clips are noted in the right upper quadrant.", "output": "No acute intrathoracic process." }, { "input": "New small bilateral pleural effusions with new nodular opacity in the right lower lobe. Heart size is normal. There is no pneumothorax. Cholecystectomy close project in the right upper quadrant. There is no subdiaphragmatic free air.", "output": "New small bilateral pleural effusions with new nodular opacity in the right lower lobe can be aspiration." }, { "input": "Cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The chest is hyperinflated. The lungs appear clear. Vague sclerosis projects along the anterior aspect of the left third, fourth and sixth ribs, possibly due to interval nondisplaced fractures although not necessarily acute.", "output": "No evidence of acute cardiopulmonary disease. Possible nondisplaced rib fractures on the left although not necessarily acute." }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. Mild bronchial cuffing is noted in the right upper lobe. The cardiomediastinal silhouette is within normal limits.", "output": "Mild bronchial wall cuffing may relate to reactive airways disease." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest. The lungs are clear of focal consolidation. Cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral radiographs of the chest are somewhat technically limited, especially the lateral view. The lungs are clear and aside from aortic tortuosity, the hilar and cardiomediastinal contours are normal. There is no pneumothorax or pleural effusion, and the pulmonary vascularity is normal, without edema. Median sternotomy cerclage wires are intact.", "output": "No evidence of pneumonia." }, { "input": "ET tube terminates 6 mm above the carina. ET tube tip is curved towards the right stem bronchus. Left lower lobe is better aerated compared to 1 day prior. Mild bibasilar opacities are likely secondary to atelectasis and/or small pleural effusions. There is no new consolidation. Right PICC terminates in upper SVC. Cardiomediastinal silhouette is unchanged.", "output": "1. ET tube tip is pointing towards the right stem bronchus and terminates 6 mm above the carina. Consider pulling back by 2 cm. 2. Transesophageal tube terminates at the GE junction. Consider advancing by 10 cm. NOTIFICATION: The findings regarding ET tube position was text paged by Dr. ___ to Dr. ___ on ___ at 10:14 AM, 5 minutes after discovery of the findings." }, { "input": "The nasogastric tube has been removed with insertion of a PEG. The tracheostomy is in standard position. The remaining support devices are also in standard position. Extensive pneumoperitoneum is new since PICC insertion. Worsening low lung volumes with more basal atelectasis and crowding of the bronchovascular vascular markings. No pneumothorax. The heart size is unchanged.", "output": "Extensive pneumoperitoneum post PEG insertion, greater than expected. Suggest close clinical follow-up and repeat radiographs. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 1:28 PM, 5 minutes after discovery of the findings." }, { "input": "The right lower lung consolidation has slightly progressed. There is also a possible second region of central consolidation in the right upper lobe in the paramediastinal region. Pulmonary vascular congestion and edema are a persistent finding. The right PICC line and tracheostomy are unchanged in position. A large amount of intraperitoneal air is again demonstrated.", "output": "Regions of consolidation in the right lung are compatible with clinical history of pneumonia, coexisting with CHF." }, { "input": "The patient is now rotated to the right and lung volumes are somewhat lower. . Bilateral pulmonary opacities most pronounced at the lung bases are again demonstrated. Mediastinal structures are unchanged. An endotracheal tube is been pulled back and now terminates approximately 3.3 cm above the carina. A right subclavian line remains in place terminating in the region of the superior vena cava. An enteric tube is present and can be followed to the level of the gastroesophageal junction as before.", "output": "No significant change in the appearance of the lungs, allowing for differences patient position technique. The endotracheal tube now appears to be in satisfactory position. The enteric tube is still high." }, { "input": "The lungs are clear. Cardiac silhouette is normal in size. No pleural effusion or pneumothorax. No rib fractures identified.", "output": "No evidence of rib fractures. Normal chest x-ray." }, { "input": "AP portable upright view of the chest. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process" }, { "input": "Frontal and lateral chest radiographs demonstrate clear lungs without focal consolidation, effusion, or pneumothorax. The heart size is normal. The mediastinal contours are normal. The pulmonary vasculature is normal.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Patchy right mid lung opacity is worrisome for pneumonia. The left lung is clear. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Patchy right mid lung opacity is worrisome for pneumonia. Recommend followup to resolution." }, { "input": "PA and lateral views of the chest provided. Cardiomegaly is stable and mild. There is no focal consolidation concerning for pneumonia. No large effusion or pneumothorax. No signs of congestion or edema. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Mild cardiomegaly, otherwise unremarkable." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "There are low lung volumes, which accentuate the bronchovascular markings. There is mild bibasilar atelectasis without definite focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable. Partially imaged hardware is seen the lower cervical spine. No displaced fracture is seen.", "output": "Low lung volumes and bibasilar atelectasis." }, { "input": "PA and lateral chest radiographs are provided. Exam is limited by underpenetration but there is no overt focal consolidation, pleural effusion, or pneumothorax. Cervical fusion hardware is present. Cardiomediastinal silhouette is unremarkable. No acute skeletal abnormalities.", "output": "No acute cardiothoracic process on this study limited by underpenetration." }, { "input": "Frontal and lateral views of the chest were obtained. The chest is relatively underpenetrated due to the patient's body habitus. Given this, no definite focal consolidation is seen. There is no pleural effusion or evidence of pneumothorax. The cardiac and mediastinal silhouettes are unremarkable given AP technique. The study is suboptimal to evaluate for acute rib fractures.", "output": "Underpenetrated due to the patient's body habitus. Given this, no definite acute cardiopulmonary process. Non-optimal evaluation of the ribs." }, { "input": "Lung volumes are low. Mild cardiomegaly is unchanged. Mediastinal and hilar contours are within normal limits. There is mild crowding of bronchovascular structures without pulmonary edema. Streaky atelectasis is noted in the lung bases without focal consolidation. No pleural effusion or pneumothorax is demonstrated. There are no acute osseous abnormalities. Fusion hardware within the cervical spine is incompletely assessed.", "output": "Low lung volumes with minimal bibasilar atelectasis. No focal consolidation to indicate pneumonia." }, { "input": "The cardiomediastinal silhouette is increased in size from ___ study which is likely exaggerated by low lung volumes. The hilar silhouettes are normal. There are no pleural effusions or pneumothorax. There is opacification of the right lower lung which could represent pulmonary vascular congestion, though given unilateral appearance and absence of pleural effusion raises the concern of developing pneumonia. .", "output": "Right lower lung opacification concerning for developing pneumonia." }, { "input": "Frontal and lateral radiographs of the chest were acquired. The lungs are clear. The heart size is normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen. Note is made of mild eventration of the right hemidiaphragm.", "output": "No acute cardiac or pulmonary findings." }, { "input": "The lungs are well expanded and clear. Hila and cardiomediastinal contours and pleural surfaces are normal. No osseous abnormality within the limits of plain radiography.", "output": "No pneumothorax or evidence of traumatic injury within the limits of plain radiography." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is identified. The heart size is top normal. Mediastinal contours are normal.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "The heart is upper limits normal in size. The lungs are clear without infiltrate or effusion. The bony thorax is normal.", "output": "Normal chest." }, { "input": "Lung volumes are normal. Lungs are clear without focal consolidation, effusion, or pneumothorax. Mediastinum, hila and pleural surfaces are unremarkable. The cardiomediastinal silhouette is normal.", "output": "No acute intrathoracic process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. The lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is present. There is marked gaseous distention of the stomach. No acute osseous abnormality is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lung volumes are low, accentuating the cardiac silhouette as well as causing vascular crowding. The cardiac silhouette is moderately enlarged with tortuosity of the thoracic aorta. There is mild prominence of the central pulmonary vasculature without frank interstitial edema. There is a trace right-sided pleural effusion with fluid tracking along the minor fissure. A ring-like density projects over the right upper lung field measuring roughly 2.6 cm without clear lateral correlate. There is no pneumothorax.", "output": "1. Moderate cardiomegaly with mild fluid overload and trace right-sided effusion. 2. A 2.6 cm ring density projecting over the right upper lung field without clear lateral correlate. Recommend oblique views for further characterization as well as acquisition of prior studies for comparison, if available. Discussed with Dr. ___ by Dr. ___ ___ the phone at 1:56am ___." }, { "input": "The ET tube terminates at the level of the clavicles. A nasogastric tube enters the stomach, distal tip not visualized. There is no pneumothorax. The lungs are clear. The heart and mediastinum are within normal limits despite the projection.", "output": "No evidence of pneumonia or congestive heart failure" }, { "input": "ET tube tip is 3.3 cm from the carina. Enteric tube passes below the inferior field of view. Low lung volumes are seen with secondary crowding of the bronchovascular markings. There is no confluent consolidation, large effusion or evidence of pneumothorax on this supine film. The cardiomediastinal silhouette is within normal limits for technique.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well inflated and clear. There is persistent prominence of the right paratracheal station, compatible with known lymphadenopathy. The cardiac silhouette is normal. There is no pleural effusion or pneumothorax. A right chest Port-A-Cath is noted terminating at the mid SVC. Bilateral breast implants are identified.", "output": "Persistent fullness at the right paratracheal station compatible with known lymphoma. No focal consolidation." }, { "input": "PA and lateral views of the chest provided. Overlying EKG leads are present. Bilateral breast implants are noted. Lungs are clear. No pleural effusion or pneumothorax. Cardiomediastinal silhouette appears normal. Bony structures are intact.", "output": "No acute findings. No pneumonia. Of note, mediastinal widening has improved as compared with chest radiograph from ___." }, { "input": "Right-sided Port-A-Cath tip terminates in the mid SVC. Heart size is normal. Mediastinal and hilar contours are within normal limits. Pulmonary vasculature is not engorged. Lungs are clear. No pleural effusion or pneumothorax is detected. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is normal. Mediastinal contour remains prominent, though less pronounced compared to the prior study, suggestive of improving lymphadenopathy. The hilar contours are again prominent compatible with underlying lymphadenopathy. No pulmonary edema, focal consolidation, pleural effusion or pneumothorax is seen. No acute osseous abnormality is visualized. Bilateral breast implants are again seen.", "output": "No radiographic evidence for pneumonia. Mediastinal contour appears less pronounced suggestive of improving lymphadenopathy. Continued bilateral hilar lymphadenopathy." }, { "input": "PA and lateral views of the chest provided. Right chest wall Port-A-Cath again seen with catheter tip extending into the upper SVC. Lungs are clear. No signs of pneumonia or edema. No pleural effusion or pneumothorax. Cardiomediastinal silhouette appears normal. Bony structures are intact.", "output": "No acute findings. Port-A-Cath appropriately positioned." }, { "input": "No significant interval change. Right Port-A-Cath tip ends in the mid SVC. The lungs are well-expanded and clear. No focal consolidation, effusion, edema, or pneumothorax. The heart size is normal. Mediastinal and hilar contours are unchanged. No acute osseous abnormality.", "output": "No pneumonia." }, { "input": "Right chest wall port is again seen with catheter tip in the upper SVC. The lungs are clear. There is no consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views the chest provided. Increased opacity projecting over the lower lungs on the frontal view likely reflects known breast implants. There is prominence of the mediastinum most notably along the right peritracheal stripe which is compatible with no lymphadenopathy. Lungs are clear. No large effusion or pneumothorax. Heart size is normal. Bony structures are intact.", "output": "As above." }, { "input": "Compare ___, there is no significant change.Heart size is within normal limits.Mediastinal and hilar lymphadenopathy previously seen on CT from ___, is not well seen on this exam. There is no evidence for pulmonary edema, pulmonary consolidation, pleural effusion, or pneumothorax.Right-sided Port-A-Cath is mostly unchanged, now located between posterior fourth and fifth rib space, previously between fifth and sixth. The tip of the Port-A-Cath is likely in mid SVC, unchanged from prior. There continues to be kinked appearance of the catheter near the clavicle.", "output": "No pneumothorax. No significant short-term interval change." }, { "input": "Right sided Port-A-Cath tip terminates in the upper SVC, unchanged. Lung volumes are lower compared to the previous study which slightly accentuates the size of the cardiac silhouette which remains top normal. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is not engorged. Streaky opacities in the lung bases likely reflect areas of atelectasis. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormality is detected. Bilateral breast prostheses and demonstrated.", "output": "Low lung volumes with streaky bibasilar opacities, likely reflective of atelectasis. Please note that infection cannot be completely excluded." }, { "input": "The lungs are well inflated and grossly clear. The cardiomediastinal silhouette is stable. Dense calcifications are again noted within the aortic arch. There is no pleural effusion, pneumothorax, or focal consolidation concerning for pneumonia.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs are hyperinflated with a paucity of vasculature seen in the upper lobes, suggesting emphysema. No pleural effusion. Heart is normal size. No pulmonary edema. Mediastinal and hilar contours are unremarkable. Old-appearing clavicular fractures bilaterally are noted. A tendon anchor is present in the right shoulder.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top normal. Mediastinal and hilar contours are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Exam is limited due to portable technique and patient body habitus. There is pulmonary vascular congestion. Right hilum appears enlarged. Cardiac silhouette is likely top-normal based on portable AP technique. No acute osseous abnormalities.", "output": "Limited exam. Pulmonary vascular congestion. Mild edema would be possible. Enlarged right hilum. Repeat with PA and lateral suggested show further characterize if patient is amenable." }, { "input": "Frontal and lateral views of the chest were obtained. The lateral view was suboptimal due to the patient's overlying arm. Given this, there may be minimal pulmonary vascular congestion without overt pulmonary edema. No definite focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac silhouette is top normal. Mediastinal contours are unremarkable.", "output": "Possible minimal vascular congestion without overt pulmonary edema." }, { "input": "The heart size is normal. The hilar and mediastinal contours are normal. The lungs are clear without evidence of focal consolidations concerning for pneumonia. There is no pleural effusion or pneumothorax. The visualized osseous structures are unremarkable.", "output": "No acute intrathoracic abnormalities identified." }, { "input": "PA and lateral views of the chest were obtained. Midline sternotomy wires and mediastinal clips are noted compatible with prior CABG. The lungs are clear. No pleural effusion or pneumothorax is seen. Heart and mediastinal contours appear normal. Bony structures are intact. There is no free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "The patient is status post coronary artery bypass graft surgery. The heart is normal in size. Coronary arteries appear calcified, possibly with stents. The lungs appear clear. There are no pleural effusions or pneumothorax. Small osteophytes are noted along the mid thoracic spine. There has been no significant change.", "output": "No evidence of acute disease." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced rib fracture is seen.", "output": "No acute cardiopulmonary process. No displaced rib fracture. If clinical concern persists, dedicated rib series or CT are more sensitive." }, { "input": "Frontal and lateral chest radiographs demonstrate unremarkable cardiomediastinal and hilar contours. Lungs are clear. No pleural effusion or pneumothorax evident. Surgical clip in upper mediastinum is unchanged since ___. No osseous abnormality evident.", "output": "No acute intrathoracic process." }, { "input": "The lungs are well expanded and clear. The cardiomediastinal silhouettes, hilar contours, and pleural surfaces are normal. Surgical clips in the anterior mediastinum are seen as far back as ___. No pleural effusion or pneumothorax is present.", "output": "Normal radiograph of the chest." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Lungs are fully expanded and clear. Previously described diffuse pulmonary edema versus pneumonia has resolved. Mild bilateral pleural effusions are mildly improved. There is no new focal consolidation. Mediastinal and hilar contours are normal. Heart size is normal. Small effusions are smaller.", "output": "1. Resolved pulmonary edema versus pneumonia has resolved. 2. Mild bilateral pleural effusions are mildly improved." }, { "input": "There are diffuse ___ B-lines and interstitial thickening bilaterally, which likely represents an atypical bacterial infection, mycoplasma, or viral infection. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Diffuse interstitial thickening bilaterally, without other signs to suggest pulmonary edema, likely representing an atypical bacterial infection, mycoplasma, or viral infection. NOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on the telephone on ___ at 11:28 AM, 2 minutes after discovery of the findings." }, { "input": "There is mild enlargement of cardiac silhouette. The aorta remains mildly tortuous and demonstrates atherosclerotic calcifications of the knob. Hilar contours are unchanged. Cluster of punctate calcifications within the left lung apex is compatible with prior granulomatous disease. Streaky opacity within the left lung base likely reflects atelectasis. Small hiatal hernia is re- demonstrated. No new focal consolidation is present. Clip overlies the right lateral chest wall, and the patient is status post right mastectomy. Pleural calcification is again seen within the left posterobasal hemithorax compatible with prior fibrothorax. Previously seen left lower lobe nodule on CT is not clearly visualized on the current exam.", "output": "Minimal left basilar atelectasis. Small hiatal hernia." }, { "input": "AP upright and lateral views of the chest were provided. As better assessed on the dedicated left shoulder radiograph, there is an acute fracture involving the neck of the left humerus. No definite displaced left rib fractures are seen. Leftward rotation does limit the evaluation through the chest, though there is no large consolidation, effusion or pneumothorax identified within the chest. Cardiomediastinal silhouette appears grossly stable. No large pneumothorax or effusion.", "output": "Left humeral neck fracture. Otherwise, no acute injury seen." }, { "input": "Mild enlargement of cardiac silhouette with a left ventricular predominance is re-demonstrated. The aorta knob is calcified. Mediastinal and hilar contours are otherwise unremarkable and there is no pulmonary edema. As before, multiple calcified granulomas are seen within the left upper lobe, and there is calcification of the pleura posteriorly within the left hemithorax compatible with fibrothorax. No focal consolidation, pleural effusion or pneumothorax is seen. The patient is status post right mastectomy with a clip demonstrated in the right chest wall. There are multilevel degenerative changes in the thoracic spine including a mild compression deformity at the thoracolumbar junction, unchanged.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is no acute focal consolidation, pleural effusion, or pneumothorax. Again seen is nodular opacity in the left upper lobe corresponding to calcified nodules seen on the recent chest CT. Calcified pleural plaques are again noted. Cardiomediastinal silhouette is stable. Osseous structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. Retrocardiac opacity is similar in appearance to prior study and may represent atelectasis. There is mild prominence of pulmonary vasculature which may be due to mild pulmonary edema or due to technique. Nodular opacity in the left upper lobe corresponds to calcified nodules seen on recent CT chest.", "output": "Possible mild pulmonary edema. Otherwise, no acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. There is increased opacification of the left base, although only well depicted on the frontal view. There is no definite pleural effusion or pneumothorax. Calcified pleural plaques are present. A surgical clip projects over the right anterolateral chest wall. Bony demineralization and degenerative changes along the thoracolumbar spine are unchanged.", "output": "Left basilar opacity worrisome for pneumonia without findings that would suggest pulmonary edema." }, { "input": "A left internal jugular vein catheter terminates in left brachiocephalic vein. There is no pneumothorax. There is no focal consolidation or pleural effusion. The cardiomediastinal silhouette is within normal limits.", "output": "Left IJ catheter terminates in left brachiocephalic vein. No pneumothorax. Findings were relayed by Dr. ___ to Dr. ___ by phone at 10:55 a.m. on ___." }, { "input": "Frontal view of the chest demonstrates low lung volumes, which accentuate bronchovascular markings. There is no pleural effusion, focal consolidation or pneumothorax. Bibasilar opacities likely represent atelectasis. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. Left internal jugular central venous catheter tip projects over left brachiocephalic vein, unchanged.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Heart size is normal. The cardiomediastinal and hilar silhouette is unremarkable. The lungs are clear without consolidations, effusions or pneumothorax. No radiopaque airway foreign body is identified. Surgical clips are visualized in the right upper quadrant. No acute bony abnormality.", "output": "No acute intrathoracic process. No airway radiopaque foreign body is identified." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs which are clear. There is no pleural effusion or pneumothorax. Again noted are surgical clips in the right upper abdomen, likely cholecystectomy clips.", "output": "Normal chest radiograph." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. Unchanged surgical clips are noted in the right upper quadrant, likely from a prior cholecystectomy.", "output": "No acute cardiopulmonary process; specifically, no evidence of pneumonia." }, { "input": "The lungs are clear. There is no pneumothorax. The heart and mediastinum are within normal limits. Mammilation of the bilateral hemidiaphragms is unchanged. Multiple right upper quadrant metallic surgical clips may be due to prior cholecystectomy. The bones are unremarkable.", "output": "Clear lungs with no evidence of residual pneumonia." }, { "input": "There has been interval placement of a transvenous dual lead pacemaker. The these appear to be in appropriate position. No pneumothorax seen. No pleural effusion or consolidation seen. Air-filled bowel loops are seen under the diaphragm consistent with Chilaiditi syndrome. No free air under the diaphragm.", "output": "No acute cardiopulmonary process seen." }, { "input": "The cardiac silhouette size is normal. The mediastinal and hilar contours are unremarkable. The lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is present. There is marked gaseous distention of the bowel loops within the abdomen.", "output": "No acute cardiopulmonary abnormality. Mild gaseous distention of the bowel loops of bowel." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest demonstrate moderate dextroconvex thoracic scoliosis. Allowing for such, the cardiomediastinal silhouette is within normal limits. The lungs are clear. There is no pneumothorax, vascular congestion, or pleural effusion.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiac sillhouette is stable. The thoracic aorta is tortuous, unchanged from prior. The bilateral hila are unremarkable. The lungs are clear without focal consolidation. There is no pulmonary vascular congestion. There is no pneumothorax or pleural effusion. There is mid thoracic dextroscoliosis.", "output": "No acute cardiopulmonary process. No pneumothorax." }, { "input": "Portable AP upright chest radiograph was provided. Evaluation is markedly limited due to low lung volumes and under penetrated technique. There is limited evaluation, possible at the lower lungs. There is increased pulmonary opacity which could in part reflect technique, though the possibility of edema or infection is impossible to exclude. The heart and mediastinal contours appear grossly stable. No definite bony abnormalities are seen.", "output": "Markedly limited exam, findings as discussed above, for which a dedicated PA and lateral view would be advised to further assess." }, { "input": "The examination is limited secondary to underpenetration due to patient body habitus. The heart remains significantly enlarged, which may be secondary to cardiomegaly or pericardial effusion, but essentially unchanged as compared to the prior examination. The aorta is tortuous and unfolded. The lung volumes remain mildly low, and there is bibasilar atelectasis. Patient is rotated to her right, with the right heart border simulating and a region of abnormality in the right lung. There is a possible small left pleural effusion. No pneumothorax is identified. Multilevel degenerative changes are noted within the thoracic spine.", "output": "1. No definite lung abnormality aside from mild bibasilar atelectasis. 2. Stable, severe cardiomegaly." }, { "input": "Massive enlargement of the cardiac silhouette is re- demonstrated, similar compared to the previous exam. The aorta remains unfolded. There is mild pulmonary vascular congestion, but this appears improved compared to the prior study. No definite focal consolidation, large pleural effusion or pneumothorax is seen though assessment lung bases is somewhat limited by underpenetration. There are mild to moderate multilevel degenerative changes in the thoracic spine.", "output": "Severe cardiomegaly with mild pulmonary vascular congestion." }, { "input": "Assessment is limited by underpenetration secondary to patient's body habitus. The heart is markedly enlarged, but unchanged compared to the prior studies, which may reflect cardiomegaly or a pericardial effusion. Clinical correlation is advised. The lung volumes are somewhat low, with bibasilar atelectasis, and pulmonary vascular congestion with peribronchial cuffing, suggesting mild pulmonary edema. Aorta is unfolded. There is no pneumothorax or large pleural effusion. Multi level degenerative changes are again seen in the thoracic spine.", "output": "1. Stable marked cardiomegaly. 2. Mild pulmonary edema and bibasilar atelectasis." }, { "input": "Enteric tube tip is below diaphragm, not included on the radiograph. Endotracheal tube tip is 1.8 cm above carina. Stable cardiopulmonary findings.", "output": "Enteric tube tip is below diaphragm." }, { "input": "Heart size is at the upper limits of normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. The upper lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. There are multiple remote left posterior rib fractures.", "output": "The upper lungs are clear. The lower lungs are not well evaluated. Recommend oblique views for further evaluation." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is normal. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Mild biapical scarring is unchanged. Heart size, mediastinal and hilar contours are normal. Mild atelectasis is present at the right lung base. No lung opacities concerning for pneumonia. There is no pleural abnormality. Fracture of the right ninth anterolateral rib is seen, however fracture of eighth rib seen on prior radiograph could not be visualized due to overlying monitoring and supporting device.", "output": "1. No pneumonia. 2. Mild right lower lung atelectasis." }, { "input": "A supine portable frontal chest radiograph demonstrates low lung volumes with increased prominence of the cardiac silhouette and bronchovascular crowding. There is been interval placement of a right internal jugular catheter, with the tip likely within the proximal right atrium. There is persistent elevation of the right hemidiaphragm. No definite focal consolidation, pleural effusion, or pneumothorax is identified. The visualized upper abdomen is unremarkable.", "output": "1. Low lung volumes. No definite focal consolidation identified. 2. A right internal jugular catheter terminates within the proximal right atrium. This catheter can be pulled back approximately 2.5-3 cm to place the tip in the distal SVC, if desired." }, { "input": "Since most recent chest radiograph, there has been interval placement of a right IJ central venous catheter which terminates projecting over the right atrium. There is no pneumothorax. Lungs are clear. Persistent elevation the right hemidiaphragm is noted. Radiopaque lucencies overlie the right upper mediastinum.", "output": "Right IJ central venous catheter terminates projecting over the right atrium. No pneumothorax." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen. Elevation of the right hemidiaphragm is unchanged from chest radiograph ___", "output": "No acute intrathoracic process." }, { "input": "Interval removal of a right-sided internal jugular central venous line. Multiple metallic clips overlying the superior mediastinum are unchanged in position. Lung volumes remain low leading to crowding of the bronchovascular structures. There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Cardiac silhouette size is normal. The mediastinal and hilar contours are unremarkable. The pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is detected. Elevation of the right hemidiaphragm is unchanged. Multiple clips are again noted in the right paramediastinal region.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There are low lung volumes and persistent elevation of the right hemidiaphragm. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "Low lung volumes and persistent elevation of the right hemidiaphragm. No significant interval change." }, { "input": "A portable supine frontal chest radiograph demonstrates a right internal jugular catheter, which now terminates in the low SVC. Lung volumes remain low, without definite focal consolidation, pleural effusion, or pneumothorax.", "output": "Repositioned right internal jugular catheter, which now terminates in the low SVC." }, { "input": "PA and lateral views of the chest. Again, low lung volumes are seen with relative elevation of the right hemidiaphragm which is unchanged. The lungs are clear without effusion, pulmonary vascular congestion or pneumothorax. Again seen are surgical clips in the right paramediastinal region. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is detected. No free air is seen below the diaphragm.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, hilar, and mediastinal contours are normal. The pulmonary vascularity is normal. Mild elevation of the right hemidiaphragm is unchanged with mild tenting of the diaphragm suggestive of mild volume loss. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded clear lungs. The cardiomediastinal and hilar contours are on remarkable. There is no pneumothorax, pleural effusion, or consolidation. On the lateral view note is made of increased density in the anterior mediastinum, which is similar in appearance ___. The stability over this period of time favors a benign etiology such is mediastinal lipomatosis or thymic cyst.", "output": "1. No acute cardiopulmonary process. 2. On the lateral view note is made of increased density in the anterior mediastinum, which is similar in appearance ___. The stability over this period of time favors a benign etiology such is mediastinal lipomatosis or thymic cyst. If clinically indicated, non-urgent CT of the chest with contrast could be performed for further evaluation. RECOMMENDATION(S): On the lateral view note is made of increased density in the anterior mediastinum, which is similar in appearance ___. The stability over this period of time favors a benign etiology such is mediastinal lipomatosis or thymic cyst. If clinically indicated, non-urgent CT of the chest with contrast could be performed for further evaluation. NOTIFICATION: Updated impression and recommendations were discussed with Dr. ___ by Dr. ___ ___ telephone at 4:37pm on ___, approximately 30 minutes after discovery." }, { "input": "PA and lateral views of the chest. The lungs are clear without evidence of consolidation, pleural effusion or pneumothorax. The cardiac, mediastinal and hilar contours are normal. The pleural surfaces are normal.", "output": "Resolution of pneumonia. No new consolidation." }, { "input": "There are new vague opacities in the right mid to lower lung, probably for the most part within the lower lobe. Elsewhere the lungs appear clear. There is no pleural effusion or pneumothorax. The cardiac, mediastinal and hilar contours appear stable.", "output": "Vague right lung opacities. These are not specific but may indicate pneumonia in the appropriate clinical setting. Correlation with clinical presentation is suggested. If an unusual appearance of atelectasis or asymmetric pulmonary congestion may explain the findings, and for general reassessment, short-term repeat radiographs may be helpful." }, { "input": "Cardiac size is top-normal. There is new mild to moderate pulmonary edema. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable central catheter is in standard position", "output": "New mild to moderate pulmonary edema." }, { "input": "Portable semi-upright radiograph of the chest demonstrates low lung volumes results in bronchovascular crowding. Engorged pulmonary vasculature and increase interstitial markings is suggestive of mild pulmonary edema. Cardiomediastinal and hilar contours are unchanged. No pneumothorax or pleural effusion.", "output": "Mild pulmonary edema." }, { "input": "PA and lateral views of the chest provided. A right IJ access double lumen catheter terminates at the expected location of the SVC. There is a small right pleural effusion and mild right basilar atelectasis, as seen on same date CT a/p. The left lung is clear. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. Chronic left 7 & 8th rib deformities again noted. No free air below the right hemidiaphragm is seen.", "output": "Small right pleural effusion and mild right basilar atelectasis." }, { "input": "In comparison to the prior study the lung volumes are much lower and new bibasilar opacities probably represent atelectasis; superimposed consolidation cannot be excluded. Small pleural effusions are possible.", "output": "Low lung volumes and bibasilar atelectasis, left more than right. Superimposed consolidation would be difficult to exclude." }, { "input": "Intact medial sternal hardware. Evidence of prior CABG. Heart size is normal. Mediastinal and hilar contours are unremarkable. No evidence of pneumonia, pulmonary edema, or pleural effusions. Lungs are clear.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs demonstrate clear lungs without pleural effusion or pneumothorax. The cardiac silhouette is normal in size. The mediastinal contours are normal.", "output": "Normal chest radiograph." }, { "input": "The lungs are hyperexpanded compatible with clinical history of COPD. No focal consolidation, pulmonary edema or pleural effusions IS seen. The heart size is normal, and the mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. Mildly displaced acute rib fractures of the right eighth and nineth lateral ribs are noted. Remote fractures of the left third through fifth ribs are also seen. Compression deformity of a vertebral body at the thoracolumbar junction appears unchanged.", "output": "Acute fractures of the right eighth and nineth lateral ribs. No pneumothorax or acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. There is a small right pleural effusion and overlying atelectasis. There may also be some fluid tracking in the right fissure. The cardiac silhouette is mildly enlarged. There is no overt pulmonary edema. No evidence of pneumothorax is seen. The mediastinal contours are stable, and there is calcification of the aortic knob.", "output": "Small right pleural effusion and enlargement of the cardiac silhouette." }, { "input": "The patient is status post median sternotomy and CABG. Heart size is normal. Mediastinal and hilar contours are unremarkable. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormalities are visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Posterior lower opacity projecting over the spine on the lateral view likely reflects right lower lobe pneumonia. There is no pleural effusion or pneumothorax. The heart size is normal. The mediastinal contours are normal.", "output": "Right lower lobe pneumonia." }, { "input": "Streaky opacities more prominent in the left upper lung and bilateral lung bases in the appropriate clinical setting may represent pneumonia. There is multilevel mild loss of vertebral body height throughout the thoracic spine. Cardiomegaly is mild.", "output": "Bibasilar and left upper lobe opacities in the appropriate clinical setting are concerning for pneumonia. RECOMMENDATION(S): Followup of the patient 4 weeks after completion of antibiotic therapy is required, in particular to document the resolution of left upper lobe perihilar opacity. If findings are unchanged, assessment with chest CT is required. Additionally giving the presence of left lower lobe pulmonary nodule, followup with chest CT in 3 months based on the size of the left lower lobe nodule is recommended as well." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lung fields are clear. There is no pneumothorax, fracture or dislocation. Limited assessment of the abdomen is unremarkable.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Lung volumes are low, which limits evaluation of the lower lobes.Prominent pulmonary vessels are similar to before. Moderately enlarged cardiomediastinal silhouette is stable. There is no pneumothorax or pleural effusion.", "output": "Suboptimal inspiration limits evaluation of the lower lobes. Upper lungs are clear. Repeat chest radiograph with full inspiration is recommended. RECOMMENDATION(S): Suboptimal inspiration limits evaluation of the lower lobes. Upper lungs are clear. Repeat chest radiograph with full inspiration is recommended." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process" }, { "input": "The lungs are clear lung volumes are normal. No pleural effusion, pneumothorax or focal airspace consolidation. Heart is normal size. The mediastinal and hilar structures are unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Interval removal of right internal jugular Swan-Ganz catheter, with no visible pneumothorax. Stable postoperative widening of cardiomediastinal contours. Worsening bibasilar retrocardiac opacities are likely due to atelectasis, and are accompanied by small bilateral pleural effusions, increased on the left and apparently new on the right in the interval. On the left, the pleural effusion is apparently superimposed on pre-existing pleural thickening adjacent to numerous healed left rib fractures, a finding present since ___. Subcutaneous emphysema is present in the chest wall. Retrosternal gas is probably related to recent sternotomy procedure.", "output": "Worsening bibasilar atelectasis and increasing pleural effusions." }, { "input": "Compared to the recent study from approximately 3 hr prior, there has been interval placement of an NG tube looping in the stomach with tip at the level of the fundus. Otherwise low lung volumes have decreased with associated left base atelectasis/scarring. No other relevant change. Several chronic left-sided rib fractures.", "output": "Appropriate positioning of an NG tube." }, { "input": "Moderate cardiomegaly is unchanged. Re- demonstration of postoperative mediastinal silhouette with intact sternotomy wires. Hilar contours are unremarkable. Improved consolidation at the left lung base correlates to scarring on prior CT. Lungs are otherwise clear. No effusion or pneumothorax. Right lower lobe nodule identified on prior CT is not visualized on this study.", "output": "No acute cardiopulmonary abnormality. Nodule previously identified on CT is not evident on radiography." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well expanded and clear. There is no focal consolidation, effusion, or pneumothorax. Cardiac and mediastinal contours are normal.", "output": "Normal chest radiograph." }, { "input": "AP upright and lateral views of the chest provided. There is left lower lobe opacity concerning for pneumonia. Additionally, there is subtle opacity projecting over the right lower lung on the AP view, also concerning for pneumonia. The lungs are hyperinflated which suggests emphysema. No large pleural effusion is seen. There is no pneumothorax. The cardiomediastinal silhouette appears grossly within normal limits. No convincing evidence for edema. Bony structures are intact.", "output": "Emphysema with lower lung opacities concerning for multifocal pneumonia." }, { "input": "There are right middle and anterior segment of the right upper lobe involving confluent opacities with an oval component in the upper lobe consistent with pneumonia. There is no pleural effusion and no pneumothorax. The cardiomediastinal shilhouette and hila are normal.", "output": "Right middle and upper lobe pneumonia with widespread dense consolidation. Short-term follow-up chest radiographs are recommended within six weeks to resolution is recommended to rule out underlying coinciding malignancy noting a area of somewhat oval confluent opacification in the right upper lobe. In a high risk patient chest CT could also be considered preferably with intravenous contrast if that course is pursued." }, { "input": "The lungs are well-expanded and clear. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No evidence of pneumonia." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Enteric tube terminates within the proximal stomach and could be advanced 4 - 5 cm for appropriate positioning. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "Enteric tube in the proximal stomach and could be advanced 4-5 cm for appropriate positioning. No acute cardiopulmonary abnormality." }, { "input": "Of note, the right costophrenic angle is not imaged. Enteric tube terminates over the proximal stomach. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "Enteric tube terminates over the proximal stomach. No pneumothorax or focal consolidation." }, { "input": "Dual-chamber pacemaker device is noted in the left chest with leads terminating in the right atrium and right ventricle. The heart is mildly enlarged. Atherosclerotic calcification of the aorta is noted. Mediastinal and hilar contours are otherwise unremarkable. Lungs appear mildly hyperinflated. No pulmonary vascular engorgement is seen. Left basilar opacification is noted, with a small left pleural effusion . No pneumothorax is seen, and there is no right-sided pleural effusion. Loss of height of several thoracic vertebral bodies is age indeterminate.", "output": "1. Left basilar opacification may reflect atelectasis or infection, with adjacent small left pleural effusion. 2. Multiple compression fractures in the thoracic spine, of indeterminate chronicity." }, { "input": "Upright portable view of the chest demonstrates moderate bilateral pleural effusions. Right pleural effusion with probable subpulmonic component. Left lung base consolidation is noted. Right lung base opacities are also seen. There is mild pulmonary edema. Heart size is difficult to assess due to the adjacent opacities, which is likely enlarged. Aortic arch calcifications are noted. Pacemaker leads are in place, projecting over right atrium and ventricle. There is no pneumothorax. Bones are diffusely demineralized.", "output": "Moderate bilateral pleural effusions, cardiomegaly and pulmonary edema. Left lung base consolidation, likely atelectasis, however, superimposed infection cannot be excluded." }, { "input": "Left-sided dual-chamber pacemaker with leads terminating in the right atrium and right ventricle is unchanged. The heart is mild to moderately enlarged, with mild pulmonary vascular congestion noted. Diffuse atherosclerotic calcifications of the aorta are seen. Retrocardiac opacity may reflect atelectasis or infection. Small left pleural effusion is relatively similar compared to the prior study, as is a tiny right pleural effusion. There is no pneumothorax.", "output": "Mild pulmonary vascular congestion with small bilateral pleural effusions, left greater than right. Retrocardiac opacity may reflect atelectasis though infection is difficult to exclude." }, { "input": "Lungs are well expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax. Of note, degenerative changes of the right AC joint are noted.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Upright portable view of the chest demonstrates normal lung volumes. Costophrenic angles are blunted bilaterally, suggestive of small pleural effusions. There is moderate cardiomegaly and upper lobe vascular redistribution are chronic. Predominantly bibasilar redistribution of airspace opacities over the past three hours is good evidence that the process is hydrostatic edema. The most pronounced opacification, in the right upper lobe, abutting the minor fissure, might well be concurrent pneumonia. Hilar and mediastinal silhouettes are unremarkable. Descending aorta is slightly tortuous with aortic arch calcifications. There is no pneumothorax. The imaged upper abdomen is unremarkable.", "output": "Moderate cardiomegaly, small bilateral pleural effusions, edema have slightly improved since ___ exam. Possible right upper lobe pneumonia." }, { "input": "Heart size likely is moderately enlarged but difficult to assess given the presence of moderate bilateral pleural effusions, increased from the prior exam. Bibasilar airspace opacities may reflect compressive atelectasis. There is mild to moderate pulmonary edema. No pneumothorax is identified. There are no acute osseous abnormalities.", "output": "Moderate congestive heart failure with moderate size bilateral pleural effusions, bibasilar atelectasis, mild to moderate pulmonary edema." }, { "input": "The lungs are clear. Bilateral small pleural effusions have resolved. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Bilateral small pleural effusions have resolved." }, { "input": "There are small bilateral effusions with mild adjacent compressive atelectasis. The lungs are otherwise clear without focal consolidation or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "Small bilateral pleural effusions without focal consolidation." }, { "input": "The heart is normal in size. There is a new convex contour which appears immediately lateral to the upper part of the descending aorta. Otherwise, the mediastinal and hilar contours appear unchanged. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable.", "output": "A new contour abnormality along the aortopulmonary window. Etiologies may be vascular, projectional or potentially due to neoplasm. When clinically appropriate, a chest CT is suggested, preferably with intravenous contrast to assess further. An email was sent to the ___ nursing group regarding recommendation for chest CT on ___." }, { "input": "PA and lateral chest views were obtained with patient in upright position. Comparison is made with the next preceding AP and lateral chest examination of ___. Status post sternotomy and aortic vascular repair as before. Appearance of superior mediastinal structures has not changed during the latest interval, and no pneumothorax has developed. Heart size remains unchanged and no pulmonary vascular congestive pattern is identified. Comparing the frontal views with the previous examination demonstrates that a right-sided pleural effusion has developed which mildly blunts the lateral pleural sinus. Also slight increase of left-sided lateral pleural sinus blunting is noted. When comparing the findings on the lateral views, the previously present pulmonary parenchymal infiltrate with atelectatic component in the posterior segment of the left lower lobe has disappeared. There remains evidence of small pleural effusions extending into both posterior pleural sinuses. No pneumothorax can be identified on the frontal view in the apical area.", "output": "The amount of bilateral pleural effusion matches that found on most recent chest CT of ___." }, { "input": "The patient is rotated to the right. The patient's chin overlies the right lung apex, making its evaluation suboptimal. There are low lung volumes, which accentuate the bronchovascular markings. Evidence of mild interstitial edema is seen. On the lateral view, there is patchy opacity projecting over posterior lung base, possibly on the right, consolidation at that location due to infection or aspiration not excluded. The cardiac silhouette is not enlarged. Prominence of the hila may relate to pulmonary vascular engorgement.", "output": "Low lung volumes and evidence of interstitial edema. Focal patchy opacity projecting over posterior lung base, possibly on the right, may represent underlying consolidation possibly due to infection or aspiration, atelectasis, or artifact." }, { "input": "Pulmonary hyperinflation. The heart size normal. Mild unfolding of the aorta. Mild prominence of the main pulmonary artery and right interlobar artery which suggest pulmonary hypertension. No airspace consolidation. No suspicious pulmonary nodules or masses. Spondylotic changes of the thoracic spine.", "output": "No airspace consolidation to suggest pneumonia. Pulmonary hyperinflation suggesting COPD. Mild prominence of the main pulmonary artery and right interlobar pulmonary artery may be in keeping with pulmonary hypertension." }, { "input": "The heart size is normal. Mild unfolding of the aorta. Normal hila. No airspace consolidation. No pulmonary edema. Mild increase in the bronchovascular markings. No suspicious pulmonary nodules or masses. No pleural effusions. No pneumothorax. Spondylotic changes of the thoracic spine.", "output": "No features of cardiac decompensation or an acute pleuropulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. Note is made of anterior cervical fixation hardware.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Portable AP upright chest ___ at 14:31 is submitted.", "output": "Stable cardiac enlargement. There has been interval development of mild interstitial edema. Subtle patchy opacities at both bases likely reflect patchy atelectasis rather than aspiration or pneumonia. Clinical correlation is recommended. No pneumothorax. Previously reported 6 mm nodular opacity in the right mid lung is not well appreciated on the current study." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The chest is hyperinflated. There is no pleural effusion or pneumothorax. The lungs appear clear. Mild degenerative changes are noted along the mid through lower thoracic spine.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The patient has been intubated. The endotracheal tube closely approaches the carinal within about 1 cm. An orogastric tube passes into the stomach on and terminates there. The cardiac, mediastinal and hilar contours appear stable. The lung volumes are decreased with patchy left basilar opacity which is probably due to atelectasis.", "output": "Status post endotracheal intubation. Low-lying endotracheal tube, although at the time of this dictation, it had already been retracted on a subsequent film. Left basilar opacity, probably due to atelectasis. Attention in follow-up is suggested." }, { "input": "Heart size remains moderately enlarged. The mediastinal and hilar contours are unchanged. The pulmonary vasculature is not engorged. Patchy opacities are noted within the right lung base, more pronounced when compared to the previous exam. Nodular opacity measuring 6 mm is re- demonstrated within the right mid lung field. No pleural effusion or pneumothorax is present. No overt pulmonary edema is demonstrated. Moderate multilevel degenerative changes are again seen in the thoracic spine.", "output": "Worsening patchy opacity in the right lung base, potentially worsening atelectasis though infection is not excluded." }, { "input": "AP upright and lateral views of the chest were provided. Lung volumes are low, though the lungs remain clear. The heart size is normal. Dual-lead pacer is unchanged. No pneumothorax or pleural effusion is seen. On the lateral view, a metallic stent is visualized in the right upper abdomen.", "output": "No signs of pneumonia. Low lung volumes limit evaluation." }, { "input": "Frontal and lateral views of the chest were obtained. There has been interval placement of a left-sided PICC line, terminating in the region of the distal-to-mid left subclavian vein, not in appropriate position. Recommend repositioning. Elevation of the right hemidiaphragm persists. No definite pleural effusion is seen. There is no focal consolidation or pneumothorax. The cardiac and mediastinal silhouettes are stable.", "output": "Left-sided PICC terminates in the distal-to-mid left subclavian vein, in appropriate position. These findings and recommendations were discussed with nurse, ___, at 5:57 p.m. on ___ 3 minutes after discovery and 10 minutes later also discussed with Dr. ___ on ___." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. There is very minimal streaky left basal atelectasis. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear and the lung volumes are normal. There is no pleural effusion, pneumothorax or focal airspace consolidation. Heart is normal size. The mediastinal and hilar structures are unremarkable. There is no free air seen under the diaphragm.", "output": "No acute cardiopulmonary process." }, { "input": "Left-sided AICD is seen, with lead extending the expected positions of the right atrium right ventricle. The cardiac silhouette is mild to moderately enlarged. Mediastinal contours are grossly unremarkable. Left lower lobe calcified granuloma is seen. Small pleural effusions are better demonstrated on CT. No pulmonary edema is seen.", "output": "Small bilateral pleural effusions better demonstrated on subsequent CT. ___, MD ___=___ CC: DR. ___" }, { "input": "AP upright and lateral chest radiographs were obtained. The exam is limited by body habitus. Despite these limitations, the lungs are well expanded and clear. There is no focal consolidation, effusion, or pneumothorax. Cardiomegaly is severe.", "output": "Severe cardiomegaly. No acute cardiopulmonary process." }, { "input": "Mild cardiomegaly is unchanged as are the mediastinal and hilar contours. Patchy opacity in the right lung base could reflect resolving infection and/or infarction. A small right pleural effusion appears similar. Linear opacities in the left lung base likely reflect atelectasis. No pulmonary vascular engorgement is seen, and there is no pneumothorax. Degenerative changes of both glenohumeral and acromioclavicular joints are noted.", "output": "Persistent patchy opacity in the right lower lobe which could reflect residual infection or infarction. Unchanged small right pleural effusion. Subsegmental atelectasis in the left lung base." }, { "input": "The cardiac, mediastinal and hilar contours are normal. The pulmonary vascularity is normal. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are present.", "output": "Normal chest radiograph." }, { "input": "A single portable view of the chest. Indistinctness of the pulmonary vascular markings is seen. There is no definite confluent consolidation. Blunting of the costophrenic angles may be due to small effusions, more apparent on the left. Cardiac silhouette is enlarged but given lower lung volumes and portable technique has not significantly changed. No acute osseous abnormality detected.", "output": "Mild pulmonary vascular congestion without consolidation." }, { "input": "When compared to previous exam, there has been no definite interval change. Degree of cardiomegaly is unchanged. Bibasilar opacities, right greater than left are again seen compatible with bronchiectasis and peribronchial opacities. These may have subtly increased at the right lung base compared to prior. Apparent increased opacity projecting over the right upper lung is due to patient's overlying scapula which was not in this position on prior.", "output": "Bibasilar parenchymal opacities compatible with chronic changes, noting slightly conspicuous consolidation at the right lung base which could represent an active component of disease. Consider PA and lateral for more complete evaluation." }, { "input": "The heart is at the upper limits of normal size with a left ventricular configuration. Mild unfolding and calcification are noted along the aorta. The lung volumes are low. There is no pleural effusion or pneumothorax. Although there is no focal opacity, the interstitium is mildly prominent suggesting slight fluid overload. A crowding of interstitial markings suggests atelectasis associated with low lung volumes and mild elevation of the right hemidiaphragm. A severe lower thoracic compression deformity includes nearly complete collapse of the vertebral body and mild retropulsion, of uncertain chronicity.", "output": "1. Mild interstitial abnormality suggesting slight fluid overload. 2. Crowding of right basilar lung markings, more suggestive of minor atelectasis than pneumonia. However, if pneumonia is a persistent clinical concern, then short-term followup radiographs may be helpful, preferably with PA and lateral technique, if possible. 3. Severe lower thoracic compression deformity, age-indeterminant on radiography, but with not clear indication of recent chronicity. Correlation with clinical presentation and findings is suggested." }, { "input": "Heart size is mildly enlarged with of left ventricular predominance. The aorta remains tortuous with mild atherosclerotic calcifications. The mediastinal and hilar contours are unchanged. Mild pulmonary vascular congestion is re- demonstrated. Lungs are hyperinflated with streaky opacity at the left lung base, likely atelectasis. Minimal blunting of the costophrenic angles suggests trace bilateral pleural effusions. No pneumothorax is detected.", "output": "Mild pulmonary vascular engorgement with patchy left basilar opacity, likely atelectasis. Possible trace bilateral pleural effusions. No pneumothorax." }, { "input": "Endotracheal tube tip terminates approximately 5 cm from the carina. Orogastric tube tip is within the stomach. The heart size is normal. The aorta is tortuous. The pulmonary vascularity is normal. The mediastinal and hilar contours otherwise unremarkable. Except for minimal streaky opacity in the retrocardiac region which likely reflects atelectasis, the lungs are clear without focal consolidation. No pleural effusion or pneumothorax is detected. No displaced fractures are seen. There are multilevel degenerative changes in the thoracic spine with dextroscoliosis present.", "output": "Endotracheal tube and orogastric tube tips in standard positions. Minimal left basilar atelectasis, though given the history of seizure, aspiration cannot be excluded." }, { "input": "AP upright and lateral views of the chest were provided. Vagal nerve stimulator is present in the left chest wall with catheter extending into the left neck soft tissues. The heart is top normal in size. The lungs are clear. No effusion or pneumothorax is seen. The bony structures are intact. Hypertrophic changes at the right AC joint noted.", "output": "No acute intrathoracic process." }, { "input": "The right upper lobe demonstrates a sclerotic reaction likely at the first rib. This appears to have been stable compared to multiple prior exams dating back to ___. However, to delineate if this is truly at the rib or intraparenchymal, would recommend additional apical lordotic views for further evaluation. There is mild bibasilar atelectasis; otherwise, no focal consolidations are seen. There is no pleural effusion or pneumothorax. The heart size is stable. The hilar and mediastinal contours are unremarkable.", "output": "There is a sclerotic lesion at the right upper lobe which appears to have been stable compared to multiple prior exams dating back to ___. However, to truly delineate if this is intraparenchymal or part of the rib, would recommend apical lordotic views." }, { "input": "The patient is rotated somewhat to the left. The PAC is noted overlying the left lateral upper hemithorax. There is a relative opacity projecting over the left mid-to-lower lung, possibly in the lingula which could relate to patient positioning, underlying consolidation due to an infection or contusion given not excluded. No pleural effusion is seen. There is no evidence of pneumothorax. The cardiac and mediastinal silhouettes are unremarkable. Thoracic scoliosis is noted.", "output": "Opacity projecting over the left mid-to-lower lung is nonspecific, however, may represent consolidation which could be due to infection or if in the setting of trauma pulmonary contusion." }, { "input": "A single AP radiograph of the chest was acquired. The patient is rotated to the left. The endotracheal tube ends 4.2 cm above the level of the carina. There is minimal bilateral lower lung atelectasis. The lungs are otherwise clear. The heart size is top normal. The mediastinal contours are normal. There are no definite pleural effusions. No pneumothorax is seen.", "output": "1. Appropriately positioned endotracheal tube, ending 4.2 cm above the level of the carina. 2. No acute cardiac or pulmonary process." }, { "input": "AP upright and lateral views of the chest provided. Lung volumes are low with bibasilar atelectasis again noted. The mid upper lungs appear well aerated. No large effusion or pneumothorax. Overall cardiomediastinal silhouette is stable. No free air below the right hemidiaphragm.", "output": "Low lung volumes with basilar atelectasis." }, { "input": "Overlying trauma board limits evaluation. Endotracheal tube tip terminates approximately 5 cm from the carina. Orogastric tube is noted within the stomach and the tip projects off the inferior borders of the film. Bilateral chest tubes are noted terminating near the lung apices. Left subclavian central venous catheter tip terminates within the upper SVC. The heart size is normal. The superior mediastinum is widened. Small bilateral pneumothoraces are present. Minimal streaky opacity is noted in the left lung base, which could reflect atelectasis. More focal opacity is also seen within the left mid lung field, which is nonspecific. No pleural effusion is identified. There are multiple bilateral rib fractures noted.", "output": "1. Lines and tubes in standard positions. 2. Widened superior mediastinum. Subsequent CT of the torso demonstrated an extensive type A aortic dissection. 3. Small bilateral apical pneumothoraces. 4. Streaky opacity left lung base may reflect atelectasis. More focal opacity in the left mid lung field is nonspecific but could reflect an area of aspiration or contusion." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are normal. The lungs are clear without cavitary nodules or focal consolidations. There is no pleural effusion or pneumothorax.", "output": "No radiographic sequela of granulomatosis with polyangiitis." }, { "input": "A right-sided PICC remains in place terminating at the level of the mid SVC. Cardiomediastinal silhouette and hilar contours are normal. There is no evidence of fluid overload. Lungs are clear without focal consolidation. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours are normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "The visualized mediastinal structures are unremarkable. There is no cardiomegaly. There is a new retrocardiac opacity present in the left lower lobe which is concerning for pneumonia. No associated effusions. The faintly visible right mid lung opacity projecting over the posterior seventh rib is again visualized. No pneumothorax. There is a right sided PICC line with distal tip projecting over the upper SVC.", "output": "New retrocardiac opacity concerning for left lower lobe pneumonia." }, { "input": "The lungs are well expanded and clear. The cardiomediastinal silhouette is unremarkable. There is no pleural effusion, pulmonary edema, pneumothorax, or focal airspace opacification.", "output": "No acute cardiopulmonary process." }, { "input": "Diffusely increased interstitial markings unchanged from prior CT. There is no airspace consolidation. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "No acute cardiopulmonary process. Diffusely increased interstitial markings consistent with NSIP as more completely evaluated on the prior CT." }, { "input": "PA and lateral views of the chest provided. Compared to prior study, there is little change. There is no focal consolidation. Pulmonary vasculature is normal. There is trace pleural effusion.", "output": "No acute pneumonia." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unchanged. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is present. Calcified granuloma in the left upper lobe is unchanged. No acute osseous abnormalities seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is normal. Mediastinal and hilar contours are normal. Pulmonary vascularity is normal. Left upper lobe tiny calcified granuloma is unchanged. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. There is no free air under the diaphragms. Leftward deviation of the trachea is unchanged. A left sided rib deformity is old. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Mildly rotated frontal radiograph. Frontal and lateral chest radiograph demonstrates moderately well inflated clear lungs. No pleural effusion or pneumothorax. Heart size and mediastinal contour are unremarkable. The left hilum is mildly enlarged and slightly more prominent when compared to ___, but positional differences between the exams limit comparison. Leftward deviation of the trachea is stable. Left upper lobe tiny calcified granuloma is stable. limited assessment of the upper abdomen is within normal limits.", "output": "1. Enlarged left hilum has apparently increased in PROM from ___ but is difficult to compare due to patient rotation. Recommend a nonurgent non rotated radiograph for more accurate direct comparison to previous study. 2. No pneumothorax." }, { "input": "There is mild cardiomegaly. Of unknown chronicicty is diffuse heterogeneous airspace opacification throughout both lungs nearly obscures interstitial abnormality and a handful of centimeter or smaller lung nodules, most pronounced in the right midlung. Bilateral pleural effusions are small. There is no pneumothorax. Widening of the mediastinum is also of unknown duration and although it could be due to fat deposition and vascular engorgement could be due to adenopathy as well.", "output": "1. Severe, diffuse heterogeneous airspace opacities throughout the lungs could be pneumonia/aspiration or alveolar hemorrhage. Many small lung nodules. 2. Mild interstitial thickening suggests a component of pulmonary edema. 3. Small bilateral pleural effusions. 4. Possible mediastinal adenopathy. NOTE: As Dr ___ discussed with Dr ___ ___ the ___ staff, at 7:45am, A CT scan of the chest would be very helpful to confirm and characterize the abnormalities." }, { "input": "The lungs are symmetrically well-expanded and well aerated without focal consolidation, pleural effusion or pneumothorax. A faint nodule projecting over the left mid lung zone corresponds to an abnormality seen on the prior chest CT. The pulmonary vasculature is not engorged. The cardio mediastinal and hilar contours are within normal limits. The trachea is midline. No acute osseous abnormality is detected.", "output": "1. No acute cardiopulmonary process. 2. Faint nodule projecting over the left mid lung zone corresponds to a pulmonary nodule seen on the prior chest CT possibly representing atypical/fungal infection in the setting of neutropenia." }, { "input": "No focal consolidation, pleural effusion, or pneumothorax is present. Normal heart size, mediastinal and hilar contours. No evidence of pulmonary vascular congestion.", "output": "No pneumonia. NOTIFICATION: Telephone notification to Dr. ___ office by Dr. ___ at 2:46 p.m. on ___ per request." }, { "input": "Heart size is normal. Cardiomediastinal silhouette and hilar contours are unremarkable. Lungs are clear. There is no pleural effusion or pneumothorax. The visualized osseous structures are grossly unremarkable.", "output": "No acute intrathoracic process." }, { "input": "The lungs are well-expanded and clear. No focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal silhouette, hila, and pleura are normal.", "output": "No acute cardiopulmonary process. Normal chest radiograph." }, { "input": "The lung volumes are low. This causes accentuation of the cardiac silhouette size which is mildly enlarged. The mediastinal contour is slightly widened superiorly and this is likely due to low lung volumes. No pulmonary edema is seen though there is crowding of the bronchovascular structures as a result of low lung volumes. Hilar contours are normal. Minimal streaky bibasilar opacities likely reflect atelectasis. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities detected. No free air is noted under the diaphragms.", "output": "No subdiaphragmatic free air. Low lung volumes with bibasilar atelectasis." }, { "input": "The lungs are well inflated and clear. The cardiomediastinal silhouette is unremarkable. Hilar and pleural surfaces are normal.", "output": "Normal chest." }, { "input": "The lungs are clear.The cardiac, hilar and mediastinal contours are normal.No pleural abnormality is seen. Nasogastric tube tip terminates in the stomach with the proximal side hole at the gastroesophageal junction.", "output": "Proximal side hole of the nasogastric tube is at the gastroesophageal junction and could be advanced by 3-5 cm for more optimal positioning." }, { "input": "AP portable upright view of the chest. There has been placement of an NG tube with its tip in the mid gastric body. Lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "NG tube positioned properly." }, { "input": "An enteric tube terminates in the stomach. The bilateral lung apices are cut off from the exam a cannot be evaluated. However, the remaining visualized lungs appear clear without evidence of focal consolidation or pulmonary edema. The heart size is normal. The mediastinal silhouette, hilar contours, and pleural surfaces are normal.", "output": "An enteric tube terminates in the stomach. Otherwise, no acute cardiopulmonary process in the visualized lungs." }, { "input": "The lungs are clear, the cardiomediastinal silhouette and hila are normal. There is no pleural effusion or pneumothorax.", "output": "No acute cardiothoracic process." }, { "input": "PA and lateral views of the chest provided. The heart is top-normal in size and there is mild interstitial edema. No large effusion or pneumothorax. No focal opacity concerning for pneumonia. Mediastinal contour appears normal. Minimal hilar congestion is noted. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Top normal heart size with mild interstitial pulmonary edema." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation, or pneumothorax. Descending aorta is mildly tortuous. There is no pulmonary edema. Old left-sided rib fractures are again noted.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Compared to the prior film, the degree of opacification in left mid and lower zones has progressed, with new obscuration left hemidiaphragm. The appearance is suggestive of a left pleural effusion, probably loculated, with underlying collapse and/or consolidation. Allowing for obscuration of the left heart border, prominence of the cardiomediastinal silhouette appears stable and the mediastinum remains midline. Possible minimal prominence of the right pulmonary artery is unchanged. There is mild upper zone redistribution, without other evidence of CHF. The right lung is grossly clear, except were minimal atelectasis or scarring at the right lung base. No gross right effusion.", "output": "Worsening opacification of the left mid and lower zones, likely a combination of pleural fluid can collapse and/or consolidation." }, { "input": "A left lung base pigtail catheter remains in place. There is a stable small left pleural effusion. Right basilar linear is new from the prior exam. A left lung base airspace opacity likely representing subsegmental atelectasis is essentially unchanged. There is no pneumothorax. The heart and mediastinum cannot be accurately assessed on this projection. Regional bones and soft tissues are unremarkable.", "output": "Unchanged small left pleural effusion. New right lower lobe linear atelectasis. Stable left lung base subsegmental atelectasis." }, { "input": "Since the prior CXR performed ___, there has been interval placement of a left-sided pigtail catheter. The large left pleural effusion has decreased in size. Right lung is essentially clear, without focal consolidations or pleural effusions. No pneumothorax bilaterally. Right heart border is unremarkable. No acute osseous abnormalities.", "output": "Interval placement of a left-sided pigtail catheter, with slight improvement in large left pleural effusion." }, { "input": "The large left pleural effusion has improved significantly compared to yesterday's radiograph. However, it now appears to be loculated. The left pigtail catheter is unchanged in position. The right lung is essentially clear without evidence of pneumonia, pleural effusion or pneumothorax. Heart size is within the upper limits of normal. No acute osseous abnormalities.", "output": "Significant interval improvement in large left pleural effusion, which now has a loculated appearance." }, { "input": "Left-sided dual-chamber pacemaker device is noted with leads terminating in the right atrium and right ventricle. Moderate cardiomegaly is re- demonstrated along with tortuosity of the thoracic aorta. Mediastinal and hilar contours otherwise are stable. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is increased opacification of the right hemithorax suggesting a large pleural effusion with associated lung collapse, noting nearly balanced mass effect. There is no evidence for pleural effusion on the left. Calcified pleural plaques are again noted along the left mid hemithorax.", "output": "Increased opacification of the right lung, probably reflecting increasing pleural effusion and lung collapse." }, { "input": "There has been marked interval increase in the right pleural effusion which is now layering posteriorly and almost completely opacifies the right lung. There is a small amount of residual aerated right lung in the mid upper region. There is some volume loss in the left lung and calcified pleural plaques are again seen.", "output": "Increased right effusion with associated volume loss." }, { "input": "PA and lateral chest radiographs were provided. Again seen is a large paramediastinal opacity, similar to the previous exam. A right pleural effusion is again noted. Increased right basilar opacity may represent increasing effusion or pneumonia. The left lung is relatively clear with pleural plaques, unchanged since the previous exam. Cardiomediastinal silhouette is unchanged.", "output": "Increasing right basilar opacity which may represent increasing pleural fluid, pneumonia or a combination of both." }, { "input": "Frontal and lateral chest radiographs were obtained. There has been interval appearance of a right upper lobe mass measuring approximately 5 x 7 cm, as well as increased mediastinal width. The right pleural effusion has also increased. The heart size and left lung are grossly unchanged. No focal opacity suggestive of pneumonia is seen. No pneumothorax is visualized.", "output": "1. Interval appearance of a right upper lobe mass measuring approximately 5 x 7 cm, with increased mediastinal width. 2. Increased right pleural effusion. These findings were entered into the critical communications dashboard by Dr. ___ at ___ on ___." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of top normal size, although exaggerated by low lung volumes. The thoracic aorta is slightly unfolded. Lungs are clear without focal or diffuse abnormality. No pleural effusion or pneumothorax. No radiopaque foreign body. No displaced fracture seen.", "output": "No acute cardiopulmonary process. No displaced fracture seen." }, { "input": "A single AP semi-erect view of the chest demonstrates clear lungs. Linear lucency running in a vertical direction along the left hemithorax is presumed to be a skin fold. There is no evidence pleural effusion, pneumonia, pneumothorax or pulmonary edema. Cardiac size is normal. Hilar contours are within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest demonstrate normal cardiomediastinal silhouette. The thoracic aorta is mildly unfolded. The lungs are clear. There is no pneumothorax, vascular congestion, or pleural effusion.", "output": "No acute cardiopulmonary process. Specifically, no pneumonia." }, { "input": "AP portable upright view of the chest. Right IJ central venous catheter is seen with its tip projecting over the mid SVC. Scattered opacities are noted in the lungs right greater than left concerning for pneumonia. No large effusion or pneumothorax. Cardiomediastinal silhouette appears normal. Bony structures appear intact.", "output": "Appropriately positioned right IJ central venous catheter. Multifocal pneumonia." }, { "input": "", "output": "PA and lateral chest read in conjunction with abdomen CT showing the lower lungs on ___ and a torso CT from ___. FINDINGS: No findings of pneumonia. There might be a small lung nodule at the level of the right second anterior interspace, and another above the left clavicle at the level of the third posterior rib. Nipple shadow should not be mistaken for nodules but nor should a button projecting over the mid portion of the right first rib. Heart size is normal. There is no mediastinal or hilar abnormality and the pleural surfaces are normal." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable.", "output": "No evidence for radiodense foreign body or acute cardiopulmonary disease." }, { "input": "The tip of the right PICC line projects over the distal SVC. No left-sided PICC is identified. No focal consolidation, pleural effusion or pneumothorax identified. The size of the cardiac silhouette is enlarged but unchanged.", "output": "No left PICC line is visualized. Unchanged right PICC line." }, { "input": "Frontal and lateral views of the chest were obtained. There has been interval removal of a left-sided PICC. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. Cardiac and mediastinal silhouettes are stable and unremarkable. Degenerative changes are seen along the spine.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral chest views were obtained with patient in upright position. The heart size is within normal limits. No configurational abnormality is identified. Thoracic aorta mildly widened with a few calcium deposits in the wall at the level of the arch. No local contour abnormalities are seen. No mediastinal abnormalities are present. The pulmonary vasculature is not congested. No signs of acute or chronic parenchymal infiltrates are seen and the lateral and posterior pleural sinuses are free. No pneumothorax in the apical area on frontal view. Mildly accentuated kyphotic curvature in the thoracic spine with generally moderately demineralized skeletal structures, but no evidence of vertebral body compression fracture. Our records do not include a preceding chest examination available for comparison.", "output": "Chest findings within normal limits in this ___-year-old female patient. No evidence of pulmonary congestion or acute infiltrates." }, { "input": "Lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. The mediastinal and hilar contours are notable for calcified lymph nodes, but otherwise are unremarkable. The pulmonary vascularity is not engorged. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is identified. No acute osseous abnormalities seen.", "output": "No acute cardiopulmonary abnormality. Calcified mediastinal and hilar lymph nodes compatible with prior granulomatous disease." }, { "input": "Subtle right perihilar opacities are new. Lungs are otherwise clear. No pleural abnormalities. Moderate cardiomegaly without pulmonary vascular congestion or edema. Cardiomediastinal and hilar silhouettes are normal.", "output": "Subtle right perihilar opacities likely reflect aspiration or atelectasis." }, { "input": "The lungs are well-expanded and clear. No focal consolidation, effusion, edema, or pneumothorax. The heart is normal in size. The mediastinum is not widened. No acute osseous abnormality is identified on this nondedicated exam.", "output": "No acute cardiopulmonary process. No pneumothorax. RECOMMENDATION(S): Note that this exam is not dedicated for imaging of subtle fractures. If focal exam findings are concerning for fracture, dedicated radiographs of these areas is recommended." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral radiographs of the chest show an ill-defined peripheral wedge-shaped opacity in the right lung base at the level of the right fifth rib. There is increased opacification at the left lung base compared to the preceding radiograph of ___. Irregular wedge-shaped peripheral opacities at that time were present in the left lung base. Small bilateral pleural effusions are present. No pneumothorax is appreciated. The pulmonary vasculature is not engorged. The cardiac silhouette is slightly increased in size from the prior study with new prominence of the azygos vein. The mediastinal and hilar contours are otherwise within normal limits.", "output": "Findings concerning for recurrent pulmonary embolism and infarction. Findings were communicated by Dr. ___ to Dr. ___ by phone at 13:31 p.m. on ___." }, { "input": "The lungs are normally expanded and clear. The cardiomediastinal silhouette, hilar contours and pleural surfaces are normal. There is no pleural effusion or pneumothorax. There are few somewhat prominent gas-filled loops of bowel in the left upper quadrant.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear. Cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications are noted at the arch. No acute osseous abnormalities. There is no free intraperitoneal air.", "output": "No acute cardiopulmonary process." }, { "input": "Interstitial markings are diffusely increased and likely represent pulmonary edema superimposed on chronic interstitial lung disease. Hazy opacities in both lower lobes with blunting of the costophrenic angles are consistent with pleural effusions and adjacent atelectasis. Stable biapical scarring. No pneumothorax. Heart size and mediastinal contours are stable.", "output": "Pulmonary edema superimposed on chronic interstitial lung disease with small bilateral pleural effusions." }, { "input": "The opacity in the anterior right upper lobe is almost completely resolved with a tiny residual focal opacity. There is no new focal consolidation, pleural effusion, or pneumothorax. Peripheral interstitial opacities at the bases are consistent with a previously described NSIP. The heart size is within normal limits. The cardiac, hilar, and mediastinal contours are within normal limits.", "output": "Resolved right upper lobe pneumonia with a focal residual opacity. Recommend followup chest radiograph in four weeks. Results were entered into the critical results dashboard by ___ at 4:55 p.m. on ___." }, { "input": "Compared with the immediate prior study, mild central pulmonary vascular congestion with moderate associated interstitial pulmonary edema is new with interval increase in moderate cardiomegaly. Underlying interstitial lung disease is present. Blunting of bilateral costophrenic angles is chronic and likely related to pleural-parenchymal scarring rather than small effusions. Biapical scarring is unchanged. There is no focal consolidation or pneumothorax. The cardiomediastinal contour is stable.", "output": "Moderate volume overload in the setting of underlying interstitial lung disease. No focal consolidation." }, { "input": "The patient is status post median sternotomy with multiple intact and aligned sternal wires. A mitral valve prosthesis is unchanged. There is dense calcification throughout the aortic arch extending into the descending thoracic aorta. The mediastinal contours are prominent, but stable. There is slight deviation of the trachea to the right by the aortic knob. The cardiac silhouette is moderately enlarged but unchanged. A chronic moderate left pleural effusion is unchanged with opacification at the left lung base, likely reflecting associated compressive atelectasis of the left lower lobe. A small right pleural effusion is increased from ___. The lungs are otherwise relatively clear without new focal airspace opacity. No pneumothorax is detected. There is mild pulmonary vascular congestion. An exaggerated thoracic kyphosis is noted with hypertrophic degenerative changes at the thoracic spine. Degenerative changes of the right shoulder joint are also noted.", "output": "1. No new focal airspace opacity. 2. Chronic moderate left pleural effusion with underlying atelectasis. Superimposed infection cannot be excluded in the appropriate clinical context. 3. Slightly increased size of small right pleural effusion from ___. 4. Mild pulmonary vascular congestion." }, { "input": "There is no pleural effusion, pneumothorax or focal airspace consolidation worrisome for pneumonia. The lung volumes are normal. The mediastinal and hilar contours are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Right-sided Port-A-Cath tip terminates in the proximal right atrium, unchanged. The patient is status post median sternotomy and aortic valve replacement. Low lung volumes are present. Mild to moderate enlargement of the cardiac silhouette is re- demonstrated. Mediastinal and hilar contours are unchanged. There is crowding of the bronchovascular structures without overt pulmonary edema. Minimal atelectasis is noted in the lung bases. No focal consolidation, pleural effusion or pneumothorax is visualized. There are no acute osseous abnormalities.", "output": "Low lung volumes with mild bibasilar atelectasis." }, { "input": "Right-sided Port-A-Cath terminates in the proximal right atrium without evidence of pneumothorax. Patient is status post median sternotomy and cardiac valve replacement. Minimal left base atelectasis/scarring is seen.No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Port-A-Cath resides over the right chest wall with catheter tip in the region of the right atrium. Midline sternotomy wires and prosthetic cardiac valve are again seen. Lung volumes are low limiting evaluation. A similar overall pattern is seen compared with multiple prior imaging studies with prominent bronchovascular markings which in the setting of low lung volumes likely reflect bronchovascular crowding. The possibility of mild pulmonary vascular congestion is difficult to exclude in the correct clinical setting. There is no overt evidence for edema, effusion, pneumothorax or pneumonia. Cardiomediastinal silhouette is stable. Osseous structures appear intact.", "output": "No overt signs of pneumonia or edema. Mild pulmonary vascular congestion difficult to exclude given extensive bronchovascular crowding in the setting of low lung volumes." }, { "input": "When compared to priors, there has been no significant interval change. Low lung volumes again resulting in crowding of the bronchovascular markings. There is no superimposed overt edema. Cardiomediastinal silhouette is stable. Median sternotomy wires are intact and prosthetic valve is noted. Right chest wall port is seen with catheter tip in the right atrium. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Right chest wall port is again noted. Relatively low lung volumes are seen with secondary crowding of the bronchovascular markings. There may be superimposed vascular congestion. There is left basilar atelectasis without confluent consolidation or effusion. The cardiomediastinal silhouette is stable. Prosthetic aortic valve and median sternotomy wires are again noted.", "output": "Low lung volumes with possible superimposed pulmonary vascular congestion." }, { "input": "The heart is at the upper limits of normal size. Mediastinal and hilar contours appear within normal limits. The lungs appear clear. There are no pleural effusions or pneumothorax. Bony structures appear within normal limits.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "AP upright and lateral views of the chest provided. Asymmetric breast tissue, smaller on the right noted. Prominent costochondral calcification noted on the lateral view. This may account for the prominent calcification projecting over the head of the right clavicle. No convincing signs of pneumonia or edema. No large effusion or pneumothorax. The heart size is normal. The mediastinal contour is not widened. There is mild elevation/eventration of the right hemidiaphragm. Bony structures are intact.", "output": "Prominent costochondral calcification, likely the cause of prominent calcification projecting over the right clavicle head. No evidence of pneumonia." }, { "input": "ET tube in standard position. NG tube extending into the stomach and out of view. Slight improvement in left lower lobe pulmonary edema since yesterday. Right upper lobe and right lower lobe opacities are more confluent compared with yesterday and could be pneumonia. Moderate cardiomegaly is unchanged. No pneumothorax. Stable small pleural effusion on the left, no pleural effusion on the right.", "output": "Worsening confluent opacities in the right upper and lower lobes in the setting of improving pulmonary edema on the left could be pneumonia on the right. Telephone notification of Dr. ___ by Dr. ___ at 10:42 on ___." }, { "input": "Two AP portable chest radiograph were obtained. There is cephalization of the pulmonary vasculature, thickened ___ B-lines, and fluid in the right minor fissure. No pleural effusion is visualized. The left costophrenic angle is excluded from the field of view. There is no pneumothorax or airspace consolidation. Cardiomegaly is severe.", "output": "Severe cardiomegaly and interstitial pulmonary edema." }, { "input": "ET tube is in adequate position. The NG tube is below the diaphragm. Moderate interstitial edema is unchanged. There is no pneumothorax. Moderate cardiomegaly is stable.", "output": "No interval change from yesterday. Tubes and lines in adequate position." }, { "input": "Cardiac silhouette size is top normal in size. Mediastinal and hilar contours are within normal limits. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is identified. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral chest radiograph demonstrate clear lungs bilaterally. Cardiomediastinal and hilar contours are within normal limits. There is no pneumothorax, pleural effusion, or evidence of pulmonary edema. There is no air under the right hemidiaphragm.", "output": "No acute intrathoracic abnormality." }, { "input": "Upright AP and lateral radiographs of the chest were obtained. There is top normal heart size. Mild platelike right lower lung atelectasis is noted. Otherwise, lungs are clear. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Previously seen patchy opacities at the lung bases have resolved with better inspiration. The cardiac size is top normal with no concrete evidence of pulmonary congestion. No focal consolidation, pleural effusion or pneumothorax is present.", "output": "1. Previously seen patchy opacities resolved with better inspiratory effort. 2. Top normal heart size with no concrete evidence of pulmonary vascular congestion." }, { "input": "The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax. There is no pleural effusion. Pulmonary vascularity is normal.", "output": "Normal radiographs of the chest." }, { "input": "PA and lateral views of the chest. There is an ovoid hyperintensity in the anterior lungs that may represent pleural plaque calcification or calcified lymph node. A 5 mm round opacity in the posterior left lobe represents a calcified granuloma. There is no evidence of interstitial disease. No evidence of pneumonia. Heart size is normal. Mediastinal and hilar contours are normal. No pleural effusion or pneumothorax.", "output": "1. No evidence of interstitial disease. 2. Calcified lymph node or pleural plaque in the anterior mediastinum or anterior lungs. 3. Calcified granuloma in the posterior left lung." }, { "input": "PA and lateral chest radiograph demonstrates no focal consolidation convincing for pneumonia. Cardiomediastinal and hilar contours are stable in appearance when compared to prior study dated ___. The heart is moderately enlarged. Stable linear scarring or atelectasis in the right base. The trachea is deviated to the right secondary to a tortuous aorta. Eventration of the right hemidiaphragm is noted. Additional note is made of multilevel degenerative changes throughout the thoracic spine. Right posterior sixth rib markedly diminutive as on prior exam.", "output": "No evidence of pneumonia. Stable cardiomegaly." }, { "input": "Frontal and lateral views of the chest were obtained. The patient is status post median sternotomy. There are relatively low lung volumes. The aorta is calcified and tortuous. The cardiac silhouette is top normal. Bilateral suprahilar opacities are felt to more likely represent vascular structures versus less likely areas of consolidation. No pleural effusion or pneumothorax is seen. Right upper lobe nodular calcifications measuring up to 5 mm are most consistent with calcified granuloma.", "output": "Bilateral suprahilar opacities may be due to vascular structures, although underlying consolidation due to infection is not excluded." }, { "input": "AP portable upright view of the chest. This examination is limited by very low lung volumes and suboptimal patient positioning. Central pulmonary vascular congestion appears new since the ___ examination, without overt edema. Multiple intact sternal wires are again seen. There is no large pneumothorax or pleural effusion.", "output": "Central pulmonary vascular congestion appears new since the earlier study today, without overt edema. Very low lung volumes." }, { "input": "The lung volumes are low. Pulmonary edema has resolved. There is no pleural effusion or pneumothorax. Heart size is top-normal. Mediastinal and hilar structures are unchanged. The patient has median sternotomy closures and mediastinal clips consistent with coronary artery bypass graft.", "output": "No pulmonary edema." }, { "input": "Frontal and lateral views of the chest were obtained. Again seen is a right suprahilar opacity, also present on the prior study, may relate to the anterior first rib. No new focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The patient is status post median sternotomy. The aorta remains calcified and tortuous. The cardiac silhouette is not enlarged.", "output": "Right suprahilar opacity, while could relate to the anterior right first rib. Suggest confirmation with oblique radiographs." }, { "input": "AP upright and lateral views of the chest provided.There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Portable chest radiograph ___ 11:12 is submitted.", "output": "Right internal jugular central line unchanged in position. Overall cardiac and mediastinal contours are stable. There is mild pulmonary venous hypertension but no overt pulmonary or interstitial edema at this time. Right basilar patchy opacity persists and may reflect atelectasis, although pneumonia or aspiration should also be considered. No pneumothorax." }, { "input": "Interval placement of an SVC filter since ___. Again seen is the opacification of the entire left lung and associated volume loss, status post left pneumonectomy in ___. The right lung is well opacified with no evidence of consolidations or pneumothorax. There is a small right-sided pleural effusion that is new since the last radiograph. No osseous abnormalities.", "output": "1. Interval placement of an SVC filter. 2. New small right-sided pleural effusion." }, { "input": "AP portable upright view of the chest. A right thoracostomy tube is present. No pneumothorax is detected. There is complete opacification of the left hemi thorax with a leftward tracheal shift, reflecting left pneumonectomy. An SVC stent remains unchanged in position. There is a small right pleural effusion.", "output": "No right pneumothorax. Unchanged position of a right thoracostomy tube. Small right pleural effusion." }, { "input": "Frontal and lateral chest radiographs demonstrate the expected post-pneumonectomy changes, including total opacification of the left hemithorax with leftward shift of the mediastinum. The right lung is clear without consolidation, effusion, or pneumothorax.", "output": "Status post left pneumonectomy with expected postsurgical changes. The right lung appears normal." }, { "input": "There is stable appearance of the left hemithorax status post left pneumonectomy with a large hydropneumothorax. Calcification in the aortic knob are noted. The heart cannot be assessed. The right lung remains hyperinflated but clear with no pleural effusion, pneumothorax, or focal consolidation concerning for pneumonia.", "output": "Stable appearance after left pneumonectomy." }, { "input": "AP portable upright view of the chest. The patient is post left pneumonectomy, with leftward shift of the mediastinum. An SVC stent is unchanged in position. There is no right pneumothorax. A small right pleural effusion is stable. The overall radiographic appearance is unchanged since the ___ study performed at 7:04 PM.", "output": "No right pneumothorax. Unchanged small right pleural effusion." }, { "input": "Complete opacification of the entire left lung associated with left tracheal deviation, post-pneumonectomy findings which have remained stable. There is no significant change in appearance of the right lung, with no areas of focal consolidation or pneumothorax. The SVC filter is again seen. No acute osseous abnormalities.", "output": "No significant chance since prior radiograph." }, { "input": "Multiple air fluid levels noted in the left hemithorax with almost complete opacification. Trachea and mediastinum is shifted to the left. Hyperinflated right lung is noted with no focal consolidation, pleural effusion or pulmonary edema.", "output": "Multiple air-fluid levels consistent with hydropneumothorax and previous surgery. Compensatory right lung hyperinflation with no acute cardiopulmonary disease seen." }, { "input": "AP portable upright view of the chest. An SVC stent is unchanged in position. The patient is post left pneumonectomy, with fluid throughout the left hemithorax. There is expected leftward shift of the mediastinum. A small right pleural effusion is unchanged. There is no pneumothorax. A right thoracostomy pigtail catheter is no longer visualized.", "output": "No pneumothorax. Post left pneumonectomy with expected leftward shift of the mediastinum. Unchanged position of an SVC stent." }, { "input": "Frontal and lateral views of the chest. Postoperative changes of left-sided pneumonectomy are seen with left-sided volume loss and complete opacification. The right lung is clear. Atherosclerotic calcifications are noted at the aortic arch. No acute osseous abnormality is identified.", "output": "Expected postoperative changes of left pneumonectomy without definite acute cardiopulmonary process." }, { "input": "A single AP chest view has been obtained with patient in semi-erect position. Analysis is performed in direct comparison with the next preceding similar study of ___. As there is report of recently performed left-sided pneumonectomy, increased mediastinal shift towards the left is not surprising. There exists now an empty proportion of the left hemithorax in which a wide caliber chest tube advanced from the left lower lateral chest wall curves around and reaches the area of the posterior inferior pleural sinus. The contour of the left diaphragm is now obscured, but assuming that the left-sided pneumonectomy was total, the diaphragm appears to be elevated and one can identify partially gas-filled structures of the stomach. Pulmonary structures in the right hemithorax remain normal, without signs of congestion, new infiltrates or pleural effusions in the lateral sinus.", "output": "Findings compatible with a total left-sided pneumonectomy. Right-sided lung remains normal." }, { "input": "Equivocal tiny left apical pneumothorax is seen. There is persistent left upper lobe collapse. Further opacification of the left lung may reflect an increase in atelectasis given the associated volume loss, with a pleural effusion. A more rounded area of lucency within the left upper lung is new on this study. The right lung is essentially clear. The cardiac silhouette is unchanged and the mediastinal contours are normal.", "output": "1. Equivocal tiny left apical pneumothorax versus artifact from the Luftsichel sign. Continued surveillance is recommended. 2. Lucency within the left mid lung may represent a necrotic, air-filled mass. The findings could be further evaluated with a lateral view. 3. Increased opacification of the left lung may reflect further collapse in the left lung and/or a pleural effusion. These findings were discussed with Dr. ___ by Dr. ___ at 15: on ___ by telephone at the time of discovery." }, { "input": "Heart size is top-normal. Cardiomediastinal silhouette and hilar contours are unremarkable. Lungs are hyperinflated but clear. There is no large pleural effusion or pneumothorax. Clips are noted in the right anterior chest wall and right axilla. Degenerative changes seen at the shoulders bilaterally. Old healed right lateral rib fractures are noted.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiac silhouette size is normal. Low lung volumes are present. The aorta demonstrates mild aortic arch calcifications. Mediastinal and hilar contours are normal. Streaky opacity within the right lung base likely reflects atelectasis. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities. Two clips are seen projecting over the right scapula.", "output": "Streaky right basilar opacity likely reflective of atelectasis." }, { "input": "Lungs are low in volume but appear clear. There is no pleural effusion or vascular congestion. The heart is likely top normal in size with normal cardiomediastinal silhouette.", "output": "No acute intrathoracic process with top normal heart size." }, { "input": "A PICC line has been removed. The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable. There has been no definite change.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "There are relatively low lung volumes and mild right basilar atelectasis. No focal consolidation, pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Aortic calcifications are noted. There are some degenerative changes along the spine.", "output": "No acute cardiopulmonary process. Relatively low lung volumes." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "Previous bilateral diffuse heterogeneous and ill-defined opacities have nearly resolved back to baseline. Lungs are clear of focal consolidation, pleural effusion or pulmonary edema. The cardiac, mediastinal, and hilar contours are normal.", "output": "Near complete resolution of previous edema since ___." }, { "input": "The ET tube terminates approximately 2.6 cm from the carina. There is an enteric tube with the tip terminating below the diaphragm. The heart size is top normal. There is evidence of pulmonary vascular congestion with mild-to-moderate bilateral pulmonary edema. There appears to be interval worsening of a focal opacity overlying the mid left lung in the perihilar region. There is no pleural effusion. No pneumothorax is identified. Note is made of mild bibasilar atelectasis, and worsening right middle lobe atelectasis.", "output": "1. ET tube terminates approximately 2.6 cm above the carina. 2. Interval increase in the mild bilateral pulmonary edema. 3. There is prominence of left perihilar focal opacity concerning for infection or aspiration." }, { "input": "Bilateral interstitial markings have increased, and previously seen left upper lung opacity has increasied in size. The cardiac size is normal. No pleural effusions or pneumothorax are seen, and the ET tube is in appropriate position. Gastric tube ends in the stomach with the side port near the diaphragm and GE junction.", "output": "Increase in both mild pulmonary edema and moderate left upper lobe pneumonia. Recommend advancing gastric tube approximately 5 cm." }, { "input": "Heart size is normal. Mediastinal and hilar contours are similar with mild enlargement of the pulmonary arteries suggestive of pulmonary arterial hypertension. Lungs remain hyperinflated with bullous emphysematous changes most pronounced at the lung bases compatible with panlobular emphysema. Pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities. Multiple spiral tacks are seen along the left diaphragm contour with chronic elevation of the left hemidiaphragm compatible with previous diaphragmatic hernia repair. Multiple old left-sided rib fractures are also noted.", "output": "Panlobular emphysema and evidence of pulmonary arterial hypertension. No focal consolidation to suggest pneumonia." }, { "input": "Relative elevation of the left hemidiaphragm is again noted. Chain sutures project over the upper lungs bilaterally suggesting prior wedge resections. Increased interstitial markings seen the lungs which appear chronic. There is no superimposed consolidation or effusion. Cardiomediastinal silhouette is stable. Multiple old posterior left rib fractures are noted. Surgical material, potentially mesh anchors project over the left upper quadrant.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest provided. Mildly elevated left hemidiaphragm again noted with underlying mesh coils. Numerous left rib cage deformities are again noted. Severe emphysema and hyperinflation again noted. Subtle micronodular opacities in the right mid lung raise potential concern for atypical infection versus aspiration. A similar cluster of micronodular opacity is noted in the left lower lung. Heart size cannot be assessed. Mediastinal contour is unchanged. Bony structures are intact. Suture is seen projecting over the right apex likely reflecting an old resection site. No acute fracture.", "output": "Subtle nodular opacities in the right mid lung and left lower lung raise concern for atypical infection versus chronic aspiration. Severe background emphysema." }, { "input": "Relative elevation of the left hemidiaphragm is unchanged. Chain sutures project over the upper lungs bilaterally. Postthoracotomy changes are seen on the left. There is no focal lung consolidation. Cardiomediastinal silhouette is unchanged. There is no pneumothorax or pleural effusion. Severe emphysema is again noted.", "output": "No acute process. No significant change compared to the most recent prior chest radiographs." }, { "input": "Lungs are hyperexpanded with lucent areas consistent with bullae corresponding to findings on CT, unchanged. No pneumonia, pulmonary edema, or pneumothorax. Mediastinal contours, hila, and cardiac borders are stable. Persistent elevation of the left hemidiaphragm with subdiaphragmatic coils and healed left rib fractures are unchanged. Sutures in the right apex and right mid lung are consistent with prior surgery.", "output": "Severe COPD. No acute cardiopulmonary process." }, { "input": "Chain sutures in the lungs bilaterally are re- demonstrated compatible with prior wedge resections. Panlobular and centrilobular emphysema is re- demonstrated with chronic interstitial and nodular abnormality, most pronounced in the upper lobes, likely reflecting areas of bronchiectasis, scarring, and known pulmonary nodules better assessed on the previous CT. The cardiac and mediastinal contours are unchanged with the heart size within normal limits. Rightward shift of mediastinal structures is unchanged. Spiral tacks are seen along the left hemidiaphragm compatible with prior diaphragmatic hernia repair, and the left hemidiaphragm remains elevated. The pulmonary vasculature is not engorged. No new focal consolidation, pleural effusion or pneumothorax is seen. Multiple remote left-sided rib fractures are re- demonstrated.", "output": "Centrilobular and panlobular emphysema with chronic interstitial abnormality and nodules, as seen on the previous exams. Evidence of prior left diaphragmatic hernia repair and remote left-sided rib fractures. No substantial interval change from the previous exams." }, { "input": "Elevation of left hemidiaphragm is as seen on prior. Right basilar and right apical surgical chain sutures are again seen. Lucency at the right lung base and coarsened interstitial markings are compatible with emphysema. Scattered nodular opacities again seen throughout the lungs not significantly changed since recent chest x-ray but progressed since ___. No new confluent consolidation or large effusion. The cardiomediastinal silhouette is unchanged. Posterior left rib fractures are old.", "output": "No acute cardiopulmonary process. Nonurgent chest CT is suggested to evaluate the bilateral nodular opacities present on recent chest x-ray but new since ___." }, { "input": "There is persistent elevation of the left hemidiaphragm, unchanged. The right lung is hyperinflated, and there is chronic blunting of the right costophrenic angle. Chain suture material seen in the lungs bilaterally, consistent with prior wedge resections. Severe changes from panlobular and centrilobular emphysema is again seen. Cardiomediastinal and hilar contours are unchanged. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No consolidative pneumonia." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unchanged with rightward shift of mediastinal structures again noted. There is similar elevation of the left hemidiaphragm with mesh material projecting over the diaphragmatic contour. Post thoracotomy changes are again noted on the left with chain sutures seen in both lung apices. The pulmonary vasculature is not engorged. Bullous emphysematous changes are re- demonstrated, with the largest bulla seen at in the right lung base. Unchanged linear opacities in both upper lobes likely reflect areas of scarring. No new focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No interval change from the previous exam without new acute cardiopulmonary abnormality." }, { "input": "Patient is status post left diaphragmatic hernia repair with elevation of the left hemidiaphragm and shift of the cardiac silhouette to the right, similar in appearance as compared to the prior study. The right lung is hyperinflated and there is chronic blunting of the right costophrenic angle. Chain sutures in the lungs bilaterally are compatible with prior wedge resections. Panlobular and centrilobular emphysema are again seen with chronic interstitial nodular abnormality, most pronounced in the upper lobes, similar in appearance as compared to the recent prior study. The cardiac and mediastinal silhouettes are stable. Multiple old left-sided rib deformities are re- demonstrated.", "output": "No significant interval change as compared to ___" }, { "input": "Elevation of the left hemidiaphragm is unchanged compared to the prior examination. Lungs are markedly hyperinflated suggestive of underlying emphysema. Relative lucency at the right base corresponds to bullous changes on a CT dated ___. Since the prior study, there is coarsening of the interstitium with associated parenchymal distortion and scarring, particularly in the upper lungs. There are scattered nodular opacities, some of which are stable, but some of which have developed, especially a 1cm irregular opacity at the left apex. Further imaging evaluation with chest CT is recommended at this time. There is no focal consolidation, pleural effusion, or pneumothorax. Cardiomediastinal silhouette is stable. Healed left sided rib fractures are noted.", "output": "Increased upper lobe predominant interstitial abnormality and bilateral nodular opacities. Further imaging evaluation with dedicated chest CT is recommended at this time." }, { "input": "Increased interstitial markings again seen throughout the lungs with increased lucency at the right lung base with flattening of the diaphragm, similar in configuration compared to prior exams. Surgical chain sutures seen at the right lung apex. There is no definite superimposed acute process are new consolidation. The cardiomediastinal silhouette is stable. No acute osseous abnormalities. Old left-sided rib fractures are again noted.", "output": "Chronic changes without acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is stable elevation of the left hemidiaphragm. Suture material is noted in the right upper lung likely related to a prior resection. The overall pattern of the lungs appears stable likely reflecting fibrosis/ emphysema. No new consolidation, effusion or pneumothorax is seen. Old left rib cage deformities are again noted. Cardiomediastinal silhouette is stable.", "output": "Emphysema with fibrotic changes in the lungs without superimposed pneumonia or edema." }, { "input": "There is no significant change compared with prior radiograph. The right lung is hyperinflated, with large emphysematous bullae seen in the right lower lung. There is elevation of the left hemidiaphragm, also unchanged from prior. There is no new focal opacity concerning for pneumonia. Multiple nodules in both lungs seen in prior CT cannot be appropriately evaluated with a radiograph. There is no pleural effusion or pneumothorax. Cardiac size cannot be evaluated due to superimposition of the diaphragm. No subdiaphragmatic free air is identified.", "output": "1. No evidence of pneumonia. Unchanged appearance of the lungs compared with the right ___, with large emphysematous bullae on the right. 2. Multiple spiculated nodules seen on prior CT in both lungs cannot be properly evaluated with plain film." }, { "input": "Heart size is top normal. Re- demonstrated is a superior anterior mediastinal mass with deviation of the trachea to the right, similar compared to the prior exam, likely related to a large thyroid goiter. Mediastinal and hilar contours are otherwise unchanged. Lungs are clear. No focal consolidation, pleural effusion or pneumothorax is demonstrated. No acute osseous abnormalities seen.", "output": "No evidence of pneumonia. Unchanged superior anterior mediastinal mass with rightward tracheal deviation likely reflective of a large thyroid goiter." }, { "input": "There is no focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal contour is normal. Extensive flowing osteophyte formation is noted in the visualized thoracic spine.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Lung volumes are low, exaggerating the cardiomediastinal contours, however note is made of mild pulmonary vascular congestion. There has been an interval development of mild pulmonary edema. The heart size is normal. Interval improvement in the consolidation at the left lung base, compared to the exam performed 3 hr prior, is suggestive of atelectasis, however an infectious component may be persistent. There is no pleural effusion. There is no evidence of pneumothorax.", "output": "1. New mild pulmonary edema. 2. Interval improvement in the consolidation of the left lung base, compared to the radiograph performed 3 hr prior, is suggestive of atelectasis, however given the mild persistent opacity at the left lung base, an acute infectious process cannot be excluded." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. No free air under the diaphragms is seen.", "output": "No acute cardiopulmonary abnormality. No subdiaphragmatic free air identified." }, { "input": "Frontal and lateral views of the chest were obtained. Subtle right lower lobe opacity, better seen on the lateral view is concerning for pneumonia in this patient with history of cough. The left lung is clear. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Right lower lobe opacity worrisome for pneumonia. Recommend followup to resolution." }, { "input": "PA and lateral chest radiographs demonstrate clear lungs bilaterally. Cardiomediastinal and hilar contours are within normal limits. There is no evidence of pneumothorax, pulmonary edema, or pleural effusion. No air into the right hemidiaphragm is seen.", "output": "No acute intrathoracic abnormality." }, { "input": "AP upright and lateral views of the chest were provided. The lungs are clear bilaterally without consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette appears normal. Bony structures appear intact. No free air below the right hemidiaphragm.", "output": "No acute findings in the chest." }, { "input": "There is mild blunting of the right lateral and posterior costophrenic angles which may be due to trace right-sided effusion. The lungs are clear, there is no pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "Possible trace right-sided effusion. Otherwise comment no acute cardiopulmonary process." }, { "input": "Decreased lung volumes are noted causing crowding of the central bronchovascular structures. There are possible small left pleural effusion. No focal consolidation or pneumothorax is seen. The heart is normal in size given the low lung volumes. The bones are diffusely demineralized which limits assessment.", "output": "Low lung volumes with possible left pleural effusion." }, { "input": "Lung volumes are low leading to crowding of the bronchovascular structures. There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is unchanged. Median sternotomy wires are again noted.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "A right internal jugular double-lumen hemodialysis catheter is present, ending in the right atrium. The size of the cardiac silhouette is at the upper limits of normal. The mediastinum is normal. The lungs are clear without consolidation or pulmonary edema. There is no evidence of active or old tuberculosis. There is no pleural effusion or pneumothorax.", "output": "No evidence of recent or non-recent tuberculosis." }, { "input": "Left-sided chest tube is new in the interval with tip overlying the medial aspect of the left lower lung field. Previously noted large left pneumothorax is markedly decreased in size with only a small apical pneumothorax now visualized. The left lung has re-expanded with streaky opacities in the left lung base likely reflective of atelectasis. Right subclavian central venous catheter tip terminates in the lower SVC. Right lung is clear. Cardiac and mediastinal contours are normal. There is no evidence of pulmonary vascular congestion or pleural effusion. No acute osseous abnormalities visualized.", "output": "Interval placement of left-sided chest tube with decreased size of left-sided pneumothorax, now small, with re-expansion of the left lung. Streaky left basilar atelectasis." }, { "input": "There is a new large left pneumothorax without signs of mediastinal shift. The mediastinal and hilar contours are otherwise unremarkable. There is no pleural effusion. The right lung is well expanded and otherwise unremarkable. A right chest port is present with tip terminating mid SVC. The upper abdomen is unremarkable.", "output": "New large left pneumothorax. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 3:15 PM, 0 minutes after discovery of the findings." }, { "input": "Right-sided Port-A-Cath tip terminates in the upper/mid SVC. Heart size is normal. Mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. No displaced rib fracture is seen.", "output": "No acute cardiopulmonary abnormality. No displaced rib fractures seen. If there is continued concern for a rib fracture, consider a dedicated rib series" }, { "input": "PA and lateral views of the chest were provided. The lungs are clear bilaterally. There is a small left pleural effusion with blunting noted on the lateral view. The heart size is mildly enlarged, which is better assessed on the same day outside hospital CT in this patient with a known small pericardial effusion. No focal consolidation is seen within the lungs. There is no pulmonary edema. The mediastinal contour is stable. The bony structures are intact.", "output": "Mild cardiomegaly reflecting known pericardial effusion. Small left pleural effusion. Findings better assessed on the same day outside hospital chest CT." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "No significant interval change. Lung volumes are slightly low. Otherwise, the lungs are clear. No focal consolidation, effusion, edema, or pneumothorax. The cardiomediastinal silhouette is unchanged. No acute osseous abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. No prior. The lungs are clear. Cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "Unremarkable chest x-ray." }, { "input": "There has been interval placement of a right internal jugular central venous catheter with tip terminating in the right atrium approximately 2 cm in below the cavoatrial junction. No pneumothorax or pleural effusion. The lungs are well expanded and clear. Mediastinal contours, hila, and cardiac silhouette are normal.", "output": "Interval placement of a right internal jugular central venous catheter terminating in the right atrium. No pneumothorax." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Lung volumes are somewhat low which limits evaluation. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear without focal opacity, pulmonary edema, pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal. There is no free air beneath the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "The lungs are clear of focal consolidation or large effusion. Cardiomediastinal silhouette is stable. Thoracolumbar posterior fixation hardware is partially visualized. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "A single portable AP semi-upright view of the chest was obtained. Heart is normal in size and cardiomediastinal contour is unremarkable. Lungs are clear. Right lower rib fractures are better evaluated on the CT scan. There is no pleural effusion or pneumothorax.", "output": "No significant change compared to the most recent study." }, { "input": "As compared to the chest radiograph from a day earlier, an endotracheal tube is been placed with the tip 4 cm from the carina. Given for differences in technique the moderate right-sided effusion is likely layering posteriorly and not significantly changed. Right basal opacity has increased. Moderate left-sided pleural effusion has increased. There is also increasing left basal opacity. Moderate cardiomegaly.", "output": "Endotracheal tube is 4 cm from the carina. Moderate bilateral pleural effusions with increasing bibasilar opacities" }, { "input": "AP portable upright view of the chest. Cardiomegaly appears unchanged with bilateral small pleural effusions and lower lobe atelectasis. There is hilar congestion. Airspace opacities in the right mid to lower lung could reflect pneumonia. No large pneumothorax. Densely calcified tracheobronchial tree appears slightly kinked along the superior mediastinum though this is similar to the prior exam. Bony structures appear grossly intact.", "output": "Cardiomegaly with hilar congestion, small bilateral effusions and probable pneumonia in the right mid to lower lung." }, { "input": "The lungs are clear without focal consolidation concerning for pneumonia, pleural effusion, or pneumothorax. The pulmonary vasculature is not engorged and there is no overt pulmonary edema. The cardiac, mediastinal and hilar contours are within normal limits. The aortic knob is well defined. The trachea is midline. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac silhouette size is mildly enlarged. Mediastinal and hilar contours are unremarkable. There is no pulmonary edema. Streaky opacities in the lung bases likely reflect atelectasis. No focal consolidation, pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Streaky opacities in the lung bases likely reflect atelectasis." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Several clips are noted at the gastroesophageal junction.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. The lungs are clear. There is no effusion or pneumothorax. The cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are within normal limits. The trachea is central. The cardiomediastinal contour is normal. The heart is not enlarged. No blunting of the costophrenic angles to suggest a pleural effusion. No pneumothorax or consolidation seen. The visualized bony structures are unremarkable in appearance. No free air seen under the diaphragm.", "output": "No acute cardiopulmonary process seen. No pleural effusion seen." }, { "input": "PA and lateral views of the chest were provided. There is interval increase in size of left pleural effusion with increasing consolidation in the left lower lobe. Right lung is clear. Heart size is difficult to assess. Mediastinal contour is normal. No pneumothorax. Bony structures are intact.", "output": "Increasing consolidation in the left lower lobe with increasing effusion. Differential considerations include atelectasis, pneumonia, and possible infarction given this patient's recent history of PE." }, { "input": "The lung volumes are normal. Normal size of the cardiac silhouette. Normal hilar and mediastinal structures. No pneumonia, no pulmonary edema. No pleural effusions.", "output": "Normal chest radiograph without evidence of pleural effusions." }, { "input": "New, moderate right pleural effusion with linear atelectasis at the right base. Superimposed pneumonia cannot be excluded. Normal mediastinal and hilar contours. No cardiomegaly. No definite osseous or soft tissue abnormalities.", "output": "Moderate right pleural effusion. Underlying pneumonia cannot be excluded. NOTIFICATION: Findings were communicated to Dr. ___ at 15:08." }, { "input": "PA and lateral views of the chest were provided. There is stable area of scarring at the left lung base. No new consolidation, effusion, or pneumothorax. Heart and mediastinal contours are normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Chronic scarring at the left lung base. No evidence of pneumonia." }, { "input": "PA and lateral views of the chest were reviewed. Compared to the most recent prior study of ___, the moderate left pleural effusion has significantly decreased and only a small residual pleural effusion in the posterior costophrenic sulcus remains. The previously noted left lower lobe atelectasis has completely resolved. The lungs are clear, and the cardiac and mediastinal contours are normal.", "output": "Significant decreased small left pleural effusion. Resolved left lower lobe atelectasis." }, { "input": "Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal. No pulmonary edema is seen.", "output": "Top-normal cardiac silhouette size. No pulmonary edema." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are markedly hyperinflated with significant elevation of the left hemidiaphragm similar, with overlying atelectasis. Streaky linear opacities in the mid and lower right lung are increased from the previous examination but their appearance is more suggestive of a chronic process. There is mild blunting of the posterior right costophrenic angle, which may be due to a small pleural effusion or pleural thickening. Cardiac silhouette and mediastinal contours are unchanged.", "output": "Increased mid and lower right lung streaky opacities are more suggestive of a chronic pulmonary process. Comparison with any priors since ___ and continued follow-up. Mild blunting of the posterior right costophrenic angle, small pleural effusion vs pleural thickening." }, { "input": "A single AP radiograph of the chest was obtained. There has been interval resolution of previously seen bibasilar heterogeneous opacities on radiographs from ___. The lungs are clear. Moderate cardiomegaly is unchanged. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen. An old posterior right fifth rib fracture is noted, as before. The bony thorax is otherwise grossly intact.", "output": "1. No acute cardiac or pulmonary process. 2. Unchanged moderate cardiomegaly." }, { "input": "The lung volumes are low but there is no focal airspace opacity to suggest pneumonia. Heart size is exaggerated by low lung volumes, likely top-normal. There is no pleural effusion or pneumothorax. The mediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or pneumothorax is seen. The cardiac silhouette is top normal to mildly enlarged but decreased in size as compared to ___. No overt pulmonary edema is seen. The mediastinal contours are unremarkable.", "output": "Top normal to mildly enlargement of the cardiac silhouette, decreased in size as compared to the prior study." }, { "input": "Frontal and lateral views of the chest. There are new small bilateral effusions. There is mild engorgement of the central vasculature and enlargement of the azygous and suggesting mild fluid overload. Cardiac silhouette is enlarged, slightly more so on compared to prior poor. No acute osseous abnormality detected.", "output": "New mild fluid overload and small effusions. No consolidation." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are normal. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic abnormality." }, { "input": "Mild cardiomegaly is unchanged. There is new mild pulmonary edema, evidenced by peribronchial cuffing and increased interstitial lung markings. No new focal consolidation, pleural effusion, or pneumothorax. Lung volumes are slightly lower. Enteric tube courses below the left hemidiaphragm and out of view.", "output": "New mild pulmonary edema, evidenced by peribronchial cuffing and increased interstitial lung markings. No new focal consolidation." }, { "input": "Enteric tube tip is well below diaphragm, tip not included on the radiograph. Shallow inspiration accentuates heart size, pulmonary vascularity, which are prominent and stable since prior. Stable mild interstitial prominence.", "output": "Enteric tube tip well below diaphragm." }, { "input": "There is no focal consolidation, effusion, or pneumothorax. Cardiomegaly is mild and accompanied by pulmonary vascular congestion. The cardiomediastinal silhouette is otherwise normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No evidence of pleural effusion or pneumonia." }, { "input": "Feeding tube tip is in the mid stomach. Shallow inspiration accentuates heart size, pulmonary vascularity. Mild left basilar opacity, likely atelectasis, consider pneumonitis in the appropriate clinical setting, more prominent since prior. Right lung is clear.", "output": "Feeding tube tip in the mid stomach. Mild left basilar opacity, likely atelectasis, consider pneumonitis in the appropriate clinical setting" }, { "input": "AP portable upright view of the chest. Lung volumes are low. Overlying EKG leads are present. Heart size cannot be reliably assessed given low lung volumes. There is no convincing evidence for pneumonia or edema. No large effusion or pneumothorax is seen. The mediastinal contour is unchanged. Bony structures are intact.", "output": "No acute findings on this limited chest radiograph." }, { "input": "Frontal and lateral views of the chest were obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No overt pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest provided. Retrocardiac opacity with an air-fluid level is compatible with known hiatal hernia. There is a small right pleural effusion. The lungs appear clear without convincing sign of pneumonia or overt edema. Cardiomediastinal silhouette appears within normal limits. No acute osseous abnormality.", "output": "Hiatal hernia, small right pleural effusion. No overt edema or pneumonia." }, { "input": "AP single view of the chest has been obtained with patient in semi-upright position. Comparison is made with the next preceding similar study of ___. The heart size remains unchanged and there is no evidence of pulmonary vascular congestion. Similar as on the next preceding portable chest examination, there is evidence of bilateral plate atelectasis in supradiaphragmatic position. They have decreased in size. No new infiltrates are seen. The lateral pleural sinuses remain free as before. To exclude or to assess volume of possible pleural effusion, a lateral view would be required to assess posterior pleural sinuses, which can accumulate up to 300 mL without being detectable on frontal view.", "output": "Decreasing basal atelectasis, no new infiltrates, no pulmonary vascular congestion." }, { "input": "Frontal and lateral views of the chest were obtained. Right base atelectasis is again seen, likely decreased as compared to the prior study. There is also evidence of medial left base atelectasis/scarring. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "Bibasilar atelectasis, right greater than left, continues to improve since prior studies." }, { "input": "Recently reported right upper lobe abnormality on CTA has rapidly cleared radiographically. Residual patchy and linear opacities within the right middle lobe and both lower lobes with associated volume loss appear relatively similar to the prior CT study. Small right pleural effusion is also noted.", "output": "1. Rapid resolution of right upper lobe opacities, which were most likely due to aspiration given the rapid clearance. 2. Residual right middle and bilateral lower lobe opacities with volume loss are likely due to atelectasis, but coexistent infection is not excluded." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "Normal chest radiographs." }, { "input": "There is persistent hyperinflation of the lungs which may be due to chronic obstructive pulmonary disease. No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Hyperinflated lungs suggesting COPD. No focal consolidation." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "There is mild bibasilar atelectasis; otherwise, the lungs are clear with no evidence of consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. No acute fractures are identified. No free air is noted under the hemidiaphragms. A tube is visualized overlying the sternum in the lateral projection, is likely external to the patient, but clinical correlation is recommended. Nodular opacity over left lung base is likely nipple as this area of lung is clear on CT performed the same day. Calcific densities are again noted in the region of the pancreatic tail and consistent with patient's history of chronic pancreatitis.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac silhouette size is borderline enlarged. Mediastinal and hilar contours are normal. The pulmonary vascularity is normal. The lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities visualized. Degenerative spurring of the right acromioclavicular joint is present.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Sternotomy wires are intact. Heart size is top normal and the thoracic aorta is tortuous. Mild diffusely increased interstitial lung markings are likely chronic. No focal consolidation, pleural effusion, or pneumothorax. No displaced rib fracture. There is a compression deformity of a lower thoracic or upper lumbar vertebral body, likely L1, age indeterminate", "output": "No acute cardiopulmonary process. No displaced rib fracture. Compression deformity of a lower thoracic or upper lumbar vertebral body, likely L1, age indeterminate." }, { "input": "The lungs are hyperinflated but clear. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. Hilar and mediastinal contours are normal. No focal consolidations concerning for pneumonia are identified. There is no pleural effusion or pneumothorax. Visualized osseous structures are unremarkable.", "output": "No acute intrathoracic abnormalities identified." }, { "input": "A single portable supine chest radiograph is obtained. Endotracheal tube ends in the mid airway. An enteric tube projects over the stomach. The lungs are well inflated. Blunting of the bilateral costophrenic angles suggests small bilateral effusions. Aeration of the lungs has mildly improved. Airspace opacities remain in the right lower lobe. Sclerotic changes of the left humerus is unchanged. A nondisplaced right first rib fracture noted on CT is not seen on radiography. Lower thoracic vertebral compression fractures are again seen.", "output": "Focal opacity in the right lower lobe may be atelectasis or developing consolidation. Suggest attention on follow up radiography." }, { "input": "The lungs are well aerated. Blunting of the bilateral costophrenic angles is unchanged. An endotracheal tube is positioned low, only 1.7 cm from the carina. A left subclavian central line terminates at the SVC brachiocephalic junction. Mid thoracic spinal fusion hardware is intact without evidence of periprosthetic lucency. The enteric catheter projects over the stomach, the side hole is at the level of the gastroesophageal junction.", "output": "1. Low position of endotracheal tube. 2. Stable small bibasilar effusions. 3. Side hole of enteric tube at the diaphragmatic hiatus. The tube could be advanced 6cm to ensure the side hole is in the stomach. Findings were communicated with Dr. ___ with via telephone at 10:___." }, { "input": "Overyling material limits evaluation to some degree. Lungs are low in volume with mild apical scarringand increased interstitial markings suggesting preexisting interstitial lung disease. No definite effusion or pneumothorax is seen. The heart is likely top normal. Irregularity of T10 and T11 on the frontal projection is compatible with the fracture seen on the outside imaging.", "output": "No acute process with poor visualization of the T10 and T11 fractures, better assessed on the previously obtained CT. Likely preexisting interstitial lung disease." }, { "input": "Portable AP upright chest radiograph was obtained. Low lung volumes noted. Allowing for this, the lungs appear clear. No large effusion or pneumothorax is seen. The cardiomediastinal silhouette appears normal. A calcified granuloma projects over the right lateral mid lung. Bony structures are intact.", "output": "No acute findings in the chest." }, { "input": "The heart size is top normal. The mediastinal and hilar contours are unremarkable. The pulmonary vascularity is not engorged. There is minimal streaky opacity in the left lung base. No focal consolidation, pleural effusion or pneumothorax identified. There are no acute osseous abnormalities.", "output": "Minimal streaky opacity in the left lung base. This likely reflects atelectasis though developing infection cannot be completely excluded." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Apparent opacity projecting over the right middle lobe on the frontal view, not seen on the lateral view, likely relates the patient's pectus excavatum deformity.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal lateral radiographs of the chest demonstrate top normal heart size. Low lung volumes accentuate bronchovascular markings. There is heterogeneity of the right lung and increased density of the left hilus. No focal consolidation, pleural effusion or pneumothorax.", "output": "Dense left hilus and heterogeneity of the right lung parenchyma. Recommend further evaluation with routine oblique views. Telephone notification regarding change in wet read and recommendations to Dr ___ by Dr ___ at 8:05 on ___." }, { "input": "Lungs are well-expanded and clear. Cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation. No acute displaced rib fractures.", "output": "1. No acute cardiopulmonary process. 2. No acute displaced rib fractures. If there is ongoing concern for rib fracture, recommend dedicated rib series radiographs with a marker placed over the region of pain. RECOMMENDATION(S): No acute displaced rib fractures. If there is ongoing concern for rib fracture, recommend dedicated rib series radiographs with a marker placed over the region of pain." }, { "input": "The lungs are clear, the cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax.", "output": "No acute cardiothoracic process." }, { "input": "There is new dense opacification over the right lower hemithorax concerning for pneumonia. There is mild cardiomegaly as well as likely mild edema. No pneumothorax is identified. There is tortuosity of the aorta with calcifications of the aortic arch.", "output": "Findings consistent with pneumonia. Followup to resolution recommended to exclude underlying lesion. Mild pulmonary edema." }, { "input": "An ET tube, NG tube and right IJ central venous catheter are unchanged in position. There is interval improved aeration of the right upper lobe with persistent rounded opacity in the right suprahilar region and ill-defined opacity of the left lung base concerning for multifocal infectious process. The inspiratory lung volumes are slightly improved from the prior study. There is no significant pleural effusion or pneumothorax. Bibasilar plate-like atelectasis is new from the prior study. The mediastinal and hilar contours are within normal limits. The cardiac silhouette is incompletely evaluated.", "output": "Improved aeration of the right upper lobe and left lung base with persistent multifocal opacities consistent with infection." }, { "input": "Single portable view of the chest. There is interval slight improvement in the pleural effusions bilaterally. There is no change in the bibasilar atelectasis as compared to the prior radiograph. Monitoring and support devices are seen, unchanged.", "output": "Slight improvement in pleural effusions with otherwise minimal change." }, { "input": "NG tube terminates below the diaphragm. Mild bibasilar atelectasis but no focal consolidation, pleural effusion, or pneumothorax. Mediastinal contours and mild enlargement of the cardiac silhouette are stable.", "output": "Mild bibasilar atelectasis but no focal consolidation." }, { "input": "The heart continues to be moderately enlarged. There is volume loss at both bases with a left pleural effusion. There is pulmonary vascular redistribution. The feeding tube tip is off the film, at least in the stomach", "output": "Pulmonary edema. An underlying infectious infiltrate in the lower lobes cannot be excluded" }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Patchy basilar opacities could be due to atelectasis but raise concern for pneumonia in the appropriate clinical setting. No pleural effusion or pneumothorax is seen. Cardiac silhouette is top-normal to mildly enlarged. Mediastinal contours are unremarkable.", "output": "Patchy basilar opacity could be due to atelectasis, aspiration, and/or pneumonia." }, { "input": "Frontal and lateral chest radiographs demonstrate intact sternal wires and clips along the left mediastinum. The heart is top-normal in size. Opacity projecting over the lower lungs on lateral view may correspond to either retrocardiac opacity or right infrahilar opacity. There are bilateral small pleural effusions and possible mild heart failure. No pleural effusion or pneumothorax is appreciated. The visualized upper abdomen is unremarkable.", "output": "1. Opacity projecting over the lower lung on lateral view may correspond either retrocardiac or right infrahilar opacity. 2. Bilateral small pleural effusions and possible mild heart failure. RECOMMENDATION(S): Oblique views may be helpful in further evaluation of lower lung opacity seen on lateral view. NOTIFICATION: The above recommendation was communicated via telephone by Dr. ___ to Dr. ___ at ___ on ___, approximately 1 hour after attending review." }, { "input": "PA and lateral views of the chest. No prior. The lungs are clear. There is no pneumothorax or effusion. The cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There are low lung volumes, which results in bronchovascular crowding. The cardiomediastinal contours are unchanged. The aorta is tortuous. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. Cardiac size is normal. Aorta is mildly unfolded. No pleural effusion, pneumonia, pneumothorax, pulmonary edema.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear with no evidence of a consolidation, effusion, or pneumothorax. Heart and mediastinal structures appear normal. No acute displaced fractures are identified.", "output": "No acute cardiopulmonary process." }, { "input": "A right chest port ends in the low SVC. The cardiomediastinal silhouette is unremarkable. There is no pneumothorax or pleural effusion. Surgical clips project over the upper abdomen on the lateral view. The lung fields are clear. There is a mild endplate deformity of a lower thoracic vertebral body, unchanged from ___.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral chest radiographs demonstrate hyperexpanded and clear lungs without a focal opacity convincing for pneumonia. Cardiomediastinal and hilar contours are within normal limits. A right chest port terminates within the right atrium. There is no pleural effusion or pneumothorax. Mild compression deformity at the thoracolumbar junction is of indeterminate age.", "output": "No acute intrathoracic abnormality." }, { "input": "Portable AP upright chest film ___ at 00:09 is submitted", "output": "Lungs remain clear. No focal airspace consolidation, pleural effusions, pulmonary edema or pneumothorax. Overall cardiac and mediastinal contours are stable with the heart being upper limits of normal in size. No acute bony abnormality." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. The hilar contours are unremarkable. The hilar contours are not enlarged to suggest hilar lymphadenopathy.", "output": "No radiographic findings to suggest sarcoidosis. No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were obtained. The central catheter tip of the right chest port terminates in the distal SVC. The patient is slightly rotated. There is a nodular opacity adjacent to the left heart border, which is compatible with the known history of pulmonary nodules. There is no clear sign of effusion or pneumonia, although assessment is limited by the patient's rotation, and no correlating of effusion or pneumonia on the lateral view. The cardiomediastinal silhouette is normal. No bony abnormality is identified.", "output": "1. No acute findings. 2. Nodular opacity adjacent to the left heart border, compatible with known history of pulmonary nodules. 3. No clear sign of effusion or pneumonia, although assessment is limited by rotation." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pulmonary edema is seen. Heart and mediastinal contours are normal. Lung nodules, largest in the left mid lung, are better evaluated with CT. Right-sided Port-A-Cath terminates in the low SVC, unchanged. Lytic sternal metastasis is better seen on recent CT. No large thoracic spine lesion is detected.", "output": "Lung and sternal metastases, better evaluated with CT, without radiographic evidence for acute cardiopulmonary process." }, { "input": "Portable semi-upright radiograph of the chest demonstrates well expanded clear lungs. The cardio mediastinal and hilar contours are unremarkable. There is no pneumothorax. Right-sided Port-A-Cath density cavoatrial junction. Epidural catheter projects over the midline of the spine, ending at approximately C6-7. Left breast mass is better evaluated on recent chest CT.", "output": "1. No pneumonia. 2. Epidural catheter projects over the midline of the spine, ending at approximately C6-7. NOTIFICATION: Finding number 2 was discussed with Dr. ___ by Dr. ___ ___ telephone at 1pm on ___, 30 minutes after discovery." }, { "input": "A right-sided Port-A-Cath is seen with tip terminating in the right atrium. Patient is status post right mastectomy. A large nodule in the lingula and left lower ___ characterized on recent CT on ___ is again noted on the PA and lateral views but appears enlarged. Multiple other nodules seen on the recent CT are not well seen on the current radiograph; however, there may be a couple seen in the right hemithorax. No pneumothorax or pleural effusion is seen. Heart size is normal. Bowel gas pattern is nonspecific.", "output": "Multiple pulmonary nodules, better seen on recent CT examination, at least on e appears enlarged. No acute consolidations to suggest acute infectious process." }, { "input": "A right Port-A-Cath ends at the cavoatrial junction. Normal heart, lungs, mediastinum, hila and pleural surfaces.", "output": "No pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. There has been interval placement of a right-sided Port-A-Catheter, terminating at the cavoatrial junction. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "A right-sided indwelling catheter is present, tip at SVC/RA junction. No pneumothorax detected. Note is made of asymmetry in the patient's breast shadows, smaller on the left. There appears to be some increased density over the left lung. Given the density of the left breast on the ___ CT, it is possible that this is accounted for by increased soft tissue density in the present. In addition, there is a nodular density at the left lung base, projecting adjacent to the left cardiac contour, measuring approximately 21 mm in diameter. Possible right base pulmonary nodules similar to the ___ film. The cardiomediastinal silhouette is at the upper limits of normal. The right lung is grossly clear. Though the mediastinum appears midline, there does appear to be slight asymmetry in the lungs, slightly larger on the right. No CHF or right-sided opacity is detected. No effusion is detected on either side. Punctate density overlying the left neck may represent a small amount of carotid artery calcification.", "output": "1. Possible slight asymmetry in the size of the hemithoraces, though not clearly different from ___. 2. Hazy opacity overlying the left lower lung. Given the degree of increased density in the left breast on the ___ CT, this could be due to density of the overlying breast tissues, rather than a primary process in thelung. 3. Nodular density at left lung base concerning for a lung nodule or pulmonary metastasis. This probably is accounted for by a pulmonary nodule seen on the ___ chest CT(series 2, image ___ from that study), though has likely grown since that time and is clearly larger than on the ___ CXR (approximately 21 mm in diameter today versus ___.7 mm on ___ CXR). 4. ___ CT also described sternal metastasis, which is not readily visible on today's exam due to technical limitations of the modality. 5. The right lung shows no CHF, focal infiltrate or effusion. Possible right base pulmonary nodules similar to the ___ film. 6. No ptx detected." }, { "input": "A right-sided Port-A-Cath ends at the cavoatrial junction and is in appropriate position. The patient is status post right mastectomy. Heart size is normal. The mediastinal contour is normal. The pulmonary vasculature is normal. A large nodule in the lingula characterized on recent CT on ___ is seen on both the PA and lateral views. Multiple other nodules seen on recent CT are not well visualized on the chest radiograph. No pleural effusion or pneumothorax is seen.", "output": "1. Multiple pulmonary nodules are better seen on recent chest CT from ___. No evidence of pneumonia." }, { "input": "PA and lateral views the chest provided demonstrate no focal consolidation, large effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Compared to the prior film, the right IJ line appears to have been retracted, and now lies near the cavoatrial junction, perhaps very slightly distal to it. Otherwise, I doubt significant interval change. Again seen is a left-sided dual lead pacemaker, with lead tips over right atrium right ventricle; marked cardiomegaly, with a calcified, unfolded aorta; CHF, with interstitial and probable areas of alveolar edema; and small right greater left effusions, with underlying collapse and/or consolidation. Calcified nodes and granulomas again noted, consistent with prior granulomatous disease. No pneumothorax detected.", "output": "Apparent interval retraction of right IJ line, which now lies near the cavoatrial junction, possibly slightly distal to it. Otherwise, I doubt significant interval change. No pneumothorax detected." }, { "input": "There is a dual lead pacemaker the heart is moderately enlarged. There bilateral pleural effusions that are small. There is pulmonary vascular redistribution with perihilar haze", "output": "CHF." }, { "input": "The patient is status post median sternotomy and CABG. Left-sided pacer with leads terminating in the right atrium and right ventricle appears unchanged. Mild to moderate cardiomegaly is re- demonstrated along with diffuse atherosclerotic calcifications of the aorta. Dense mitral annular calcifications are present. Calcified mediastinal and hilar lymph nodes are demonstrated suggestive of prior granulomatous disease. Mild pulmonary edema is noted along with small bilateral pleural effusions, right greater than left. Bibasilar atelectasis is also visualized. There is no pneumothorax. No acute osseous abnormality is detected.", "output": "Mild pulmonary edema with small bilateral pleural effusions and bibasilar atelectasis." }, { "input": "The lungs are hyperinflated selected of COPD. Biapical scarring is also noted. There is a left retrocardiac opacity concerning for pneumonia. There is no pleural effusion, pulmonary edema or pneumothorax. The heart is normal in size.", "output": "Left retrocardiac opacity seen on the lateral radiograph concerning for pneumonia. Recommend follow-up radiographs in ___ weeks following treatment of pneumonia." }, { "input": "There are low lung volumes without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable. No free air is seen beneath the diaphragms.", "output": "No free air beneath the diaphragms. Low lung volumes. Clear lungs." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes. No pleural effusion, focal consolidation or pneumothorax is seen. Hilar and mediastinal silhouettes are unremarkable. Aortic arch calcifications are present. Heart size is top normal. Mild perihilar vascular congestion is longstanding.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided demonstrate dense consolidation within the right lower lobe posterior segment, compatible with pneumonia. Otherwise, the lungs are clear. No effusions or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "Right lower lobe consolidation, compatible with pneumonia. Followup to resolution." }, { "input": "Portable AP chest radiograph. NGT courses below the diaphragm and terminates outside the field of view. Right IJ catheter tip is in the right atrium. Multifocal consolidations have continued to worsen, most notably in the right lung base. Moderate bilateral pleural effusions have also developed in the interim. There is no pneumothorax. The cardiomediastinal silhouette is stable.", "output": "Worsening multifocal pneumonia, most notably in the right lung base." }, { "input": "AP upright and lateral views of the chest were obtained. CT chest ___ ___ also used for comparison purposes. There is no focal consolidation, effusion, or pneumothorax. Lung volumes are slightly low. Cardiomediastinal silhouette is normal. Atherosclerotic calcifications along the aortic knob noted. Bony structures appear intact.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest. The lungs are clear of consolidation effusion, or pulmonary vascular congestion. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unchanged noting degenerative changes at the acromioclavicular joints.", "output": "No acute cardiopulmonary process." }, { "input": "Portable AP chest radiograph. NG tube courses below the diaphragm and terminates outside the field of view. Right IJ catheter is in stable position. Multifocal consolidations are slightly worsen in the right upper lobe. Confluent consolidation of the left lower lobe and a small effusion are stable. There is no pneumothorax. The cardiomediastinal silhouette is stable.", "output": "1. NG tube tip is below the diaphragm. 2. Multifocal pneumonia, worsening in the right upper lobe." }, { "input": "Lungs are borderline hyperinflated but clear bilaterally. The heart, mediastinum and hilar silhouettes are within normal limits and stable. Calcification of the aorta is again noted. Pleural surfaces are normal. There is no pleural effusion or pneumothorax. There is no displaced rib fracture; radiographic evaluation of the chest cage requires detail views of clearly marked areas where the patient has focal physical findings.", "output": "No radiographically evident cause for chest pain. No pneumothorax or displaced fracture is observed." }, { "input": "The ET tube is in appropriate position, and the orogastric tube ends in the stomach outside the view of this radiograph. A right IJ central venous line ends at the cavoatrial junction. Multifocal opacities in the mid and lower lungs persist. A right middle lobe opacity has appeared comparison to the chest radiograph from ___. The cardiac, mediastinal and hilar contours are normal.", "output": "Multifocal opacities in the mid and lower lung continue with a new right middle lung opacity likely representing aspiration." }, { "input": "PA and lateral views of the chest. The lungs are clear. Cardiomediastinal silhouette and hilar contours are unremarkable. No pleural effusion or pneumothorax. Atherosclerotic calcifications line the aorta.", "output": "No acute intrathoracic process." }, { "input": "Portable AP chest radiograph. Right-sided IJ catheter and NGT are in stable position. Multifocal consolidations and peribronchial consolidations involving the right lung have progressed from 24 hours prior. However, confluent opacification of the left lower lobe remains the worst site. There is no pneumothorax. The cardiomediastinal silhouette is not well delineated due to the consolidations.", "output": "Worsening multifocal pneumonia in the right lung." }, { "input": "Frontal and lateral views of the chest. No prior. The lungs are clear. The cardiac silhouette is enlarged. Surgical clips are seen in the right upper quadrant suggesting prior cholecystectomy. Osseous and soft tissue structures are otherwise unremarkable.", "output": "Cardiomegaly but no acute cardiopulmonary process." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Lung volumes are low but the lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormality is visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "A new left chest wall dual lead ICD is in place with leads in the expected location of the right atrium and right ventricle. A large hiatus hernia is present. Mild enlargement of the cardiac silhouette is improved compared to the prior study. An eventration in the diaphragm is noted. No focal consolidation, pleural effusion or pneumothorax.", "output": "ICD with leads in the expected location the right atrium and right ventricle. No pneumothorax. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 9:50AM, 2 minutes after discovery of the findings." }, { "input": "There is a retrocardiac opacity which is resulting in obscuration of the medial and posterior margin of the left hemidiaphragm, better assessed in the lateral view. There are small bilateral pleural effusions. There is no evidence of pulmonary edema. Moderate cardiomegaly is present, and heart size is significantly worsened compared with ___ when there was no cardiomegaly. Otherwise, mediastinal contour is unremarkable. There is no evidence of pneumothorax.", "output": "Left lower lobe pneumonia. Cardiomegaly." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lung volumes are low. There are bibasilar linear opacities, atelectasis and/ or consolidation. Diffuse vascular prominence and cardiomegaly noted. No pleural effusion or pneumothorax present. EKG leads overlie the anterior chest. Bony thorax is stable.", "output": "Low lung volumes with bibasilar atelectasis and/or consolidation. Underlying mild pulmonary edema also noted." }, { "input": "Moderately well inflated lungs with no change in prominence of pulmonary vasculature. Stable cardiomegaly. Enlarged left atrial shadow is again identified. No pleural effusions or pneumothorax. No change in bony thorax.", "output": "No change in mild to moderate pulmonary edema and cardiomegaly. No lobar consolidation." }, { "input": "Multiple overlying EKG leads are present. Lungs are clear. Cardiomediastinal and hilar contours are within normal limits. There is no pneumothorax or pleural effusion. No free air under the right hemidiaphragm. Degenerative changes at the acromioclavicular joints bilaterally. Cervical hardware is identified.", "output": "No acute intrathoracic abnormality." }, { "input": "A right-sided subclavian Port-A-Cath is in-situ, the tip is at the cavoatrial junction. The cardiomediastinal contour is unchanged compared to the prior study. There is stable mild cardiomegaly. There is new right basal airspace opacity with partial silhouetting of the right heart border. No other areas concerning for infection are seen. No pleural effusion or pneumothorax. Curvilinear calcification adjacent to the left humeral head.", "output": "New right basal airspace opacity likely reflecting right middle lobe pneumonia." }, { "input": "Portable AP chest radiograph ___ at 05:13 is submitted.", "output": "There is a large layering left effusion. Bilateral mild to moderate perihilar and pulmonary edema has slightly worsened. The heart remains stably enlarged which may reflect cardiomegaly, although pericardial effusion should also be considered. Mediastinal contours are stable. Right internal jugular Port-A-Cath is unchanged in position with its tip projecting in the proximal right atrium. No pneumothorax, although the sensitivity to detect pneumothorax may be diminished as the patient was not imaged in the upright position." }, { "input": "The tip of an accessed right pectoral MediPort extends to the superior cavoatrial junction. Pain right middle lobe airspace opacity is compatible with known pneumonia. The left lung is clear. There is a new small right pleural effusion. There is no pneumothorax.", "output": "Resolving right middle lobe pneumonia. A followup chest radiograph in 4 weeks is recommended. If the right middle lobe opacity fails to completely resolve by that time, a chest CT should be performed at that time to exclude an endobronchial lesion. New small right pleural effusion." }, { "input": "Opacity at the right lung base likely represents residual scar from site of prior right middle lobe pneumonia. The catheter from a right chest wall port terminates within the right atrium. There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac silhouette is enlarged. There is mild pulmonary edema, possibly mildly improved since the most recent examination. No definite new consolidation is identified. There is mild bibasilar atelectasis. A right-sided chest port is in stable position, terminating in the right atrium. There is no definite pleural effusion or pneumothorax.", "output": "Pulmonary edema without definite consolidation." }, { "input": "PA and lateral views of the chest provided. There is residual scarring at the previous region of right middle lobe consolidation. Since prior study, there is now new consolidation in the posterior basilar segment of the left lower lung, concerning for pneumonia. There is no pleural effusion. Cardiomediastinal and hilar contours are stable. Right-sided central catheter terminates in the caval atrial junction.", "output": "1. New focal consolidation and bronchial wall thickening in the posterior basilar segment of left lower lobe, suggestive of developing pneumonia. Recommend followup chest x-ray in ___ weeks after completion of antibiotic therapy to document resolution. 2. Residual scarring at previous right middle pneumonia site. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 9:58 AM, immediately after discovery of the findings." }, { "input": "The cardiac silhouette is enlarged, stably. There is mild pulmonary edema, not significantly changed since the most recent examination. No definite new consolidation is identified. There is bibasilar atelectasis. A right-sided chest port is in stable position, terminating at the cavoatrial junction. There is no pleural effusion or pneumothorax.", "output": "Stable examination of the chest." }, { "input": "AP portable semi supine view the chest provided. Port-A-Cath resides over the right chest wall with catheter tip in the region of the right atrium. Cardiomegaly persists with hilar congestion and persistent left pleural effusion. Pulmonary edema is moderate. No acute fracture is identified.", "output": "As above." }, { "input": "Frontal and lateral views of the chest demonstrate fully expanded and clear lungs. The cardiomediastinal and hilar contours are normal. There is no pleural effusion or pneumothorax. Pleural surfaces are unremarkable.", "output": "Normal chest radiograph. Specifically, no evidence of pneumonia." }, { "input": "In comparison with the chest radiograph obtained 6 days prior, mild to moderate pulmonary vascular congestion and pulmonary edema have resolved. Hazy opacities in the lower right lung are likely due to chronic lateral segment, right middle lobe atelectasis, better appreciated on CT chest dated ___. Lungs are otherwise clear without focal consolidation. Heart size top-normal. No pleural effusions. Cardiomediastinal hilar silhouettes are normal.", "output": "No radiographic evidence of pneumonia or acute cardiopulmonary abnormalities. Chronic atelectasis of the lateral segment, right middle lobe. RECOMMENDATION(S): The findings were discussed by Dr. ___ with ___ on the telephone on ___ at 12:12, approximately 120 minutes after discovery of the findings, but 60 minutes after paging." }, { "input": "The cardiac silhouette is stably enlarged. There is new vascular congestion in comparison to most recent prior. The lungs are otherwise clear. No definite pleural effusion or pneumothorax identified. Again noted is a right Port-A-Cath which terminates in the right atrium.", "output": "Pulmonary edema." }, { "input": "In comparison to the chest radiograph obtained 1 day prior, moderate pulmonary edema has changed in distribution but not and severity. Moderate cardiomegaly, vascular pedicle widening, pulmonary vascular engorgement are unchanged. No focal consolidations or pleural effusions. No pneumothorax. A right-sided port terminates near the superior cavoatrial junction PICC", "output": "Moderate pulmonary edema has changed in distribution, but not severity." }, { "input": "The lungs are clear. There is no evidence of pneumonia, pneumothorax, or pleural effusion. Cardiac silhouette is normal in size.", "output": "Normal chest x-ray." }, { "input": "There is no consolidation, effusion or pneumothorax. Cardiomediastinal contours are normal. There is no subdiaphragmatic free air. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process identified." }, { "input": "Right PICC line terminating at the mid SVC, no pneumothorax. The cardiomediastinal silhouette is largely unchanged from prior. No parenchymal consolidation is seen.", "output": "Right PICC line terminates at the mid SVC, no pneumothorax." }, { "input": "Re-identified is a tunneled left IJ dialysis catheter with distal tip projecting over the high right atrium. A right axillary region vascular graft is new since prior. The cardiomediastinal contours are within normal limits. The bilateral hila are unremarkable. The lungs are clear without focal consolidation. There is no evidence of pulmonary vascular congestion. There is no pneumothorax or pleural effusion.", "output": "No acute cardiopulmonary process. No pneumonia. No pulmonary edema or pulmonary vascular congestion." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. Surgical clips noted in the upper abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Left internal jugular approach dual lumen catheter tip terminates in the high right atrium. Heart size is normal. Cardiomediastinal silhouette and hilar contours are unremarkable. Lungs are clear. Pleural surfaces are clear without effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded, clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral images of the chest. The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable. Old rib fractures are noted on the right.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is stable. Electronic device overlies the left chest wall. Old right lateral rib fractures are identified as well as possibly remote prior traumatic changes at the right acromioclavicular joint.", "output": "No acute cardiopulmonary process." }, { "input": "Heart is top normal size and cardiomediastinal silhouette is stable. A well-defined rounded retrocardiac opacity containing an air-fluid level is consistent with known hiatal hernia. There is mild bibasilar atelectasis. No focal consolidation, pleural effusion or pneumothorax.", "output": "No evidence of pneumonia." }, { "input": "PA and lateral views of the chest provided demonstrate a large retrocardiac opacity with an air-fluid level compatible with a large hiatal hernia, not significantly changed from prior. The lungs are clear without focal consolidation, effusion or pneumothorax. There is linear density at the left lung base which could represent a small amount of scarring or atelectasis. Heart size appears grossly stable. The mediastinal contour is unremarkable. No pneumothorax is seen. Bony structures are intact.", "output": "No acute findings in the chest. Large hiatal hernia re-demonstrated." }, { "input": "Cardiomediastinal and hilar contours are normal. Minimal streaky atelectasis at the left base is stable. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "Minimal left basal atelectasis. No pneumonia. No pneumothorax." }, { "input": "There is streaky atelectasis at the left lung base. The lungs are otherwise clear. The cardiomediastinal silhouette and hilar contours are unchanged. There is no pleural effusion or pneumothorax. There is no free air under the diaphragm. Degenerative changes are seen throughout the thoracic spine.", "output": "Minimal left basilar atelectasis. No focal consolidation." }, { "input": "Mild cardiomegaly is noted. A large paraesophageal hiatal hernia is present with mild adjacent bibasilar atelectasis, and better evaluated on the concomitant CT examination. The upper lung fields are clear.", "output": "Large paraesophageal hiatal hernia with adjacent atelectasis. No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest ___ at 15:41 are submitted.", "output": "Interval resolution of mild to moderate pulmonary edema. The air-filled structure in the right retrocardiac region has decreased in size. Retrocardiac opacity persists and may reflect atelectasis, although aspiration or pneumonia should also be considered. Interval decrease in chest wall subcutaneous emphysema. No pneumothorax. Overall cardiac and mediastinal contours are stable." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged allowing for differences in technique. There is no pleural effusion or pneumothorax. The lungs appear clear. The bones appear demineralized. There is an unchanged mild chronic-appearing anterior wedge compression deformity of a mid thoracic vertebral body.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Interval removal left-sided PICC.No discrete focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process." }, { "input": "Moderate enlargement of the cardiac silhouette. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "1. Moderate enlargement of the cardiac silhouette. 2. No evidence of interstitial lung disease." }, { "input": "Low lung volumes are again noted. The lungs are grossly clear without confluent consolidation or large effusion. The cardiomediastinal silhouette is stable. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The known left PICC line tip is somewhat obscured, however it appears to terminate in the mid SVC. Lungs are clear without focal consolidation, pleural effusion, or pneumothorax. Heart size is top normal.", "output": "Left PICC line tip terminates in the region of the mid SVC. No focal consolidation concerning for pneumonia." }, { "input": "The lungs are clear without focal consolidation, pleural effusion or pneumothorax. The heart is normal in size. Anterior cervical fusion hardware is partially visualized.", "output": "No acute cardiopulmonary process." }, { "input": "Single AP semi-upright portable view of the chest was provided. Patient is rotated to her right which somewhat limits the evaluation. The lungs appear clear bilaterally without focal consolidation, effusion, or pneumothorax. There is some prominence of the right paratracheal stripe which could reflect mediastinal lymphadenopathy in this patient with known metastatic lung cancer. The heart size appears normal. No pleural effusion or pneumothorax is seen though the left CP angle and the inferior right CP angle are excluded. The imaged osseous structures appear intact.", "output": "Widened mediastinum which could reflect lymphadenopathy in this patient with metastatic lung cancer. No signs of pneumonia or CHF." }, { "input": "Asymmetric fullness of the right hilum is accompanied by a nonspecific right lower lobe opacity projecting over the lower thoracic spine on the lateral radiograph. Lungs are otherwise clear, and there are no pleural effusions. Cardiomediastinal contours are normal.", "output": "Asymmetrical enlargement of right hilum accompanied by a cyst is is the wall it is is is as as any acute is a the all cysts is a is nonspecific right lower lobe opacity. In the absence of infectious symptoms, neoplasm should be considered. RECOMMENDATIONS: If the patient has infectious symptoms, recommend initial chest radiograph in 4 weeks after completion of antibiotic therapy. In the absence of infectious symptoms, contrast-enhanced chest CT would be recommended rather than followup chest radiograph. NOTIFICATION: The impression and recommendation above was entered by Dr. ___ on ___ at 09:46 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "AP upright and lateral views of the chest provided. Lungs are clear. Cardiomediastinal silhouette is normal. Bony structures are intact.", "output": "Normal chest radiograph." }, { "input": "AP upright chest film ___ at 10:40 is submitted.", "output": "Spinal hardware is now seen overlying the lower cervical and upper thoracic spine. Right subclavian PICC line is unchanged in position. The nasogastric tube has been removed. An endotracheal tube remains in place with the tip approximately 2.5 cm above the carina. There is improved aeration but persistent consolidation in the retrocardiac area suggestive of partial lower lobe atelectasis, although pneumonia cannot be entirely excluded. There has been interval appearance of free air within the peritoneal space likely related to recent PEG placement. No pneumothorax." }, { "input": "Lines and tubes: ETT tip is approximately 4.4 cm above the carina. Enteric tube passes into the stomach with the side port below the GE junction and the tip out of view. Right IJ venous line tip is in the lower SVC. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Left retrocardiac opacity is not significantly changed. No pleural effusion or pneumothorax.", "output": "Left lower lobe atelectasis is not significantly changed from yesterday." }, { "input": "A right internal jugular central venous catheter terminates within the mid SVC. An endotracheal tube terminates 5.0 cm above the level of the carina. An orogastric tube courses into the stomach and out of view. As compared to the prior examination, there has been no relevant change. Redemonstrated is a dense retrocardiac left lower lobe opacity. The remainder of the visualized lungs are grossly clear. There is no pneumothorax. The cardiomediastinal silhouette is stable.", "output": "Persistent, dense left lower lobe retrocardiac opacity. No relevant interval change." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Tiny bilateral effusions, right inferomedial opacity, and left lower lobe atelectasis are not significantly changed. No pneumothorax. Lines and tubes: ET tube tip is approximately 3.5 cm above the carina. Right IJ venous line is in the lower SVC. Enteric tube extends into the stomach and passes out of view, but the side port is seen below the GE junction.", "output": "Tiny bilateral effusions, right inferomedial opacity, and left lower lobe atelectasis are not significantly changed." }, { "input": "A right IJ catheter terminates at the caval atrial junction. An endotracheal tube is unchanged in position, terminating 6.2 cm above the carina. The cardiac and mediastinal contours are unchanged. There is a trace left pleural effusion. A persistent left retrocardiac opacity likely reflects atelectasis. There is no pneumothorax or new consolidation.", "output": "Persistent left retrocardiac opacity, likely atelectasis, though underlying consolidation cannot be excluded. No new opacities. Unchanged small left pleural effusion." }, { "input": "A persistent left retrocardiac density is again seen, reflecting left lower lobe atelectasis or consolidation. No new consolidation, effusion, or pneumothorax is detected. An endotracheal tube and right IJ catheter are unchanged in position. An orogastric tube terminates within the stomach.", "output": "1. Persistent left lower lobe retrocardiac opacity. 2. No new superimposed consolidation or effusion." }, { "input": "The lungs are hyperinflated. There are streaky retrocardiac opacities. No pleural effusion or pneumothorax. Heart is normal size. There is no pulmonary edema. The mediastinal and hilar structures are unremarkable. Sternotomy wires, some fractured, and cervical hardware are noted.", "output": "Streaky retrocardiac opacities may reflect atelectasis but pneumonia is not excluded in the correct clinical setting. If necessary, a lateral view could be obtained for further evaluation." }, { "input": "Hyperexpansion of the left upper lobe and leftward mediastinal shift are explained by recurrent left lower lobe collapse, little changed from prior chest radiographs dating back to ___. Small pleural effusions have increased. There is no focal consolidation, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is normal.", "output": "1. Recurrent left lower lobe collapse. 2. Small pleural effusions, increased." }, { "input": "A new right internal jugular approach central venous catheter terminates at the mid SVC. Endotracheal tube terminates approximately 5.2 cm. An orogastric tube courses below the diaphragm, tip is not included in this examination. Evaluation of the lung parenchyma is somewhat limited secondary to overlying respiratory tubing. Findings however are unchanged since prior examination with dense retrocardiac opacity. No pneumothorax identified based on this supine film.", "output": "New right internal jugular approach central venous catheter terminates in the mid SVC. No pneumothorax." }, { "input": "A right IJ terminates at the caval atrial junction. The endotracheal tube terminates 4.9 cm above the carinal. An orogastric tube is appropriately positioned. The cardiac and mediastinal contours are stable since the ___ examination, remaining within normal limits. There is no pneumothorax or pleural effusion. A persistent left retrocardiac opacity, likely reflecting atelectasis, is minimally changed over several recent radiographs.", "output": "1. Unchanged persistent left retrocardiac opacity. 2. No new consolidation, effusion, or pneumothorax." }, { "input": "Patient is status post median sternotomy. Heart size is mildly enlarged. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is not engorged. Streaky left basilar opacity likely reflects left lower lobe atelectasis. Right lung is clear. No pleural effusion or pneumothorax is seen. Cervical spinal fusion hardware is re- demonstrated, partially imaged.", "output": "Streaky left basilar opacity, likely reflective of left lower lobe atelectasis. Early infection is not excluded in the correct setting." }, { "input": "Lines and tubes: ET tube tip is approximately 3 cm above the carina. Right IJ venous line tip is approximately at the CA junction. NG tube passes into the stomach and the tip is not imaged, but the side port is at least 5 cm below the GE junction. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Substantial left lower lobe atelectasis persists. No pleural effusion or pneumothorax. The tip of an IVC filter is seen in the upper abdomen, but cannot be localized on this view alone", "output": "Persistent severe left lower lobe atelectasis." }, { "input": "Endotracheal tube tip is approximately 5.2 cm from the carinal. There is progression of a now dense retrocardiac opacity silhouetting the medial hemidiaphragm. Elsewhere, the lungs are clear. The cardiomediastinal silhouette is within normal limits for technique. Anterior cervical spine fixation hardware is identified. Median sternotomy wires are also noted.", "output": "ET tube 5.2 cm from the carina. Worsening retrocardiac opacity potentially atelectasis although aspiration or pneumonia are possible." }, { "input": "Cardiac size is normal. Left lower lobe almost total collapse is unchanged. Blunting of the lateral CP angles suggests small bilateral effusions Lines and tubes are in standard position. There is no evidence of pulmonary edema. There is no pneumothorax .", "output": "Persistent almost complete collapse of the left lower lobe." }, { "input": "Semi-erect portable AP chest radiograph demonstrates low lung volumes. Atelectasis at the bases is noted. No focal opacity convincing for pneumonia is present. Cardiomediastinal and hilar contours are within normal limits. There is no pneumothorax. No evidence of pulmonary edema.", "output": "Small lung volumes with atelectasis. No focal opacity convincing for pneumonia." }, { "input": "Heart size is borderline enlarged. The aorta is mildly tortuous. Mediastinal and hilar contours are otherwise unremarkable. Lungs are clear and the pulmonary vasculature is normal. No acute osseous abnormality seen.", "output": "No acute cardiopulmonary process." }, { "input": "Two portable frontal radiographs of the chest were acquired. Lung volumes are slightly low. There is central pulmonary vascular congestion with increased widespread interstitial opacities and Kerley B lines, consistent with moderate interstitial pulmonary edema. Moderate bilateral pleural effusions have markedly increased compared to the prior study from ___. There is no pneumothorax. The heart size is difficult to assess, but appears mildly enlarged, not significantly changed. The mediastinal contours are normal.", "output": "Findings most consistent with moderate interstitial pulmonary edema and increased moderate bilateral pleural effusions. While thought less likely, infection at either lung base is certainly possible." }, { "input": "PA and lateral images of the chest demonstrate well expanded lungs, which are generally clear. There are bilateral pleural effusions seen on the lateral but not on the frontal views. The retrocardiac opacity previously visualized has resolved. The chest radiograph is otherwise unchanged. There is no pneumothorax. Cardiomediastinal silhouette is unremarkable.", "output": "Bilateral pleural effusions. Resolution of previously visualized retrocardiac opacity. These findings were made at 10:48 a.m. on ___ and were communicated to the patient's primary team at 10:53 a.m. on ___ by telephone." }, { "input": "PA and lateral images of the chest demonstrate marked improvement in the vascular congestion seen on previous imaging. A small left pleural effusion is seen. There is an opacity, best seen on the lateral view, in the retrocardiac space which suggests a left lower lobe pneumonia or possibly atelectasis. There is no pleural effusion on the right. There is no pneumothorax. Cardiomediastinal silhouette is unremarkable.", "output": "Improvement in previously seen diffuse vascular congestion. Retrocardiac opacity concerning for left lower lobe pneumonia or possibly atelectasis. Left pleural effusion. These findings were communicated via Radiology Critical Findings Dashboard at 4:53 p.m." }, { "input": "Left-sided tunnel dialysis catheter tip terminates in the right atrium. There is no focal consolidation, pleural effusion, or pneumothorax. The heart size is top normal. The cardiac, hilar, and mediastinal contours are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Overlying EKG leads are present somewhat limiting assessment. Minimal right infrahilar opacity could represent mild atelectasis. The heart size is top-normal. Aortic calcifications at the knob noted. No pneumothorax or pleural effusion. Bony structures are intact.", "output": "No convincing signs of pneumonia. Top-normal heart size. Mild right infrahilar atelectasis." }, { "input": "Frontal and lateral radiographs of the chest demonstrate normal heart size. The right subclavian approach porta catheter terminates in the lower SVC. The cardiomediastinal silhouette and hilar contours are normal. The lungs are clear. No pleural effusion or pneumothorax. No displaced rib fracture identified.", "output": "No evidence of pneumonia." }, { "input": "There has been interval removal of a right Port-A-Cath from ___. The lungs are clear of focal consolidation, pleural fusion pneumothorax. There is no overt pulmonary edema. The heart size is normal, and the mediastinal and hilar contours are within normal limits.", "output": "No acute cardiopulmonary process." }, { "input": "Right-sided MediPort tip terminates within the low SVC. The heart size is normal. Mediastinal and hilar contours are unremarkable. No focal consolidation, pleural effusion or pneumothorax is seen. Old left-sided rib fractures are noted.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unchanged. Heart size is normal. There is no pulmonary edema. A Port-A-Cath tip projects over distal SVC.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "A right-sided subclavian MediPort terminates in the distal SVC. The appearance of the catheter is unchanged from prior. There is no pleural effusion, pneumothorax or focal airspace consolidation. The cardiac and mediastinal contours are normal. The hilar structures are unremarkable. The imaged upper abdomen is normal. There are no acute osseous abnormalities.", "output": "Unchanged appearance of a right-sided subclavian MediPort." }, { "input": "Frontal and lateral radiographs of the chest demonstrate clear lungs with no evidence of pneumonia. The cardiac and mediastinal contours are normal. A right chest wall port with the catheter terminating in the mid-to-low SVC is unchanged. Subacute left lower rib fractures are seen, which appear partially healed. No acutely displaced rib fractures are identified. No pneumothorax or pleural effusion is seen.", "output": "No evidence of pneumonia or acutely displaced rib fractures. Subacute left lower rib fractures. No pneumothorax. These findings were relayed to Dr. ___ as requested." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. The lungs appear clear. There is a suspected trace new pleural effusion on the left.", "output": "Suspected trace new left-sided pleural effusion; otherwise unremarkable." }, { "input": "PA and lateral views of the chest provided. Lungs are hyperinflated suggesting underlying COPD. Vague opacity projecting over the right lung base on the frontal projection does not have a correlate abnormality on the lateral projection and appears unchanged suggesting the possibility of a prominent fat pad. Otherwise the lungs are clear. No effusion or pneumothorax. Heart size is stable and mildly enlarged. Mediastinal contour is unremarkable. No free air below the right hemidiaphragm.", "output": "Probable COPD with hazy opacity at the right medial lung base thought to represent a prominent fat pad." }, { "input": "Upright AP and lateral radiographs of the chest demonstrate the lungs are well expanded, with no evidence of pneumothorax, pleural effusion, or pulmonary edema. Right apical pleural thickening and aortic knob calcifications are noted. A poorly localized opacity projecting over the lower thoracic spine on the lateral view may be due to summation artifact from overlying structures.", "output": "No acute cardiopulmonary process." }, { "input": "Enteric tube tip is seen within the distal esophagus, advancement recommended for optimal positioning. Dilated loops of bowel again seen throughout the abdomen as well as excreted contrast in the renal pelves bilaterally. Right basilar opacity is again noted which could be atelectasis although infection would also be possible.", "output": "Enteric tube tip in the distal esophagus and advancement is still suggested." }, { "input": "Low lung volumes are noted with secondary crowding of the bronchovascular markings. Right basilar opacitiy is likely secondary to atelectasis. The cardiomediastinal silhouette is grossly unremarkable. Enteric tube seen coiled in the pharynx and the tip is located in the distal esophagus. Branching hypodensities in the right upper quadrant are compatible with portal venous gas seen on prior CT. Massively distended loops of bowel seen in the abdomen without definite free intraperitoneal air based on this supine film. Excreted contrast seen within the renal collecting systems bilaterally.", "output": "Enteric tube coiled in the pharynx and repositioning is suggested. Portal venous gas as seen on prior CT. Distended loops of bowel without evidence of free intraperitoneal air on this supine film." }, { "input": "The lungs are clear. Heart size is normal. A round density overlying the right tracheobronchial angle is unchanged compared to exams dating back through ___ and may be within the chest wall. There are no pleural abnormalities. Multilevel degenerative changes of the thoracic spine are noted.", "output": "No acute cardiac or pulmonary process. ______________________________________________________________________________ FINAL REPORT INDICATION: Status post seizure. Evaluate for acute infectious process. COMPARISON: Chest radiograph from ___. FINDINGS: The lungs are clear. Heart size is normal. A round density overlying the right tracheobronchial angle is unchanged compared to exams dating back through ___ and is probably a large costovertebral osteophyte or benign expansion of a vertebral transverse process. There are no pleural abnormalities. Multilevel degenerative changes of the thoracic spine are noted. A very dilated left piriform sinus is probably of no clinical significance. IMPRESSION: No acute cardiac or pulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. Mild relative elevation of the right hemidiaphragm is unchanged. New streaky posterior basilar opacification, partly obscuring the posterior right hemidiaphragm is suggestive of minor atelectasis. Projecting over the right mid lung is a new irregular nodular focus, possibly a confluence of shadows but a developing pulmonary nodule should be excluded with further chest imaging when clinically appropriate.", "output": "No evidence of acute disease. Possible lung nodule; evaluatin with chest CT is recommended when clinically appropriate." }, { "input": "Lateral ninth right rib fracture. No pleural effusion or pneumothorax. The cardiac and mediastinal contours are stable. Elevation of the right hemidiaphragm is stable over multiple prior studies. Opacity in the right lower lung corresponds to scarring, better on the prior chest CT. There is no new focal opacity, pulmonary edema or vascular congestion.", "output": "Nondisplaced right ninth rib fracture." }, { "input": "PA and lateral views of the chest provided. There is stable mild elevation of the right hemidiaphragm with mild scarring in the right lower lobe accounting for the linear opacity at the right lung base. There is no convincing evidence for pneumonia or CHF. No large effusion or pneumothorax is present. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. A curvilinear hyperdensity projecting along the right mediastinal border corresponds with the costovertebral junction based on comparison with prior CT. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Elevation of the right hemidiaphragm is re- demonstrated along with streaky opacities in the lung bases compatible with areas of chronic scarring. No focal consolidation, pleural effusion or pneumothorax is present. Moderate multilevel degenerative changes are seen in the thoracic spine.", "output": "Chronically elevated right hemidiaphragm with chronic bibasilar scarring. No focal consolidation." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unchanged. Pulmonary vasculature is not engorged. Elevation of the right hemidiaphragm is chronic. Linear opacities in the lung bases likely reflect areas of subsegmental atelectasis or scarring. No focal consolidation, pleural effusion or pneumothorax is identified. Moderate to severe multilevel degenerative changes are again seen in the thoracic spine.", "output": "Bibasilar subsegmental atelectasis or scarring." }, { "input": "PA and lateral views of the chest provided. Port-A-Cath resides over the right chest wall with catheter tip in the region of the mid SVC. Clips in the right upper quadrant as well as metallic stents in the region of the common bile duct noted in the upper abdomen. Stable elevation of the right hemidiaphragm noted. The lungs appear clear without focal consolidation, effusion or pneumothorax. Cardiomediastinal silhouette is stable. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Central venous catheter terminates in the superior vena cava. The cardiac, mediastinal and hilar contours are stable. There is similar elevation of the right hemidiaphragm. There is no pleural effusion or pneumothorax. The lungs appear clear. Biliary stents project over the right upper quadrant. There is no free air.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The lungs are well inflated and clear. There is stable elevation of the right hemidiaphragm. The cardiomediastinal silhouette and hilar contours are stable. There is no pleural effusion or pneumothorax. A right chest Port-A-Cath terminates at the distal SVC, as before. A metallic CBD stent is again noted projecting over the right upper quadrant.", "output": "No acute cardiopulmonary process." }, { "input": "Compared to prior, there is mild decrease in lung volume, especially on the left likely from mild atelectasis. Small pleural effusion on the right is possible. The heart appear mildly enlarged, accentuated due to decreased lung volumes. Right-sided port appear unchanged from prior. Aortic knob calcification is again seen, unchanged. No pneumoperitoneum is seen.", "output": "1. No pneumoperitoneum. 2. Small right pleural effusion and bibasilar atelectasis." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette and well-aerated lungs which are clear. There is no focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "Normal chest radiograph." }, { "input": "Dual lead left-sided pacemaker is seen with leads extending to the expected positions of the right atrium and right ventricle.No focal consolidation is seen. No pleural effusion or pneumothorax is seen. The cardiac silhouette is mildly enlarged. Mediastinal contours are unremarkable. There may be minimal central pulmonary vascular engorgement without overt pulmonary edema.", "output": "No focal consolidation to suggest pneumonia. Mild cardiomegaly. Possible minimal central pulmonary vascular engorgement without overt pulmonary edema." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unremarkable. The lungs are clear. No pleural effusion or pneumothorax is present. Minimal scarring is noted in the lung apices. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest. As on prior, there is increased interstitial markings throughout the lungs potentially chronic heart failure. Increased soft tissue density seen at the right lung apex medially. This area was not well evaluated on the most recent prior. There has been interval development of an apparent right air-fluid level on the frontal. There is also a moderate left pleural effusion. Cardiac silhouette is enlarged but unchanged. Diffuse osteopenia is noted. No displaced fractures seen.", "output": "1. Air-fluid level in the right hemithorax raising concern for hydropneumothorax. Additional imaging with CT is suggested. 2. Increased density at the right lung apex medially, potentially within the lung apex versus tortuosity of vessels and possible thyroid enlargement. This can be further assessed at time of CT." }, { "input": "The lungs are clear. No effusion or pneumothorax is noted. Heart and mediastinal contours are within normal limits.", "output": "No acute process." }, { "input": "Stable cardiomegaly and tortuosity of the thoracic aorta. Minimal linear atelectasis at the left lung base, but no focal areas of consolidation to suggest the presence of pneumonia. Relative flattening of hemidiaphragms suggests the possibility of COPD in the appropriate clinical setting. Bones are diffusely demineralized, and degenerative changes are present within the spine.", "output": "Linear left basilar atelectasis. No evidence of pneumonia." }, { "input": "AP upright and lateral views of the chest provided. Lung volumes are low limiting assessment. There is mild left basal atelectasis which appears unchanged. There is likely mild hilar congestion with mild stable cardiomegaly. The aorta is calcified and somewhat unfolded. No convincing evidence for pneumonia, large effusion or pneumothorax. Visualized osseous structures appear intact.", "output": "As above." }, { "input": "Lung volumes remain low. Heart size is mildly enlarged with a left ventricular predominance. The mediastinal and hilar contours are unchanged. Pulmonary vasculature is not engorged. Patchy opacities in the lung bases may be due to atelectasis, but infection is not excluded in the correct clinical setting. No pleural effusion or pneumothorax is identified. Mild degenerative changes are noted in the thoracic spine.", "output": "Low lung volumes with patchy opacities in the lung bases, likely atelectasis. Infection however is not excluded in the correct clinical setting." }, { "input": "Right PICC continues to course superiorly off the superior portion of the image in the right internal jugular vein. Otherwise, the study is unchanged. Right lower lung consolidation is again seen but less apparent.", "output": "Right IJ central venous line continues to course up the upper right IJ. Right lower lobe consolidation again seen but less apparent and may represent atelectasis or pneumonia." }, { "input": "Lung volumes are low. There may be a left retrocardiac opacity. There is bibasilar atelectasis. There is no large pleural effusion or pneumothorax. The heart is not enlarged. The mediastinal and hilar contours are normal. Upper median sternotomy wire is in minimally different orientation since ___ and possibly fractured.", "output": "1. Possible left retrocardiac opacity may reflect pneumonia in the right clinical setting. 2. Possible fractured or minimally displaced superior median sternotomy wire. Please correlate for site of pain, if any, on physical exam." }, { "input": "There is volume loss in both lower lungs. Early infiltrates in these regions cannot be excluded. Compared to the study from 4 months ago the right upper lobe process has resolved the heart continues to be mildly enlarged. Sternal wires are again seen. Mediastinal clips are again visualized. There are tiny bilateral pleural effusions", "output": "Volume loss/early infiltrates in both bases." }, { "input": "The lungs are clear and there is no evidence of a consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. No definite hiatal hernia is visualized. There are no fractures noted.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest are provided. Clips are noted in the upper abdomen, unchanged. Lungs are clear without focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours are normal. The imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral chest radiographs were provided. A subtle opacity in the medial right lower lobe with obscuration of a portion of the right hemidiaphragm may represent an early pneumonia. The left lung is clear. No pleural effusion or pneumothorax is present. The cardiomediastinal silhouette is normal. Multiple clips are noted in the mid abdomen, left upper quadrant and right upper quadrant. Bones are intact.", "output": "Subtle right lower lobe opacity may represent early pneumonia. These findings were discussed with Dr. ___ by Dr. ___ at 2:30 p.m." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "There are moderate bilateral pleural effusions, which appear similar in size from the prior CT of the chest in ___. There are prominent interstitial markings, which likely represent mild pulmonary edema. Bibasilar hazy opacities are most consistent with atelectasis. There is no evidence of a pneumothorax. The mediastinal silhouette is normal. The cardiac silhouette is difficult to fully evaluate, as the left heart border is obscured by the adjacent pleural effusion, but appears mildly enlarged, and stable from the prior chest CT.", "output": "1. Stable bilateral moderate pleural effusions. 2. Prominent interstitial markings are likely due to mild pulmonary edema. 3. Bibasilar atelectasis. 4. Stable mild cardiomegaly." }, { "input": "A single frontal portable radiograph of the chest was acquired. Small-to-moderate bilateral pleural effusions are increased compared to the prior study from ___. Consolidative opacities at both lung bases likely reflect compressive atelectasis and pleural effusions, although concomitant infection at either lung base is certainly possible. There is engorgement of the pulmonary vasculature with mild interstitial pulmonary edema. Background emphysematous changes are redemonstrated. The heart size is top normal. The descending thoracic aorta is slightly tortuous, as before. There is no pneumothorax.", "output": "1. Increased moderate bilateral pleural effusions with bilateral lower lobe consolidative opacities, likely compressive atelectasis given the adjacent effusions, although infection at either lung base is certainly possible. 2. Mild interstitial pulmonary edema." }, { "input": "Again noted is small right-sided pleural effusion, similar in size to the ___ study. There now an increasing left-sided pleural effusion compared to the prior study, but it is small in size. Prominent interstitial markings likely represent mild pulmonary edema. No opacities that are concerning for an infectious process. Bones are grossly intact. Atherosclerotic disease is seen within the aorta. Cardiomediastinal silhouette is unremarkable.", "output": "1. Increasing size of small left-sided pleural effusion. Stable small right-sided pleural effusion. 2. Mild pulmonary edema." }, { "input": "AP view of the chest provided. Compared to prior study, the cardiac silhouette has increased in size. There is also increased opacity in bilateral lung bases. These findings are suggestive of pulmonary vascular congestion. However, in view of the clinical history provided, these findings could also reflect multifocal pneumonia. Old deformity of the left clavicle is again seen.", "output": "Bilateral lung base opacity, in association with increase in cardiac size, likely refecting pulmonary vascular congestion. However, given clinical history, multifocal pneumonia is also a possibility. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 11:28 AM, 10 minutes after the images were radiology." }, { "input": "There are vague bilateral perihilar peribronchovascular opacities, concerning for an atypical pneumonia. The lungs are otherwise clear. The cardiac and mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen.", "output": "Peribronchovascular opacities bilaterally, concerning for an atypical infectious process. Findings were discussed with Dr. ___ by Dr. ___ at 5:53 p.m. via telephone on the day of the study." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No displaced fracture is identified.", "output": "No acute cardiopulmonary process. No displaced fracture seen. If high clinical concern for rib fracture, consider dedicated rib series with bb marker overlying site of concern or chest CT." }, { "input": "The lungs are clear without consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications seen at the aortic arch. Coronary artery stents are also seen. Mid thoracic dextroscoliosis is unchanged. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process, no focal consolidation." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications seen at the aortic arch. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Single portable chest radiograph was provided. Basilar opacities and small left pleural effusion are unchanged. Mild cardiomegaly has slightly increased since the most recent prior exam. The tracheostomy tube is in appropriate position. Left PICC terminates in the right atrium. Bony structures are unremarkable.", "output": "1. Stable bibasilar opacities and left pleural effusion. 2. Left PICC in right atrium. Recommend retracting 3-4cm. 3. Mild increase in heart size since the prior exam." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The lungs are relatively hyperinflated. Cardiac and mediastinal silhouettes are unremarkable.", "output": "No focal consolidation." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. THE CARDIAC SILHOUETTE IS TOP-NORMAL. AORTA SLIGHT TORTUOUS. THE PATIENT IS STATUS POST MEDIAN STERNOTOMY AND CABG.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. The lungs are clear without focal consolidation effusion or pneumothorax. The cardiomediastinal silhouette is normal. The bony structures appear intact. There is deformity and osseous irregular thickening of the right distal clavicle which could reflect an old injury.", "output": "No signs of pneumonia." }, { "input": "The lungs are well inflated. There is left lower lobe patchy opacity that does not transgress the major fissure on the lateral view. No other focal opacities are present. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "Left lower lobe pneumonia." }, { "input": "The lungs are clear, the cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax.", "output": "No acute intrathoracic process." }, { "input": "There has been interval placement of a tracheostomy tube, the tip terminates 4 cm above the level of the carina. A left internal jugular catheter terminates in the mid to distal SVC. The cardiomediastinal contour is normal. The heart is not enlarged. Lung volumes are within normal limits. No consolidation, pneumothorax or pleural effusion seen.", "output": "A tracheostomy tube terminates approximately 4 cm above the level of the carina." }, { "input": "Single portable chest radiograph demonstrates an endotracheal tube, its tip which projects approximately 4 cm above the level of the carina in appropriate position. Enteric tube descends the thorax in uncomplicated course, its tip out of the field-of-view although below the level of the diaphragm. The lungs are clear bilaterally. There is no large pleural effusion or pneumothorax. Cardiomediastinal and hilar contours are within normal limits.", "output": "Appropriate positioning of support devices without evidence of complications." }, { "input": "AP portable supine view of the chest. Tracheostomy tube and PICC line are unchanged in position. A VP shunt traverses the right hemi thorax. Lungs are clear. Cardiomediastinal silhouette appears normal. No acute osseous abnormalities.", "output": "No acute findings." }, { "input": "Right-sided PICC terminates in the upper to mid SVC without evidence of pneumothorax. A right-sided catheter courses vertically over the chest and into the abdomen most likely representing a VP shunt. Subtle patchy left base retrocardiac opacity appears less prominent as compared the prior study may represent atelectasis rather than pneumonia. There is no pulmonary edema. No large pleural effusion is seen. Tracheostomy tube is again noted.", "output": "No pulmonary edema. Left base retrocardiac opacity is less prominent as compared to the prior study and may represent atelectasis rather than pneumonia." }, { "input": "A right PICC terminates in the low SVC tracheostomy tube is in adequate position. VP shunt traverses the right hemithorax. Bibasilar opacities may reflect atelectasis versus pneumonia. Findings are more pronounced on the left than the right. Mid upper lungs appear well aerated. No convincing evidence for effusion or pneumothorax on this supine radiograph. The cardiomediastinal silhouette is unremarkable.", "output": "Bibasilar opacities may reflect atelectasis versus pneumonia, left greater than right." }, { "input": "Frontal and lateral views of the chest. The lungs are hyperinflated but clear of focal consolidation, effusion or pneumothorax. Cardiac silhouette is mildly enlarged. The thoracic aorta is tortuous. Moderate-sized hiatal hernia is identified. No definite displaced fracture is identified.", "output": "Hyperinflation without acute cardiopulmonary process. Mild cardiomegaly. Moderate hiatal hernia. No displaced fractures identified on this nondedicated examination." }, { "input": "The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process; specifically, no evidence of pneumonia." }, { "input": "There are low lung volumes bilaterally. The lungs are clear. No evidence of focal consolidations, pulmonary edema, pleural effusions, or pneumothorax. The mediastinum is slightly widened, likely due to tortuosity of ascending aorta. The hila and heart are within normal limits. No acute osseous abnormalities.", "output": "There is no pulmonary edema." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is mild to moderately enlarged. The aorta is tortuous. No pulmonary edema is seen. Some degenerative changes are seen along the spine.", "output": "Cardiomegaly. No pulmonary edema." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes. No pleural effusion, focal consolidation or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is top normal. There is no pulmonary edema. Cervical fixation hardware is noted.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "The lungs are clear.The cardiac, hilar and mediastinal contours are normal.No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear, the cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax.", "output": "No acute cardiothoracic process." }, { "input": "There are small bilateral pleural effusions. The cardiac silhouette remains mildly enlarged. Mediastinal contours are stable. Left basilar retrocardiac patchy opacity may be due to atelectasis however, consolidation due to infection or aspiration is not entirely excluded. There is no pneumothorax. There has been interval decrease in right basilar opacity and pulmonary edema since the prior study.", "output": "Small bilateral pleural effusions. Patchy left base retrocardiac opacity may be due to atelectasis, however consolidation due to infection or aspiration is not excluded. Significant interval decrease in right basilar opacity and in previously seen pulmonary edema." }, { "input": "AP portable upright view of the chest. The lungs are grossly clear aside from mild left basilar atelectasis. No large effusion or pneumothorax is seen. Cardiomediastinal silhouette appears grossly unremarkable. No acute bony abnormalities are seen.", "output": "No acute intrathoracic process" }, { "input": "There is a left basilar retrocardiac opacity which obscures the left heart border. This may reflect atelectasis, though a consolidation due to infection or aspiration is not excluded. Otherwise, the lungs are clear without pleural effusion, pneumothorax or pulmonary edema. The cardiac silhouette is normal in size. The mediastinal and hilar contours are normal. Cervical spinal fusion hardware is partially visualized.", "output": "Left basilar retrocardiac opacity obscuring the left heart border may reflect atelectasis, though consolidation cannot be excluded." }, { "input": "AP portable semi-upright chest radiograph was obtained. Left basal opacity is unchanged with increasing right basal opacity. Bilateral small pleural effusions are increased. Mild-to-moderate pulmonary edema is unchanged or slightly increased. Left PICC is in unchanged position. Heart and mediastinal contours reveal stable cardiomegaly.", "output": "Increased right basal opacity is concerning for aspiration given the provided clinical history with bilateral increased small pleural effusions and unchanged or slightly increased mild-to-moderate pulmonary edema. Unchanged left basal opacity, likely atelectasis." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Since the radiographs obtained ___, no significant changes are appreciated. Lungs are fully expanded and clear without consolidations or effusions. Heart size is normal. Cardiomediastinal and hilar silhouettes are normal. Pleural surfaces are normal.", "output": "No radiographic evidence of pneumonia or other significant cardiopulmonary abnormalities." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. There is a small left posterior diaphragmatic hernia versus eventration. The heart size is normal and the mediastinal contour is unremarkable. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute findings." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The patient is in status post midline sternotomy for CABG with sternal metal wire and mediastinal clips. The cardiac and great vessel contours are unchanged and still enlarged. The left subclavian PICC line was removed. The lungs are well inflated and clear without consolidation or nodules. There is no pleural effusion.", "output": "Chest findings are unchanged." }, { "input": "Frontal and lateral radiographs of the chest when compared to the prior study demonstrate new asymmetric opacity at the left base well seen on the frontal and in the retrocardiac region, well seen on the lateral, corresponding to a left lower lobe pneumonia. Additionally, there is mild increase in interstitial markings concerning for worsening pulmonary edema. Mild-to-moderate cardiomegaly is noted and stable. Intact median sternotomy wires are seen. A tortuous aorta alters the contour of the mediastinum which is otherwise unchanged. The remainder of the lung parenchyma is clear. No pleural effusion or pneumothorax is seen.", "output": "New asymmetric opacity at the left base consistent with left lower lobe pneumonia. Mild interval worsening of pulmonary edema." }, { "input": "Single portable chest radiograph was provided. A right subclavian central line terminates at the cavoatrial junction. Median sternotomy wires are intact. There is left basilar atelectasis. The lungs are otherwise clear without focal consolidation, pleural effusion or pneumothorax. The cardiac silhouette is top normal and pericardial calcifications are noted.", "output": "Left basilar atelectasis, otherwise no acute process." }, { "input": "There are focal opacities in the right and left lower lobes which likely represent pneumonia. No pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "Focal opacities in the right and left lower lobes which likely represent pneumonia." }, { "input": "Normal heart size, and hilar contours. There is an opacity in the retrosternal space on the lateral view, though this is not a true lateral view and could be related to technique. No focal consolidation, pleural effusion or pneumothorax.", "output": "Opacity in the retrosternal space on the lateral view, potentially related to suboptimal positioning. Repeat lateral radiograph is recommended to help exclude an anterior mediastinal abnormality such as a thymoma. RECOMMENDATION(S): Recommend non emergent repeat lateral radiograph with improved position to evaluate the retrosternal clear space. NOTIFICATION: The updated findings and recommendations were emailed to the ED QA nurses by Dr. ___ on ___" }, { "input": "Chest, PA and lateral. The lungs are clear. The hilar and cardiomediastinal contours are normal. There is no pneumothorax or pleural effusion. Pulmonary vascularity is normal.", "output": "Normal radiograph of the chest." }, { "input": "Cardiac silhouette size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is normal. Focal ill-defined opacity is seen within the left lung base, potentially in the left lower lobe, though not well localized on the lateral view. Right lung is clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Focal ill-defined opacity in the left lung base concerning for pneumonia. Follow up radiographs after treatment are recommended to ensure resolution of this finding." }, { "input": "The previously seen opacities in bilateral lung bases are no longer seen. There is no consolidation, pleural effusion, or pneumothorax. Cardiomediastinal and hilar silhouettes are normal size.", "output": "Normal chest." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are clear without focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "There is a Port-A-Cath overlying the right upper lung with the tip terminating in the right atrium. There is a left-sided chest tube within tip terminating in the apex, without any evidence of pneumothorax. There is improvement in lingular aeration. There is a poorly defined opacity in the superior segment of the left lower lobe at the site of the mass noted on the prior chest CT. There are small unchanged bilateral pleural effusions. Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. There are no acute osseous abnormalities.", "output": "1. Port-A-Cath with tip in the right atrium. 2. Left chest tube in appropriate positioning without pneumothorax. 3. Small unchanged bilateral pleural effusions. 4. Improvement in lingular atelectasis. Persistent left lower lobe lung mass, more fully evaluated by a recent CT." }, { "input": "Unilateral interstitial and alveolar pattern in the left lung is accompanied by left-sided volume loss and a moderate left pleural effusion. There is a suggestion of a possible left hilar mass, difficult to assess on this portable radiograph. Right lung and pleural surfaces are clear.", "output": "Unilateral combined alveolar and interstitial pattern in the left lung with associated volume loss and left pleural effusion. These findings raise the possibility of a central malignancy with associated lymphangitic carcinomatosis and possible postobstructive pneumonia and atelectasis. Contrast enhanced CT may be helpful for further assessment if not already performed." }, { "input": "Lungs: Unchanged left mid and lower zone opacity, a combination of moderate left pleural effusion and atelectasis/consolidation. Persistent reticulo nodular opacities in the left upper lobe also remain unchanged, corresponding to the diffuse interlobular septal thickening noted on the prior CT. Right lung is clear. Pleura: Moderate left pleural effusion, unchanged. No right pleural effusion or pneumothorax. Mediastinum: There is no cardiomegaly. Mediastinal silhoutte is within normal limits. Bony thorax: No change in bony thorax", "output": "Unchanged left mid and lower zone opacity, a combination of moderate left pleural effusion and atelectasis/consolidation. Persistent reticulo nodular opacities in the left upper lobe also remain unchanged, corresponding to the diffuse interlobular septal thickening noted on the prior CT. NOTIFICATION:" }, { "input": "Compared to most recent study, there has been no significant interval change with a large left pleural effusion with adjacent compressive atelectasis. There may be some increased atelectasis due to leftward shift of mediastinal structure. There is fluid partially loculated within the left major fissure. There may be a tiny right pleural effusion as well. The right lung remains clear. The left heart border is obscured entirely. Mediastinal structures are otherwise unremarkable. A right chest Port-A-Cath is noted.", "output": "Large partially loculated left pleural effusion with probable increase in atelectasis. Tiny right pleural effusion." }, { "input": "PleurX catheter at the left lung base and chest port terminating in the right atrium. Lingular mass obscuring the left heart border is slightly smaller. Small left pleural effusion is unchanged. No appreciable pneumothorax. Mediastinal and hilar contours are normal.", "output": "Unchanged small left pleural effusion. No appreciable pneumothorax. Lingular mass is slightly smaller." }, { "input": "There is a right Port-A-Cath, which terminates in the right atrium. T left chest tube appears unchanged in orientation. The poorly defined opacity in the superior segment of the left lower lobe is unchanged. The left pleural effusion is also unchanged. The right lung is clear. Heart size is stable. The mediastinal and hilar contours are stable. The pulmonary vasculature is normal. No pneumothorax is seen. There are no acute osseous abnormalities.", "output": "1. Right Port-A-Cath in appropriate positioning. 2. Unchanged left pleural effusion. 3. Unchanged left lower lobe opacity." }, { "input": "A left-sided chest tube is in-situ. There is persistent visualization of a loculated pneumothorax of the left lung base. There is persistent left lower lobe consolidation which may be due to atelectasis. Free air again noted under the right hemidiaphragm. The right lung appears grossly clear.", "output": "No significant interval change when compared to the earlier study. Persistent loculated left pneumothorax and pneumoperitoneum." }, { "input": "Right chest wall port catheter terminates in the upper right atrium. In comparison to ___, there has been significant improvement in the left pleural effusion. The mass like lingular opacity and reticulonodular opacity seen in the mid and lower left lung could reflect changes secondary to lymphangitic spread. Left-sided pleural catheter projects over the left lung base. Lungs are hyperinflated which may reflect underlying COPD. Heart size is normal. Hilar and mediastinal contours are within normal limits. No pneumothorax.", "output": "1. Significant interval decrease in left pleural effusion following placement of pleural catheter. 2. Masslike lingular opacity and reticulonodular opacity in the left mid and lower lung." }, { "input": "Interval insertion of a left-sided pigtail catheter with decrease in the left-sided pleural effusion. No pneumothorax. Left retrocardiac opacity has improved. The right lung remains clear. Right-sided Port-A-Cath with the tip in the right atrium.", "output": "No pneumothorax, post left-sided chest tube placement with decrease in left pleural effusion." }, { "input": "There is a right Port-A-Cath, which terminates in the right atrium. Total left chest tube has been removed. The left pleural effusion has decreased in size. The poorly defined left lower lobe opacity persists. The lungs are otherwise clear. Heart size is stable. The mediastinal and hilar contours are stable. The pulmonary vasculature is normal. Lungs are clear. No pneumothorax is seen. There are no acute osseous abnormalities.", "output": "1. Right Port-A-Cath in appropriate positioning. 2. Improved left pleural effusion after removal of chest tube without evidence of pneumothorax. 3. Unchanged poorly defined left lower lobe opacity." }, { "input": "A right internal jugular port terminates at the cavoatrial junction. There is a persistent small amount of air below the right hemidiaphragm. The loculated pneumothorax at the left lung base is similar in appearance when compared to the prior study. Left basal atelectasis and presumed pulmonary edema is also unchanged. Consolidation in the left mid lung with partial silhouetting of the left heart border consistent with left upper lobe consolidation.", "output": "Overall, appearances are unchanged compared to the prior study. Persistent pneumoperitoneum and loculated left basal pneumothorax." }, { "input": "Again visualized is a moderate left pleural effusion with underlying atelectasis and/ or consolidation. Unchanged linear opacities in the left upper lobe. Right lung is clear. Left-sided pigtail is not visualized on this radiograph. Stable cardiomegaly. Bony thorax is unchanged.", "output": "Left pigtail not visualized on this radiograph. Overall unchanged left pleural effusion and underlying atelectasis and/or consolidation. Unchanged left upper lobe interstitial markings." }, { "input": "There is a persistent moderately large left pleural effusion with associated atelectasis. Infection cannot be excluded. The right lung and left upper lung are grossly clear. A right-sided Port-A-Cath terminates in the distal SVC or right atrium, the tip is difficult to visualize. No pneumothorax seen.", "output": "No significant interval change when compared to the prior study." }, { "input": "Since prior, there has been a increased opacity at the left lung base compatible with a worsening effusion. Lingular opacity is also increased. The mediastinal contour is unremarkable. The left cardiac border is obscured. The right lung is hyperinflated but grossly clear. There is no pneumothorax. A right chest wall port a catheter ends in the proximal right atrium. Lymphangitic spread better seen on prior CT.", "output": "Increased size of left-sided pleural effusion and lingular opacity." }, { "input": "The moderate left pleural effusion is unchanged. Prominent interstitial lung markings in the left lung are also unchanged, and remain concerning for lymphangitic spread of metastasis. Left-sided volume loss is unchanged. The right lung remains clear. There is no pneumothorax. The heart and mediastinum cannot be accurately assessed.", "output": "No significant interval change." }, { "input": "Given for differences in technique, now PA and lateral compared to portable view from the moderate to large multiloculated left pleural collection has not substantially changed. At least 4 air-fluid levels are again demonstrated. The pleural catheter is in similar position. The right lung remains clear.", "output": "Moderate to large multiloculated collection, given for differences in technique has not substantially changed" }, { "input": "PA and lateral views of the chest provided. There has been interval thoracentesis with persistent elevation of the left hemidiaphragm with left basal atelectasis. Left pleural effusion is decreased in the interval. No pneumothorax. Right lung remains clear. Port-A-Cath is unchanged with tip in the low SVC likely within the right atrium.", "output": "As above." }, { "input": "As on prior, low lung volumes are seen. There has, however, been interval clearance of the retrocardiac opacity seen on the previous lateral view. Cardiomediastinal silhouette is unchanged and likely within normal limits given positioning and low lung volumes. No acute osseous abnormality is identified.", "output": "Limited exam given low lung volumes; however, no evidence of large confluent consolidation." }, { "input": "The lungs are clear. Cardiac silhouette is normal in size. There is no pleural effusion, pneumonia or evidence of pulmonary edema. Degenerative changes of the spine are noted.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "There is a subtle opacity in the right middle lobe, concerning for pneumonia. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. No pneumothorax, pulmonary edema, or pleural effusion.", "output": "Subtle right middle lobe pneumonia. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 5:06 PM, 10 minutes after discovery of the findings." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs demonstrate a small residual opacity in the right infrahilar region and are otherwise clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Focal residual or recurrent opacity in right infrahilar region in comparison to ___ radiograph. RECOMMENDATION(S): Considering recurrent symptoms, either follow-up chest x-ray in 4 weeks after treatment for recurrent pneumonia. If persistent, CT would be recommended. NOTIFICATION: The impression and recommendation above was entered by Dr. ___ on ___ at 11:22 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "The heart size is top normal. The cardiomediastinal silhouette and hilar contour is stable. The lungs are clear bilaterally without focal consolidation, effusion or pneumothorax. No acute bony abnormality is identified.", "output": "No acute intrathoracic process." }, { "input": "The small right lower lobe opacity is smaller compared to before. Small residual opacity remains on the lateral view. There is no pneumothorax or pleural effusion. Cardiomediastinal silhouette is normal size.", "output": "The small right lower lobe opacity is smaller compared to before, consistent with improved pneumonia." }, { "input": "The lungs are well inflated and clear. Previous small consolidation in the medial basal segment of the right lower lobe is largely resolved with some residual scarring. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. No focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "There is mild cardiomegaly but this is likely accentuated due to technique and positioning. There is mild pulmonary vascular congestion without overt edema or effusion. No acute osseous abnormality.", "output": "Pulmonary vascular congestion without focal consolidation." }, { "input": "AP and lateral views of the chest. The lungs are grossly clear. The cardiomediastinal silhouette is within normal limits. There is no effusion or pneumothorax. No displaced fractures identified.", "output": "No acute cardiopulmonary process." }, { "input": "Single frontal view of the chest. Heart size and cardiomediastinal contours are normal. Lungs are clear without focal consolidation, pleural effusion, pneumothorax. Mid thoracic scoliosis is not accompanied by obvious vertebral body or disc space abnormality. Clinical evaluation recommended.", "output": "Normal chest radiograph. Thoracic scoliosis should be evaluated clinically." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac silhouette is not enlarged. There is minimal prominence at the AP window which may be artifactual; however, underlying lymph node not excluded. This could be further assessed on a non-urgent chest CT. No displaced fracture seen.", "output": "No focal consolidation to suggest pneumonia. Slight prominence of the AP window may be artifactual; however, underlying lymph nodes not excluded. Findings could be further assessed on a non-urgent chest CT." }, { "input": "Portable chest radiograph demonstrates interval placement of a tracheal stent in the midline. When compared to chest film 1 day prior, there is no interval parenchymal changes. There is no pleural effusion or pneumothorax. Cardiomediastinal silhouette stable in appearance.", "output": "Interval placement of tracheal stent. No new pneumothorax." }, { "input": "Frontal and lateral chest radiographs demonstrate general radiolucency within bilateral lungs to suggestive mild overinflation. The lungs are otherwise without nodules, mass, or focal consolidation to suggest pneumonia. There is nonspecific calcification within the right lower lung zone which may represent calcification versus foreign body in or around the bronchi. The cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "No evidence of mass or nodule. Mild overinflation consistent with emphysematous changes." }, { "input": "Single portable view of the chest. Compared with prior there has been essentially complete resolution of bilateral pleural effusions. Blunting of the right costophrenic angle may be due to trace effusion. The lungs are otherwise clear without focal consolidation to suggest infection or aspiration. The cardiomediastinal silhouette is stable. Median sternotomy wires are again noted. No acute osseous abnormality is detected.", "output": "Essentially complete resolution of the bilateral pleural effusions with possible trace effusion on the right. Otherwise, no acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. A calcified granuloma in the right middle lobe is again seen and unchanged in size. No pleural effusion or pneumothorax is seen. Note is made of cholecystectomy clips in the right upper quadrant.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest were obtained. Low lung volumes results in bronchovascular crowding. There is no focal consolidation, pleural effusion or pneumothorax. A calcified granuloma in the right middle lobe is again seen. Heart size is top-normal, unchanged. Mediastinal silhouette and hilar contours are normal. Rightward tracheal deviation is due to left goiter. Cholecystectomy clips are seen in the right upper quadrant.", "output": "No pneumonia, edema or effusion." }, { "input": "The lungs are clear of focal consolidation. Calcified granuloma at the right lung base is again seen. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size and mediastinal contours are within normal limits. The lungs are clear of consolidations, cavitary masses or abnormal calcifications. There is no pleural effusion. The visualized portion of the spine appears normal.", "output": "No evidence of active or latent TB." }, { "input": "Frontal and lateral radiographs of the chest show clear lungs without focal consolidation, pleural effusion, or pneumothorax. The previously seen opacity projecting at the left lung base overlying the posterior ninth rib is no longer seen. The pulmonary vasculature is not engorged. The cardiac silhouette is normal in size. The mediastinal and hilar contours are within normal limits.", "output": "No pulmonary or osseous lesion identified on today's exam. No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. Small, subtle opacity, measuring approximately 6 mm projecting over the posterior right 9th rib may be artifactual or summation of shadows/vascular structures, but small ground glass opacity from underlying infection can not be excluded. No pleural effusion, or evidence of pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "Small, subtle opacity, measuring approximately 6 mm projecting over the posterior right 9th rib may be artifactual or summation of shadows/vascular structures, but small ground glass opacity from underlying infection can not be entirely excluded. Recommend f/u chest radiograph to resolution to exclude an underlying nodule. If clinical concern for pulmonary mass persists, CT is more sensitive for pulmonary nodules. Findings/recommendation submitted to the ED QA nurses on ___ at 8:25PM." }, { "input": "PA and lateral views of the chest were compared to previous exam from ___. The lungs are hyperinflated but clear of confluent consolidation or effusion. The cardiomediastinal silhouette is within normal limits.", "output": "Hyperinflation without acute cardiopulmonary process." }, { "input": "Small bilateral pleural effusions with minimal compressive atelectasis. No pneumothorax is seen. The heart is moderately enlarged, unchanged compared to ___.", "output": "1. Small bilateral pleural effusions with compressive atelectasis. 2. Moderate cardiomegaly." }, { "input": "As compared to prior radiograph from ___, there has been slight worsening of right-sided pleural effusion, with fluid tracking within the minor fissure. No focal consolidations are identified and there is no pneumothorax. There is increased anteroposterior diameter of the thorax with hyperinflated lungs suggestive of COPD. There is moderate to severe cardiomegaly. Left-sided dual-lead pacemaker leads terminate in the expected positions of the right atrium and right ventricle. There is evidence of kyphosis.", "output": "Slight worsening of right-sided pleural effusion. Increased anteroposterior diameter of the thorax with hyperinflated lungs suggestive of COPD." }, { "input": "Frontal and lateral views of the chest are obtained. Left-sided dual-lead pacemaker is again seen with leads in the expected positions of the right atrium and right ventricle. There are bilateral pleural effusions, right greater than left, moderate on the right and small on the left, with overlying atelectasis. There is either fluid tracking in the minor fissure versus possibly fissural thickening. Bibasilar opacity most likely represents combination of pleural effusion and atelectasis but underlying consolidation cannot be excluded. There is mild left base atelectasis. The cardiac silhouette is top normal to mildly enlarged. Mediastinal contours are unremarkable and stable. Degenerative changes are seen along the spine.", "output": "Bilateral right greater than left pleural effusions with overlying atelectasis. Right basal opacity likely represents combination of pleural effusion and atelectasis although underlying consolidation cannot be excluded." }, { "input": "Frontal and lateral views of the chest demonstrate moderate bilateral pleural effusions, left greater than right. Bilateral vascular congestion and perihilar edema has increased. The heart remains enlarged. A left-sided dual lead pacer is unchanged in position. There is no pneumothorax.", "output": "1. Moderate bilateral pleural effusions, left greater than right. 2. Worsening vascular congestion and perihilar pulmonary edema." }, { "input": "A left axillary dual-lead pacemaker is again seen with tips in standard unchanged position. The cardiomediastinal and hilar contours are stable. The left pleural effusion appears improved, although this may be accounted for by change in patient positioning, with the patient upright on the current examination. The right pleural effusion appears to have increased, although this may also be partly due to change in patient positioning. There is no focal consolidation concerning for pneumonia.", "output": "Improvement in left pleural effusion and slight increase in right pleural effusion." }, { "input": "A frontal semi-upright view of the chest was obtained portably. Small bilateral pleural effusions with adjacent atelectasis are increased on the left and decreased on the right. The upper lung zones are clear and pulmonary vasculature is within normal limits. The right apical pneumothorax is not seen on this semiupright study. Mild cardiomegaly is unchanged. The left chest wall pacemaker leads are unchanged in position.", "output": "Small bilateral pleural effusions with adjacent atelectasis, larger on the left and smaller on the right. No edema." }, { "input": "The cardiomediastinal and hilar contours are stable, with mild cardiomegaly. A right basal pleural catheter has been removed. A small residual right pleural effusion is seen with fissural extension. No pneumothorax is seen. The left lung is well expanded and clear. Left chest wall AICD device is seen with leads in the expected position of the right atrium and right ventricle.", "output": "Small-to-moderate residual right pleural effusion. No pneumothorax." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest were compared to scout films from CT scan from ___. Given differences in technique, there has been no significant interval change. Again seen are increased interstitial markings identified throughout the right lung, most notably at the base. Increased soft tissue density at the right hilum is compatible with lymphadenopathy identified on CT scan. There is no effusion. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable. Right chest wall port via IJ is seen with catheter tip in the mid SVC.", "output": "Increased interstitial markings in the right lung as seen on CT scan from almost two weeks prior. This could be related to infection; however, metastatic disease is also possible. Right hilar adenopathy is better delineated on prior CT scan." }, { "input": "The lungs are clear. There is no pleural effusion or pneumothorax. Cardiac and mediastinal outlines appear normal. No acute fracture is identified.", "output": "Normal chest radiograph." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. The heart appears normal in size. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable. There has been no significant change.", "output": "No evidence of acute disease." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Lines and tubes are in appropriate and stable position. The cardiac silhouette is prominent. The mediastinal and hilar contours are within normal limits allowing for low lung volume. There is mild to moderate perihilar vascular congestion. THere is increasingly dense retrocardiac consolidation, in the setting of fever, could represent pneumonia. There are bilateral pleural effusions. Upper lungs are well aerated. There is no pneumothorax. Preiously seen gastric air distention has resolved. Several clips are seen projecting over the left hemithorax laterally.", "output": "Progressive left lower lobe consolidation and small effusion in the setting of fever is concerning for pneumonia." }, { "input": "AP single view of the chest has been obtained with patient in semi-upright position. Comparison is made with the next preceding similar studies obtained at 5 a.m. and 6:30 a.m. during the same day. All three examinations performed at the bedside and with the patient in semi-erect position. There is marked cardiac enlargement and bilateral pleural effusions that obliterate the diaphragmatic contours and blunt the lateral pleural sinuses. Adjustment of a right internal jugular approach central venous line was made. On the present examination obtained at 15:23 hours, patient is intubated. An NG tube has been advanced and reaches well below the diaphragm including its side port. The line terminates in a markedly air distended stomach. There is no evidence of pneumothorax. Evidence of old multiple right-sided rib trauma with corresponding deformities as before. Status post surgery in left axillary area also unchanged. A portable chest examination on the preceding day ___ demonstrated already marked cardiac enlargement and pulmonary congestion with bilateral pleural effusions clearly different from the next preceding PA and lateral chest examination of ___. No evidence of CHF was present.", "output": "The latest four portable chest examinations clearly indicate cardiac enlargement, pulmonary congestion and pleural effusions located mostly in the posterior compartments related to patient's semi-erect position. Questions raised in the requisition to comment on presence of infiltrates versus edema cannot be answered in such detail on these four recent portable single view chest examinations. Consider consultation with cardiology department with regard to patient's obvious advanced CHF condition." }, { "input": "AP view of the chest provided. Compared to prior study from earlier today, there is no significant change. There is no interval mediastinal widening. Cardiac silhouette appears stably enlarged. Extent of pulmonary vascular engorgement is also unchanged. There are no large pleural effusions. There is no pneumothorax or pneumomediastinum.", "output": "No pneumomediastinum" }, { "input": "PA and lateral views of the chest provided. As compared to prior study from 1 day ago, there is increased right lung base opacity. Preoperative right peritracheal widening expanded postoperatively and may reflect localized hematoma or fluid collection. It is unchanged since the recent postoperative radiograph of 1 day earlier. There is no pneumothorax or pneumomediastinum.", "output": "Increased right base opacity, concerning for aspiration or developing pneumonia. Stable postoperative right peritracheal mediastinal widening as described above NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 10:28 AM, minutes after the images were reviewed." }, { "input": "AP portable upright view of the chest. Overlying EKG leads are present somewhat limiting the evaluation. There is no focal consolidation, effusion, or pneumothorax. No overt signs of edema. Suture in the right mid lung is noted. Heart size is top-normal. Imaged osseous structures are intact.", "output": "No acute intrathoracic process" }, { "input": "Single AP portable radiograph through the chest demonstrates an enlarged heart. There is an opacity which appears to obscure the left heart border concerning for consolidation within the lingula of the left upper lobe. There is additional a pulmonary vascular congestion though no findings convincing of pulmonary edema. No large pleural effusion is identified. There is no pneumothorax. Visualized osseous structures demonstrates no acute abnormality.", "output": "Consolidation within the lingula of the left upper lobe thought reflective of infectious process in the correct clinical setting." }, { "input": "The prior left upper lobe lingular pneumonia has resolved. No new focal consolidation concerning for pneumonia. A right pleural plaque correlates with findings from the ___ CT chest and is likely due to prior right pleural injury or insult. Mild cardiomegaly is unchanged. No evidence of edema. No pneumothorax.", "output": "The left upper lobe/lingular pneumonia has resolved. No new focal consolidations." }, { "input": "Compared to the prior study, no definite interval change. Again seen is patchy opacity about the right lung base and minimal atelectasis at the left lung base. No pneumothorax is detected. Prominence of the mediastinum is similar to the prior film. No mediastinal emphysema is identified.", "output": "No definite change compared with ___ at 08:54. The cardiomediastinal contours are similar to the prior film. (Note is made that the report from a prior film noted that the paratracheal widening expanded postoperatively.)" }, { "input": "Prior VATS right wedge resection no pneumothorax or pleural effusions. Subsegmental atelectasis in the lower lobes has improved. No pulmonary edema no acute focal consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs demonstrate a left chest port with the catheter terminating in the low SVC. Heart size is borderline enlarged. Mildly tortuous aorta is demonstrated. Hilar contours and pulmonary vasculature are normal. The lungs are well expanded, without focal consolidation, pleural effusion, or pneumothorax. Other than clips projecting over the right upper quadrant, the visualized upper abdomen is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. There is slight increased opacity at the right lung base which could be due to atelectasis. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "Slight increase in right base opacity, likely atelectasis. However, in the appropriate clinical setting, early consolidation is not excluded." }, { "input": "Heart size is normal. Mediastinal and hilar contours are unremarkable. The pulmonary vasculature is not engorged. Lungs are hyperinflated without focal consolidation, pleural effusion or pneumothorax. Multiple remote right-sided rib fractures are re- demonstrated.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest. No prior. The lungs are clear of consolidation. There is no effusion or pneumothorax. The cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of chest demonstrate no evidence of pneumonia. In the lateral right apex, there may be a small amount of parenchymal scaring. The heart is of normal size. There is no pleural effusion, pneumothorax or pulmonary edema. No displaced fracture is seen.", "output": "Possible lateral right apex scarring. No acute findings to explain left sided chest pain." }, { "input": "Supine portable frontal chest radiograph shows a NG tube terminating a ___ portion of the duodenum. A right upper extremity PICC has been withdrawn in the interim, now terminating at the confluence of the right brachiocephalic vein and superior vena cava. The lung volumes remain low, which accentuates the bronchovascular structures. There is prominence of the central pulmonary vasculature. There is no pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal.", "output": "1. Satisfactory ET tube position. 2. Withdrawal of the right PICC to the junction of the right brachiocephalic vein and superior vena cava. These findings were discussed with Dr. ___ by Dr. ___ at 4:30 on ___." }, { "input": "Low lung volumes continue to be low with bilateral small pleural effusions. The heart size is upper limit of normal, and the previous mild pulmonary edema is improving. Lungs are clear of focal consolidation, and the ET tube is in appropriate position. Right IJ hemodialysis line ends in the right atrium near the tricuspid valve, and the left IJ central venous line ends at the cavoatrial junction. The feeding tube ends in the duodenum.", "output": "Mild pulmonary edema is improving with new small bilateral effusions compared to radiograph from ___." }, { "input": "Normal no radiopaque density overlying the chest to suggest a tooth aspiration. Lung volumes are low. The heart is upper limits normal in size. There is mild pulmonary vascular congestion which is increased compared to the prior study. The PICC line tip is at the junction of the right brachiocephalic vein and superior vena cava. Enteric tube has been removed.", "output": "no aspirated tooth" }, { "input": "Lung volumes are low. A right-sided hemodialysis catheter terminates deep in the right atrium. NG tube courses into the stomach. Cardiac size is stable. Previously waxing and waning edema is mild today in comparison to prior exams. There is no pleural effusion. There are no focal consolidations concerning for pneumonia.", "output": "No evidence of pneumonia. Mild pulmonary edema. Healing posterior left lower rib fracture." }, { "input": "There has been interval placement of the Dobbhoff tube with the tip terminating in the gastric body. There is otherwise no significant change compared to prior examination with redemonstration of poor inspiratory effort with low lung volumes, emphasizing vascular congestion and heart size. Bibasilar atelectasis is unchanged. There is no large effusion or pneumothorax. There is redemonstration of a right-sided PICC terminating into the upper-to-mid SVC.", "output": "Adequate positioning of Dobbhoff tube." }, { "input": "A single frontal portable radiograph of the chest was acquired. There are new bilateral moderate pleural effusions. Compressive bilateral lower lung atelectasis is greater on the left. Infection or aspiration in either lung base cannot be excluded. There is no pneumothorax. The heart is moderately enlarged. Aortic calcifications are seen. The mediastinal contours are normal. Surgical clips overlie the lateral aspect of the right hemithorax. Degenerative changes of the thoracolumbar spine are noted.", "output": "1. New bilateral moderate pleural effusions compared to prior radiograph from ___. 2. Bilateral lower lobe compressive atelectasis, left greater than right. Infection or aspiration pneumonitis at either lung base cannot be excluded." }, { "input": "Supine and portable AP view of the chest was provided. There has been interval intubation with tip of the endotracheal tube residing approximately 1 cm above the carina. Recommend at least 2 cm retraction. There has also been placement of an NG tube with its tip in the left upper quadrant, likely in the stomach. Otherwise no change.", "output": "Low lying ET tube, for which retraction by at least 2 cm is advised. NGT position in appropriate position." }, { "input": "Blunting of the right costophrenic angle appears unchanged compared to prior. There is increased density at the left costophrenic angle, which may represent pleural effusion. The lungs are hyperinflated with underlying emphysematous changes. Linear opacity in the left mid-lung likely represents atelectasis. Heart and mediastinal contours are stable with a densely calcified aorta. No pneumothorax is detected. Mitral annular calcification is seen.", "output": "Increased blunting of the left costophrenic angle, which may represent effusion or atelectasis." }, { "input": "There is blunting of the left costophrenic angle in the area of the prior pleural effusion. This may represent pleural thickening or a small chronic effusion. It is unchanged in appearance from the prior exam approximately one week prior. There is no right-sided pleural effusion. There is no consolidation, pulmonary edema, or pneumothorax. The cardiomediastinal silhouette is normal. Atherosclerotic calcifications are noted in the aortic arch. An irregular contour of the lateral border of the fifth left rib is noted. No definite fracture is identified. This irregularity is new since the prior exam on ___.", "output": "1. New lateral fifth left rib irregularity. Recommend further evaluation with dedicated rib radiographs. 2. Stable small left chronic pleural effusion or pleural thickening. Results were entered into the critical communications results dashboard on ___ by Dr. ___." }, { "input": "PA and lateral views of the chest are compared to previous exam from earlier the same day and from ___. Compared to prior, there is slight increased conspicuity of a vague opacity at the right costophrenic recess best seen on the frontal projection. This opacity may represent an early pneumonia. Tiny bilateral pleural effusions are also noted. Cardiac silhouette is stable as are the osseous and soft tissue structures. Atherosclerotic calcifications again noted throughout the aorta.", "output": "Possible early pneumonia in the right lateral lung base with tiny pleural effusions." }, { "input": "Chest PA and lateral radiograph demonstrates unremarkable mediastinal, hilar and cardiac contours. Lungs are clear. No pleural effusion or pneumothorax evident. Stable mild kyphosis of the thoracic spine with anterior osteophyte formation.", "output": "No acute cardiopulmonary process." }, { "input": "There are bilateral lower lobe opacities suggestive of pneumonia. Otherwise, blunting of the left hemidiaphragm is again noted likely present of either a chronic small pleural effusion or stable pleural thickening. There is no right pleural effusion. Cardiac silhouette remains stable. Atherosclerotic calcifications are again noted at the aortic arch. Old left-sided rib fractures are again noted.", "output": "Findings are suggestive of bilateral lower lobe pneumonia." }, { "input": "Single portable view of the chest. Somewhat ill-defined interstitial markings seen throughout the lungs. There is no confluent consolidation. Cardiac silhouette is enlarged but likely in part accentuated by technique. Atherosclerotic calcifications noted at the aortic arch. Left chest wall dual-lead pacing device is identified.", "output": "Increased markings throughout the lungs which could be chronic, although superimposed interstitial edema is also suspected." }, { "input": "Mild cardiomegaly is stable. Mediastinal and hilar contour is are also stable. There is no pleural effusion or pneumothorax. The lungs are expanded without focal consolidation concerning adenoma. Pulmonary vasculature is within normal limits. The upper abdomen is unremarkable. Dual lead pacemaker is noted with leads terminating in the right atrium and right ventricle as expected.", "output": "No acute cardiopulmonary process." }, { "input": "A 1.8 x 1.2 cm relatively nodular opacity is seen projecting over the right upper lung, worrisome for pulmonary lesion. Right middle lobe opacity is seen which may be due to atelectasis or consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable and stable.", "output": "1.8 x 1.2 cm right upper lung nodular opacity is new since the prior study and worrisome for pulmonary lesion. Recommend further evaluation with chest CT. Right middle lobe consolidation versus atelectasis." }, { "input": "PA and lateral chest radiograph demonstrates a triangular opacity on the lateral view which corresponds to an opacity projecting within the medial left lower lung zone. This appears more conspicuous relative to prior chest radiograph dated ___. This likely corresponds to region of bronchiectasis, mucoid impaction, and peribronchiolar nodules as described on CT dated ___. Nodular opacities are additionally present projecting over the right upper lobe additionally worrisome for airspace disease. Disease at the right cardiophrenic angle is also more conspicuous. Cardiomediastinal and hilar contours are within normal limits. Blunting of the left costophrenic angle may reflect a trace pleural effusion.", "output": "Opacities within the lingula and right lung base medially are more conspicuous relative to prior examination performed ___. Nodular opacities within the with right upper lobe are additionally noted as well. Findings together likely reflect bronchocentric abnormality, infectious or inflammatory, more conspicuous compared to yesterday's exam." }, { "input": "PA and lateral views of the chest. No prior. The lungs are clear of consolidation or effusion. The cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No radiographic evidence of active tuberculosis." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well-expanded clear lungs. The cardiomediastinal and hilar contours are unremarkable. No pneumothorax, consolidation, or pleural effusion.", "output": "No pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. There is subtle right upper lobe patchy opacity in one to two locations which could represent pneumonia. The left lung is clear. There is no pleural effusion or pneumothorax. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Subtle patchy opacities projecting over the right upper lung may raises concern for infection. Recommend followup to resolution." }, { "input": "Frontal and lateral views of the chest were obtained. Since the prior study, there has been interval resolution of previously seen bilateral pleural effusions. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac silhouette is top normal. The aorta is slightly tortuous. No overt pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Motion limits detailed evaluation. There is faint left basilar opacity potentially atelectasis. Elsewhere the lungs are grossly clear. The cardiomediastinal silhouette is stable. No acute osseous abnormalities.", "output": "Probable left basilar atelectasis. Otherwise, no definite acute cardiopulmonary process." }, { "input": "The patient is status post median sternotomy and CABG. There is mild enlargement of the cardiac silhouette, unchanged. Mediastinal and hilar contours are similar. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is present. Minimal atelectasis is demonstrated in the left lung base. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There is moderate cardiomegaly that is increased compared to prior and bilateral pleural effusions that are also larger. There is a right IJ line with tip in the upper SVC. There is volume loss in both lower lungs.", "output": "Worsened fluid status." }, { "input": "AP upright and lateral views the chest provided. Midline sternotomy wires and mediastinal clips are again noted. There is persists and atelectasis in the left lower lung. No convincing signs of pneumonia. No pleural effusion or pneumothorax. Cardiomediastinal silhouette appears stable. Bony structures are intact.", "output": "Persistent mild left basal atelectasis. No convincing signs of pneumonia." }, { "input": "AP upright and lateral views of the chest provided demonstrate no focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours are stable and normal. Bony structures are intact.", "output": "No acute findings in the chest." }, { "input": "Frontal and lateral views of the chest. The heart size and cardiomediastinal contours are normal. The lungs are clear without focal consolidation, pleural effusion, or pneumothorax.", "output": "Normal chest radiographs." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. The heart and mediastinal contours are normal. The imaged osseous structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest. Lower lung volumes are seen on the current exam and there is elevation of the right hemidiaphragm. Known posterior right 11th rib fracture is not seen on these plain films. There is no pneumothorax. Right basilar opacity suggestive of atelectasis. Cardiomediastinal silhouette is within normal limits.", "output": "Known posterior right 11th rib fracture not identified. No pneumothorax. No definite acute cardiopulmonary process." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unremarkable. Lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is identified. There are no acute osseous abnormalities. Marked degenerative changes of the left glenohumeral joint are visualized with subchondral cysts and sclerosis.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. Please note that tiny millimetric pulmonary nodules seen on prior CT are better assessed on CT.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are hyperinflated and grossly clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. Patient is slightly rotated to his left. Bilateral lower lobe airspace consolidation is concerning for pneumonia. No large effusion or pneumothorax. Cardiac silhouette appears mildly enlarged. Mediastinal contour is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "Bilateral lower lobe pneumonia." }, { "input": "Heart is upper limits of normal in size. The aorta is tortuous. Prominence of the central pulmonary artery suggests the possibility of pulmonary arterial hypertension. Lungs are clear, with the exception of minimal linear scar or atelectasis at the extreme bases. Lung volumes appear increased. No pleural effusion or acute skeletal findings.", "output": "1. Prominent central pulmonary vascularity suggesting possible pulmonary arterial hypertension. 2. No acute pulmonary abnormality." }, { "input": "AP and lateral views of the chest. The lungs are clear given low lung volumes with secondary crowding of the bronchovascular markings. There is no consolidation or effusion. Cardiomediastinal silhouette is stable as are the osseous and soft tissue structures.", "output": "No definite acute cardiopulmonary process given relatively low lung volumes." }, { "input": "Assessment is somewhat limited due to patient rotation and kyphosis. Lung volumes are low. Heart size is mildly enlarged. The aorta remains tortuous. Perihilar hazy opacities with vascular indistinctness is more pronounced on the right compared to the left, likely reflective of asymmetric mild to moderate pulmonary edema. No pneumothorax is demonstrated. Small right pleural effusion is likely present. No acute osseous abnormalities are seen.", "output": "Perihilar hazy opacities and vascular indistinctness, more pronounced on the right compared to the left likely reflects asymmetric mild to moderate pulmonary edema. Probable small right pleural effusion." }, { "input": "The lung volumes are low. There is interstitial prominence consistent with mild pulmonary edema. No pleural effusion is present. The cardiac silhouette is moderately enlarged. There is no consolidation or pneumothorax.", "output": "1. Mild pulmonary edema. 2. Moderate cardiomegaly." }, { "input": "There is stable enlargement of the cardiac silhouette. There has been interval removal of a right internal jugular central venous catheter. There are unchanged pleural effusions greater on the left than the right. Left lower lobe opacity is similar in appearance to prior. Median sternotomy wires are intact. No pulmonary edema or pneumothorax.", "output": "Stable appearance of the chest from ___ with persistent pleural effusions and left lower lobe opacification. While this likely reflects combination of atelectasis and effusion, superimposed infection is possible." }, { "input": "Portable AP semi-erect chest film ___ at 20:33 is submitted.", "output": "Interval extubation and removal of the nasogastric tube and mediastinal drain. The right internal jugular central line is unchanged in position. Stable postoperative cardiac and mediastinal contours status post median sternotomy for CABG. Layering left effusion with patchy retrocardiac opacity most likely reflecting atelectasis, although pneumonia or aspiration cannot be excluded. No pulmonary edema. No pneumothorax." }, { "input": "Heart size is normal. Calcifications are noted at the aortic knob. Cardiomediastinal silhouette and hilar contours are otherwise unremarkable. Lungs appear hyperexpanded with flattening of the diaphragm. Lungs are grossly clear. Pleural surfaces are clear without effusion or pneumothorax. Bones are diffusely demineralized with mild to moderate anterior wedging of multiple thoracic vertebral bodies.", "output": "1. No acute cardiopulmonary abnormality. Lungs are hyperexpanded. 2. Multiple mild to moderate anterior wedge compression deformities of the thoracic vertebral bodies, age indeterminate." }, { "input": "There is near complete opacification of the left hemithorax likely reflective of a combination of large pleural effusion and atelectasis. Heart size cannot be assessed due to the presence of the left hemithorax opacification. Dense atherosclerotic calcifications of the thoracic aorta are present. No pulmonary vascular congestion is seen. The right lung is grossly clear. No pneumothorax is noted. No acute osseous abnormalities are visualized.", "output": "Near-complete opacification of the left hemithorax likely due to a combination of a large left pleural effusion and atelectasis. CT of the chest is recommended to exclude an obstructing central endobronchial lesion." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are well expanded with persistent right lung opacities without evidence of worsening consolidation, pleural effusion, or lung collapse. Mediastinal contour, cardiac borders, and hila are stable.", "output": "Persistent right lung opacities without evidence of worsening infection. RECOMMENDATION(S): Repeat chest radiograph 6 weeks after treatment is recommended to ensure resolution. NOTIFICATION: The findings were discussed with ___, M.D. by ___ ___, M.D. on the telephone on ___ at 11:42 AM, 5 minutes after discovery of the findings." }, { "input": "Right upper, middle and lower lobe peribronchial wall thickening suggests bronchocentric abnormality. The bilateral hemidiaphragms, cardiac borders, and mediastinal silhouettes are normal. There is no pneumothorax or pleural effusion.", "output": "Multifocal broncoconcentric inflammation in the right lung could be caused by infection or primary airway reactivity, including allergic bronchopulmonary aspergillosis. RECOMMENDATION(S): Repeat chest radiographs in 6 weeks, sooner if symptoms do not resolve. NOTIFICATION: The findings were discussed with Dr. ___, M.D. by ___, M.D. on the telephone on ___ at 3:45 PM, 5 minutes after discovery of the findings. Pertinent critical findings and changes to the earlier version of this report were posted by Dr. ___ on ___ at 08:44 to the Department of Radiology online critical communications system for direct communication to the referring provider." }, { "input": "Endotracheal tube terminates approximately 5.8 cm above the level of the carina. A right-sided PICC terminates at the cavoatrial junction without evidence of pneumothorax. There are low lung volumes. No new focal consolidation is seen. There is no large pleural effusion. Prominence of the right hilum is grossly stable.", "output": "Endotracheal tube terminates 5.8 cm above the level of the carina. Right-sided PICC now terminates at the cavoatrial junction. No evidence of pneumothorax." }, { "input": "PA and lateral chest radiographs were provided. Multiple dense opacities throughout the lungs correspond to known pleural plaques. However compared to prior studies there appear to be more discrete opacities, particularly in the right lung. This may represent worsening of metastatic disease or infection. The bones are sclerotic compatible with known metastases. Sclerosis in the right humerus is again noted. The cardiomediastinal silhouette is normal. Wedging of multiple thoracic vertebral bodies may have progressed from the prior exam, although visualization is obscured by overlying opacities. There is no pneumothorax or pleural effusion.", "output": "1. Pulmonary opacities, corresponding to known calcified pleural plaques. 2. New opacities particularly in the right lung base may represent metastases versus infection. This can be further clarified by CT as indicated. 3. Diffuse bony metastases with possible new wedging of multiple thoracic vertebral bodies. , new since ___." }, { "input": "The heart is normal in size. The aorta arch is calcified. There is no pleural effusion or pneumothorax. The lungs appear clear.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The lungs are clear without focal consolidation, effusion, or edema. The cardiomediastinal silhouette is within normal limits. Atherosclerotic calcifications noted at the aortic arch. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are unremarkable. Atherosclerotic calcifications are noted of the aortic arch. The lungs are mildly hyperexpanded but clear. There is no definite pleural effusion or pneumothorax, though evaluation is limited on this supine examination.", "output": "No acute intrathoracic process." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are unremarkable. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral images of the chest were obtained. The patient is status post median sternotomy with multiple fractured wires, unchanged. Clips are located in the left thorax. Stable enlarged cardiac silhouette. The lung fields are clear without focal consolidation or pulmonary edema. Pleural thickening located in the left lateral pleura, especially inferiorly. There are no adjacent changes in the ribs. There are no bony abdnormalities. There is no free air below the right hemidiaphragm.", "output": "Pleural thickening of the left lateral pleura could represent a loculated effusion or prominent extrapleural fat. Stable enlarged cardiac silhouette." }, { "input": "The patient is status post median sternotomy and CABG. Heart size is normal. An epicardial lead is noted on the lateral view. Mediastinal and hilar contours are unremarkable. Lung volumes are somewhat low with minimal atelectasis noted within the left lung base. No focal consolidation, pleural effusion or pneumothorax is present. The pulmonary vasculature is normal. Multilevel degenerative changes are seen in the thoracic spine.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiac, mediastinal and hilar contours appears unchanged. There is no pleural effusion or pneumothorax. Parenchymal abnormalities appear unchanged and reflect emphysema with mild accompanying interstitial disease. Subpleural scarring and a small hyperdense nodules at the right lung apex appear unchanged. Scarring and bullous changes are also stable at the base of the left chest. The chest is hyperinflated. There has been no significant change.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "There is mild interstitial edema, and the heart is normal in size. A left basilar opacity may reflect atelectasis versus pneumonia. There is no pleural effusion or pneumothorax.", "output": "Mild interstitial edema. Left basilar opacity may reflect atelectasis though infection can be considered in the appropriate clinical setting." }, { "input": "Parenchymal abnormality including emphysema with mild interstitial disease appears stable. There is mild pulmonary vascular congestion and interstitial edema. Scarring at the left lung base also unchanged. No pleural effusion or pneumothorax. Mild cardiomegaly is noted. The aortic knob is calcified.", "output": "Emphysema with mild congestion and edema. Bibasal atelectasis, mild cardiomegaly." }, { "input": "Frontal and lateral views of the chest show no acute intrathoracic process. Flattened diaphragms and pulmonary blebs are consistent with obstructive lung disease. The mediastinum and pleural structures are unremarkable. Calcifications are seen within the aortic arch. The shoulders are not fully evaluated, however, there are no suspicious osseous lesions. Degenerative changes are seen within the thoracic spine.", "output": "No acute intrathoracic process." }, { "input": "There are no lung opacities concerning for pneumonia. Both pleural spaces are normal. Heart size is normal, mediastinal and hilar contours are unremarkable.", "output": "No pneumonia." }, { "input": "PA and lateral chest radiograph demonstrates an airspace opacity within the right upper lobe marginated by the minor fissure. The left lung field is clear. There is no pleural effusion or pneumothorax. Heart size is normal. There is no evidence of pulmonary edema.", "output": "Right upper lobe pneumonia." }, { "input": "Heart size and cardiomediastinal contours are normal. Multiple small pulmonary nodules, right base subpleural atelectasis, and central bronchial wall thickening seen on the same-day chest CT are not well appreciated on this radiograph. No focal consolidation, pleural effusion, or pneumothorax. Congenital coalition of the right first and second ribs is incidentally noted.", "output": "No focal consolidation. Pulmonary nodules and bronchial wall thickening are better demonstrated on the same-day chest CT." }, { "input": "There is no appreciable pneumothorax. A right IJ central venous catheter terminates in the upper right atrium. An endotracheal tube terminates at the level of the thoracic inlet, and may be advanced by 2-3 cm for more optimal ventilation. A nasogastric tube enters the stomach, tip not visualized. Small layering pleural effusions with bibasilar subsegmental atelectasis are unchanged. The heart and mediastinum are within normal limits despite the projection. A third radiopaque tube projects over the add line cervical soft tissues, terminates at the level of the first rib. If there is a second intended device, it ends in the neck.", "output": "Stable small bilateral layering pleural effusions with bibasilar subsegmental atelectasis. Slightly high-riding ET tube may be advanced by 2-3 cm for more optimal ventilation. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 11:42 AM, 10 minutes after discovery of the findings." }, { "input": "There is no new focal consolidation. Small bilateral pleural effusions are present. The nodules seen on recent chest CT are not well visualized by radiograph. There is no pneumothorax. The heart and mediastinum are within normal limits. Regional bones and soft tissues are unremarkable.", "output": "No new consolidation. Small bilateral pleural effusions. Small pulmonary nodules are not well seen radiographically." }, { "input": "AP upright and lateral views of the chest provided. Patient's known pulmonary nodules are better assessed on recent CT of the chest. There is increased opacity in the right lower lung which could reflect atelectasis versus pneumonia. There is also increasing retrocardiac opacity suggesting left lower lobe atelectasis versus pneumonia. Tiny pleural effusions are likely present. Cardiac silhouette is unchanged. Mediastinal contour is normal. Bony structures are intact.", "output": "Increased opacities in the lower lungs concerning for atelectasis versus pneumonia. Pulmonary nodules better assessed on prior CT. Probable tiny pleural effusions." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided demonstrating no focal consolidation, effusion, or pneumothorax. The heart size is normal. Mediastinal contour is unremarkable. The imaged osseous structures are intact. There is no free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Lung volumes are low. This accentuates the size of cardiac silhouette which is mildly enlarged. The aorta is slightly tortuous. Crowding of bronchovascular structures is present without overt pulmonary edema. Streaky and linear opacities in the lung bases likely reflect areas of atelectasis. No pleural effusion or pneumothorax is present. There are moderate degenerative changes noted in the lower thoracic spine.", "output": "Low lung volumes with probable bibasilar atelectasis." }, { "input": "The cardiomediastinal and hilar contours are normal. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. Small hiatal hernia is re- demonstrated. The mediastinal and hilar contours are otherwise unremarkable. Pulmonary vasculature is normal. Extensive bronchiectasis is re- demonstrated predominantly involving both lung bases with bronchial wall thickening and mucous plugging. No pleural effusion or pneumothorax is present. Scarring is noted at the lung apices. No acute osseous abnormalities present.", "output": "Extensive bibasilar bronchiectasis with mucous plugging. Superimposed infection is difficult to exclude." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and radiographs of the chest demonstrate normal heart size. The mediastinal silhouette and hilar contours are normal. The lungs are clear. No pleural effusion or pneumothorax. Calcified right apical pleural plaque is unchanged. Unchanged dextroscoliosis of the thoracic spine.", "output": "No pneumonia." }, { "input": "Two PA and 1 lateral chest radiograph were obtained. The lungs are well expanded and clear. There is no focal consolidation, effusion or pneumothorax. Calcified right apical pleural plaques are again seen. Cardiac and mediastinal contours are normal. Convex right scoliosis is unchanged.", "output": "No acute cardiopulmonary process." }, { "input": "As compared to prior chest radiograph from ___, there has been no significant change. Lung volumes remain low. There is no evidence of pneumonia, pleural effusions, pulmonary edema or pneumothorax. Cardiomediastinal and hilar contours are within normal limits. An orogastric tube terminates in the stomach and the side port is seen below the GE junction. Scoliosis is unchanged.", "output": "Stable chest radiograph with no evidence of pneumonia." }, { "input": "There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest demonstrate normal lung volumes without pleural effusion, focal consolidation, or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. There is no pulmonary edema. Partially imaged upper abdomen is unremarkable.", "output": "Normal cardiac size without evidence of acute cardiopulmonary process." }, { "input": "The lungs are clear. There is no pneumothorax. The heart and mediastinum are within normal limits. Regional bones and soft tissues are unremarkable.", "output": "Clear lungs with no evidence of pneumonia." }, { "input": "PA and lateral views of the chest were obtained demonstrating clear well-expanded lungs without focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. There is no free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest were provided. The lungs are hyperinflated but clear bilaterally. The heart is mildly enlarged. The mediastinal contour is stable with atherosclerotic calcifications involving the thoracic aorta. A tiny clip is positioned in the left axilla. A left breast shadow is absent. The bony structures appear intact. A subtle chronic deformity of the right eighth posterolateral rib arch is noted. Eventration of the right hemidiaphragm is noted.", "output": "Hyperinflated lungs without signs of pneumonia or CHF. Mild cardiomegaly." }, { "input": "There is no evidence of focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits. A rounded density in the superior portion of the left lower lobe correlates with a calcified granulomas seen on recent CT. A right-sided Port-A-Cath is noted with the tip terminating in the right atrium.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low which leads to bronchovascular crowding. There is bibasilar atelectasis without focal consolidation. The cardiac silhouette mildly enlarged. There is no pleural effusion or pneumothorax.", "output": "1. Bibasilar atelectasis without focal consolidation. 2. Mild cardiomegaly." }, { "input": "PA and lateral views of the chest provided. Compared to ___, right pleural effusion has resolved. Left pleural thickening is chronic. Severe cardiomegaly is chronic. Equivocal pericardial effusion. Left central venous dialysis catheter terminates in the right atrium. No pulmonary edema. No pneumothorax.", "output": "Resolved right pleural effusion. Equivocal pericardial effusion." }, { "input": "Right-sided dual lumen central venous catheter tip terminates in the proximal right atrium, unchanged. The cardiac, mediastinal and hilar contours are unchanged and within normal limits. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are visualized. No subdiaphragmatic free air is seen.", "output": "No acute cardiopulmonary abnormality. No subdiaphragmatic free air is visualized." }, { "input": "Since ___, interval removal of right chest tube is seen with a new small right apical pneumothorax measuring 1.6 cm below the lung apex and residual opacity projecting over the right lung base possibly representing combination of atelectasis and small pleural effusion. The left lung is clear. Unchanged positioning of hemodialysis catheter. Stable moderate to severe cardiomegaly.", "output": "Interval removal of right chest tube with new small right apical pneumothorax and residual opacity projecting over the right lung base, possibly representing a combination of atelectasis and small pleural effusions, since ___." }, { "input": "PA and lateral chest radiograph demonstrates a left chest port, 2 leads which project over the anticipated location of the right atrium and just below the superior cavoatrial junction. There is a moderate-sized right pleural effusion which obscures the right heart border. The left lung appears grossly clear, streaky opacity at the left lung base thought likely atelectatic. There is no evidence of pulmonary edema. There is no pneumothorax.", "output": "New relative to prior examination dated ___ is a moderate to large-sized right pleural effusion which obscures the right heart border. No focal opacity convincing for pneumonia." }, { "input": "Since earlier same day chest radiograph, the right pigtail catheter appears kinked in position. No interval changes are seen in the lungs. No pneumothorax, pneumonia, or pulmonary edema. The heart continues to be enlarged. Positioning of left dialysis catheter is unchanged.", "output": "1. Since earlier same day chest radiograph, the right pigtail catheter appears kinked in position. Otherwise, no interval changes are seen. NOTIFICATION: The findings were discussed by Dr. ___ with ___ Intern ___ on the telephoneon ___ at 4:50 PM, 1 minutes after discovery of the findings." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Despite the history of 2 L of fluid being removed, there is still a moderate-sized right pleural effusion that is only slightly smaller compared to prior. There continues to be compressive changes at the right base. There continues to be retrocardiac opacity. There is mild pulmonary vascular redistribution. There is no pneumothorax. .", "output": "No change." }, { "input": "Single AP upright portable view of the chest was obtained. The cardiac silhouette remains mildly enlarged. Mediastinal contours are stable, as are hilar contours. No focal consolidation, pleural effusion or evidence of pneumothorax is seen. There is no overt pulmonary edema. Costochondral calcifications are seen.", "output": "Persistent mild enlargement of the cardiac silhouette. No overt pulmonary edema." }, { "input": "Right PICC tip terminates in the upper SVC. Cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Right PICC tip in the upper SVC. No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Left-sided Port-A-Cath tip terminates in the mid SVC. Cardiac silhouette size is normal. Mediastinal and hilar contours are unremarkable. Lungs are hyperinflated with mild emphysema re- demonstrated. Right apical patchy opacity with calcifications is grossly unchanged. Remainder of the lungs are clear. No focal consolidation, pleural effusion or pneumothorax is present. Percutaneous biliary catheter is seen within the upper abdomen.", "output": "No acute cardiopulmonary abnormality. Grossly unchanged appearance of right apical patchy opacity with calcifications, better assessed on previous chest CT." }, { "input": "Left-sided Port-A-Cath terminates in the low SVC without evidence of pneumothorax.Chronic right upper lobe opacity corresponds to partially calcified opacity seen on chest CT from ___ No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. The tubular structure projects over the upper abdomen, partially imaged", "output": "No acute cardiopulmonary process. Again seen right apical opacity better assessed on prior chest CT." }, { "input": "The left lung base is densely opacified by a combination of pleural effusion and lower lobe collapse. Heterogeneous density in the right lower hemithorax is also likely a combination of pleural effusion and atelectasis. A large area of vaguely increased radiodensity in the right upper lobe is probably consolidation. Heart size is top-normal. There is no pneumothorax.", "output": "1. Left pleural effusion and lower lobe collapse. Smaller right pleural effusion and less severe atelectasis. 2. Right upper pneumonia." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There are moderate bilateral pleural effusions with volume loss/infiltrate in both lower lungs. There is mild pulmonary vascular redistribution. The heart size is mildly enlarged. The aorta is calcified and tortuous. Spine demonstrates a mild scoliosis and degenerative changes.", "output": "CHF. An underlying infectious infiltrate cannot be excluded." }, { "input": "Portable chest radiograph demonstrates interval development of moderate pulmonary edema as demonstrated by increased interstitial fluid and central vascular congestion. Mild cardiomegaly is unchanged. Small bilateral pleural effusions are increased in size. There is no pneumothorax. An old left healed clavicular fracture is once again identified.", "output": "Interval development of moderate pulmonary edema." }, { "input": "Portable chest radiograph demonstrates improved vascular plethora and decreased interstitial fluid consistent with overall improved pulmonary edema. Bilateral small pleural effusions are mildly increased in size. Mild cardiomegaly is unchanged. The right minimally enlarged hila is unchanged. Redemonstration of old left healed clavicular fracture.", "output": "Improved pulmonary edema with stable mild cardiomegaly." }, { "input": "There is stable mild enlargement of the cardiac silhouette. The mediastinal silhouette is within normal limits. The trachea is midline. Aortic arch calcifications are noted. Linear opacities in the left lung likely reflect post treatment lung parenchymal changes, as seen on prior exams. Linear opacities within the right lower lung likely reflect minimal atelectasis. There is no focal lung consolidation or pulmonary vascular congestion. There is no pleural effusion. There is no pneumothorax. There is mild anterior wedging of a lower thoracic vertebral body, grossly unchanged from prior CT.", "output": "No acute cardiopulmonary process." }, { "input": "Moderate cardiomegaly is stable since ___. Mediastinal widening is likely due to lipomatosis. There is no pulmonary edema. There has been interval improvement of the pre-existing opacities at the right lung base. The small right pleural effusion is stable. Mild left lung base atelectasis and a small left pleural effusion persist. There is no pneumothorax. There has been interval removal of a right-sided IJ.", "output": "Interval improvement of the pre-existing right lung base pneumonia." }, { "input": "PA and lateral chest radiographs were provided. Compared to the most recent prior radiograph there is no significant change. Patient is rotated. There is subtle opacity at the right lung base which is most likely scarring. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is stable.", "output": "No significant change from prior study." }, { "input": "Frontal and lateral chest radiographs demonstrate a normal cardiomediastinal silhouette. A focal opacity over the right heart border, unchanged over time, likely represents focal scarring. A posterior round opacity seen on lateral view is not localized on frontal view. There is no pleural effusion or pneumothorax.", "output": "Focal opacity seen posteriorly on lateral view is not localized on frontal view. CT chest would be necessary to exclude malignancy. These findings were entered onto the critical communications dashboard at ___ on ___." }, { "input": "PA and lateral views of the chest were obtained demonstrating clear, well-expanded lungs without focal consolidation, effusion or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Heart size is normal. Mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. Cervical spinal fusion hardware is incompletely assessed. A gastric band is noted within the left upper quadrant of the abdomen as well as clips in the right upper quadrant of the abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The previously noted linear opacities in the bases bilaterally have improved. There are no other new opacities. Heart size is stable. The mediastinal and hilar contours are stable. The pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "Improvement in prior linear opacities in the bases bilaterally, with almost complete resolution." }, { "input": "PA and lateral views of the chest ___ at 18 49 are submitted.", "output": "Faint predominantly linear opacities in the right upper lobe and in both lower lobes, right greater than left, are seen suggestive of an atypical infectious process, especially when correlated with the recent chest CT. Clinical correlation is recommended. Overall cardiac and mediastinal contours are stable. No pneumothorax. No large effusions." }, { "input": "Lung volumes are low, but lungs are otherwise clear without focal consolidation, pleural effusion, or pneumothorax. Cardiomediastinal and hilar contours are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest. Left-sided AICD device is seen with leads in the expected position of the right atrium and right ventricle. There are bibasilar effusions, left greater than right, both of which have slightly increased in size compared to prior study. There is bibasilar atelectasis. The upper lung zones are clear. The cardiac, mediastinal and hilar contours are stable.", "output": "Slight increase in bibasilar effusions, left greater than right, compared to study on ___." }, { "input": "The aortic contour and calcification pattern appears similar compared to prior studies. Descending thoracic aortic contour also appears similar to prior studies, but is obscured inferiorly by adjacent lung and pleural abnormalities. Cardiac silhouette remains enlarged, and is accompanied by upper zone vascular redistribution. Small-to-moderate bilateral pleural effusions are present as well as adjacent basilar atelectasis and/or consolidation, worse on the right than the left. ICD pacing device remains in place with leads in the right atrium and right ventricle.", "output": "No portable chest radiographic findings to suggest aortic dissection, but the sensitivity of this study is low for detecting this diagnosis. If there is clinical suspicion for acute aortic dissection, a CT angiogram would be recommended." }, { "input": "There is a dual-lead pacemaker/ICD device, which is in an unchanged position. The heart is mild-to-moderately enlarged but not well visualized. The mediastinal and hilar contours appear unchanged. There has been partial clearing of left basilar opacity that may have represented atelectasis but with persistent pleural effusions that are similar to perhaps minimally increased with suggestion of loculated components. Elsewhere, the lungs appear clear. The bony structures are unremarkable.", "output": "Moderate bilateral pleural effusions with associated opacities likely attributable to atelectasis, perhaps with minimal increase in pleural effusions. Similar cardiomegaly." }, { "input": "PA and lateral views of the chest are compared to previous exam from ___. Compared to prior, there has been no significant interval change. Again seen are moderate bilateral pleural effusions. Linear opacity also seen at the right lung base, unchanged, potentially due to atelectasis. Superiorly, the lungs are clear without significant pulmonary vascular congestion. Cardiomediastinal silhouette is stable as are the osseous and soft tissues.", "output": "No significant interval change. Persistent moderate bilateral pleural effusions." }, { "input": "PA and lateral views of the chest. The lungs are clear. There is no consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright and lateral chest radiograph demonstrates clear lungs bilaterally. Cardiomediastinal and hilar contours are within normal limits. There is no pleural effusion or pneumothorax. Osseous structures are without an acute abnormality.", "output": "No acute intrathoracic abnormality." }, { "input": "PA and lateral views of the chest were obtained demonstrating clear well-expanded lungs. No focal consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Hyperinflated lungs without acute intrathoracic process." }, { "input": "The lungs are clear without consolidation, effusion, or pneumothorax. Nodular opacity projecting over the right lung base is most suggestive of a nipple shadow. Right chest wall central venous catheter seen with tip at the RA SVC junction. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. Chronic changes seen at the distal left clavicle.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral chest radiographs were obtained. The tip of the right chest Port-a-Cath terminates in the mid SVC. There is no evidence of catheter fracture or complications. The right hilar enlargement is consistent with known mass seen on previous CT scan. There are multiple bilateral, ill-defined nodules, consistent with known metastatic disease, better characterized on recent CT. Heart size is normal. There is no pleural effusion or pneumothorax.", "output": "1. Right chest Port-A-Cath terminates in the mid SVC without complications. 2. Right hilar mass and multiple bilateral lung nodules consistent with known metastatic disease." }, { "input": "Frontal and lateral radiographs of the chest demonstrate well expanded, clear lungs. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation. Again seen is an old healed left lateral ninth rib fracture.", "output": "No acute cardiopulmonary process." }, { "input": "A portable frontal chest radiograph demonstrates a normal cardiomediastinal silhouette and hyperinflated lungs compatible with emphysema. No focal consolidation, pleural effusion, or pneumothorax. No displaced rib fracture is identified. The visualized upper abdomen is unremarkable.", "output": "1. No displaced rib fracture identified. If there is continued concern, dedicated rib radiographs can be obtained. 2. Hyperinflated lungs, consistent with known emphysema." }, { "input": "The lungs are clear. Nodular opacities projecting over the the mid lungs bilaterally are most compatible with nipple shadows. Cardiomediastinal silhouette is within normal limits. Coronary artery stent is identified. Atherosclerotic calcifications noted at the aortic arch. No displaced fractures identified.", "output": "No acute cardiopulmonary process." }, { "input": "AP portable upright view of the chest provided. The bilateral pulmonary hila appear symmetrically prominent which is of unclear etiology though could reflect the presence of lymphadenopathy. Consider dedicated PA and lateral views to further assess. Aside from this, the lungs are clear. The heart size is normal. Mediastinal contour is stable. No pneumothorax or effusion is seen. Bony structures are intact.", "output": "Bilateral hilar prominence which could be better assessed with a dedicated PA and lateral view of the chest. Otherwise, unremarkable." }, { "input": "Cardiomediastinal and hilar contours are within normal limits. No focal consolidation concerning for pneumonia is seen. There is no pneumothorax. Visualized osseous structures demonstrates no acute abnormality.", "output": "No evidence of aspiration or pneumonia." }, { "input": "The tip of the endotracheal tube is approximately 3 cm from the carina. The enteric tube courses beyond the diaphragm, terminating in the left upper quadrant, likely in the region of the stomach. The lungs are relatively well inflated with obscuration of the costophrenic angles bilaterally, likely a combination of pleural fluid and atelectasis. Heart size is within normal limits and the cardiomediastinal contour is normal. Exuberant costochondral calcifications are noted bilaterally.", "output": "Satisfactory position of endotracheal and enteric tubes." }, { "input": "All monitoring devices and tube have been removed The cardiovascular silhouette is still enlarged, but unchanged A minimal layer of pneumothorax on the left apex, without mediastinal shift", "output": "Minimal pneumothorax in the left apex without mediastinal shift" }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes. The right lung base opacity is new since prior. No pleural effusion is seen. Mild vascular congestion is new. Hilar and mediastinal silhouettes are unchanged. The heart is mildly enlarged. The left lung is essentially clear. There is no pneumothorax or pleural effusion. The patient is status post median sternotomy. Right ventricular pacer lead is in unchanged position.", "output": "Probable RLL pneumonia. New borderline cardiac decompensation." }, { "input": "PA and lateral radiographs demonstrate mild pulmonary edema. The lungs are otherwise clear. The hila and cardiomediastinal contours are normal. There is no pneumothorax or pleural effusion. Sternotomy wires are present. The ___ wire from the top is fractured. The implantable AICD is unchanged in position and the leads are intact.", "output": "Mild pulmonary edema. No evidence of pneumonia." }, { "input": "There has been interval increase in right lung base opacity. In addition, diffuse increase in interstitial markings bilaterally suggests mild interstitial edema. Cardiomediastinal silhouette is stable. There is no pleural effusion or pneumothorax. Sternotomy wires are intact. An ICD monitor is seen overlying the left hemithorax, with a single lead ending in unchanged position in the inferior wall of the heart.", "output": "Mild interstitial pulmonary edema. Relative increase in opacity at the right lung base could be due to underlying infection/pneumonia or relate to assymetric fluid overload." }, { "input": "The lungs are well inflated with mild vascular congestion. No focal opacity. No pleural effusion or pneumothorax. Heart size, mediastinal contour, and hila are unremarkable. A right PICC tip is in the low SVC. Limited assessment of the osseous structures are notable for mild multilevel degenerative changes of thoracolumbar spine.", "output": "1. Right PICC tip in low SVC. 2. Mild vascular congestion." }, { "input": "Right PICC terminates at mid SVC. Lung volume remains low. Extensive airspace opacities in bilateral lungs are less compared to 1 day ago. Cardiomediastinal silhouette is stable. There is possible small right pleural effusion.", "output": "Extensive airspace opacity is less than 1 day ago, likely reflecting improved pulmonary edema in setting of multifocal pneumonia." }, { "input": "Extensive diffuse airspace opacities are slightly worse than on ___, progressively worsening since ___, accentuated by lower lung volumes. A right PICC terminates in the mid SVC, unchanged. No pneumothorax. Stable mild cardiomegaly. No larger pleural effusions.", "output": "Slightly worse extensive airspace opacities since ___, progressively worsening since ___, concerning for multifocal infection or severe pulmonary edema." }, { "input": "Single supine AP portable view of the chest was obtained. A right internal jugular central venous catheter is seen terminating in the low SVC without evidence of pneumothorax. There are prominent right greater than left perihilar opacities. No large pleural effusion is seen, although a trace right pleural effusion would be difficult to exclude. Cardiac silhouette is top normal. Mediastinal contours are unremarkable.", "output": "1. Right internal jugular central venous catheter terminates in the low SVC without evidence of pneumothorax. 2. Right greater than left perihilar opacities may be due to infection vs asymmetric pulmonary edema, other alveolar process not excluded." }, { "input": "A rounded retrocardiac opacity is not well seen on the AP view but likely reflects a hiatus hernia. This would be an atypical appearance for pneumonia but further characterization with CT may be helpful. The cardiomediastinal contour is otherwise normal. There is no pneumothorax or pleural effusion. Borderline loss of vertebral body height in 2 of the mid thoracic vertebrae are likely within the range for normal.", "output": "A rounded retrocardiac opacity has somewhat distinct borders and may represent a hiatus hernia or an atypical appearance for pneumonia, however a more focal lesion cannot be excluded. CT chest may be helpful to clarify, alternatively followup with repeat chest radiograph in ___ weeks following completion of treatment to re-evaluate would be recommended." }, { "input": "Lung volumes remain low, slightly worse from the prior exam. Opacification in the right lung base with increased rightward shift of the mediastinum loss of the right hemidiaphragm and right heart border interval increase in atelectasis as well as a moderate right pleural effusion that has progressed despite the presence of a drain projecting over the right hemithorax. Small left pleural effusion and is overall unchanged. Unchanged retrocardiac opacity. Moderate edema is worse from the prior exam. A left PICC line is appropriately placed.", "output": "Progressive edema and re-accumulation of right pleural effusion despite drain, now moderate in size." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Tracheostomy and enteric tubes are unchanged. Left PICC line appears to have been advanced, which may be a function of arm position, now terminating in the right atrium. Lung volumes are low with obscuration of the lung bases bilaterally, a combination of pleural effusion and atelectasis. Heart size is similar. There is new pulmonary vascular congestion and moderate interstitial edema.", "output": "Pulmonary vascular congestion and interstitial edema has increased, as have apparent bilateral pleural effusions, however this may be secondary to supine positioning." }, { "input": "Left-sided Port-A-Cath terminates in the mid SVC. Low lung volumes persist. There are seen small bilateral pleural effusions with overlying atelectasis. Mild central pulmonary vascular engorgement is seen. The cardiac and mediastinal silhouettes are stable.", "output": "Low lung volumes and small bilateral pleural effusions with overlying atelectasis. Central pulmonary vascular engorgement." }, { "input": "An ET tube is present -- the tip lies approximately 5.9 cm above the carina and lies at the level of the clavicular heads. The tip of a left subclavian line overlies the distal SVC. No pneumothorax detected. There are bilateral effusions, with underlying collapse and/or consolidation. There is upper zone redistribution and diffuse vascular blurring, consistent with CHF. The cardiomediastinal silhouette, including prominence of the SVC, is enlarged, but unchanged. Compared with ___ at 05:42, the CHF findings may be slightly worse, but the appearance is otherwise unchanged.", "output": "CHF, with bibasilar effusions and underlying collapse and/or consolidation. The possibility of an underlying infectious infiltrate cannot be excluded. The appearance is overall similar to 1 day earlier, but the CHF findings could be slightly worse." }, { "input": "Tracheostomy tube appears midline and intact. Enteric tube traverses the diaphragm. Right PICC line ends in the low SVC, unchanged. Pigtail catheter projects over the right lower hemithorax and appears intact but its orientation has changed. Lung volumes remain low, but slightly improved from the prior exam. The right pleural effusion has slightly decreased in size, now small. Left pleural effusion, if present, is small. No pneumothorax.", "output": "1. Minimal interval improvement in aeration and decrease in size of small right pleural effusion. 2. Interval change in orientation of right pigtail catheter - correlate with clinical assessment." }, { "input": "The tube overlying the upper mediastinum raises the question of interval placement of a tracheostomy tube. Linear density over the mediastinum in the midline likely represents an NG tube. On today's study, due to underpenetration, this is traced only to the level of the diaphragm. It may very well course beyond that, but be obscured by underpenetration. A left subclavian central line and right subclavian PICC line are again noted. The tips are not well delineated in a partially obscured by the overlying right pleural drain, but both appear to lie in the region of the SVC/RA junction. No pneumothorax is detected. Again seen are low inspiratory volumes, stable prominence the cardiomediastinal silhouette, CHF, moderate bilateral pleural effusions each with underlying collapse and/or consolidation, all similar to the prior study. Again seen is tubing in the region the right hilum, apparently a right-sided drain.", "output": "Question interval placement of tracheostomy tube. Otherwise, overall similar to the prior study. Please note that on today's exam, likely due to underpenetration, the NG tube cannot be traced beyond the level of the diaphragm." }, { "input": "As compared to chest radiograph from earlier today, interval thoracentesis with significant decrease an left-sided effusion which is now small to moderate. No pneumothorax. Very low lung volumes with increasing bibasilar opacities likely atelectasis. Small right sided effusion. Right-sided port terminates near the cavoatrial junction.", "output": "No pneumothorax, interval decrease and left-sided pleural effusion." }, { "input": "Left-sided Port-A-Cath tip terminates in the SVC. Right-sided dual-lumen pacemaker device is again noted with leads terminating in the regions of the right atrium and right ventricle. Moderate cardiomegaly has decreased in size compared to the prior study. Similarly, widening of the mediastinal contour has also improved, with continued but improved mild to moderate pulmonary edema. Moderate, multiloculated left pleural effusion has slightly decreased in size with unchanged trace right pleural effusion. Thickened irregular pleural thickening is also noted bilaterally, as seen previously. Patchy left basilar opacity likely reflects compressive atelectasis, however infection cannot be completely excluded. No pneumothorax is present. Compression deformities within the lower thoracic spine with associated kyphosis are unchanged.", "output": "Persistent moderate multiloculated left pleural effusion, but decreased in size from the previous study. Unchanged small right pleural effusion and diffuse irregular pleural thickening. Interval improvement in pulmonary edema, now mild to moderate in extent. Left basilar patchy opacity may reflect compressive atelectasis however infection is difficult to exclude in the correct clinical setting." }, { "input": "Lung volumes remain low. A left subclavian central venous catheter terminates in the mid to the low SVC. The endotracheal tube terminates at the level of the clavicles. A nasogastric tube can be traced to the lower esophagus. Moderate pleural effusions with bibasilar subsegmental atelectasis are unchanged. Mild pulmonary edema is unchanged. The heart and mediastinum cannot be accurately assessed.", "output": "No significant interval change. Nasogastric tube can only be traced to the lower esophagus. A repeat frontal radiograph with attention to optimal positioning is suggested if the tip location is in question." }, { "input": "Lung volumes are low secondary crowding of the bronchovascular markings. Superimposed mild pulmonary edema is also possible. Blunting of the left lateral costophrenic angle suggests an effusion. There may also be a small right pleural effusion as well. Left chest wall Port-A-Cath is again noted, catheter tip not clearly delineated but likely in the region of the RA SVC junction.", "output": "Low lung volumes and probable bilateral effusions, left larger than right. Superimposed mild edema is also possible." }, { "input": "An enteric tube terminates in the proximal stomach and could be advanced for appropriate placement. Lungs are markedly low which accentuates bronchovascular markings. Given that, the cardiac silhouette is enlarged. No focal consolidation or pleural effusion. No pneumothorax. There is mild pulmonary vascular engorgement and mild pulmonary edema.", "output": "Exam limited by technique. Markedly low lung volumes mild pulmonary edema. Enteric tube terminates in the proximal stomach and could be advanced 5-6 cm for appropriate positioning." }, { "input": "Compared with earlier the same day, CHF findings may be very slightly improved. Otherwise, no significant change is detected. No pneumothorax identified.", "output": "As above." }, { "input": "A portable frontal chest radiograph demonstrates an enteric tube, with the tip in the stomach. The heart remains mildly enlarged, with decrease in mediastinal caliber. The lungs are moderately inflated. There is no focal consolidation, pulmonary edema, or pneumothorax. The left pleural effusion seen on prior chest radiographs is improved, with only a trace amount of pleural fluid, if any. The visualized upper abdomen is unremarkable.", "output": "1. Interval decrease in a left pleural effusion, with trace pleural fluid, if any. 2. Improvement of pulmonary edema and mediastinal vascular engorgement. NOTIFICATION: ." }, { "input": "The lungs are clear. There is no pleural effusion, pneumothorax or focal airspace consolidation. The cardiac and mediastinal contours are normal. The pulmonary vascularity is normal. The hilar structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Cardiomediastinal silhouette is within normal limits. Lungs are clear. There is no pleural effusion or pneumothorax. Bones and the upper abdomen are grossly unremarkable.", "output": "No evidence of pneumonia." }, { "input": "There is a slightly suboptimal and inspiratory effort leading to crowding of the pulmonary bronchovascular structures. No consolidation, pneumothorax or pleural effusion seen. The visualized bony structures are unremarkable in appearance.", "output": "No acute cardiopulmonary process seen." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable. No overt pulmonary edema is seen. There is no displaced fracture.", "output": "No acute cardiopulmonary process." }, { "input": "Portable AP upright chest radiograph obtained. There is bibasilar opacity, likely atelectasis, though a component of aspiration not excluded. No large effusion or pneumothorax. Cardiomediastinal silhouette appears grossly unremarkable aside from an unfolded partially calcified thoracic aorta. No definite bony injuries are seen.", "output": "Bibasilar atelectasis, possible mild aspiration. Otherwise, no acute findings." }, { "input": "Heart size is borderline enlarged. The aorta remains tortuous and diffusely calcified. The hilar contours are stable. Crowding of the bronchovascular structures is likely attributable to low lung volumes. No overt pulmonary edema is seen. Streaky bibasilar airspace opacities are more pronounced on the left rather than right, and may be slightly improved compared to the prior study. No pleural effusion or pneumothorax is demonstrated, and there are no displaced fractures noted.", "output": "Bibasilar airspace opacities most likely reflective of atelectasis though aspiration is not excluded. Overall, the aeration of the lung bases is slightly improved compared to the prior exam." }, { "input": "Heart size is top normal. Mediastinal silhouette and hilar contours are unremarkable. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "Interval insertion of bilateral chest tubes, appear low. Heart is moderately enlarged. Mild pulmonary edema unchanged. Most of the abnormalities due to persistence of the pleural effusions and left lower lobe atelectasis. There is no pneumothorax. Atrioventricular pacer leads follow their expected courses, continuous from the left pectoral generator. No pneumothorax.", "output": "No pneumothorax. No substantial change in bilateral moderate effusions. Bilateral chest tubes appear low." }, { "input": "The lungs are clear without focal opacity to suggest pneumonia. No pleural effusion, pulmonary edema, or pneumothorax is present. The heart size is normal. No displaced fracture is identified. No free air beneath the diaphragm.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "AP upright and lateral views of the chest provided. Low lung volumes limits the evaluation. The patient's chin also obscures the superior mediastinum and portions of the lung apices. There are bibasilar opacities which may reflect atelectasis and small effusions. There is hilar engorgement and mild congestion noted. Heart size appears mildly enlarged. The mediastinal contour is stable. The imaged bony structures appear intact.", "output": "As above." }, { "input": "The heart size is mildly enlarged. The mediastinal and hilar contours are unremarkable. There is no pulmonary vascular congestion. Minimal streaky opacities in the lung bases are compatible with atelectasis. No focal consolidation, pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. There is relative narrowing of the transverse dimension of trachea as seen on prior CT, and compatible with COPD. Lungs are hyperinflated consistent with known diagnosis of chronic obstructive pulmonary disease. There is biapical scarring. Right mid lung opacity is likely related to scarring as seen on prior chest CT and is not definitely changed given difference in techniques. There is no new focal consolidation, large pleural effusion or pneumothorax. Previously described 0.9 cm nodular opacity in the left lung is not clearly visualized on today's examination.", "output": "No acute cardiopulmonary process." }, { "input": "Endotracheal tube terminates 6.6 cm above the carina, and advancement is recommended. Tip of the enteric tube extends to the proximal fundus of the body, but the sidehole is at the GE junction, and advancement is also recommended. Lungs are hyperinflated, with moderate to severe emphysema. No focal consolidation to suggest pneumonia. Ill-defined opacities are noted in the right upper lobe and left lower lobe, which are of unclear clinical significance. No pleural effusion or pneumothorax. Heart size is normal. There are multiple old bilateral rib fractures.", "output": "1. Endotracheal tube terminates 6.6 cm above the carina. Recommend advancement of both the endotracheal and enteric tubes. 2. Moderate to severe emphysema. 3. Ill-defined opacities in the right upper and left lower lung, of unclear clinical significance. Close interval follow-up is recommended, with consideration for a repeat PA and lateral chest radiograph if appropriate." }, { "input": "Enteric tube in right-sided PICC line are similar in position. There are persistent bibasilar opacities without significant interval change since the prior study.", "output": "No significant interval change." }, { "input": "Heart size is normal. Mediastinal contours are unremarkable. Hilar contours are prominent suggestive of underlying pulmonary arterial enlargement. Relative paucity of pulmonary vascular markings towards the apices indicates underlying emphysema. Streaky and patchy opacities are seen within the right mid lung field of both lung bases, potentially areas of atelectasis and/or infection. No large pneumothorax or pleural effusion is detected on this supine exam. Multiple bilateral rib fractures are noted, potentially related to recent resuscitation.", "output": "Emphysema and probable underlying pulmonary arterial hypertension. Patchy opacities within the right mid lung and both lung bases, potentially atelectasis and/or infection. Multiple bilateral rib fractures which may be related to recent resuscitation, without large pneumothorax identified." }, { "input": "An endotracheal tube has been placed in the interval, terminating approximately 8.5 cm from the carina. An enteric tube courses below the left hemidiaphragm, into the stomach and tip located off the inferior borders of the film. Heart size remains within normal limits. Mediastinal contours unchanged. Bilateral hilar enlargement compatible with underlying pulmonary arterial hypertension is re- demonstrated. Emphysema is again noted along with patchy airspace opacities within the right mid lung field and both lung bases, unchanged. No pneumothorax or pleural effusion is present. Bilateral rib fractures are unchanged.", "output": "1. Endotracheal tube tip is slightly high, terminating 8 cm from the carina. Enteric tube in standard position. 2. Unchanged right mid and bibasilar patchy airspace opacities, findings which may reflect atelectasis and/or infection. No pneumothorax." }, { "input": "Appliances are in good position. There is no pneumothorax. Linear atelectasis left lung base, similar. Probable small left pleural effusion, similar. Significant gastric distention, new since prior exam. Increased heart size", "output": "New significant gastric distention. No pneumothorax. Stable cardiopulmonary findings." }, { "input": "PA and lateral chest radiographs show clear lungs. The cardiac size is normal and the mediastinum displays normal contours aside from a tortuous descending thoracic aorta. Hila are unremarkable and there is no pleural effusion or pneumothorax. The osseous structures are normal.", "output": "No acute cardiopulmonary process." }, { "input": "Prior radiographs from ___ at ___ are not available for comparison, however compared with prior radiographs on ___, there is no significant change.The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiomegaly and aortic atherosclerotic calcification is unchanged. Median sternotomy wires are stable in appearance.", "output": "No pneumonia." }, { "input": "PA and lateral views of the chest provided. Midline sternotomy wires and mediastinal clips are again noted. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Aortic atherosclerotic calcification noted. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process" }, { "input": "PA and lateral views of the chest were provided. There is known scarring in the left lower lobe which likely accounts for the subtle retrocardiac opacity. There is a stable area of scarring in the lingula inferiorly. There is no definite sign of pneumonia or overt CHF. No large pleural effusion or pneumothorax is seen. Heart size is normal. Mediastinal contour is unremarkable. Bony structures appear intact.", "output": "Stable areas of scarring at the left lung base. No definite signs of pneumonia or CHF." }, { "input": "Mild hyperinflation and flattened diaphragms is consistent with COPD. Left basilar bronchiectasis is stable, although new impaction cannot be excluded. There is no consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "1. No evidence of pneumonia. 2. Stable left basilar bronchiectasis. Results were telephoned to Dr. ___ at 11:30 a.m. on ___ by Dr. ___." }, { "input": "Unchanged plate-like lingular atelectasis and stable left lower lobe chronic bronchiectasis. There is no focal consolidation to suggest pneumonia. The cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax.", "output": "1. No acute cardiothoracic process including no evidence of pneumonia. 2. Chronic left lower lobe bronchiectasis." }, { "input": "The lungs are well expanded and clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. The heart size and cardiomediastinal contours are normal. The lungs are clear. No focal consolidation, pleural effusion, or pneumothorax. Numerous surgical metallic clips are present in the lower cervical soft tissues. No free abdominal air or calcific density foreign body.", "output": "No free abdominal air or calcified foreign body." }, { "input": "PA and lateral views of the chest show no consolidation, pulmonary edema, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "A right-sided internal jugular Port-A-Cath terminates in the mid SVC. The cardiomediastinal contour is unchanged compared to the prior study with borderline cardiomegaly. Previous median sternotomy noted and calcification aortic arch. There are peripheral subpleural reticular opacities at the lung bases suggestive of interstitial lung disease. This is similar in appearance when compared to the prior study. No pneumothorax or pleural effusions seen. Minimal right basilar atelectasis. There has been prior aortic valve replacement. The bones are diffusely demineralized.", "output": "Overall appearances are very similar when compared to the prior study. Peripheral reticular opacities of the lung bases are difficult to evaluate and further evaluation with CT of the chest could be performed if there is concern for interstitial lung disease." }, { "input": "Frontal and lateral chest radiographs demonstrate multiple intact sternotomy wires and aortic valve replacement. Fine reticular opacities of the lateral lung bases appear to be chronic. The lungs are otherwise clear There is no pleural effusion or pneumothorax.", "output": "Chronic fine reticular opacities of the lateral lung bases; otherwise clear lungs." }, { "input": "The patient is status post median sternotomy and aortic valve replacement. Mild enlargement of the cardiac silhouette is again noted. Mediastinal lymphadenopathy is again noted, most pronounced within the region of the AP window. Pulmonary vasculature is normal. Increased interstitial markings are seen within the periphery of the lung bases compatible with chronic lung disease, better characterized on the recent CT. Lungs are hyperinflated. No focal consolidation, pleural effusion or pneumothorax is present. There are mild degenerative changes noted within the thoracic spine.", "output": "No acute cardiopulmonary abnormality. Unchanged mediastinal lymphadenopathy and mild chronic interstitial abnormality." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is again an abnormal contour to the prevascular window reflecting known lymphadenopathy. There is no pleural effusion or pneumothorax. The lungs appear clear. The patient is status post aortic valve replacement.", "output": "Mediastinal lymphadenopathy. No evidence of acute cardiopulmonary disease." }, { "input": "There has been interval placement of a right-sided Port-A-Cath with its tip ending in the low SVC. Otherwise, no significant interval change. No focal consolidation to suggest pneumonia. No pleural effusion or pulmonary edema. No pneumothorax. The heart is top-normal in size, unchanged. The descending aorta calcifications are also unchanged. Prominence of the left perihilar region is unchanged and corresponds to conglomerate of enlarged lymph nodes better seen on CT. Median sternotomy wires and aortic valve replacement are unchanged. Degenerative changes and diffuse demineralization of the visualized thoracic spine are also unchanged.", "output": "No pneumonia." }, { "input": "Port-A-Cath catheter tip is at the level of lower SVC. Heart size and mediastinum are unchanged including cardiomegaly. Peripheral interstitial opacities have increased slightly on the right. The left peripheral interstitial opacities are stable. The lung volumes are stable and mildly reduced. The patient appears to be after transcatheter aortic valve replacement. No pleural effusions or pneumothorax.", "output": "Progressive peripheral interstitial opacities since ___ can be active flare of interstitial lung disease including fibrotic NSIP or drug toxicity, versus superimposed infection in the appropriate clinical setting. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 5:17 PM, 15 minutes after discovery of the findings." }, { "input": "Since chest radiographs dated ___, no significant changes are appreciated. Bilateral interstitial opacities are unchanged since ___, but have shown marked, progressive worsening since ___. There are no focal consolidations or pulmonary effusions. Port catheter tip terminates in the lower SVC. Median sternotomy wires are midline and intact.", "output": "No evidence of pneumonia or other acute cardiopulmonary abnormalities. Chest radiograph grossly unchanged since ___. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 4:42 PM, minutes after discovery of the findings." }, { "input": "The extensive subcutaneous emphysema, pneumomediastinum, and small right apical pneumothorax has marginally decreased since ___. median sternotomy with stable cardiac and mediastinal contours. Persistent low lung volumes with stable, periphery parenchymal opacities in both lungs due to pulmonary fibrosis. Bibasilar atelectasis unchanged since ___. Right internal jugular Port-A-Cath unchanged in position. No pulmonary edema.", "output": "Minimal interval decrease in the extensive subcutaneous emphysema when compared to ___" }, { "input": "Enlarged lymph nodes in the aorticopulmonary window and left hilum appear less prominent than on the prior radiograph. Cardiomediastinal contours are otherwise stable. Within the lungs, persistent reticular opacities are demonstrated bases. There are no new areas of consolidation and there is no pleural effusion or pneumothorax. Note is made of previous median sternotomy and aortic valve procedure.", "output": "1. Apparent decrease in intrathoracic lymphadenopathy. 2. No acute pulmonary findings to account for shortness of breath." }, { "input": "The patient is status post aortic valve replacement. The heart is mildly enlarged. The mediastinal and hilar contours appear unchanged. The aorta is partly calcified. Bilateral nipple shadows are visualized. Fine reticulation in the periphery of the basilar portions of the lungs suggesting interstitial changes is similar since the prior study without evidence for a superimposed process. Mild degenerative changes are similar along the thoracic spine. The bones are probably demineralized to some degree.", "output": "Similar mild interstitial process. Status post aortic valve replacement. Suspected bony demineralization." }, { "input": "Moderate cardiomegaly and stable prosthetic aortic valve are noted. Considerably calcified aortic knob and intact sternal wires are noted. The lungs are hyperinflated with streaky bibasilar opacities likely represent atelectasis and minimal interstitial reticulation in the periphery, better seen on the current CT, likely representing chronic interstitial changes. There is no pleural effusion or pneumothorax. Osseous structures demonstrate multilevel degenerative change in thoracic spine.", "output": "1. Moderate cardiomegaly. 2. Hyperinflated lungs with bibasilar atelectasis, but no evidence for pneumonia." }, { "input": "Sternotomy wires are intact. Right pectoral infusion port terminates at the cavoatrial junction. Prosthetic aortic valve and TAVR is in unchanged position. Lung volume is low. Chronic interstitial fibrosis is similar to before. Focal areas of increased opacity in the periphery of the right mid and left lower lungs appear more conspicuous than on the prior radiograph, but lower lung volumes limit comparison. There is no pleural effusion or pneumothorax. Cardiac silhouette is normal size.", "output": "1. Increased constant acuity of right mid and left lower lung opacities, possibly due to accentuation by lower lung volumes. Followup PA and lateral radiographs would be helpful for more complete assessment when the patient's condition allows, in order to exclude developing pneumonia at either of the sites. . 2. Extensive interstitial fibrosis." }, { "input": "Portable AP upright chest radiograph ___ at 09:36 is submitted.", "output": "Pneumomediastinum and extensive subcutaneous emphysema appears unchanged. Possible small stable right pneumothorax, although this may just represent overlying subcutaneous emphysema. Status post median sternotomy with stable overall cardiac and mediastinal contours. A right internal jugular Port-A-Cath remains unchanged in position. Bibasilar opacities are again seen suggestive of atelectasis, although the appearance is slightly more consolidative at the left base raising concern for developing pneumonia. No pulmonary edema." }, { "input": "In comparison to the prior chest radiographs, no significant change is appreciated. Diffuse interstitial opacities appear unchanged. Obscuration of the right heart border also appears unchanged compared to many prior chest radiographs, likely due to adjacent pericardial fat silhouetting the diaphragm. Lungs are otherwise clear without focal consolidation. Moderate cardiomegaly is unchanged without pulmonary vascular congestion or pulmonary edema. A right-sided Port-A-Cath terminates in the lower SVC. Median sternotomy wires are midline and intact.", "output": "No radiographic evidence of pneumonia or other acute cardiopulmonary abnormalities. Chronic interstitial changes likely due to known bleomycin toxicity." }, { "input": "Portable AP upright chest radiograph ___ at 12:22", "output": "The extensive subcutaneous emphysema, pneumomediastinum, and small right apical pneumothorax do not appear to be significantly changed. Status post median sternotomy with stable cardiac and mediastinal contours. Persistent low lung volumes with stable parenchymal opacities in both lungs. Right internal jugular Port-A-Cath unchanged in position. No pulmonary edema." }, { "input": "PA and lateral views of the chest provided. Posterior spinal hardware is seen extending from the mid thoracic spine inferiorly. There has been recent left thoracotomy with reason removal of a left chest tube. Previously noted left pneumothorax has resolved. In this patient with known left hilar mass, there is persistent vague opacity in the left mid upper lung which may reflect known lung cancer. There is elevation of the left hemidiaphragm with probable small left effusion and left basal atelectasis. The right lung remains clear. Heart size cannot be assessed. The mediastinal contour appear is similar to prior. Bony structures are grossly intact.", "output": "Interval resolution of left pneumothorax with persistent left mid to upper lung opacity compatible with known malignancy. Interval elevation of the left hemidiaphragm with left basal atelectasis and small left effusion." }, { "input": "PA and lateral views of the chest provided. Cardiomegaly is noted with small bilateral pleural effusions and mild pulmonary congestion and edema. No pneumothorax. Difficult to exclude a superimposed subtle pneumonia. No pneumothorax. Bony structures appear intact.", "output": "Mild pulmonary edema." }, { "input": "The lungs are clear.The cardiac, hilar and mediastinal contours are normal.No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "There is a consolidation in the right lower lobe, consistent with pneumonia. There is no pleural effusion, pneumothorax or focal airspace consolidation. The cardiac and mediastinal contours are normal. The left hilus is unremarkable. There is an abnormal contour to the right hilus, indicating some degree of lymphadenopathy.", "output": "Right lower lobe pneumonia. Follow-up to resolution in 4 to 6 weeks is recommended. Findings discussed with Dr. ___ by Dr. ___ on ___ by telephone at the time of discovery." }, { "input": "A single portable frontal view of the chest was performed. There is no pleural effusion, pneumothorax or focal airspace consolidation. The cardiac and mediastinal contours are normal. The hilar structures and pleural surfaces are unremarkable. There are no acute osseous abnormalities appreciated.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest provided demonstrate midline sternotomy wires and mediastinal clips. The heart is normal in size. Mediastinal contour is normal. lungs are clear. No pneumothorax or pleural effusion. Bones appear intact.", "output": "No acute traumatic injury seen." }, { "input": "Portable semi-erect chest film ___ at 11:28 is submitted.", "output": "Interval extubation and removal of the nasogastric tube. Interval removal of the mediastinal drains and left chest tube. Right internal jugular central line remains in place with its tip in the distal SVC. No pneumothorax is seen. No evidence of pulmonary edema. Stable cardiac and mediastinal contours status post median sternotomy for CABG. Patchy left basilar opacity and streaky opacities at the right base most likely reflect lower lobe patchy atelectasis. Probable small left effusion." }, { "input": "Patient status post median sternotomy and CABG. Heart size is mildly enlarged. The mediastinal and hilar contours are unremarkable. The pulmonary vasculature is not engorged. Small bilateral pleural effusions, left greater than right are present, with the left-sided pleural effusion slightly larger compared to the prior exam. Left basilar opacity may reflect atelectasis or pneumonia in the correct clinical setting. No pneumothorax is seen. No acute osseous abnormalities seen.", "output": "Bilateral small pleural effusions, left greater than right, with interval increase in size of the left pleural effusion. Left basilar opacity may reflect atelectasis but pneumonia is not excluded in the correct clinical setting." }, { "input": "Heart size is normal. The mediastinal and hilar contours are remarkable for tortuosity of the thoracic aorta. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. No free intraperitoneal air identified in the visualized upper abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is mildly enlarged but unchanged. The mediastinal and hilar contours are within normal limits. Lungs are clear and the pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "There are relatively low lung volumes and mild bibasilar atelectasis. The cardiac silhouette is mildly enlarged. No focal consolidation is seen. There is no pleural effusion or pneumothorax. No pulmonary edema is seen.", "output": "Relatively low lung volumes with minimal bibasilar atelectasis. Mild enlargement of the cardiac silhouette without pulmonary edema." }, { "input": "Cardiac, mediastinal, and hilar contours are normal. The pulmonary vascularity is normal. No focal consolidation, pleural effusion or pneumothorax is identified. 3 mm rounded opacity in the left lung base likely reflects a calcified granuloma. Eventration of the right hemidiaphragm is noted. No acute osseous abnormality is identified.", "output": "No acute cardiopulmonary process. No displaced fractures are seen. If there is continued clinical concern for a rib fracture, then a dedicated rib series is recommended." }, { "input": "P. A frontal chest radiograph was provided demonstrating no focal consolidation effusion or pneumothorax. The heart size is normal. There is a slightly unfolded thoracic aorta though the mediastinal contour is otherwise unremarkable. Bony structures appear intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "The lungs appear hyperexpanded. No focal consolidation, pleural effusion or pneumothorax identified. The size of the cardiac silhouette is within normal limits.", "output": "Hyperexpanded lungs. No radiographic evidence of acute cardiopulmonary disease." }, { "input": "Single portable view of the chest. The lungs are clear consolidation or large effusion. The trachea is mildly deviated to the left at the thoracic inlet raising possibility of underlying thyroid enlargement on the right. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process. Slight leftward deviation of the trachea at the thoracic inlet. Could repeat exam with PA and lateral technique to optimize positioning versus consider thyroid ultrasound." }, { "input": "The cardiac, mediastinal and hilar contours are normal. The pulmonary vascularity is normal. There is minimal subsegmental atelectasis within the left mid lung field. Remainder of the lungs are clear. No pleural effusion or pneumothorax is visualized. No displaced rib fractures or other acute osseous abnormality is detected.", "output": "No acute cardiopulmonary abnormality." }, { "input": "There has been slight interval retraction of a right-sided chest tube which now projects over the mid right lung field. The inferior chest tube projects over the lower lung. Right-sided subcutaneous emphysema persists. Small right apical pneumothorax is unchanged. Large known upper lobe consolidation on the right appears similar to the prior exam with persistent mild right basilar atelectasis. Mild plate-like atelectasis is seen at the left lung base; otherwise, the left lung is clear. There is no interval change in the appearance of the cardiac silhouette. Small right-sided pleural effusion is persistent. The visualized osseous structures are unremarkable.", "output": "1. Unchanged small right apical pneumothorax with persistent right basilar atelectasis. 2. Persistent small right pleural effusion." }, { "input": "Two views of the chest. Consolidative mass and collapse involves a greater portion of the right upper lobe than on the previous radiograph. The remainder of the lung is well expanded with increased small right pleural effusion. Heart and mediastinal contours are unchanged.", "output": "Increase in degree of consolidation of the right upper lobe, a combination of mass and collapse, with accompanying increased small pleural effusion." }, { "input": "ETT terminates 4.6 cm above the level of the carina. An enteric tube is seen courseing below the diaphragm, terminating in the proximal stomach. There is prominence of the right hilum with suggestion of retraction seen. There is also opacity projecting over the right lung apex, as was also the case on the prior study. There appears to be volume loss in the right lung with elevation of the right hemidiaphragm as well. Areas of opacity in the right mid to lower lung appear somewhat increased and there is suggestion of right perihilar air bronchograms. There is slight blunting of the right costophrenic angle, which may be due to trace effusion or pleural thickening. The left lung is clear. No pneumothorax is seen. The cardiac silhouette is mildly enlarged.", "output": "Volume loss on the right hemithorax. Right pleural effusion. Increased opacities in the right mid to lower lung, with air bronchograms may be due infection and/or worsening of malignant disease." }, { "input": "Overall, two right-sided chest tubes are similar in position compared to the prior exam. Small right apical pneumothorax is unchanged. There has been slight interval improvement in the extent of the right subcutaneous emphysema. Large known upper lobe consolidation on the right appears similar to the prior exam with an interval increase in right lung base atelectasis. The left lung is clear aside from plate-like areas of atelectasis at the left lung base. There is no interval change in the appearance of the cardiac silhouette. There may be a small right-sided pleural effusion.", "output": "Unchanged small right apical pneumothorax with interval increase in right basilar atelectasis." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The aorta is calcified and somewhat tortuous. The cardiac silhouette is not enlarged. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest were obtained. The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Minimal prominence of the left hilum is stable since ___.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. Clips from prior cholecystectomy are re- demonstrated in the right upper quadrant of the abdomen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear. Heart size and mediastinal contours are normal. There is no pleural effusion or consolidation. Osseous structures are intact.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. There is no pleural effusion or pneumothorax. There is a retrocardiac opacity that is not specific obscuring medial left hemidiaphragmatic contours. Otherwise the lungs appear clear.", "output": "Left lower lobe opacity, which could be seen with atelectasis, although an infectious process is not excluded and results should be correlated with clinical presentation. No evidence of congestive heart failure." }, { "input": "The lungs are hypoinflated. In comparison to the prior examination, the cardiomediastinal silhouette appears stable. The pulmonary vasculature is mildly indistinct, though not significantly changed since prior examination. No definite pneumothorax or pleural effusion is noted.", "output": "No acute intrathoracic process." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. Patchy retrocardiac opacity appears streaky and probably due to atelectasis. Otherwise the lungs appear clear. There are no pleural effusions or pneumothorax.", "output": "Mild retrocardiac opacification, most commonly due to atelectasis also although not entirely specific." }, { "input": "Cardiac silhouette size appears mildly enlarged but unchanged. The mediastinal and hilar contours are similar. There is mild pulmonary vascular congestion and small bilateral pleural effusions. Patchy opacities in the lung bases may reflect a combination of the patient's known bronchiectasis and fibrosis with superimposed atelectasis. Elevation of the right hemidiaphragm is unchanged. Known right hilar mass is better assessed on the previous radiograph. Marked degenerative changes are seen involving the left shoulder with narrowing of the left acromiohumeral interval suggestive of underlying rotator cuff disease.", "output": "1. Mild pulmonary vascular congestion and small bilateral pleural effusions. 2. Known right hilar mass is better assessed on the previous CT. 3. Patchy opacities in the lung bases may reflect a combination of atelectasis as well as known bronchiectasis with fibrotic changes." }, { "input": "Diffuse increase in interstitial markings bilaterally may be due to mild interstitial edema. No lobar consolidation is seen. There is no pleural effusion or pneumothorax. There is mild elevation of the right hemidiaphragm. The cardiac and mediastinal silhouettes are stable.", "output": "Possible minimal interstitial edema which may in part be technical. No focal consolidation seen." }, { "input": "Cardiac silhouette size is mildly enlarged but unchanged. The mediastinal and hilar contours are similar. Pulmonary vasculature is normal. Streaky atelectasis is seen in the lung bases without focal consolidation. No pleural effusion or pneumothorax is the benefit. Degenerative changes are noted involving both acromioclavicular joints.", "output": "Mild bibasilar atelectasis." }, { "input": "The ET tube is 4 cm above the carina. NG tube tip is off the film, at least in the stomach. There is volume loss/ consolidation at both bases. Heart size is upper limits of normal.", "output": "The bilateral lower lobe volume loss/infiltrate" }, { "input": "Single AP view of the chest. No prior. The lungs are clear of consolidation, vascular congestion or effusion. Cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures demonstrate no acute abnormality.", "output": "No acute cardiopulmonary process." }, { "input": "Portable chest radiograph demonstrates apparent widening of mediastinum this is due to patient rotation. Cardiomediastinal and hilar contours are unremarkable. Low lung volumes with vascular crowding. Lungs are clear. No pleural effusion or pneumothorax.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral views of the chest provided. Midline sternotomy wires are noted. There is persistent left lower lobe atelectasis accounting for retrocardiac opacity. Difficult to exclude a superimposed pneumonia though overall pattern appears similar. Right lung is clear. No large effusion or pneumothorax. Overall cardiomediastinal silhouette appears similar to prior", "output": "Persistent left lower lobe atelectasis." }, { "input": "The cardiac silhouette is vascular congestion. No focal consolidation is identified. There is no pleural effusion or pneumothorax.", "output": "Mild vascular congestion." }, { "input": "Patient is status post median sternotomy. The cardiac and mediastinal silhouettes are stable with prominence of the mediastinum stable. There may be a trace left pleural effusion, but no large pleural effusion is seen. There is been improved aeration of the left lower lobe. No pneumothorax is seen.", "output": "Possible trace left pleural effusion. Otherwise, no acute cardiopulmonary process. Improved aeration of the left lower lobe." }, { "input": "Heart size is top normal. The aorta is unfolded. Bilateral enlargement of the superior mediastinal contour is compatible with a thyroid goiter, unchanged. Pulmonary vasculature is normal. There is mild elevation of the right hemidiaphragm which is unchanged, with associated right basilar linear atelectasis. No focal consolidation, pleural effusion or pneumothorax is visualized. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart is upper limits of normal in size and accompanied by mild pulmonary vascular congestion and small right pleural effusion. Bibasilar platelike atelectasis is slightly improved. There is no pneumothorax or focal consolidation. The cardiomediastinal silhouette is stable. The left-sided Bochdalek's hernia is unchanged. Impression on the right aspect of the trachea may be related to an enlarged thyroid gland.", "output": "1. No evidence of pneumonia." }, { "input": "There is new pulmonary vascular congestion, but no pleural effusion or pneumothorax. Mild cardiomegaly is unchanged. Mediastinal and hilar contours are normal. No focal consolidation is present.", "output": "New pulmonary vascular congestion with stable mild cardiomegaly and no pleural effusions. NOTIFICATION: Telephone notification to Dr. ___ by Dr. ___, ___:36 a.m. on ___ per request." }, { "input": "There is moderate pulmonary edema, increased since prior study. No focal consolidation is seen, although lung volumes are low. Moderate cardiomegaly is noted. There is no pleural effusion or pneumothorax.", "output": "Moderate pulmonary edema and moderate cardiomegaly. No focal consolidation." }, { "input": "There are low lung volumes, which accentuate the bronchovascular markings. Given this, there is persistent mild elevation of the right hemidiaphragm with overlying atelectasis. Right middle lobe opacity most likely represents atelectasis rather than consolidation due to pneumonia. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are stable given differences in lung volume and technique.. Prominence of the pulmonary vasculature is likely accentuated by a low lung volumes and technique.", "output": "Low lung volumes which accentuate the bronchovascular markings. Persistent elevation of the right hemidiaphragm with overlying right middle lobe atelectasis, underlying consolidation not entirely excluded." }, { "input": "A left chest wall port catheter tip terminates at the cavoatrial junction. The lungs are well expanded. There are worsening confluent basilar opacities, right greater than left with new patchy opacities in the right upper lobe. Diffuse ground glass and linear opacities have also progressed since the prior radiograph. Small bilateral pleural effusions are new. There is no pneumothorax. The cardiomediastinal silhouette is normal. The bones are intact.", "output": "Worsening multifocal opacities most confluent at the lung bases are concerning for worsening atypical infection and less likely asymetric pulmonary edema or hemorrhage." }, { "input": "Cardiomediastinal and hilar contours are stable. There is a new small right pleural effusion, but there is no pneumothorax or left pleural effusion. There are increased bibasilar opacities compared to the most recent prior study. Additionally, there are subtle increased opacities in the right upper lung. Slight increase in interstitial markings is present. Again seen is a left chest port with tip terminating in the cavoatrial junction.", "output": "Increased bibasilar opacities and new opacities in the right upper lung with a new small right pleural effusion concerning for multifocal pneumonia. Given additional finding of prominent interstitial markings, PCP pneumonia may be considered, although review of the patient's chart indicates that the patient is on prophylaxis." }, { "input": "Heart size remains mildly enlarged. The aorta is tortuous. Mediastinal and hilar contours are unchanged. Pulmonary vasculature is not engorged. Streaky and patchy opacities in the lung bases likely reflect areas of atelectasis, No pleural effusion or pneumothorax is present. No acutely displaced rib fractures are identified.", "output": "Streaky and patchy opacities in lung bases likely reflect areas of atelectasis." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Mild enlargement of the cardiac silhouette is present. The aortic knob is calcified. Mediastinal contours unremarkable. There is mild pulmonary edema along with small bilateral pleural effusions. Elevation the right hemidiaphragm is of unknown chronicity. Patchy opacities in lung bases may reflect areas of atelectasis. No pneumothorax is present. There are no acute osseous abnormalities demonstrated.", "output": "Mild pulmonary edema with small bilateral pleural effusions and bibasilar patchy opacities, likely atelectasis." }, { "input": "Lungs are well-expanded and clear. The hilar pleural surfaces are normal. The cardiomediastinal silhouette is unremarkable.", "output": "Normal chest." }, { "input": "Frontal and lateral views of the chest demonstrate hyperexpanded lungs without pleural effusion, focal consolidations or pneumothorax. Subtle left base opacity is noted. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. Vascular congestion is noted.", "output": "Subtle left lung base opacity, may represent early pneumonia, in the appropriate clinical setting. Suggest outpatient CT chest to evaluate for growth of left lung base ground glass opacity seen on CT exam of ___ (but not on concurrent conventional CXR) as suggested in that report, in order to evaluate possibility of BAC masquerading as pneumonia. ED QA nurses notified by email of approved text, including recommendation." }, { "input": "The cardiomediastinal and hilar contours are normal. The lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiac, mediastinal and hilar contours are normal. Lungs are clear. Pulmonary vascularity is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormalities are detected.", "output": "No acute cardiopulmonary process." }, { "input": "Again seen are signs of volume loss in the right lung with rightward shift of the mediastinum and irregularity of the right upper chest wall after resection of tumor. The heart size is normal. There is no pleural effusion or pneumothorax. There is no focal consolidation concerning for pneumonia. Nonunion of an old right clavicular fracture is again noted.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. Surgical clips are noted in the right supraclavicular region and at the level of the right pulmonary hilum. There is volume loss in the right lung related to prior right upper lobectomy and chest wall resection. There is no new consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is stable and shifted to the right as on prior. A chronic right clavicular deformity is re- demonstrated.", "output": "No acute findings, postsurgical changes in the right hemi thorax appear stable." }, { "input": "Frontal and lateral views of the chest were obtained. The patient is status post resection of a Pancoast tumor with partial right lung and chest wall resection. Rightward shift of the mediastinum and postoperative right lung volume loss is similar to prior, allowing for patient rotation with respect to the film. The heart size is normal. No focal consolidation, pleural effusion, or pneumothorax. A displaced fracture of the right clavicle is new since ___, but similar to ___. No new displaced rib fracture is present.", "output": "1. No new displaced right rib fracture. Chronic displaced right clavicular fracture. 2. Stable postoperative appearance of the chest status post resection of a Pancoast tumor." }, { "input": "The lungs are clear. There is no evidence of pneumonia, pneumothorax, or pleural effusion. Cardiac silhouette is normal in size.", "output": "No acute cardiopulmonary process. Specifically no cardiomegaly." }, { "input": "Frontal and lateral radiographs show clear lungs. The lung fields are slightly obscured by overlying soft tissue attenuation. The heart size is top normal. The mediastinum is normal. No pleural effusion or pneumothorax is seen.", "output": "Mild cardiomegaly." }, { "input": "Frontal and lateral views of the chest demonstrate interval decrease in a previously moderate left pleural effusion, now small in size. There is, however, interval development of a small right pleural effusion with atelectasis. Upper lungs are well aerated. There is no pneumothorax or consolidation. Cardiomediastinal silhouette is within normal limits.", "output": "Smaller left pleural effusion and new small right effusion since six days prior." }, { "input": "Moderate left and small right pleural effusions are comparable to volumes on the CTA ___ for, certainly no bigger. Upper lungs are clear. Left hilus is mildly enlarged, right is not. Heart size normal. There is no distention of mediastinal veins to suggest and increased central venous pressure.", "output": "Persistent moderate left and small right pleural effusion. No evidence of right or left heart decompensation." }, { "input": "Portable upright chest radiograph ___ at 19:58 is submitted.", "output": "There is volume loss in the right upper lobe with faint opacity at the right apex likely correlating to an area in the right upper lobe seen on ___ which most likely reflects post radiation change. Clinical correlation is recommended. Lungs are otherwise clear. No pleural effusions or pulmonary edema. No focal airspace consolidation to suggest pneumonia. No pneumothorax. Heart is upper limits of normal in size given portable technique. Mediastinal contours are within normal limits. The aorta is somewhat unfolded and tortuous. Old left-sided posterior lateral rib fractures." }, { "input": "Again seen is mild volume loss in the right upper lobe with peribronchial consolidation in the right upper lobe which may correspond to consolidation and cavitation seen on prior CT. The cardiomediastinal silhouette is stable since the prior examination. The aorta is tortuous. There is no pleural effusion or pneumothorax. No focal consolidation is identified. There is evidence of healed left rib fractures.", "output": "1. No acute intrathoracic abnormality. 2. CT of the chest is recommended on a non-emergent basis to evaluate right upper lobe abnormality. RECOMMENDATION(S): CT of the chest is recommended on a non-emergent basis to evaluate right upper lobe abnormality" }, { "input": "Single frontal view of the chest was obtained. Midline tracheostomy tube is again seen. There is mild left greater than right bibasilar atelectasis. Minimal blunting of the left costophrenic angle could be due to a trace effusion. No definite focal consolidation is seen. The cardiac silhouette is top normal. The aortic knob is calcified.", "output": "Possible trace left pleural effusion with overlying atelectasis." }, { "input": "AP single view of the chest obtained with patient in sitting semi-upright position. Analyzed in direct comparison with the next preceding similar study of ___. Tracheostomy as before. Unchanged position of right-sided PICC line. The previously described bilateral basal densities persist and may even have increased. Diffuse haze over the bases suggests pleural effusions that probably are layering mostly in the posterior compartments as the patient is in semi-erect position only. No pneumothorax has developed.", "output": "Persistent and somewhat increased bilateral parenchymal densities." }, { "input": "When compared to prior, there has been interval development of bibasilar opacities, more extensive on the left than on the right. Superiorly, the lungs are clear. Cardiomediastinal silhouette is stable. No acute osseous abnormality is identified.", "output": "New multifocal regions of consolidation worrisome for infection in the proper clinical setting at the lung bases, left greater than right." }, { "input": "PA and lateral views of the chest were provided demonstrating clear well-expanded lungs without pleural effusion, pneumothorax, focal consolidation or signs of pulmonary edema. Heart size is stable and top normal. The mediastinal contour appears normal. Bony structures are intact.", "output": "No acute findings." }, { "input": "PA and lateral views of the chest. The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormality is identified. Mid thoracic dextroscoliosis is identified. Pectus deformity is noted.", "output": "No acute cardiopulmonary process." }, { "input": "Since chest radiographs dated ___, no appreciable changes are identified. Lungs are fully expanded and clear. Heart size is normal. Cardiomediastinal and hilar silhouettes and pleural surfaces are normal. Incidental note is made of pectus excavatum.", "output": "No evidence of lung mass or acute cardiopulmonary process." }, { "input": "The heart is top normal in size. The mediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Pectus excavatum deformity distorts the cardiomediastinal silhouette, which is otherwise normal.There is no focal consolidation, pleural effusion, pneumothorax, or pulmonary edema. The cardiomediastinal silhouette is within normal limits.", "output": "No evidence of acute cardiopulmonary process. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 12:27 PM, 2 minutes after the discovery of the findings." }, { "input": "An ET tube is seen terminating approximately 6 cm from the carina. NG tube tip is seen in the stomach. A left-sided subclavian line ends in the mid SVC. A PICC is seen ending in the atriocaval junction. The lungs are otherwise clear of focal opacities. Heart size is normal. No obvious pleural effusions or pneumothoraces are seen. No pulmonary edema is present.", "output": "No acute cardiopulmonary process. Lines in position as above." }, { "input": "No focal consolidation, pleural effusion, pneumothorax, or pleural pulmonary edema is seen. Heart size is normal. Mediastinal contours are normal. No bony abnormality is detected.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "Two frontal and one lateral view of the chest were reviewed. Cardiomediastinal and hilar contours are stable. There is no pleural effusion or pneumothorax. The lungs are well expanded and clear. Pulmonary vasculature is within normal limits. No displaced fracture is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The chest is well expanded and clear. Cardiomediastinal silhouette is unremarkable. There is no pneumothorax or pleural effusion. Visualized osseous structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low, accounting for bronchovascular crowding. There is no focal opacity concerning for pneumonia. Cardiomediastinal and hilar contours are unremarkable. There is no pleural effusion or pneumothorax.", "output": "Low lung volumes. No evidence of acute cardiopulmonary process." }, { "input": "Frontal and lateral views of the chest demonstrate normal lung volumes. There is no pleural effusion, focal consolidation, or pneumothorax. Hilar and mediastinal silhouettes are unremarkable. Heart size is normal. Partially imaged upper abdomen is unremarkable.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "There is evidence of right apical scarring and possible calcified node at the right hilum. Opacity at the right cardiophrenic angle is felt most likely to be a fat pad as seen on the lateral view. Elsewhere, lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is top-normal in size. The mediastinal and hilar contours are within normal limits. There is atelectasis at the right lung base. There is no pleural effusion, focal consolidation or pneumothorax.", "output": "Atelectasis at the right lung base. No focal consolidation concerning for pneumonia." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. A linear left upper lobe opacity suggests minor atelectasis or scarring, but otherwise the lungs appear clear. There is no pleural effusion or pneumothorax. Bony structures are unremarkable. There is mild rightward convex curvature centered along the lower thoracic spine.", "output": "No evidence of acute disease." }, { "input": "PA and lateral views of the chest provided. The lungs are clear aside from mild platelike left mid lung atelectasis. A fat pad effaces the left lower heart border. Lungs are mildly hyperinflated. No signs of pneumonia or edema. No large effusion or pneumothorax. The cardiomediastinal silhouette is stable. Chronic degenerative disease is noted at both shoulders. No free air below the right hemidiaphragm.", "output": "No pneumonia or other acute intrathoracic process." }, { "input": "PA and lateral views of the chest. There is mild biapical scarring. The lungs are otherwise clear without consolidation effusion or pulmonary vascular congestion. Cardiac silhouette is mildly enlarged. Descending thoracic aorta is ectatic. Degenerative changes are noted at the shoulders bilaterally. Osseous structures are otherwise unremarkable.", "output": "Cardiomegaly without definite acute cardiopulmonary process." }, { "input": "The lungs are hyperinflated but clear of consolidation or effusion. Moderate cardiomegaly is again noted. Slightly tortuous descending thoracic aorta is also noted. Chronic appearing degenerative changes seen centered at the left shoulder.", "output": "Hyperinflation and cardiomegaly without acute cardiopulmonary process." }, { "input": "There has been interval decrease in the size of the right pleural effusion status post drainage. There is a new small right apical pneumothorax. A nasogastric feeding tube courses below the hemidiaphragm, tip not visualized. Mild pulmonary edema is unchanged. Small left pleural effusion with associated left lower lobe atelectasis are unchanged. Surgical skin ___ and metallic hardware in the cervical region are unchanged.", "output": "Status post drainage of right pleural effusion which is now small. New small right apical pneumothorax. Stable mild pulmonary edema, left lower lobe atelectasis and small left pleural effusion. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 3:13 PM, 30 minutes after discovery of the findings." }, { "input": "The enteric tube courses below the hemidiaphragm, tip not visualized. Moderate right and small left pleural effusions are unchanged. Mild cardiomegaly despite the projection is unchanged. There is slightly increased pulmonary vascular congestion, and new obscuration of the left hemidiaphragm, which is most likely due to atelectasis. A tiny left apical pneumothorax shows no appreciable change. The patient has had previous cervical spine fusion.", "output": "New left lower lobe atelectasis. Slightly increased pulmonary vascular congestion. Stable tiny left apical pneumothorax." }, { "input": "", "output": "Malpositioned NG tube enters the right main bronchus to terminate in the distal bronchial tree. Repositioning is advised. No other appreciable interval change. TECHNIQUE: PA and lateral radiographs of the chest. FINDINGS: The nasogastric tube enters the right main bronchus and extends well into the right bronchial tree. There is no pneumothorax. Mild pulmonary edema with moderate bilateral pleural effusions are unchanged. Moderate cardiomegaly despite the projection is also unchanged. Coarse vascular calcifications are incidentally noted. The patient has had prior cervical spine fusion. NOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 4:15 PM, 5 minutes after discovery of the findings. COMPARISON: ___." }, { "input": "PA and lateral views of the chest provided. Mild atelectasis in the left lower lobe is new. No pleural effusion or pneumothorax. Hilar and cardiomediastinal contours are normal. A VP shunt is partially visualized.", "output": "Mild atelectasis in the left lower lobe is new. No pneumonia." }, { "input": "Portable AP upright chest radiograph is obtained. The lungs appear clear bilaterally without focal consolidation, effusion, or pneumothorax. A left fifth rib fracture seen on CT is not evident on this chest radiograph. Cardiomediastinal silhouette appears normal.", "output": "No acute findings. Please refer to CT chest from outside hospital for further details." }, { "input": "The heart is normal in size. There is mild unfolding of the thoracic aorta. The mediastinal and hilar contours appear unchanged. The lungs appear clear. A nipple shadow is visualized on the left. A deformity of the left proximal humerus appears similar allowing for differences in technique. There is mild leftward convex curvature centered along the lower thoracic spine.", "output": "No evidence of acute disease." }, { "input": "The cardiac, mediastinal and hilar contours appear unchanged. The aorta shows mild unfolding, as before. The heart is normal in size. There is no mediastinal or hilar lymphadenopathy. There is no pneumothorax. Slight new blunting of each costophrenic sulcus potentially indicates trace effusions, but if confirmed, quite small. Moderate degenerative changes are similar along the mid thoracic spine.", "output": "No evidence of acute disease aside from perhaps trace pleural effusions." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. The aorta is again mildly tortuous. There is no pleural effusion or pneumothorax. The lungs appear clear. The patient is status post anterior cervical fusion. The usual kyphotic curvature of the lower thoracic spine is straightened. Mid thoracic interspaces are mildly narrowed.", "output": "No evidence of acute disease." }, { "input": "No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The cardiac and mediastinal silhouettes are stable and unremarkable. No pulmonary edema is seen. No displaced fracture is identified.", "output": "No acute cardiopulmonary process. No significant interval change." }, { "input": "MILD TO MODERATE CARDIOMEGALY AND PULMONARY VASCULAR CONGESTION ARE CHRONIC. THERE IS NO GOOD EVIDENCE FOR PULMONARY EDEMA LEFT PLEURAL THICKENING AND ASSOCIATED LOWER LOBE ATELECTASIS ARE LONG-STANDING. SMALL RIGHT PLEURAL EFFUSION HAS RECURRED. NO PNEUMOTHORAX.", "output": "1. PERSISTENT LEFT LOWER LOBE ATELECTASIS ASSOCIATED WITH CHRONIC LEFT PLEURAL SCARRING. 2. Pulmonary vascular congestion AND MILD TO MODERATE CARDIOMEGALY OR CHRONIC. ALTHOUGH THERE IS RECURRENT SMALL RIGHT PLEURAL EFFUSION THERE IS NO PULMONARY EDEMA." }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is a small residual right-sided loculated pleural effusion but decreased with associated streaky opacities suggesting minor associated atelectasis. Overall, however, aeration is much better than the more recent of the prior radiographs. Mild degenerative changes affect the lower thoracic spine.", "output": "Atelectasis at the right lung base with small but decreased pleural effusion." }, { "input": "Moderate retrocardiac atelectasis is unchanged. A moderate-to-large left pleural effusion is unchanged. Hilar contours are normal. The heart is moderately enlarged unchanged from ___. Patient is status post median sternotomy. The wires are properly aligned and intact. A left central venous line ends in the mid SVC unchanged from prior.", "output": "1. A moderate to large left pleural effusion is unchanged from ___. 2. Left central venous line ends in the mid SVC unchanged from prior. 3. Moderate retrocardiac atelectasis is unchanged from ___." }, { "input": "The heart is moderately enlarged, unchanged from ___. There is mild pulmonary edema. There are small bilateral pleural effusions with fluid tracking along the right costophrenic sulcus. Bilateral basilar opacities are likely atelectasis. There is no pneumothorax. The mediastinal and hilar contours are unchanged. Eventration of the right hemidiaphragm is less conspicuous on this study.", "output": "Moderate cardiomegaly with mild pulmonary edema, small bilateral pleural effusions, and bibasilar atelectasis." }, { "input": "Frontal and lateral chest radiographdemonstrates stable large left pleural effusion with retrocardiac opacity. Right lung is clear. No right pleural effusion. Heart is moderately enlarged, unchanged from ___. Mediastinal contour and hila are otherwise unremarkable. Intact median sternotomy wires and mediastinal clips are noted. Limited assessment of the upper abdomen is within normal limits.", "output": "1. Stable large left pleural effusion with retrocardiac atelectasis, unchanged from ___. Cannot exclude superimposed infection in the appropriate clinical setting. 2. Persistent moderate cardiomegaly, stable since ___. 3. No pulmonary edema." }, { "input": "Patient is status post median sternotomy and CABG. Cardiac silhouette size remains moderately enlarged but unchanged. The aorta remains tortuous. Pulmonary vasculature is mildly engorged. Linear and patchy bibasilar opacities likely reflect areas of atelectasis. Small left pleural effusion appears relatively unchanged compared to the previous study. No pneumothorax is identified. There are no acute osseous abnormalities. Degenerative changes are seen within the thoracic spine.", "output": "Mild pulmonary vascular engorgement and unchanged small left pleural effusion. Continued bibasilar atelectasis." }, { "input": "Median sternotomy wires are intact. Mild to moderate cardiomegaly is unchanged. There is no overt pulmonary edema. Mild pulmonary vascular congestion has improved from ___. There are small bilateral pleural effusions, larger on the left, not changed from prior exam. There is no pneumothorax. There is platelike left basilar atelectasis.", "output": "1. Improved pulmonary vascular congestion. No over pulmonary edema. 2. Persistent left lower lobe atelectasis. 3. Small bilateral pleural effusions." }, { "input": "There is no subdiaphragmatic free air. Moderate cardiomegaly is unchanged. Eventration of the right hemidiaphragm is again noted. Bilateral pleural thickening, right greater than left is unchanged. There is no pneumothorax, overt pulmonary edema, or focal consolidation worrisome for pneumonia. Scarring in the right lower lobe may be from chronic aspiration.", "output": "No acute cardiopulmonary process. Moderate cardiomegaly and pleural thickening is unchanged.Scarring in the right lower lobe may be from chronic aspiration." }, { "input": "There is moderate cardiomegaly, unchanged. Left pleural effusion is decreased in size, and linear opacities in the left lower lung are indicative of atelectasis, likely chronic. The right lung demonstrates mild atelectasis at the base. Sternal wires are intact.", "output": "Smaller left pleural effusion compared to ___, with unchanged heterogeneous opacity in the left lower lung, likely representing atelectasis." }, { "input": "Moderate cardiomegaly is unchanged. Eventration of the right hemidiaphragm is noted. Blunting of the bilateral costophrenic angles, likely secondary to pleural thickening, as demonstrated on CT from ___. Bibasilar opacities, likely represent atelectasis. There is no pneumothorax. Mediastinal and hilar contours are stable.", "output": "No acute cardiopulmonary process. Chronic changes of pleural thickening at the bilateral lung bases and moderate cardiomegaly." }, { "input": "PA and lateral chest radiographs. There is no focal consolidation, pleural effusion, or pneumothorax. Subsegmental areas of atelectasis in the right lung base can be seen on CT Abdomen from same date. Eventration of the right hemidiaphragm and tortuosity of the thoracic aorta are unchanged from multiple priors. The heart size is top normal.", "output": "No acute cardiopulmonary process." }, { "input": "A moderate left pleural effusion is stable in size since ___. Linear opacities in left lower lobe represent partial left lower lobe collapse. There is mild pulmonary vascular congestion which is new since ___. The cardiac and mediastinal contours are stable. No pneumothorax identified.", "output": "Mild pulmonary vascular congestion is new since ___. Moderate left pleural effusion and left lower lobe volume loss are stable since ___." }, { "input": "AP and lateral views of the chest. The lungs are hyperinflated but are clear. Focal opacity projects over the anterior right 4th rib is thought to be calcification of the costochondral cartilage. The lungs are otherwise notable for right apical calcified scarring. Small hiatal hernia is noted. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "Lungs are well-expanded. There is no focal consolidation, pleural effusion or pneumothorax. Scarring at the right apex is unchanged. The cardiomediastinal silhouette is unchanged. The imaged upper abdomen is unremarkable. The bones are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest demonstrate the lungs are well expanded and clear. The cardiomediastinal silhouette is unremarkable. The hilar and pleural surfaces are unremarkable with no evidence of pleural effusion. There is no pneumothorax, pulmonary edema or focal consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. Mild degenerative changes are seen in thoracic spine. Clips are noted in the right upper quadrant of the abdomen compatible with prior cholecystectomy.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Endotracheal tube tip 4.5 cm above carina. Enteric tube tip in the mid stomach. Right Port-A-Cath tip near cavoatrial junction. Postoperative changes in the upper abdomen with drains, ___, IVC filter in place. Lungs are clear. Normal heart size, pulmonary vascularity. No effusion. No pneumothorax.", "output": "Postoperative changes. No acute cardiopulmonary changes." }, { "input": "Frontal and lateral views of the chest. Peribronchial cuffing in the periohilar region is identified. There is no focal opacity, pleural effusion or pneumothorax. The cardiac and mediastinal contours are normal.", "output": "Nonspecific peribronchial cuffing in the perihilar region could indicate acute or chronic bronchitis or asthma." }, { "input": "Heart size is normal. Hilar contours are unremarkable. Focal pulled along the left lateral aspect of the descending thoracic aortic contour at the level of the aortic hiatus is noted. The pulmonary vascularity is normal. Focal round hazy opacity is noted within the left mid lung field, concerning for pneumonia. Right lung is clear. No pleural effusion or pneumothorax is identified. There are no acute osseous abnormalities detected.", "output": "1. Rounded hazy opacity in the left mid lung field, concerning for pneumonia. 2. Left lateral bulge along the descending thoracic aortic contour at the level of the aortic hiatus, of uncertain etiology. This could be further assessed with CT or MRI on a nonemergent basis." }, { "input": "Normal heart size, mediastinal and hilar contours. No focal consolidation, pleural effusion or pneumothorax. No apical mass to suggest Pancoast tumor.", "output": "No mass to suggest Pancoast tumor." }, { "input": "The heart is again mildly enlarged but difficult to visualize on this film in its entirety. The aortic arch is again calcified. The lung volumes are low. Patchy perihilar opacification with indistinct pulmonary vascularity suggests mild vascular congestion or fluid overload. Otherwise, the examination is limited. It is difficult to exclude pleural effusions. There is no pneumothorax. Similar moderate relative elevation of the right hemidiaphragm is noted. Prominent lucency beneath the right hemidiaphragm appears very similar and is likely to reflect colonic interposition noting that the appearance is basically unchanged. There is a mildly prominent gas distended segment of bowel projecting over the right upper quadrant, potentially small bowel.", "output": "Findings suggesting mild vascular congestion. Similar elevation of the right hemidiaphragm with lucency compatible with colonic interposition, noting lack of change. However, clinical correlation is suggested. There is also mildly dilated segment of probable small bowel projecting over the right upper quadrant of the abdomen. Correlation with abdominal symptoms, if any, is recommended." }, { "input": "Persistent mild-to-moderate pulmonary vascular congestion; however, pulmonary edema is improved asymmetrically better on the right. Mediastinal silhouette remains stably at the upper limits of normal. Calcifications are noted at the aortic arch. Colonic interposition is again noted. Osseous structures remain normal.", "output": "Continued mild-to-moderate vascular congestion. However, pulmonary edema has improved asymmetrically better on the right." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. There is mild reverse S-shaped thoracolumbar curvature.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "Compared to the scout film from the CT chest of ___, the right upper lobe opacity is increased. Right lower lung zone opacity, most likely in the middle lobe is also worse. The left lung is clear. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal. The osseous structures are unremarkable.", "output": "Worsening right upper lobe and right middle lobe opacities when compared to the scout film from CT chest on ___." }, { "input": "Right basilar opacities most likely atelectasis. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities. There is no free intraperitoneal air.", "output": "No acute cardiopulmonary process. Probable right basilar atelectasis." }, { "input": "AP and lateral views of the chest ___ at 17 38 are submitted.", "output": "Small bilateral pleural effusions with minimal patchy opacity at the right base suggestive of improving atelectasis. No pulmonary edema. There is central vascular congestion with slight cephalization consistent with pulmonary venous hypertension. No developing consolidation is seen to suggest pneumonia. Overall cardiac mediastinal contours are stable. No pneumothorax." }, { "input": "The cardiac silhouette size is normal. Mediastinal and hilar contours are unchanged. The pulmonary vascularity is not engorged. Minimal patchy opacity within the left lower lobe could reflect an area of infection, best seen on the lateral view. No pleural effusion or pneumothorax is identified. Bilateral pleural thickening laterally is unchanged.", "output": "Patchy left lower lobe opacity could reflect an area of infection." }, { "input": "Frontal and lateral chest radiographs were obtained. Compared to prior study, median sternotomy wires are unchanged in position and orientation. However, there is a questionable focal break in the seventh wire, best appreciated on the lateral view. There is improvement in the small left pleural effusion and associated retrocardiac compressive atelectasis. The right pleural effusion has improved, although there is now linear atelectasis in the right juxtahilar region. No focal consolidation, pneumothorax, or pulmonary edema is seen. Postoperative cardiomediastinal silhouette and hilar contours are stable.", "output": "1. Possible tiny/focal disruption in the seventh sternotomy wire best visualized on lateral view, in retrospect unchanged since ___. If there is clinical suspicion for dehiscence or peristernal infection, CT would be recommended. 2. Interval improvement in bilateral pleural effusions and left retrocardiac atelectasis, but new right juxtahilar linear atelectasis." }, { "input": "There is a mild interstitial abnormality similar to the prior study, but no focal opacification. There is no pleural effusion or pneumothorax. The cardiac, mediastinal and hilar contours appear unchanged.", "output": "Mild interstitial abnormality, possibly due to slight vascular congestion or airway inflammation, but not significantly changed." }, { "input": "AP and lateral views of the chest were provided. Right lower lung consolidation is seen with loculated right pleural effusion/thickening. While this may represent pneumonia, underlying neoplasm cannot be excluded and followup to resolution is advised. The left lung is clear. Cardiomediastinal silhouette appears grossly unremarkable allowing for subtle effacement along the right heart border. Bony structures appear grossly intact. No free air below the right hemidiaphragm is seen.", "output": "Consolidation within the right lower lung with subjacent loculated pleural fluid/thickening. Given the absence of prior imaging studies, differential is broad and includes infection and neoplasm. Please correlate clinically and with prior imaging studies if available. Consider CT to further assess." }, { "input": "Portable AP chest radiograph. Right basilar pleural pigtail is curled within the periphery of the right hemithorax with interval decrease in size of basal component of the loculated right pleural effusion. The more superior portion persists unchanged. Improved basilar aeration is noted. The left lung is clear. No pneumothorax is seen. Heart and mediastinal contours are unremarkable.", "output": "Status post placement of right basal pleural catheter located in the peripheral right hemithorax with decrease in the right basal component of the pleural effusion without pneumothorax." }, { "input": "Frontal and lateral chest radiographs demonstrates left PICC tip within the lower SVC. The lungs are mildly hypoinflated, unchanged from previous examination. No pleural effusion or pneumothorax. Mild perihilar and interstitial opacities are likely related to vascular crowding from low lung volumes. No focal opacity. Bibasilar linear atelectasis is noted. Persistent mild cardiomegaly. Mediastinal contour and hila are unremarkable. Limited assessment of the osseous structures are is within normal limits and upper abdomen is unremarkable.", "output": "1. Left PICC tip within the lower SVC. 2. Persistent mild cardiomegaly with bibasilar atelectasis." }, { "input": "There is a in 8 mm rounded nodular opacity projecting over the left mid to upper lung overlying the left sixth rib, not clearly seen on the prior chest radiograph. A CT is needed to further assess. Lungs are otherwise clear without focal consolidation, large effusion or pneumothorax. The cardiomediastinal silhouette appears normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "8 mm nodule projecting over the left upper lung requires further evaluation by chest CT. NOTIFICATION: Findings and recommendations were entered into the critical results dashboard for communication." }, { "input": "The lung volumes are slightly low, accentuating the heart size, which is top normal. There is no pneumothorax, pleural effusion, overt pulmonary edema, or focal consolidation worrisome for pneumonia. Anterior wedge compression deformity of the T5 vertebral body is stable since ___.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low, resulting in bronchovascular crowding. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural effusion, or consolidation.", "output": "No acute cardiopulmonary process." }, { "input": "In comparison with the chest radiograph obtained 1 day prior, there is been interval intubation. An ET tube terminates 2.8 cm above the carina. An enteric tube side port projects over the mid stomach. No other significant changes are appreciated. Right upper lung and perihilar opacification is similar, probably a combination of known lung cancer with postobstructive pneumonia. Substantial emphysematous changes are stable bilaterally.", "output": "An ET tube terminates 2.8 cm above the carina. Unchanged appearance of right upper lobe opacities concerning for postobstructive pneumonia." }, { "input": "In comparison with the study of ___, there has been the development of a large right hilar and suprahilar mass measuring approximately 6 cm in diameter with fibrotic stranding extending to a region of pleural thickening in the lateral chest wall. This most likely represents a malignancy. Hyperexpansion of the lungs is consistent with the clinical diagnosis of COPD. There is a right pleural effusion with suggestion of some apical thickening on the side. No evidence of vascular congestion or acute focal pneumonia.", "output": "Large right hilar mass most likely representing malignancy RECOMMENDATION(S): CT for further evaluation NOTIFICATION: Dr. ___" }, { "input": "There is a cavitating mass in the right upper lobe with associated volume loss and destruction of 1 of the overlying ribs. This is unchanged in appearance when compared to the prior study. An endotracheal tube is in-situ, the tip terminates approximately 3.5 cm above the level the carina. A nasoenteric tube terminates below the left hemidiaphragm, the tip is not visualized. A left internal jugular catheter terminates in the proximal SVC. Prominence of the right hilum is presumed reflect lymphadenopathy versus direct extension of the known mass. Left lung appears grossly clear. No pleural effusion seen.", "output": "No significant interval change when compared to the prior study." }, { "input": "Similar to scout image from ___, there is large area of opacity in the right upper hemi thorax in right perihilar region concerning for postobstructive pneumonia secondary to known large juxta hilar mass. The left lung remains hyperinflated. No large pleural effusion is seen. There is no evidence of pneumothorax. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Large area of right upper hemi thorax and right juxta hilar opacity, grossly similar in distribution as compared to the prior CT, although with possibly slightly more fluid in the right lung apex, overall worrisome for postobstructive pneumonia secondary to right juxta hilar mass. Reported right chest wall metastasis on prior CT better assessed on CT." }, { "input": "Cardiac, mediastinal and hilar contours are within normal limits. Lungs are clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormality is visualized.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac silhouette is top-normal. Mediastinal contours are unremarkable. No pulmonary edema is seen.", "output": "No acute cardiopulmonary process." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The aorta is unremarkable and there is no distention of the azygos vein. The lungs are clear. There are no focal consolidations, pleural effusions, pulmonary edema or pneumothorax.", "output": "No evidence of pulmonary metastases." }, { "input": "Very subtle opacity at the right lung base may be artifactual but a very mild/very early consolidation is not excluded. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Very subtle opacity at the right lung base may be artifactual but a very mild/very early consolidation is not excluded." }, { "input": "Moderate left pleural effusion and left lower lobe atelectasis are unchanged and left trans subclavian right atrial ventricular pacer leads, continuous from the left pectoral generator pharyngeal. There is no pneumothorax or mediastinal widening. Right lung is clear.", "output": "No unfavorable change, stable appearance of the pacer leads and moderate left effusion." }, { "input": "There is a NG tube which extends below the diaphragm with the tip out of view of this exam. Small-to-moderate bilateral pleural effusions have slightly improved compared to the prior exam. There is no pulmonary edema. No focal consolidations concerning for pneumonia are identified. There is no pneumothorax. The visualized osseous structures are unremarkable.", "output": "Interval improvement of the small-to-moderate bilateral pleural effusions, left greater than right. No other acute intra-thoracic abnormalities identified." }, { "input": "Normal heart size and mediastinal contours. Bibasilar atelectasis persists. No large pleural effusion or pneumothorax. The cystgastrostomy tube is in unchanged position in the left upper quadrant.", "output": "Unchanged atelectasis. No evidence of pneumonia." }, { "input": "The lungs are clear without consolidation, effusion, or edema. Biapical scarring which is partially calcified is again noted. The cardiomediastinal silhouette is within normal limits. Median sternotomy wires are intact. Atherosclerotic calcifications seen at the aortic arch. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process. ___, MD CC: DR. ___" }, { "input": "PA and lateral views of the chest were provided. There is no focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours are normal. Atherosclerotic calcification seen along the aortic knob. The bony structures are intact. No free air below the right hemidiaphragm. Degenerative anterior spurring in the mid and lower thoracic spine noted.", "output": "No acute findings in the chest." }, { "input": "PA and lateral chest radiographs demonstrate mildly increased central pulmonary vascular prominence and a small left pleural effusion. There is no pneumothorax. The heart size is mildly enlarged.", "output": "Mild interstitial edema." }, { "input": "The heart size is moderately enlarged. Aortic knob is densely calcified. The ascending aorta is dilated, but similar compared to the prior exams. Pulmonary vascularity is not engorged. The lungs are hyperinflated. Streaky bibasilar airspace opacities could reflect atelectasis. No pleural effusion or focal consolidation is noted. There is no pneumothorax. No acute osseous abnormalities are seen. Mild degenerative changes of the thoracic spine are present.", "output": "Mild bibasilar atelectasis. Unchanged dilated ascending aorta." }, { "input": "A dialysis catheter has been removed. The heart is again mild-to-moderately enlarged. The mediastinal and hilar contours appear unchanged. There is mild perihilar congestion, but less than on the prior examination. There is no pleural effusion or pneumothorax. Mild-to-moderate degenerative changes are noted along the thoracic spine.", "output": "Findings suggesting mild vascular congestion, although less than on the prior exam." }, { "input": "PA and lateral views of the chest were obtained. A right IJ dialysis catheter is seen with its tip in the expected location of the cavoatrial junction. There is mild pulmonary venous congestion with probable mild pulmonary edema. No large pleural effusions are seen. In the presence of pulmonary edema the possibility of a superimposed mild/early pneumonia is impossible to exclude, though none is clearly seen. No pneumothorax. Heart size is top normal though stable. Aortic calcifications are noted. Bony structures appear intact though there are degenerative spurs along the mid thoracic spine.", "output": "Mild pulmonary edema without definite signs of pneumonia though post-diuresis films may be obtained to further assess if clinically warranted." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. Lungs are well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. The lungs are clear. There are no pleural effusions or pneumothorax. The bony structures appear within normal limits.", "output": "No evidence of acute cardiopulmonary disease." }, { "input": "The lungs are clear. There is no consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "Left-sided Port-A-Cath tip terminates at the junction of the SVC and right atrium. Lung volumes are low. Heart size is accentuated as a result appearing mildly enlarged. Mediastinal contour is similar. The hilar contours are unremarkable. Crowding of bronchovascular structures is present without overt pulmonary edema. There are patchy opacities in the lung bases, potentially atelectasis in the setting of low lung volumes. Previously described nodules seen on chest CT are not visualized on the current exam. No large pleural effusion or pneumothorax is present. There are no acute osseous abnormalities.", "output": "Limited study as result of low lung volumes. Patchy opacities in the lung bases may reflect atelectasis but infection or aspiration cannot be excluded in the correct clinical setting." }, { "input": "The heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures are unremarkable.", "output": "No evidence of acute disease." }, { "input": "The lungs are clear. There is no evidence of pneumonia, pneumothorax, or pleural effusion. Cardiac silhouette is normal in size.", "output": "No acute cardiopulmonary process" }, { "input": "The lungs are clear. The cardiomediastinal silhouette and hilar contours are within normal limits. The pleural surfaces are clear without effusion or pneumothorax.", "output": "No evidence of pneumonia." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process. No free air below the right hemidiaphragm." }, { "input": "Cardiac, mediastinal and hilar contours are normal. Pulmonary vasculature is normal and the lungs are clear. No pleural effusion or pneumothorax is seen. There is minimal scarring in the lung apices. No acute osseous abnormalities seen.", "output": "No acute cardiopulmonary process." }, { "input": "On the frontal view, there is very subtle opacity projecting over the region of the posterior right fifth rib but also overlaps with the scapula and anterior right second rib, maybe due to overlap of structures; however, this could be confirmed with oblique views to further assess. No focal consolidation is seen elsewhere. No large pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are unremarkable.", "output": "Subtle opacity projecting over the right upper hemithorax in the region where the posterior fifth rib overlies with the anterior second rib and part of the scapula, may be due to overlapping structures. However, this could be confirmed with oblique radiographs for further evaluation. No focal consolidation seen elsewhere." }, { "input": "The lungs are clear. There is no focal consolidation, effusion, or edema. Cardiac silhouette is top-normal, accentuated by slightly low lung volumes. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "AP upright portable chest radiograph is obtained. There is no evidence of free air below the right hemidiaphragm. The lungs appear clear bilaterally. Cardiomediastinal silhouette is normal. Bones appear intact.", "output": "No acute findings including no sign of pneumoperitoneum." }, { "input": "Patient is status post median sternotomy and CABG. An SVC stent is re- demonstrated in unchanged position compared to the previous CT. The heart size is mildly enlarged. Paramediastinal radiation fibrosis is again noted. The mediastinal and hilar contours are relatively unchanged, with the known anterior mediastinal mass better appreciated on the previous chest CT. Pulmonary vasculature is not engorged. The lungs are hyperinflated. Small right pleural effusion with thickening along the right minor fissure is unchanged. Patchy atelectasis is seen in the lung bases. No new focal consolidation or pneumothorax is present. Known metastatic involvement of the manubrium is also better assessed on the recent CT.", "output": "No substantial interval change from the previous chest CT. Continued small right pleural effusion with bibasilar atelectasis. Paramediastinal radiation fibrosis re- demonstrated." }, { "input": "Frontal and lateral chest radiographs demonstrate a mildly enlarged heart, unchanged. Median sternotomy wires are intact. Paramediastinal radiation fibrosis is unchanged, allowing for differences in inspiration. There may be slightly decreased volume in the right lower lobe, with mild rightward shift of the mediastinum. There is a new focal opacity in the left upper lung, as well as increased opacity in the right lung. Bilateral pleural effusions, right greater than left, right increased. There is no pneumothorax. The visualized upper abdomen is unremarkable.", "output": "1. New focal opacity in the left upper lung, as well as more diffusely in the right lung. These are evaluated in greater detail on CTA chest from the same day. 2. Increased bilateral pleural effusions, right greater than left." }, { "input": "The AP view of the chest. The lungs are clear of confluent consolidation. Biapical scarring is again seen. Linear opacity at the left lung base most suggestive of atelectasis. Cardiomediastinal silhouette is within normal limits. Surgical clips seen in the left upper quadrant. There is no free intraperitoneal air. No acute osseous abnormality detected.", "output": "No acute cardiopulmonary process, no free intraperitoneal air." }, { "input": "The lungs are clear without focal infiltrate. There are minimal bilateral pleural effusions. The heart is upper limits normal in size. Aorta is mildly tortuous. There is apical pleural thickening.", "output": "No focal infiltrate." }, { "input": "Lung volumes are low on the right without convincing evidence of lobar atelectasis. There are multiple right-sided rib deformities consistent with old rib fractures. No pneumothorax. There is mild prominence of the bilateral hila and pulmonary vasculature consistent with a mild degree of congestive heart failure but no frank pulmonary edema. Mild cardiomegaly may be exaggerated by the projection. No consolidation or pleural effusion seen.", "output": "5 suggestive of mild congestive heart failure. No frank pulmonary edema seen." }, { "input": "The lungs are clear of consolidation, effusion, or edema. Two calcified nodules project over the left mid lung and right upper lung laterally are likely calcified granulomas. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process. Two calcific densities projecting over the lungs, 1 at the right lung apex and 1 over the left mid lung suggestive of calcified granulomas in the setting of prior granulomatous disease." }, { "input": "The lungs are clear with no evidence of a consolidation, effusion, or pneumothorax. Cardiomediastinal silhouette is normal. No acute fractures are identified.", "output": "No acute cardiopulmonary process." }, { "input": "Two views were obtained of the chest. Right Port-A-Cath terminates with tip in the upper right atrium. The lungs appear well expanded and clear without pleural effusion or pneumothorax. The heart is normal in size with normal cardiomediastinal contours.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest. Right chest wall port is seen with catheter tip in the upper right atrium, similar to prior. The lungs are clear of consolidation or pulmonary vascular congestion. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities detected.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest were obtained. Left-sided Port-A-Cath is seen terminating in the low SVC without evidence of pneumothorax. No focal consolidation is seen. There is no pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Left-sided Port-A-Cath tip terminates in the lower SVC. Heart size is normal. Mediastinal and hilar contours are unremarkable. Pulmonary vasculature is not engorged. Patchy right upper lobe opacities are re- demonstrated, as seen on the prior CT, and thought to reflect infection. Small bilateral pleural effusions, larger on the left are re- demonstrated with associated lower lobe atelectasis. No new focal consolidation or pneumothorax is present. Multilevel degenerative changes are seen in the thoracic spine.", "output": "Patchy right upper lobe opacities, as seen on the prior chest CT, and thought to reflect areas of infection. No new focal consolidation. Small bilateral pleural effusions, with associated bilateral lower lobe atelectasis." }, { "input": "Left-sided Port-A-Cath terminates in the low SVC. New dense left lower lobe and lower under consolidation can be pneumonia and/or aspiration. There is likely adjacent pleural fluid. The right lung is clear. Heart size is normal. No pneumothorax.", "output": "New dense consolidation in the left lower lobe with associated moderate effusion can be pneumonia." }, { "input": "Frontal and lateral views of the chest were obtained. Popcorn-like calcification is seen along the right paratracheal region of unclear etiology. Recommend correlation with prior studies to assess stability, if none, nonurgent chest CT for further evaluation. Anterior, inferior right upper lobe linear atelectasis/scarring is seen. There is no focal consolidation, pleural effusion, or evidence of pneumothorax. The aorta is calcified and tortuous. The bones are diffusely osteopenic.", "output": "Area of amorphous calcification spanning approximately 6 cm projecting over the right paratracheal region, of unclear etiology. Recommend correlation with any prior radiograph to assess for stability, if none, nonurgent chest CT would help further evaluate." }, { "input": "Cardiomediastinal contours are normal. The lungs are clear. There is no pneumothorax or pleural effusion. The osseous structures are unremarkable", "output": "No acute cardiopulmonary abnormalities" }, { "input": "No focal consolidation, pleural effusion, or pneumothorax is seen. Heart and mediastinal contours are within normal limits.", "output": "No radiographic evidence for pneumonia. These findings were discussed with Dr. ___ by Dr. ___ by telephone at 8:45 p.m. on ___." }, { "input": "There is no new consolidation. The heart and mediastinum are within normal limits. Trace bilateral pleural effusions are new.", "output": "No new consolidation. New trace bilateral pleural effusions." }, { "input": "Stable bilateral lower lung volumes. The small left pleural effusion is new. There is minor atelectasis of the left lung base. No pneumothorax, focal consolidation, or pulmonary edema. Stable appearance of the mediastinum and hila. The heart size is normal.", "output": "Small left pleural effusion and minor left lower lung atelectasis." }, { "input": "The lungs are clear. The heart size is normal. The mediastinal contours are normal. There are no pleural effusions. No pneumothorax is seen.", "output": "No acute cardiac or pulmonary findings." }, { "input": "Portable upright chest radiograph demonstrates bibasilar opacity likely reflecting atelectasis with superimposed mild lower lobe edema, worse on the right. Small bilateral effusions may be present, but this is incompletely evaluated without a lateral view. The cardiac silhouette is unchanged and normal in size. There are post-surgical changes of median sternotomy and CABG. Mediastinal contours are normal. A left chest pacemaker with atrial and ventricular leads is unchanged in appearance. The pulmonary vasculature is normal.", "output": "Bibasilar opacities likely reflect mild CHF." }, { "input": "Median sternotomy wires appear intact. Surgical clips again project over the mediastinum following coronary artery bypass graft. Left chest wall pacemaker has leads in the right atrium and right ventricle. The heart is top normal, unchanged. There are small worsening bilateral pleural effusions and bibasilar opacities likely atalectasis. There is calcification of the aortic arch. Interstitial pulmonary edema is mild.", "output": "1. Stable mild cardiomegaly with mild interstitial pulmonary edema and interval increase in small bilateral pleural effusions. 2. Mild bibasilar opacities likely reflect atalectasis, less likely pneumonia." }, { "input": "The lungs are clear without focal opacity, pulmonary edema, pleural effusion or pneumothorax. The cardiac size is normal. A pacer has leads ending in the right atrium and right ventricle. Sternotomy wires are intact.", "output": "No pulmonary edema or acute intrathoracic process." }, { "input": "Frontal and lateral views of the chest. Left chest wall pacing device seen with leads in the right atrium and right ventricular apex. The lungs are clear of consolidation, effusion or pneumothorax. Linear opacities at the left costophrenic angle are suggestive of atelectasis. Cardiomediastinal silhouette is within normal limits. Median sternotomy wires and mediastinal clips again noted. No acute osseous abnormality is detected.", "output": "No acute cardiopulmonary process." }, { "input": "Midline sternotomy wires, mediastinal clips and left chest wall pacer device are again noted with dual leads extending to the region of the right atrium and right ventricle. Top normal heart size again noted with interval improvement of mild pulmonary edema. Although there is mild bibasilar atelectasis, there is a persistent opacification of the left lower lobe. Small bilateral pleural effusions are evident on the lateral projection. There is no evidence of pneumothorax. Mediastinal contour is stable. Atherosclerotic calcifications along the thoracic aortic arch are noted. The visualized osseous structures are unremarkable. There is no evidence of pneumothorax.", "output": "Interval improvement of mild pulmonary edema. Persistent opacity in the left lower lobe, for which a CT is recommended for further evaluation. Findings placed in critical results dashboard on the day of the exam." }, { "input": "PA and lateral views of the chest provided. Midline sternotomy wires, mediastinal clips and left chest wall pacer device again noted with dual leads extending to the region of the right atrium and right ventricle. Top normal heart size is again noted with mild pulmonary edema, similar to slightly progressed from prior exam. There is mild basilar atelectasis. Small bilateral pleural effusions are evident on the lateral projection. There is no pneumothorax. Mediastinal contour is stable. Atherosclerotic calcifications along the thoracic aorta at the arch noted. Bony structures appear intact. No free air below the right hemidiaphragm.", "output": "Mild cardiomegaly with mild pulmonary edema and small bilateral pleural effusions." }, { "input": "The lungs are clear with no focal opacities. There is some minimal bibasilar atelectasis. The cardiomediastinal silhouette and hilar contours are normal. The pleural surfaces are clear without effusion or pneumothorax. The left chest wall pacing device and pacer leads are unchanged in appearance.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Mild linear opacities in the lung bases have slightly increased can be increasing atelectasis. No pulmonary edema. Mild cardiac enlargement. Pacer wires in the right atrium and right ventricle. No pleural effusion or pneumothorax.", "output": "Minimal atelectasis in the lung bases, lungs are otherwise clear." }, { "input": "The lungs are hyperinflated bilaterally, but are otherwise clear without evidence of focal consolidation. Cardiomediastinal and hilar silhouettes and pleural surfaces are normal.", "output": "Hyperinflated lungs may reflect obstructive pulmonary disease. No evidence of acute cardiopulmonary process." }, { "input": "No focal consolidation is seen there is no pleural effusion or pneumothorax The cardiac and mediastinal silhouettes are stable.", "output": "No acute cardiopulmonary process. No significant interval change." }, { "input": "The lungs are clear. Streaky left basilar opacity is likely atelectasis versus scarring. Cardiomediastinal silhouette is stable. Tortuosity of the descending thoracic aorta is again noted. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear. The mediastinal silhouette and hila are normal. There is mild cardiomegaly. There is no pleural effusion and there is no pneumothorax.", "output": "No acute cardiothoracic process. Mild cardiomegaly." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is stable. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well inflated and clear. No focal consolidation, nodule, effusion, or pneumothorax is present. The cardiac and mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are mildly hyperinflated, but are otherwise clear. Cardiomediastinal silhouette is unremarkable. There is no pneumothorax or pleural effusion. Visualized osseous structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is opacity in the right lung apex with central lucency raising concern for a cavitary lesion or consolidation around a bleb. No additional consolidation is seen. No pleural effusion, pulmonary edema, or pneumothorax is present. The heart size is within normal limits.", "output": "Opacity in the right lung apex with central lucency raising concern for a cavitary lesion. Patient underwent subsequent chest CT on which this was better evaluated." }, { "input": "AP and lateral views of the chest provided. The heart is moderately enlarged with a left ventricular configuration. There is no edema or signs of pneumonia. No effusion or pneumothorax. Bony structures appear intact.", "output": "Moderate cardiomegaly." }, { "input": "There is an oblong 1.6 x 0.7 cm opacity projecting over the right mid lung which could relate to scarring however underlying pulmonary nodule is not excluded. This could be further assessed on non urgent chest CT. The left lung is clear. There is no pleural effusion or pneumothorax. Cardiac and mediastinal silhouettes are unremarkable. No pulmonary edema is seen.", "output": "Oblong 1.6 x 0.7 cm opacity projecting over the right mid lung without priors for comparison. Recommend nonemergent chest CT for further assessment. RECOMMENDATION(S): Oblong 1.6 x 0.7 cm opacity projecting over the right mid lung without priors for comparison. Recommend nonemergent chest CT for further assessment." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Again seen is mild postoperative widening of the cardiomediastinal silhouette, similar to prior. Median sternotomy wires are intact. Lung volumes are low, and there is a small left basilar pleural effusion with adjacent atelectasis. The presence of low lung volumes makes it difficult to exclude mild pulmonary edema. No pneumothorax.", "output": "1. Small left basilar pleural effusion with adjacent atelectasis. 2. Interstitial edema is mild if present." }, { "input": "There has been interval removal of the ET tube, Swan-Ganz catheter, chest tube, mediastinal drains, and NG tube. There is volume loss in both lower lungs. The heart is mildly enlarged. Sternal wires and mediastinal clips are again seen. There is minimal pulmonary vascular redistribution. There is no pneumothorax.", "output": "No pneumothorax post chest tube removal." }, { "input": "PA and lateral views of the chest provided. Sternotomy wires are noted. Linear opacities in the bilateral lower lobes likely represent bibasilar atelectasis versus scarring. There are atherosclerotic calcifications involving the aortic arch and descending thoracic aorta. No radiopaque cardiac valve is seen. S-shaped curvature of the thoracolumbar spine is noted.", "output": "1. No radio opaque cardiac valve is seen. 2. Bibasilar atelectasis." }, { "input": "No focal consolidation is seen. No pleural effusion or pneumothorax is seen. Cardiac silhouette is top-normal. The aorta is calcified and tortuous.", "output": "No acute cardiopulmonary process." }, { "input": "Compared with the prior radiograph, no change in the positioning of the left-sided AICD leads, projecting to the right atrium and right ventricle. Mild cardiomegaly is unchanged. No new focal consolidation, pleural effusion, or pneumothorax.", "output": "No acute intrathoracic process. No change since ___." }, { "input": "AP portable upright view of the chest. Overlying EKG leads are present somewhat limiting assessment. The heart appears top-normal in size. Interstitial opacities are noted bilaterally which could reflect chronic lung disease i.e. fibrosis and/or interstitial pulmonary edema. Please correlate clinically. No large effusion or pneumothorax. No focal opacity concerning for pneumonia. Bony structures are intact", "output": "Interstitial opacities noted bilaterally which could reflect chronic lung disease and/or pulmonary interstitial edema. Please correlate clinically." }, { "input": "Dual lead left-sided pacer device is stable in position. The cardiac and mediastinal silhouettes are stable. No focal consolidation is seen. There is no pleural effusion or pneumothorax. No pulmonary edema is seen.", "output": "Stable position of the left ICD. No pulmonary edema." }, { "input": "When compared to prior, there has been no significant interval change. Moderate size right-sided pneumothorax is not significantly changed. Right-sided Port-A-Cath is in stable position. There is no focal consolidation. Cardiomediastinal silhouette is stable. Subcutaneous gas again projects over the right axilla.", "output": "No significant interval change of a moderate right-sided pneumothorax." }, { "input": "A right chest wall Port-A-Cath ends in the proximal right atrium. A right sided pneumothorax has not significantly changed in size but there is a new fluid component. The cardiomediastinal silhouette is unchanged. Subcutaneous gas is less conspicuous on the current study. There is no focal consolidation. Linear areas of atelectasis are noted at the left lung base.", "output": "Moderate right hydropneumothorax." }, { "input": "Right chest wall port is seen with catheter tip at the RA SVC junction. There is a moderate right-sided pneumothorax which is new from prior. There is no definite signs of tension. Linear opacity at the left lung base is likely atelectasis. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified. Subcutaneous gas projects over the right axilla.", "output": "New moderate right sided pneumothorax. NOTIFICATION: Clinical team was aware of diagnosis at time of dictation based on dashboard note." }, { "input": "Again seen is a moderate right hydro pneumothorax and a right porta cath. Compared to the prior study there is no significant change", "output": "No change" }, { "input": "The cardiac, mediastinal and hilar contours appear stable. There is no pleural effusion or pneumothorax. The lungs appear clear. Prior right anterior lateral fourth through seventh rib fractures appear unchanged. There has been no significant change.", "output": "No evidence of acute disease." }, { "input": "PA and lateral views of the chest provided. A retrocardiac opacity contains a small air bubble likely a small hiatal hernia. Lungs are clear. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process. Small hiatal hernia." }, { "input": "The lungs are clear.The cardiac, hilar and mediastinal contours are normal.No pleural abnormality is seen.", "output": "No acute cardiopulmonary process." }, { "input": "Normal heart size, mediastinal and hilar contours. No focal consolidation, pleural effusion or pneumothorax. Old healed rib fractures are noted on the right fifth and sixth anterior ribs.", "output": "No acute process" }, { "input": "Cardiomediastinal contours are normal. Lungs and pleural surfaces are clear. Healed right rib fractures are again demonstrated.", "output": "No radiographic evidence of pneumonia." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.Prior right anterolateral rib fractures are unchanged.", "output": "No evidence of pneumonia. NOTIFICATION: The above findings were communicated via telephone by Dr. ___ to ___ at 16:02 on ___, ___ min after discovery." }, { "input": "Subtle left basilar opacity may represent atelectasis however early infectious process is not excluded in the appropriate clinical setting. The right lung is clear. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Subtle left basilar opacity may represent atelectasis however early infectious process is not excluded in the appropriate clinical setting." }, { "input": "Heart size, mediastinal and hilar contours are normal. Lungs are well expanded and clear. There are no pleural effusions or concerning new skeletal findings.", "output": "No radiographic evidence of pneumonia." }, { "input": "Frontal and lateral chest radiograph demonstrates unremarkable cardiomediastinal and hilar contours. Interstitial markings are more prominent, likely related to low lung volumes. No focal opacification identified. No pleural effusion or pneumothorax is present. No osseous abnormality identified.", "output": "No acute intrathoracic process." }, { "input": "No significant interval change as compared to chest radiograph from 1 day prior. No pulmonary edema, pneumonia, effusions or pneumothorax. Cardiomediastinal silhouette is unchanged. The dual lead pacer is in similar positioning.", "output": "No pulmonary edema. No significant interval change." }, { "input": "The lungs are fully inflated and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax. Visualized upper abdomen is unremarkable. There is unchanged diffuse osteopenia with some loss of height in the midthoracic vertebral bodies.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "In comparison to the chest radiograph obtained 1 day prior, there has been interval removal of a pericardial drain. Heart size in cardia ___ mediastinal silhouettes are unchanged. Lungs are fully expanded and clear without focal consolidation. No pleural effusions or pneumothorax.", "output": "Interval removal of pericardial drain, otherwise no significant changes. If concerned about pericardial effusion, echocardiogram is recommended." }, { "input": "The lateral view is limited secondary to patient's arms being by his side. The lungs are clear of consolidation or edema. There are small bilateral pleural effusions as seen on recent prior. There is mild to moderate cardiomegaly. Left chest wall dual lead pacing device again seen with lead tips in the right atrium and right ventricle. Surgical clips project over the right upper quadrant.", "output": "Persistent small bilateral pleural effusions. No superimposed acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest demonstrate slightly lower lung volumes than on the prior study. Increased interstitial marking are potentially due to lower volumes and possible vascular congestion. No focal opacity is seen. There is also blunting of the right costophrenic angle, with possible trace pleural effusion. The heart size is moderately enlarged, but stable, with a tortuous aorta. No pneumothorax is seen and there is no evidence of pneumonia.", "output": "Possible trace right pleural effusion. Otherwise, no acute cardiopulmonary disease." }, { "input": "PA and lateral views of the chest were reviewed and compared to the prior study. Moderate-to-severe cardiomegaly and tortuosity of the aorta are unchanged. Normal lungs and pleural surfaces.", "output": "No acute cardiopulmonary process. Unchanged moderate-to-severe cardiomegaly." }, { "input": "The lungs are clear without consolidation, pleural effusion or pneumothorax. The heart size is normal. The aortopulmonary window is indistinct which could be due to adenopathy. Widening of the right paratracheal stripe may be due to a lymphadenopathy or dilated esophagus.", "output": "Widening of the right paratracheal stripe and abnormality of the left mediastinal contours are of uncertain etiology. Further evaluation with chest CT is recommended. NOTIFICATION: The findings and recommendations were discussed by Dr. ___ with Dr. ___ on the telephone on ___ at 1:44 PM, 5 minutes after discovery of the findings." }, { "input": "The lungs are low volume but clear. Mild cardiomegaly. Prior opacity seen in the right lung on ___ has resolved. Mediastinal and hilar silhouettes are normal. Pleural surfaces are normal. Hyperdensities in the abdomen consistent with prior coil embolization of splenic artery.", "output": "Mild cardiomegaly. No acute cardiopulmonary process." }, { "input": "Inspiratory volumes are slightly low. There is new platelike atelectasis the right lung base. Again seen is patchy opacity in the right cardiophrenic region, similar to the prior study. There is subsegmental atelectasis at the left lung base, similar to the prior study. Slight lateralization of left hemidiaphragm and minimal blunting of the left costophrenic angle is unchanged . No CHF or gross right effusion. Radiographs or limited for assessment of pulmonary embolism, but no pathognomic changes of PE are identified.", "output": "1. Slightly low inspiratory volumes. 2. Patchy opacity left lower lobe again seen, consistent with left lower lobe collapse and/or consolidation. 3. Minimal patchy opacity in the right cardiophrenic region is unchanged. New platelike atelectasis at the right lung base. 4. No CHF, gross effusion or pneumothorax detected." }, { "input": "There are curvilinear areas of parenchymal opacity in the right mid zone and an additional irregular opacity in the left base posteriorly. These are of indeterminate acuity. There are opacities that are somewhat similar in distribution seen on the ___ chest x-ray, but the distribution is not identical hand both opacities are larger and more pronounced on today's examination. There is mild cardiomegaly and mild prominence of the cardiomediastinal silhouette. Although cardiac silhouette itself is probably not significantly changed, the mediastinal prominence is new and not clearly fully accounted for by technique. Within the limits of plain film radiography, no hilar adenopathy is detected. No CHF, air bronchograms or effusions are identified. Mild elevation of the right hemidiaphragm is more pronounced than in ___. Mild left greater right apical pleural thickening is also more pronounced. Probable embolization material seen projecting over the upper abdomen distal left of midline, similar to ___.", "output": "Opacities at the right base and posterior left lower lobe are new or significantly changed compared with ___. These are of indeterminate acuity and not fully characterized by a chest x-ray. The differential includes infectious, inflammatory and neoplastic processes. Further assessment with chest CT is recommended. Prominence of the mediastinum appears increased compared with ___. Has there been a change in body habitus to account for this? Attention to this area at the time of the chest CT is recommended. Mild cardiomegaly. Mild left-greater-than-right apical pleural thickening, slightly increased compared with ___. Embolization in the upper abdomen, likely in the region of the left gastric artery. The appearance is grossly unchanged compared with ___. RECOMMENDATION(S): Chest CT recommended to further assess opacities in the right middle and left lower lobes, with additional attention to mediastinal prominence. NOTIFICATION: The impression and recommendation above was entered by Dr. ___ ___ on ___ at 22:21 into the Department of Radiology critical communications system for direct communication to the referring provider." }, { "input": "Compared with ___ at 11:39 a.m. and allowing for technical differences, no definite change is identified. Again seen is patchy opacity in the right infrahilar region and at the left base (previous chest x-ray suggested in the left lower lobe). Cardiomediastinal silhouette is unchanged. There is upper zone redistribution, without overt CHF. No new focal opacity is detected. No pneumothorax is identified. Densities in the upper abdomen likely relate to prior embolization.", "output": "Allowing for technical differences, doubt significant interval change compared with earlier the same day. Again noted (but better seen on the most recent prior study), are non-specific patchy opacities in the right middle and left lower lobes. Chest CT is recommended for further assessment of these opacities and for evaluation of the apparent interval increase in the size of the mediastinum compared with ___. RECOMMENDATION(S): Chest CT is recommended for further assessment of these opacities and for evaluation of the apparent interval increase in the size of the mediastinum compared with ___." }, { "input": "Frontal and lateral views of the chest were obtained. The heart is of normal size with normal cardiomediastinal contours. Pulmonary vasculature is unremarkable. Lungs are clear without focal or diffuse abnormality. No pleural effusion or pneumothorax. Osseous structures are unremarkable. No radiopaque foreign body.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "The lungs are mildly hyperinflated. The cardiomediastinal contour is within normal limits. The heart is not enlarged. There is a slightly prominent epicardial fat pad along the right heart border. No consolidation, pneumothorax or pleural effusion seen. There are moderately severe multilevel degenerative changes in the thoracic spine.", "output": "No acute cardiopulmonary process seen. The lungs appear mildly hyperinflated." }, { "input": "PA and lateral views of the chest were obtained demonstrating midline sternotomy wires and mediastinal clips unchanged. Lungs are clear. There is slight elevation of right hemidiaphragm, unchanged. No focal consolidation, effusion, or pneumothorax. Heart and mediastinal contours are normal. Bony structures are intact.", "output": "No acute intrathoracic process." }, { "input": "PA and lateral chest radiographs were obtained. The lungs are well expanded and clear. There is no focal consolidation, effusion, or pneumothorax. Cardiac and mediastinal contours are normal. Sternal wires are intact. Anterior thoracic vertebral body osteophytes are seen at several levels.", "output": "No acute cardiopulmonary process." }, { "input": "An ET tube is present, tip approximately 3.7 cm above the carina. An NG tube is present, tip and side-port overlying stomach. A third tube, likely an enteric tube with the radiopaque tip, overlies the lower mediastinum and has not pass beyond the GE junction. Inspiratory volumes are low. This likely accounts for the appearance of mild vascular plethora and for atelectasis at the left lung base. No focal consolidation or effusion is identified. No supine film evidence of pneumothorax is detected.", "output": "1. Minimal patchy opacity at the left lung base, most likely atelectasis in the setting of low lung volumes. If there is specific concern for focal infection infiltrate, then a lateral view may help for further assessment. 2. Lungs otherwise grossly clear. 3. Tube with radiopaque tip overlying the lower mediastinum and not extending beyond the GE junction,? enteric tube . Clinical correlation requested." }, { "input": "ETT in standard position. Enteric feeding tube traverses the midline and ends in the left upper quadrant, unchanged. Atelectasis of the left lung base is mild. Otherwise, the lungs are clear. No focal consolidation, pleural effusion, pulmonary edema, or pneumothorax. The heart is normal in size. The mediastinum is not widened. The hila are unremarkable.", "output": "ETT in standard position." }, { "input": "A portable frontal chest radiograph demonstrates an endotracheal tube terminate in the mid to low thoracic trachea and an enteric tube terminating in the stomach. Cardiomediastinal silhouette is normal in the lungs are well-aerated, without focal consolidation, pleural effusion, or pneumothorax. The visualized upper abdomen is unremarkable.", "output": "No evidence of pneumonia." }, { "input": "No significant interval change. The ETT in standard position. The feeding tube traverses the midline and its tip ends in the stomach projecting over the mid abdomen. The lungs are well-expanded and clear. No focal consolidation, edema, pleural effusion, pneumothorax. The heart size is normal. The mediastinum is not widened. The hila are within normal limits. A tube projecting over the left lower hemithorax is external to the patient.", "output": "No significant interval change. No pneumonia." }, { "input": "The lungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.", "output": "No acute cardiopulmonary process." }, { "input": "A ___ type tube is present. The radiopaque tip likely overlies the stomach. It does not extend across the midline into the right abdomen and is unlikely to have passed through the pylorus. Lungs are grossly clear. No air-filled dilated loops of bowel are seen in the visualized portion of the upper abdomen. No free air is detected beneath the diaphragms. Stool noted in the right colon, incompletely evaluated.", "output": "Radiopaque ___ tip overlies the stomach." }, { "input": "There are relatively low lung volumes. Large opacity projecting over the left mid to lower lung fields with subtle air bronchograms seen is worrisome for pneumonia. No definite pleural effusion is seen, although small left pleural effusion is difficult to exclude. The right lung is clear. There is no pneumothorax. The cardiac and mediastinal silhouettes are unremarkable.", "output": "Large left lower lobe consolidation worrisome for pneumonia." }, { "input": "Previously visualized scarring in the left lung base has remained stable. Otherwise, the lungs are clear with no evidence of a consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette remains stable. Visualized osseous structures are normal. Calcifications of the aortic knob are again noted.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs and pleural spaces are clear without evidence of pneumothorax or pleural effusions. No cavitary lesions are seen. The heart is normal in size. Osseous structures are intact.", "output": "No acute intrathoracic process." }, { "input": "AP and lateral views of the chest. No prior. The lungs are clear. Costophrenic angles are sharp. The cardiomediastinal silhouette is within normal limits. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes are low. Heart size is normal. Mediastinal contours are unremarkable, though the superior mediastinum is not well assessed as the patient's chin obscures this region. Tracheostomy tube is in unchanged position. Hilar contours are normal. There is no pulmonary edema. Minimal blunting of the left costophrenic angle may suggest a small pleural effusion. Retrocardiac patchy opacity and minimal right basilar opacity likely reflect atelectasis. No pneumothorax is identified but the apices are not well assessed due to the patient's chin and soft tissues of the neck obscuring these regions. There is no acute osseous abnormality.", "output": "Limited assessment. Bibasilar patchy opacities likely reflect atelectasis in the setting of low lung volumes, but infection or aspiration cannot be excluded completely." }, { "input": "PA and lateral chest radiograph demonstrates no focal opacity convincing for pneumonia. Cardiomediastinal and hilar contours appear unchanged since ___, the heart is top-normal in size. There is no pleural effusion or pneumothorax.The vessels appear engorged which given history may reflect high output cardiac dysfunction.", "output": "No focal opacity concerning for pneumonia. Stably enlarged heart and engorged vessels may reflect high output cardiac dysfunction in this patient with Sickle Cell Disease. NOTIFICATION: These findings communicated to Dr. ___ by Dr. ___ ___ telephone at 14:53 on ___ at the time study was reviewed." }, { "input": "Frontal and lateral views of the chest were obtained. The cardiac silhouette remains mildly enlarged. Mediastinal and hilar contours are stable. There is slight prominence of the vascular markings which may be due to mild congestion/edema. No focal consolidation is seen. There is no pleural effusion or pneumothorax.", "output": "Persistent mild cardiomegaly with possible mild vascular congestion/edema. No focal consolidation seen." }, { "input": "Frontal and lateral views of the chest were obtained. There is no focal consolidation, pleural effusion or pneumothorax. Heart size is normal. Mediastinal silhouette and hilar contours are normal, noting an aortic \"nipple\" likely from traversing left superior intercostal vein. Note again made of a round 5mm radioopaque foreign body projecteing over the neck.", "output": "No pneumonia, edema, or effusion." }, { "input": "The lungs are relatively hyperinflated. No focal consolidation is seen. There is no pleural effusion or pneumothorax. The cardiac silhouette is top-normal to mildly enlarged. The aorta is calcified and tortuous. There is slight increase in interstitial markings diffusely bilaterally which may be due to mild interstitial edema.", "output": "Mild interstitial pulmonary edema. No focal consolidation." }, { "input": "PA and lateral views of the chest. The small right apical pneumothorax is unchanged. There is a possible small left apical pneumothorax, difficult to appreciate on prior studies. Lungs are otherwise clear. No pleural effusion. The cardiomediastinal and hilar contours are normal.", "output": "Small right apical pneumothorax is unchanged compared to ___ at 11:12 a.m. Possible small left apical pneumothorax, difficult to appreciate on prior studies, attention on follow up. These findings were discussed with Dr. ___ by Dr. ___ at 1013am on ___ by phone at time of discovery." }, { "input": "There is a small right-sided pneumothorax with a chest tube traversing medially and terminating along the right mediastinal border. The heart size is mildly enlarged. There is mild pulmonary vascular congestion. Note is made of subcutaneous emphysema along the right lateral chest wall. Increased opacities at the mid right lung, is likely secondary to aspiration. No acute fracture is identified. The left lung aside from mild pulmonary vascular congestion is otherwise clear. There is no large pleural effusion.", "output": "1. Chest tube in appropriate position with small right-sided pneumothorax. 2. Increased opacities at the mid right lung is likely secondary to aspiration. Continued close interval follow up is recommended." }, { "input": "Small right apical pneumothorax is unchanged. Right chest tube is in unchanged position. Cardiomediastinal contours are normal. Bibasilar opacities have increased consistent with worsening atelectasis or aspiration there is no pleural effusion.", "output": "Stable small right pneumothorax Increased bibasilar opacities could be due to atelectasis and or aspiration" }, { "input": "PA and lateral views of the chest. Again seen is a small right apical pneumothorax, unchanged. There is no evidence of pneumothorax on the left. No focal consolidation or pleural effusion. Cardiomediastinal and hilar contours are normal.", "output": "Unchanged small right apical pneumothorax. No evidence of pneumothorax on the left." }, { "input": "Endotracheal tube tip terminates approximately 4 cm from the carina. Orogastric tube tip courses below the diaphragm, off the inferior borders of the film. The heart size is normal. The mediastinal and hilar contours are unremarkable. The lungs are clear and the pulmonary vascularity is normal. No pleural effusion or pneumothorax is present. No acute osseous abnormality seen.", "output": "Endotracheal tube and orogastric tube in standard positions. No acute cardiopulmonary abnormality." }, { "input": "The heart size, mediastinal, and hilar contours are normal. The lungs are clear without pleural effusion, focal consolidation, or pneumothorax.Incidental note of a prominent small bowel loop in the left upper quadrant.", "output": "No evidence of pneumothorax or other acute intrathoracic process." }, { "input": "Single portable AP upright chest radiograph demonstrate cardiomegaly, the size of the heart which appears decreased in size relative to prior study performed ___. There is no evidence of pulmonary edema. There is no pleural effusion or pneumothorax. Lungs are clear without a focal consolidation convincing for pneumonia.", "output": "Cardiomegaly without evidence of pulmonary edema. No evidence of pneumonia." }, { "input": "The lungs are normally expanded. The cardiomediastinal silhouette, hilar contours and pleural surfaces are normal. There is no focal consolidation. Right middle lobe linear opacities, likely atelectasis, scarring. There is no pleural effusion or pneumothorax. There is no pulmonary edema.", "output": "No evidence of pneumonia or other acute cardiopulmonary abnormality." }, { "input": "AP portable supine view of the chest. Vagal nerve stimulator projects over the left chest wall with catheter extending to the left neck soft tissues, unchanged. Heart size is mildly enlarged. Lung volumes are low. No overt signs of pneumonia or edema. No large effusion or pneumothorax. The mediastinal contour is stable. No acute osseous injuries.", "output": "No acute intrathoracic process" }, { "input": "Left pectoral neurostimulator device is unchanged. The lungs are clear. There is no pneumothorax. Moderate cardiomegaly despite the projection is unchanged.", "output": "Clear lungs with no radiographic evidence of pneumonia or aspiration. Stable moderate cardiomegaly." }, { "input": "A left-sided pacemaker and dual leads are seen in expected position. The cardiomediastinal and hilar contours are within normal limits. The lungs are clear without focal consolidation, pleural effusion, pulmonary edema or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear of focal consolidation, pleural effusion or pneumothorax. The heart size is normal. The mediastinal contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lung volumes are low. The lungs are clear without consolidation or edema. There is no pleural effusion or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear without consolidation or edema. Since the prior exam, a small right pleural effusion has developed. There is possibly a tiny left pleural effusion, too. There is no pneumothorax. The mediastinal contours are normal. The heart is mildly enlarged and unchanged.", "output": "New small right and possibly tiny left pleural effusions. No focal opacity to suggest pneumonia." }, { "input": "Portable frontal upright radiograph of the chest. Lower lung volumes are noted. Mild enlargement of the cardiac silhouette is again noted, perhaps slightly smaller than on prior study. No focal consolidation, pleural effusion or pneumothorax is present. Vascularity is within normal limits.", "output": "No evidence of pneumonia." }, { "input": "AP portable upright view of the chest. Patient is slightly leftward rotated. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air is seen below the right hemidiaphragm.", "output": "No acute intrathoracic process. No signs of pneumoperitoneum." }, { "input": "Overall, there has been little change from the radiograph of earlier the same day. Bibasilar opacities appear similar, likely representing atelectasis, although short interval stability does not exclude an infectious process. No frank consolidation is seen. There is probably a trace right pleural effusion. There is no pneumothorax or pulmonary edema. The cardiomediastinal silhouette is within normal limits. Density projecting over the left upper lobe is consistent with a granuloma.", "output": "Short interval stability of bibasilar opacities, which likely represent atelectasis, however aspiration or pneumonia cannot be excluded." }, { "input": "PA and lateral views of the chest provided. There is airspace consolidation which is new in the medial aspect of the right middle lobe concerning for pneumonia. Background emphysema is present. There is similar appearance of calcified granuloma projecting over the left upper lung. Cardiomediastinal silhouette is stable. No large effusion or pneumothorax. Bony structures are intact.", "output": "Findings compatible with right middle lobe pneumonia." }, { "input": "Compared with ___ at 20:19, the radiopaque tip of the aortic balloon pump appears lies slightly higher, now projecting in the region of the aortic knob. Allowing for technical differences, the parenchymal findings are similar, possibly slightly worse. No effusions are identified. ET tube and NG tube are similar. The cardiomediastinal silhouette is probably unchanged.", "output": "1. Radiopaque portion of aortic balloon pump now lies slightly higher. Clinical correlation regarding retraction is requested. (Most recent film from ___ at 08:15 shows that the radiopaque tip has been retracted). 2. Diffuse alveolar opacities, with relative sparing of lung bases, are similar, possibly slightly worse." }, { "input": "AP view of the chest provided. Compared to most recent radiograph from 1 day ago, the left apical consolidation is unchanged. Right apical scarring is stable. Right base atelectasis is minimal. Cardioediastinal and hilar contours are normal. There are no pleural effusions. Left IJ line terminates in the distal SVC.", "output": "No significant change in left apical consolidation since prior study from 1 day ago." }, { "input": "Compared to the prior film, the tip of the aortic balloon pump appears to lie higher. Though the aortic knob is not well delineated, it appears to lie at the top of the expected location of the aortic knob. ET tube tip approximately 3.9 cm above the carina. NG tube, beneath the diaphragm, with tip overlying fundus. Catheter from an inferior approach, question Swan-Ganz catheter, with tip overlying the region of the main pulmonary artery. Compared to the prior study, there may have been slight leftward shift of the mediastinum. Again seen are diffuse patchy opacities throughout both lungs, most pronounced in the upper zones, with relative sparing of the lower zones. Density of the left upper zone is more confluent than on the prior study. There are not fully characterized, but could represent an atypical distribution of CHF with pulmonary edema or other alveolar infiltrates.", "output": "1. Positioning of aortic balloon pump is thought to be high--___ see comments above. This has been subsequently repositioned, as seen on a radiograph from ___ at 08:15. 2. Possible slight interval leftward shift of the mediastinum, suggesting the presence of some volume loss on the left. 3. Dense, somewhat patchy, bilateral alveolar infiltrates, with upper zone predominance. This is not fully characterized. In the appropriate clinical setting, this could represent atypical distribution of pulmonary edema, ARDS, or other causes of alveolar infiltrates. Possibility of a component pleural fluid or apical capping cannot be excluded. If clinically indicated, chest CT may help for more complete characterization." }, { "input": "Slightly rotated positioning. An ET tube is present, tip approximately 5.4 cm above the carina. An NG tube an NG type tube is present, tip overlying the gastric fundus, beneath the diaphragm. An IABP is present, extending from an inferior approach. The aortic knob itself is not well-defined, but the radiopaque tip probably lies at or immediately below the lower edge of the aortic knob. There are dense, confluent opacities in both upper zones, extending into the mid/ lower zones, but with sparing of both lung bases. The degree of confluence is greater on the left. No effusion is identified. Cardiomediastinal silhouette is at the upper limits of normal, but not frankly enlarged. No pneumothorax is detected.", "output": "1. ET and NG tubes, as described. 2. IABP radiopaque tip probably lies at or immediately below the inferior edge of the aortic knob. 3. Dense left-greater-than-right opacities, with upper lobe predominance and sparing of the bases. While this could represent an atypical distribution of CHF, including changes associated with valve dysfunction, in the appropriate clinical setting, the upper lobe predominance would also raise the question of infectious or inflammatory etiologies." }, { "input": "The ET tube lies approximately 5.4 cm above the carina, with its tip at the level of the mid clavicular heads, similar to the prior film. An NG tube is present, tip extending beneath diaphragm, curling in the expected location of the gastric fundus, also similar to prior. An intra-aortic balloon pump is present. It appears to lie more distal in the descending aorta than on the prior film. Although the aortic knob is not well delineated, the radiopaque tip of the inferior bone pump appears to lie slightly inferior to the expected site of the inferior edge of aortic knob, nominal in alignment. An inferior approach catheter is present. This likely represents a Swan-Ganz catheter, with tip superimposed over the main pulmonary artery. A large caliber tube or catheter lies immediately to the right of midline, extending from inferior to overlie the upper/mid thoracic spine. Again seen are opacities in both lungs, most pronounced in the upper lobes, where either fluid or pleural parenchymal scarring may also be present. On the left, there is dense opacity throughout the upper and mid zones. On the right, there are opacities in a similar distribution, but these do not appear is density appearance. Compared to a semi supine film from very early the same-day (just after midnight), there appears to been some leftward shift of the mediastinum, raising the question of volume loss in the left lung. The left hemidiaphragm canal appears tented and the diaphragm is also partially obscured medially. This appearance is similar to the film from 03:42 a.m..", "output": "1. ET tube tip at level of mid clavicular heads, approximately 5.4 cm above the carina, essentially unchanged. 2. Interval distal retraction of the radiopaque portion of the intra-aortic balloon pump. I suspect that the tip now lies very slightly below the inferior edge of the aortic knob, nominal in position. 3. Findings suggestive of left-sided volume loss, with leftward shift of mediastinum. 4. Opacities in both lungs, within upper zone predominance and relative sparing of the bases. This is similar to multiple prior films, though the difference in degree of opacity --___ much denser on the left-- has progressed compared with the initial film. The reason for this is uncertain. While it could be technical, it may also be accentuated by atelectasis/volume loss. 5. Increased retrocardiac density, consistent with left lower lobe collapse and/or consolidation, has also progressed since the initial film. This may be accentuated by supine positioning." }, { "input": "There is opacity obscuring the left heart border, new since ___, likely indicating lingular atelectasis. Dual-chamber pacemaker is seen with the leads in the expected location. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "1. Lingular atelectasis, new since ___. 2. Dual-chamber pacemaker with the leads in expected location." }, { "input": "PA and lateral chest views have been obtained with patient in upright position. Comparison is made with the next preceding similar study of ___. Heart size and mediastinal structures are unchanged. The previously described remaining pleural densities along the upper right lateral chest wall in the shoulder area show diminished thickness of the pleural density surrounding the operative area. Postoperative localized apical pneumothorax has diminished further and is now barely 1 cm wide, also showing increasing pleural scar formation. No new abnormalities are seen. The left hemithorax is unchanged, though no evidence of new pulmonary abnormalities.", "output": "Progression of postoperative healing, status post right upper lobectomy accomplished via VATS extended to thoracotomy intervention." }, { "input": "PA and lateral radiographs of the chest were acquired. There is volume loss on the right with associated elevation of the right hemidiaphragm, consistent with the provided history of prior right upper lobectomy. Pleural densities along the right upper lateral chest wall are not significantly changed. Similarly, opacity at the right apex along the superior mediastinum is not significantly changed, possibly loculated fluid in the pleural space. There is no focal consolidation concerning for pneumonia. There is no left pleural effusion. No definite pneumothorax is seen. There is evidence of prior right thoracotomy, involving the right posterior sixth rib. Cervical fusion hardware is incompletely assessed.", "output": "1. No significant interval change. 2. Post-surgical changes on the right, as described above." }, { "input": "AP single view of the chest has been obtained with patient in sitting semi-upright position. Comparison is made with the next preceding similar study obtained four hours earlier during the same day. Again identified is status post right upper lobectomy with moderately elevated right-sided diaphragm and local chest wall emphysema in the right shoulder area. No pneumothorax has developed since the preceding study, and no new infiltrates are seen.", "output": "Stable chest findings as seen on portable followup examination, status post right upper lobectomy." }, { "input": "Heart size is borderline enlarged but unchanged. Mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Hyperinflation of the lungs with bullous emphysematous changes are again noted in the upper lobes. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is present. Pulmonary vasculature is normal. Right-sided rib cage deformities are chronic. Partially visualized is cervical spinal fusion hardware.", "output": "No acute cardiopulmonary abnormality. Bullous emphysema." }, { "input": "PA and lateral views of the chest provided. Lung volumes are low. Linear opacities at the bilateral lung bases are likely atelectasis. There is no pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact.", "output": "Bibasilar atelectasis in this setting of low lung volumes." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Heart size is mildly enlarged. The aorta is tortuous. Low lung volumes results in crowding of the bronchovascular structures without overt pulmonary edema. Patchy opacity in the right lung base may reflect atelectasis. No focal consolidation, pleural effusion or pneumothorax is detected. There are no acute osseous abnormalities visualized.", "output": "Low lung volumes with patchy right basilar opacity, potentially atelectasis." }, { "input": "There is no consolidation, pleural effusion, or pneumothorax. Cardiomediastinal and hilar silhouettes are normal size. No displaced fracture is identified.", "output": "No acute cardiopulmonary process. No displaced fracture is identified." }, { "input": "Frontal and lateral views of the chest were obtained. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. The aorta is calcified and tortuous. The cardiac silhouette is not enlarged.", "output": "No acute cardiopulmonary process." }, { "input": "Single AP upright portable view of the chest was obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are stable and unremarkable with calcifications at the aortic knob. No evidence of free air is seen beneath the diaphragms. The right paratracheal opacity is stable since the prior study.", "output": "No acute cardiopulmonary process. No evidence of free air beneath the diaphragms." }, { "input": "Patient is status post coronary artery bypass graft surgery. The cardiac, mediastinal and hilar contours appear unchanged including moderate cardiomegaly. What is new is bilateral opacification of each lung base, which is especially confluent in the retrocardiac region on the left. Particularly on the right, small coinciding pleural effusion is suspected. Indistinct pulmonary vasculature appears mildly distended suggesting coinciding vascular congestion.", "output": "Substantial opacities at both lung bases, raising concern for pneumonia. Findings also suggest mild coinciding vascular congestion and possibly small pleural effusions." }, { "input": "Bronchial wall thickening in the lower lobes bilaterally, consistent with findings from prior CT. The lungs are hyperinflated with linear opacities and paucity of the pulmonary vasculature, similar to prior CT and consistent with history of emphysema. The cardiomediastinal and hilar contours are normal. Trace bilateral pleural effusions. Mild cervical and thoracic scoliosis.", "output": "1. Likely flair of chronic lower lobe bronchiectasis. 2. Stable emphysema." }, { "input": "Minimally increased interstitial markings in the retrocardiac area most likely represent atelectatic changes, however early infectious process is possible in the proper clinical setting. There is no pneumothorax, pulmonary vascular congestion, or pleural effusion. The descending aorta is tortuous. The cardiomediastinal silhouette is otherwise unremarkable. Chronic appearing right-sided rib deformities likely reflect remote fractures.", "output": "Minimally increased interstitial markings in the left lung base likely represent atelectasis, however no early infectious process is possible in the proper clinical setting." }, { "input": "AP portable supine view of the chest. Underlying trauma board is in place. Lungs appear clear. No supine evidence of effusion or pneumothorax. The cardiomediastinal silhouette appears grossly within normal limits. No acute bony injury.", "output": "Limited, negative." }, { "input": "The lungs are clear.The cardiac, hilar and mediastinal contours are normal.No pleural abnormality is seen.", "output": "No acute cardiopulmonary process. No evidence of pneumonia or heart failure." }, { "input": "PA and lateral views of the chest. Right port ends in the low SVC. There is no focal consolidation, pleural effusion or pneumothorax. The cardiomediastinal and hilar contours are normal.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided. There is a severe dextroscoliosis of the thoracic spine with spinal stabilization hardware in place, unchanged from prior exam. There is a band-like consolidation in the right lower lung which is new from prior exam and could represent pneumonia in the correct clinical setting. There is a trace right pleural effusion. Left lung is clear. Cardiomediastinal silhouette is difficult to assess but appears grossly stable. No free air below the right hemidiaphragm.", "output": "Band-like opacity in the right lower lung could represent pneumonia. Followup to resolution is advised." }, { "input": "Lungs are fully expanded and clear. Cardiomediastinal and hilar silhouettes and pleural surfaces are normal. There are multiple healed right-sided rib fractures.", "output": "No acute cardiopulmonary process." }, { "input": "Multiple healed rib fractures are re- demonstrated on the right. An opacity at the cardiac apex is new from ___ and concerning for lingular pneumonia. There is no pneumothorax. Apical capping is noted bilaterally, unchanged from prior.", "output": "An opacity at the cardiac apex is concerning for pneumonia." }, { "input": "PA and lateral views of the chest provided. Faint linear densities in the lower lungs likely reflect platelike atelectasis. The lungs are otherwise clear. There is stable prominence of the mediastinal silhouette, which has been previously assessed by CT chest from ___. The heart size is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute findings." }, { "input": "AP and lateral views of the chest were performed with patient positioned upright. Linear density at the left lung base is most compatible with subsegmental atelectasis and scarring as seen on prior CT chest from ___. Otherwise, the lungs are clear. No effusion or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "Linear density at the left lung base is most compatible with atelectasis/scarring as seen on prior CT chest from ___. No convincing signs of pneumonia." }, { "input": "The lungs are well-expanded and clear other than pleural and parenchymal scarring at both lung apices and in the lower left hemi thorax. No focal consolidation, edema, effusion, or pneumothorax. The heart is normal in size. Mediastinal contours are unchanged and likely reflective of mediastinal lipomatosis. No large pleural effusion. No acute osseous abnormality. Multiple contiguous right posterior lateral rib fractures are unchanged.", "output": "No pneumonia." }, { "input": "Aside from mediastinal and extrapleural fat deposition, often seen with chronic steroid use, cardiomediastinal and hilar contours are within normal limits. There is mild atelectasis at the lingula. Lungs are otherwise well expanded and clear. There is no focal consolidation, pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "PA and lateral views of the chest were provided demonstrating no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette appears normal. Subtle opacities projecting over the lower lungs are most compatible with subsegmental atelectasis. No effusion or pneumothorax is seen. Biapical pleural parenchymal scarring is noted.", "output": "No acute osseous abnormality." }, { "input": "The cardiomediastinal silhouette and pulmonary vasculature are unchanged. The lungs are clear. There is no pleural effusion or pneumothorax. No acute osseous injury.", "output": "No acute intrathoracic abnormality." }, { "input": "Frontal and lateral views of the chest demonstrate low lung volumes, which accentuate bronchovascular markings. There is small right pleural effusion. Right lung base opacities likely represent atelectasis. Linear opacity in the left lower lung zone, likely represents plate-like atelectasis. Hilar and mediastinal silhouettes are unremarkable. Moderate enlargement of the cardiac silhouette is new since ___ due to cardiomegaly and/or pericardial effusion. There is no pulmonary edema. Partially imaged upper abdomen is unremarkable.", "output": "1. Small right pleural effusion. Right lung base opacity, most likely atelectasis, however, superimposed infection cannot be excluded. 2. Mild cardiomegaly and/or pericardial effusion new since ___. Consider cardiac ultrasound for further assessment." }, { "input": "Normal heart size, mediastinal and hilar contours. No focal consolidation, pleural effusion or pneumothorax. Multiple healed right-sided rib fractures are noted which appear new from ___.", "output": "No acute process. Multiple healing right-sided rib fractures." }, { "input": "Biapical scarring is noted. Linear opacity at the left lung base is most suggestive of atelectasis and likely scarring. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities identified.", "output": "No acute cardiopulmonary process." }, { "input": "The heart size is normal. The mediastinal and hilar contours are unchanged. The pulmonary vasculature is not engorged. Persistent crescentic focal opacity is noted within the left lower lobe, which could reflect an area of infection or atelectasis. Minimal streaky opacities elsewhere in both lung bases are compatible with areas of atelectasis. No pleural effusion or pneumothorax is seen. Mild paraseptal emphysematous changes are noted in the lung apices. There are no acute osseous abnormalities.", "output": "Persistent crescentic area of opacification within the left lower lobe which may reflect an area of infection or atelectasis." }, { "input": "The cardiomediastinal contours are normal. The bilateral hila are normal. The lungs are clear without evidence of focal consolidation. There is no pulmonary vascular congestion. The minimal paraseptal emphysema as well the left lower lobe rounded atelectasis appreciated on prior CT are not seen on the current study. There are no pneumothoraces or effusions.", "output": "No evidence of acute cardiopulmonary process." }, { "input": "Since the prior CXR, there has been interval placement of an enteric tube that terminates in the stomach, but the sidehole is at the GE junction. Endotracheal tube terminates 5.5 cm above the carina. The right sided PICC line has been advanced and now terminates in the mid right atrium. There has been interval worsening of the right layering pleural effusion and adjacent atelectasis. No left pleural effusion. No pneumothorax. Heart size is top normal. Mediastinum appears widened, likely due to patient rotation. Cervical fusion device is unchanged in location.", "output": "1. Interval advancement of the right PICC line, which now terminates in the right atrium. There is should be retracted 2 cm to place it at the cavoatrial junction. 2. Sidehole of enteric tube is at the GE junction and should be advanced by 4 cm. 3. Worsening layering right effusion. NOTIFICATION: Findings telephoned to Dr. ___ by Dr. ___ on ___ at 3:37PM, approximately 10 minutes after discovery." }, { "input": "There has been interval increase in the right pleural effusion is layering posteriorly. There content there continues to be dense retrocardiac opacification that has increased in the interval. There is probably a small left effusion as well. NG tube tip is off the film, at least in the stomach. The ET tube tip is 5.4 cm above the carina hardware overlying the cervical spine is again visualized. Right-sided PICC line tip is at the cavoatrial junction", "output": "Worsened fluid status." }, { "input": "PA and lateral views of the chest provided demonstrate no focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute findings in the chest." }, { "input": "AP and lateral views of the chest provided. Dual lead pacemaker is unchanged in position with leads extending to the region the right atrium and right ventricle. Midline sternotomy wires and mediastinal clips are again noted. There is mild pulmonary edema with small bilateral pleural effusions. Heart size is top-normal contours unremarkable. No pneumothorax. No acute osseous abnormalities.", "output": "Mild pulmonary edema with small bilateral pleural effusions." }, { "input": "The patient is status post median sternotomy and CABG. Left-sided pacemaker device is noted with leads terminating in the regions of the right atrium and right ventricle. The heart size is at least mild to moderately enlarged. Atherosclerotic calcifications are demonstrated in the aortic knob. Moderate pulmonary edema is demonstrated along with a moderate left and small right pleural effusion. Bibasilar airspace opacities likely reflect compressive atelectasis. No pneumothorax is demonstrated though the lung apices is somewhat obscured by the patient's neck projecting over this area. Multilevel degenerative changes are seen within the thoracic spine.", "output": "Moderate congestive heart failure with moderate left and small right bilateral pleural effusions. Bibasilar airspace opacities likely reflect compressive atelectasis." }, { "input": "PA and lateral views of the chest. The lungs are clear without consolidation, effusion, or pulmonary vascular congestion. The cardiac silhouette is mildly enlarged. The thoracic aorta is tortuous. No acute osseous abnormality detected.", "output": "Cardiomegaly without acute cardiopulmonary process." }, { "input": "Left-sided pacer device is noted with leads terminating in the regions of the right atrium, right ventricle, and coronary sinus, unchanged. Moderate enlargement of the cardiac silhouette persists. The aorta remains mildly tortuous. The mediastinal and hilar contours are unchanged. Pulmonary vasculature is not engorged. No focal consolidation, pleural effusion or pneumothorax is present. No acute osseous abnormality is visualized.", "output": "Moderate cardiomegaly without congestive heart failure." }, { "input": "Right PICC remains in place. It is seen to at least the at the level of the cavoatrial junction but tip is not clearly delineated. Left chest wall triple lead pacing device is again noted. Degree of cardiomegaly is stable. There is no edema or effusion. No focal consolidation.", "output": "Cardiomegaly without superimposed acute cardiopulmonary process." }, { "input": "The heart is considerably enlarged but stable in size from prior exams. Aorta is mildly tortuous. The pulmonary vasculature is within normal limits. There is no evidence of pulmonary edema. No focal infiltrate, consolidation, pleural effusion, or pneumothorax detected. The lungs are clear without focal consolidation, pleural effusion or pneumothorax.", "output": "Moderate to moderately severe cardiomegaly. No acute pulmonary process identified." }, { "input": "PA and lateral views of the chest provided. Mild cardiomegaly is grossly unchanged from comparison study. There is no pneumothorax, effusion, or focal consolidation. There is no pulmonary interstitial edema or congestion. Imaged osseous structures are unremarkable. No free air below the right hemidiaphragm is seen.", "output": "Cardiomegaly without pulmonary edema or other acute intrathoracic abnormality." }, { "input": "NG tube tip is in the stomach. The appearance of the lungs is unchanged.", "output": "NG tube in the stomach." }, { "input": "Cardiomediastinal silhouette and hilar contours are stable. Left base atelectasis is noted. The lungs are otherwise clear. There is no pleural effusion or pneumothorax.", "output": "Little change compared to ___ with streaks of atelectasis at the left lung base." }, { "input": "Heart size is top-normal. The thoracic aorta is mildly tortuous with atherosclerotic mural calcifications. Lungs are clear. There is no pleural effusion or pneumothorax.", "output": "No acute cardiopulmonary process." }, { "input": "A right-sided PICC line ends in the mid SVC. Hazy bilateral airspace opacities are likely due to pulmonary edema. Retrocardiac airspace opacities are likely due to atelectasis. There is a moderate layering right pleural effusion. Moderate cardiomegaly is present. There is no pneumothorax.", "output": "Newly placed right PICC line ends in the mid SVC. Moderate pulmonary edema. Retrocardiac atelectasis. Moderate layering right pleural effusion." }, { "input": "Moderate cardiomegaly has been persistent compared to exams dated back to at least ___. There is mild pulmonary vascular congestion with overall somewhat improved mild-to-moderate diffuse pulmonary edema. Small bilateral pleural effusions are persistent. There is mild bibasilar atelectasis. There is no evidence of a pneumothorax. Left-sided pacer leads are in unchanged position. Interval removal of a right sided central line.", "output": "Moderate pulmonary edema, eppars somewhat improved compared to prior." }, { "input": "The endotracheal tube ends 3.5 cm from the carina. An enteric tube ends off the inferior portion of the image. A pacemaker is seen in place. There is moderate cardiomegaly. There are bilateral diffuse streaky opacities likely representing atelectasis or aspiration. No pneumothorax or pleural effusion.", "output": "Streaky opacities bilaterally, likely from aspiration or atelectasis. Endotracheal tube in appropriate position." }, { "input": "The lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. The cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "There is a large right-sided pleural effusion which is difficult to directly compare to the prior PET-CT, but probably similar in size. A suspicious nodule projects over the right upper lobe, measuring 9 mm in diameter. There is only slight leftward shift of mediastinal structures so areas of atelectasis in the right lung coinciding with an effusion, particularly involving the right lower lobe, are suspected. The left lung remains clear. There is no pneumothorax. The cardiac, mediastinal and hilar contours appear unchanged. The bones are probably demineralized.", "output": "Large right-sided pleural effusion. Suspicious nodule projecting over the right upper lobe." }, { "input": "Frontal and lateral views of the chest are obtained. Lungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "Portable AP upright chest radiograph was obtained. The lungs are clear bilaterally. Prominent epicardial fat pad accounts for the opacity at the left heart border inferiorly. No pleural effusion or pneumothorax is seen, though the left CP angle is partially excluded. Cardiomediastinal silhouette appears stable. Patient is known to have mediastinal lymphadenopathy due to Hodgkin's lymphoma and overall appearance of the mediastinum is stable-to-slightly less thickened along the right paratracheal stripe. Bony structures appear intact. No pneumothorax or pneumomediastinum.", "output": "No pneumonia or other acute process in the chest. Mediastinal prominence is compatible with known lymphadenopathy in the setting of lymphoma." }, { "input": "The cardiac, mediastinal, and hilar contours appear unchanged. There are patchy new opacities in the left mid-to-lower lung, predominantly in the lingula, but streaky in morphology. Otherwise, the lungs appear clear. There are no pleural effusions or pneumothorax. Moderate anterior osteophytes are present along the mid-to-lower thoracic spine.", "output": "Patchy new left mid and lower lung opacities, typical in morphology for atelectasis, although an infectious etiology is difficult to completely exclude based on the imaging." }, { "input": "PA and lateral chest radiographs are obtained. Heart is normal size and cardiomediastinal contours are unchanged. Lungs do not demonstrate significant changes compared to the prior radiograph. Opacification of the left base represents atelectasis or consolidation. Persistent small right pleural effusion with increased small left pleural effusion. No pneumothorax.", "output": "1. Persistent small pleural effusions bilaterally. 2. Left lower lobe atelectasis or consolidation." }, { "input": "Since the prior radiograph there are now small bilateral pleural effusions. Left retrocardiac opacity likely represents lower lobe pneumonia. There is no pneumothorax. The cardiomediastinal silhouette is similar in appearance to the prior radiograph. Bony structures are intact.", "output": "1. Interval development of bilateral pleural effusions. 2. Retrocardiac opacity likely represents left lower lobe pneumonia. These findings were reported to ___ by Dr. ___ ___ telephone at 5 p.m." }, { "input": "Frontal and lateral chest x-rays were obtained. A Port-A-Cath terminates in the lower SVC. The lungs are fully extended and clear. The cardiomediastinal silhouette, hilar contours, and pleural surfaces are normal. There is no pleural effusion or pneumothorax.", "output": "No radiographic evidence for acute cardiopulmonary process." }, { "input": "Heart size remains mildly enlarged. The aorta is diffusely calcified. Mediastinal and hilar contours are unchanged with prominence of the right paramediastinal contour, again likely due to tortuous vessels. Pulmonary vasculature is not engorged. Lungs are clear. No focal consolidation, pleural effusion or pneumothorax is present. Hypertrophic changes are re- demonstrated on the thoracic spine. Clips are noted within the right upper quadrant of the abdomen. No subdiaphragmatic free air is present.", "output": "No acute cardiopulmonary abnormality." }, { "input": "The cardiac silhouette is normal. A mass in the superior segment of the left lower lobe is not significantly changed from prior. No new focal consolidations. A calcified pleural plaque in the lateral aspect of the mid right lung is also stable. There are no pleural effusions or pneumothorax. Visualized osseous structures are grossly unremarkable.", "output": "Stable left lower lobe mass. Correlate with subsequent CT chest." }, { "input": "Heart size is mildly enlarged. The aorta remains unfolded. There is perihilar haziness and vascular indistinctness compatible with moderate interstitial pulmonary edema. Additionally, more focal opacity within the right upper lung field, likely within the posterior aspect of the right upper lobe, is concerning for pneumonia. Small bilateral pleural effusions are present. Known left upper and lower lobe mass is unchanged resulting in prominence of the left hilar region. No pneumothorax is identified. Lungs remain hyperinflated compatible with underlying emphysema. Calcified pleural plaques are again demonstrated bilaterally.", "output": "Moderate interstitial pulmonary edema with small bilateral pleural effusions. Focal opacification in the right upper lung field is concerning for pneumonia. Unchanged mass in the left upper and lower lobes." }, { "input": "The cardiac silhouette is normal. The mass in the superior segment of the left lower lobe seems slightly more prominent in today's examination. No new focal consolidations. There are no pleural effusions or pneumothorax. Visualized osseous structures are grossly unremarkable.", "output": "Stable left lower lobe mass, which is slightly more prominent on today's examination." }, { "input": "In comparison to the most recent prior study, there is increased opacification in the medial right lung base which may represent an early developing pneumonia in the appropriate clinical context but could also represent atelectasis. A large left juxtahilar mass is unchanged, corresponding to the patient's biopsy-proven small cell carcinoma, better characterized on recent CT of the chest. Bilateral calcified pleural plaques are present. No significant pleural effusion or pneumothorax is detected. The pulmonary vasculature is not engorged. The cardiac silhouette is top normal in size but stable. The thoracic aorta is tortuous. The trachea is midline.", "output": "1. Slightly increased opacification at the medial right lung base could represent an early developing pneumonia in the appropriate clinical context or, alternatively, atelectasis. 2. Left juxtahilar mass corresponding to known small cell carcinoma, better characterized on recent CT of ___. 3. Calcified pleural plaques compatible with prior asbestos exposure." }, { "input": "Portable semi-erect chest film dated ___ at ___ is submitted for interpretation.", "output": "Endotracheal tube has its tip approximately 4.5 cm above the carina. Streaky opacities at the right lung base may reflect areas of atelectasis, although aspiration or pneumonia should also be considered. No pulmonary edema. No pleural effusions or pneumothorax. Overall cardiac and mediastinal contours are within normal limits given portable technique." }, { "input": "Portable AP upright chest film ___ at 05:10 is submitted.", "output": "Interval removal of the endotracheal tube. Lungs are well inflated without evidence of focal airspace consolidation, pleural effusions pulmonary edema or pneumothorax. The patchy opacity at the right base has resolved and therefore was consistent with atelectasis. Overall cardiac and mediastinal contours are within normal limits." }, { "input": "PA and lateral views of the chest provided. There is no focal consolidation, effusion, or pneumothorax. The cardiomediastinal silhouette is normal. Imaged osseous structures are intact. No free air below the right hemidiaphragm is seen.", "output": "No acute intrathoracic process." }, { "input": "In comparison to the chest radiograph obtained 1 day prior, right greater than left left pleural effusions are probably unchanged, taking into account changes in patient positioning. Bibasilar atelectasis is also unchanged. Lungs are otherwise clear without focal consolidations. Heart size and cardiomediastinal silhouette are unchanged. Mild pulmonary edema has resolved.", "output": "Unchanged, bilateral, moderate pleural effusions with associated bibasilar atelectasis. Interval resolution of mild pulmonary edema." }, { "input": "PA and lateral views of the chest were obtained. The lungs are clear without focal consolidation, effusion, or pneumothorax. The heart size is within normal limits. The aorta is slightly unfolded. No signs of CHF. No effusion. Bony structures appear intact. No free air below the right hemidiaphragm. Clips in the upper abdomen noted.", "output": "No acute findings in the chest." }, { "input": "The patient is status post median sternotomy and coronary artery bypass surgery. Cardiomediastinal widening is stable in the postoperative period. Moderate partially loculated left pleural effusion is again demonstrated, and has slightly decreased in size overall. However, an intrafissural component has increased. On the right, a small-to-moderate pleural effusion has slightly increased in size and may be slightly loculated laterally. Increased opacity in the retrosternal space is consistent with known postoperative fluid collection as seen on recent CT of ___. Bibasilar atelectasis adjacent to the pleural effusion is noted.", "output": "Bilateral partly loculated pleural effusions and retrosternal fluid collection." }, { "input": "The lungs are clear, without evidence of pneumothorax or pleural effusions. The heart is normal in size. There is no evidence of pneumoperitoneum. Osseous structures are intact.", "output": "No acute intrathoracic process." }, { "input": "There is a large left upper lobe cavitary mass which is similar in size to the prior chest CT. There is associated destruction of the adjacent ribs, most marked in the lateral left second and third ribs. Since the prior exam, there is worsening opacification at the bilateral bases, more prominent on the right than the left. There is no pulmonary edema, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal.", "output": "1. Increasing basilar opacities, slightly more worse on the right than the left. These are nonspecific, though could represent infection. 2. Grossly unchanged large left upper lobe cavitary mass with destruction of the adjacent ribs. Results were discussed with Dr. ___ at 5:30 p.m. on ___ via telephone by Dr. ___ at the time the findings were discovered." }, { "input": "There is a large left upper lobe cavitary lesion with associated pleural thickening. Additionally, on the lateral view, there is a well-circumscribed opacity projecting in the posterior compartment over the spine, likely at the apex of the left lower lobe concerning for a second lesion. There is no pleural effusion or pneumothorax. The heart size is normal. The bones are intact.", "output": "Large left upper lobe cavitary lesion with second well-circumscribed lesion in the apex of the left lower lobe. These findings are concerning for either tuberculosis or malignancy. Recommend chest CT for further evaluation. Findings were entered into the critical results dashboard by Dr. ___ at 5:15 pm and then discussed with Dr. ___ ___ telephone at 6:20pm." }, { "input": "Heart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.", "output": "No acute cardiopulmonary abnormality." }, { "input": "PA and lateral views of the chest provided demonstrate clear lungs without focal consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. Bony structures are intact. No free air below the right hemidiaphragm.", "output": "No acute intrathoracic process." }, { "input": "Right upper lobe consolidation has resolved since ___. The left lower lobe consolidation is improved; however, hazy increased density persists, possibly due to overlying soft tissue. No new focal consolidation. Normal heart, mediastinum, hila and pleural surfaces.", "output": "Resolution of right upper lobe pneumonia with improvement in left lower lobe consolidation, but hazy increased density persists, possibly due to overlying soft tissue, recommend ___ view to clarify. Telephone notification to Dr. ___ by Dr. ___ at 11:45 on ___." }, { "input": "A PICC line terminates in the superior vena cava. The patient is status post fusion of the lumbar spine and sternotomy. The base of the chest is not completely included, but cardiac, mediastinal and hilar contours appear unchanged. Hazy opacification projecting over the lower lungs suggests persistent pleural effusions. Otherwise, the lungs appear clear, however. There is no pneumothorax.", "output": "Findings consistent with persistent substantial pleural effusions on limited examination." }, { "input": "Semi-upright portable AP view of the chest was provided. The patient is intubated with the tip of the endotracheal tube poorly visualized. The NG tube courses inferiorly though the tip is not clearly visualized. Left upper extremity PIC line is in unchanged and appropriate position. Midline sternotomy wires and spinal fixation hardware again noted with skin ___ along the body wall. There are bilateral pleural effusions with bibasilar opacities which could represent either atelectasis or pneumonia, or a combination. The mid upper lungs appear well aerated. Overall, heart size is difficult to assess due to patient rotation, though appears grossly unchanged. Bony structures are intact.", "output": "Bilateral pleural effusions appear slightly increased with associated lower lung opacities which could represent atelectasis and/or pneumonia." }, { "input": "Since prior study, there has been no interval change in position of right chest wall Port-A-Cath, terminating in the upper right atrium, as well as a left chest wall pulse generator, with dual lead pacing wires terminating in the right atrium and right ventricle. Median sternotomy wires are intact. A right pleural effusion has slightly increased compared to the prior study, along with fluid tracking along the horizontal fissure on the right, and subsegmental atelectasis in the right lung base. Left basilar atelectasis is also increased, as has a small left pleural effusion. There is no pneumothorax. Biapical pleural thickening is stable. The overall heart size is unchanged.", "output": "Interval increase in size of moderate right and small left pleural effusions, with bibasilar atelectasis." }, { "input": "Dual lead pacer leads terminate in stable position. Post CABG. Cholecystectomy clips. Accessed right porta catheter terminates in the RA. Unchanged cardiomegaly. Overall similar appearance of mild to moderate pulmonary edema. Improved atelectasis of right lung base.", "output": "Similar appearance of mild to moderate pulmonary edema. Improved atelectasis of the right lung base." }, { "input": "Frontal and lateral chest radiographs demonstrate a dual lead pacemaker with leads overlying the right atrium and ventricle, and a right chest central catheter terminating in the low SVC. Bilateral pleural effusions are again seen, right greater than left, with the right unchanged to slightly increased and the left unchanged. There is no focal consolidation or pneumothorax. The heart is top-normal in size.", "output": "Bilateral pleural effusions, right greater than left. The right is unchanged to slightly increased in size, and the left is unchanged." }, { "input": "Compared to the prior study there is no significant interval change.", "output": "No change." }, { "input": "Portable semi-upright radiograph of the chest demonstrates low lung volumes which results in bronchovascular crowding. There is a moderate-sized partially loculated right pleural effusion with adjacent atelectasis. A chest tube projects over the right hemi thorax. Median sternotomy wires are in place. The right-sided Port-A-Cath is in unchanged position. There is no pneumothorax .", "output": "Moderate-sized partially loculated right pleural effusion with adjacent atelectasis, not significantly changed from the prior radiograph." }, { "input": "PA and lateral views of the chest were reviewed and compared to the prior study. In the left hemithorax, a dual-chamber pacemaker is seen with leads ending in the right atrium and right ventricle. A right subclavian Port-A-Cath with a tip ending in the mid-to-lower superior vena cava is unchanged. Unchanged asymmetrical left apical pleural thickening extends to the mediastinal surface and is characterized as post-radiation fibrosis the prior CT. Normal heart and lungs with no focal area of consolidation.", "output": "No radiographic evidence of pneumonia." }, { "input": "Portable semi-upright radiograph of the chest demonstrates low lung volumes with resultant bronchovascular crowding. Two chest tubes project over the right hemithorax. There is a small right-sided pleural effusion with adjacent atelectasis. No pneumothorax. Right-sided Port-A-Cath is in unchanged position. The cardiomediastinal and hilar contours are unchanged. The left lung is essentially clear.", "output": "Small right-sided pleural effusion with adjacent atelectasis. No pneumothorax." }, { "input": "AP single view of the chest has been obtained with patient in semi-upright position. Analysis is performed in direct comparison with the next preceding similar study of ___. Status post sternotomy, ___ mitral valve prosthesis in place, permanent left-sided pacer with dual intracavitary electrode system, all unchanged. On the right side, the evidence of pleural effusion has again decreased slightly in comparison with the next preceding study of ___ at which time a mild increase of pleural effusion was noted in comparison with an image obtained two days earlier. These variations illustrate difficulties to quantitate pleural effusions on single portable chest views. On the left side, the evidence of pleural effusion is more impressive as it obliterates totally the entire left-sided diaphragm and the density reaches up to the hilar area and beyond. Also noted is an increased amount of pleural density along the mediastinal structures reaching into the left-sided apical area. No pneumothorax is identified.", "output": "Further increasing left-sided pleural effusion likely to compromise left side lung function severely. ___ was paged to transmit findings. He had already observed the findings with massive pleural effusion and a pleural tap is planned later this afternoon." }, { "input": "Patient is status post median sternotomy and mitral valve repair. Right-sided Port-A-Cath tip terminates at the junction of the SVC and right atrium. Left-sided dual-chamber pacemaker device is re- demonstrated with leads in the right atrium and right ventricle. Heart size is normal. Aortic knob calcifications are re- demonstrated. Mediastinal and hilar contours are unchanged. Small right pleural effusion which is partially loculated laterally and medially appears relatively unchanged as is a small left pleural effusion. Lungs remain hyperinflated with streaky opacities in the lung bases, potentially atelectasis though infection cannot be excluded. No pneumothorax is identified, and no pulmonary vascular congestion is present. The patient is status post left mastectomy and breast implant. Cholecystectomy clips are noted in the right upper quadrant of the abdomen. There are no acute osseous abnormalities.", "output": "Relatively unchanged appearance of small bilateral pleural effusions, with the right pleural effusion appearing partially loculated. Patchy opacities in lung bases are nonspecific and may reflect atelectasis or infection." }, { "input": "PA and lateral views of the chest demonstrates the lungs are well expanded and clear. There is a dual lead pacemaker device with leads terminating in the right atrium and right ventricle, as before. Additionally, a Port-A-Cath is in place projecting over the right chest, terminating in the mid to lower SVC, as before. There is no evidence of pneumothorax. Left apical pleural thickening is again seen, previously described is postradiation fibrosis. The breast shadows are asymmetrical, in keeping with left breast prosthesis. The cardiomediastinal silhouette is unremarkable and no focal pneumonia is present. There is no pleural effusion.", "output": "No acute cardiopulmonary process." }, { "input": "A right-sided Port-A-Cath is unchanged in position as is a left chest wall pacer and leads. Sternotomy wires are stable. Mild enlargement of the cardiac silhouette is again demonstrated and stable from the prior studies. Mediastinal contours are similar. There is moderate pulmonary edema, increased from the prior examination done on ___. The focal opacity seen at the right lung base could represent an area of atelectasis and effusion however infection should be considered. There may be a small left pleural effusion. Visualized osseous structures are stable.", "output": "Moderate pulmonary edema, new from the prior exam on ___. Right basal opacity is increased from the prior exam and infection should be considered in the appropriate clinical setting. Small bilateral pleural effusions, right greater than left. S" }, { "input": "Portable semi upright radiograph the chest demonstrates low lung volumes with resultant bronchovascular crowding. Two pigtail chest tubes project over the right hemi thorax with the more superior pigtail incompletely formed. Kinking cannot be excluded on the current single view. There has been interval decrease in size of the right-sided pleural effusion, however there is a new small right-sided lateral pneumothorax. The cardiomediastinal and hilar contours are unchanged. A a right-sided central venous line ends at the cavoatrial junction. Median sternotomy wires are in place.", "output": "New a small lateral right-sided pneumothorax status post new pigtail chest tube placement. NOTIFICATION: These findings were discussed with Dr. ___ by Dr. ___ ___ telephone at 9:31 on ___, 2 minutes after discovery." }, { "input": "A portable frontal chest radiograph demonstrates a decreased right pleural effusion after thoracentesis. The small left pleural effusion is unchanged. There is no pneumothorax. The remainder of the exam is unchanged.", "output": "Decreased right pleural effusion after thoracentesis. No pneumothorax." }, { "input": "Compared to most recent exam, there has been no significant interval change. There is persistent right basilar pleural-based thickening and likely scarring. Hazy right basilar opacities are similar and may be due to chronic underlying changes noting that they have significantly improved since ___. The left lung remains clear where not obscured by overlying the left chest wall dual lead pacing device. Cardiac silhouette is stable in configuration. Prosthetic valve is again noted. Right chest wall port remains in place.", "output": "No definite acute cardiopulmonary process. Right basilar changes appear chronic." }, { "input": "Compared with prior, there has been no significant interval change. Right chest wall port and left chest wall dual lead pacing device are again seen. Partially loculated right-sided pleural effusion persists. Probable small left effusion is partially loculated laterally. Right basilar opacities medially may be due to atelectasis, similar to prior. The cardiomediastinal silhouette is unchanged, mitral valve prosthesis again noted. Surgical clips seen in the right upper quadrant. No acute osseous abnormalities.", "output": "No significant interval change. Bilateral effusions. Right medial basilar opacity potentially atelectasis noting that infection is not excluded." }, { "input": "PA and lateral views of the chest provided. Left pacemaker and leads are in stable position. Patient is status post median sternotomy. Mild collapse of the right middle lobe is unchanged from ___. No pneumothorax. Small, bilateral pleural effusions are mildly worsened from ___. Hilar and cardiomediastinal contours are normal.", "output": "1. Small, bilateral pleural effusions are mildly worsened from ___. There is no evidence of pulmonary vascular congestion. 2. Chronic atelectatic change at the right lung base is persistent, however mildly improved from ___." }, { "input": "A left pacemaker and to pacer leads are seen unchanged in position. A Port-A-Cath is seen with its tip at the cavoatrial junction. Again seen are bilateral pleural effusions, which are largely unchanged allowing for differences in the positioning of the patient. There is mild cardiomegaly. There is no pneumothorax.", "output": "No significant interval change." }, { "input": "Left-sided pacer is re- demonstrated with leads terminating in the regions of the right atrium and right ventricle. The patient is status post median sternotomy and mitral valve replacement. Mild enlargement of the cardiac silhouette is re- demonstrated. Mediastinal contours are similar with atherosclerotic calcifications noted at the aortic knob. Moderate pulmonary edema persists. A more focal opacity is seen in the right lung base, potentially atelectasis but infection is not excluded. Small bilateral pleural effusions, right greater than left, have slightly increased in size. No pneumothorax is present. Multilevel mild degenerative changes are noted in the thoracic spine. Clips in the upper abdomen are from prior cholecystectomy. Patient is status post left mastectomy and breast implant.", "output": "Moderate pulmonary edema, similar compared to the previous exam with slight increased size of small bilateral pleural effusions, right greater than left. More focal right basilar opacity could reflect atelectasis though infection is not excluded." }, { "input": "The patient is status post median sternotomy and CABG. Left-sided pacemaker device with leads terminating in the right atrium and right right ventricle is again noted. A right-sided Port-A-Cath is present with tip terminating in the SVC. Heart size is borderline enlarged. Aortic knob is calcified. There is no pulmonary edema demonstrated. Opacification of the left lower lobe appears improved in the interval. Small bilateral pleural effusions however are new compared to the prior exam. No pneumothorax is demonstrated. Biapical pleural thickening or scarring is present. Cholecystectomy clips are noted in the right upper quadrant of the abdomen.", "output": "New small bilateral pleural effusions. Interval improvement in aeration of the left lower lobe likely reflecting improving atelectasis." }, { "input": "No change is seen in bilateral pleural effusions. Left pleural effusion is larger than the right pleural effusion. Left cardiac pacemaker is in stable position with leads ending at the right atrium and right ventricle respectively. No consolidation, pulmonary edema, or pneumothorax is seen. Right Port-A-Cath is unchanged with the tip ending at the mid SVC. Osseous structures are grossly unremarkable.", "output": "Stable bilateral pleural effusions, left greater than right." }, { "input": "The patient is status post CABG with sternotomy wires noted to be well aligned. A biventricular pacemaker is seen with leads located within the right atrium and right ventricle. There is a Port-A-Cath identified with the tip extending into the mid SVC. A moderate sized right-sided pleural effusion is noted, in addition to a small left-sided pleural effusion. There is no focal consolidation, pneumothorax, or pulmonary edema identified. The heart size is at the upper limits of normal. Mediastinal contours are stable.", "output": "Moderate-sized right-sided pleural effusion, and a small left-sided pleural effusion. No evidence of focal consolidation or pneumothorax." }, { "input": "Portable semi upright radiograph of the chest demonstrates low lung volumes with resultant bronchovascular crowding. There is a persistent moderate-sized loculated right pleural collection with adjacent atelectasis. There is stable left apical thickening with volume loss. The cardiomediastinal and hilar contours are unchanged. Mild pulmonary edema is unchanged. A right-sided Port-A-Cath ends at the cavoatrial junction. A dual-chamber pacemaker is again seen over the left chest, with appropriate position of the leads in the right atrium and ventricle.", "output": "Persistent moderate size loculated right pleural collection with adjacent atelectasis. CT could be considered for additional evaluation." }, { "input": "There has been interval removal of the femoral Swan-Ganz catheter. The trachea is central. The cardiomediastinal contour is unchanged with moderate cardiomegaly and prominence of the bilateral hila. Prominence of the pulmonary vasculature is consistent with mild pulmonary vascular congestion. No frank pulmonary edema seen. There is persistent left lower lobe atelectasis. No definite pleural effusion seen. No pneumothorax.", "output": "Moderate cardiomegaly and pulmonary vascular congestion without frank pulmonary edema." }, { "input": "Increased interstitial markings are seen throughout the lungs without focal consolidation. There is also blunting of the posterior costophrenic angles suggestive of small pleural effusions. Moderate cardiac enlargement and tortuosity of the descending thoracic aorta is noted. There is no acute osseous abnormality.", "output": "Cardiomegaly with small bilateral pleural effusions and pulmonary vascular congestion." }, { "input": "The pulmonary edema has essentially resolved. There is minimal bilateral costophrenic blunting laterally that could represent small effusions. There is minimal left basilar atelectasis. Cardiomegaly persists. As before there is aortic arch atherosclerosis and a tortuous descending aorta. Degenerative changes are noted within the spine as well as slight sigmoid scoliosis.", "output": "Resolved pulmonary edema with persistent cardiomegaly and possibly small bilateral pleural effusions with mild basilar atelectasis." }, { "input": "Portable supine chest radiograph ___ at 23:16 is submitted.", "output": "The Impella support device now has its tip projecting over the more proximal aspect of the right ventricle being retracted approximately 6 cm since the previous study. The femoral Swan-Ganz catheter is unchanged in position. Interval appearance of streaky opacities at the right base likely reflectsing atelectasis, although aspiration or pneumonia should also be considered. No pulmonary edema. No large effusions. No pneumothorax. Overall cardiac and mediastinal contours are stable." }, { "input": "There is no radiopaque foreign body identified. Lungs are equal in volume, without evidence for air trapping. There is no pneumothorax, pneumomediastinum or air seen underneath the diaphragm. Cardiac, mediastinal and hilar contours are unremarkable.", "output": "No radiopaque foreign body identified." }, { "input": "PA and lateral views of the chest. The known hiatal hernia is seen with residual contrast from upper GI study ___ earlier today. The previously seen thoracic compression fractures are unchanged. The lungs are clear. There is no evidence of pneumonia. The cardiac, mediastinal, hilar, and pleural surfaces are normal. No pleural effusion. No pulmonary nodules.", "output": "No abnormalities identified to explain patient's symptoms." }, { "input": "Heart size is mildly enlarged. The aorta remains tortuous and diffusely calcified. There is no pulmonary vascular congestion. Mild bibasilar atelectasis is seen. A moderate size hiatal hernia is re- demonstrated. No focal consolidation, pleural effusion or pneumothorax is present. There are no acute osseous abnormalities. Multilevel degenerative changes are noted in the thoracic spine with a levoscoliosis centered at the thoracolumbar junction. No free air is identified under the diaphragms.", "output": "Moderate size hiatal hernia. Mild bibasilar atelectasis. No free air identified under the diaphragms." }, { "input": "The cardiac, mediastinal and hilar contours appear stable including mild cardiomegaly with a left ventricular configuration. There is again a poorly visualized substantial, possibly large, hiatal hernia with streaky left basilar opacification suggesting associated minor atelectasis. Elsewhere, the lungs remain clear. There are no definite pleural effusions. The bones appear demineralized. Thoracolumbar curvature appears stable with loss in height of one or more upper lumbar vertebral bodies, probably unchanged.", "output": "Substantial hiatal hernia. No definite evidence of acute disease." }, { "input": "AP portable upright chest radiograph obtained. Lungs are clear bilaterally without focal consolidation, effusion, or pneumothorax. The heart and mediastinal contours are normal. Bony structures are intact. No displaced rib fractures are seen.", "output": "No acute traumatic injuries." }, { "input": "Lungs are low in volume. Endotracheal tube is appropriately positioned within the trachea 3.5 cm above the carina. Nasogastric tube is curved within the stomach. Moderate pulmonary edema is seen with stable moderate cardiomegaly. A small layering right-sided pleural effusion is likely also present. No focal consolidation suspicious for pneumonia is seen.", "output": "Moderate pulmonary edema with small right pleural effusion." }, { "input": "Portable AP upright chest radiograph is obtained. Cardiomegaly with moderate pulmonary edema is noted. Evaluation for effusion is limited. No pneumothorax.", "output": "Cardiomegaly with pulmonary edema." }, { "input": "Portable semiupright chest radiograph is obtained portably. Patient is rotated to her right, which limits the evaluation. There is persistent pulmonary edema with bilateral pleural effusions noted, size cannot be assessed. No pneumothorax is seen. Degenerative changes of the left shoulder again noted.", "output": "Pulmonary edema, small bilateral effusions. If there is oncern for pneumonia, recommend repeat chest radiograph post-diuresis." }, { "input": "Single AP portable view of the chest is compared to previous exam from ___. Again seen is eventration of the right hemidiaphragm. Instinct pulmonary vascular markings suggesting pulmonary vascular congestion. Blunting of the left lateral costophrenic angle may be due to overlying soft tissues and technique. Cardiac silhouette is enlarged, but stable compared to prior. Osseous and soft tissue structures are unchanged, noting degenerative changes at the left glenohumeral joint.", "output": "Findings suggestive of pulmonary vascular congestion." }, { "input": "An endotracheal tube has been placed since the prior examination, which terminates 3 cm above the carina. An orogastric tube courses towards the stomach. Its tip not visualized. The sidehole, however, appears to lie slightly above the left hemidiaphragm. Superimposed on background elevation of the right hemidiaphragm, there is persistent opacification at the right lung base with right infrahilar opacification and suspected pleural effusion. Aeration is much better in the left lower lung, however, which appears better expanded with reduction in opacification. There is no pneumothorax. Mild congestion appears similar to slightly decreased with enlarged indistinct vessels.", "output": "1. Status post endotracheal tube placement; sidehole of orogastric tube projecting above the gastroesophageal junction. The clinician was aware of the finding and the tube had apparently been replaced by the time of interpretation. 2. Findings suggesting mild vascular congestion. 3. Persistent right basilar opacification suggesting atelectasis associated with elevation of the right hemidiaphragm and suspected pleural effusion. 4. Improved aeration of the left lung base." }, { "input": "PA and lateral chest radiographs are provided. Lung volumes are low. There is no focal consolidation, pleural effusion or pneumothorax. The heart size is mildly enlarged. There is no evidence of CHF.", "output": "No acute cardiopulmonary process." }, { "input": "Lung volumes remain low. This accentuates the size of the cardiac silhouette which is mildly enlarged, unchanged. Mediastinal and hilar contours are normal. Pulmonary vasculature is normal. Minimal atelectasis is noted in the lung bases. No focal consolidation, pleural effusion or pneumothorax is present. Mild to moderate multilevel degenerative changes are seen in the thoracic spine.", "output": "Low lung volumes with mild bibasilar atelectasis." }, { "input": "The lungs are clear. There is no focal consolidation, pleural effusion, or pneumothorax. The cardiomediastinal silhouette is normal. There is no free air under the hemidiaphragms. No pancreatic calcificaitons visualized. Osseous structures are intact.", "output": "No acute cardiopulmonary process. No evidence of free air." }, { "input": "Single portable supine chest radiograph was provided. A new right chest tube is present. The subcutaneous gas persists in the right lateral chest wall soft tissues. No pneumothorax is seen. Lung volumes remain low. There is no focal consolidation or pleural effusion. The endotracheal tube projects in the upper trachea. Nasogastric tube courses below the diaphragm within the stomach. Right rib fractures are incompletely visualized. Right clavicular fracture is again seen.", "output": "1. Status post chest tube placement. 2. Right rib fractures and right clavicular fractures." }, { "input": "Single AP view of the chest provided. Lungs are well inflated. No pleural effusion or pneumothorax. Mild cardiomegaly is unchanged. Prominence of pulmonary vasculature and diffuse interstitial lung markings are concerning for volume overload. Multiple old rib fracture deformities are unchanged.", "output": "Diffuse, prominent interstitial lung markings in the setting of prominence of pulmonary vasculature and mild cardiomegaly likely represents pulmonary edema." }, { "input": "There are persistent small bilateral pleural effusions. The lungs are otherwise clear. The cardiomediastinal silhouette is within normal limits. Left chest wall dual lead pacing device is again noted.", "output": "Persistent small bilateral effusions." }, { "input": "PA and lateral views of the chest provided. Left chest wall dual lead pacer is unchanged in position. There is persistent blunting of the right CP angle suggesting a small effusion. The previously noted left effusion has resolved in the interval. The lungs appear clear without evidence of pneumonia or CHF. Cardiomediastinal silhouette is normal. No pneumothorax. Bony structures are intact.", "output": "Persistent small right pleural effusion. Otherwise unremarkable. Pacemaker in unchanged position." }, { "input": "Permanent pacemaker is present with leads in the region of the right atrium and right ventricle with somewhat lateral course of the atrial lead. Heart is upper limits of normal in size, in the aorta is mildly tortuous. Bibasilar atelectasis is present with adjacent small pleural effusions, left greater than right.", "output": "Small bilateral pleural effusions." }, { "input": "Frontal AP and lateral views of the chest were obtained. The lungs are well expanded and clear without focal consolidation, pleural effusion or pneumothorax. Heart size is normal. The mediastinal silhouette and hilar contours are normal. There is a mild pectus excavatum deformity. No upper abdominal or osseous abnormality is identified.", "output": "No pneumonia, edema or effusion." }, { "input": "There is no focal consolidation, pleural effusion, vascular congestion, or pneumothorax. The cardiac, hilar, and mediastinal contours within normal limits.", "output": "No acute cardiopulmonary abnormality." }, { "input": "Frontal and lateral views of the chest. No prior. The lungs are clear without consolidation, effusion or pneumothorax. The cardiomediastinal silhouette is normal. Osseous and soft tissue structures are unremarkable.", "output": "No acute cardiopulmonary process." }, { "input": "The lungs are clear of airspace or interstitial opacity. The cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax. No acute or aggressive osseus changes.", "output": "No evidence of active or latent TB." }, { "input": "Compared to the prior study the ET tube has been removed, otherwise there is no significant interval change", "output": "No change" }, { "input": "New collapse of the left upper lobe around a large, obstructing, left hilar mass explains leftward shift of the mediastinum and elevation of the left lung base though subpulmonic pleural effusion is probably also present, and aeration of the left lower lobe is poor, probably also due to bronchial obstruction. Patient has had right upper lobectomy. There may be a small right pleural effusion. There is no evidence for pneumothorax. The visualized osseous structures are unremarkable.", "output": "1. New upper lobe collapse and some lower lobe atelectasis around a large obstructing left hilar mass. 2. Probable small bilateral pleural effusions. NOTIFICATION: Findings were discussed with Dr. ___ at 4:___A, approximately 2-minutes after discovery by Dr. ___ on the day of the exam." }, { "input": "AP portable upright view of the chest. In this patient with known left lower lobe mass, a fiducial marker projects over the cardiac silhouette. There is interval improvement in overall aeration in the left upper lobe. Mild persistent perihilar opacity persists which may represent residual atelectasis or may be related to known hilar mass. There is stable blunting of the right CP angle which may represent pleural thickening or tiny effusion. The cardiomediastinal silhouette appears grossly unchanged. The imaged osseous structures appear intact.", "output": "Improved aeration in the left upper lobe. Persistent perihilar opacity and left lower lobe mass as seen on prior PET-CT." }, { "input": "The cardiomediastinal and hilar contours are within normal limits. The lungs are well expanded and clear. There is no large pleural effusion, pneumothorax or focal consolidation concerning for pneumonia. There is no evidence of free air.", "output": "No acute cardiopulmonary process. No evidence of free air." }, { "input": "The lungs are clear, and the cardiomediastinal silhouette and hila are normal. There is no pleural effusion and no pneumothorax.", "output": "No acute cardiothoracic process." }, { "input": "Portable supine AP view of the chest provided demonstrates an endotracheal tube with tip positioned approximately 3.5 cm above the carina. The NG tube courses into the left upper abdomen. There is bibasilar atelectasis. Heart and mediastinal contour appears grossly unremarkable. The bony structures appear intact.", "output": "Appropriately positioned ET and NG tubes. Bibasilar atelectasis." }, { "input": "The ET tube terminates approximately 2.9 cm from the carina. The NG tube courses below the diaphragm with the tip out of the field of view of the film. There has been interval worsening of the right linear opacification likely secondary to atelectasis. No pneumothorax or definite pleural effusion is seen. The hilar and mediastinal contours are normal. There is mild cardiomegaly, stable compared to the preior exam.", "output": "Slight interval worsening of right lower lung atelectasis." } ] }